new jersey partnership for healthy kids - vineland strategic planvldhealth.org/pdf/obesity strategic...

February 2011

New Jersey Partnership for Healthy Kids Vineland Strategic Plan

Project Partners Robert Romano, Mayor City of Vineland

Vineland City Council Vineland Board of Education

City of Vineland Engineering Department City of Vineland Recreation Department Alliance for a Healthier Generations

Vineland Downtown Development Initiative City of Vineland Department of Public Works

Vineland Police Department Sodexho Corporation

Triad Associates South Jersey Healthcare

Vineland Community Development Program

Acknowledgements

The production of this document was possible due to the efforts and input of many valued residents, organizations and government agencies. Sincere thanks to all our participants and their member organizations.

Vineland Partnership Steering Committee Members Lisa Scheetz, Partnership Co‐Director, Cumberland Cape Atlantic YMCA George Sartorio, Partnership Co‐Director, Vineland Health Department

George Steinbronn, Jr, Cumberland Cape Atlantic YMCA Cara Messore, Cumberland Cape Atlantic YMCA

Emma Lopez, Vineland Health Department Diane Holtaway, Rutgers Food Innovation Center Diego Cuartas, Vineland Health Department

Rosolyn Williams, Vineland Board of Education Alysia Mastrangelo, Richard Stockton College of New Jersey

Community Outreach Members Mary Barner—Vineland Senior Center

Debra Bechtel—Winslow School Brenda Bundy—Word of Life Church

Judy Ford—Open Arms Wendy Lopez—Sol Boricano

Francis Wolf—Tri‐County Community Action Partnership Head Start

Table Of Contents I. Executive Summary

II. Introduction Why the planning process was undertaken How the local Partnership was formed Who participated in the process

III. Community Focus

Community demographics Target Area Map

IV. Mission Alignment, Community Partnership & Planning Policy and environmental change in community and schools Community engagement in the local Partnerships and strategic planning process

V. Data & Assessment

Background – detailed description of childhood obesity in target community Summary of Data ‐ Process used to compile, assess and report data ‐ Summary of community‐specific data

VI. Strategies and Impact Vision and Values Strategies, Action Plans and Timeline

VII. Monitoring & Quality

VIII. Summary

IX. Resources

1

3

9

13

17

35

39

41

43

Through a partnership with the Robert Wood Johnson Foundation, the Cumberland Cape Atlantic YMCA, and the City of Vineland Health Department the Vineland Healthy Kids Partnership is pleased to present the NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan. The goal in preparing this document is to present a comprehensive picture of the problems and solutions related to childhood obesity in the City of Vineland along with a plan to reverse this epidemic by 2015. It is our goal that organizations, the community and individuals will see this document as a tool to help improve the health of children in the Center City area of Vineland, as the pilot, and then all the youth of this community in subsequent years. Throughout the process the Partnership engaged various government partners, community residents and not‐ for‐profit organizations in the planning and drafting of the obesity prevention and intervention strategies. The selected strategies meet the Partnerships goals and guiding principles, and enjoy broad support by partners. They are realistic and financially feasible and represent a clear means to an end. The strategies are:

Wellness in Schools Goal #1: Collaborate with organizations that focus on children’s health to strengthen and enforce the Vineland School District Wellness Policy. Goal #2: To increase access to opportunities for healthy eating for children by integrating innovative healthy meal components into the Vineland School District meal program.

Community Food & Nutrition Goal #3: Provide training and resources to corner stores and eateries to offer healthy meal and food options. Goal #4: Explore ways of making healthy foods affordable and accessible.

Environment/Community Goal #5: In partnership with the City of Vineland Engineering and Police Departments create calming measures and enforcement plans which will promote safety and ultimately physical activity within the target area. Goal #6: To increase access to opportunities for physical activity for children and families

Please review this document and bring it to life. It is truly a blueprint for how to reduce childhood obesity but it can only be as useful as the people who read it allow it to be. Childhood obesity is no doubt a challenging and complex problem and by working together, sharing information, ideas, successes and failures, we will make progress and save lives.

Section 1

Executive Summary

1

"Child hunger and child obesity are really just two sides of the same coin. Both rob our children of the energy, the strength and the

stamina they need to succeed in school and in life. And that, in turn, robs our country of so much of their promise."

– First Lady Michelle Obama Healthy, Hunger‐Free Kids Act signing

Change the Conversation ...

Obesity in children and teens ‐ The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise (American Academy of Child Adolescent Psychiatry). What is obesity – There are many definitions and guiding statements for what constitutes obesity; a few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10% higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence, although recent studies are finding children 3 years of age or younger approaching the criteria for being obese

(Center for Disease Control). Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult. What causes childhood obesity ‐ The causes of obesity are complex and include genetic, biological, behavioral and cultural factors .

Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that their children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to: • poor eating habits • overeating or binging • lack of exercise

• family history of obesity • medical illnesses • stressful life events or changes • family and peer problems

Section 2

Introduction

3

Overweight and Obesity: An Overview • Overweight and obesity result from an energy imbalance. This involves eating too many calories and a lack of adequate physical activity.

• Body weight is the result of genes, metabolism, behavior, environment, culture and socio‐economic status.

• Behavior and environment play a large role in causing people to be overweight or obese. These are the greatest areas for prevention and treatment actions.

Adapted from The Surgeon General’s Report, 2009

Put Play in Your Day


• low self‐esteem • depression or other emotional problems

Obesity and School Achievement – The U.S. Surgeon General recently identified the obesity epidemic as one of the greatest health problems today. The National Association of State Boards of Education (NASBE) has also recently proclaimed that health and success in school are interrelated, and schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially. Health‐risk behaviors, such as poor food choices and physical inactivity, can lead to poor school performance and have been consistently linked to academic failure and often affect students’ school attendance, grades, test scores, and ability to pay attention in class. Furthermore, academic success is an excellent indicator for the overall well‐being of youth and a primary predictor and determinant of adult health outcomes.

