Program description summary
Ohio Action for Healthy Kids is a community organization, focused on preventing obesity and undernourishment among children and fighting to promote healthy eating and lifestyles. The organization’s mission is “to activate individuals, schools and communities to advance nutrition and physical activity policies and programs that lead to better health and academic success through communications, resources, and advocacy” (Ohio Action for Healthy Kids, 2011). The community organization pursues three major goals: (1) better nutrition through increased participation of students in school breakfasts, healthy snacks provision in schools, and nutrition education; (2) increased physical activity in all children, from pre-kindergarten to grade 12; and (3) school wellness policies (Ohio Action for Healthy Kids, 2011). Unfortunately, the problem of childhood obesity in Linden Area, Franklin County, Ohio continues to persist. In 2010, more than 30 percent of Ohio’s children were either overweight or obese (Office of Public Affairs, 2010). Ohio is facing the highest obesity-related health expenditures, compared with other states (Office of Public Affairs, 2010). Children who are overweight or obese face a wide range of health and social problems, including poor learning and depression (Office of Public Affairs, 2010). Ohio Action for Healthy Kids wants to establish a county-wide obesity prevention program for children ages 8-12 and requests a grant of $100,000 to meet this goal. The program will cause a broad behavior change to reduce overweight and obesity among school children ages 8-12 and their parents.
Community Description/ Statement of Need
The state of Ohio is made up of 88 counties, and the burden of obesity and physical inactivity is disproportionately distributed across them (The Ohio Department of Health, 2008). The target area is North Linden Neighborhood, Franklin County, Ohio, zip code 43224. The target area is 5.566 square miles (City Data, 2011). In 2009, 26,074 residents lived in North Linden Neighborhood (City Data, 2011). Population density in Linden is higher than that in Columbus – 4,685 against 3,384 per square mile, accordingly (City Data, 2011). Most North Linden residents are white; the most populous age group is 35-40 years (City Data, 2011). Residents of North Linden earn around $6,000 less than their counterparts in Columbus: $35,327 compared to $41,370, accordingly (City Data, 2011). North Linden is a low-income community, and we believe that the situation with obesity here is more serious than in the rest of Franklin County.
Unfortunately, obesity data for North Linden Neighborhood is absent. However, it is possible to assume that the situation with obesity in Linden Area reflects the general obesity trends in Franklin County, Ohio. During 2004-2007, almost 40 percent of Franklin County adults were reported to have high blood cholesterol levels (The Ohio Department of Health, 2008). Between 2004 and 2007, an average of 272 Franklin County residents died from diabetes every year (The Ohio Department of Health, 2008). The death picture in Franklin County reflects that of Ohio and the United States, with heart diseases and cancer as the main causes of death among Franklin County residents (The Ohio Department of Health, 2008). According to The Ohio Department of Health (2008), individuals with high blood cholesterol levels, high blood pressure, overweight or obesity, low physical activity, and low fruits and vegetables intake are at the highest risks for developing health states and complications leading to death. In this situation, early detection and prevention are the most reliable ways to reduce the occurrence of diseases leading to increased mortality across all population groups (The Ohio Department of Health, 2008).
As of today, 78.3% of all Franklin County residents consume less than 5 fruit and vegetable servings per day (The Ohio Department of Health, 2008). 24.4% of county residents experience the lack of physical activity (The Ohio Department of Health, 2008). 36.2% of all county residents are claimed to be overweight (The Ohio Department of Health, 2008). The overall health situation in Franklin County indicates the need for a broad behavioral intervention and lifestyle changes across all population groups.
The situation with childhood obesity is no better. Franklin County has the fifth highest rate of obesity among children ages 2-5, compared with other counties in Ohio (Mid-Ohio Regional Planning Commission, 2009). The state of Ohio has the 12th highest rate of childhood obesity at the national level (Office of Public Affairs, 2010). Office of Public Affairs reports that almost 30% of Ohio’s children are either overweight or obese. Almost every fifth adolescent aged 10-17 is either overweight or obese (Office of Public Affairs, 2010). Together with Alabama, Arkansas, Pennsylvania and South Carolina, Ohio is in the top quartile for obesity, diabetes, and leisure-time inactivity (Centers for Disease Control and Prevention, 2008). Health risks faced by overweight and obese children are numerous. These include but are not limited to asthma, heart and blood vessels damage, high blood pressure, sleep apnea, high blood cholesterol, type 2 diabetes, premature puberty onset, depression, stigmatization, and bullying (The Ohio Department of Health, 2008). With this in mind, Franklin County needs to implement a school-based behavioral change program, to reduce the scope and prevent overweight and obesity among school children. Ohio Action for Healthy Kids expects that the grant will ensure the success of program implementation and cause considerable health improvements among children ages 8-12. The grant requested by Ohio Action for Healthy Kids will be used to attract and involve expert staff, spread overweight and obesity information among children and their parents, and work towards long-term positive behavior change in children living in North Linden Neighborhood.
