1. Choose Plain Milk, Not Chocolate: A Health Education Campaign to Remove Chocolate Milk from New York City Elementary Schools Lauren Taylor, MPH Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP Spring Seminar April 7, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. “To protect and promote the health of all New Yorkers” “To strengthen and amplify the Health Department’s work to eliminate health inequities” “To promote health equity and work to reduce health disparities at the neighborhood level” New York City Department of Health and Mental Hygiene

3. Brooklyn District Public Health Office (DPHO) Priorities

4. Healthy Schools Initiative WELLNESS COUNCILS INCREASE PHYSICAL ACTIVITY CHOCOLATE MILK REMOVAL WELLNESS POLICY

5. BACKGROUND

6. Childhood Obesity in NYC  41% of elementary school children are overweight or obese  Obese children are at higher risk for  Bone and Joint Problems  Sleep Apnea  Diabetes  Heart disease  Hypertension  Many types of cancer *New York City FITNESSGRAM, New York City Department of Education & New York City Department of Health and Mental Hygiene Office of School Health *Centers for Disease Control and Prevention. Childhood Obesity Facts. http://www.cdc.gov/healthyschools/obesity/facts.htmhttp://www.cdc.gov/healthyschools/obesity/facts.htm

7. Obesity Rates in DPHO Neighborhoods East & Central Harlem North & Central Brooklyn South Bronx

8. RATIONALE FOR PROJECT

9. Sugar-Sweetened Beverages  Are the single biggest contributor to the nation’s obesity epidemic  Promote tooth decay - one of the most common chronic conditions of childhood  A New York State Survey found about 4 out of 10 NYC 3 rd graders have experienced cavities  Have no added nutritional value *Bleich, SN, Wang YC, Wang Y, Gortmaker SL: Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr 2009; 89: 372:381. *American Dental Association. Mouth Healthy. http://www.mouthhealthy.org/en/nutritionhttp://www.mouthhealthy.org/en/nutrition *NYS 2009-2012 3 rd Grade Survey *Image: http://appforhealth.com/2015/01/added-sugar/http://appforhealth.com/2015/01/added-sugar/

10. Kids & Added Sugar  Less than 5% of a child’s daily calories should come from added sugars  For a 7-year old child, that’s about 15 grams  One eight-ounce carton of chocolate milk in NYC schools contains 8 grams of added sugar If a child drinks two cartons of chocolate milk at school… They have already met the daily recommended amount of added sugar *WHO Guidelines: Sugar intake for adults and children What does this mean?

11. = Once a day40 grams of Added Sugar Each Week

12. An easy way to reduce sugar intake… Remove chocolate milk! USDA requires that schools serve two milk options; these options do not have to include chocolate milk These two options can be: 1% plain milk and skim plain milk

13. Milk Consumption in Schools Children entering elementary school are already accustomed to drinking plain milk The recommended-daily value of calcium can come from a variety of sources readily available in schools (leafy greens, cheeses, beans, oranges, etc.) Other large school districts have successfully eliminated flavored milk

14. HEALTH EDUCATION CAMPAIGN

15. Chocolate Milk Removal Campaign  To motivate individual schools to adopt a plain milk policy  Pressure from special interest groups  Similar process to remove whole milk  Initiative has two components  Healthy Schools Survey  Educational Materials Development

16. Pressure from Special Interest Groups *American Dairy Council

17. Methods School Survey Bronx, Harlem & Brooklyn In-person Interviews Collaborate to Develop Materials Palm CardFact Sheet Removal Guide Presentati on Letter Template Disseminate Materials Provide Technical Assistance Presentation Disseminate Materials

18. School Survey

19. SCHOOL SURVEY FINDINGS

20. Chocolate Milk  Reached out to 310 elementary schools  233 surveys completed (75%)

21. Schools Currently Serving Chocolate Milk Of the Schools Surveyed (N=233):  73% currently serve chocolate milk (n=170)  27% do not Serve Chocolate Milk (n=63)

22. EDUCATIONAL MATERIALS

23. Fact Sheet

24. Palm Card

25. Chocolate Milk Removal Guide TECHNICAL ASSISTANCE

26. PowerPoint Presentation  Target Audience: school staff, parents or students  Content  Childhood obesity data  Rationale for chocolate milk removal  Examples of Department of Health and Department of Education initiatives focused on addressing obesity  Examples of programs and changes schools have implemented to promote nutrition and physical activity  How to remove chocolate milk  “Canned” presentation for citywide use

27. Letter Template Date Dear School Food Manager, Our school, [insert name], would like to stop serving chocolate milk in the cafeteria as of MM/DD/YYYY (Remember that orders are placed up to 6 weeks in advance) to reduce students’ consumption of sugary beverages. For the two milk options that are required by the USDA, we would like to offer our students fat-free plain milk and low-fat plain milk. Thank you and please confirm that this menu change will take place on the date requested above. Sincerely, Principal

28. Evaluation Plan & Impact  Outreach began November 2015  Evaluation Plan  Materials Dissemination  Technical Assistance Requests  Adoption of Plain Milk Policy  Implications for Practice  Direct assistance to schools facilitates changes to school wellness environment  Increase in schools advocating for chocolate milk removal --> strengthen support for a citywide plain milk policy

29. Challenges and Lessons Learned  Working in schools is difficult  Survey method presented challenges  Chocolate milk is controversial!  Developing health education materials is an iterative process

31. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Lauren Taylor Email: ypd1@cdc.govypd1@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support