1. A Survey of Kentucky Schools: Food and Nutrition Environment Emma S. Walters, MS, RD, LD Dietitian Consultant Kentucky Department for Public Health

2. Objectives By the end of the session, program participants will be able to: Describe the survey design and data collection method used in this study. Discuss the current status of the food and nutrition environment in Kentucky schools. Identify ways to use survey data to support public health initiatives.

4. How did this even get started? In March 2001, Lt. Governor Stephen Henry spoke at the Kentucky Public Health Association meeting. A Kentucky Public Health dietitian from Lexington-Fayette County HD spoke with him of her concerns: Increase in obesity in children and adolescents in KY Increase in Type 2 Diabetes in children and adolescents in KY

5. Obesity in Kentucky Youth Data is limited for KY Over the last 5 years, a 19% increase in obesity has been seen in children served in WIC. KY 2001 indicates that 14.2% of the children on WIC are above the 95 th percentile wt./ht. as compared to 13.1% nationwide. KY 2001 indicates that 15.7% of children age 2 and older are at risk for overweight (85 th to 95 th percentile) as compared to 16.8% in the nation. NHANES III indicates that 20% of children and adolescents are now overweight (BMI > 85 th percentile.

6. Type 2 Diabetes Taskforce First meeting held June 19, 2001 Agenda topics Nutrition and physical activity among youth National School Lunch Program in KY Physical fitness in KY schools Type 2 Diabetes in Youth

7. Taskforce Workgroups Nutrition Education/Media Legislative Concerns Physical Education GOAL developed on July 26, 2001 Reduce the prevalence of Type 2 Diabetes

9. Nutrition Workgroup/Subcommittee First meetings focus: Analysis of school meals/plate waste study Develop assessment tool Total calories Fat grams Carbohydrates Protein Sample schools across the state Develop pilot project on school nutrition and physical activity

10. Plate waste study Scrapped Cost Difficult to conduct with manpower available Timeframe – trying to develop legislation for January 2002 Session Concern about information that would be generated

11. New focus What can Nutrition Workgroup/Subcommittee accomplish that can affect eating habits of KY children? Vending machines Ala carte items School rewards centered on foods

13. School Health Policies and Programs Study (SHPPS) - CDC National survey conducted to assess school health policies and programs at following levels: State District School Classroom

14. SHPPS Areas Health education Physical education and activity Food service School policy and environment Faculty and staff health promotion Family and community involvement Website http://www.cdc.gov/nccdphp/dash/shpps/

15. Sample Question - SHPPS Has your state adopted a policy stating that schools will offer students a choice between the following items each day for lunch? 1. 2 or more different entrees or main courses 2. 2 or more different vegetables 3. 2 or more different fruits or types of 100% fruit juice

16. Kentucky Survey Epidemiologist (KDPH) selected sample of schools 200+ elementary schools 200+ middle and high schools Total of 471 schools were selected for the sample.

17. Kentucky Survey Design Face-to-face interviews with school principal Short as possible Sections: Vending machines School Store, Canteen or Snack Bar Food Used As Rewards Classroom Parties/Celebrations

18. How surveys were conducted? Elementary schools School sample divided by counties Sent supply of surveys to Public Health Dietitian/Nutritionist, Nurse or WIC Coordinator with name and address of school, name of principal Middle/High Schools School sample divided by counties Sent supply of surveys to Extension Agents with name and address of school, name of principal Packet included letter from Lt. Gov. and letter from Public Health or Extension

19. Results 471 schools selected for sample 343 returned the sample (73% return) Vending machines 97% of high schools 88% of middle schools 44% of elementary schools

20. Vending Machines More than one vending machine existed in many schools Range of machines in elementary schools 0 to 11 Range of machines in middle schools 0 to 16 Average number in high schools – 8 (with a maximum of 29)

21. Accessibility of Vending Machines Before school 11.7% Throughout the day 5.8% During lunch 5.6% After lunch54.3% After school59.2% Other19.3%

22. Revenue from Vending Machines Ranged from $100.00 to $44,000.00 High schools highest $9,736.27 Middle schools next $5,933.13 Elementary schools $3,145.50 83% of schools that have vending machines have contracts with soft drink companies (56% - Pepsi; 47% - Coke); or 56% of the total schools have contracts with soft drink companies

23. Vending machines - Other beverage and snack items Few healthy snack items Ratio of regular soft drinks to diet soft drinks was 6 to 1 Ratio of chips/fried snack items to granola bars and trail mix was 9 to 1

24. School stores/Canteens/Snack Bars 36% of the schools have store Accessibility Before school 6.4% Throughout day 1.6% During lunch33.6% After lunch33.6% After school13.6% Other25.6%

25. Stocked Items Chips/fried snacks68% Candy61% Water51% < 100% Juice54% Cookies53% 100% Juice23% Yogurt16%

26. Food Rewards/Class Parties 81% of all the schools use food as a reward for behavior, attendance or academic achievement Almost 90% of elementary and middle schools use food rewards; 57% high schools 89% of all schools use non-food rewards

27. Types of food rewards Candy67% Soft drinks47% Pizza83% Ice Cream44% Fruit12%

29. Celebrations 93% of schools have holiday or birthday celebrations Only 15% of these have policies regarding the types of food. Pizza is the food of choice

30. Physical Activity 90% of elem. schools offer PE grades P– 4; data for grades 5 – 12 could not be determined due to ineffective classification Minutes spent per week in PE Elementary 67 minutes Middle 34 minutes 9 th 36 minutes 10 th 9 minutes 11 th 4 minutes 12 th 6 minutes

31. Average Recess Time Elementary14 minutes Middle 2.5 minutes High 2 minutes

32. Where do we go from here? Data was used in position paper for legislature Introduce legislation Community awareness Media/video Future taskforce(s) Site Based Decision Making Councils