Program Goals and Objectives
The goal of the project is to establish a school-based program to promote behavioral and lifestyle changes, reduce overweight and obesity among 8-12 year olds, promote active leisure time and, eventually, cause a long-term positive change in public health.
Objective 1: by the end of the project, at least 85% of program participants will consume at least five servings of fruits and vegetables on a daily basis.
Objective 2: by the end of the project, at least 70% of program participants will engage in at least 30 minutes of physical activity on a daily basis.
Objective 3: by the end of the project, at least 75% of program participants will have better knowledge of overweight and obesity, its risks and potential health complications.
Objective 4: by the end of the project, North Linden Elementary School will have a long-term behavior change program for 8-12 year old students.
The goal of the project is to improve public health in North Linden Elementary School and reduce/ prevent obesity and overweight among 8-12 year olds, through increased awareness of the overweight/ obesity problem and broad behavior changes. The latter imply proper nutrition (reduced calorie intake and increased amount of fruits and vegetables consumed on a daily basis) and increased physical activity (as part of school curriculums and during leisure time). The organization expects that, by the end of the project, at least 70% of program participants will spend no less than 30 minutes on physical activity every day, and at least 75% of participants will develop awareness of obesity risks and prevention. The project aims to cause a long-term positive change in individual behaviors, leading to improved public health.
Program Description
The project aims to cause a broad behavior change, leading to reduced overweight and obesity among children ages 8-12 and, consequentially, improved public health in North Linden Elementary School. The project builds on the constructs of the knowledge-attitude behavioral model, which suggests that knowledge and attitudes predict individual choices and health-related behaviors (Baranowski et al., 2003). Individuals must accumulate knowledge and develop awareness of the risk factors, health and social consequences of obesity and overweight, leading to a change in attitudes and behaviors (Baranowski et al., 2003). These attitudes will also influence eating and physical activity decisions among 8-12 year olds and their parents.
The program includes several important elements: education, better nutrition, increased physical activity, expert follow-up, and parental involvement at all stages of program implementation. Each component builds on and is supported by a vast body of empirical research into overweight and obesity prevention among children. The program is titled Nutrition and Fitness to Raise Healthy Children and includes education (1 hour, once a week, 12 months, 48 lessons/hours total), better nutrition, and physical activity lessons, leading to a long-term positive change in behaviors and lifestyles among children and their parents. The entire program is based on the premise that environment and not biology is the primary cause of overweight and obesity (Hill, Wyatt, Reed & Peters, 2003). The main environmental factors of overweight and obesity among children and adults are those, which promote overconsumption of energy and low physical activity (Hill et al., 2003). Inexpensive and good-tasting energy-dense foods, physical inactivity during classes and during leisure time, television watching, computer games, Internet surfing and other sedentary activities, as well as low overweight/ obesity awareness, contribute to overweight and obesity in children (Hill et al., 2003). The project will involve publishing and distributing newsletters among school children and their parents. The newsletters will educate them about the risks and consequences of obesity and encourage participation in the Nutrition and Fitness to Raise Healthy Children project. The education component will also include a series of forty-eight 1-hour lessons, once a week, for students of North Linden Elementary School ages 8-12 and their parents. The main topics will include (1) definition of overweight and obesity; (2) signs and symptoms of overweight and obesity in children; (3) risk factors for obesity and overweight; (4) health consequences of overweight and obesity in children; (5) nutrition changes to prevent overweight and obesity; (6) physical activity recommendations to reduce the scope of overweight and obesity among program participants; and (7) recommendations to sustain long-term effects of the behavior change among children and their parents.
