May 2005

Grant Results

SUMMARY

From January to July 2004, Action for Healthy Kids worked with experts in education, health, physical education and nutrition to test and apply a set of evaluation criteria for the best school-based interventions that address childhood obesity.

Action for Healthy Kids, formed in response to the Surgeon General's Call to Action, is a national-state effort with 51 state teams working at the grassroots level to improve nutrition and physical activity levels in schools.

Key Findings
Project staff reported the following findings, which are based on a literature review, to RJWF:

  • The use of the term "best practices" varies considerably, and evaluators of school-based approaches often use inconsistent standards.
  • Researchers did not find standard criteria to evaluate methods or to serve as guidelines for creating innovations that conform to "best practices" in school nutrition and physical activity.
  • Evaluations of methods and approaches often overlook the needs and priorities of those who will adopt and implement them, and be held accountable for the results. To effectively evaluate school-based innovations, criteria must reflect the needs of all relevant stakeholders.

Project staff published findings in a report entitled Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity, which is available online. The report also lists a set of guidelines for determining the value of a particular policy and incentives for schools to adopt approaches for improving nutrition and increasing physical activity.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $50,000 for the project from January to July 2004.

 See Grant Detail & Contact Information
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THE PROBLEM

According to the 2001 Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, an estimated 13 percent of children aged six to 11 years and 14 percent of adolescents aged 12 to 19 years are overweight.

During the past two decades, the percentage of children who are overweight has nearly doubled (from 7 to 13 percent), and the percentage of adolescents who are overweight has almost tripled (from 5 to 14 percent).

Without a reversal in this trend, experts project that 30 percent or more of America's schoolchildren may be classified as overweight by 2020. The potential consequences of childhood obesity are staggering: increased rates of type 2 diabetes, hypertension, colon cancer, depression and anxiety, and weak muscles and bones.

The 2001 report outlined actions for creating school environments that support good nutrition and increased physical activity. But school administrators often are hard-pressed to choose among the many possible approaches for tackling the problem, according to the project director.

To assess a program's feasibility for their particular setting, administrators need standard criteria. These criteria must take into account the priorities of those important stakeholders who will ultimately adopt, implement and participate in the program.

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RWJF STRATEGY

The focus of RWJF's work in addressing childhood obesity is on children and families in low-income and minority populations, concentrating on ages three to 12, an age range that represents a critical period for developing lifelong habits. Because there are few known, effective strategies for addressing the problem, RWJF will use multifaceted approaches, to be developed with partners at many levels.

The initial goals are to support innovative school and community pilot projects to reduce childhood obesity and to address the huge gaps in knowledge about the causes of obesity in children, particularly environmental factors such as availability of junk food in schools and inadequate healthy food choices in local supermarkets.

The Childhood Obesity Team will also identify opportunities to build on and/or embed healthy eating and physical activity into existing child health initiatives funded by RWJF (e.g., the Center for Health and Health Care in Schools [see also Grant Results] and the Urban Health Initiative) and create opportunities to speak with and influence specific audiences regarding RWJF strategies.

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THE PROJECT

Action for Healthy Kids, formed in response to the Surgeon General's Call to Action, is a national-state effort with 51 state teams working at the grassroots level to decrease childhood obesity by improving nutrition and increasing physical activity in schools. Action for Healthy Kids staff works with a steering committee of representatives from over 40 national organizations and government agencies to support state-level action.

Action for Healthy Kids set out to develop, test and apply a set of criteria for the best school-based approaches for increasing children's physical activity and improving nutrition. The staff wanted criteria that reflected the needs of all relevant stakeholders — those who will adopt, implement and give an account of the results of the program.

To help guide the project, staff reviewed literature from the field and lessons learned from the organization's state teams (see Findings). Staff then convened a panel of 31 experts from 27 national organizations and government agencies to identify the criteria.

Key stakeholders on the panel included administrators, teachers, parents, students, nutrition and food service professionals, school health professionals, physical activity and education providers, and representatives from communities, government, higher education and minority populations (see the Appendix for a list of panel members).

Employing group conference calls, an e-mail survey and one-on-one interviews, the panel worked in three phases:

  1. Identifying criteria for attaining best practices common to four approaches (policies, programs, interventions and practices).
  2. Ranking the criteria.
  3. Testing the criteria by using them to score specific approaches contained in the Action for Healthy Kids' database.

