Georgia s Nutrition and Physical Activity Strategic Plan

Transcription

1 Georgia s Nutrition and Physical Activity Strategic Plan DEPARTMENT OF PUBLIC HEALTH Facilitated by the Georgia Department of Public Health 1

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3 3 TABLE OF CONTENTS FROM THE GOVERNOR S DESK... 4 FOREWORD... 5 ACKNOWLEDGEMENTS... 6 SPECIAL THANKS... 7 INTRODUCTION... 8 OBESITY BURDEN... 9 PLAN FRAMEWORK PLAN REVISION PROCESS USING THE STRATEGIC PLAN GEORGIA s NUTRITION AND PHYSICAL ACTIVITY STRATEGIC PLAN ( )...23 LONG-TERM OUTCOME OBJECTIVES LONG TERM POLICY OBJECTIVES DEVELOPMENTAL...25 MID-TERM OBJECTIVES: COMMUNITY _Toc MID-TERM OBJECTIVES: SCHOOL...30 MID-TERM OBJECTIVES: WORKSITE MID-TERM OBJECTIVES: HEALTHCARE MID-TERM OBJECTIVES: FAITH-BASED MID-TERM OBJECTIVES: EARLY CHILDCARE EVALUATION STRATEGY REFERENCES GLOSSARY APPENDICES I-V APPENDIX I. TASKFORCE MEMBERS APPENDIX II. WORKGROUP CO-CHAIRS & CONTRIBUTING PARTNERS...69 APPENDIX III. NUTRITION AND PHYSICAL ACTIVITY INITIATIVE...72 APPENDIX IV. COLLABORATIONS APPENDIX V. PARTNER ORGANIZATIONS... 75

4 4 FROM THE GOVERNOR S DESK Dear Friends: As Governor of Georgia, I am pleased to support the development and implementation of this Nutrition and Physical Activity State Strategic Plan. The Georgia Nutrition and Physical Activity Taskforce worked diligently to identify strategies and activities that are instrumental in helping improve the health of our state. I applaud the many Georgians who selflessly invested their time and expertise in developing this plan, which serves as a guide to reducing Georgia s obesity rate. With the increasing rates of child and adult obesity, it is vitally important that we come together to find ways to decrease obesity, offer increased access to healthy foods, and get all Georgians active. The state is committed to this important work and I wholeheartedly support the Georgia Department of Public Health and the Georgia Nutrition and Physical Activity Initiative in their efforts to address obesity in Georgia. The plan requires collaboration and partnership building across all sectors to create long term sustainable solutions to this public health crisis. A coordinated statewide strategy that encompasses all the places where we live, work, learn, worship, and play is key to addressing obesity. This cannot be accomplished by any one agency alone; it requires that we all work together with common mission and purpose. I invite you to help bring this plan to life by focusing your efforts in concert with Georgia s to reduce and prevent obesity statewide. Thank you. Sincerely, Nathan Deal Governor

5 5 FOREWORD Dear Partners and Stakeholders: I would like to express my gratitude to the Georgia Nutrition and Physical Activity Initiative and the partner organizations who came together to develop Georgia s Nutrition and Physical Activity State Strategic Plan. The Georgia Department of Public Health convened a statewide wide group of nutrition and physical activity professionals to develop a ten-year Nutrition and Physical Activity State Strategic Plan to address the alarming rise of obesity in our state. Overweight and obesity is an epidemic in Georgia, affecting all segments of the population. Georgia exceeds the Healthy People 2020 national goal for children and youth in every age, sex, race and ethnic group. Since obesity is a vast problem affecting over half of Georgia s population, solutions and strategies must be implemented where Georgians live, work, and play. Therefore, with a particular focus on policy and environmental change approaches, this plan addresses overweight and obesity in the settings of schools, early childcare, worksites, healthcare, communities, and faith-based organizations. This plan is a roadmap that establishes priorities, allocates responsibilities, and sets targets using evidence-based strategies designed to focus the efforts of all stakeholders. It is designed to pool the resources of the Nutrition and Physical Activity Initiative taskforce partnership around the state to promote increased physical activity, increased fruit and vegetable consumption, increased breastfeeding, decreased sugar loaded beverages, decreased consumption of high energy dense foods, and decreased television viewing. Everyone has a role to play in creating a healthier Georgia. I encourage you to review the strategies in the enclosed plan and identify ones that you can implement in your community, agency or organization. Sincerely, Brenda Fitzgerald, M.D. Commissioner Georgia Department of Public Health

6 6 ACKNOWLEDGEMENTS Georgia Department of Public Health Brenda Fitzgerald, MD, Commissioner Health Promotion Programs Yvette Daniels, Director Health Promotion Disease Prevention Kimberly Redding, MD, MPH, Director Epidemiology Branch Anil Mangla, PhD, MPH, Director For more information on: Georgia s Nutrition and Physical Activity Plan please contact: Sonya Crutchfield, MPH, Program Manager Behavioral Risk Reduction Unit, Health Promotion Disease Prevention Georgia Department of Public Health Two Peachtree Street NW, Suite Atlanta, Georgia [email protected] Tel: Fax: Suggested Citation: Georgia Department of Public Health. Georgia s Nutrition and Physical Activity Plan to Prevent and Control Obesity and Chronic Diseases in Georgia, July Publication Number:

7 7 SPECIAL THANKS Georgia appreciatively acknowledges the expertise, contributions, time, and commitment of all the members of the Nutrition and Physical Activity Initiative Taskforce, in the development of Georgia s Nutrition and Physical Activity Plan (see Appendix I for a list of committee members). We would like to offer a special thanks to the Nutrition and Physical Activity Initiative s taskforce s Steering Committee for their dedication towards this effort. Mark Anderson, Ed. S Cobb County Schools/ Georgia Action for Healthy Kids Monica Barnett, MS Georgia Department of Public Health Lindsay Bishop, MPH Children s Healthcare of Atlanta Jimmy Calloway, PhD Georgia Coalition for Physical Activity and Nutrition Kylia Crane, RD, LD Georgia Chapter of the American Academy of Pediatrics Sonya Crutchfield, MPH Georgia Department of Public Health Anjulyn Davis Department of Early Care and Learning Donna DeCaille, MS, RD, LD Georgia Department of Public Health Claire Drogula Georgia Department of Community Health Lauren Farnum, MPH, RD, LD Georgia Department of Public Health Monica Fink, MS, RD, LD Georgia Department of Early Care and Learning Marissa Hamm, MPH Georgia Department of Early Care and Learning Marcia Hunter, BSN, RN, IBCLC, RLC Georgia Department of Public Health Martha Jackson, M.BED Community Consultant Mary Nicholson Jackson, CLC Georgia Breastfeeding Coalition Grady WIC Lactation Services Patricia M. Jones, RN, CDE Georgia Department of Public Health Debra Kibbe, MS ILSI Research Foundation Karen Kierath Georgia Coalition for Physical Activity and Nutrition Frank Lawrence, MPH Georgia Department of Public Health Rodney Lyn, PhD, MS Georgia State University Kiley Morgan, PhD, MS, MPH, CHES Georgia Department of Public Health Arlene Murrell, MS, RD, LD Southeast United Dairy Industry Association, Inc. Chad D. Neilsen, MPH Georgia Department of Public Health Beth Passehl, MS, RYT Healthcare Consultant Marcia Rafig Georgia Coalition for Physical Activity and Nutrition LaToysa Scaife Rooks, MPH Clayton County Board of Health Cheryl Scales Magnificent Woman Organization Holly Sealer, RN, MSN, PCNS BC Children s Healthcare of Atlanta Andrea Wimbush, MPA, CHES Georgia Department of Public Health

8 8 INTRODUCTION In July 2003, the Division of Public Health, * in the Georgia Department of Human Resources, was awarded a five year grant from the Centers for Disease Control and Prevention (CDC) to support statewide nutrition and physical activity programs. The public health agency was one of 17 grantees across the country being encouraged by CDC to develop and implement strategic plans aimed at preventing obesity and other chronic diseases. The resulting state strategic plan, Take Charge of Your Health Georgia, was developed with input from many diverse stakeholders across Georgia. The original plan was finalized in 2005 and was scheduled to run through Over the last five years however, more has become known about best practices and evidence based strategies that address obesity. This increasing body of knowledge has necessitated a plan revision with a stronger and strategic focus on policy, systems and environmental change. The revised strategic plan will run from 2011 through This ten year plan is intended to focus on improving the health status of Georgia s residents by improving healthy eating and physical activity habits, increasing breastfeeding rates and decreasing television viewing/screen time in a variety of settings. The plan seeks to affect health behaviors through a focus on policy implementation, infrastructure development and multi systems collaboration. Sustained commitment from multiple public and private sector partners throughout the state will be required to successfully achieve the objectives of this plan, which seeks to comprehensively address the complex issue of obesity control in our state. The plan targets all Georgians, with additional emphasis on children and their families (especially low income families), older adults, rural residents and specific racial and ethnic groups, who experience a disproportionate burden in chronic disease morbidity and mortality rates as compared to the rest of the population. * The Division of Public Health became the Georgia Department of Public Health on July 1, 2011

