Fit For Life

Based on the 2004 Saline County Children’s Health Survey

Introduction
Comprehensive Plan

Salina relies upon data to define its issues and on its community collaborative social service network to successfully address pressing community health and quality of life challenges. Its collaborative partners strengthen the community through planning using a community asset model, employing creative solutions, leverage private and public resources, avoiding service duplication, building service capacity, and monitoring and using results to meet or exceed community outcomes. This effective process has led to a strong social service network with several successful private public partnerships.

The Salina media is one community asset that is supportive of health-related issues, and generous with in-kind donations. Between the grant funded community-wide education/media campaign and a local medical champion, the Salina public voted decisively to pass a smoke-free restaurants’ ordinance, demonstrating its strong public support for a healthier lifestyle.

Salina now brings its full attention and muscle to address childhood obesity in Saline County. The 2004 Saline County Children’s Health Survey Salina sponsored by the Alliance for Healthy Community and the Saline County Fit for Life Coalition and funded through a Sunflower Foundation grant confirms obesity as one of the eight community issues. The data, while alarming, will rally the already committed and informed as well as enlist new partners to wage this battle. The obesity battle will engage new segments of the community as well as some of the same segments involved in the tobacco free restaurant campaign. The Saline County multi-component plan relies upon many committed partners and evidence based strategies targeted at various segments of the community.

The components include the media in a community-wide education program. School based interventions including the Center for Disease Control and Prevention School Health Index and other evidence-based strategies are the linchpins of the plan. Research based community interventions are targeted at eliminating environmental barriers, creating adult role models, and publicizing community wellness opportunities. Alerting the community as well as the many health care professionals to the local data and available community assets to address the issue using a web page and recruiting a medical “champion” will promote the reduction of childhood obesity.

Sunflower Foundation, focusing on Health Care for Kansans, awarded Saline County Alliance for a Healthy Community a grant (RFP – 02 –103) submitted by the Saline County Fit for Life Coalition. The award was to collect baseline school age BMI/nutrition and activity survey data and develop a comprehensive action plan to reduce the prevalence childhood obesity in targeted Saline County student populations. The Salina Area United Way acted as the project manager and fiscal agent.

In July of 2003, following a RFP bidding process and United Way board approval, contracted with Hedlund Consulting, Inc., was awarded the survey contract to do the survey portion of this grant. Under the supervision of the project manager and volunteer assistant, the Fit for Life Coalition members, Salina Regional Health Center nurses, Kansas Wesleyan University and South High students assisted with the BMI data collection process. The nutrition/physical activity paper survey accompanied the BMI collection and was completed under the direction of building nursing or instruction staff.

Planning Objectives
>>back to top<<

Desired Outcome: Reduce the proportion of Saline County students who are overweight or at risk.

Target specific interventions at overweight and at risk student populations and their families based upon the BMI study.
Raise community awareness of public health problem and stimulate action.
Support, and implement evidence based strategies that encourage increased physical activity and improved nutrition.
Improve community accessibility to nutrition/ physical activity information, education, and resources.
Select culturally appropriate communication, interventions, and education.
Create community and school environments conducive to prevention.
Reduce barriers to achieve goals. (Environmental, policy, transportation, economic, educational, cultural, language)
Strengthen existing interventions through collaborations and resource development.

Interventions

Media
>>back to top<<

Goals:

Raise community awareness of childhood obesity as a public health problem and stimulate action.

Improve accessibility to nutrition/physical activity information and education.

Select culturally appropriate communication strategies, interventions, and education.

Reduce barriers to achieve goals.

Strategy 1:

Conduct a community-wide social marketing campaign in English and Spanish targeted to community, children/adolescents, families, school staff, and health professionals. The Center for Disease Control and Prevention Task Force on Community Preventive Services highly recommends community-wide education campaigns. They were found to be effective in increasing various measures of physical activity, including the percentage of people who are active, their estimated energy expenditure, and their activity levels. The campaign will be patterned after a social marketing campaign outlined by the Indiana Prevention Resource Center.

