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Transcript of Www.letsgo.org Tory Rogers, MD Barbara Bush Children’s Hospital at Maine Medical Center (207)...
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Tory Rogers, MDBarbara Bush Children’s Hospital at Maine Medical Center
(207) 662-4982 [email protected] 7th, 2013
www.letsgo.org
What I want to talk about today?
What is Let’s Go! – The First 5 years 2006-2011– Birth to the awkward tween years
Let’s Go! 2011-2016 – The Teen years
Evaluation Data – What is working
What we could have done better
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Now…… What do you want me to talk
about???
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Let’s Go!Core Principles Environmental and policy change influences behavior change Interconnectivity across settings is essential Strategies are evidence based and continuously evaluated
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Tools, Resources, and Trainings
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Why Environmental/Policy Change?
Policies Environments
Activities
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1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.
2. Provide water and low fat-milk; limit or eliminate sugary beverages.
3. Provide non-food rewards.
4. Provide opportunities for children to get physical activity every day.
5. Limit screen time.
Let’s Go! Key Strategies for Success – Priority Strategies
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Let’s Go! Key Strategies for Success – Supporting Strategies
6. Participate in local, state and national initiatives that promote HEAL.
7. Engage community partners to help support and promote HEAL at your site.
8. Partner and educate families in adopting and maintaining a lifestyle that supports HEAL.
9. Implement a staff wellness program that includes HEAL.
10. Collaborate with food and nutrition programs to offer healthy food and beverage options.
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StoryWalks
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Marketing Campaign
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It Worked!
Environments are ChangingPolicies are being Implemented
Healthy Behaviors are increasingObesity appears to be leveling
off
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Greater Portland Reach
As of June 2011, Let’s Go! had engaged the following in the 12 Greater Portland communities:
• 56 schools educating more than 23,000 students;
• 8 district-wide school nutrition programs serving over 20,000 students;
• 34 child care programs caring for over 1,400 children;
• 28 after school recreation programs serving over 1,800 students;
• 29 healthcare sites; and
• 7 of Greater Portland’s largest employers.
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60 Let’s Go! Sites (in Greater Portland) Reported Implementing Let’s Go! Strategies in 2010-11
*Strategy was implemented in year five or sustained from a previous year, in most classrooms or school- or program-wide.
Strategies Elementary
SchoolsChild Care Programs
After School Programs
Healthy choices for snacks/celebrations 24/29 (83%) 16/16 (100%) 15/15 (100%)
Participate in initiatives that promote HEAL 25/29 (86%) 11/16 (69%) 8/15 (53%)
Include community organizations 12/28 (43%) 6/16 (38%) 11/15 (73%)
Involve and educate families 27/29 (93%) 16/16 (100%) 5/15 (33%)
Encourage water and low fat milk 24/29 (83%) 16/16 (100%) 13/15 (87%)
Discourage the use of food as a reward 26/29 (90%) 16/16 (100%) 12/15 (80%)
Incorporate physical activity into the day 21/28 (75%) 15/16 (94%) 7/15 (47%)
Develop 5-2-1-0 staff wellness program 16/29 (55%) 4/16 (25%) 15/15 (100%)
Collaborate with nutrition program 19/21 (90%) Not measured 4/15 (27%)
Implement or strengthen wellness policy 16/28 (57%) 6/15 (40%) Not measured
Number (%) that Implemented Strategy*
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Let’s Go! School Nutrition Initiative
Let’s Go! led 35 schools in reaching the USDA’s Healthier US School Challenge.
Healthier US School Challenge Criteria• A different fruit and vegetable every day•At least three dark green or orange vegetables per week•Offer legumes at least once per week•Offer whole grains three times per week•Offer only low fat or fat free milk•Offer nutrition education•Provide at least 45 minutes of physical education per week
Technical assistance, tools, and resources were provided by Let’s Go! during workgroup meetings, phone calls and emails as they improved the nutritional quality of school meals.
Only 2% of schools in the nation have achieved this award.
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There are 14 Let’s Go! Practicesin Greater Portland
A recognized Let’s Go! Healthcare site must meetbasic criteria for the following three components:
1. Connect to their community and the Let’s Go! community efforts Hang a Let’s Go! poster in waiting room and exam rooms
2. Accurately weigh and measure patients Determine Body Mass Index (BMI), BMI percentile, and
weight classification in patients > 2 yrs.
3. Have a respectful conversation around weight Use the 5210 Healthy Habits Questionnaire
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Parents’ Awareness Increased Significantly from 2007 to 2011
422% Increase
293% Increase
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
293% Increase
422% Increase
422% Increase
293% Increase
10% 14%
45% 43%47%55%
Let's Go! Campaign 5-2-1-0 Message
% Who Heard of Campaign and Message
2007 2009 2011
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Exposure to Let’s Go! in Multiple Settings Increased Parents’ Awareness of 5-2-1-0
153% Increase 153%
Increase
Note: In 2011 n=801
153% Increase
34%
64%
85%
No Exposure 1 to 2 3 or more
Number of Settings Exposed to Let's Go!
