Healthy messages for young learners 5-7 and families

Joan Temmerman, MD

Background:Community Needs

Assessment• Nutritional problem: pediatric obesity is

a public health crisis with lifelong ramifications

• Marion County, IN ranked low for health behaviors, health outcomes, SES

• Children in Marion County at high risk for overweight & obesity:

-22% obese; 18% overweight in Marion County-20% obese; 17% overweight outside

Marion County pediatric weight status

Age % overweight or obese

5-9 37%

10-13 44%

14-17 40%

N = 90,147

Background:Pediatric intervention tools

• Lifestyle interventions should involve both school and home environment

• Include dietary education, physical activity, healthy lifestyle habits and family

• Most effective in younger children• Simple messages with pictures/cartoons

improve attention & recall (Houts et al, 2006)

Simple prevention messages

• Eating ≥ 5 servings fruit & vegetables daily• Decreasing sugar-sweetened drinks• Decreasing TV & screen time to ≤ 2 hrs/d• Increasing activity ≥ 1 hour daily• Preparing more meals at home• Eating at the table as a family• Eating a healthy breakfast• Being active as a family• Involving whole family in lifestyle changes• Getting enough sleep

Barlow and the Expert Committee, 2007

Assessment: conclusions

• Marion County children would benefit from school-based & family centered lifestyle intervention tool

• Focusing on early school age might positively impact high middle school obesity rates

Plan of Action: develop a family-centered wellness lesson & brochure, focusing on healthy lifestyle habits to improve health of young school age children and their families

Timetable for Nutrition Education Program and

Marketing Plan

Set goals& objectives

Revise objectives

Begin program design

Developmarketingplan

FinalizeMarketingplan

Program finalized

Print all Educationalmaterials

Programlaunch

Revise program

IncorporateInto website

DecemberNovemberSeptember October

Marketing Plan and Costs

Target Markets

• Children 5-7 and their families

• Health educators

Product Place Price Promotion

‘Let’s Be Healthy!’

Wellness education

•Kindergarten and f irst grade classrooms in pilot Marion County, IN elementary school

free • Brochures/booklets

• Internet: INAFHK website

Marketing Mix

Expenses: Direct: Graphic Designer (Brochure) $250 brochure printing: $207

Pre- and post-tests $50_Total direct expenses $507Indirect expenses $0

Methods: Lesson Plan

• Target audience: kindergarten and 1st graders

• Duration: 45 minutes

• General Objectives: to promote healthy lifestyle habits for early school age children & their families

• Specific Objectives: at the end of the lesson, students will be able to:

-identify that active play is healthier than watching TV-differentiate between fast food & healthier food choices-identify what 5 a Day refers to-identify that eating at the table as a family is healthier than

eating out-identify that family activity is healthier than watching TV

Lesson concepts

• Children understand the concept of wellness

• Clear, positive, simple messages help promote specific health or nutritional objectives

• Using pictures to support key points improves attention to and recall of health education information

Lesson concepts• Wellness lesson emphasizing healthy

lifestyle habits for young school age children and their families

• Simple captions and colorful multicultural cartoon pictures used to promote health messages:– increasing activity– improving nutrition and eating patterns – decreasing sedentary behaviors– getting enough sleep

• These healthy habits are recommended for obesity prevention (Barlow and the Expert Committee, 2007)

Walk or ride to school

(Example: simple health messages)

Implementation

• Difficulty accessing local public schools– Curriculum fixed– Not happy to take away any instruction time– Would have to go through a review of IPS grants

Private schools approached-nutrition month January

-Montessori schools do not test at all

Pilot studySt. Monica Elementary School

• White 64%• Black 22%• Hispanic 8%• Asian 5%

• ~450 students• 14:1 student:teacher ratio• kindergarten ~40 students; 2 classes

Results

• 38 students participated in wellness lesson

• Took test before & after lesson; asked to circle healthier picture

• Comparison of pre- and post-tests

• Final number = 35 (2 sick for post-test; 1 unclear answers)

Results

• 35 students completed pre- and post-tests

• 12/35 students perfect scores on both

• 23/35 remaining students: – 17/23 (74%) had improvement on post test– 6/23 (26%) no change

2-tailed t-test: 0.00007; p<.001

17/23 scored higher on post-test:increase in correct answers

Post-test improvement

(increase in correct answers)

0

1

2

3

4

5

6

7

(+1) (+2) (+3) (+4) (+5)

Num

ber

of S

tude

nts

What can I improve?

• I would have liked to observe lesson(lesson very interactive; affected by leader)

• Reading ability may have affected test

• Some pictures may have been misleading• 1st graders weren’t tested

Circle the healthiest breakfast

• correct answer on right, but is portion size misleading?

What can I improve?

Conclusions

• Intervention shows highly significant effect

• Participation increased through Indiana Action for Healthy Kids (INAFHK) website: http://take.actionforhealthykids.org/site/Clubs?club_id=1122&sid=2980&pg=newsand Indiana Afterschool Network

Conclusions

• Preventative health messages follow recommended guidelines

• Brochure alone may be useful as family wellness intervention outside of school

• Future goals: provide brochure to medical sites and educators

•Dr. Patsy• My Networking Team:• Stella• Denise• Nicole• Katherine• Stacey•& all my classmates! A happy dance!

References1. 2010 Indiana County Health Rankings. Mobilizing Action Toward Community

Health. Retrieved August 3, 2010 from http://www.countyhealthrankings.org/

2. Marion County, Indiana. Stats Indiana. Retrieved Sept. 27, 2010 from www.stats.indiana.edu/profiles/pr18097.html

3. Barlow S and the Expert Committee. Recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120:S164-S192.

4. Child Health and Wellness Initiative Results, Marion County. Retrieved Sept. 27, 2010 from www.mchd.com/CHWI_results_report.htm

5. Healthy People. Office of Disease Prevention and Health Promotion. U.S. Department of Health and Human Services. Retrieved November 1, 2010 from http://www.healthypeople.gov/

6. Indiana Healthy Eating Patterns; Physical Activity and Body Weight Indicators. USDA ARS Products and Services; Community Nutrition Mapping Project, CNMap. Retrieved Sept. 7, 2010 from www.ars.usda.gov/Research/docs.htm?docid=12396

7. The Obesity Epidemic and Indiana Statistics. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Division of Adolescent and School Health. Retrieved Sept. 27, 2010 from www.cdc.gov/HealthYouth/yrbs/index.htm

References

8. Brug J, te Velde SJ, Chinapaw MJ, et al. Evidence-based development of school-based and family-involved prevention of overweight across Europe: The ENERGY-project’s design and conceptual framework. BMC Public Health 2010;10:276.

9. Zenzen W, Kridli S. Integrative review of school-based childhood obesity prevention programs. J Pediatr Health Care. 2009;23(4)242-258.

10. Boyle MA, Holben DH. Community Nutrition in Action: An Entrepreneurial Approach. 5th edition. Belmont, CA: Wadsworth, Cengage Learning; 2010.

11. Whaley, Cathy. Personal communication, August 9, 2010.12. Whaley, Cathy. Personal communication, September 27, 2010.13. Maibach EW & Cotton D. Moving people to behavior change. In: Maibach

EW, Parrott RL, eds. Designing Health Messages. Thousand Oaks, CA: Sage; 1995:41-64.

14. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication, comprehension, recall, and adherence. Patient Educ Counsel. 2006;61:173-190.

15. Noar SM, Chabot M, Zimmerman RS. Applying health behavior theory to multiple behavior change: considerations and approaches. Prev Med. 2008 Mar;46(3):275-80.