Background:
In 2006, a Community Health Improvement Partnership (CHIP) implemented a community health development process model to engage citizens in rural Jefferson County, Oregon around locally identified health concerns. Through an iterative process childhood obesity emerged as a priority health issue. In 2007, a research component was added. The Mountain View CHIP and its Community-based Participatory Research Partnership (CBPR) have secured resources, conducted research, and proposed policy suggestions for the local school board.
Objectives:
PATCH objectives were threefold. We examined the school district policy to inform parents of their child/children’s body mass index (BMI); assessed menu labeling in the middle school; and assessed recess before lunch in the elementary school. All three aims sought to understand obesity in this community and approaches for reversing the trends.
Methods:
We used a mixed methods approach to assess our three aims. Focus groups were used to assess views on BMI notification letters with youth and parents. These letters described BMI, plotted the child’s status on standard CDC growth charts, and offered suggestions for community resources. Menu labeling of the food items in middle school cafeteria was assessed by gross-caloric intake per student over a two month time period and was followed by qualitative research. In the first month the menu ran without caloric labels. In the second month the intervention occurred and the same menu was duplicated with caloric labels at the point of purchase. Gross consumption per student served was calculated for each menu item. Further, interviews were conducted with 6th-8th graders regarding their perceptions of menu-labeling on their purchasing and eating decisions. The third aim assessed whether having recess before lunch in grades K-2 improved nutrient consumption and classroom behaviors. We assessed consumption by plate waste study conducted over five discriminate days with all students grade K-2. Approximately half the classrooms across each grade were in the intervention arm and the other half maintained traditional lunch followed by recess schedule. To evaluate classroom and lunch room behaviors we conducted focus groups with teachers, food service staff and playground staff.
All quantitative analyses were conducted using STATA 10.0. The plate waste analysis was computed against the National Nutrition Standards set by USDA’s Food and Nutrition Service. Menu labeling was calculated as differences in gross calories consumed per student per day using a t-test. All qualitative analyses were performed using Ethnograph 6.0.
Results:
Focus groups with students revealed that students generally do not mind being weighed and measured; parents generally did not speak to their children about the BMI letter; and the students think it is a good idea to compute BMI despite the fact that most students could not describe BMI or indicate the usefulness of computing BMI.
Parents also thought measuring BMI was a good idea but could not define BMI or explain the usefulness. We also found that Hispanic parents would not feel comfortable calling a non-Hispanic white about their children’s health due to language and the perception of not understanding them. They would prefer to have a Hispanic contact and would recognize a Hispanic name. They felt it was not enough to have someone that spoke Spanish if they were outside of the community they would still lack comfort. In general, parents did not use the suggested resources.
Students who had recess first consumed greater quantities of milk and hence calcium in their diet. No other nutrients were statistically different. Additionally we found that all students exceed recommend fat intake. Teachers and staff identified better behavior and a readiness to get to work when students came from the lunch room rather than the playground.
In our analysis of menu labeling we found that some but not all middle school children did use the labels. Specifically, kids ate more salad bar items and took more skim and 1% milk and less chocolate milk when calories were posted. Most of the youth did not recall how many calories they need in a day despite learning this in health class and the inclusion of a colorful poster on the cafeteria walls that indicate needs based on a 2,000 calorie diet.
Conclusions:
Our findings indicate that BMI is not understood well by students or parents. The research team and school believe that BMI surveillance is important but the letter in current form is not effectively assisting families. We did see some benefits in our reverse recess arm, namely calcium intake improved, however most of the behavioral changes observed were likely due to reduced volume of children on the playground and in the cafeteria at one time. Menu-labeling is cited as a tool for reducing childhood obesity in best-practice guidelines and is being more fully implemented across the country in national healthcare reform. We support this practice.
Support:
Northwest Health Foundation
