Healthy Food Choices

Healthy Food ChoicesBy: Kara Derry, Nichole Kraai, Jessica Olcheske, Nicole Towns, & William Winowiecki

For our group presentation we chose to bring Healthy Food Choices for adolescents and families to the Kent County region. This presentation was created by Kara Derry, Nichole Kraai, Jessica Olcheske, Nicole Towns, & William Winowiecki

U.S. Statistics31.8% of children and adolescents 2-19 years were either overweight or obese70 to 80 percent of overweight children become obese adultsMore than 25 percent of all U.S. health care costs are related to obesity and inactivityBetween 1979 and 1999, obesity-associated hospital costs for children tripled from $35 million to $127 millionEmpty calories from added sugars and solid fats contribute to 40% of daily calories for children and adolescents aged 218 years Nearly half of these empty calories come from six sources: Soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk (Ogden, Carroll. Kit, & Flegal, 2012) (Center for Disease Control and Prevention [CDC], 2013) (Healthy Kids, Healthy Michigan [HKHM], n.d.)

In the United States 31.8% of children and adolescents 2-19 years were either overweight or obese and 70 to 80 percent of overweight adolescents will become obese adults. Over 25 percent of U.S health care costs are related to obesity and inactivity. Obesity- associated hospital costs for children tripled from $35 million to $127 million between 1979 and 1999. Many of these empty calories consumed by the youth ages 2-18 years are from added sugars and solid fats, which contributes to 40% of their daily calories. Approximately half of these calories are from six sources, which include soda, fruit drinks, dairy desserts, grain desserts, pizza and whole milk. This affects the overall quality of their diets and eating habits. U. S. StatisticsAdolescents drink more full-calorie soda per day than milk Males ages 1219 drink more than twice as much soda as milkFemales drink on average 2 and times soda than milkObese children ages 611 in the U. S. increased from 7% in 1980 to nearly 18% in 2010.Obese adolescents ages 1219 in the U.S. increased from 5% to 18% over the same periodIn 2010, more than one third of children and adolescents were overweight or obese (CDC, 2013) (HKHM, n.d.)

In the U.S. adolsecents drink more full calorie soda per day than milk. Males ages 12-19 drink an average of 22 ounces of soda per day, which is more than twice their intake of milk. Males average about 10 ounces of milk daily. Females ages 12-19 drink an average of 14 ounces of soda per day and only 6 ounces of milk. Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. The percentage of obese children ages 6-11 in the United States increased from 7% in 1980 to nearly 18% in 2010. The percentage of obese adolescents ages 12-19 in the U.S. increased from 5% in 1980 to nearly 18% in 2010. In 2010 more than one third of children and adolescents were overweight or obese.Michigan Statistics18.2 percent of Michigan youth ages 10-17 are overweight and 12.4 percent are considered obese, compared to the U.S. percentage of 15.3 overweight and 16.4 obese.

(Healthy Kids Healthy Michigan, 2007)

According to the National Survey of Childrens Health (2007) 18.2 percent of Michigans youth ages 10-17 are overweight and 12.4 percent are considered obese, Overall in the US the percentage of youth that are overweight is 15.3 percent and16.4 percent for obese. Community Problem DiagnosisAccording to Michigan Public Health Institute (2011), access to healthy food has a national benchmark of 92% and Kent County is at 89%. With that being said, we would like children ages 18 and under in Kent County to have access to healthier foods with an overall goal to meet the national benchmark of 92%.

Our vision is that we want the children of Kent County to live a healthier lifestyle.

(Michigan Public Health Institute [MPHI], 2011)

According to the Michigan Public Health Institute (MPHI) (2011), access to healthy food has a national benchmark of 92% and Kent County is at 89%. Knowing this, we would like children ages 18 and under in Kent County to have better access to healthier foods. Our vision is that we want the children of Kent County to live a healthier lifestyle.Kent County StatisticsAccording to Kent County Health Connect (2013), the following statistics stand true for Kent County 29% of adults are obese34% of youth report eating healthy or balanced meals19,200 people do not have access to a grocery store or fresh produce

(Kent County Health Connect [KCHC], 2013)

According to Kent County Health Connect (2013), 29% of adults in Kent County are obese. Only 34% of youth in Kent County report eating healthy or balanced meals. 19,200 people in Kent County do not have access to a grocery store or fresh produce.Current Kent County ResourcesKent County Coordinated School Health Program (KCCSHP)Works with income-eligible schools in promoting healthy behaviors of studentsHelps schools assess nutrition and physical activitySupply access to community resources and implement plan of actionAction for Healthy Kids (MAFHK)Non-profit org fighting against childhood obesity by partnering with schools to improve nutrition and physical activityOffer education series to elementary, middle and high school children (Access Kent, 2013)

