Healthy Weight, Healthy Child Initiative

Healthy Weight, Healthy Child Initiative GOVERNMENT & ELECTED OFFICIALS: Literature Review of Potential Interventions How to Use this Document: The following table includes interventions that address childhood obesity. The first column describes an intervention and the second and third columns offer the rationale, citing whether the intervention is evidence or non-evidence. Intervention Interventions Related to Increasing Access to Nutrition-Dense Food Make fruits and vegetables more affordable to residents who receive food stamps. For every five dollars worth of food stamps spent at farmers markets, individuals receive a $2 Health Bucks coupon, which can be redeemed year round at more than 30 farmers markets citywide. Ensure that local farmers markets accept food stamps. In 2007, the NYC Health Dept. reported that New Yorkers used more than 40% of the 9,000 Health Bucks distributed in 2006. 1 Create new funding initiative to leverage supermarket development in underserved areas. May require the development of a task force. The Philadelphia Food Market Task Force initiative has committed $67 million in funding for 69 supermarket projects in 27 Pennsylvania counties, creating or preserving 3,900 jobs. 2 Create a program for corner-store markets to sell fresh produce. This would include job training and resources for materials to ensure produce remains fresh and available for sale. Louisville, KY, implemented this initiative in a pilot corner-store. After 4 months, the corner-store began turning a profit. Increase the number of farmers markets located in neighborhoods underserved by supermarkets, grocery stores, and other fresh food outlets. Require all of the farmers markets to accept food stamps and Farmers Market Nutrition Program vouchers. Philadelphia, PA 3 1

Launch an initiative to improve bus service routes to grocery stores by creating a special cross-town bus route that cuts travel time for low-income residents to reach a shopping area with a major supermarket. One-third of the riders were using the new bus route to reach the supermarkets in Hartford, CT. 4 Provide zoning and financial incentives to property owners, developers, and grocery store operators in areas of the city currently underserved by grocery stores. One study of white and black Americans found that adults living in areas with one or more supermarkets were more likely to meet dietary recommendations for fruits and vegetables than adults living in areas with no supermarkets. 5 NYC will help create an estimated 15 new grocery stores and upgrade 10 existing stores, creating 1,100 new jobs and retaining 400 others (City of New York, 2009). 6 Encourage restaurants to serve healthier portion sizes to consumers. Participating restaurants receive specialized 9-inch plates that indicate proper portions of key food groups such as vegetables, protein, and whole grains. The program is designed to encourage participating restaurants to increase the vegetable portion of the meal and to decrease the entrée and starch portions of the meal. TX Dept of State Health Services 7 Encourage restaurants to promote healthier food options for customers. For example, implement a campaign in which participating restaurants provide customers the option of placing half of their meal in a to-go box, while enjoying the other half at the restaurant. The Colorado Department of Public Health and Environment 8 Consider adopting local policies to require fast-food and chain restaurants to provide calorie or nutrition information in their establishments. Six nationally-representative polls have found that between 62 and 87 percent of Americans support the idea of requiring restaurants to list nutrition information. 9 Implement a tax strategy to discourage consumption of foods and beverages that have minimal nutritional value, such as sugarsweetened beverages. Institute of Medicine 10 Develop media campaigns that utilize multiple channels (print, radio, internet, television, social networking, and other promotional materials) to promote healthy eating (and active living) using consistent messages tailored to a specific community. Institute of Medicine 11 Design a media campaign that establishes community access to healthy foods as a health equity issue and that reframes obesity as a consequence of environmental inequities, not just the result of poor personal choices. Institute of Medicine 12 Develop counter-advertising media approaches against unhealthy products to reach youth, as have been used in the tobacco and alcohol prevention fields. Institute of Medicine 13 2