Significance ‐ Rising childhood obesity in the United States has caused increased childhood incidence of various health conditions that used to affect only adults. Examples include type II diabetes, high cholesterol and high blood pressure. Children who are overweight also have a higher risk of becoming obese adults, which can increase their chances of developing related medical problems and even dying prematurely. Taking into account the extensive research around childhood obesity and the complications it causes, the City of Vineland accepted the New Jersey Partnership for Healthy Kids charge as set forth by the Robert Wood Johnson Foundation. That charge was to:

• Create/develop core planning teams and community partnerships;

• Make a commitment to childhood obesity prevention; • Understand the nature of the environmental and policy

changes required to address childhood obesity; • Collaborate in the development of a strategic planning

process; • Participate in community evaluation/assessment.

A strategic planning process was created to carry out ‘Change the Conversation’ and utilize the leadership, expertise, and local knowledge about the multiple areas (e.g., community design, access to healthy foods, etc.) affecting childhood obesity to develop strategies to enhance the health and wellness of target area located within the City of Vineland.

Change the Conversation …

“The goal was to create, with community and partner organization input, a short list of targeted strategies

with multiple approaches for implementation and to engage partners across sectors of the community to affect policy change in addressing

childhood obesity.”

4

The NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan was developed through a deliberative process led by a dedicated Steering Committee and an experienced strategic consultant (Triad Associates) while utilizing substantial input from a large and diverse group of individuals who participated at various levels in setting goals and objectives for the Initiative. The Steering Committee created a mission, vision and guiding principles that became the strategic plan. The goal was to create, with community and partner organization input, a short list of targeted strategies with multiple approaches for implementation and to engage partners across sectors of the community to affect policy change in addressing childhood obesity. The first step in planning was the creation of the Core Team, comprised of local government and organizational leaders, an evaluator from the Richard Stockton College of New Jersey, the Rutgers Food Innovation Center, representatives from the Vineland School District, local businesses, members of the faith‐based community, and representatives from the health care systems. The team was lead by Co‐Directors, one from the City of Vineland Health Department the other from the Cumberland Cape Atlantic YMCA of Vineland. The original purpose of the Core Team was to draft a planning grant to the Robert Wood Johnson Foundation. Upon award of the planning grant the Core Team realigned its membership and transitioned into what is currently known as the Steering Committee. The purpose of the Steering Committee was to create a Strategic Vision and Plan for Implementation for the NJ Partnership Initiative and to provide continued support in the arenas of policy

development, systems change, and sustainability for the process as it moves forward. The Strategic Vision/Plan was created over a period of eight months beginning in June 2010 and culminating in January 2011, during which time committee members conducted Community Healthy Living Index (CHLI) assessments, reviewed childhood obesity data, solicited community input, identified additional partners necessary for planning and implementation, and reached consensus on vision and mission statements, core values, and strategic goals for the NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan. In order to maximize the work flow of the Steering Committee, three (3) sub‐committees were formed, to distribute planning activities. First, the Outreach Committee, which was charged with community engagement, solicitation of information and input from community residents, local businesses and staff from organizations servicing individuals from within the target area. The Outreach Committee was lead by Diego Cuartas from the City of Vineland Health Department. Next, a Data Team, lead by Dr. Alysia Mastrangelo, administered the CHLI Assessments, analyzed CHLI data, reviewed the Rutgers Chartbooks and synthesized obesity & health related data from numerous sources including Robert Wood Johnson, Vineland School District, and Alliance for a Healthier Generation, Centers for Disease Control, The Food Trust as well as other national organizations. The third committee is the Implementation Grant Team. This committee, lead by Lisa Scheetz, Co‐Director of the NJ Partnership for Healthy Kids – Vineland and COO of the Cumberland Cape Atlantic YMCA, was charged with facilitating information for the Strategic Plan as well as vetting views, ideas and concepts to the community through a series of Healthy Kids activities.

Reversing the Childhood Obesity Epidemic by 2015

5 Eat Healthy


The Steering Committee, along with various Partners, hosted two Healthy Kids Rallies, designed to test the strategies, generate new ideas, solicit information through surveys and provides an opportunity for individuals to share their opinions. More than 100 participants suggested new ideas and provided feedback and suggestions for revising and refining the strategies and implementing guidelines. Some participants also volunteered to become implementation partners for the strategies or suggested ways of leveraging strategies with existing organizations and programs through collaborative action and communication to spread key messages. The participants made new connections, shared ideas, and sparked interest in working with each other to address the health concerns of Vineland youth. Although the Strategic Plan is being moved into a state of action it’s important to point out that the Vineland Partnership will continue to engage the community after approval of the strategic plan. In particular, residents will participate in education and policy changes through a Community Ambassador Program (to be developed), and business partners will be recruited to implement and/or sponsor wellness focused activities. The NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan represents a tremendous opportunity to leverage resources among a network of partners united by a common purpose. The preparation of this strategic plan signals a commitment to progressive action and puts the target communities in a state of readiness. Even though some components of the plan can be implemented at no cost to the

community, other components will require new resources and new funding. Given the current economic conditions and budget constraints within the City of Vineland, Vineland School District and participating partners no monies will be expected, and efforts will be made to minimize the responsibilities of staff. Every effort will be made to leverage implementation funds when appropriate and available. To ensure the effective implementation of the Plan the Steering Committee has been working to secure commitment of key stakeholders. To date the following stakeholders have committed to assisting with the implementation of the NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan:

• City of Vineland Health Department • Cumberland Cape Atlantic YMCA • Vineland School District • Rutgers University‐ Food Innovation Center • Alliance for a Healthier Generation


More than 100 participants suggested new ideas and provided feedback and

suggestions for revising and refining the strategies and implementing guidelines.

