Addressing Childhood Wellness in West Georgia I would like to introduce my colleagues, Ms. Gina Brandenburg, Program Manager, Tanner Health System; Dr. Diana Mindrila, Assistant Professor of Research, University of West Georgia, and Ms. Denise Taylor, Sr. Vice President, Community Health, Branding and Strategy Officer, Tanner Health System. Barbara Kawulich, Ph.D. Professor of Research University of West Georgia

Purpose This program evaluation addressed a multi-pronged program of initiatives addressing improved nutrition and increased physical activity for West Georgia youth by Tanner Health System and its community partners. How have the activities affected the number of opportunities for access to affordable healthy food in this region? What changes in fitness level of school aged children are evidenced by FitnessGram results for BMI and HFZ over the two year grant period? In a two-year CDC-funded Community Transformation Grant, which took place in 2013 and 2014, a multi-pronged approach was taken by Tanner Health System’s Get Healthy, Live Well initiative in partnership with community organizations to address the nutritional and physical activity needs of West Georgia’s youth population. Our evaluation focused on how these programs have affected the number of opportunities for our youth to access affordable healthy food in this region and what changes are evidenced in their fitness levels as measured by FitnessGram over the last two years. What I’m focusing on today are the FitnessGram results for the past three years.

Selected Initiatives 7 Cooking Matters classes for kids/teens (86 participants) Power of Produce Program enabled youth to purchase fruits/vegetables (168 participants) Community gardens at schools/youth centers (4 of 12 community gardens designated for/by children) School systems established healthy salad bars and other nutrition education interventions 93 first grade teachers in 15 schools were trained to implement Take 10! With the support of Get Healthy, Live Well, a variety of educational programs were implemented, including 7 Cooking matters classes specifically taught for kids and teens, the Power of Produce program, which gave 168 youth $2 tokens to spend at farmers markets, along with weekly activities involving tasting fresh fruits/vegetables, making seed starters, games and scavenger hunts, and the Zucchini 500 Squash races. Of the 12 community gardens, 4 were designated for youth at schools or community centers, and local school systems provided a variety of nutrition education interventions, including activities that qualified them for the Healthier US Challenge Award, a variety of grants, such as Let’s Move Salad Bars to Schools and Fuel up to Play 60, among others. To increase opportunities for kids to be active, Dr. Brian Mosier provided training on Take 10! To 93 first grade teachers in 15 schools. This served as a beginning step in the Power up for 30 program that the school systems are committed to implement.

School System Initiatives Training for school nutrition directors to focus on healthy school meals Carrollton City awarded USDA Regional Best Practice Award in 2013 2014 Gold level recognition for Golden Radish Farm to School initiative CJHS selected by USDA as GA test kitchen Various grants from GA SHAPE, Action for Healthy Kids, Let’s Move, Southeastern Dairy Council, USDA Farm to School In September, 2013, an educational training event was help for local school nutrition directors to assist them in making changes to qualify for the Healthier US Challenge Award. Four of the five systems were represented. Some of the improvements made included establishing meal pattern standards for lunches, nutritional signage, grants for Let’s Move Salad Bars to Schools, Fuel Up to Play 60, Southeastern Dairy Council grant and Action for Healthy Kids to expand breakfast programs, Grab & Go Breakfast plan, Georgia Shape Planning grants for all school systems, and USDA Farm to School Planning grant, among others. In 2013, Carrollton City was awarded USDA’s Regional Best Practice award, and in 2014, they received gold level recognition for their Golden Radish Farm to School initiative. Carrollton Junior High School was selected by the USDA as a Georgia Test Kitchen. These are just a few of the initiatives in which the schools of this region participated and which continue to expand and contribute to the fitness of our youth today.

Results FitnessGram results were used as the quantitative means for determining effectiveness of the multi-pronged interventions. FitnessGram results for Bremen City, Carrollton City, Carroll County, Haralson County, and Heard County were compared for 2011-12 (baseline), 2012-13, and 2013-14. We analyzed FitnessGram data for 2011-12, 2012-13, and 2013-14 school years.

Average BMI by Gender and School Year for 5 School Systems Average BMI showed an increase of 0.5 points from 2011-12 to 2012-13 and decrease of 0.3 points from 2012-13 to 2013-14. Repeated measures analysis of variance using school level data did not show significant differences in school BMI averages across years.

Average Percentage of Students in HFZ by Gender and Year for 5 School Systems The average percentage of students in the Healthy Fitness Zone (HFZ) decreased by 4.6% from the 2011-12 to the 2012-13 school year and increased by 1.3% from the 2012-13 to the 2013-14 school year.

Trends in Average BMI by Year for 5 School Systems A similar pattern was observed across school districts, except for Bremen City, where the average BMI was relatively consistent across years. Heard County was the only school district to show a decrease in average BMI from the 2011-12 to the 2013-14 school year.

Trends in Average % of Students in HFZ by Year for 5 School Systems In Bremen City and Heard County the percentage of students in HFZ increased by 5% and 8% respectively, while in the other school systems, the percentage of students in HFZ decreased across years. The changes in average BMI observed at the school system level were consistent across genders. Nevertheless, changes in the percentage of students in HFZ showed slight variations across genders in Carrollton City, Haralson County, and Heard County. For instance, in Haralson County the female percentage in HFZ decreased consistently across years, whereas the male percentage decreased from the 2011-12 to the 2012-13 school year, and increased from the 2012-13 to the 2013-14 school year. While results do not indicate that significant changes have occurred in BMI averages and percentages of students scoring in the HFZ, we will continue the multi-pronged effort. These interventions began in mid-2013 and had only been in progress for little more than a year at the time of analysis; our efforts to address the nutrition and physical activity needs of West Georgia youth continue to grow through expansion of existing programs. Whereas much of the effort thus far has concentrated on improving nutrition, that emphasis is being broadened to include more focus on physical activity. For example, to date, sixteen schools in four systems have committed to participate in the Power Up for 30 program, an effort that was initiated in Georgia in 2014 and which will provide more opportunities for youth to be physically active during the school day. Dr. Brian Mosier held training sessions in November, 2014, and January, 2015, to prepare teachers and administrators for implementing the program. In addition, Carrollton City school system, during the August, 2015, pre-planning period prior to the onset of classes, Dr. Mosier, sponsored by Get Healthy, Live Well, provided the Power up for 30 training to every elementary teacher. Further, Get Healthy, Live Well formed a Safe Routes to School task force of interested parents and community partners who created a plan that was adopted by the Carrollton City Schools Board of Education; as a result, more kids are riding bikes and walking to school regularly. The overarching goal is to provide nutritious snacks and meals to our school aged youth and to provide opportunities for them to become more physically active during the school day by maximizing the use of personnel and facilities to help schools meet their health and academic goals through a united community effort.