Project staff published findings in a report entitled Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity. Along with the criteria, the report also lists a set of guidelines for determining the value of a particular policy, incentives for schools to adopt approaches for improving nutrition and increasing physical activity, and some of the approaches from the Action for Healthy Kids' database that received high scores from the panel.

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FINDINGS

Project staff reported the following findings, based on the literature review, to RJWF. They support the staff's knowledge of the problem at the start of the grant.

  • The use of the term "best practices" varies considerably, and evaluators of school-based approaches often use inconsistent standards.
  • Researchers did not find standard criteria to evaluate methods or to serve as guidelines for creating innovations that conform to "best practices" in school nutrition and physical activity.
  • Evaluations of methods and approaches often overlook the needs and priorities of those who will adopt, implement and be held accountable for the results. To effectively evaluate school-based innovations, criteria must reflect the needs of all relevant stakeholders.

Recommendations

The expert panel determined two levels of criteria: Essential and Critical. Essential Criteria are the core standards that all approaches should meet. Critical Criteria relate specifically to how easily a school can implement an approach. They reported both lists in Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity. (See the Bibliography.)

Essential Criteria

  • The approach is based on professional theories and is consistent with professional and/or national standards of practice.
  • The approach is practical and realistic.
  • The goal/purpose of the approach is clearly stated and easy to understand by multiple audiences.
  • The approach has specific and measurable objectives that address one or more of the following:
    1. Knowledge
    2. Attitudes
    3. Skills
    4. Behaviors
    5. Policy
    6. School environment.
  • The approach is both age- or developmentally appropriate and culturally relevant.
  • The approach is engaging to students, interactive and skills-based.
  • The approach can be adapted to a variety of situations and environments.
  • The approach can be assessed and monitored and includes an evaluation component.
  • The goals of the approach are supported by results from evaluation data.
  • The approach supports easy implementation by providing the following:
    1. Clearly written and user-friendly instructions.
    2. Training resources.
    3. Contact information to obtain technical support or additional resources.
    4. Instructions or materials in languages in addition to English.

Critical Criteria

  • The approach is cost-effective and resources (e.g., staff, budget, grant dollars) are available for its implementation.
  • The approach fits into required school mandates, has a positive effect on student achievement outcomes and would help to meet state nutrition and physical activity standards.
  • The approach can be integrated across curricula, feasibly implemented within a school schedule, and aligned with a coordinated school health model.
  • The approach has strong support from critical audiences (e.g., students, parents, teachers and administrators), and all relevant stakeholders were involved with its planning.
  • The approach is sustainable, not just a one-time or irregularly implemented event.

Communications

Project staff published the criteria in its report entitled Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity and distributed it electronically to Action for Healthy Kids partner organizations and state team leaders, and existing and potential donors and select leaders in the areas of health, education and government.

The report and a briefer executive summary can be downloaded at the Action for Healthy Kids Web site. The project director also published an article on the criteria in the State Education Standard, the journal of the National State Boards of Education. See Bibliography for more details.

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AFTER THE GRANT

The project ended with this grant. According to the project director, Action for Healthy Kids will continue to promote the criteria established in the project among parties interested in education, health, fitness and nutrition. The organization also will incorporate the criteria into the procedures it uses to evaluate new policies, interventions, practices and programs, such as an after-school program it is developing with the National Football League.

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GRANT DETAILS & CONTACT INFORMATION

Project

Establishing Evaluation Criteria for School-Based Interventions That Address Childhood Obesity

Grantee

Healthy Schools Incorporated dba Action for Healthy Kids (Washington,  DC)

  • Amount: $ 50,000
    Dates: January 2004 to July 2004
    ID#:  049649

Contact

Alicia Moag-Stahlberg, M.S., R.D., L.D.
(800) 416-5136
alicia@actionforhealthykids.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Expert Panel Members

Dan Albertsen
National Association of Secondary School Principals
Principal, Watertown Middle School
Watertown, S.D.

Jim Bogden, M.P.H.
Project Director
National Association of State Boards of Education
Alexandria, Va.

Clementine Bufo, R.D., M.P.H., N.C.S.N., R.N.
National Association of School Nurses
Creedmoor, N.C.

Dana Carr, M.P.H.
Program Specialist, Office of Safe and Drug-Free Schools
U.S. Department of Education
Washington, D.C.