6

• Vineland Police Department • Richard Stockton College of New Jersey • Vineland Recreation Commission • Vineland Downtown Improvement District • City of Vineland Engineering Department • City of Vineland Department of Public Works • Sodexho Corporation • The Food Trust • Sweet Life Bakery • City of Vineland Recreation Department • City of Vineland Environmental Commission • Cumberland County Agricultural Producers

As the Plan moves into implementation the Steering Committee will continue to add partners and implementation team members. This entire process is fluid where members will be engaged at any point in the process with preference given to long term affiliations and to neighborhood residents who wish to participate.


7 Visit a Local Farm Stand

The City of Vineland is located in the north central portion of Cumberland County, New Jersey and is bordered by Atlantic County to the east and northeast, and Salem County to the northwest. According to the United States Census Bureau, the city has a total area of 69.0 square miles (178.7 km2). Of all the municipalities in New Jersey to be defined as a 'city,' Vineland is the largest in total area. Additionally, Vineland is home to the largest farmer's cooperative on the east coast, the Vineland Produce Auction. As of the 2000 Census, there were 56,271 people, 19,930 households, and 14,210 families residing in the city. The population density was 819.2 people per square mile. There were 20,958 housing units at an average density of 305.1/sq mile. The racial makeup of the city was 67% White, 14% African American, 0.54% Native American, 1.16% Asian, 0.08% Pacific Islander, 14% from other races, and 3% from two or more races. Hispanic or Latino of any race was 30% of the population. There are 19,930 households, 80.9% of those had children under the age of 18 living with them, 48.8% were married couples living together, 16.8% had a female householder with no husband present, and 28.7% were non‐families. The average household size was 2.70 and the average family size was 3.17. The city population was more diverse with 25.7% under the age of 18, 8.3% from 18 to 24, 29.0% from 25 to 44, 22.9% from 45 to 64, and 14.2% who were 65 years of age or older. The median age was 36 years.

The median income for a household in the city was $40,076, and the median income for a family was $47,909. The per capita income for the city was $18,797. About 9.8% of families and 13.8% of the population were below the poverty line, including 17.3% of those under age 18 and 13.8% of those ages 65 or over. Median household income and per capita income figures show that the City is ahead of the county figures, but well behind state figures, though New Jersey is one of the wealthiest states. Vineland income figures lag those of the US by a small margin as shown below: Median Household Income $40,076 ‐ Vineland $39,150 – Cumberland County $55,146 – NJ $41,994 – US Per Capita Income $18,797 ‐ Vineland $17,376 – Cumberland County $27,006 – NJ $21,587 ‐ US

The percentage of persons living in poverty in 2006 was 13.8 percent, a figure lower than that of the County (15.0%), but well above the State percentage of 8.5 percent. Among the 7,560 persons in poverty, 1,004 were 65 or over and 2,395 were under 18. Educational attainment levels indicate that the City has a high percentage of persons lacking a high school diploma, and a relatively low

Section 3

Community Focus

9 Change the Conversation


percentage of persons with college or advanced degrees. Vineland has a well‐defined central core and business district, distinct neighborhoods, as well as a number of commercial and industrial areas. The main street in Vineland is Landis Avenue, and is located in the center of the target area. The traditional downtown area is located several blocks east and west of the intersection of Landis Avenue and the Boulevard. The Boulevard is a pair of roads that flank the main north/south railroad which connected Vineland with Cape May to the south and Camden/Philadelphia to the north. After many years of decline there has been much recent activity to restore the vitality of "The Avenue" and the center city area. New construction includes a new transportation center, courthouse, post office, elementary school / community center and sidewalk upgrades. In 2006, Vineland was designated a Main Street Community and, through the work of this group, money has been earmarked to continue this improvement through property and facade improvements, business retention and marketing. The Vineland Public School District serves students grades preschool ‐12. There are eight (8) elementary schools, five (5) Middle Schools, 0ne (1) High School, (1) Adult Education Center and 1) Alternative School. In total the District provides educational services to approximately 10,500 students. There are not less than seventeen (17) parks and/or recreation facilities within the City of Vineland. Of that total number seven (7) parks/recreational fields are located within the identified target area along with the Cumberland Cape Atlantic YMCA, two (2) fitness

centers, a community pool and several gyms and dance studios. Realizing the immense geographic size of the City of Vineland, a decision was made to target an area with the highest density; for this area the ‘urban center’ of the community was chosen. As such the target area is defined as a one mile radius centered on City Hall, see Figure 1 and 2. The target area captures more than 55% of Vineland’s population, is the location of the highest poverty rates within the City, is the main commercial center, captures a large portion of the City’s assets (parks, schools, community school) and contains the highest concentration of eateries within City limits.

Change the Conversation ... 10


Eat Healthy Meals 11

Figure 1: Target Area Ortho Map used to show density

Figure 2 Target Area Map with Streets and Parks

"I want to challenge every restaurant to offer healthy menu options and provide them up front so that parents don't have to hunt around and read the small print to find an appropriately sized portion that doesn't contain high levels of fat, salt and sugar. These choices have to be easy to make and they have to give parents the confidence to know that they can go into any restaurant in this country and choose a genuinely

healthy meal for their kids." – First Lady Michelle Obama National Restaurant Association Fall Board Meeting, 9/13/2010


The NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan was created to spark a shift in the community perception of living healthy, so that eating healthy and including movement in ones daily life becomes the norm for the residents of Vineland. This will be accomplished over time by many coordinated partners working across sectors such as health, education and the environment, as well as through community engagement. This Strategic Plan seeks to engage a diverse network of people and organizations to leverage efforts towards common goals. Rather than a top‐down organization, the Partnership acts as a convener and facilitator to fuel and help organize a grassroots movement: to spread key messages, collaborate with other organizations, and develop partnerships engaged in the common goal of reversing the childhood obesity epidemic by 2015 by improving access to affordable healthy foods and increasing opportunities for physical activity in schools and communities across the nation. Planning and community strategies were envisioned to align with the policy goals of the Robert Wood Johnson Foundation, the Vineland Partnership directed policy planning with the following six Policy Priorities set forth by Robert Wood Johnson:

1. Ensure that all foods and beverages served and sold in schools meet or exceed the most recent dietary guidelines for Americans.

