Valerie Minor, RN, MSN., Christa Ice, Ph.D.,

& Shannon Holland, MA.

CARDIAC on the Move: School-based Surveillance and

Intervention

1. Valerie Minor, Associate Director CARDIAC, will introduce the CARDIAC project

2. Christa Ice will present findings from the past year of CARDIAC and give examples of CARDIAC research projects

3. Shannon Holland, Executive Director WVOM, will talk about the Schools on the Move grants

Outline for today’s talk

The West Virginia CARDIAC Project

Coronary

Artery

Risk

Detection

In

Appalachian

Communities

“To reduce cardiovascular disease, diabetes, and other

chronic illnesses in West Virginia through

research and intervention in children.”

1998: 3 counties

2012: 55 counties

Once upon a time…

W.A.Neal, MD

…there was a famous pediatric cardiologist. He saved and improved the quality of the lives of hundreds of sick children.

He was very happy about this.

But he knew there was more.

In 1995, the WV age adjusted death rate from heart disease was 21% higher than the national average.

Something had to be done. But the grown-ups just didn’t seem to be getting it.

Now, this was not just your average “run of the mill” famous pediatric cardiologist. He was a deep thinker!

Hold that thought.

The postman delivered letters that invited lots of people (including the famous pediatric cardiologist and a cranky nurse) to a meeting.

And lots of people went to the meeting to do good work.

And everyone listened carefully to all the speeches.

Lfdoas lfoei ad ald da ll ldjpe fj j erd lfoe d 0p aod ap apo

A[a aeipf apoia’p d ka adl k

Then they all got their special assignment to a special focus group.

And the famous pediatric cardiologist with the bright idea was assigned to the same focus group as the cranky nurse.

Welcome to “our” focus group.

“Geez, you’re the worst focus group I’ve ever seen.”

Geez, you’re the worst focus group I’ve ever seen.”

…blah blah…if the school nurses had money…blah blah…reports that never go anywhere…A-B nursing & RHEP…

The cranky nurse didn’t like focus groups with all talk and no action and said so as she introduced herself to the group.

The land of dead-end reports

The famous pediatric cardiologist agreed. He decided to introduce himself to the cranky nurse.

W.Neal, MD

And there are 2 others who can make this happen…

So over lunch at the meeting, the famous pediatric cardiologist talked to the cranky nurse. He told her about his bright idea and about 2 other people...

WVU SOM Department of Pediatric Cardiology

Super-duper RHEP Site Coordianator

And you will do community service projects…

And the pieces came together…

CDC

Benedum Foundation

Departm

ent of

Pediatrics FoundationCompton Nutrition Chair

American Heart Association

…and the givers gave…

Private contributions

WE CARDIAC

…and the legislature gave…

And the famous pediatric cardiologist said, “This is good.”

A-B Senior Nursing Students: The Dream Team since ’98

Major Change: Demise of RHEP

Based at WVU SOM

Many of the same peopleRemains community basedAble to focus on CARDIAC aloneSo far, so good!

1) Active consent 5th grade (CARDIAC Kid)1) Family history2) BMI3) Blood pressure4) Acanthosis Nigricans5) Fasting lipid profile

2) Eight county active consent research program

3) Passive consent 2nd grade (CARDIAC TOO)

CARDIAC: Results from 2011-2012

County and state results for 5th grade are available on our website: www.cardiacwv.org

Since 1998, we’ve screened over 81,156 5th graders!

In 2011-2012:1. 48 counties were screened2. 259 schools3. 4,780 students4. 60 parents

Results – 5th grade

Among those 4,780 screened: 18.7% were overweight 27.8% were obese 20.3% had high blood pressure 23.5% had abnormal lipids (high TC and/or low HDL) 3.9% had Acanthosis Nigricans

Of those with AN, 62.1% had high insulin Many of the students screened do not realize they need medical

attention! Parents can call our toll-free hotline with questions. Parents are contacted if their child should seek immediate medical

attention.

5th grade results, cont.

Since 2005, over 50,082 2nd graders have been screenedDuring 2011-2012:

41 counties participated8,591 students15.7% were overweight24.5% were obese2% had Acanthosis Nigricans

Results for 2nd grade

Screened 868 kindergartners17.2% were overweight13.6% were obese0.7% had Acanthosis Nigricans

Screened 97 8th graders19.8% were overweight26% were obese6.2% had Acanthosis Nigricans

Other grades 2011-2012

Validate a Model for Reducing and Preventing Obesity in WV School Aged Children

3 year project following students in 6th, 7th, and 8th grades In collaboration with Marshall University regarding School Based

Health Centers Funded by The Claude Worthington Benedum Foundation Compared school-based health centers to a physician office-based

model

Other screening projects

Evaluation and program develop of Greenbrier CHOICES, an integrated adolescent health promotion program on the physical activity, fitness, and dietary behaviors of middle school students.

