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The text and photographs contained on this diskette are copyrighted and registered with the United States Copyright Office and may not be duplicated or modified in any way nor can a portion of any size be incorporated into the work of another without prior written consent of the author, the Women’s Heart Foundation. Copyrights © WHF1999 All Rights Reserved. WHF, P.O. Box 7827, Trenton, NJ. 08628. www.womensheart.org Rel 2004-07

Presenter: Bonnie Arkus, RN , WHF Exec Director and Founder

NJEA Convention 2008

Nov 6 & 7

Raising the Bar for Girl Health©

A successful gym-alternative program that can finally institutionalize essential health, wellness and prevention programs in our schools

The Problem

• The past 20 years, obesity rates of adults and children have doubled in America and tripled in teens.

• As the number of overweight children continues climb, so too their risks for type II diabetes, and the development of chronic disabling conditions and premature death if they remain untreated

• Changing habits NOW is key

Why the Rutgers University did this particular study with WHF

• In 2002, educators at the Trenton Central High School approached the Women’s Heart Foundation with concern for teen girls’unhealthy lifestyle choices and requested a wellness and healthy lifestyles intervention program

Champion for the Cause

Teacher Ruthann Bailey Championed girl health at TCHS and helped bring Teen Esteem Health and Fitness into the school

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A Collaborative Research Project

Constance Kelley, Lead Teacher

Kathleen Ashton, RN, PhD, APRN, Lead Investigator

Who was studied?• Vulnerable minority teen girls• The study included

– 126 10th-grade female students yr 2004-05– 122 10th-grade female students yr 2005-06 – 130 10th-grade female students yr 2006-07

• Population of participants: 55% African American; 20% Hispanic; 10% white; 15% non-white other

Community Related Issues:• STD’s: When comparing Mercer county STD rates

to other counties in the state, it ranked third highest for gonorrhea and sixth highest for Chlamydia. (NJDHSS, 2004).

• HIV/AIDS: Of all NJ cities Trenton has the 6th highest population of HIV/AIDS infected individuals (NJDHSS, 2007).

• School Violence: 2006 news- TCHS named the most violent school in the state with over 30 gang-related deaths the prior year. Many students say they don’t feel safe in their community… murders, vandalism, deteriorating school, The Tipping Point

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Research HypothesesSubjects in the experimental group who complete the

nutrition/fitness program will demonstrate:1. Greater levels of self-esteem as measured by the

Multidimensional Self Concept Scale (MSCS)2. Improved scores on the nutrition subscale of the

Youth Risk Behavior Surveillance Survey (YRBSS)3. Improved scores on the physical activity subscale of

the Youth Risk Behavior Surveillance Survey 4. Body Mass Index (BMI),BP,waist circumference, blood

glucose, and cholesterol all in the acceptable range

How was the study done?• Students had a physical exam by school physician and

blood drawn for blood sugar, cholesterol, triglycerides• The students self-selected to a class that met five days a

week for 42 minutes over the entire school year (8 ½mos)

• Students were taught about healthy eating. They also prepared heart-healthy recipes in the Teen Esteem kitchen, under the direction of a registered dietitian

• A weekly interactive health class took place. • Students took part in a structured physical activity 3 days

a week that included one day with a personal trainer• Survey tools were employed to measure youth risk at the

beginning and again, at the end of the school year. The students in “regular” gym class served as the control group

Target Community: TrentonDemographic Comparisons

New Jersey

Trenton Hamilton Bordentown

Total population 8,414,350 85,403 87,109 8,380

Race: White (%) 72.6 32.6 85.1 89.3

Race: Black or African American (%)

13.6 52.1 8.2 5.0

Hispanic or Latino (of any race, %)

13.3 21.5 5.1 3.0

Household Type: married couple family (%)

53.5 29.0 55.3 56.5

Household Type: femalehouseholder, noHusband present (%)

12.6 27.1 11.5 9.8

(source: US Census Bureau, 2000)

Physical Measurements taken in September and April

• Blood Pressure• Height• Weight (BMI scores obtained)• Waist circumference• Blood Work (Yr 1+2)• BMI results + metabolic

syndrome indicators shared with school nurse, parents and student at the end of school year

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Instruments

• The Multidimensional Self-Concept Scale (MSCS)

• The Youth Risk Behavior Surveillance Survey (YRBSS)– The nutrition subscale– The physical activity subscale

• Year 3, the Forms were modified to one page to increase rate of completion

What did the researchers find?