2. Increase access to high‐quality, affordable food through new or improved grocery stores and healthier corner stores and bodegas.

3. Increase the time, intensity, and duration of physical

activity during the school day and out‐of‐school programs.

4. Increase Physical Activity by improving the built

environments in communities. 5. Use pricing strategies‐both incentives and disincentives –

to promote the purchase of healthier foods. 6. Reduce youth exposure to unhealthy food marketing

through regulation, policy and effective industry self‐regulation.

Vineland’s Strategic Plan is based on a collaborative model. Its goal is to engage a diverse array of non‐for‐profit organizations, community leaders and partners across many sectors. In this model, many disparate groups—from educators to bodega owners—can find a place to explore their common ground, form partnerships, and implement the ideas and strategies from in this plan in their own organizations. For instance, a school could create a menu with several locally sourced produce projects while a local down‐town market

Section 4

Mission Alignment, Community Partnership & Planning

13 Family Time


could approach the same farmer for affordable fresh produce to sell or offer as a menu option within their store. A key goal of the collaborative model is to create a cultural/community shift, where many organizations and individuals, including parents, create opportunities over time for children to recognize and use healthy & nutritional food products in their daily lives. The NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan comes at a critical time. Awareness about the movement is increasing; First Lady Michelle Obama is celebrating the one year anniversary of her ‘Let’s Move’ healthy living campaign. It’s also at a time when headlines across all forms of media outlets are reporting the serious obesity epidemic of the youth. There is a growing understanding of intertwined issues: alarm about the obesity epidemic, enthusiasm for urban gardens and pedestrian‐friendly urban design, concern that overscheduled schoolchildren are losing recess time and experiencing stress. Partners in the community are ready to take action and work toward achieving policy & environmental change within the target community. The New Jersey Partnership for Healthy Kids – Vineland team developed these key messages to test with participants at community events. Overall, participants liked the key messages but some messages will not be transformed into final goals for the plan.


Wellness in Schools: • Strengthen the Vineland School District Wellness Policy • Source local fresh produce for Vineland School District meal program.

• Integrate innovative healthy meal components into the Vineland School District meal program.

• Create awareness of healthy meal packing options for Vineland School District students

Community Food & Nutrition: • Encourage local restaurants/eateries to offer healthy meal options.

• Create a target neighborhood Food Cooperative.

Environmental Changes: • Create traffic calming measure in target neighborhoods and places were residents convene to exercise.

• Work with City of Vineland Police Department to create an enforcement plan for the target area.

• Increase availability of water fountains in common areas within the target neighborhoods.

• Community street closures for exercise and family activities.

14

Gathering the community’s collective strength to take action; the Vineland Partnership sought community engagement and participation throughout the entire process. From December 28, 2010 through February 4, 2011 the Steering Committee presented a New Jersey Healthy Kids Partnership – Vineland PowerPoint presentation outlining the mission of the Partnership, obesity statistics for the City of Vineland from the Rutgers Chartbooks & CHLI Assessments and potential goals for the plan at ten (10) functions. Outreach included two (2) Healthy Kids Rallies, one at the Cumberland Cape Atlantic YMCA with the other at the Gloria M. Sabater Community School. Collectively the two presentations engaged over 200 community residents in the dialogue of the Vineland obesity epidemic. At each of these events the Partnership engaged the community in active exercise while providing a healthy meal. Community providers attended each session offering nutritional information, blood pressure checks, tobacco awareness and heart healthy advice. Beyond the two Healthy Kids Rallies ‐ presentations, with corresponding dialogue, took place at the Vineland Health Department Community Health Advisory Council’s monthly meeting, Food Safety Council Meeting, Human Services Advisory Council Vineland Stakeholders Committee meeting, Voices (Grandparent support group in Vineland), Vineland Policy Prevention Board meeting, Vineland Chamber of Commerce Meeting and two Community Sessions – one at Vineland City Hall and the other at the Carl Arthur Community Center. In total the Partnership presented the PowerPoint presentation to not less than 175 additional members of the community.

All activities were hosted within the target area boundaries and focused on resident, business and organizations that would be directly impacted by the anticipated policy and environmental changes. The Steering Committee made a concerted effort to schedule activities and meetings in the evening hours to accommodate the schedule of working parents. Specific attention was given to actively involving residents from the low‐income areas within the target area. Particular attention and accommodations were also made to address the language issues of a large portion of the target area population who are Spanish speaking. It was through the process at Healthy Kids Rallies and community meetings/forums that the key messages where refined to become what the Partnership is presenting as their goals and strategies. Robert Wood Johnson Foundation embraces continuous learning and so that was a principle supported and utilized as a guiding practice throughout the planning process. With the planning process now complete the selected strategies, presented in Section V of the Plan, meet the Partnership’s goals and guiding principles, and enjoy broad support by partners as well as the community. They are realistic and financially feasible and represent a clear means to an end. Finally, these strategies leverage other efforts and build on existing resources to respond to community needs, use best practices and produce sustainable results.


