1. Youth Initiatives Cristina S. Barroso, DrPH University of Texas School of Public Health, Brownsville Regional Campus Presented at the Texas Association of School Based Health Centers 14 th Annual Child & Adolescent Conference February 12, 2010

2. Children Born Today have a Lower Life Expectancy than their Parents  1 in 3 will develop diabetes  3/5 if African American  ½ if Hispanic  > ½ if Native American

3. Obesity by the Numbers  National Health and Nutrition Examination Survey (NHANES 2007-2008)  9.5% of infants & toddlers ≥ 95 th percentile  16.9% of children & adolescents ≥ 95 th percentile  11.9% of children & adolescents ≥ 97 th percentile Ogden et al., 2010 BMI = body mass index [weight (kg)/height (m) 2 ]

4. Impact of Childhood Obesity on Adult Obesity  One out of four obese adults were overweight children  Onset ≤ 8 years – more severely obese as adults (BMI = 41.7 vs. 34.0)  One-half of adults with BMI ≥ 40 were obese as children Freedman et al., 2001

5. Obesity is caused by long-term positive energy balance Fat Stores ~ 600 calories per day

6. A Framework for Obesity Prevention

7. Toxic Environment  Availability & affordability of high fat/high carbohydrate food (fast food, soft drinks)  Large portion sizes  Marketing to children  Fewer family meals  TV, computers, video games  Safety issue  Decrease in physical education Schwartz MB & Brownell KD, 2007

8. Dollars Spent on U.S. Food Advertising in 2005  Food, beverages, candy $7,313,200,000  Restaurants & fast food $5,061,000,000 Advertising Age, 2006

9. NO SINGLE INTERVENTION WILL REVERSE THE CURRENT TRENDS IN OBESITY

10. Legislation & Policy  Passage of Senate Bill 19 9/1/2001  Daily PE (30 min/d or 135 m/week) 4 th grade  School Health Advisory Councils 4 th grade  Coordinated School Health Programs (CSHPs) 4 th grade (9/1/2007)  Texas Public School Nutrition Policy all grades (8/2004)  Passage of Senate Bill 42 9/1/2005  CSHP: 6-8 th grade (2007-2008 school year)

11. New Legislation – Senate Bill 530 (2007-2008) (Amends Sections 28.002 and 28.004, Education Code)  K-5: 30 minutes/day  6-8: 30 minutes/day for minimum of 4 semesters  Physical Fitness assessment (Fitnessgram), grades 3- 12  Pacer  Strength & flexibility  SHAC should determine importance of daily recess for elementary school students  SHAC should evaluate CSHP

12. 4 th Grade Prevalence of Obesity* by Health Service Region in Texas, SPAN 2000-2002, 2004-2005 2000-2002 2004-2005 *Obesity is > 95th Percentile for BMI by Age/Sex

13. Texas Senate Bill 42 (SB42) Awareness of & adherence to SB42 in a representative sample of public middle schools Impact of SB42 (along Texas-Mexico border): – Frequency of school PE class – Quality of school PE – Prevalence of child self-reported physical activity & child overweight

14. Are You Aware that SB42 Requires…? 2006-2008, Key Informants

15. How Did You Become Aware of SB42…? 2006-2008, Key Informants

16. What type of PE Class Schedule is Followed? 2006-2008, Key Informants

17. How Many Minutes per Class? 2006-2008, Key Informants

18. How Many Days per Week? 2006-2008, Key Informants

19. Self-Reported Structured Physical Activity of 8 th Grade Border Students, 2004-2005 & 2006-2008

20. Self-Reported Structured Physical Activity of 8 th Grade Border Students, 2004-2005 and 2006-2008 (±0.0005) (±0.05)(±0.15) *p<0.001; difference between border districts 2004-2005 and border districts 2006-2008

21. The Rio Grande Valley Solution

22. Coordinated Approach To Child Health (CATCH)

23. Does CATCH Work?  Reduced total fat and saturated fat content of school lunches  Increased moderate-to-vigorous physical activity (MVPA) during PE classes  Improved students’ self-reported eating and physical activity behaviors  Effects persisted over three years without continued intervention Luepker et al., 1996; Nader et al.,1999

25. CATCH Characters