2. The HEALTHY Study Dr. Stanley Bassin, Ed.D. Institute for Clinical and Translational Science University of California, Irvine School of Medicine Co-Investigator Funded by National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health

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4. National Multi Site School Based Studies peer reviewed findings: National Multi Site School Based Studies peer reviewed findings: Not Successful in Making Changes in Biological Markers within School Day. Not Successful in Making Changes in Biological Markers within School Day. Changes only seen in Fitness, if there were any changes at all. Changes only seen in Fitness, if there were any changes at all. Most studies focus on Elementary Age Children. Most studies focus on Elementary Age Children. 4

5. Obesity Epidemic Prevalence of adult obesity has doubled in the last 30 years. Prevalence of adult obesity has doubled in the last 30 years. Relative increase has been greater among young people under 18 Relative increase has been greater among young people under 18

7. 7 Type 2 Diabetes 20 Million Diabetes Management PREPRE Obesity Insulin resistance Genetic susceptibility Family history Environmental factors Beginning in utero

8. Obesity in California Children 32% are overweight or obese 32% are overweight or obese Pacific Islanders(42%), Latinos(40%), American Indians(37%) Pacific Islanders(42%), Latinos(40%), American Indians(37%) 75% of overweight children will become overweight or obese adults 75% of overweight children will become overweight or obese adults

9. CAN A COORDINATED SCHOOL HEALTH INTERVENTION PROGRAM, REDUCE RISK FACTORS FOR TYPE 2 DIABETES? FOR TYPE 2 DIABETES? 9

10. 10 42 middle schools 42 middle schools 6 @ 7 field centers 6 @ 7 field centers 21 randomized to intervention 21 randomized to intervention 21 to control (data collection only) 21 to control (data collection only) Eligible schools Eligible schools ≥ 50% minority and/or ≥ 50% eligible for free/reduced lunch Eligible 6 th graders took PE, had no diabetes, provided consent/assent Eligible 6 th graders took PE, had no diabetes, provided consent/assent

11. Nutrition Nutrition Behavior Behavior Physical Education Physical Education Communication/Social-Marketing Communication/Social-Marketing 11

12. Implementation of goals and strategies Implementation of goals and strategies Food service staff training each semester Food service staff training each semester School wide taste tests School wide taste tests Learning activities Learning activities Cafeteria improvements and messaging Cafeteria improvements and messaging Research dietitian on center staff for mentoring Research dietitian on center staff for mentoring

13. Brief classroom-based lessons and activities Brief classroom-based lessons and activities Teacher training each semester Teacher training each semester 1 aide per school 1 aide per school Family outreach newsletters Family outreach newsletters School break family plans and materials School break family plans and materials Health promotion coordinator on center staff Health promotion coordinator on center staff

14. Lesson plans for MVPA Lesson plans for MVPA Equipment ($1000 per school for the 3 year study) Equipment ($1000 per school for the 3 year study) 1 teacher aide per school 1 teacher aide per school PE teacher training each semester PE teacher training each semester Physical activity coordinator on center staff for weekly teacher mentoring. Physical activity coordinator on center staff for weekly teacher mentoring.

15. School-wide messaging – posters, announcements, banners School-wide messaging – posters, announcements, banners Events and activities Events and activities Student peer assistants Student peer assistants Student development of media campaigns Student development of media campaigns

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20. Baseline End of Study ChangeP-value BMI ≥ 85th Percentile.72 Control100%84.1%-15.9% Intervention100%83.5%-16.5% BMI ≥ 95th Percentile.04 Control61.7%53.2%-8.5% Intervention59.8%48.3%-11.5% BMI z-score.06 Control1.801.66-0.14 Intervention1.801.62-0.17

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22. Baseline End of Study ChangeP-Value Fasting Insulin ≥ 30 µU/ml.31 Control13.7%20.5%6.8% Intervention12.2%18.2%6.0% Fasting Insulin (μU/dL).04 Control18.522.64.1 Intervention17.921.53.6 22

23. 23 Blood Pressure Categories in Males by Race/Ethnicity Hispanic(p=.8142) Black NH (p=.0022) White NH (p=.0451) 6th8th6th8th6th8th Normal Intervention Intervention 85.478.174.783.882.091.5 Control Control 79.278.078.970.173.983.0 Pre-hypertension Intervention Intervention 7.85.22.4 Control Control 9.812.96.6 Hypertension stage I Intervention Intervention 5.610.210.95.2 Control Control 9.39.39.17.5 Hypertension stage II Intervention Intervention 1.22.74.13.71.90.9 Control Control 1.73.21.35.74.12.9

