Background:
In response to the childhood obesity epidemic, the Robert Wood Johnson Foundation created Generations Working Together to Prevent Childhood Obesity, funded pilot projects in four Active for Life® (AFL) public health and community-based organizations. The overall goal was to utilize the learning, partners, and expertise to implement projects aimed at prevention/reduction of childhood obesity. The original AFL project focus was program implementation, and the grantees were asked to go beyond programming to create strategies to impact the physical environment and policies related to physical activity and healthy eating for low-income, diverse populations. The three grantees sustaining these projects are: FirstHealth of the Carolinas, Hamilton County Health District, and The Oasis Institute.

Objectives:

• Produce intergenerational models and/or tools that can be further developed for larger-scale testing and implementation.
• Disseminate effective community-developed strategies that will change the environments to encourage and support active living and healthy eating.

Methods:
The AFL National Program Office (NPO) worked with individual grantees to frame their workplans in the “5P” Strategy model: preparation, promotion, program, policy, and physical environment. Each site started with the same programmatic foundation, but due to specific strengths in their respective partnerships, geographic locations, and community readiness they demonstrated successes in unique ways.

FirstHealth established a 5,600 square foot organic community garden in Southern Pines, North Carolina to facilitate physical activity and healthy eating for low-income children, as well as children not considered low-income but at-risk for obesity. This garden has transformed a previously unused lot adjacent to a low-income housing development into a learning laboratory for children, volunteers, and other stakeholders, and has increased visibility of community gardening as a viable, meaningful approach to addressing childhood obesity.

The overall goal for Hamilton County Health District in southwest Ohio was to develop a School Health Advisory Council (SHAC) within the Mt. Healthy City School District to assess, recommend, promote, implement, and evaluate expanded healthy eating and physical activity policies and environmental supports. The process of developing an effective SHAC could then be replicated throughout the additional 18 public school districts within the Health District’s jurisdiction. The OASIS Institute implemented the CATCH (Coordinated Approach to Childhood Health) after-school program in two government funded after-school programs, and partnered with the Metropolitan Planning Organization (MPO) to conduct two walkability assessment workshops in low-income, diverse neighborhoods surrounding the elementary schools in which they implemented CATCH.

Results:
FirstHealth has expanded to 5 school gardens and 2 community gardens, established a hospital farmer’s market which led to two additional locations, initiated “farm to cafeteria” programs, and documented individual behavior changes in children participating in FirstGarden. Parents reported their children were more likely to try new foods (91%), played more outdoors (91%), ate more fruits and vegetables (90%), and had asked to start a garden (82%) as a result of participating in FirstGarden. In addition, 75% of parents said their relationship with their child had improved as a result of the child’s participation in the project.

Hamilton County activities included the completion of the School Health Index for evaluating health-related needs and the development of a district-wide Wellness Policy. The Wellness Policy was formally adopted by the Board of Education and serves as the guide for future assessment of need, implementation of programs, and development of policy to support and encourage healthy eating and physical activity. Indicators of Wellness Policy implementation success were demonstrated in the food service area. Healthy food options for students were expanded, including the addition of a salad as an available side every day of the week, the replacement of fruit beverages with 100 percent fruit juices, the substitution of whole wheat breads and pastas for refined grains and the reduction in serving size for higher fat options. In addition, the District adopted the Universal Breakfast program. This will provide all students access to a breakfast and help support additional healthy food initiatives through increased Federal reimbursements. The results from The OASIS Institute included: a policy requiring 15-20 minutes of physical activity at each Learning Tree after-school program site which affects 1800 children; a successful intergenerational model of the CATCH program which is now being copyrighted and expanded nationwide; neighborhood improvements as a result of the MPO workshop; 120 Learning Tree staff trained in the Active Generations program; and individual child behavior changes including increased consumption of healthy foods, decreased media usage, and increased physical activity.

Conclusions:
A small amount of money combined with strong partnerships and a comprehensive approach can lead to the development of successful models for childhood obesity prevention. The dissemination of these models to other community organizations is important to create large scale environmental and policy changes in order to increase opportunities for physical activity and healthy eating.

Support:
FirstHealth of the Carolinas; Hamilton County Health District; The OASIS Institute; The Robert Wood Johnson Foundation; Texas A&M Health Science Center, School of Rural Public Health