15 Shop Healthy

The City of Vineland reviewed various documents and contacted a number of resources about the childhood obesity epidemic. Much of the information reviewed was National in focus; giving the Vineland Steering Committee a background of trends and best case practices. Information from the Food Trust, Healthy Weight Commitment Foundation, Partnership for a Healthier America, Alliance for a Healthier Generation and several Robert Wood Johnson Foundation reports. Information from these reports was used to direct conversation, provide continual learning about childhood obesity to the Steering Committee as well as community at large and provide detailed description of the national childhood obesity trend. However, for the City of Vineland the most detailed and relevant information was contained within the New Jersey Childhood Obesity Study, completed by Rutgers Center for Health Policy, and the CHLI Assessments completed by the Data Analyst Sub‐Committee. These two resources provided real time, target population specific data. Although it should be noted that some data contained within the NJ Childhood Obesity Study and CHLI Assessments was in conflict with one another. The Steering Committee was very diligent in their evaluation of the data. When a contradiction in data was noted the Committee took necessary actions, such as participating in neighborhood walk‐about and administering additional surveys, to try and confirm data. The Vineland Partnership is confident that the following outlined data

highpoints are detailed and in alignment with the strategies envisioned for reversing childhood obesity by 2015. Analyses of the Rutgers and CHLI data were lead by Dr. Alysia Mastrangelo, professor of Physical Therapy at the Richard Stockton College of New Jersey. Dr. Mastrangelo’s analysis and evaluation of the various statistics and findings was critical to the Vineland Steering Committee utilizing the data to it’s fullest without complications of misinterpretation. Overall Key Findings New Jersey Childhood Obesity Study:

School BMI: Vineland children are more likely to be overweight or obese compared to their national counterparts. The rates are highest among children ages 6–11 and Hispanic children. The largest differences between Vineland public school children and national estimates are seen among the youngest children (40% in Vineland are overweight and obese compared to 21% nationally). Food Behaviors: Almost all children in Vineland (90%) do not meet recommendations for vegetable consumption. Energy‐dense foods such as fast food, sugar‐sweetened beverages, and sweet snacks are frequently consumed and this is more prevalent among children 6 and older. Food Environment: Almost all the parents in Vineland visit supermarkets and superstores for most of their food

Section 5

Data & Assessment



shopping. Over 40% report limited availability of fresh produce and low‐fat items at these stores. 23% of families do not food‐shop in their neighborhood. Lack of stores in the neighborhood and cost are the main barriers to shopping in the neighborhood identified by the parents.

Physical Activity Behaviors: The majority of children do not meet the guidelines for being physically active for 60 minutes each day. In addition, a large proportion spend more than 2 hours watching television, using the computer, and playing video games, and this is more prevalent among boys and older children. Most children (85%) do not walk or bike to school. Physical Activity Environment: Nearly half the neighborhoods do not have sidewalks, one third do not have parks, and 40% lack exercise facilities. Even when facilities are available, 22% do not use the parks and 21% do not use exercise facilities. A quarter of the parents report that their neighborhood is unsafe due to traffic.

Beyond the key findings above the following pages outline key finds in three primary areas, Children’s Weight Status, Food Behavior and Physical Activities Behavior. These three areas were highlighted for they align with Vineland’s Strategies and are data baselines the Partnership would like to track moving forward.

Change the Conversation … 18

Childhood Weight Status by Age: Vineland Public Schools vs. US

• Compared to the national data, a higher percentage of Vineland public school children in all age categories are overweight or obese. About 1 in 4 Vineland children in every age category is obese.

• The largest difference between Vineland public school children and national estimates is seen among the youngest children (40% in Vineland are overweight and obese compared to 21% nationally).


Take a Walk Daily 19

Children’s Weight Status


Parent’s perception of child’s weight status (based on survey data)

• Despite the high prevalence of overweight and obesity among children attending Vineland public schools, when asked about their child’s weight status on the survey, a vast majority of parents of Vineland children do not think their children are overweight or obese.

• Vineland parents of children ages 3–5 are more likely to say their children are not overweight (99%), compared to parents of children ages 6–11 (89%) and ages 12–18 (72%). Yet, differences between Vineland children and the national averages are greatest for the youngest age group.

Children’s Weight Status


Key findings from data on children’s weight status: • Based on measured heights and weights data obtained from

public schools in the city, Vineland children have high rates of overweight and obesity. Compared to the national data, the rates are particularly high among children in the youngest (3–5 years) age group. National data for the youngest age group are based on 2–5 year olds while the Vineland data includes only 3–5 year olds.


Use Your Playgrounds 21

Despite these high rates of overweight and obesity among children, the vast majority of

parents of children ages 3–18 in Vineland think that their


Percentage with two or more fast‐food visits per week

• Overall, 20% of 3–18 year old children in Vineland eat at fast food restaurants 2 or more times a week.

• Fast food visits increase with age: 26% of Vineland adolescents eat at fast‐food restaurants 2 or more times a week, compared to 19% of children ages 6–11 and 14% of children ages 3–5.

Food Behavior


Don’t Smoke 23


Percentage who do not eat breakfast daily

• Overall, 21% of 3–18 year old children in Vineland do not eat breakfast daily.

• Eating breakfast daily decreases with age: Almost three times as many Vineland adolescents (36%) as younger children do not eat breakfast.

Food Behavior


Key findings from data on Food Behavior

• Only 10% of the children in Vineland meet the Healthy People 2010 recommendations for eating vegetables three times per day. While 59% of the children meet the recommendations for fruit, the consumption of 100% juice, a more concentrated source of calories, is higher among those who consume more total fruit (fruit + 100% juice).

• 20% of children in Vineland consume fast food at least

twice a week and adolescents eat at fast‐food restaurants more often.

• Consumption of energy‐dense foods such as sugar‐

sweetened beverages and salty snacks is prevalent among children in Vineland, especially among older children. Sweet snack consumption is higher among non‐Hispanic white children.

• Overall, 52% of Vineland children do not eat fruits and

vegetables as snacks on a daily basis and an even larger number of boys (59%) and older children (60%) do not eat fruits and vegetables as snacks daily.

Despite these findings, the majority of parents (86%) in Vineland think that their children eat healthy.


25


Percentage not active at least 60 min a day, 6–7 days a week

• 68% of 3–18 year olds do not meet this recommendation.

• Frequency of inactivity increases with age: 74% of Vineland adolescents are not active at least 60 minutes a day 6–7 days a week, compared to 68% of children ages 6–11 and 59% of children ages 3–5.

Physical Activities Behavior

Know Your Numbers


Percentage who spend more than 2 hours a day on weekdays on TV, computer, or video games

• Overall, 27% of 3–18 year old children in Vineland spend more than 2 hours a day on weekdays outside of school watching TV, being on the computer (not including doing schoolwork), or playing video games.