Results YEARS 1 & 2• Improvements in

– Average waist circumference– Overall glucose and lipid levels

• Greater % of girls eating 2 or more servings of fruits and vegetables each day

• In TE participants -zero high school dropouts• Increase in participation in exercise classes

(90% vs less than 50% in regular gym class

Results YEAR 3

• Improvements in– Waist circumference – BMI– Intake of Green Salad – Blood Pressure – Self esteem

• TE participants -zero high school dropouts• Increase in participation in exercise

classes

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What were the limitationsof the study?

• Funding– depended upon volunteer support from Rutgers community-

graduate nurse program + researchers– Lipid panel obtained year two only, yet this was the best

indicator for evidence-based intervention of inflammatory markers for metabolic syndrome (early diabetes)

• School attendance sporadic each spring, hence ability to collect end-of-year data limited affecting results of the study

• Participants self-selected - may impact results• Large number of non-responders in both groups in the

follow up groups

How the Program Worked

• Monday: C-V Activity -Exercise Circuit• Tuesday: Health w/ a series of expert presenters

• Wednesday: C-V Activity -Personal Trainer• Thursday: Nutrition• Friday: C-V Activity -Karate or Power Walk

(“teacher’s pick”)

The School Nurse and the School Resource Counselor

Devote 2 days each to Teen Esteem

Barbara Palmer, RN , TCHS

Shakina Jones, Resource Counselor, TCHS - SYBS Program

Health Partners as Expert Presenters

• UMDNJ School of Health Professionals Dietetic Internship Programs – Shopping for a Healthy Heart

• Rutgers Extension Services – Hands-on prep of heart-healthy foods

• Rutgers University Camden – Cutting, Eating Disorders, Violence in the Home and Self-protection, Date Rape

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Shopping for a Healthy Heart©UMDNJ School of Health Professionals- Dietetic Interns

Media Imageshyper-sexualization of Teens… ads purposely reminiscent of child pornography

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Peer Leadership & Mentoring Support End of Year Celebrations

What were the implications of the study?• A comprehensive, customized 8 ½ month

program in an all-girl fitness environment can improve participation rate in health and physical education classes and promote healthful habits in a group of people likely to develop type 2 diabetes. The program can also help keep teen girls in school

• Behavior change can take place in the short-term, indicating a need to continue the study long-term

Tools, curriculum and equipment• TEEN ESTEEM Recipe book• TEEN ESTEEM Exercise

book with health card• Teacher manual• Data base to measure

outcomes• Electronic Scale• Yard stick for height• Cloth tape for waist • Omron digital blood

pressure machine• Fully equipped kitchen with

work island

• Exercise circuit• Yoga physio balls – 24-30• Bands, jump ropes• Stable for balls• Wood or cork dance floor• Plexi-glass mirrors and regular

mirrors• Resource station • TV with VCR and DVD player• 4 Round tables. 24 chairs• Sound system and Dynamix CD

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Our Staff• Personal Trainer to teach students how to use

circuit equipment and for weekly sessions• Nutritionist and dietary aide for hands-on

preparation of heart-healthy foods in TE kitchen• Project manager• Volunteers to help collect /input data• Researchers to analyze data• Volunteers for mentoring support • Expert presenters from universities and in-school

support• Measurements-day support- School of Nursing

Measurements Day Expanded Sept08

• Height• Weight• Waist• Arms, neck, hips• Acanthosis Nigricans• Blood pressure• Endurance tests• Irregular pulse• Clinical signs of arrhythmia

disturbance

Screening for Acanthosis nigricansAcanthosis nigricans is a skin thickness and

discoloration that can easily be evaluated by a simple visual examination (the same child in grades 1,2,3,4)