9 INTRODUCTION In July 2003, the Division of Public Health, * in the Georgia Department of Human Resources, was awarded a five year grant from the Centers for Disease Control and Prevention (CDC) to support statewide nutrition and physical activity programs. The public health agency was one of 17 grantees across the country being encouraged by CDC to develop and implement strategic plans aimed at preventing obesity and other chronic diseases. The resulting state strategic plan, Take Charge of Your Health Georgia, was developed with input from many diverse stakeholders across Georgia. The original plan was finalized in 2005 and was scheduled to run through Over the last five years however, more has become known about best practices and evidence based strategies that address obesity. This increasing body of knowledge has necessitated a plan revision with a stronger and strategic focus on policy, systems and environmental change. The revised strategic plan will run from 2011 through This ten year plan is intended to focus on improving the health status of Georgia s residents by improving healthy eating and physical activity habits, increasing breastfeeding rates and decreasing television viewing/screen time in a variety of settings. The plan seeks to affect health behaviors through a focus on policy implementation, infrastructure development and multi systems collaboration. Sustained commitment from multiple public and private sector partners throughout the state will be required to successfully achieve the objectives of this plan, which seeks to comprehensively address the complex issue of obesity control in our state. The plan targets all Georgians, with additional emphasis on children and their families (especially low income families), older adults, rural residents and specific racial and ethnic groups, who experience a disproportionate burden in chronic disease morbidity and mortality rates as compared to the rest of the population. * The Division of Public Health became the Georgia Department of Public Health on July 1, OBESITY BURDEN Overweight and Obesity in Children and Youth In Georgia, overweight among children aged 2 to <5 years has increased by 60 percent over the last decade. The Georgia Pediatric Nutrition Surveillance System 1 (2009) found that 31 percent of children enrolled in the Women, Infants, and Children (WIC) Program were either overweight (16%) or obese (15%). Hispanic children in the program were more likely to be overweight or obese than any other race or ethnic group (Figure 1). Figure 1 Prevalence of overweight and obesity among children aged 2 to <5 years, by race and ethnicity, Georgia, 2009 The Georgia Student Health Survey 2 (2009) indicates that just over one in three (34%) middle school students aged years and over one in four (27%) high school students aged years are either overweight or obese (Figure 2). Figure 2 Prevalence of overweight and obesity among students by school type, Georgia, 2009

10 OBESITY BURDEN Overweight and Obesity in Children and Youth In Georgia, overweight among children aged 2 to <5 years has increased by 60 percent over the last decade. The Georgia Pediatric Nutrition Surveillance System 1 (2009) found that 31 percent of children enrolled in the Women, Infants, and Children (WIC) Program were either overweight (16%) or obese (15%). Hispanic children in the program were more likely to be overweight or obese than any other race or ethnic group (Figure 1). Figure 1 Prevalence of overweight and obesity among children aged 2 to <5 years, by race and ethnicity, Georgia, 2009 The Georgia Student Health Survey 2 (2009) indicates that just over one in three (34%) middle school students aged years and over one in four (27%) high school students aged years are either overweight or obese (Figure 2). Figure 2 Prevalence of overweight and obesity among students by school type, Georgia, Approximately 18 percent of middle school males and 20 percent of middle school females are overweight. Among high school students, 14 percent of males and 16 percent of females are overweight. Black middle and high school students have disproportionate levels of overweight and obesity, compared to white students. Figure 3 Prevalence of overweight and obesity among students by school type, race and sex, Georgia, 2009 Overweight and Obesity in Adults Overweight and obese adults are at increased risk for cardiovascular disease, diabetes, stroke, hypertension, gall bladder disease, osteoarthritis and certain cancers. In 2010, approximately 65 percent of adults in Georgia were overweight or obese with 35 percent being overweight (i.e. having a body mass index (BMI) of 25 to 29.9) and 30 percent obese (i.e. having a BMI of 30 or more). The percentage of adults who are overweight or obese has been on the increase since the Georgia Behavioral Risk Factor Surveillance System 3 (BRFSS) data was first collected in 1984, rising from 37 percent in 1984 to 65 percent in 2010 (Figure 4). In 2010, almost three quarters of adult men (73%) and almost two thirds of adult women (59%) were overweight or obese (Figure 5).

11 11 Figure 4 Overweight or obese adults, Georgia, Figure 5 Overweight and obese adults, by sex, Georgia, 2010

12 12 White non Hispanic adults (27%) were less likely than black non Hispanic (41%) and Hispanic (31%) adults to be obese. Black non Hispanic females (45%) were more likely to be obese than any other race or gender (Figure 6). Adults who were years of age were more likely to be overweight or obese than any other age group (Figure 7). Figure 6 Overweight and obese adults, by sex and race, Georgia, 2010 Figure 7 Overweight and obese adults, by age group, Georgia, 2010

13 13 College graduates were less likely to be obese than those in any other educational attainment category (Figure 8) and adults with the lowest income were more likely to be obese than any other category (Figure 9). Figure 8 Overweight and obese adults by years of education, Georgia, 2010 Figure 9 Overweight and obese adults by household income, Georgia, 2010

14 14 Among the 18 Health Districts in Georgia, the prevalence of overweight adults in 2009 ranged from 28 percent to 44 percent, and the prevalence of obesity ranged from 21 percent to 42 percent. The rise in prevalence of overweight and obesity in Georgia from 1984 to the present has affected all health districts Figures (10 12). Figure 10 Overweight and Obese adults by Health District, Georgia, Overweight Adults 32-33% 34-35% 36-37% 38-39% 40%+ Obese Adults 19-23% 24-26% 27-29% 30%+ Figure 11 Overweight and Obese adults by Health District, Georgia, Overweight Adults Obese Adults 32-33% 34-35% 36-37% 38-39% 40% % 24-26% 27-29% 30%+ Source: Georgia Behavioral Risk Factor Surveillance System.

15 15 Figure 12 Overweight and Obese adults by Health District, Georgia, Overweight Adults Obese Adults 32-33% 34-35% 36-37% 38-39% 40% % 24-26% 27-29% 30%+ Contributing Behavioral Risk Factors Georgians have made less than optimal progress in adopting health promoting behaviors such as regular physical activity, consumption of five or more servings of fruits and vegetables per day, and limited television viewing. Only 52 percent of middle school students and 43 percent of high school students are meeting physical activity recommendations (i.e. at least 60 minutes of physical activity per day). Approximately 39 percent of middle school students and 44 percent of high school students watch at least 3 hours of television per school day and approximately a quarter of middle school (25%) and high school (23%) students play at least 3 hours of video games per school day. Only 17 percent of high school students eat 5 or more servings of fruits and vegetables per day. Among adults, only 23 percent eat 5 or more servings of fruits and vegetables per day and only 42 percent are regularly active (Figure 13) Figure 13 Prevalence of physical activity, fruits and vegetables consumption, TV viewing, and video game playing behaviors among youth and adults in Georgia

