A community needs assessment of a Chinese-American community in New York City several years ago found multiple barriers to physical activity for children and teens including parents unable to supervise kids at play because of long work hours, unsafe neighborhoods, limited knowledge or access to existing programs, financial hardship, inadequate support for physical activity in schools, limited time due to competing priorities such as academics, and too much time in front of video games, computer screens and television. To increase exercise time and options and help to reduce obesity rates among Chinese-American youth, public health professionals from the Charles B. Wang Community Health Center sought out funding from the New York State Department of Health and Mental Hygiene to create the Chinatown JUMP (Joining Urban Partners for More Physical Activity) program.

>>Read more on New York's Health Improvement Plan, which sets out a plan for similar community health assessments and cross-sectoral collaborations in response to these findings.

Chinatown JUMP currently works with eight afterschool programs to incorporate daily physical activity into the curriculum of these academic programs, blending activity with learning. Program goals include:

• Promote healthier and fit children by educating them and their families about the correlation between exercise and staying healthy.
• Increase staff capacity to support students’ healthier lifestyle through training and technical assistance.
• Establish an afterschool culture that supports physical activity as well as academic achievement.

The program works hard to incorporate parents’ support and involvement as well. Participating students in iMove receive a community resource guide with information about free and low-cost recreational centers and public spaces in the neighborhood to share with their parents. Parents are also invited to workshops on the importance of physical activity and healthy eating habits.

NewPublicHealth recently spoke with Susan Yee, Associate Director of Programs at the Charles B. Wang Community Health Center, about Chinatown JUMP.

NewPublicHealth: What is the Chinatown JUMP program and what do you think sets it apart from other programs with similar goals?

Susan Yee: Chinatown JUMP’s goal is to try to improve opportunities for more physical activity in the Manhattan Chinatown area in order to create sustainable changes within the community.

A new report released today examines state standards for the types of snacks that can be sold in secondary schools. The report was developed by the Kids’ Safe & Healthful Foods Project, a joint initiative of RWJF and The Pew Charitable Trusts that is focused on ensuring all foods and beverages in school are healthy and safe. 

Some of the findings were discussed earlier this week at a session at the American Public Health Association annual meeting, and the full report is now available online. NewPublicHealth caught up with Jessica Donze Black, the project’s director, to learn more about the report.

NewPublicHealth: You’ve just released a new report about school snacks – what did you find?

Jessica Donze Black: We found that the majority of our nation’s students live in states where less healthy snacks like full-fat chips and candy are readily available in snack bars, school stores and vending machines – but there is limited access to healthy snacks. What students are able to buy varies widely from state to state, with some offering healthy snacks and others primarily providing less-healthy snack options.

The report recommends that the U.S. Department of Agriculture issue consistent, science-based standards to ensure all students have access to healthy snacks at school, regardless of where they live. The standards will establish a baseline that will help local communities make healthy choices when choosing what snacks to offer.

NPH: Have any states had success with offering healthy snack foods in schools? 

Over the past few years, many cities and states have considered taxing sodas and other sugary beverages. At the American Public Health Association meeting, Judy Jou, a PhD candidate at the University of Minnesota School of Public Health, discussed a study in which she and her colleagues interviewed stakeholders about their views on a sugary beverage tax. The study was supported by a grant from the Robert Wood Johnson Foundation through its national Healthy Eating Research program.

Most of the eleven interviews were with public health advocates and policy-makers. These stakeholders indicated that the main arguments in favor of the tax revolve around health:

• Sugary beverages contain large amounts of sugar and/or calories.
• Sugary beverages are a major contributor to obesity and related health conditions, especially for children.
• The revenue generated by a sugary beverage tax can be used to fund community health programs.

Some stakeholders said that visual representations of the sugar in these beverages were effective at communicating the first point. Stakeholders learned messaging ideas through personal networking, published documents, other sugary beverage tax efforts and—less frequently—testing from focus groups or surveys.

The most common messages used against sugary beverage taxes included:

• Government is acting as a “nanny state” and is restricting personal choice.
• These taxes would have a negative economic impact on businesses and workers.
• Soda and other sugary beverages are unfairly targeted and are not the only cause of obesity.

Citizens in two California cities, Richmond and El Monte, will vote on sugary beverage taxes on Election Day next Tuesday. In both cities, the campaigns to defeat the taxes have much more funding than the campaigns to pass them. One big challenge identified by the stakeholders Jou and her team interviewed was the vast resources the beverage companies have to fight these tax efforts.

>>The Los Angeles Times recently reported on the effort to pass a sugary beverage tax in El Monte.

>>Learn more about how pricing strategies— both incentives and disincentives—can promote the purchase of healthier foods.

Get kids active now and often was the message at a session on childhood obesity at the American Public Health Association 2012 Annual Meeting in San Francisco.