24. Number of laps completed for the 20-Meter Shuttle Test used as a proxy for fitness Number of laps completed for the 20-Meter Shuttle Test used as a proxy for fitness Fitness in schools equivalent at end of study Fitness in schools equivalent at end of study 21 laps in 6 th grade and 27 laps in 8 th grade 21 laps in 6 th grade and 27 laps in 8 th grade Consistent with other reports, boys had higher levels of fitness than girls Consistent with other reports, boys had higher levels of fitness than girls 35 and 21 laps, respectively, in 8 th grade 35 and 21 laps, respectively, in 8 th grade 24

25. InterventionControl MaleFemaleMaleFemale 6 th Grade Fitness Level Below Average 60.5%37.9%64.4%38.9% Average39.3%60.1%35.3%57.8% Above Average 0.2%2.0%0.3%3.2% 8 th Grade Fitness Level Average35.1%32.6%34.1%32.3% Above Average 0.5%1.9%1.0%1.9% 25

26. 26 Overall, fitness levels were low at both baseline and end of study Overall, fitness levels were low at both baseline and end of study Almost 2/3 of students were classified as below average in 8 th grade Almost 2/3 of students were classified as below average in 8 th grade Supports national trend Supports national trend Limitations Limitations The 20-MST may lack precision The 20-MST may lack precision The physical education intervention may not have been sufficient The physical education intervention may not have been sufficient

27. 27 Data were collected at baseline and annually for Intervention and Control schools Data were collected at baseline and annually for Intervention and Control schools Administrative data, including number of students, mandated school days, new programs, and changes in management and administration Administrative data, including number of students, mandated school days, new programs, and changes in management and administration Factors related to the physical education environment Factors related to the physical education environment Factors related to the nutrition and food service environment Factors related to the nutrition and food service environment

28. Intervention (N=21) Control (N=21) 6 th 7 th 8 th 6 th 7 th 8 th Mean PE class length (minutes) 545455576055 Mean PE classes per 2 weeks 7.77.57.76.76.97.1 Mean % MVPA 39.643.241.538.437.935.4 Number of schools with the following: l PE classes > 27 weeks of year 182020151716 l Classes have ≤ 30 students per teacher 878587 l Increased PA in response to govern- ment mandate 543633 28

29. 29 Despite an intensive intervention implemented with high levels of fidelity, there were few differences between Intervention and Control schools with respect to: Despite an intensive intervention implemented with high levels of fidelity, there were few differences between Intervention and Control schools with respect to: Food service administration Food service administration New academic programs New academic programs Changes in administration at the district or school level Changes in administration at the district or school level Physical education Physical education

30. 30 With regard to the food environment: With regard to the food environment: Equal numbers of Intervention and Control schools eliminated vending machines Equal numbers of Intervention and Control schools eliminated vending machines The quality of foods improved substantially in Intervention schools The quality of foods improved substantially in Intervention schools More Intervention schools reduced full fat and sugar- added beverages More Intervention schools reduced full fat and sugar- added beverages

31. 31 Changes in local, state, and federal policies and mandates influenced all schools during study. Changes in local, state, and federal policies and mandates influenced all schools during study. Participation in the HEALTHY study may have influenced the environment and awareness in Control schools. Participation in the HEALTHY study may have influenced the environment and awareness in Control schools. Reports of health screening values sent to parents at baseline may have raised awareness and influenced behavior. Reports of health screening values sent to parents at baseline may have raised awareness and influenced behavior.

32. 32 Recent data from the National Health and Nutrition Examination Survey (NHANES) suggest that rapid increases in pediatric obesity may be slowing down. Recent data from the National Health and Nutrition Examination Survey (NHANES) suggest that rapid increases in pediatric obesity may be slowing down. HEALTHY data suggest decreases in combined rates of overweight and obesity in high risk US middle school students. HEALTHY data suggest decreases in combined rates of overweight and obesity in high risk US middle school students.

33. 33 A multi-component, (School Coordinated Health) school-based program appears to favorably affect various indicators of adiposity, blood pressure, and insulin among low income, ethnically diverse youth. A multi-component, (School Coordinated Health) school-based program appears to favorably affect various indicators of adiposity, blood pressure, and insulin among low income, ethnically diverse youth. The secular trends in overweight and obesity are encouraging and need to be replicated in other longitudinal cohorts. The secular trends in overweight and obesity are encouraging and need to be replicated in other longitudinal cohorts. These results have implications for school- based policies. These results have implications for school- based policies.