Mandate and implement strong nutrition standards for foods and beverages available in government-run or -regulated afterschool programs, recreation centers, parks, and child care facilities (which includes limiting access to calorie-dense, nutrient-poor foods). Institute of Medicine 14 Ensure that local government agencies that operate cafeterias and vending options have strong nutrition standards in place wherever foods and beverages are sold or available. Institute of Medicine 15 Provide incentives or subsidies to government-run or -regulated programs and localities that provide healthy foods at competitive prices and limit calorie-dense, nutrient poor foods (e.g., to after-school programs that provide fruits or vegetables every day and that eliminate calorie-dense, nutrient poor foods in vending machines or as part of the program). Institute of Medicine 16 Put policies in place that require government-run and -regulated agencies responsible for administering nutrition assistance programs to collaborate across agencies and programs to increase enrollment and participation in these programs (i.e., WIC agencies should ensure that those who are eligible are also participating in SNAP, etc.). Ensure that child care and after-school program licensing agencies encourage utilization of the nutrition assistance programs and increase nutrition program enrollment (CACFP, Afterschool Snack Program, and the Summer Food Service Program). Adopt land use and zoning policies that restrict fast food establishments near school grounds and public playgrounds. Institute of Medicine 17 Institute of Medicine 18 Institute of Medicine 19 Implement local ordinances to restrict mobile vending of calorie-dense, nutrient-poor foods near schools and public playgrounds. Implement zoning designed to limit the density of fast food establishments in residential communities. Institute of Medicine 20 Eliminate advertising and marketing of calorie-dense, nutrientpoor foods and beverages near school grounds and public places frequently visited by youths. Institute of Medicine 21 Create incentive and recognition programs to encourage grocery stores and convenience stores to reduce point-of-sale marketing of calorie-dense, nutrient-poor foods (i.e., promote candyfree check out aisles and spaces). Institute of Medicine 22 Interventions Related to Promoting Breastfeeding Require all employers to ensure that employees are provided with adequate facilities for breastfeeding or expressing milk. California state law. 23 3

Adopt practices in city and county hospitals that are consistent with the Baby-Friendly Hospital Initiative USA (United Nations Children s Fund/World Health Organization). This initiative promotes, protects, and supports breastfeeding through ten steps to successful breastfeeding for hospitals. Institute of Medicine 24 Permit breastfeeding in public places, rescind any laws or regulations that discourage or do not allow breastfeeding in public places, and encourage the creation of lactation rooms in public places. Institute of Medicine 25 Develop incentive programs to encourage government agencies to ensure breastfeeding-friendly worksites, including providing lactation rooms. Institute of Medicine 26 Allocate funding to WIC clinics to acquire breast pumps to loan to participants. Institute of Medicine 27 Interventions Related to Increasing Physical Activity Coordinate recreational sports programs and the public school system to allow all school facilities to be available for free or a small service charge to community organizations, civic groups, private nonprofit agencies, commercial businesses, faith organizations, private or commercial sport leagues, and individuals to promote physical activity. Pit County, NC 28 Develop, revitalize, or rehabilitate local hiking trails, biking, and walking/jogging routes and publicize and distribute maps of the routes throughout the community. KaBOOM!, a national nonprofit organization that empowers local communities to build playgrounds in neighborhoods that lack play spaces for children, may be a good source to review for ideas.http://www.kaboom.org An analysis of studies in six communities found that, on average, residents in highly walkable neighborhoods took twice as many walking trips as people in less walkable neighborhoods mostly to work or to run errands. 29 Duarte, CA 30 Commit a percentage of the city s annual transportation budget toward bicycle enhancement and maintenance activities. Equip all local and regional buses with bike racks. Create an online bike routing system that provides cyclists a direct and safe bike route to travel within city limits. An analysis of 33 studies demonstrated that children in neighborhoods with sidewalks and controlled intersections were more physically active than children in neighborhoods with road hazards and unsafe intersections. 31 Boulder, CO 32 Enlist a traffic engineer to help schools identify and create safe walking and biking routes between residential areas and participating schools. Marion Co., CA - In the first 2 years of the program, the number of children walking to school increased 64%, and biking increased 114%. 33 4

Adopt a Pedestrian Master Plan, which designates a network of pedestrian facilities and distinguishes segments and intersections in need of particular attention for safety enhancements. Pedestrian volumes throughout the city were estimated on land use, population, and other network characteristics, and these estimates were used in conjunction with crash data, traffic data, and community input to identify and prioritize areas with both safety problems and high pedestrian demand. Oakland, CA 34 Allocate and distribute funding from the local government and the Federal Transit Administration (FTA) to business owners and residents to implement a series of improvements to the existing public transit system, such as new artistic bus shelters, new traffic signals, and additional sidewalk and curb access ramps for public transit users, bicyclers, and pedestrians. Tucson, AZ 35 Develop a comprehensive land use plan, building off of the Urban Street Design Guidelines, that encourages zoning for mixed-use development as a way to support active living among residents. Incorporate into transportation master plan. King County, WA; Eugene, OR 36 Increase sense of personal safety by passing a land use policy that allows public use of private vacant lots for community purposes, such as community gardens, recreational spaces, temporary public art installations, and youth recreation. A 2007 study of planning directors and residents of 67 North Carolina counties showed that more sidewalks, bicycle lanes, and trails; more walkable, mixed-use development; and strong planning policies were associated with higher levels of physical activity. 37 Escondido, CA 38 Transform abandoned properties into active fruit and vegetable garden plots that improve the aesthetic appeal of city neighborhoods and increase access to fresh fruits and vegetables. Detroit, MI 39 Increase the numbers of parks and green-space areas in underserved neighborhoods and communities. Furthermore, a 2006 study of more than 1,500 teenage girls found that they achieved 35 additional minutes of physical activity weekly for each park that was within a half mile of their homes. 40 Adopt a county-wide traffic calming policy to improve street safety for non-motorized users: retrofit main streets with important pedestrian safety measures, including raised intersections, two-way streets, road narrowings and roundabouts to slow traffic, wide sidewalks, tree-lined streets, and shortened pedestrian crossings. West Palm Beach, Florida: City streets are perceived as safe by pedestrians; property values more than doubled in the downtown area; and commercial retail space is 80% occupied. 41 5