16 16 Contributing Environmental Factors Policies and environments that support healthy eating and physical activity may shape the attitudes and behavior of the population. Results from the School Health Education Profile 4 (2002) showed that only 6 percent of middle and 11 percent of high schools in Georgia had a policy to offer fruits and vegetables at school settings. Sixty two percent of middle and 94 percent of high schools require students to take one course in physical education. The 2002 Georgia Worksite Survey 5 found only 17 percent of worksites in Georgia offered physical activity or fitness programs and only 10 percent of worksites offered healthy eating or weight management classes or counseling to employees. Community design and growth has led to urban sprawl, encouraging individuals to drive rather than walk to work, school or stores. A recent study 6 provided evidence for the association between increased rates of obesity and indicators of the built environment and urban sprawl in the metro Atlanta region. Residents living in areas of more mixed land use, where they spend less time in their cars and more time walking each day, are less likely to be obese. Cost of Overweight and Obesity Population Attributable Risk (PAR) calculations show that if all Georgians were of normal weight, an estimated 6,560 fewer deaths would occur annually, 40,821 fewer hospitalizations each year, and $1.3 billion fewer hospital charges due to obesity related conditions. For Georgians, diabetes, arthritis, and high blood pressure were more prevalent in overweight and obese adults as compared to adults of normal weight. The direct medical costs of obesity in the U.S. are approximately $147 billion a year. In 2008, Georgians spent $2.5 billion on the direct medical cost of obesity, or $385 per Georgian per year. 7 Population attributable risk (PAR) is an estimate of the proportion of deaths or other measures of disease burden caused by a particular risk factor. The PAR estimates the proportion of disease in a population that would be eliminated if the risk factor were removed from the population. For example, the PAR for heart disease deaths due to overweight and obesity is the fraction of deaths that would not occur if everyone were of normal weight

17 17 PLAN FRAMEWORK The causes of obesity in the United States are numerous and complex. The factors that contribute to the growing epidemic move far beyond individual behavior, occurring at the social, environmental, systems and policy levels. The places where we live, study, work and play often discourage physical activity and make it difficult for many people to access healthy food choices. In order to effectively address the problem of obesity in our communities, strategies are needed that will affect large numbers of people across multiple settings: schools, work sites, hospitals and clinics, early child care centers, faith based institutions and the wider local community. Strategies that address policy, systems and environmental changes help make healthy choices easier and more affordable and, to that end, are critical to addressing the issue of obesity 8. As such, this revised plan uses a policy, systems and environmental change framework as its guiding focus. The references to policy, systems, and environmental change in this plan are defined in the following ways 9 : Policy Change: Interventions that use laws, ordinances, rules, regulations and or mandates to effect change in population behavior. Examples of a policy change include: Mandated menu labeling, or requiring physical activity in schools. Systems Change: Interventions or changes that leverage the functional components of an organization, institution, or system. Examples of systems include implementing fitness assessment in the school system. Environment Change: Interventions that involve changes to the economic, social, or built/physical environment. Examples of an environment al change include the construction of bike paths/trails, or the creation of mixed use development communities. A focus on policy, systems and environment change does not preclude the need for programmatic interventions that lead to changes in individual knowledge, behavior and health outcomes. Programs can often serve as the on ramp to broader and more permanent policy, systems or environmental change. For example, a community wide Walk to School Day may serve to galvanize support for working towards changes in the built environment that promote sidewalks, bike lanes and other design considerations that promote physical activity. A focus on larger scale change will put in place the systems, the policies and the environments that support individuals, families and communities in making healthier choices (Figure 14).

18 18 Figure 14 Schema of interplay between Policy, Systems, and Environmental Change, and program implementation Policy Change Systems & Environmental Change Program Implementation Source: Adapted from the Georgia Health Policy Center, 2008 While the development of Georgia s Nutrition and Physical Activity Plan objectives was guided by the lens of policy, systems and environmental change, the socio ecological model provides the framework for the structure of the plan and its implementation. The organization of the objectives and strategies around the six settings (community, early childcare, faith based, healthcare, school and worksite) is meant to ensure that the plan is comprehensive and that the focus on policy, systems and environmental change is maintained across settings and spheres of influence. At the center of the socio ecological model is the individual surrounded by increasingly larger spheres of influence: interpersonal, organizational, community, and societal. The socio ecological model is a framework for planning health promotion interventions where the relationship between the environmental and behavioral determinants of health is spotlighted. The relationship is thought to be reciprocal; the environment affects health related behaviors, and individuals can, through their actions, affect the environment. Based on the complex dynamics of the socio ecological model and the identified partnerships and state resources, the Georgia Nutrition and Physical Activity Plan was conceptualized to systematically target public policy changes, community changes, organizational changes, and interpersonal changes to ultimately impact individual behavior change.

19 19 Figure 15 The Socio ecological Model Individual: awareness, knowledge, attitudes, beliefs, values, preferences Interpersonal: family, friends, peers that provide social identify and support Institutional/Organizational: rules, policies, procedures, environment, informal structures Community: social networks, norms, standards and practices Society/State: state, and federal governmental policies, regulations, and laws Source: Adapted from McLeroy 10, et al, 1988

20 20 PLAN REVISION PROCESS In July 2010, the Department of Public Health, formerly, the Division of Public Health in the Georgia Department of Community Health (DCH), convened more than seventy stakeholders to lead the revision of the Nutrition and Physical Activity Plan for Georgia. Attendees included leaders and representatives from multiple agencies and organizations including the Georgia Department of Community Health, Georgia Department of Education, Georgia Department of Transportation, Georgia Department of Natural Resources State Parks and Historic Sites, Georgia Recreation and Parks Association; local faithbased organizations; community based organizations; health care organizations; universities; local school systems; local boards of health and statewide coalitions. During that meeting participants confirmed that the six work groups, already established under the previous plan, would be responsible for reviewing, revising and implementing the long term and mid term objectives and strategies of Georgia s Nutrition and Physical Activity Plan The six workgroups are organized by implementation settings: Community Early Childhood Faith based Healthcare School Worksite Functional leadership of the work groups was provided by co chairs, one of whom was a program representative from the Department of Public Health (DPH) and the other content expert representative from a partner agency outside of DPH. The Georgia Health Policy Center (GHPC) at Georgia State University provided facilitation and staff support to the work groups that met regularly by teleconference and in person throughout the eight month process. The GHPC provided initial background training to work group members aimed at improving the understanding, and importance of policy, systems and environmental (PSE) change approaches in informing the revision. Additionally, GHPC staff provided the work groups with evidence based, best or promising practice information related to physical activity and nutrition. The Steering Committee, made up of representatives from each of the six work groups and other key stakeholders, provided oversight and guidance to the process. At the end of the work group process, the Committee presented a draft of the recommended objectives and strategies to the Georgia Nutrition and Physical Activity Taskforce in June 2011 during a half day work session at the Live Healthy Georgia Convening. Taskforce members provided feedback to the draft which was finalized thereafter by the Steering Committee with input from DPH leadership. Contextually, two other processes helped to inform and shape the plan. These were: Ongoing strategic reorganization at CDC aimed at a more collaborative program model to control chronic disease. This approach is being piloted in a few select states and will potentially

21 21 have implications for the Nutrition and Physical Activity Plan implementation funding in the near future. Ongoing state government reorganization that resulted in DCH s Division of Public Health becoming a separate Department on July 1, 2011 with its own Commissioner reporting directly to the Governor of the state.

22 22 USING THE STRATEGIC PLAN The Nutrition and Physical Activity Strategic Plan is developed to be used as a practical guide in Georgia s obesity control effort. To that extent, the document is designed to be reviewed, revised, and/or modified regularly to reflect prevailing externalities and lessons learned from ongoing evaluation. Specifically the plan will be used in the following ways: Development of implementation roadmap During the dissemination period and ongoing engagement of critical stakeholders, the strategic plan will be used to inform the development of setting specific, time bound implementation activities to be monitored by each of the 6 work groups as appropriate. It is anticipated that each group will develop annual action (work) plans based on the direction laid out in the strategic plan and conduct timely assessments of progress. Focused integration of current efforts Georgia has a history of active collaborations working to improve nutrition standards and increase physical activity among residents across the state. These partnerships have a critical stake in Georgia s Nutrition and Physical Activity Plan and have made key contributions to obesity reduction and control. Additionally, several state agencies, private sector organizations, and non profits have long been a part of the programmatic prevention efforts to date. These organizations will continue to be engaged to support the implementation of the strategic plan. Given the Plan s revised emphasis on PSE strategies, efforts will also be made to develop new partnerships that will serve the anticipated macro level change. With leadership from the Department of Public Health, the aim will be to synchronize and integrate the efforts of state agencies and external partners in the implementation process. Prioritization of Resources The plan will be used as a guide to set obesity control funding priorities at state and local levels. The objectives and strategies included in this document serve as a blueprint for state agencies, external partners and local public health agencies to help direct funding to areas of emphasis. The aim will be to secure and disseminate federal, public and private philanthropic funds to support sustainable statewide and local efforts. Design of data collection methods Evaluation is a key component of the strategic plan. Evaluation indicators have been identified for each of the long term goals. Most of the indicators will be informed by existing public health surveillance. In cases where baseline data do not currently exist, new tools will be developed through the work group s collaborative partnerships. Each setting area will work with the DPH to establish baseline measurements and plan for follow up data collection.