% Who Heard of 5-2-1-0 Health Message, by Exposure (2011)
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Exposure to Let’s Go! in Multiple Settings Increased Parents’ Knowledge of 5-2-1-0
Note: In 2011 n=801
51% Increase
51% Increase
39%51%
58%
No Exposure 1 to 2 3 or more
Number of Settings Exposed to Let's Go!
% Who Provided Correct Numbers for All Four 5-2-1-0 Recommendations, by Exposure (2011)
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Child’s Adherence with “5” and “0” Behaviors Increased Significantly from 2007 to 2011
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
63% Increase
18% Increase63%
Increase
18% Increase18%
63%
22%
66%
26%
69%
"5" or More Fruits & Vegetables Daily
"0" Sugar Sweetened Beverages
% Reported Child (<18 yrs.) Adheres to "5" and "0" Recommendations
2007 2009 2011
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Overweight and Obesity Prevalence for Ages 3-18 in Greater Portland Trended Down, While U.S. Rate Remained the Same
33%
32%
32%
31%
NOTE: NHANES data reflect 2006 and 2008 rates, and include ages 2-19. Greater Portland: In 2006 n=3,051; in 2009 n=3,132.
0%
5%
10%
15%
20%
25%
30%
35%
2006 2009
% Overweight and Obese (Age 3-18)
Greater Portland
U.S. (NHANES)
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Overweight and Obesity Prevalence Decreased for Females Age 3-5 in Greater Portland
63% Increase
18% Increase
31%
25%
2006 2009
% Overweight and Obese Females 3-5 yrs in Greater Portland
Note: In 2006 n=157; in 2009 n=133
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Let’s Go! 2011-2016
Our teen years - growing up and out
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0
50
100
150
200
250
300
350
2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
Growth of Let's Go! Engaged Sites (2006-2013)Schools Child Care After School Healthcare School Nutrition
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Let’s Go! Dissemination Statewide
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Survey Response Rates
30
324
194
117152
787
261
166
92135
654
Child Care School After School Healthcare Total
Registered Sites Completed Survey
81%86%
79% 89%
83%
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Let’s Go! Reach Across Four Sectors(Survey Participants)
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Area of Reach Child Care School
After School Healthcare
Counties 16 15 15 21Towns 132 106 59 86Sites 261 166 92 135Students/Patients 7,388 53,626 7,016 343,223
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Implementing Five Priority Strategies
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*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.**This year, the survey included questions about limiting unhealthy choices for snacks and celebrations, but those responses are not included in the analysis for this strategy; they will be included next year.***The school and after school surveys did not include a question about milk; it’s a requirement for all schools participating in the national school meals program.
Strategy Implemented* Child Care
(n =261)School
(n =166)
After School (n =92)
1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.**
72% 65% 83%
2. Provide water and low fat milk; limit or eliminate sugary beverages.***
68% 75% 92%
3. Provide non-food rewards. 95% 55% 80%4. Provide opportunities for children to get physical activity every day.
72% 80% 95%
5. Limit recreational screen time. 82% 72% 96%
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Implementing Five Supporting Strategies
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Strategy Implemented* Child Care
(n =261)School
(n =166)
After School (n =92)
6. Participate in local, state, or national initiatives that support healthy eating and active living.
51% 61% 61%
7. Engage community partners to help support healthy eating and active living at your site.
43% 63% 55%
8. Partner with and educate families in adopting and maintaining a lifestyle that supports healthy eating and active living.
70% 66% 54%
9. Implement a staff wellness program that includes healthy eating and active living.
56% 55% 32%
10. Collaborate with Food Nutrition Programs to offer healthy food and beverage options.
63% 64% 65%
*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.
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Policies are Changing (Schools & After School Programs)*
Due to their involvement with Let’s Go! in the past year:
56% of schools did more to implement the district wellness policy and its recommendations around physical activity and healthy eating (n=166).
49% of schools reported their district strengthened their wellness policy to support the 5-2-1-0 messages or strategies (n=166).
61% of after school programs either created, implemented or strengthened an existing wellness policy and its recommendations around physical activity and healthy eating (n=92).
*This policy question was not included in the child care survey this year.
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Healthcare Practices Meeting Basic Criteria
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Meet BASIC Criteria for Three ComponentsHealthcare
(n =135) 2012-2013
Healthcare(n =99)
2011-2012
1. Connect to your community & the Let's Go! Community EffortsLet's Go! poster is displayed in practice waiting area. 96% 86%
Let's Go! poster is displayed in all exam rooms. 76% 43%
2. Accurately weigh & measure patients
At well child visits, all providers routinely have BMI determined for patients age two years and older.
96% 86%
3. Have a respectful conversation around weight
At well child visits, all providers routinely counsel on HEAL using the 5-2-1-0 Healthy Habits Questionnaire.