Olivia Carter-Pokras, Ph.D.
Associate Professor
Department of Epidemiology and Preventive Medicine
University of Maryland School of Medicine
Baltimore, Md.

Velma Cobb, Ph.D.
Vice President, Education and Youth
National Urban League
New York, N.Y.

Lily Eskelsen
Secretary-Treasurer
National Education Association
Washington, D.C.

Diana Fox, M.Ed.
Director
Network Channels
American Cancer Society
Hershey, Pa.

Joan Glick, R.N.C., M.S.N.
Nurse Administrator
School Health Services
Montgomery County
Rockville, Md.

Susan Gross, Ph.D., M.P.H., R.D.
Adjunct Faculty, Program in Public Health
Morgan State University
Reisterstown, Md.

Nora Howley, M.A., C.H.E.S.
Director
School Health Project
Council of Chief State School Officers
Washington, D.C.

Gay James, Ph.D.
Professor
Texas State University, San Marcos
Texas Alliance for Health, Physical Education, Recreation and Dance
San Marcos, Texas

Theresa Lewallen, M.A., C.H.E.S.
Director
Health in Education Initiative
Association for Supervision and Curriculum Development
Alexandria, Va.

Nancy Lubarsky, Ed.D.
National Association of Elementary School Principals
Principal
Village School
Holmdel, N.J.

Leslie Lytle, Ph.D., R.D.
Professor
School of Public Health
University of Minnesota
Society for Nutrition Education
Minneapolis, Minn.

Tammy Martin
Research Assistant Professor
Department of Health Management and Policy
University of New Hampshire
Chair
AFHK, New Hampshire State Team
Durham, N.H.

Alejandro Menendez
Student and National Vice President of Peer Education
Family, Career and Community Leaders of America
Toa Alta, P.R.

Christi Moss
Principal
Chaires Elementary School
National Association of Elementary School Principals
Tallahassee, Fla.

Rebecca Mullis, Ph.D., R.D.
Professor
University of Georgia
Athens, Ga.

Sharon Murray, M.H.S.E., C.H.E.S.
Executive Director
Society of State Directors of Health, Physical Education and Recreation
Reston, Va.

Carla Nino
Assistant Hospital Administrator
ValleyCare Olive View-UCLA Medical Center
County of Los Angeles Department of Health Services
National Parent Teacher Association
Los Angeles, Calif.

Erica Odom
Education Program Specialist
Centers for Disease Control and Prevention
Atlanta, Ga.

Pamela Palmo, M.S., R.D.
MSHRM Director
Food Services Department
Tucson Unified School District
American School Business Officials International
Tucson, Ariz.

Karyl Thomas Rattay, M.D., M.S.
Physical Activity, Nutrition and Children's Health Advisor
Office of Disease Prevention and Health Promotion
U.S. Department of Health and Human Services
Washington, D.C.

JoAnne Robinett, M.S., S.F.N.S.
Food Service Supervisor
Beavercreek City Schools
School Nutrition Association
Beavercreek, Ohio

Barry Sackin, S.F.N.S.
Staff Vice President for Public Policy
School Nutrition Association
Alexandria, Va.

Sandy Sherman, M.S., Ed.M., Ed.D.
Director of Nutrition Education
The Food Trust
Philadelphia, Pa.

Sandy Spavone
Director of Programs
Family, Career and Community Leaders of America
Reston, Va.

Rick Stevenson
Supervisor of Health and Physical Education
West Chester Area School District
American Alliance for Health, Physical Education, Recreation and Dance
West Chester, Pa.

Susan Wooley, Ph.D., C.H.E.S.
Executive Director
American School Health Association
Kent, Ohio

Judy Young, Ph.D.
Vice President for Programs
American Alliance for Health, Physical Education, Recreation and Dance
Reston, Va.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Moag-Stahlberg A. "Creating and Evaluating School-Based Initiatives to Increase Nutrition and Physical Activities." State Education Standard, 5(2): 43–47, 2004.

Reports

An Action for Healthy Kids Report. Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity. Washington: Action for Healthy Kids, 2004. Also available online.

An Action for Healthy Kids Report. Executive Summary: Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity. Washington: Action for Healthy Kids, 2004. Also available online.

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Report prepared by: Robert Crum
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Terry L. Bazzarre
Program Officer: Jeane Anne Grisso