"Students are not getting enough exercise," said Christina Economos as she opened the session, though "physical education develops skills." Childhood Obesity 180 created the Active School Acceleration Project, which works to promote exercise inside as well as outside of school.

The Active Schools Acceleration Project works to increase quality physical activity in schools to combat childhood obesity and to get the beneficial health, behavioral, and academic outcomes that follow. American children today experience far fewer daily opportunities for movement and exercise because there is a decreased emphasis on physical activity in schools.

Economos noted that physical education is often one of the first programs to go following school budget cuts. Their goal is to reverse the trend of childhood obesity, one generation at a time—the benefits of which, aside from healthier, longer lives, include improved academic performance in school. This makes childhood obesity prevention a priority for schools, despite strapped budgets.

Economos and her team developed a four-pronged process—to find innovation, identify best practices, support existing and start up new interventions, and make plans for long term sustainability. They looked at grassroots programs in local schools as well as established national movements. The result was an "American Idol" type contest to solicit entries that showcase best practices for encouraging vigorous physical activity among students.

The ultimate goal is to showcase the best approaches to physical activity in schools. Practitioners hope to influence school policy change on physical activity from the bottom up.

City parks can be a cost-free venue for people of all ages and backgrounds to be physically active. Two presenters at the American Public Health Association meeting discussed programs to increase physical activity opportunities in city parks during a session on Tuesday afternoon. The two projects were funded by Communities Putting Prevention to Work grants and focused on neighborhoods that have a high proportion of low-income and minority residents.

Adam B. Becker, PhD, MPH, from Lurie Children's Hospital, spoke about the work the Consortium to Lower Obesity in Chicago Children (CLOCC) undertook to increase walking access to parks. Members of 10 community-based organizations were trained to assess barriers to park access using the Neighborhood Walkability Assessment Tool.  The tool included analyses of possible recommendations to overcome any identified obstacles to walking.

CLOCC also created a guide to be used by city planners and engineers when deciding how to improve the walkability of local streets. The guide included suggestions such as improving sidewalks and installing pedestrian countdown timers and pedestrian islands in streets. Dr. Becker said that the city agencies are excited to have better data to help them identify walkabilty problems and prioritize solutions.

In the second presentation, Mary Thomas, MPH, from the San Antonio Metropolitan Health District, described a program that installed outdoor fitness equipment for use by community members in city parks. The goal of this program was to increase park use, and to increase physical activity among residents when they use parks.

In a partnership with the Parks and Recreation Department, fitness equipment was installed in 28 San Antonio parks, and the project was publicized using flyers and newspapers. A survey of park users showed that 54 percent spent more time in the park after the installation of fitness equipment, and most said that the equipment was user friendly and had clear instructions.

Park users identified the lack of water fountains and shade as the biggest barriers to using the fitness equipment more often.  And, it should be noted that 88 percent of park users traveled to the park by car. San Antonio and Chicago clearly have the opportunity to learn from each other’s efforts.

A joint use agreement (or shared use agreement) allows school facilities such as playgrounds and fields, to be used by the broader community when school is not in session. Health advocates are working to implement more joint use agreements as a way to help neighborhood residents be active in their community. These joint use agreements are being used more and more around the country, but evaluations of their effectiveness are less common.

At the American Public Health Association conference on Monday, Mariah Lafleur, MPH, from Samuels & Associates, presented an evaluation of joint use agreements with schools in some low-income neighborhoods in Los Angeles County. As part of a Communities Putting Prevention to Work grant, the Los Angeles County Department of Public Health worked with seven school districts to implement joint use agreements. The program focused on school districts in areas with limited access to public parks.

One part of the evaluation showed that, following the joint use agreement, both children and adults were using the school facilities, and that males and females used the facilities pretty equally. Perhaps most criticals, about two-thirds of users were participating in moderate to vigorous physical activity.

The evaluation also revealed a 16-fold increase in the use of the facilities when there was some kind of programming available, such as organized sports. One of the more popular activities was a walking club for mothers, which was timed so that they could drop their students at school and then participate in the walking club.

Lafleur, the presenter, and the audience in attendance were not aware of any previous published studies showing the importance of including programming along with the joint use agreements.  Lafleur recommends partnering with community groups, such as YMCAs, Boys and Girls Clubs, and parks and recreation departments, to greatly increase community use of school facilities. “We think it is a very cost-efficient way to increase physical activity,” said Lafleur.

>>Learn more about joint use agreements.

The Kids Safe & Healthful Foods Project, a collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently posted a Q&A with their director, Jessica Donze Black. The Q&A about new healthy school lunch nutrition guidelines is reposted below.

Q: As the new nutrition guidelines for school meals go into effect, lunches now feature healthier foods and portion sizes. What are the new calorie limits for meals being served in schools?