71% 55%
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Reach of School Nutrition Workgroups
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Let's Go! School Nutrition Workgroup
Startup Year Districts Schools Students
Greater Portland 2007-2008 12 76 31,557Southern Maine 2010-2011 12 64 27,307Somerset 2010-2011 7 27 7,168Lincoln/Knox 2012-2013 6 32 7,818Oxford/Androscoggin 2012-2013 9 53 20,303
Total 46 252 94,153
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Nudging Kids Toward Healthy Choices
Changes made as a result of school nutrition initiative: Decreased the portion size of a la carte items. Increased number of locations that fruit is available. Moved healthier items to high traffic areas. Offered cut up fruit such as apples and oranges. Put healthy options at eye level. Added new entrees or sides. Offered free samples of new menu items. Encouraged staff to use verbal reminders to encourage fruit and
vegetable consumption. Required cash for a la carte or less healthy items.
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%. Questions were grouped around six categories of best practices: manage portion size, increase convenience of healthier items, improve visibility, enhance taste expectations, utilize suggestive selling, and set smart pricing strategies.
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Impact of School Nutrition Program Changes
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100%
88%
100%
72%
Students liked at least some of the changes
Students are making healthier choices
Purchase of produce increased
Purchase of whole grains increased
% of Schools Reporting Change (n=25)
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%.
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Let’s Go! Recognition ProgramSites of Distinction
Eligibility for Schools, Child Care and After School Programs: Implement all 5 priority strategies: BRONZE 1-4 enforced written policies: SILVER All 5 enforced written policies: GOLD
Note: Written policies will be reviewed by Let’s Go! staff.
Eligibility for Healthcare Practices: Display a Let’s Go! poster in the waiting room and all exam rooms
where pediatric patients are seen. All providers determine BMI for patients age two years and older. All providers use the 5-2-1-0 Healthy Habits Questionnaire at well
child visits.
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Let’s Go! Sites of Distinction
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324
194
117152
787
9257 61 77
287
Child Care School After School Healthcare Total
Registered Sites Recognized Sites
28% 29% 52% 51%
36%
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Let’s Go! Is Changing Environments About 7 in 10 child care sites are providing healthy choices for snacks and celebrations and
opportunities for recommended levels of physical activity. Nearly all child care sites rarely or never use food to encourage positive behavior. The vast majority of child care sites are limiting screen time. More than two thirds of schools are providing healthy choices for snacks and celebrations and are
limiting unhealthy choices. More than 7 in 10 schools have implemented strategies around physical activity, water and sugar-
sweetened beverages, and screen time. In the past two years, purchase of whole grains and produce has increased in over 100 schools that
have been part of the Let’s Go! school nutrition program. About three-quarters of school nutrition programs are certified in the new federal meal pattern. The vast majority of after school programs have implemented all five priority strategies. Nearly all healthcare practices display the Let’s Go! poster in their waiting areas and routinely
determine BMI for their pediatric patients. Over three quarters of healthcare practices display the Let’s Go! poster in all exam rooms where
children are seen. In 7 in 10 healthcare practices, all providers routinely use the 5-2-1-0 Healthy Habits survey.
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Our Work is Not Done
More trainings are needed around wellness policies. – Schools located within the same school district in as many as 23 of 55
districts reported different policy information.
Increase the reach of School Nutrition Workgroups.– Establish workgroups across all regions of the state.– Continue trainings for Dissemination Partners to facilitate workgroups
in their regions.
More trainings are needed in the healthcare sector.– Especially with larger practices (>5 clinicians).
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Key Learnings…….
Consistency in message and approach is critical
Working across a community wherever kids live, learn, work and play is essential
It’s the environment, not the activities that matter most
Partnerships and Collaboration are paramount Innovation and risk taking have been key to
our success
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Some of our challenges (mistakes)
Not fully understanding and acknowledging the current efforts on the ground
Moving too fast and getting ahead of people Trying to please everybody Making things too complicated Not publishing sooner
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Local and State Partners
Let’s Go! Dissemination Partners, including participating Healthy Maine Partnerships and health care systems
Participating Schools, Child Care Programs, Healthcare Practices, After School Programs, Employers and Communities
Maine Center for Disease Control and Prevention
Maine Department of Education
Maine Bureau of Parks and Lands
Maine Department of Health and Human Services, including Maine Head Star
University of Maine Cooperative Extension
Maine Dairy and Nutrition Council
Community based programs working to increase physical activity and healthy eating in Maine,) for ex. WinterKids
Maine After School Network
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National Partners
National Initiative for Children’s Healthcare Quality (NICHQ)
Let’s Move
American Academy of Pediatrics (AAP)
American Medical Association (AMA)
National Convergence Partnership
Innovators and Risk Takers all over the country
And You!
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Let’s Go! Is Generously Funded by Our:Founding Partners
Platinum Sponsors
Additional FundersAmerican Academy of Pediatrics/Healthy Active Living, Fairchild Semiconductor, Leonard C. & Mildred F. Ferguson Foundation, Maine Department of Health & Human Services/ARRA, The Rite Aid Foundation
Gold SponsorsSilver Sponsors
Walmart Jane’s Trust
Bronze Sponsors
The Bingham Program, Convergence Partnership, The Mattina R. Proctor Foundation, Sam L. Cohen Foundation
Francis Hollis Brain Foundation, Poland Spring, Rite Aid Foundation,Visiting Board of BBCH, Estate of Mary R. Hodes
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Comments Thoughts
Questions
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