• Vineland boys are more likely to spend more than 2 hours a day on weekdays outside of school watching TV, being on the computer, or playing video games (33%) than girls (21%).

• Adolescents (31%) and children ages 6–11 (30%) are more likely to spend more than 2 hours a day on weekdays outside of school watching TV, being on the computer, or playing video games, compared to children ages 3–5 (18%).

Physical Activities Behavior


Visit a Park 27


Key findings from data on Physical Activities Behavior (Individual Oriented)

• Only 32% of the Vineland children ages 3–18 meet the 2008 Physical Activity Guidelines for Americans. Adolescents are least likely to meet these recommendations. However, 90% of parents think that their children get enough physical activity.

• Younger children and non‐Hispanic white children are least

likely to walk, bike, etc., to school, while children ages 6–11 are least likely to get physical activity at school.

• Girls are considerably less likely than boys to get physical

activity at school. • The American Academy of Pediatrics recommends that

children spend no more than two hours per day on entertainment media like television, computers, and video games. Over a quarter of Vineland children ages 3–18 years spend more than two hours per day watching TV, playing video or computer games during weekdays and 58% do so on weekend days, and this is more common among boys and older children. Weekend media time is also higher among non‐Hispanic white children, although weekday time does not vary by race/ethnicity.

Even though only 32% of Vineland children meet the

recommended level of physical activity, 90% of parents think their children get enough

physical activity.

Percentage who say neighborhood is unsafe due to traffic

• Overall, 23% of Vineland parents of children ages

3–18 think their neighborhoods are somewhat or very unsafe due to traffic.


Physical Activity Environment


Buy Local Produce 29


Physical Activity Environment

Percentage who say neighborhood is unsafe due to criminal activity

• Overall, 12% of Vineland parents of children ages 3–18 think their neighborhoods are somewhat or very unsafe due to criminal activity.

• Parents of children ages 6–11 (18%) are more likely to think their neighborhoods are unsafe due to criminal activity, compared to parents of those ages 12–18 (10%) and ages 3–5 (5%).

• Parents of Hispanic children (21%) are four times more likely to think their neighborhoods are unsafe due to criminal activity, compared to parents of non‐Hispanic white children (5%).


Key findings from data on Physical Activity Behavior (Community Oriented)

• Nearly half of Vineland families live in neighborhoods without

sidewalks, considerably more so for non‐Hispanic white families (67%). When sidewalks are present, an additional 10% of families report that their children rarely or never use sidewalks to walk, run, bike, or play. Of those with sidewalks, about one‐quarter feel that the sidewalks are in poor condition, and twice as many Hispanic families(31%) report this condition as non‐Hispanic white families (14%).

• Four times as many parents of Hispanic children report that their

neighborhoods are unsafe due to criminal activity (21%) compared to parents of non‐ Hispanic white children (5%).

• Over one‐third of the parents report living in neighborhoods

with no parks. In neighborhoods that have parks, 16% of parents feel that the parks are unsafe. 22% also report that their children do not use neighborhood parks for any type of physical activity.

• 39% of Vineland children ages 3–18 live in neighborhoods with

no exercise facilities. A final snapshot of the key findings from the Rutgers New Jersey Study: Body Mass Index (BMI)

• Vineland children are more likely to be overweight or obese than

the national average • Children 6‐11 year olds are at greatest risk • Hispanic children are at greatest risk • Youngest children (3‐5 year olds) 40% are overweight and obese

(nationally 21%) • 1 in 4 Vineland children are categorized as obese • 44% of boys and 43% of girls are overweight or obese, nationally

32% boys and 31% girls • Parents do not perceive their children as overweight or obese;

parents reported boys 15% overweight and none obese and girls 12% overweight and 2% obese.

Food behaviors • 90% of Vineland children do not meet recommendations for

vegetable consumption • Energy‐dense foods are frequently consumed. Increase in

consumption is noted in children aged 6 and older. • 59% of children meet the fruit consumption requirement • 20% of children eat at fast food restaurants 2 or more times per

week • 21% of children do not eat breakfast. This is higher in older

children

Food environment • Most Vineland residents (71%) report access to supermarkets

and superstores • 40% report limited availability of fresh produce and low‐fat items • 23% of families do not food shop in their neighborhood


• Barriers include lack of stores and cost. • Physical activity behaviors • Most children (68%) do not achieve the recommended 60

minutes of physical activity per day. • 49% of children are not active 30 minutes per day • Many children (27%) report 2 or more hours of screen time on

weekdays, 58% on weekends. More prevalent among boys and older children.

• 85% of children do not walk or bike to school.

Physical activity environment • 49% of the neighborhoods do not have sidewalks • 34% of the neighborhoods do not have parks • 40% lack exercise facilities • When accessible, 22% do not use parks and 21% do not use

exercise facilities • 23% of parents reported the neighborhood is unsafe due to

traffic • 12% of Vineland parents think their neighborhood is unsafe due

to criminal activity. • 16% reported parks are unsafe due to criminal activity • 39% of children do not live near exercise facilities • Hispanic children (65%) are more likely to live in neighborhoods

with free exercise facilities, compared to non‐Hispanic white children (48%)

In addition to the Rutgers University data the Vineland Partnership completed six (6) CHLI assessments within target area. CHLI’s where

administered at the Vineland Senior Center, Winslow School, Vineland City Hall (workplace assessment), a resident’s home, Open Arms (Prenatal Program), Word of Life Church and Tri‐County Community Action Partnership Head Start. Dr. Mastrangelo reviewed the data and created the following snapshot of the data. The household income level of the majority of the people in the target area is lower to middle income. This specific survey does not state the ethnic makeup or the racial make up of the target area. In terms of target area design, about half the places (41%‐60%) in the target area have a network of walkable sidewalks that are unobstructed, well maintained, and leveled. In some places (21%‐40%), the target area parks (public or private), shared‐use paths/trails, and open spaces are provided and maintained within easy walking distance (i.e. within a half mile) of most homes or public transportation stops. In terms of the area’s use of street safety measures to support walking and biking, rarely or nowhere (0%‐20%) does the target area have any traffic calming measures (e.g., road narrowing, central islands, roundabouts, speed bumps, etc) or crosswalk counters with timer countdowns at major intersections. Some places (21%‐40%) in the neighborhoods provide a pleasant visual environment (e.g. landscaping, attractive buildings, views, trees) for walking and bicycling. Some places (21%‐40%) have parks, roads, and trails that are free of significant air pollution, noise pollution, litter, and physical disorder. Of the planning, safety, and up keeping of community playgrounds (public or private), some places (21%‐40%) are overseen by city or local government, not for profits, or private associations.