Kent County has several resources already in place. These include the Kent County Coordinated School Health program (KCCSHP) and Action for Healthy Kids (MAFHK). The KCCSHP works with income-eligible schools in promoting healthy behaviors of students. They also help schools assess nutrition and physical activity levels that are currently in place and what they need to do for improvement. The program supplies access to community resources and implement a plan of action. MAFHK is a non-profit organization that fights against childhood obesity by partnering with schools to improve nutrition and physical activity. They offer an educational series to elementary, middle and high school children. Community StrengthsStrengths include having resources already available in the community and in place like KCCSHP and MAFHK

Noticing that changes need to be made and taking the steps to do it

Having information available on accesskent.com under school wellness, which includes contact information

Having access to healthy foods at local farmers markets for families to shop at

(Access Kent, 2013)

Kent County has several strengths as a community, these include having resources already available in the community like KCCSHP and MAFHK. Kent county has noticed that changes are needed and are taking the necessary steps to so. Access Kent.com has information on the different programs available in the county. Kent county also offers access to healthy foods at local farmers markets where families can shop. Two of the farmers markets are located on the bus route. There are several links to two local farmers markets. The other link brings you to a site that you can look up farmers markets available in your area.Community Barriers/ Unmodifiable FactorsAccording to MPHI (2011), Lack of healthy food resourcesWhere resources are available they are often very expensiveAs many as one fifth of children in Kent County live in povertyLack of options for people with dietary restrictionsHealth foods are not always available in schoolsVending machines Convenience and abundance of fast foods chains with affordable prices(MPHI, 2011)

According to MPHI (2011) Some of the barriers to healthy eating are the lack of healthy food resources in some communities and the dependence on the corner stores that either do not carry healthy food options or carry them at a cost prohibitive price. Also while food is available through food pantries, they do not always have healthy food or food for people with dietary restrictions. We also heard that there was a difference in the healthy food options in different schools, with some districts making healthy food available and others not. School vending machines also get in the way of healthy eating. Some of the food choices made by community members had to do with convenience, saving time by eating fast food, and the affordability and prevalence of fast food chains. Michigan Public health institute (2011) also stated a fifth of the children in Kent County ages birth to five were living in poverty.Causative/ Modifiable Risks or FactorsEating healthy helps reduce the risk of obesity which can reduce the risk of many other diseases Insufficient nutrition can weaken the immune system Children from birth to age 5 are at risk for nutrition deprivationInhibit their ability to learn, grow and fight infections

A second indicator of access to healthy foods is food insecurity. Food insecurity is calculated based on responses to a population survey conducted by the US Census. The rate is made up of three questions, including 1) are you worried your food will run out before you have money to buy more, 2) if the food you bought doesnt last, do you have money to buy more, and 3) can you afford to eat balanced meals. The food insecurity rate for Kent County is 15% overall, but households with children in Kent County experience a much higher food insecurity rate of 23%. (MPHI, 2011)

Having healthy eating habits helps to reduce the risk of obesity. Obesity may lead to diseases like type 2 diabetes, cancer, coronary heart disease and stroke. Having insufficient nutrition can weaken the immune system. Children from birth to five are at risk for nutrition deprivation which could inhibit their ability to learn, grow and fight infections. According to MPHI (2011), A second indicator of access to healthy foods is food insecurity. Food insecurity is calculated based on responses to a population survey conducted by the US Census. The rate is made up of three questions, including 1) are you worried your food will run out before you have money to buy more, 2) if the food you bought doesnt last, do you have money to buy more, and 3) can you afford to eat balanced meals. The food insecurity rate for Kent County is 15% overall, but households with children in Kent County experience a much higher food insecurity rate of 23%.Social Learning TheoryAccording to Harkness and DeMarco (2012) a social learning theory, is a behavior change approach affected by environmental influences, personal factors, and attributes of the behavior itself. Most importantly, a person must believe in his/her capability to perform the behavior (self-efficacy) as well as perceive an incentive to do so (positive expectations outweigh the negative). The immediate or long-term benefits must be valued. (p. 78)Explains some of the factors that contribute to the failure for Kent County to meet the national benchmarkExplains how we can provide intervention to help kids make healthier food choices

According to Harkness and DeMarco (2012), a social learning theory, is a behavior change approach affected by environmental influences, personal factors, and attributes of the behavior itself. Most importantly, a person must believe in his/her capability to perform the behavior (self-efficacy) as well as perceive an incentive to do so (positive expectations outweigh the negative). The immediate or long-term benefits must be valued p.78. This theory explains some of the factors that contribute to the failure for Kent County to meet the national benchmark. It also explains how we can provide intervention to help children and adolescents make healthier food choices. Role of the Public Health NurseThere are approximately 12 roles and obligations that public nurses must followAwareness, recognizing multiple social determinants of healthCapitalizing on community strengthsLeadership Achieving cultural competence Assessment population diagnosis and priority settingPartnering with others Creating environment for careAdvocacyEducating current and future nurses in the public nursing work forceCreating public and agency policies that support and celebrate diversityEvaluation and research We would need our public health nurse to display these characteristics as they would be facilitating the interventions and measuring outcomes.(Schmelzer et al., 2009)