Increase policing in high-crime areas, pedestrian walkways, and parks. Police departments can work with communities to receive input on danger zones. A study of Chicago residents demonstrated that youth living in safer neighborhoods engaged in physical activity for an additional 49 minutes per week than youth living in unsafe neighborhoods. 42 Collaborate between local policy-makers and community members to employ alternative policing strategies, such as neighborhood watch groups. RWJF 43 Improve access to bicycles, helmets, and related equipment for lower-income families, such as through subsidies or repair programs. Institute of Medicine 44 Develop media campaigns, utilizing multiple channels (print, radio, internet, television, other promotional materials) to promote physical activity using consistent messages. Institute of Medicine 45 Design a media campaign that establishes physical activity as a health equity issue and reframes obesity as a consequence of environmental inequities, not just the result of poor personal choices. Institute of Medicine 46 Develop counter-advertising media approaches against sedentary lifestyle habits to reach youth, as has been done in the tobacco and alcohol prevention fields. Institute of Medicine 47 1. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 9. 2. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 11. 3. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 15. 4. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 11. 5. Morland K, Wing S and Diez Roux A. The contextual effect of the local food environment on residents diets: the Atherosclerosis Risk in Communities Study. American Journal of Public Health, 92(11): 1761-1768, November 2002. 6. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 13. 7. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 23. 8. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 23. 9. Anyone s Guess: The need for nutrition labeling at fast-food and other chain restaurants. Washington: Center for Science in the Public Interest, 2003. Available at www.cspinet.org/restaurantreport.pdf. and Obesity as a Public Health Issue: A Look at Solutions. A National Poll. Cambridge, MA: Harvard Forums on Health, a project of Harvard University s Interfaculty Program for Health Systems Improvement, commissioned Lake Snell Perry & Associates (LSPA), June 2003. Available at www.phsi.harvard.edu/health_reform/poll_results.pdf. 10. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-6. 11. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-6. 12. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-6. 13. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-6. 14. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 15. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 16. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 17. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 18. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 19. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. 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IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 27. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-5. 28. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 39. 29. Saelens B, Salis J and Frank L, Environmental Correlates of Walking and Cycling: Findings from the Transportation, Urban Design, and Planning Literatures. Annals of Behavioral Medicine, 25(2): 80-91, Spring 2003. 30. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 45. 31. Greves H, Lozano P, Liu L, et al. Immigrant families perceptions on walking to school and school breakfast: a focus group study. The International Journal of Behavioral Nutrition and Physical Activity, 4(64), 2007. 6

32. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 47. 33. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 47. 34. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 49. 35. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 53. 36. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 55. 37. Aytur S, Rodriguez D, Evenson K, et al. Promoting Active Community Environments through Land Use and Transportation Planning. American Journal of Health Promotion, 21(4S): 397-407, March/April 2007. 38. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 55. 39. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 57. 40. 33 Cohen D, Ashwood J, Scott M, et al. Public parks and physical activity among adolescent girls. Pediatrics, 118(5): 1381-1389, November 2006. 41. Centers for Disease Control, Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, July 2009. Pg. 59. 42. Molner B, Gortmaker S, Bull F, et al. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. American Journal of Health Promotion, 18(5): 378-386, May 2004. 43. Robert Wood Johnson Foundation, Action Strategies Toolkit: A Guide for Local and State Leaders, Pg. 53. 44. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-8. 45. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-8. 46. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-8. 47. IOM (Institute of Medicine). 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press., Pg. S-8. Prepared by Meredith K. Ledford, Initiative Coordinator. Contact her at meredith.ledford@carolinashealthcare.org if you have any questions. 1/12/10. 7