23 23 GEORGIA s NUTRITION AND PHYSICAL ACTIVITY STRATEGIC PLAN ( ) The Long Term Goal of this ten year plan is to control obesity and prevent the onset of other chronic diseases by encouraging a prevailing environment of wellness throughout the entire state. To that end, the plan identifies practical and measurable long term and mid term objectives. The Long Term Objectives consider the Healthy People 2020 targets overlaid with a conservative forecast of Georgia s emergence from current socioeconomic challenges. Nearly half of these objectives focus on reducing childhood obesity and overweight, as precursors to poor health. The Mid Term Objectives outline the expected achievements over the next five years by setting areas Community, Schools, Healthcare Facilities, Worksite, Faith based and Early Care institutions. Members of the Nutrition and Physical Activity Initiative Taskforce further prioritized the mid term objectives during the Nutrition and Physical Activity State Plan Congress in June The objectives were prioritized based on three key criteria: perceived urgency in the context of Georgia s needs, available resources and the likelihood of relatively quick, demonstrable success. Seven mid term objectives are designated as high priority. The plan also identifies Developmental Objectives, considered as being important to the achievement of the goal, but for which there will be ongoing work to identify, design and test appropriate target measurements, proxy measures and /or new data collection methods for use over the period. Many of the long term policy objectives will likely require new data collection methods to assess achievement. This approach patterns the one used in the development of the Healthy People 2020 objectives.

24 24 LONG TERM OUTCOME OBJECTIVES GEORGIA 2021 OBJECTIVE 1. By 2021, decrease the proportion of Georgia s children and youth who are obese. 2. By 2021, decrease the proportion of Georgia s children and youth who are overweight. 3. By 2021, increase the proportion of Georgia s high school students who consume five or more servings of fruits/vegetables daily. 4. By 2021, increase the proportion of Georgia s middle and high school students who engage in moderate to vigorous physical activity, of at least 60 minutes on five or more days weekly. 5. By 2021, increase the proportion of Georgia s adults who are at a healthy weight **. 6. By 2021, reduce the proportion of Georgia s adults who are obese. 7. By 2021, increase the proportion of Georgia s adults who consume five or more servings of fruits and vegetables. 8. By 2021, reduce the proportion of Georgia s adults who report no regular leisure time activity. 9. By 2021, increase the proportion of Georgia s adults who engage in daily moderate to vigorous physical activity for at least 30 minutes. 10. By 2021, increase the proportion of Georgia s worksites with 50 or more employees offering employer sponsored physical activity/fitness programs. TARGET FROM TO POPULATION Aged 2 to 5 yrs. 15% 11% Middle School 15% 12% High School 12% 10% Aged 2 to 5 yrs. 16% 11% Middle School 19% 14% High School 15% 10% High school 17% 21% Middle School 52% 57% High School 43% 47% Adults 18 yrs. and older Adults 18 yrs. and older Adults 18 yrs. and older Adults 18 yrs. and older Adults 18 yrs. and older 33% 30% 45% 23% 23% 25% 29% 18% (moderate) 20% 20% 20% Adults 18 years (vigorous) and older 25% 22% 11. By 2021, increase the proportion of Georgia s women who initiate and sustain breastfeeding of their infants. Women who had ever breastfed Women breastfeeding after 6mths 36% 27% 18% 40% Obesity in youth and children is defined as having a Body Mass Index (BMI) for age greater than 95 th percentile Overweight in youth and children is defined as having a Body Mass Index (BMI) between 85 th and 95 th percentile ** Healthy weight in adults is defined as having a Body Mass Index (BMI) that is greater than 18.0 but less than 25 Obesity in adults is defined as having a Body Mass Index (BMI) greater than 30

25 25 LONG TERM POLICY OBJECTIVES DEVELOPMENTAL GEORGIA 2021 DEVELOPMENTAL OBJECTIVES By 2021, ensure the development and implementation of policies aimed at reducing the levels of sodium consumption by Georgia residents. POTENTIAL POLICY TARGET MEASURE At least 20% of statewide local governments establish policies setting sodium guidelines for foods sold in government facilities and schools POTENTIAL PROXY BEHAVIORAL INDICATOR Less than 2500mg of sodium is consumed daily by Georgia s population aged 2 years and older By 2021, ensure the development and implementation of policies aimed at reducing the consumption of sugar sweetened beverages in Georgia s schools. Less than 50% of middle and high schools offer sugar sweetened beverages as competitive foods Less than 30% of middle and high school students report drinking more than one sugarsweetened beverage per day By 2021, ensure the development and implementation of policies aimed at increasing community access to healthy fruits and vegetables. Increase Georgia s Modified Retail Food Environment index from 8 to 25** More than 50% of Georgians report access to healthy fruits and vegetables By 2021, ensure the development and implementation of policies aimed at establishing more baby friendly hospitals throughout the state. At least 25% of Georgia s hospitals have initiated policy implementation leading to baby friendly designation At least 3 Georgia Hospitals have attained or are preparing to attain BFHI certification **Modified Retail Food Environment index measures the number of healthy and less healthy food retailers within a census tract. The scores ranges from zero (no food retailers that typically sell healthy food) to 100 (only food retailers that sell healthy food Baby friendly hospital are defined as hospitals that provide mothers with the information, skills and confidence necessary to initiate and continue breastfeeding their babies safely

26 26 MID TERM OBJECTIVE C1 (High Priority) By 2016, target at least 5% of Georgia s communities for built environment improvements to support increased physical activity in adults and children. Policy & Environmental Change KEY STRATEGIES Stakeholder/Partners 1. Encourage communities to develop and use Active Living Plans. 2. Implement existing community policies (LCI) Livable Centers Initiative. 3. Promote use of Health Impact Assessments (HIA s) in high risk areas (high rates of obesity and chronic diseases) to inform changes to policy and the built environment. 4. Support infrastructure redevelopment policies that encourage neighborhoods to utilize existing buildings within their communities to promote physical activity opportunities. 5. Encourage use of urban planning approaches, zoning and land use that promote community wide physical activity. 6. Promote mixed land use for enhanced walkability and bikeability. 7. Encourage and promote building connectivity between neighborhoods, sidewalks, schools, roads, traffic and pedestrian safety (traffic lights, stop signs, cross walks, etc.). Data Collection, Training & Awareness 8. Assess walkablity and bike ability of urban and rural communities to collect baseline data. Current Partners: Georgia Department of Public Health Public Health Districts Community based Organizations Georgia Department of Natural Resources State Parks Georgia Recreation and Parks Association Fort Valley State University Atlanta Biking Coalition Georgia Department of Transportation o Safe Routes to School Program Potential Partners: PEDS Governor s Office of Highway Safety Georgia Department of Transportation: Bike and Pedestrian Planning Local City Council and Mayors Offices Home Owners Associations Atlanta Regional Commission Metropolitan Planning Organizations (MPO) Regional Development Centers (RDC) Georgia Conservancy Georgia Department of Community Affairs Local Departments of Transportation and Planning City Planners County Planners Georgia Planning Association o Urban/Rural Planners Local School Systems COMMUNITY SETTING

27 27 MID TERM OBJECTIVE C2 A. By 2016, decrease television viewing and screen time from 44% to 42% (TV viewing) and from 25% to 23% (video/computer games and internet use) among middle school youth Georgia. B. By 2016, decrease television viewing and screen time from 39% to 37% (TV viewing) and from 23% to 21% (video/computer games and internet use) among high school youth in Georgia. Policy & Environmental Change KEY STRATEGIES Stakeholder/Potential Partners 1. Encourage schools and after school programs to adopt policies focused on eliminating or severely reducing screen time. 2. Identify best practices for screen time reduction. 3. Build a systematic online database of promising practices to reduce screen time. 4. Identify partners to enhance screen time data collection processes. Data Collection, Training & Awareness 5. Conduct assessment of youth and parents to determine the baseline of daily screen time. 6. Promote defined screen time viewing limits in communities and households no more than twohours per day for children and adolescents. 7. Promote active playtime and recreation activities to foster participation by families. 8. Support efforts that encourage parents to limit screen time for children and adolescents. 9. Encourage and educate parents to model appropriate screen time viewing behaviors and promoting an active lifestyle. Current Partners: Georgia Department of Public Health Public Health Districts Georgia Recreation and Parks Association Potential Partners: Faith based organizations Local School Systems: o Atlanta Public Schools o Clayton County Schools o DeKalb County Schools Library Association Local Recreation Centers YWCA s YMCA s Boys and Girls Clubs Georgia Parks and Recreation Georgia Department of Education Georgia PTA COMMUNITY SETTING