The nutrition component of the project will involve investigating the current state of nutrition in North Linden Elementary School and the dietary principles followed by parents at home. Children and parents will be asked to report the amount and type of foods they consume on a daily basis. The traffic-light diet will become the key element of dietary changes among children in school and at home (Epstein, Myers, Raynor & Saelens, 1998). “The traffic-light diet groups foods into categories: green foods may be consumed in unlimited quantities; yellow foods have average nutritional value; and red foods provide little nutrient density per calorie” (Epstein et al., 1998). The traffic-light diet is an easy way to understand the basic principles of healthy nutrition; it has proved to be extremely effective in reducing obesity prevalence among preadolescent children (Epstein et al., 1998). Recommendations will be provided to the school principal, teachers, health professionals and parents to change the structure of daily diets, through reduced calorie intake and increased consumption of fruits and vegetables among 8-12 year olds. The traffic-light diet will help parents to change their own and their children’s eating habits. The nutrition component of the project will also teach parents not to use food as a reward (Epstein et al., 2001).
The physical activity component of the project will involve children in at least 30 minutes of daily physical activity, as part of the North Linden Elementary School curriculum. The project will also engage program participants in after-school leisure-time sport activities, including active games and sport competitions. All children and adults benefit from having at least 30 minutes of physical activity on a daily basis (Marcus et al., 2000). The school will be encouraged to change its curriculum, towards greater inclusion of physical activity lessons for all children. Expert follow-up will help parents and children to sustain behavior change in long-term periods. Professional dietitians will provide telephone consultations, helping parents to change their own and their children’s behaviors.
North Linden Elementary School will be asked to recruit program participants. Program coordinators will contact the school principal and physical education teachers, to communicate the benefits of the project to educators and explain the project mission and message to children and parents. Parental involvement is critical to the success of the project, since family-based approaches to obesity and overweight teach parents to assume responsibility for nutrition and physical activity in their children’s lives (Golan, Weizman, Apter & Fainaru, 1998). Free extracurricular events, free access to school and out-of-school fitness facilities, and free expert support in dietary and physical activity decisions will encourage children and their parents to participate in the program. These ‘free’ benefits, coupled with continued education and accumulation of knowledge, will encourage positive behavior and lifestyle changes among program participants. The project will communicate the message of improved health and wellbeing, to persuade children and their parents to change their nutrition and physical activity habits.
Evaluation
Program evaluation will involve the use of several objective and subjective measures. To begin with, the number of children and parents enrolled in the program will be measured. At the end of the program, children will be asked to pass a small written test. The test will include twenty standard questions. Children will be asked to answer questions concerning obesity, its risks, complications, and prevention. The test will be based on the information provided during program lessons. The number and percentage of lessons attended by each participant will be calculated. The number and percentage of drop outs will be calculated, to create an objective picture of program effectiveness.
Other methods of evaluation will include self-reported feedback and expert follow-up feedback. Program participants (children and parents) will be asked to provide their responses to the program and report their perceptions of improvements during and after the project. All program participants will be asked to fill out standard feedback forms during the fifth week of the project and after the project is terminated. Feedback forms will include questions concerning perceived changes in weight, physical activity, nutrition, and wellbeing among program participants. Parents and children will be encouraged to provide recommendations to improve the intervention. Expert dietitians, nurses, and physical activity professionals will be asked to report barriers they faced in the process of implementing the project. The importance of self-reported feedback is difficult to overestimate: on the one hand, it creates a complex picture of the project and its success; on the other hand, it provides information to improve the quality and efficiency of the project outcomes.
Personnel
The program involves expert dietitians, physical activity experts, registered educators, and North Linden Elementary School principal. Expert dietitians provide information related to nutrition changes and the role of nutrition in overweight and obesity prevention. The program includes 48 nutrition classes (1 class per week, 12 months, 48 lessons total). Expert dietitians follow up program participants and provide free support and consultations to parents and their children. The program involves two expert dietitians, who are paid at a rate of $50 per hour. Each expert dietitian participates in at least 24 nutrition classes, depending on the number of participants and their health needs.
Physical activity experts work collaboratively with physical training teachers in public schools, to develop school and leisure physical activities and integrate these activities into public school curriculums. Physical activity experts assess physical training preparedness of program participants and their health needs. Material rewards will encourage physical activity experts to participate in the program. Each expert is paid $60 per hour.