1. Planning and Selecting a Strategy

a. assessing of the problem

b. determining the segmented target audience

c. leveraging the necessary resources to fund the process

d. developing goals and objectives

2. Selecting Channels and Materials

a. determine how the messages will be delivered to expose the targeted audience (website, radio Public Service Announcements, Newspaper articles, ads)

b. use culturally accessible means to reach segmented target audiences

c. select materials appropriate to the segmented target audiences

d. research free or low cost materials that meet the needs

e. select cost effective materials and methods

3. Developing Materials and Pre-testing

a. prepare a draft set of all materials and pretest them with the segmented target audience.

b. determine which materials get the expected results and revise and retest the others until they do.

4. Implementing the Plan

a. plan the evaluation process prior to launching the plan

b. use process evaluation technique

c. use information to revise and fine tune the program

5. Assessing Effectiveness

a. determine how effectiveness will be measured during the first stage

b. determine the type of evaluation

c. determine who, when, where and how results will be used to refine the program

6. Refining through Feedback

a. revise the program if it continued

b. document what was learned if the program is concluding

c. prepare evaluation report which could be used to secure future funding to continue the program, assist others conducting similar activities or document program management capabilities

School-Based
>>back to top<<

Goals:

Support and implement evidence based strategies that encourage increased physical activity and improved nutrition.

Reducing barriers to achieve goals.

Strategy:

Support a school mini-grant program to help K-12 schools choose and implement one of three evidence-based interventions to promote physical activity and healthy eating. Saline County schools may apply for mini-grants for one of the following interventions:

to improve nutrition education using the "5 A Day" fruits and vegetables program; or

to increase physical activity levels with a structured step program based on the President's Challenge guidelines for age 6 to 17; or

to implement a selected School Health Index (SHI) recommendation based upon the School Health Improvement Plan.

The application procedure for schools will be modeled on the Kansas Department of Health and Environment Tobacco Use Prevention Program (TUPP) mini-grant program. Program effectiveness will be determined through the commitment to evaluation in the mini-grant application and the reported results in the final mini-grant report. Pre and post nutrition knowledge, number of participants or classes meeting/exceeding their step improvement goals, and the impact of the (SHI) recommendation implementation on improving school health will be measured.

The three options available to schools through the mini-grant program have the following supporting evidence.

The Five A Day program is an ongoing initiative of the National Cancer Institute. NCI-funded randomized trials represent a significant body of research and offer a persuasive argument that behavioral interventions can have a positive impact on vegetable and fruit consumption. Elementary school behavioral and food service interventions had a positive impact on student vegetable and fruit consumption. The studies proved it is possible to change the elementary school environment and to reinforce the healthy dietary practices taught through the classroom curricula.

The structured step program for increasing physical activity is based on the President's Challenge Physical Activity and Fitness Awards Program, which recommends 11,000 steps for girls and 13,000 steps for boys at least 5 days a week.

The School Health Index is the recommended self-assessment and planning tool developed by the CDC, designed to:

identify the strengths and weaknesses of school's health promotion policies and programs,

develop action plans for improving student health, and

involve teachers, parents, students, and the community to improve school policies and programs.

Goal:

Create school environments conductive to prevention.

Strategy 1:

Develop resources to partially support a Coordinated School Health Consultant position for the Salina Public Schools. As a district-level "champion" for the CDC-developed School Health Index process, the consultant will significantly enhance the impact of the SHI process on school district and building policies and practices. The position will be responsible for coordinating the School Health Index (SHI) work for the Salina Public Schools impacting over 7,500 students. The consultant will coordinate health and prevention curriculum training and services, and review and submit school and district policy revisions aligned with the District Coordinated School Health Plan.

In that “champion” role, the consultant will lead the Salina Public Schools Coordinated School Health Council’s efforts to implement thirteen school improvement plans over the next two years. The consultant will form SHI implementation work groups, review and formulate new district and school policies, help set short and long-term school health improvement goals, provide assistance to district and school-building level teams, and monitor progress.

Strategy 2:

The Coordinated School Health Consultant will ensure health policy review and update as well as curriculum revision based upon the CDC School Health Index (SHI) process. The consultant will also contribute to successful implementation at each building level of each school improvement plan suggested by the Salina Public Schools’ Coordinated Health Council from the SHI process.