28 28 MID TERM OBJECTIVE C3 By 2016, increase by 5%, the utilization of state parks and community recreation centers in 5 communities. Policy & Environmental Change KEY STRATEGIES Stakeholder/Potential Partners 1. Increase access by increasing bus routes, transportation initiatives, and improving and maintaining quality of built environment around communities and community parks. Data Collection, Training & Awareness 2. Collect baseline data from Georgia State Parks and Georgia Parks and Recreation Association to identify number of people who use these locations (state parks, community recreation centers). 3. Identify and map existing community resources/interventions in Georgia that focus on healthier lifestyles to prevent obesity. 4. Encourage and promote the use of Georgia State Parks initiatives to promote physical activity opportunities (through Live Health Georgia website). 5. Encourage and promote community recreation center initiatives to promote physical activity opportunities (using already established resources Live Healthy Georgia website). 6. Promote existing community resources and interventions through media outlets, social marketing and social media to ensure that communities have access to interventions that support healthier lifestyles for obesity prevention. Current Partners: Georgia Department of Public Health Public Health Districts Community based Organizations Georgia Department of Natural Resources State Parks Georgia Recreation and Parks Association Potential Partners: Chamber of Commerce Local Schools Systems Local Recreation Centers Senior Recreation Centers YMCA YWCA Boys and Girls Club COMMUNITY SETTING

29 29 MID TERM OBJECTIVE C4 (High Priority) By 2016, increase by 10%, accessibility (reported/estimated) to affordable healthy food choices through community gardens and farmers markets in 5 urban and/or rural communities. Policy & Environmental Change KEY STRATEGIES Stakeholder/Potential Partners 1. Establish accessible farmers markets or farm stand programs in underserved areas. 2. Establish community gardening and agriculture initiatives. 3. Design communities to improve health, sustainability, and opportunity. 4. Encourage local retail establishments to buy locally grown food. 5. Increase fresh produce in grocery stores in underserved areas. 6. Decrease the amount of unhealthy foods that are made available, and advertised, to children. 7. Increase access to affordable healthy food choices; increase availability of locally produced and/or pesticide free fruits and vegetables. 8. Increase the number of farmers markets accepting electronic benefit transfers (EBTs). Data Collection, Training & Awareness 1. Collect baseline data on access to current community gardens and farmers markets. 2. Collect baseline data on the number of community gardens and farmers markets within the 5 urban and/or rural communities. 3. Increase social media and marketing campaigns aimed at increasing awareness of healthy food choices. 4. Utilize data from Georgia Organics of registered farmer s markets and community gardens. 5. Encourage farmers markets and community gardens to register with Georgia Organics. Current Partners: Georgia Department of Public Health Georgia Coalition for Physical Activity and Nutrition Potential Partners: Slow Food Society Georgia Organics Community Health Works American Gardeners Association (Georgia Chapter) Atlanta Urban Gardeners Association Georgia Department of Agriculture University of Georgia Cooperative Extension o GA Master Gardener Local Cooperative Extension Offices Atlanta Community Food Bank Local Community Gardeners Faith Based Organizations Local Master Gardeners College and Universities o College of Agriculture o and Environmental o Sciences o College of Family and o Consumer Sciences Community Residents Family and Consumer Scientists Environmental Scientists Policy Makers Statewide Food Policy Council Local Food Policy Councils and Coalitions Local Food Advocates COMMUNITY SETTING

30 30 MID TERM OBJECTIVE S1 (High Priority) By 2016, increase the proportion of students in middle and high schools who engage in moderate to vigorous physical activity for 60 minutes per day from 52% to 54% and 43% to 45% respectively. KEY STRATEGIES Policy & Environmental Change Stakeholder/Potential Partners 1. Encourage Georgia Department of Education and local school systems to require physical education (PE) for all students in Georgia (elem./middle/ high). 2. Encourage universities to address obesity and physical education within college and university curricula for students pursuing teaching professions. 3. Encourage Georgia Department of Education and local school systems to provide opportunities within the school day for students to participate in moderate to vigorous physical activity. 4. Support, promote and encourage schools and communities to promote walking and biking to school by implementing the Safe Routes to School initiative. 5. Encourage joint use agreements between schools and communities to use of school athletic facilities to promote physical activity opportunities. 6. Support Georgia Department of Education and local school systems efforts to revise Physical Education and Physical Activity recommendations to achieve the National Association of School Boards of Education (NASBE) standards for physical education (PE) in schools. Data Collection, Training & Awareness 7. Support Georgia Department of Education and local school systems efforts to assess the physical fitness of students on an annual basis. 8. Recruit the expertise of trained physical educators, or provide training to teachers to lead high quality physical activity sessions. 9. Provide technical assistance and training to parents and teachers related to motor skill activities that can be implemented to achieve moderate to vigorous physical activity during and after school. 10. Encourage schools and community facilities to utilize social media to promote physical activity initiatives for students. Current Partners: Georgia Department of Public Health Georgia Department of Education o Health/PE District Coordinators Georgia Department of Transportation o Safe Routes to School Coordinators Public Health Districts HealthMPowers Alliance for a Healthier Generation Georgia Department of Community Health o State Health Benefit Plan Southeast Dairy Association Children s Healthcare of Atlanta Atlanta Falcons Youth Foundation Georgia Health, Physical Education, Recreation and Dance PLAY Policy Leadership for Active Youth Georgia Action for Healthy Kids Southeast United Dairy Industry Association Potential Partners: Georgia Association of Educational Leaders o Georgia Association of Elementary School Principals, GA Association of Middle School Principals, GA Association of Secondary School Principals, GA School Superintendents Association, GA School Boards Association Local School Superintendents Local School Systems Local School Principals Georgia Parent Teacher Association College and University Departments o Exercise Science, Kinesiology, Exercise Physiology, etc COMMUNITY SCHOOL SETTING SETTING

31 31 MID TERM OBJECTIVE S2 By 2016, increase by 6, the number of schools (K 12) in which breastfeeding education is part of the curriculum. Policy & Environmental Change KEY STRATEGIES Stakeholder/Potential Partners 1. Incorporate breastfeeding education into the Georgia Performance Standards Framework. Data Collection, Training & Awareness 2. Assess current breastfeeding education practices within the Georgia schools K 12. Current Partners: Georgia Department of Public Health o Nutrition and Physical Activity Initiative Georgia Department of Education Georgia Breastfeeding Coalition 3. Pilot the breastfeeding education framework in six schools two elementary schools, two middle schools and two high schools. Potential Partners: Public Health Districts Georgia Department of Public Health o WIC Breastfeeding Coordinator o MCH Breastfeeding Coordinator Georgia Association of Educators Georgia School Superintendents Association Georgia School Boards Association Local School Superintendents Local School Systems United States Department of Agriculture National WIC Association Georgia PTA SCHOOL SETTING

32 32 MID TERM OBJECTIVE S3 (High Priority) By 2016, increase by 25%, the proportion of schools offering only nutrient dense foods and beverages that meet the dietary recommendations as set out by the Dietary Guidelines for Americans. Policy & Environmental Change KEY STRATEGIES Stakeholder/Potential Partners 1. Encourage schools to develop policies that promote healthy breakfast and lunch menus that include more fruits, vegetables, low fat and fat free dairy, and whole grains. 2. Encourage schools to provide healthier options in vending machines, a la carte lines, and all foods served in schools. 3. Encourage and promote healthier food choices at school events in which students, parents and teachers attend. 4. Encourage schools to develop and implement policies that limit sugar sweetened beverages. 5. Promote and support school garden projects. 6. Promote and support Farm to School programs. Current Partners: Georgia Department of Public Health Georgia Department of Education o Nutrition Program Georgia Action for Healthy Kids Southeast United Dairy Industry Association Potential Partners: Georgia Association of Educational Leaders o Georgia Association of Elementary School Principals o Georgia Association of Middle School Principals o Georgia Association of Secondary School Principals o Georgia School Superintendents Association Local School Systems Local School Superintendents Local School Principals District Nutrition Program Coordinators Georgia Parent Teacher Association Georgia Department of Agriculture Georgia Cooperative Extension Public Health Districts Georgia School Boards Association County Superintendents of Schools Teachers Volunteer Professionals University and college schools of Public Health, Nutrition Departments SCHOOL SETTING

