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POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Making Healthy EatingPolicy Practice
September 26, 2017
Michael W. Beets, M.Ed., M.P.H., Ph.D. and R. Glenn Weaver, Ph.DArnold School of Public Health, University of South Carolina
HERO Webinar
Hosted By
Paul Terry, Ph.D.President and CEO
HERO
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Making Healthy EatingPolicy Practice
A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in Afterschool Programs
Michael W. Beets, M.Ed., M.P.H., Ph.D. and R. Glenn Weaver, Ph.DArnold School of Public Health, University of South Carolina
Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL112787. The content is solely the responsibility of the authors and does
not necessarily represent the official views of the National Institutes of Health
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 1
What is your primary audience for your work in health promotion?
A. Worksite based health promotionB. School or youth based health promotionC. University, academic, researchD. Health systems, healthcare, communityE. Provider / vendor of health promotion services
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Focus onHealthy Eating in Afterschool Programs
Afterschool programs (3-6pm)Non-sport or single activity focused
Serve Snacks, Homework,Enrichment, Physical Activity
Operate everyday of school year
10.2 million youth attend
~8hrs/week
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Policies/Standardsin ASPs Healthy Eating
Types of foods and beverages served
FV and Water everyday
No sugar-based foods or drinks
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Increased
Child
HEPAPolicy
How we think policy works
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Beets, M. W., Webster, C., Saunders, R., & Huberty, J. L. (2013). Translating policies into practice: a framework for addressing childhood obesity in afterschool programs. Health Promotion Practice, 14(2), 228-237.
ASPs more complex than simply
adding policy to make changes
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
PolicyStaff
Competencies
OST Environment
• feedback loop •
Changes in Routine Practice(Considerations for differences among OSTs in human and physical resources)
Indoor/Outdoor Play Spaces & Size,
Equipment Availability, Curricula,
Evaluation, Equity Physical Activities
Attitudes & Beliefs, Skills, Modeling,
Competencies, Roles & Responsibilities
Increased
Child
HEPA
Policies need to be S.M.A.R.T.
(Specific, Measureable, Attainable,
Realistic, and Time-Bound)
Ongoing Compliance/Oversight • Technical Assistance
Continuous modification of policy goals
How policy “actually” works, maybe…
Outside Organizational
Partnerships (e.g., Universities)Collaboratively develop “how to get there” Most modifiable
characteristic of OST
programs – STAFFLeaders and Frontline Staff
Policies only state
(clearly or unclearly)
where practice should go –
NOT how to get there
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Policy is paramount, but…
alone it’s insufficient
“Best” Policy
Nexus of public health impact andwhat practice can deliver
(given a realistic amount of resources)
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
D C-SS S-unFl S-Fl V F
Serv
ing
s o
f F
ood I
tem
s (
Days/W
eek)
Afterschool Program (N = 20)
Single food item served for
snack each day(Desserts 3 days, Cereal Sugar
Sweetened 1 day, Salty Flavored 1 day)
Multiple food items served for snack each
day, children offered choice to selected
single item to eat(Program #6 served a total of 18 food items in one
week, with an average of 3 food items served per day,
for example choice of snack for a single day might
include a fruit, dessert, and salty flavored choices)
NOTE: Programs with less than 5 days
of food items served, served one or
more of the following: cereal
unsweetened, dairy, dairy sweetened,
non-fruit fruit, and/or processed meats
Desserts Cereal Salty Unflavored Salty Flavored Vegetables Fruit
Sugar-sweetened Flavored
Five most common
snack items served
Recommended snacks to
serve each day
Dashed line represents 5 day
week snack offerings
ASPs fail to serve a fruit or vegetable on any days, let alone dailyCheap empty calories that are Refined, Artificially flavored, and individually Packaged
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
What do ASPsneed to achieve HEPA?