Goals:

Target interventions to overweight and at risk student populations based upon BMI study results.

Strengthen existing interventions through collaborations and resource development.

Strategy 1:

Research community physical activity/nutrition assets, partnership, resources, and needs.

School-based:

Support to maintain, expand and replicate the Heusner/ YMCA After School Fitness program for fourth and fifth graders who fail to score in the healthy zone on the fitness assessment test is needed. The three- year-old program meets twice a week from 3:30-5:00 from October through May. Reliable transportation would not only sustain the program but could increase the number of participants from 20 to 35. Sunset School is also interested in this program. With adequate resources, the program could go countywide.

Explore all after elementary school programs provided by YMCA to determine feasibility to refocus programming on physical activity.

Community-Based
>>back to top<<

Goals:

Target specific interventions at overweight and at risk student populations and their families based upon the BMI study.

Chronic Disease Risk Reduction Grant (KDHE):

Strategy 1:

Offer bilingual cooking classes at the Emergency Aid Food Bank kitchen classroom to Hispanic families using ethnic foods with an emphasis on fruits and vegetables.

Strategy 2:

Offer bilingual nutrition classes to Hispanic parents and teens at Catholic Charities’ weekly Success By 6 Family Tutoring Program.

Create community environments conducive to prevention.

Strategy 1:

Community Social Networks: The Task Force on Community Preventative Services found through its systematic review of published studies that “efforts made in community settings to provide social support for increasing physical activity are effective. The Active Living For Adults behavior change program is based on the research study Project Active, which was developed by scientists at the Cooper Institute in Dallas, Texas. This research showed that teaching people lifestyle skills such as realistic goal setting, identifying and addressing barriers to physical activity, and developing social support systems effectively helps people become and stay physically active.

The twenty-week program is presented step-by-step in an existing manual, Active Living Every Day. The emphasis in this program is on lifestyle physical activity, encouraging people to find ways to realistically fit physical activity into their daily lives. It encourages moderate amounts and intensities of physical activity. While this program targets adults, it has potential to provide to refocus the community’s attention and participation on improving everyone’s nutrition and physical activity.

Reduce barriers to achieve goals.

Strategy 1:

Physical Access/Infrastructure: An intergenerational team of 50 volunteers utilizing the Pedestrian and Bicycle Information Center Walkability Checklist will survey the Salina community in Fall 2004. Volunteers will be recruited from Kansas Wesleyan University, the Volunteer Connection, and through the publication of the survey and checklist in the Salina Journal. Checklist results and analysis will be reported to the community through the media and used to develop a community-based proposal to the Salina City Commission to improve walking access and safety.

The walkability survey is strongly recommended by the Center for Disease Control and Prevention Task Force on Community Preventive Services. The median estimates from the reviewed studies suggest that creating or improving access to places for physical activity can result in a 25% increase in the percent of persons who exercise at least 3 times a week.

Health Care
>>back to top<<

Goal:

Improve the medical community’s accessibility to community data, nutrition/physical activity information, education, and resources.

Strategy 1:

Improve health professionals’ knowledge and awareness of local data, interventions, and community resources.

Strategy 2:

Recruit a medical champion to influence medical community support and involvement.

Strategy 3:

(Part of Social Marketing Plan) Develop web page with all relevant information, intervention/program sites with contact information. Include Saline County prevalence rates, common myths, prevention strategies, appropriate management strategies, recommended evidence-based strategies and community resource referral contacts.

Strategy 4:

Market the website to the target audiences (medical professionals is one) as part of the social marketing plan and campaign.

Barriers Report
>>back to top<<

School Health Index

Salina Public Schools convened a district coordinated school health improvement council through a technical assistance grant from KDHE in April and May. The council was divided between elementary and the middle/secondary with a full range of representation as recommended by the School Health Index.