Play Outside with your Children 31


Usually (61%‐80%), the parks and recreation facilities (public or private) provide for people of all ages in the community. Local food stores sometimes (21%‐40%) have a variety of fresh vegetables and fruits of acceptable quality, low fat products (such as low‐fat milk or lean meats), and whole‐grain products. The health foods stores offering the foods mentioned are usually (61%‐80%) easily accessible by foot, bike, and/or public transportation. Sometimes (21%‐40%) food stores provide price incentives (e.g. coupons, lower prices) for healthy foods and drinks (e.g., vegetables, fruits, water, low fat milk, etc); as well as promotional displays and signage to help people choose healthy foods. In addition to food stores, fruits and vegetables are very much available in farmers’ markets, road side vegetable and fruit stands, far stands, and community gardens. Sometimes (21%‐40%), vegetables and fruits from alternative sources are available at prices that are comparable to those in grocery stores. Some (21%‐40%), local restaurants promote healthy eating through the use of nutrition information of identification of healthy foods that are available to allow people to select healthy choices from the menu. Rarely or never (0%‐20%) do restaurant menus encourage moderate servings (e.g., reduced sized portions offered at a lower price than regular portions) and discourage all‐you‐can‐eat and super‐ sized portions. Rarely or never (0%‐20%) do local restaurants create promotional displays of healthy foods and limit displays of unhealthy foods. Some (21%‐40%) of local restaurants that support healthy choices are easily accessible by foot, bike, and/or public transportation.

Rarely or never (0%‐20%) do public facilities in the neighborhood (e.g., schools, public or private parks libraries) have functioning water fountains that are overseen by city or local government, not for profits, or private associations to ensure their up keep and the safety of the water supply. Vending/concessions that predominately provide healthy food and beverage options are not available at neighborhood parks. Neighborhood parks (public or private) rarely (0%‐20%) offer on‐site gardens and/or farmers’ markets. Usually (61%‐80%) the sidewalks, parks, and parking areas in the neighborhood are well lit to enhance safety at night. Rarely or nowhere (0%‐20%) does the neighborhood have motor vehicle speed restrictions enforced in the neighborhood. Rarely or nowhere (0%‐20%) do drivers of motor vehicles obey the speed limit in the neighborhood and yield to pedestrians to cross the street. To enhance safety, some places (21%‐40%) in the neighborhood provide law enforcement patrols (e.g., by law enforcement officers or trainer volunteers) at public sites that offer opportunities for physical activity, such as recreation centers, parks, and share use paths trails. Some places (21%‐40%) have safe routes to school (SRTS) and/or walking school‐bus programs exist so that children can safely walk or bike to school free from traffic hazards or concerns about personal safety. Usually (61%‐80%), people who walk or bike during the day/night feel safe and are unlikely to become victims of crime. In summation, a number of the recommended strategies are based on published or observed data and how the Steering Committee interpreted that data to reflect on the target community or


associations of community characteristics with healthy eating, physical activity, or weight in the particular target area or neighborhoods of the target area. The Vineland Steering Committee has already noted that it is working with some conflicting data, therefore it should be noted that the Committee will use the represented data and findings in their continual learning process. Data will be integrated and/or discarded as deemed necessary to move the process forward.


Eat a Healthy Breakfast 33

"The physical and emotional health of an entire generation and the

economic health and security of our nation is at stake. This isn't the kind of problem that can be solved overnight, but with everyone working

together, it can be solved.” – First Lady Michelle Obama Let's Move launch announcement, 2/9/2010


There is still very little evidence of effective interventions to tackle or reduce levels of childhood obesity. The evidence base is in early stage and is growing as many programs and initiatives are being developed and piloted. There is evidence that rapid weight gain in infancy and parental body mass index (BMI) are strongly linked to obesity in childhood. The Vineland strategy and action plan is therefore strongly focused on preventing childhood obesity during early years and supporting families and parents to ensure their children maintain a healthy weight. The plan aims to identify at risk families, provide better information to parents and families improve opportunities and skills required for healthy eating, build capacity and opportunities for increasing physical activity and address safety issues related to community residents participating in physical activity. The New Jersey Partnership for Healthy Kids – Vineland’s initiative that extends and integrates efforts to support healthy eating and physical activity in the Center City area of the City of Vineland, focusing primarily on environmental change and policy strategies. The initiative engages multiple sectors ‐‐ schools, healthcare, local business, and faith communities ‐‐ to coordinate with residents and local government on actions that will create a healthier community environment and work toward reversing childhood obesity by 2015.

Vineland’s vision is: To reverse the obesity epidemic among children and

young people in the City of Vineland by 2015.

The underpinning values and principles guiding the Partnership in developing the strategies are based on

recognition that: Strong communication and partnerships will enable a more comprehensive, holistic, better coordinated and therefore more effective system of measures to be developed. Strong leadership is required to inspire changes in the local environment and to act on behalf of children and their families to increase access to healthy and nutritionally sound foods. Shared targets, data, and performance management systems with clear lines of accountability will be developed to encourage ownership and investment in this strategy. These need to reflect the main drivers of the key agencies. Policy and environmental changes that increase the capacity of neighborhood environments while supporting healthy eating and an active lifestyle of residents will be encouraged. Policy and environmental changes that increase the capacity of schools, after school programs, and child care providers to promote healthy behaviors among all grade levels will be implemented.

