1. Childhood Obesity Interventions Ideas from the Oklahoma REACH 2010 & REACH CEED Projects

2. Indian Health Care Resource Center of Tulsa  Urban Indian Clinic  Non-profit, run by Board of Directors  Ambulatory clinic  Over 10,500 unduplicated patients in 2009  Medical  Dental  Optometry  Behavioral Health  Health Education & Wellness 47% of youth ages 5 – 19 are overweight or obese

3. IHCRC Clinic Policies  No vending machines  Moving toward healthier snacks for meetings  Beverage container policy  Tobacco-free 24/7

4. IHCRC REACH = New Grants Prevention grants obtained by IHCRC since REACH began:  IHS HPDP grant (renewed 3 rd time)  IHS Children & Youth Program grant  CDC HPDP grant (renewed for 5 more years)  ANA grant  IHS Public Health Nurse grant  Oklahoma Tobacco Settlement Endowment Trust

5. IHCRC Obesity Programs  We Can! Parent education program  Youth exercise class  CATCH intervention  CATCH Training  HEALTHY Training  Summer Camps program  After school programs  Youth dietitian  CYP grant

6. Oklahoma Health Disparities In Oklahoma, obesity is more prevalent among non-Hispanic American Indians at 36.6 percent than non-Hispanic whites at 28.2 percent. The prevalence of diabetes also varies by race and ethnicity in the state; 17.1 percent of non- Hispanic American Indians have diabetes compared to 9.0 percent of non-Hispanic whites. Source: America’s Health Rankings, 2009

7. The Obesity Challenge By 2018, Oklahoma is expected to have the highest obesity rate in the country…. Between 56% & 60% obesity is expected (US – 42% - 47%) Source: America’s Health Rankings, 2009

8. Here in Oklahoma…  49 th in America’s Health Rankings  Prevalence of obesity: 30.9% (12% 1990)  22% of children live in poverty  Food insecurity is a major issue  Food deserts  “3 rd generation food stamp moms”  To reduce obesity, must reduce poverty & food insecurity  School & community gardens growing

9. Potential Healthy Corner Store

10. Healthy Corner Stores Legislation  Signed by governor  “Healthy corner store” means a grocery store that markets locally grown fresh fruits and vegetables and nutritious foods and for which the sale of beer and tobacco products constitutes less than ten percent (10%) of its gross sales excluding gasoline and other non- grocery products.  Designed to reduce obesity by providing healthier food options

11. Oklahoma Challenges  One of 2 states without a health education requirement in public schools  No snack and/or soda tax  No menu labeling law  No “Complete the Streets” policy  No physical activity requirement for middle & high school

12. Oklahoma REACH Project REACH 2010:  Oklahoma State Department of Health - Central Coordinating Organization  Cheyenne Arapaho  Wichita & Affiliated  Seminole  Pawnee  Absentee Shawnee  IHCRC  Cherokee  Chickasaw  Choctaw

13. REACH 2010 Mission Reduce racial & ethnic disparities in cardiovascular disease, diabetes and their risk factors through increased availability and promotion of physical activity on a community level

14. REACH 2010 Summary  Started in 1999  Each coalition partner received $96,000  Typical had 1 FTE staff person  Community Action Plan (CAP) & budget devised to meet needs for intervention in each community  Culturally tailored activities  Focus on creating physical activity opportunities for community members

15. REACH KAP Survey (REACH 2010) The knowledge, attitudes and practice (KAP) survey showed that American Indians know about health and nutrition but feel they lack the skills to make changes themselves or to assist others with changes.

16. Accomplishments  Over 75 REACH staff & community members trained as physical activity leaders  Completed over 200 training sessions  Developed partnerships with local tribal governments, colleges, IHS or Tribal health services, public schools, local gyms  Over 75 fitness activities offered each week, in REACH communities (56 counties)  Over 6000 participants

17. REACH 2010 Outcomes  Three smoke-free tribal facilities  Three tribal nation employee health breaks  Four walking trails and playgrounds at tribal facilities  Construction of eight wellness centers  Four after school programs  Seven new college and university partnerships  One rural fitness center  Expanded tribal collaboration  At least 12 new prevention camps  Ongoing appointment of a tribal staff to city’s board and commissions.  Oklahoma REACH staff become the tribal and community experts in physical fitness

18. Lessons Learned  Training and networking are crucial  Communities must control the program for it to be sustainable  Planning for sustainability essential  Trust is critical; researchers must trust the community to implement effective programs

19. REACH US CEED  Centers of Excellence in the Elimination of Disparities  Efforts to address and overcome the unique causes of health disparities among specific ethnic populations and in key health areas

20. Southern Plains REACH US  OSDH  IHCRC & 6 tribal partners  Funding level: $61,268/year  Objective: Policy & Environmental Change  Implement evidence-based practices  Assist communities, schools, businesses, & tribes with health promotion efforts

21. Legacy Projects  Open to any tribe or agency that works with Indian people  Up to $40,000 for 1 year contract  Must present application with CAP & budget  Legacies receive mentoring from REACH coalition partners  Had 2 Legacy Projects last year, 4 projects this year

22. REACH Activities  Coordinated Approach to Child Health (CATCH)  Make It Your Business – Certified Healthy Business  24/7 Tobacco Free  HEALTHY Training (Harnessing Experiential & Active Learning for Today’s Healthy Youth)  Promoting policies/legislation for health promotion/disease prevention

23. Moving Forward  Legislative Agenda:  Tax on sweetened beverages  Health Education in middle school  Clinic – pediatric dietitian funding  Expand work in schools  Expand community partnerships

24. Nancy O’Banion, MS Director of Health Education & Wellness Indian Health Care Resource Center of Tulsa 550 S. Peoria Tulsa, OK 74120 nobanion@ihcrc.org Oklahoma REACH website: http://www.ok.gov/strongandhealthy/index.html