33 33 MID TERM OBJECTIVE S4 By 2016, a minimum of 25 school districts will adopt a Farm to School program that increases the amount of fresh, local food served in cafeterias. KEY STRATEGIES Policy & Environmental Change 1. Encourage Georgia Department of Education and Georgia Department of Agriculture to adopt a joint, state wide farm to school plan that would provide needed support and technical assistance for school nutrition staff, teachers, administrators and students to implement farm to school programming. 2. Encourage school districts to incorporate farm to school into wellness policies, adopt farm to school programs to encourage local produce served in school meals, and hands on food, gardening and nutrition activities in class. Stakeholder/Potential Partners Current Partners: Georgia Department of Public Health Georgia Organics Farm to School Program Georgia Department of Education o Nutrition Program Potential Partners: Georgia Association of Educational Leaders o Georgia Association of Elementary o School Principals o Georgia Association of Middle School Principals o Georgia Association of Secondary School Principals o Georgia School Superintendents o Association Local School Systems Local School Superintendents Georgia School Boards Association District Nutrition Program Coordinators Georgia PTA Georgia Department of Agriculture Georgia Cooperative Extension Public Health Districts Local School Principals SCHOOL SETTING

34 34 MID TERM OBJECTIVE S5 By 2016, increase by 25%, the proportion of K 12 schools that implement the component of the school wellness policy that addresses nutrition education and physical activity goals. KEY STRATEGIES Policy & Environmental Change 1. Implement the wellness policy as dictated in the Child Nutrition Reauthorization Act of Data Collection, Training & Awareness 2. Assess and determine wellness policies that are implemented that address nutrition education and physical activity at the school level. 3. Promote nutrition and physical activity curriculums are taught in schools. 4. Create a database of experts on nutrition education and physical activity to assist schools in implementing the nutrition education and physical activity goals. 5. Connect schools with volunteer health, nutrition and physical activity professionals (coaches). 6. Encourage development and implementation of staff wellness policies/activities. Stakeholder/Potential Partners Current Partners: Georgia Department of Public Health Georgia Department of Community Health o State Health Benefit Plan Georgia Department of Education Georgia Action for Healthy Kids Southeast United Dairy Industry Association Potential Partners: Public Health Districts Georgia Association of School Nurses County Superintendents of Schools Georgia School Superintendents Association Georgia School Boards Association Local School Systems Georgia PTA School Wellness Committees University and College Schools of Public Health Teachers Volunteer Professionals SCHOOL SETTING

35 35 MID TERM OBJECTIVES W1 A. By 2016, increase by 20% the number of worksites within at least 6 health districts that have written policies to support physical activity. B. By 2016, increase by 20% the number of worksites within at least 6 health districts that have written policies to support healthy eating. C. By 2016, increase by 10% the number of worksites within at least 6 health districts that have implemented written breastfeeding support policies. D. By 2016, increase by 15% the number of worksites within at least 6 health districts that make environmental changes to support physical activity. E. By 2016, increase by 15% the number of worksites within at least 6 health districts that make environmental changes to support healthy eating options. F. By 2016, increase by 10% the number of worksites within at least 6 health districts that provide designated space for employed mothers to breastfeed or pump breast milk (High Priority). KEY STRATEGIES Policy & Environmental Change 1. Encourage worksites to display point of decision prompts to promote physical activity. 2. Assist worksites in implementing a written breastfeeding policy and providing a facility (breastfeeding room) to accommodate breastfeeding at work (using evidence based resources HRSA The Business Case for Breastfeeding toolkit.) 3. Partner with fruit and vegetable vendors to provide weekly, on site farmers market and assist worksites in improving access to healthy foods (e.g. changing cafeteria options, vending machine content). 4. Encourage worksites to create or enhance access to places for physical activity. Such changes would include creating walking trails, building exercise facilities, providing access to existing nearby facilities, and/or locating worksites in regions that enable more active transportation modes such as public transit, walking, and bicycling. 5. Encourage human resource directors to include coverage for preventative care and promote physical activity, healthy eating, and breastfeeding support programs in employee health benefit plans. Stakeholder/Potential Partners Current Partners: Department of Public Health o Cardiovascular Health Initiative (CVHI) o Maternal and Child Health District Health Promotion Coordinators Chronic Disease Prevention Program Managers University of Georgia Georgia Breastfeeding Coalition Tiny Babies Foundation Magnificent Women Organization State Health Benefit Plan CIGNA Data Driven Health Care Solutions South Eastern Lactation Consultants Association Georgia Coalition for Physical activity and Nutrition WORKPLACE SETTING

36 36 Data Collection, Training & Awareness Stakeholder/Potential Partners 6. Establish baseline data that captures worksite specific nutrition, physical activity, and breastfeeding policy, and environmental changes (Building/creating a more systemic view of the programmatic data collected in the Georgia Worksite Health Promotion Policies and Practices Survey). 7. Promote the implementation and use of the Work Healthy Georgia Toolkit. Potential Partners: Business leaders County Boards of Health American Academy of Pediatrics Chambers of Commerce Latin American Association American Dietetic Association Georgia Association of Occupational Health Nurses 8. Create an executive summary tool that encourages worksite executives and leaders to incorporate wellness in their business unit strategy and practices. 9. Provide train the trainer workshops to train worksite leaders on the Work Healthy Georgia Toolkit. 10. Implement health promotion programs that target obesity prevention and reduction through nutrition, physical activity, and breastfeeding. 11. Encourage worksites to provide on site health/exercise incentive programs (to stress importance of incorporating physical activity and healthy lifestyle habits). WORKPLACE SETTING

37 37 MID TERM OBJECTIVE H1 By 2016, increase by five the number of registered dietitians within each of the three Medicaid Care Management Organizations (CMOs) who are approved providers for medical nutrition therapy and other services. KEY STRATEGIES Policy & Environmental Change 1. Advocate for a standardized approval process to enable dietitians as providers in the CMO Network. Data Collection, Training & Awareness 2. Promote access to and usage of medical nutrition therapy and other services among Medicaid and CMO providers and patients. 3. Assess perceived barriers and challenges to health care providers in partnering with and referring to dietitians. 4. Assess barriers for dietitians to become approved providers within Georgia Medicaid and the CMO Network. Stakeholder/Potential Partners Current Partners: Obesity Action Network Georgia Chapter of the American Academy of Pediatrics The Georgia Academy of Family Physicians International Life Sciences Institute Children s Healthcare of Atlanta Georgia Dietetic Association Georgia Department of Public Health Potential Partners: Georgia Department of Community Health o Georgia Health Partnership HEALTH CARE SETTING

38 38 MID TERM OBJECTIVE H2 By 2016, increase by 10, the number of medical and allied health programs in Georgia that include in their education and residency programs topic specific core competencies in obesity prevention (breastfeeding promotion, healthy eating, increased physical activity, and/or decreased sedentary activity), assessment of weight status and weight management. KEY STRATEGIES Policy & Environmental Change 1. Promote the inclusion of core competencies of obesity prevention and treatment in medical and allied health training curriculums in Georgia. 2. Promote the expansion of residency programs for medical and allied health programs to include training in the core competencies of obesity prevention and treatment. Data Collection, Training & Awareness 3. Establish the baseline of existing training in core competencies of obesity prevention and assessment and management of weight. Stakeholder/Potential Partners Current Partners: Obesity Action Network Georgia Chapter of the American Academy of Pediatrics The Georgia Academy of Family Physicians International Life Sciences Institute Children s Healthcare of Atlanta Georgia Nursing Association Georgia Department of Public Health Potential Partners: Georgia Department of Community Health o Georgia Health Partnership HEALTH CARE SETTING