Jessica Donze Black: The new nutrition guidelines make sure that meals and portions are healthy and “right sized” for kids based on their age. School lunches have always been intended to provide about a third of the recommended daily calories for the average student. Under the new standards, lunches in elementary schools range between 550 and 650 calories, middle school lunches between 600 and 700, and those in high schools have roughly 750 to 850.  These numbers allow schools to serve a large variety of filling foods.

Q: Are these enough calories for highly-active students such as athletes?

The number of obese adults, along with related disease rates and health care costs, are on course to increase dramatically in every state in the country over the next 20 years, according to F as in Fat: How Obesity Threatens America's Future 2012, a new report from the Robert Wood Johnson Foundation and Trust for America's Health.

The report forecasts adult obesity rates in each state by 2030 and the likely resulting rise in obesity-related disease rates and health care costs.

If upward trends in obesity rates continue, obesity rates could exceed 60 percent in 13 states by 2030, and the loss in economic productivity for the country could be as high as $580 billion annually.

But the news isn't all bad---critical preventive measures could make an enormous impact, and help forge a healthier future for the nation. If states can cut the average body mass index of their population by just 5 percent, millions of Americans could be spared from serious health conditions and the country could save billions of dollars in health care spending. The interactive map pictured here paints a picture of two possible futures---one if we continue on our current path of rapidly rising obesity rates, and another if states can achieve a 5 percent reduction in BMI. Click HERE to explore the possible futures in your state.

>>Explore the interactive map, Two Futures for America's Health.

>>Read the full report.

GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)

United States Department of Agriculture (USDA) Under Secretary for Food, Nutrition, and Consumer Services Kevin Concannon was recently eating lunch with elementary school students in Louisiana when a first-grader leaned over to him and said, “Sir, if you don’t finish your broccoli, I’ll finish it for you.”

In a session at the recent ASTHO Annual Meeting, Concannon cited this as one example of the progress being made in the fight against the obesity epidemic, applauding schools for creatively modifying their healthy recipes to appeal to kids. USDA aims to ensure that children receive fruits and vegetables at every meal, while still reducing trans fats and sodium in the food, said Concannon. Another school he visited adds a bit of green gelatin to their cups of applesauce—just enough to give the applesauce a hint of color, which makes it a popular lunch choice for the students, a large majority of whom come from impoverished backgrounds.

“Our goal is to ensure that Americans routinely have access to sound nutrition,” Concannon said. “We’re in the midst of an obesity crisis.”

Concannon discussed how USDA’s school lunch and breakfast programs, the Supplemental Nutrition Assistance Program, and WIC are working to create healthier environments by providing children with nutritious food options in schools and at home. He also called the Healthy Hunger-Free Kids Act of 2010 “one of the most significant” recent advances for child nutrition, and said, “We are on the verge of the first major changes to school meals in 15 years.”

>>Read up on a first-of-its-kind health impact assessment on a federal rule that would require updating school nutrition standards for snacks and beverages to meet the most recent Dietary Guidelines for Americans.

Although great strides have been made toward improving Americans’ access to healthy food, Concannon said USDA is seeking a greater partnership with public health leaders to promote wellness in schools.

“We would love to connect even more with [with public health officials] on wellness programs in schools,” he said. “We have huge challenges around obesity.”

He urged state health agencies to engage with schools on the entire wellness message, including promoting fitness at all levels of schooling.

In addition to reaching out to public health leaders at the ASTHO annual meeting, Concannon announced that USDA has begun working on dietary guidelines for children from birth to 2 years of age, which will be the first USDA guidelines to cover that age span. The new dietary guidelines will be released in 2015.

Following Concannon’s presentation, Hawaii Department of Health Director Loretta Deliana Fuddy described her agency’s partnership with the Hawaii Department of Education. She also gave examples of how Hawaii is enacting USDA’s recommendations on child nutrition, including training school cafeteria staff to be more creative in their healthy recipes, promoting breastfeeding, and forging strong relationships with community centers to address health inequities.

A new report from the Institute of Medicine, Accelerating Progress in Obesity Prevention, released today in conjunction with the Weight of the Nation Conference, finds that progress in stemming the obesity epidemic has been too slow, and that obesity has a negative impact on productivity and is the factor behind millions of people suffering from chronic and often debilitating diseases.

The report focuses on five key goals in order to prevent obesity:

• Integrating physical activity into people's daily lives.
• Making healthy food and beverage options available everywhere.
• Transforming marketing and messages about nutrition and activity.
• Making schools a gateway to healthy weights.
• Galvanizing employers and health care professionals to support healthy lifestyles.

Read more about the report and watch a video commentary about the report, featuring James S. Marks, Senior Vice President at the Robert Wood Johnson Foundation.

Follow coverage of the meeting on RWJF.org, @RWJF_ChdObesity, www.rwjf.org/childhoodobesity and on NewPublicHealth.