Source: CARDIAC Kid study website– West Virginia Dept Health

1st Grade 2nd Grade

3rd Grade 4th Grade

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Comparative Studies

• CARDIAC Kid• CARDIAC Kinder• NY City Junior High School Fitness

Intervention

Source: CARDIAC Kid study website– West Virginia Dept Health

Source: CARDIAC Kider study website– West Virginia Dept Health

“Change doesn’t come FROM

Washington…

Change comes TO Washington”

-President-elect Barrack Obama

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Change: Churches and Senior Sites• Start a QUALITY OF LIFE committee to

advise your town council on needed changes• Start a “7 Sounds 7 Days 7 Dollars” initiative

with seven churches in your community committing to adult dance opportunities w/ income to churches

• Start free fitness and wellness programs for younger women under age 65. Promote consumerism. Share the space with Senior Centers when not in use. Reserve 2hrs/day

Change: Community Planning• Town Centers as a destination point • Dedicated and safe walk and bike paths with

adequate space• Roads not to be in constant state of disrepair

(install utilities under green space and not under roadways)

• Connected mass transit systems• Free year-round fitness - A swimming pool in

every high school with free community swim for seniors and parents to swim 20/day, subsidy by town to cover lifeguard and chlorine (implemented successfully in Morris twp by Mayor Cecelia Birge. Seniors no longer balk at paying school taxes)

Change: Corporate America Needs to Put Families First

• A reduced work day to mirror the child’s school day (No more latch-key children. Moms reclaim their neighborhoods. Allow safe active outdoor playtime for kids)

• A reduced work schedule with no loss of benefits for caregivers of elderly or disabled family member

• 1-month summer vacation to reconnect with family

Change: Go Green at Schools• Incorporate “Farm to Table” concept in every

school with organic farming, hot house and foods that are served up in cafeteria that are fresh and “home grown”

• Teachers: Limit screen time assignments and homework to a total of 1 hour/day

• Parents of obese children: Attend in-school dietitian-led classes with your child on vegetarian and Mediterranean-style cooking and take home the family meal as a reward for attending and participating.

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Change: Healthy Lifestyle Programs as a part of School Curriculum

• Revise “regular” gym curriculum to include healthy lifestyles program in a nurturing environment. Teach vital consumer skills and critical thinking

• Monitor risks. Measure and benchmark results. Respond to needs.

• Free breakfast program in every school, regardless of family income. Serve only unprocessed whole grain foods.

WHF’s Challenge: Facilitate Change

• Establish Wellness Communitiesfor Prevention in Schools

• Measure Cardio-metabolic risksand Outcomes in a db that can be shared through web interface

• Form new partnerships to devise effective intervention programs that show positive results

Health Challenges• What are we measuring in our kids and

why? What does it all mean? Nurses are on the sidelines. Lack of research contributes to lack of action, no buy-in

• High cholesterol is not meaningful data in teen girls. Low HDL is more important number to know; full lipid panel is expensive

• What types of screenings should be allowed in schools? Who decides?

Can Nurturing Healthy Lifestyles Programs in Schools Help Reduce the Incidence of School Violence?

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The Coalition forHeart Disease Prevention

Rutgers University-Camden

The College of New Jersey

Rutgers Extension Services

UMDNJ School Dietetic Internship Program

…and our children are waitingThe TOOLS are in Hand

Teen Girls are at Highest Risk

…let’s not break their hearts Women’s Heart Foundationwww.WomensHeart.org

improving survival and quality of life through wellness and prevention programs

Contact: bonnie@womensheart.org