Low or No CostRun on limited budget
Easy to implementHigh year-to-year staff turnover, part-timers, low skilled
Integrate into existing practice
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Strategies ToEnhance Practice (STEPs)Intervention Framework
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
0.7
2.6
1.5
2.3
0.6
2.9
2.4
2.7
0.8
2.7
1.5
3.0
4.1
0.3
0.1
4.4
1.7
2.1
0.5
3.7
4.3
0.6
0.0
4.8
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Total fruits andvegetables
Desserts Total Sugar-sweetenedBeverages
Water Total fruits andvegetables
Desserts Total Sugar-sweetenedBeverages
Water
Delayed Treatement1Year Intervention (n = 10)
Immeidate Treatement2YearsIntervention (n = 10)Non-Intervention Year
Intervention YearN
um
ber
of D
ays/
Week
Item
Serv
ed
Healthy Eating 2 Year Outcomes
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Take Home
• Increases Achieved in Programs with…
• Control over snacks AND operating in own space
• Few Changes made in Programs without…
• Control over snacks OR
• Operating in someone else's space
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Take Home
• Outside Food/Beverage Guidelines
• Federal Reimbursement
• Difficult to convince providers to change snacks
• Across ASP and SDC providers
• Programs serving meals
• Increases challenges of altering kcal/macro/micro
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Take Home
• Changes in Snacks lead to SMALLimprovements in…
• kcals
• Select Micro and Macro nutrients
• Snacks are calorically capped – do changes really need to be made…?
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 2
Schools have led the nation in reducing access to bad for you foods.Which best represents your view of how changing food policies at companies will be different?
A. I don’t see much of a difference.B. It’s somewhat harder in companies. Unhappy students can’t be
compared to unhappy employees.C. It’s considerably harder in companies. Schools are expected to be
paternalistic but policy that relates to autonomy is more deeply felt among adults. Please don’t take my donuts!
D. It’s crazy harder in companies. Leaders tampering with food choice do so at their peril. Keep your damn hands off our donuts you Bloomberg style nanny Staters. (Must read: “Saving Gothum” by Tom Farley)
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 3
Let’s say you have a plan for reducing access to bad for you food by 75% gradually over five years and your communications plan is brilliant, persuasive and sensitive. What % of employees will be happy vs. unhappy?
A. 80% Happy – 20% UnhappyB. 60% Happy – 40% UnhappyC. 50 / 50D. 40% Happy – 60% UnhappyE. 20% Happy – 80% Unhappy
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 4
Many factors affect whether we choose healthier options. Which is the topissue you consider most persuasive when communicating about changes in food policy at the workplace?
A. The Financial Cost Burden we all incur from unhealthy eatingB. The Social Justice Benefits of carefully examining our food
manufacturing chainC. The Community Benefits of more local sourcing of foodsD. The Health Burden and suffering related to obesity and chronic diseaseE. The Personal Benefits of a relationship with real food such as we had in
the past
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 5
Many have long held that we should not refer to food as good or bad. Given today’s obesogenic culture, is it time to acknowledge there are “bad-for-you” foods? (i.e. processed foods high in sugar, salt and/or fat)
A. Strongly AgreeB. AgreeC. Not SureD. DisagreeE. Strongly Disagree
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 6
If we’re going to successfully change food policies, as compared to tobacco policy changes over the years, we should mostly emphasize the:
A. Health issuesB. Ecological issuesC. Social justice issues
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 7
Workplace health promotion practitioners advance many initiatives each year to advance health and well-being. Where does changing food access fit with other priorities like offering screenings, increasing engagement, new learning modalities, tobacco policy, incentives policies, stress and resiliency, etc.?
A. Improving food choices is already a high priority and we’re currently making substantial changes.
B. It’s in our list of high priorities and we’ll likely be making changes in the next year or two.
C. Food policy is of interest but not a high priority in the next year or two.
D. Food policy is a low priority compared to other issues for us. No likely action anytime soon.
E. It’s not on our radar and it’s doubtful it will ever be.
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Poll Question 8
Reducing access to bad for you foods is one of the most significant opportunities we have for improving the health of employees, families and communities.
A. Strongly AgreeB. AgreeC. Not SureD. DisagreeE. Strongly Disagree
POLICY TO PRACTICE IN YOUTH PROGRAMS ● MAKING POLICY PRACTICE – 2 YEAR FINDINGS AND IMPLICATIONS ● [email protected] ● P2YP.ORG
Thank You