Evaluation of School and Childcare Sector Strategies in Delaware

The Program Being Evaluated

Nemours Health and Prevention Services (NHPS), a division of Nemours, launched a child healthy lifestyle initiative called “5-2-1-Almost None” to promote healthy eating and physical activity among Delaware children. NHPS’ efforts are focused on spreading comprehensive policy and practice changes that promote healthier environments.

In 2007, Robert Wood Johnson Foundation awarded NHPS a grant to improve data collection and to monitor implementation of NHPS policies and practices in schools, child-care settings, and efforts at the population level.

About the Evaluation

The Delaware Survey of Children’s Health (DSCH) monitors population-level BMI trends, healthy eating, and physical activity behaviors among Delaware children.

Two hundred and forty-four direct observations of physical activity during physical education (PE) classes in Delaware elementary schools were completed during the 2011-2012 school year.

Surveys of 118 school principals, 74 PE teachers and 74 cafeteria mangers in the 2010-2011 school year were conducted to measure the implementation of and attitudes toward healthy eating and physical activity policies and programs in Delaware schools.

Physical activity tests using a FitnessGram were administered to 40,979 students in the 2010-2011 school year to examine the association and relationships between students’ physical fitness levels, math and reading performance, attendance and discipline-related behaviors while controlling for sex, race/ethnicity and other factors.

Surveys, direct observations, and focus groups with childcare center directors and teachers were conducted to measure the effectiveness of promoting healthy eating and physical activity in the childcare environment, and knowledge regarding nutrition, physical activity and screen time standards and recommendations.

Knowledge and Impact

The unique combination of evaluation tools permit in-depth analyses, and reveal the following key findings from policy change aimed at obesity prevention for children in Delaware.

Overweight and Obesity Findings:

  • According to DSCH data, between 2008 and 201112 the obesity trend among Delaware children reached a plateau.
  • Over one-third of Delaware children have been classified as overweight or obese in all demographic groups in all iterations of the DSCH.
  • Results from the 201112 DSCH revealed that the combined rate of overweight and obesity remained unchanged from the 2008 rate of 40.0 percent.

Key Findings in Schools:

  • The analysis shows a significant (p<0.0001) linear relationship between academic achievement scores and students’ fitness levels after controlling for the students’ sex, race, family income and school district in Delaware schools.
  • Over 80 percent of Delaware schools reported having healthy food sold in school cafeterias and offered at school celebrations.
  • Over 80 percent of Delaware schools reported providing at least 20 minutes of recess and almost 40 percent offer structured activities during class time.

Key Findings in Childcare Settings:

  • Eighty-one percent of childcare centers reported that healthy eating and physical activity practices significantly improved.
  • Over 90 percent of teachers and family childcare providers reported complying with the physical activity regulation of 20 minutes of physical activity for every 3 hours of care during morning and afternoon care.

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of Delaware schools that reported providing at least 20 minutes of recess daily

Nemours' "5-2-1-Almost None" Initiative

5 ‐ Five or more fruits and vegetables are consumed each day;

2 ‐ Screen time (television, video games and recreational computer time) is limited to no more than two hours each day;

1 ‐ Children are physically active for at least one hour each day; and

Almost None - Sugar‐sweetened beverages, specifically soft drinks, fruit drinks and sports drinks, are limited to no more than two servings per week.