Section 6

Strategies & Impact

Pack a Healthy Lunch 35


Throughout the process the Vineland Steering Committee has engaged various government partners, small businesses, community residents and not‐ for‐profit organizations in the planning, vetting and drafting of the following obesity prevention and intervention strategies. The selected strategies meet the Partnerships goals and guiding principles, and enjoy broad support by partners. They are realistic and financially feasible and represent a clear means to an end. Finally, these strategies leverage other efforts and build on existing resources to respond to community needs, use best practices and produce results.

The Steering Committee of the Partnership will serve to track these goals and strategies, and keep others within the community informed of progress, successes, lessons learned, opportunities, new ideas, and other news and information useful to the healthy living movement. Strategy implementation groups will continue to meet, act, implement and report progress. Progress reports will be provided at quarterly meetings and on the City of Vineland Health Department’s website, with an annual evaluation of the Strategic Plan’s progress. There will be a final review of the progress at the end of the two year


Policy/Environmental Change Goals Wellness in Schools Goal #1: Collaborate with organizations that focus on children’s health to strengthen and enforce the Vineland School

District Wellness Policy. Goal #2: To increase access to opportunities for healthy eating for children by integrating innovative healthy meal

components into the Vineland School District meal program. Community Food & Nutrition Goal #3: Provide training and resources to corner stores and eateries to offer healthy meal and food options. Goal #4: Explore ways of making healthy foods affordable and accessible. Environment/Community Goal #5: In partnership with the City of Vineland Engineering and Police Departments create calming measures and

enforcement plans which will promote safety and ultimately physical activity within the target area. Goal #6: To increase access to opportunities for physical activity for children and families

36


37 Join a Gym

A multi agency task group, Implementation Steering Committee, will be developed to oversee the implementation and monitoring of the Healthy Kids Healthy Community childhood obesity action plan. Representatives will include public health, nutrition and dietetics, leisure / physical activity, school nursing, health visiting, and education. All final evaluation reports will be reviewed and verified by a trained evaluator from the Richard Stockton College of New Jersey. By providing a succinct and deliberate monitoring process the Vineland Partnership seeks to create a sustainability plan based on the success of various strategies and the ability of these strategies to be replicated at a future time. The Implementation Steering Committee will oversee the ongoing, comprehensive review of the evidence base around prevention and management of obesity in children as the action plan develops, and ensure that the plan is informed by this process and regularly updated.

Section 7

Monitoring & Quality


"We don't need new discoveries or new inventions to reverse this trend. We have the tools at our disposal to reverse it. All we need is the motivation,

the opportunity and the willpower to do what needs to be done. “ – First Lady Michelle Obama Press conference announcing childhood obesity task force report, 5/11/2010


Section 8

Summary

Healthy is a Way of L:ife 41

The causes of childhood obesity are complex. Although the simple explanation is that too many calories are ingested (through consumption of food and beverages) and too few calories are expended (through physical activity), the physiological solution (a balance of the amount of calories consumed and used) is more than a matter of individual willpower or personal responsibility. Living in an environment that lacks healthy food choices and encourages unhealthy ones is difficult to overcome. An environment that offers limited places to play and nowhere safe to walk is likely to discourage optimum physical activity. Even the most motivated adult or parent, or the best‐trained child, can find it difficult to act in healthy ways if the surrounding environment does not support or even allow such activity. Thus the real solutions to obesity must take into consideration the environments in which children live, learn, and play. The characteristics of these environments, such as the availability of healthy foods and beverages, the safety of streets, and the accessibility of recreation opportunities, can have a strong impact on childhood obesity. By helping to change these environments in positive ways, local governments can enable families and children to act to maintain and improve their health and prevent the development of obesity The food and physical activity choices made every day affect short‐ and long‐being physically active may reduce the risk for heart disease, high blood pressure, and are directly related to weight outcomes.

These diseases and conditions impact the individual and his or her quality of life and are associated with increasing health care costs that place a burden on our communities. Childhood provides the opportunity to establish a solid foundation that can lead to healthy lifelong eating patterns. Prevention of childhood obesity is essential to the promotion of a healthier and more productive society. The New Jersey Partnership for Healthy Children – Vineland project is ready to implement the NJ Partnership for Healthy Kids ‐ Vineland Strategic Plan; the catalyst to reversing the childhood obesity epidemic in the City of Vineland.

Section 9

Resources

Change the Conversation 43

Alliance for a Healthier Generation – www.healthiergenerations.org

Centers for Disease Control and Prevention ‐ www.cdc.gov

Dietary Guidelines ‐ www.health.gov/dietaryguidelines

Free Fitness Log ‐ www.activelog.com

Kids Health from Nemours ‐ www.kidshealth.org

Let’s Move ‐ www.letsmove.org

National Health and Fitness Events ‐ www.fitnessday.com

National Institutes of Health ‐ www.nih.gov

Physical Activity Guidelines ‐ www.health.gov/paguidelines/guidelines/default.aspx

Reliable Health Information ‐ www.healthfinder.gov

Robert Wood Johnson Foundation – rwjf.org

The Food Trust – www.thefoodtrsut.org

USDA‐My Pyramid ‐ www.mypyramid.gov

US Department of Health and Human Services ‐ www.hhs.gov

US Food and Drug Administration ‐ www.fda.gov

Walking Programs and Resources ‐ www.creativewalking.com

Walking Resources and Information ‐ www.walking.about.com

WE CAN! ‐ www.nhlbi.nih.gov/health/public/heart/obesity/wecan

World Health Organization ‐ www.who.int/en

YMCA ‐ www.ymca.net

“Change the Conversation”


new jersey partnership for healthy kids - vineland strategic planvldhealth.org/pdf/obesity strategic...

Documents