Thursday, October 26, 11:00
a.m.-12:30 p.m.
Moderator
CAPT Laura A. McNally, M.P.H., R.D., FADA
Senior Advisor, Office of Commissioned Corps Affairs
Presentations
FLAIR: OPTIMIZING THE PRIMARY CARE PRACTICE FOR CHILDHOOD OBESITY PREVENTION
Darwin Deen, M.D., M.S.; M. Diane McKee, M.D., M.S.; Alice Fornari,
Ph.D., R.D.; Arthur Blank, Ph.D.
Albert Einstein College of Medicine, Bronx, NY
The Family Lifestyle Assessment of Initial Risk (FLAIR) project targets families with
young children to address lifestyle behaviors known to place children at risk for
overweight and smoking-related illnesses (family meals, physical activity, fast food,
juice, soda, low fat milk, sedentary behavior, and smoking exposure). In New York City,
43 percent of elementary public school children are overweight or at risk of overweight,
making early intervention in problem behaviors a critical issue.
We trained clinicians in three practices to implement a family-focused lifestyle risk
assessment during pediatric preventive care visits with 2- to 4-year-olds and then
provided brief behavior change messages utilizing the choices and changes model
(assessing conviction and confidence for the behaviors to be addressed). We also
incorporated a "lifestyle counselor" into the practice to augment the clinicians'
behavior change efforts. The lifestyle counselor's contacts have mostly been via
telephone. In addition, we recommend a follow-up interval every 3 to 6 months
rather than annual revisits.
While only half-way through the intervention, the presentation will cover what
has been learned through the development of the screening tool, the training of
the clinicians, implementation challenges, and the methodology used to assess
baseline health behaviors and behavior change. FLAIR represents a reproducible
model for changing the primary care practice environment to engage families in
preventive health behavior change. This project is funded through the Robert Wood
Johnson Foundation's Prescription for Health program.
WITH COMMUNITIES AND PARENTS, WE CAN! HELP CHILDREN MAINTAIN A HEALTHY WEIGHT
Susan G. Dambrauskas
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, MD
In September 2006, the National Heart, Lung, and Blood Institute (NHLBI) will complete
a process and outcome evaluation of the first year of the National Institutes of Health's
(NIH's) nationwide community-based childhood obesity prevention program, We Can! (Ways to
Enhance Children's Activity & Nutrition). This presentation will highlight the evaluation
methodology and findings and discuss the implications for community obesity prevention programs.
Using in-depth interviews and community event and partnership tracking measures from
14 selected sites, NHLBI is assessing the impact of We Can! on community obesity prevention
programs. To determine outcomes, NHLBI also is quantifying changes in knowledge, attitudes,
and behaviors among youth and adult participants of evidence-based curricula available
through We Can! These include three youth curricula—CATCH, Media-Smart Youth, and
SMART—and a new curriculum for parents and adult caregivers: We Can! Energize Our Family.
We Can! was developed by NHLBI to combat the public health problem of childhood
overweight and obesity and is promoted in collaboration with three other NIH Institutes
and national partners. The program provides resources and community-based programs for
parents, caregivers, and youth to help children age 8 to 13 maintain a healthy weight
through improved food choices, increased physical activity, and reduced screen time.
We Can! offers a unique approach to stakeholders through its highly flexible program
design. The initiative collaborates with national partners to expand outreach; fosters
innovation and information-sharing among community sites to raise awareness and educate
the public; and encourages local and national media to disseminate key messages.
Since its launch by Health and Human Services Secretary Leavitt and other public
health officials in June 2005, We Can! has enrolled more than 85 sites across the
United States. This diverse group includes park and recreation departments, schools,
health departments, hospitals, and faith-based groups in a variety of geographic areas.
SNEAKS AND TREATS: A FUN FAMILY FITNESS PROGRAM
MaryBeth Knowlton, R.D., C.D.N.; Kristi R. Briones
Jefferson County Public Health Service, Watertown, NY
West Carthage Elementary (WCE) in Jefferson County, New York, receives funding and
technical assistance from Steps to a HealthierNY to create sustainable programming
and policies to improve the health of students and staff at that school. A Healthy
School Team at West Carthage Elementary completed the Centers for Disease Control and
Prevention School Health Index in the fall of 2005 and identified several areas in
need of improvement. Three main areas of focus for the school were a need to increase
physical activity for their students; a need to encourage healthier eating habits among
students; and a need to get parents and the community more involved with the school.
The team designed a program called "Sneaks n' Treats" to address the three
identified areas.
"Sneaks" refers to organized physical activity, and "Treats" refers
to healthy snacks, which were provided to all who attended the program. Snacks were
centered on the idea of encouraging families to eat more fruits and vegetables everyday,
and exposing children and parents to healthier food choices. Information also available
to parents and children included easy healthy recipes and snack ideas, an emphasis on
reducing TV time, and milk taste tests and handouts to encourage a switch from 2 percent
or whole milk to 1 percent or skim milk. The family-oriented evening program was held at
WCE and was open to the community. Overall, Sneaks n' Treats averaged about 80 adults and
children on each of the 10 nights of the program. On the last night of the program, 32
adults completed a survey on the health impact of Sneaks n' Treats. The results indicated
that the program had a positive impact on parent involvement with the school, fruit and
vegetable intake, and TV viewing time.
PREVENTING HEALTH DISPARITIES BY PROMOTING BREASTFEEDING AMONG OKLAHOMA NATIVE AMERICANS
Karen K. Palumbo, M.Ed.; Piers R. Blackett, M.D.; Elisa T. Lee, Ph.D.; Dana S.
Campbell-Sternlo; Heather D. Hoffhines, M.S.; Stephen R. Glore, Ph.D.
University of Oklahoma Health Sciences Center, Oklahoma City, OK
Statewide and national studies demonstrate the existence of obesity and diabetes mellitus
in Native American adults and children. The state of Oklahoma has one of the highest obesity
ratings in the Nation. The purpose of this study is to see if additional education on healthy
feeding practices will prevent obesity in early childhood in order to help Native American
children grow up as healthy adults with lower risks for diabetes and obesity.
Interviews were conducted to determine prevailing nutritional practices. A second group was
recruited during pregnancy, and individuals in that group are being followed until the child's
second birthday. Participants attend a baby-feeding education class during pregnancy promoting
breastfeeding and healthy feeding practices.
The primary survey indicated a low initiation rate of breastfeeding, 52 percent, as the
prevailing feeding practice in the target population. Barriers to breastfeeding, obtained
by interviews, include lack of support from immediate and extended family, and education
by healthcare providers. The cohort group consists of 186 mothers. To date, 125 babies have
been born, which includes five sets of twins. The breastfeeding initiation rate of the cohort
group is 88 percent. Additional data are currently under analysis.
Risk factors for childhood obesity that can be identified in the population include low
socioeconomic status, high maternal body mass index, and absence or short duration of
breastfeeding. The information collected is being used for establishing educational needs
for Native American families. The increase in breastfeeding prevalence, continued support
for breastfeeding mothers, and nutrition education can lead potentially to a reduction in
diabetes and obesity. The study offers support and education during pregnancy and during the
child's first 2 years, and feedback from participants has been positive.
For questions or more information, please contact
summit@hhs.gov.