There are approximately 12 roles and obligations that public nurses must follow which include awareness, recognizing multiple social determinants of health, capitalizing on community strengths, leadership, achieving cultural competence, assessment population diagnosis and priority setting, partnering with others, creating environment for care, advocacy, educating current and future nurses in the public nursing work force, creating public and agency policies that support and celebrate diversity, evaluation and research. We would need our public health nurse to display these characteristics as they would be facilitating the interventions and measuring outcomes.InterventionsCollaborate with other agencies by Incorporating Foodcorps in Kent County SchoolsFoodcorps provides education and interventions to help provide better access to healthy foods across the county and locally with the help of The Michigan State Universities Center for Regional Food Systems Foodcorps objectivesTeach children about locally grown foodsHelp them plant and grow gardensMake local healthy foods available in school cafeterias

(Foodcorps, 2011)

Interventions for preventing childhood obesity include collaborating with other agencies by incorporating Foodcorps in Kent County Schools. Foodcorps provides education and interventions to help provide access to healthy foods across the county and locally with the help of the Michigan State Universities Center for Regional Food Systems. Foodcorps objectives include teaching children about locally grown foods. They also help children plant and grow gardens. Foodcorps makes local healthy foods available in school cafeterias. InterventionsThe USDA has a set of standards for schoolsWhole grain rich foods and a first ingredient which may include a fruit, vegetable, dairy product or protein Snack options must have less than 200 calories Entre items must have less than 350 caloriesMust sell plain water, unflavored low fat milk, and unflavored fat free milk 100 percent fruit or vegetable juice

School-based health programs are effective to reduce adolescent obesity (Eisenberg, 2013) (United States Department of Argriculture [USDA], 2013)

The USDA has set standards for schools. They propose that schools must have whole grain rich foods, a first ingredient which include either a fruit, vegetable, dairy product or protein. Other requirements they have in place is school snacks that are less than 200 calories, entree items less than 350 calories and sell plain water, unflavored low fat milk, unflavored fat free milk, and sell 100 percent fruit or vegetable juice. InterventionsW.K. Kellogg Foundation reaches out to communities and help those that are in need. Foundation is funded by grants and donationsEstablish access to fresh, healthy foodsIncreases community engagement to encourage consumption of local foods

(W.K. Kellogg, 2013)

The W. K. Kellogg Fountations goal is to reach out to communities and help those in need. The foundation is funded by grants and donations. One of their goals in Michigan is to establish access to fresh, healthy foods. They also want to increase community engagement to encourage consumption of local foods. InterventionsCafeteria will offer taste testing of new healthy recipes of foods.Many fresh fruits and vegetables, whole grains, and beans are unfamiliar to children and adults, so they need to be given opportunities to sample the foods. Taste-testing and cooking demonstrations in the classroom, at school assemblies, or even in the lunch line can be a fun marketing approach to introducing students to healthy foods that may be unfamiliar to them. (Gibbons, 2009, p.28 )Cafeterias will make healthier options cheaper than unhealthy ones. For students who are sent with money each day, they will get a bigger bang for their buck if they choose healthier options.

Interventions will include cafeterias offering taste testing of new healthy recipes of different types of foods. Many fresh fruits and vegetables, whole grains and beans are unfamiliar to children and adults, so they need to be given the opportunities to sample the foods. Taste-testings and cooking demonstrations in the classroom, at school assemblies, or even in the lunch line can be a fun marketing approach to introducing students to healthy foods that may be unfamiliar to them (Gibbons, 2009). Cafeterias will also make healthier options cheaper than unhealthy options. For students who are sent with money each day, then will get a bigger bang for their buck if they choose healthier options. Desired Outcomes1. 92% of the children that participated in Foodcorps can name one healthy food grown locally that they liked the taste of2. Schools will have a minimum of 75 percent compliance with the new standards set by the USDA by 2014. Then in 2015 they should have 100 percent compliance with these standards3. Every time a new healthy option is introduced it will be offered as a sample 100 percent of the time before serving to see if students will comply with eating these healthier choices4. Kent County will increase the percentage of those with access to healthy foods by 3% in the next five years in order to meet the current national benchmark. That would bring Kent County from 89% to 92%

92% of the children that participated in Foodcorps can name one healthy food grown locally that they liked the taste of. Schools will have a mininum of 75 percent compliance with the new standards set by the USDA by 2014. Then in 2015 thet should have 100 percent compliance with these standards. Every time a new healthy option is introduced it will be offered as a sample 100 percent of the time before serving to see if students will comply with eating these healthier choices. Kent County will increase the percentage of those with access to healthy foods by 3% in the next five years in order to meet the current national benchmark. That would bring Kent County from 89% to 92%.Outcome Measures/ EvaluationOutcome 1: The school will offer an annual survey to the children.