After ten hours of work, each committee had completed the eight modules and the district elementary and a secondary health improvement plans. Both plans agreed upon the need for specific district policies to improve student health and a health and wellness program for district staff. From this process, the following barriers were identified:

POLICIES: absence of key district/building policies, and inconsistent policy application from building to building

TIME: limited instructional time to increase/improve nutrition education

PERSONNEL: need for a full time district coordinated school health consultant position; shortage of school nurses due to budget considerations

MATERIALS: absence of instructional materials to integrate into instruction due to costs in time and dollars

TRAINING: limited professional development and resources beyond core curriculum due to funding issues

CURRICULUM: school nurse health education scattered among several subject curriculum guides

NUTRITION: student and staff demand for and widespread access to non nutritional ala carte choices

PHYSICAL ACTIVITY: absence of adaptive physical education classes

ROLE MODELS: absence of staff wellness priorities and programs

COMMUNICATION and AWARENESS: inconsistent communication of community resources, lack of communication and collaboration between departments and staff; absence of balanced message between tobacco, nutrition, and physical activity

STAKEHOLDER EDUCATION: education of students, parents, families, staff and community on nutrition and physical activity health issues

Local Community

Saline County has a variety of ongoing nutrition and physical activity programs, activities, and events. All or some of the following barriers affects participation.

TRANSPORTATION: Barriers for children and youth participation include foremost transportation since most children and youth prior to driving age must rely upon private transportation due to the absence of point-to-point public transportation. Most parents work creating transportation needs for summer and after school programs.

COSTS: Cost for transportation could still play a role for some participants. Program costs impact many.

ACCESS: Bilingual nutrition/physical activity education and programs require cultural sensitivity and integration into existing Hispanic service programs.

ENVIRONMENTAL: Limited access to two existing walking trails, two parks with designated walking paths, inconsistent and poor quality sidewalks availability, unlighted areas, traffic concerns, and vicious dogs are barriers.

PROGRAM MARKETING AND HEALTH EDUCATION: Limited promotion budgets by program providers to publicize programs and absence of bilingual and English education materials for community members, organizations, or health care providers.

School Health Index Plan:
>>back to top<<

USD 305 Elementary School Health Improvement Plan
>>back to top<<

Actions:

Hire a district Consolidated Health Council Coordinator and to lead and support the district School Health Improvement Council.

Research and develop for board adoption district policies to prohibit non-nutritional foods as a reward by school staff.

Research and develop for board adoption district policies to prohibit use of physical activity as a punishment by school staff.

Implement district-wide adopted policies to prohibit restrict non-nutritional foods as a reward and prohibit use of physical activity as punishment.

Develop and implement coordinated health/wellness program for district employees.

Develop a curriculum guide for nurse education.

USD 305 Secondary School Health Improvement Plan
>>back to top<<

Actions:

Educate staff, students and parents about physical activity, healthy eating, and tobacco free lifestyle.

Develop alternative delivery methods for wellness education for students, parents, and staff.

Develop health/wellness program for district employees.

Explore replacement funding for vending machines.

Sustainability
>>back to top<<

Educational policy and curriculum changes achieved district-wide through the School Health Index will be more widely sustainable than either individual teacher or individual building initiatives.

Community infrastructure changes and improvements to the physical community environment will be permanent.

The social marketing plan evaluation and refining process can promote sustainability through its development of an evaluation report that not only can be used to secure future funding but also will identify ineffective strategies to be abandoned and highly successful strategies to be continued or replicated.

The school mini grant program introduces evidence-based strategies to schools with small funding amounts that can be used to launch these strategies. Once these strategies, which are low cost by nature and easily tailored to each school’s distinct needs, become integrated, and results are seen, they will be sustained and replicated.

Recruiting an active, energetic community medical champion could impact not only the medical community but would raise community awareness of public health problem and stimulate community action.

Using recognized programs, agencies, and effective bilingual trainers to offer community bilingual interventions will ensure successful participation, acceptance and continuation.

Refocusing, expanding, and adding additional resources to the Heusner/YMCA community/school partnership to include the targeted student populations based upon the BMI data study will build on a successful, established program that can be replicated to other buildings with the same demographic profile as Heusner.

Providing access to information by developing and maintaining a bilingual Fit for Life nutrition and physical activity web page dedicated to providing the Saline County community with current prevalence rates, management and prevention strategies, the walkability survey and its subsequent report and community resource referral contacts reduces an education and information barrier for the Salina community.