39 39 MID TERM OBJECTIVE H3 (High Priority) By 2016, increase by 10%, the total number of targeted health care providers and their staff (i.e. clerical staff, home health aides, dietitians, nurse practitioners, physician assistants, and physicians) who are trained on healthy eating, breastfeeding, physical activity and/or behavior change. KEY STRATEGIES Data Collection, Training & Awareness 1. Promote and disseminate evidence based guidelines and expert recommendations for the assessment and treatment of overweight and obesity in children and adults. 2. Establish the baseline of the number of healthcare professionals in Georgia who have received training in the assessment and treatment of overweight and obesity in children and adults. 3. Establish the baseline of the number of health care providers that assess BMI and BMI for age percentile to clients. 4. Build the capacity of targeted health care staff to: assess BMI and BMI for age percentile, assess client readiness to change, promote healthy lifestyle, treat patients who are overweight or obese, and provide referrals to programs in the community. Stakeholder/Potential Partners Current Partners: Obesity Action Network Georgia Chapter of the American Academy of Pediatrics The Georgia Academy of Family Physicians International Life Sciences Institute Children s Healthcare of Atlanta Georgia Dietetic Association Georgia Department of Public Health HEALTH CARE SETTING

40 40 MID TERM OBJECTIVE H4 By 2016, develop and implement an advocacy action plan that will result in an increase in the number of currently licensed insurance companies in Georgia and state funded health coverage plans that provide reimbursement/benefits for prevention and treatment of obesity. KEY STRATEGIES Policy & Environmental Change 1. Develop and implement an advocacy action plan for increasing the number of payers that provide reimbursement/benefits for prevention and treatment of obesity. Data Collection, Training & Awareness 2. Assess what CMOs, HMOs and licensed insurance providers are currently covering related to obesity prevention and treatment and related benefits offered. Stakeholder/Potential Partners Current Partners: Obesity Action Network/Healthcare Workgroup Georgia Chapter of the American Academy of Pediatrics The Georgia Academy of Family Physicians International Life Sciences Institute Children s Healthcare of Atlanta Georgia Department of Public Health Potential Partners: Georgia Department of Community Health o Georgia Health Partnership o State Health Benefit Plan Private insurance carriers Alliance for a Healthier Generation HEALTH CARE SETTING

41 41 MID TERM OBJECTIVE H5 By 2016, develop and implement a breastfeeding friendly health care system based on guidelines on the UNICEF/WHO s Baby Friendly Hospital Initiative. KEY STRATEGIES Policy & Environmental Change 1. Develop partnerships with the Georgia Hospital Association and other health professional organizations in championing the implementation of the Baby Friendly Initiative in birthing hospitals. 2. Add at least two three Lactation Specialists to the Obesity Action Network/Healthcare Workgroup membership. Data Collection, Training & Awareness 3. Provide technical assistance, training, and support to health care facilities to develop and implement policies, systems and environmental changes that support breastfeeding. 4. Provide breastfeeding support skills training and continuing education to community based providers in obstetrics, family medicine, pediatrics, nursing, midwifery, nutrition, health education and social services. Stakeholder/Potential Partners Current Partners: Obesity Action Network/Healthcare Workgroup Georgia Chapter of the American Academy of Pediatrics The Georgia Academy of Family Physicians International Life Sciences Institute Children s Healthcare of Atlanta Georgia Department of Public Health Georgia Hospital Association Georgia Perinatal Association HEALTH CARE SETTING

42 42 MID TERM OBJECTIVE F1 By 2016, increase the number of faith based organizations by 75 that adopt a written wellness policy and the associated environmental changes which promote healthy eating, breastfeeding, and/or physical activity. KEY STRATEGIES Policy & Environmental Change 1. Develop regional faith networks and/or wellness centers across Georgia consisting of faith based and community organizations. Data Collection, Training & Awareness 2. Plan, develop, and implement a statewide Faith Summit to focus on sustainability and best practices in faith based organizations for prevention or control of obesity and other chronic diseases. Stakeholder/Potential Partners Current Partners: C.H.O.I.C.E.S. Georgia Free Clinic Network Essence in Nutrition Consultants LLC Providence Missionary Baptist Church Garden Green Team Farmer s Market Inc. Flourish Ministries Good Samaritan Health Center Georgia Department of Public Health FAITH BASED SETTING FAITH BASED SETTING

43 43 MID TERM OBJECTIVE F2 (High Priority) By 2016, train 75 faith based organizations to advocate for and implement policy, system, and environmental change interventions to support healthy eating, breastfeeding, and/or physical activity. KEY STRATEGIES Policy & Environmental Change 1. Provide step by step sample policies and built environment development guidelines for faith based organizations. 2. Develop individual faith community work plans to guide the development, implementation and evaluation of each faith based organization s health promotion initiative. Data Collection, Training & Awareness 3. Create a faith based online database on the Live Healthy Georgia Website for health resources, evidence based practices, data, and events, which are appropriate for the faith based setting. 4. Train faith based organizations to implement policy, environmental, or system interventions using the Live Healthy in Faith Toolkit. 5. Provide additional trainings and speaker engagements addressing the needs identified by faith based organizations in order to be advocates for health promotion and enhance their health initiative. Stakeholder/Potential Partners Current Partners: Emory Prevention Research Center Georgia Department of Public Health o North Central Health District C.H.O.I.C.E.S. Tiny Babies Foundation Georgia Coalition for Physical Activity and Nutrition Head Start Centers for Medicare/Medicaid Grady Health System Atlanta Masjid of Al Islam Good Samaritan Health Center Beulah Missionary Baptist Church FAITH BASED SETTING

44 44 MID TERM OBJECTIVE F3 By 2016, evaluate 75 faith based organizations which implemented policy, system, and environmental change interventions to support healthy eating, breastfeeding, and physical activity. KEY STRATEGIES Policy & Environmental Change 1. Evaluate the faith based policy, system and environmental change interventions, Faith Summit, and Live Healthy in Faith Toolkit. 2. Promote asset based community development assessment for faith communities. Data Collection, Training & Awareness 3. Provide sample forms and training for faith communities on the importance and process of record keeping and reporting data from their health promotion initiative. 4. Share success stories of faith communities with health promotion initiatives. Stakeholder/Potential Partners Current Partners: Georgia Department of Public Health Generation Next Sports Performance Facility Congregational Health Ministry of Gwinnett Medical Center Grady Medical Center FAITH BASED SETTING

45 45 MID TERM OBJECTIVE E1 By 2016, develop and disseminate a baseline survey and a needs assessment for child care centers and daycare homes to assess their breastfeeding, nutrition, and physical activity practices/environment, which will identify the practices/environments of at least 30% of childcare facilities in Georgia. KEY STRATEGIES Policy & Environmental Change 1. Encourage, promote, and support child care centers and day care home providers in evaluating their nutrition and physical activity environment. 2. Encourage facilities to voluntarily enroll in the new quality rating and improvement system (QRIS) which includes standards for nutrition and physical activity. Data Collection, Training & Awareness 3. Develop training and resources that specifically address areas that most child care centers and/or day care homes assessed as needing improvement. Stakeholder/Potential Partners Current Partners: Bright from the Start Georgia Department of Early Care and Learning (DECAL) Georgia Department of Community Health Georgia Department of Public Health United States Department of Agriculture EARLY CARE SETTING

46 46 MID TERM OBJECTIVE E2 By 2016, increase by 10%, the number of early child care centers in Georgia that have successfully developed and implemented wellness policies. KEY STRATEGIES Policy & Environmental Change 1. Provide mini grant funding for centers to conduct activities that support the adoption of wellness policies that will result in healthy practices that will reduce and/or prevent childhood obesity. 2. Encourage facilities to voluntarily enroll in the new quality rating and improvement system (QRIS) which includes standards for nutrition and physical activity. Data Collection, Training & Awareness 3. Educate early child care provider on wellness policies regarding healthy eating, physical activity, and breastfeeding via trainings and online resources. 4. Provide need assessments for child care centers to evaluate what areas of the center s operation regarding nutrition, physical activity and breastfeeding can be improved. Stakeholder/Potential Partners Current Partners: Bright from the Start Georgia Department of Early Care and Learning Georgia Department of Community Health Georgia Department of Public Health United States Department of Agriculture Child Care Resource and Referral Agency (Southwest Region ) EARLY CARE SETTING Since 2006, all school systems that participate in school lunch or school breakfast program are required to establish a local school based wellness policy that addresses Physical Activity and Nutrition Education goals, focuses on nutrition guidelines and sales compliance for all foods that are sold or are available on school campuses