Screening 6th, 7th, and 8th grade students In Greenbrier County middle schools As part of the Clinical Component of the Carol M. White Physical Education

Program (PEP) Grant

Other screening projects, cont.

With the discontinuation of WVRHEP in the 2011-2012 school year, CARDIAC hired experienced Area Coordinators

If you are currently a school nurse participating in the CARDIAC Project, please see our booth, pick up screening results, and say hi to your Area Coordinator!

If you have any questions regarding CARDIAC screening of 2nd or 5th grade students, please feel free to talk to them!

Changes

One of the biggest questions we get is what can we do with these CARDIAC results to improve child health in WV?

Area Coordinators will start implementing or facilitating intervention efforts in their areas in 2012-2013

We will generally only be screening passive consent 2nd grade and active consent 5th grade schools

We value the expertise of the School Nurses and we request that they participate in the screening

Changes for 2012-2013

These results are extremely important for families, who might not realize cardiovascular risk starts in young children

They are also important for state and nationwide research

implications.

CARDIAC in the state news: Kate Long with the Charleston Gazette:

http://theshapewerein.wordpress.com/

Research

Nationwide CARDIAC research in the news:1) 2012 AHA EPI-NPAM Science News: Sam Gidding, MD, FAHA

and Christa Ice, PhD. CV Risk Factors and Rurality in Appalachian Children

2) Ms. Ritchie’s 2010 article: Universal versus targeted blood cholesterol screening among Appalachian youth: The CARDIAC project. Pediatrics. 126, 260-265.

3) Dr. Cottrell’s 2011 article: Metabolic abnormalities in children with asthma. American Journal of Respiratory and Critical Care Medicine. 183, 441-448.

Research

20,266 Subjects Tested(5th Graders)

14,468 met NCEP screening Guidelines (71.4%)

5,798 did not meet NCEPScreening guidelines (28.6%)

170 warrant pharmacologic tx (1.2% of those who met

NCEP guidelines)(1.7% of those who did not

Meet NCEP guidelines)

Universal versus Selective Screening:Testing Current NCEP Guidelines

98 warrant pharmacologic tx98 warrant pharmacologic tx

Results Summary:

Mid-sized metro areas consistently presented with the worst outcomes (BP, BMI, cholesterol)

All areas/counties have high rates of cardiovascular risk!

Cardiovascular Risk Factorsand Rurality

Data from 2003 - 2011

Obesity by county since 1998

Obesity is defined as BMI ≥95th percentile

Data includes over 81,000 participants

National average is ~20%

All counties have prevalence above the national average

Take steps to improve West Virginia children’s health! Here are a few ways you can help:

Ask parents and schools to participate in the CARDIAC Project

Encourage state legislators to continue supporting child health initiatives, such as healthy school meals and obesity screening

Volunteer with local, community-based health initiatives, such as school gardens

Become a role model: Follow 5-2-1-0. Have your cholesterol and blood pressure checked.

Partner with CARDIAC

AAP 5-2-1-0 Campaign

Become involved in statewide initiatives, such as the physical activity plan: www.wvphysicalactivity.org

Go to West Virginia on the Move for other great physical activity ideas: www.wvonthemove.net

Partner with WVU Extension’s healthy lifestyle initiative: www.ext.wvu.edu

CARDIAC Partners

West Virginia on the Move Since 2004Statewide non-profitMission :

To promote a physically active lifestyle for all West Virginians, by providing leadership, technical expertise, and collaboration with the goal of reducing the prevalence of chronic disease.

Programs

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Schools on the Move - GoalTo help WV schools create

and foster opportunities for comprehensive school physical activity that could not be developed without external funding. *

*WV Physical Activity Plan - Priority Area 1: School-based Programs & Initiatives. Implement multi-year programs to provide resources and technical support for PK-12 schools seeking to establish comprehensive school physical activity programs. (ActiveWV Schools)

Warwood School 2010-2011

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Schools on the MoveSince 2005Up to $5,000Pre-K to 12Public or private# of grants varies

5 to 11Increase physical activity

opportunities before, during or after school for students, staff and families

Tunnelton-Denver Elementary (2011)

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Project ExamplesWalking TracksCircuit Training & Hip

Hope Dance ProgramMobile PE BoxesClimbing WallsFamily Fun NightsCycling ClubsKids Run Wild ProgramSPARK TrainingSummer Shape Up

Challenge

Williamstown Elementary 2009

Congratulations! 2012-2013 Grants

Brandywine Elementary (Pendleton) - Walking Trail

Increase physical activity most students receive by twenty minutes on a new walking trail. Activities include after-school family walking program in addition to before and during school programs.