Outcome 2: A daily audit will be completed by the cafeteria workers. The school will calculate and submit their results annually.

Outcome 3: The school will complete a monthly audit. The school will collect data and submit results annually.

Outcome 1 is that the school will offer an annual survey to the children. Outcome 2 is a daily audit will be completed by the cafeteria workers. The school will calculate and submit their results annually. Outcome 3 the school will complete a monthly audit. The school will collect data and submit results annually. Outcome Measures/ Evaluation

Outcome 4: In order to measure access of healthy foods for Kent County to meet the national benchmark, we will mimic the process used to obtain the current result. Four years after full implementation of our interventions we will start a one year process of data collection to identify if we have met our goal of 92% access to healthy foods. 4 Community Input Walls (January, April, July, October) 12 Focus Groups (1 meeting the first week of each month with 10 different members of the community) 365 Intercept Interviews conducted by trained community members (one per day)

In order to measure access of healthy foods for Kent County to meet the national benchmark, we will mimic the process used to obtain the current results. After four years of full implementation of our interventions we will start a one year process of data collection to identify if we have met our goal of 92% access to healthy foods. There will be 4 community input walls of January, April, July and October. There will also be 12 focus groups, have one meeting the first week of each month with 10 different members of the community. Community members will conduct 365 intercept interviews, which is one per day.Social Learning TheoryIn changing the environment in the school system to support healthy eating, children will start to change behaviors. Through education the students will improve in their self-efficacy.

This theory works full circle. The same factors that can contribute to unhealthy food choices can turn around and support children to make healthy choices with the right interventions.

In changing the environment in the school system to support healthy eating, children will start to change behaviors. Through education the students will improve in their self-efficacy. This theory works full circle. The same factors that can contribute to unhealthy food choices can turn around and support children to make healthy choices with the right interventions. References

Access Kent. (2013). School wellness. Retrieved from www.accesskent.comCenter for disease Control and Prevention. (2013). Retrieved from http://www.cdc.gov/Healthy Kids Healthy Michigan. (2007). Childhood obesity epidemic in michigan. Retrieved from http://www.healthykidshealthymich.com/childhood-obesity-facts-and-statistics.htmlDeMartini, D.L., Beck, A.F., Kahn, R.S., & Klein, M.D. (2013). Food insecure families: Description of access and barriers to food from one pediatric primary care center. Journal of Community Health. doi: 10.1007/s10900-013-9731-8.Downtown Market. (n.d.). Retrieved from http://downtownmarketgr.com/Eisenberb, J. (2013). Childhood obesity prevention programs: Comparative effectiveness. Agency for Healthcare Research and Quality, 13.Foodcorps. (2011). Retrieved October 7, 2013 from https://foodcorps.org/Fulton Street Farmers Market. (n.d.). Retrieved From http://fultonstreetmarket.org/history/market-facts/Gibbons, H.W. (2009). Marketing Healthy Choices in the School Cafeteria. Retrieved on October 12, 2013 from http://www.kchealthykids.org/Resource_/ResourceArticle/33/ File/MarketingHealthyFoods.pdf.

ReferencesHarkness, G., DeMarco, R., (2012) Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins: PhiladelphiaHealthy Kids, Healthy Michigan. (n.d.). Retrieved from http://www.healthykidshealthymich.com/Kent County Health Connect. (2013). Retrieved from http://www.kentcountyhealthconnect.org/en-us/healthyeatingactiveliving.aspxMichigan Farmers Market Association. (2012). Retrieved from http://mifma.org/find-a-farmers-market/Michigan Public Health Institute. (2011). Kent County: 2011 health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/pdfs/healthprofile.pdfOgden, C., Carroll, M., Kit, B., & Flegal, K. (2012). Prevalence of obesity and trend in body mass index among S.S. children and adolescence 1999-2010. Journal of American Medical Association, 305(5), pp. 483-490. doi: 10.1001/jama.2012.40Schmelzer, M., Cravetz, M., LaRosa, G., Fischer, N., Smith, F., Garvey, . (2009). The public health nurses role in achieving health equity: Elementary inequalities in health. New Mexico Nurse, 54(4), 6United States Department of Agriculture [USDA]. (2013). Retrieved from http://www.usda.gov/wps/portal/usda/usdahomeW. K. Kellogg Foundation. (n.d.). Michigan. Retrieved from http://www.wkkf.org/where-we-work/united-states/michigan.aspx#2