Registered educators and the school principal work collaboratively to develop activity and lesson schedules. The main goal of this collaboration is to make sure that children are not overloaded with new information and extracurricular tasks. Registered educators are paid $40 per hour. The school principal will be encouraged to participate in the program, as school principals naturally strive to improve students’ health and wellbeing and strengthen school’s health and social image in public. The school principal will benefit from the program, through free nutrition and physical activity expertise, which will help the school and its students to restructure diets and curriculums and reduce the risks of overweight and obesity among 8-12 year olds.
Budget
The total budget of the program is $100,000. The full-time equivalent (FTE) for the project personnel is 0.5, meaning that all experts involved in the project are assumed to work half-time. $85,900 will be used to pay benefits and rewards to the project personnel. $12,000 will be paid to out-of-school sports and fitness facilities, to provide children and parents with free access to them. The project will require publishing and disseminating newsletters and flyers, at a total cost of $100. No material rewards to program participants will be provided.
Availability of Other Resources/ Future Funding
Ohio Action for Healthy Kids has knowledge and experience working with other grantmakers. However, grants are one-time dollars, which are intended to serve as ‘seed money’. The organization realizes the importance of obtaining resources and funds from the sources other than Love Foundation. This being said, Ohio Action for Healthy Kids hired a fundraising specialist, who works collaboratively with grant-making organizations, directors, coordinators, and consultants to raise funds and resources and produce long-term positive behavior change in children and their parents. The organization expects that North Linden Elementary School will continue to serve the main basis for program implementation and provision. Public school principals and teachers are usually interested in providing students with knowledge about risks and consequences of overweight and obesity. The fundraising specialist is responsible for developing a strategic grant-raising plan, which will ensure constant availability of funds and resources. As always, American Dairy Association Mideast and Ohio Department of Health provide funding to support the organization and its programs. The organization works with public health officials and organizations, as well as local authorities, to encourage the creation of free sports facilities for youth. Ohio Action for Healthy Kids works to build strong sponsor support among wealthy community residents. All these efforts will help to expand the pool for financial, material, and non-material resources to be used in future behavior change programs. The organization uses social marketing tools to popularize its image and programs among community residents. The organization is currently developing a number of grant proposals, to be submitted to local and state grantmakers in the nearest future. All these efforts will let Ohio Action for Healthy Kids raise sufficient funds and serve public health needs of Franklin County residents in the future.
References
Baranowski, T, Cullen, K.W., Nicklas, T., Thompson, D. & Baranowski, J. (2003). Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obesity Research, 11, 23S-43S.
Centers for Disease Control and Prevention. (2008). Facts about county-level estimates of leisure time physical inactivity. CDC. Web.
City Data. (2011). North Linden neighborhood in Columbus, Ohio (OH), 43211, 43224 detailed profile. City Data. Web.
Epstein, L.H., Myers, M.D., Raynor H.A. & Saelens, B.E. (1998). Treatment of pediatric obesity. Pediatrics, 101, 554-570.
Epstein, L.H., Gordy, C.G., Raynor, H.A., Beddome, M., Kilanowski C.K. Paluch., R. (2001). Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obesity Research, 9(3), 171-178.
Golan, M, Weizman, A., Apter, A. & Fainaru, M. (1998). Parents as the exclusive agents of change in the treatment of childhood obesity. American Journal of Clinical Nutrition, 67, 1130-1135.
Hill, J.O., Wyatt, H.R., Reed, G.W. & Peters, G.C. (2003). Obesity and the environment: Where do we go from here? Science, 299 (7), 853-855.
Marcus, B.H., Dubbert, P.M., Forsyth, L.H., McKenzie, T.L., Stone, E.J., Dunn A.L. & Blair, S.N. (2000). Physical activity behavior change: Issues in adoption and maintenance. Health Psychology, 19(1), 32-41.
Mid-Ohio Regional Planning Commission. (2009). Issue: People. Metric: obesity. MORPC. Web.
Office of Public Affairs. (2010). The Ohio Department of Health recognizes national childhood obesity month. Ohio Department of Health. Web.
Ohio Action for Healthy Kids. (2011). Our approach. Ohio Action for Healthy Kids. Web.
The Ohio Department of Health. (2008). Healthy Ohio Community profiles: Franklin County. Health Ohio Program. Web.