Fountain Primary School (Mineral) - On the Go

Increase physical activity levels of students and community members through programs using paved walking track. Promote use before during and after school and increase community access.

Marlowe Elementary (Berkeley) - Marlow is Walking around the World

Increase student physical activity levels during the school day in addition to increasing levels for parents, staff and community weekly by creating walking clubs that will “walk around the world”.

Point Harmony Elementary (Kanawha) - Point Harmony After-School Activity Program

Increase physical activity levels and reduce screen time through after school clubs and integration of nature trail in school and community outdoor physical activity.

Tucker County High School (Tucker) - Wheels for the Hills

Create school based outdoor adventure club to foster a life-long enjoyment of outdoor recreation for students, staff and community through mountain biking.

West Liberty Elementary (Ohio) - Heart of an Eagle

Increase knowledge of moderate to vigorous physical activity using heart rate monitors through programming that includes best practices such as SPARK and Let’s Move! WV.

ReachTotal 39,281 Reported by Grant Contacts 2005 – 2011

Barbour

Berkeley

Boone

Braxton

Brooke

CabellClay

Fayette

Gilmer

Grant

Greenbrier

Hampshire

Hancock

Hardy

Harrison

Jackson

Kanawha

Lewis

Lincoln

Logan

McDowell

Marion

Mason

Mercer

Mineral

Mingo

Monongalia

Monroe

Morgan

Nicholas

Ohio

Pendleton

Pocahontas

Preston

Putnam

Raleigh

Randolph

Ritchie

Roane

Taylor

Tucker

Tyler

Upshur

Wayne

Webster

Wetzel

Wirt

Wood

Wyoming

Marshall

Cal-houn

Dodd-ridge

JeffersonPleas-ants

Sum-mers

6 Grants5 Grants 4 Grants  

3 Grants  

2 Grants  

1 Grants  

Grants2005 to 2013

58 grants in 30 counties

Funding for 2011-2013 Schools on the Move Program provided by WVU Children’s Hospital Foundation. Additional support from End Childhood Obesity Race (ECHO) and The CARDIAC Project.

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Reach Beyond Schools2010-2011 Reported..58% leveraged more

funding36% obtained up to $5,00027% obtained >$10,000

100% received publicity91% reached desired target

audience91% report SOM experience

encouraged them to seek other funding or increased their grant writing capacity

Bridge Elementary 2011-2012

In their words… “The sight of over 100 children staying after school and running happily

on a trail that the school community built was the vision we hoped for…

…[Children] are learning the basics of health through the activity and parents see it in action.”

“…I have noticed that students that were not normally competitive in sports activities are very successful and enjoy using the climbing wall. “

“Through [this project] our school adopted an entire health and wellness initiative”

Story from ...parent : “They took a slow, trudging, injury prone, overweight work horse and turned her into a eager, peppy and healthy race horse who is forty pounds lighter. … that running club's last group was 180 kids out of an enrollment of 460 children, more than 1/3 of our school. Crazy amounts of kids are running here thanks …”

Funders and SupportersThanks!

WVU Children’s Hospital Foundation

Additional support provided by The CARDIAC Project and End Childhood Obesity (ECHO) Race, Wheeling

Initial program funding from The Benedum Foundation

WVOM Board Members provide their expertise

In-kind support from countless organizations who help spread the word

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New Funding for 2013-2014 Academic YearWVU Children’s Hospital Foundation Information on WVOM website by September 2012List of previously funded projects – available nowCARDIAC Area Coordinators rolewww.wvonthemove.net

Announcing!

ApplicationFirst - Letter of Intent Form requiredThen - Application:

Cover SheetCommittee ListNarrative

Need/Problem StatementExpected OutcomesTarget Audience Intervention DescriptionEvaluation.

Outcomes TableBudget and Justification2 Letters of Support

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Thinking of Ideas?Proposals should support

local initiatives that promote comprehensive approaches to youth physical activity:

(a) Quality physical education

(b) Alternative before, during or after school programs

(c) Parent/community outreach

(d) Staff/faculty wellness

(e) Active transportation Tygarts Valley High School

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Thanks for all you do to help …

West Virginia Schools Get on the Move!

www.wvonthemove.net

For Schools on the Move contact:Shannon Holland: sholland@wvonthemove.net

For CARDIAC contact:Christa Ice: cice@hsc.wvu.edu OR Valerie Minor vminor@hsc.wvu.edu