47 47 MID TERM OBJECTIVE E3 (High Priority) By 2016, develop and implement an advocacy action plan that will inform and result in the adoption of nutrition and physical activity best practices becoming state licensing requirements (i.e. minimum daily number of minutes of physical activity, annual teacher/provider training on nutrition and physical activity, and limits screen time to zero two hours per day depending on the age group, family day care complying with Child and Adult Care Food Program (CACFP) meal pattern, etc.). KEY STRATEGIES Policy & Environmental Change 1. Develop and implement an advocacy plan for the revision of Child Licensing rules and regulations for Child Care Centers ( ), Group Day Care Homes ( ), Family Day Care Homes ( ) resulting in healthier practices/activities that will reduce and/or prevent childhood obesity. Data Collection, Training & Awareness 2. Assess the perceived barriers and challenges for the revision of licensing requirements. 3. Assess the perceived barriers and challenges for centers, and homes (group and family) to comply with nutrition and physical activity best practices. Stakeholder/Potential Partners Current Partners: Bright from the Start Department of Early Care and Learning Georgia Department of Community Health Georgia Department of Public Health United States Department of Agriculture EARLY CARE SETTING

48 48 MID TERM OBJECTIVE E4 By 2016, increase by 75%, the number of staff at child care centers and day care home providers that attend educational opportunities related to healthy eating, physical activity, and breastfeeding best practices. KEY STRATEGIES Policy & Environmental Change 1. Work with state and federal partners to provide training, support and technical assistance to child care providers, and staff. 2. Encourage facilities to voluntarily enroll in the new quality rating and improvement system (QRIS) which includes standards for nutrition and physical activity. Data Collection, Training & Awareness 3. Advertise training via the Child Care resource and referral agencies Healthy Eating for Life website, and Georgia s Early Education Professional Registry System Training Calendar. 4. Provide state approved credit hours for attendance and training completion by participants. Stakeholder/Potential Partners Current Partners: Bright from the Start Georgia Department of Early Care and Learning Georgia Department of Community Health Georgia Department of Public Health United States Department of Agriculture EARLY CARE SETTING

49 49 EVALUATION STRATEGY The implementation of Georgia s Nutrition and Physical Activity plan will be evaluated using both process and outcome measures. The Epidemiology Branch of the Department Public Health will bear primary responsibility for data collection, analysis and reporting over the period, particularly as it relates to outcome evaluation. Much of the evaluation will be informed by current surveillance systems and surveys that are already in place. In some instances, new surveillance tools and special surveys will be developed and administered as necessary to address current gaps in baseline and follow up data. Some of the settings based surveys that have already been established include: Worksite Setting The Georgia Worksite Health Promotion Policies and Practices Survey, modeled after the National Worksite Health Promotion Survey was conducted for the first time in 2002 to document existing policies, environments, and programs affecting the health of Georgia workers. Computer assisted telephone interviews were conducted with the director of human resources or employee health. Survey findings represent a random sample of private sector worksites with at least 15 employees identified from the Dun and Bradstreet database. Worksites were stratified into three categories: small (15 99), medium ( ), and large (250+) and four industry categories. A total of 1,085 worksites completed the survey with a response rate of 54%. Final data were weighted so that each stratum represented its true proportion in the worksite population. Health Care Setting The Health Plan Policy Survey was administered to Georgia Health plans and managed care organizations. The survey assessed whether health plans and managed care organizations have policies or guidelines to routinely provide or reimburse for assessment and counseling for physical activity and medical nutrition therapy for plan members, as part of their standard package. School Setting The Georgia School Health Profiles Survey asks school principal and lead health educators questions related to the implementation, organization, structure, and support of health education in their schools. The survey consists of two questionnaires developed by the CDC. The survey findings represent a random sample of all public middle and high schools in Georgia having at least one of grades 6 through 12. Georgia has administered the mailed survey biannually during the spring semester since 1996 with the exception of Additionally, in the first year of the plan implementation, the Nutrition and Physical Activity Initiative Taskforce Partnership will establish the data sources and collection methods for those

50 developmental objectives that have been described in this document as being important to achieving the long term goal. Program evaluation will also include an assessment of partnerships over time. Key informant interviews will be conducted with partners and stakeholders engaged in the implementation of the plan. Initial interviews will serve as baseline data and secondary interviews will occur close to or at the midpoint of the expected implementation period. The following table outlines a list of existing surveillance systems that will assist in the monitoring of changes in overweight/ obesity and behaviors related to breastfeeding, healthy eating, physical activity and TV viewing/ screen time. Table 3 SOURCE TOPIC AREA DATA COLLECTION YEARS POPULATION Behavioral Risk Factor Surveillance System (BRFSS) Risk factors Physical Activity (PA) Exercise Fruits and Vegetables Ongoing since 1984, annual Every odd year Every year Every odd year Representative statewide and 18 public health district sample of adults 18 years and older Weight Control Every odd year Height and Weight Every year Youth Risk Factor Surveillance System (YRBS) PA, Physical education, Fruits and Vegetables, TV viewing, Video game use, Height and weight, Weight control behaviors 2003 Every odd year Representative statewide sample of middle and high school students Pregnancy Risk Assessment Monitoring System (PRAMS) Breastfeeding, overweight/obesity, pregnancy weight gain , ongoing since 2000 Representative statewide of women who have had a live birth in the previous 6 months Pregnancy Nutrition Surveillance System (PNSS) Demographics, pregnancy weight status, gestational weight gain, anemia, smoking, alcohol intake, medical care, parity, breastfeeding trends, pregnancy outcome Ongoing since 1995, annual Pre natal and postpartum participants of the Georgia Women, Infants and Children (WIC) Program Pediatric Nutrition Surveillance System (PedNSS) Weight for age, height for age, anemia and iron status, breastfeeding Ongoing since 1992, annual Infant and child participants of the Georgia Women, Infants and Children (WIC) Program 50

51 51 REFERENCES 1. Centers for Disease Control and Prevention. (2009). Georgia Student Health Survey. US Department of Health and Human Services: Atlanta, GA. 2. Centers for Disease Control and Prevention. (2009). Pediatric Nutrition Surveillance System. US Department of Health and Human Services: Atlanta, GA. 3. Centers for Disease Control and Prevention. (2010). Behavioral Risk Factor Surveillance System. US Department of Health and Human Services: Atlanta, GA. 4. Kanny, D., Choi, H.S. & Hammond, D.A. (2004). School Health Education in Georgia: Results from the 2002 School Health Education Profile (SHEP) Survey. Publication number DPH04/181HW. Georgia Department of Human Resources, Division of Public Health: Atlanta, GA. 5. Choi, H.S., Bricker, S.K., Troy, K., Kanny, D., & Powell, K.E. (2004). Worksite Health Promotion Policies and Practices in Georgia: 2002 Georgia Worksite Survey. Publication Number PH03/156HW. Georgia Department of Human Resources, Division of Public Health: Atlanta, GA. 6. Frank, L.D., Martin, A., Andersen, M.A., & Schmid, T.L. (2004). Obesity Relationships with Community Design, Physical Activity, and Time Spent in Cars. American Journal Preventive Medicine, 27(2), Thorpe, K.E. (2009). The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses. United Health Foundation, American Public Health Association and the Partnership for Prevention. Retrieved from: final.pdf 8. Centers for Disease Control and Prevention. (2011). Obesity: Halting the Epidemic by Making Health Easier. At a Glance National Center for Chronic Disease Prevention and Health Promotion. US Department of Health and Human Services: Atlanta, GA. Retrieved from: 9. Ahlquist, Brooke. Understanding Policy, Systems and Environment Change to Improve Health. Minnesota Department of Health. Accessed July 12, McLeroy, K. R., Bibeau, D., Steckler, A. & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education Quarterly, 15,

52 52 GLOSSARY Active Living Community a community designed to provide opportunities for people of all ages and abilities to incorporate physical activity into their daily routines. By encouraging people to be more active, active living communities may improve health by lowering people s risk for health conditions such as obesity, diabetes and heart disease. Active Living Plans when a community develops a plan for active living, which contributes to individual physical and mental health and also to social cohesion and community well being. living planning/ Age percentile a comparison of one child s height or weight values to other children who are the same age and sex. A la Carte Lines a line serving foods that can be ordered as separate items rather than part of a set meal. Approved Provider something that an agency or organization can apply for regarding their capacity to award contact hours for continuing education activities within a particular field, planned, implemented and evaluated by the organization within a certain time period. education/download approved providerforms.dot Bikeability how safe the cycling environment is in a particular neighborhood or community; considers path surfaces, roads and intersections, other drivers, etc. BMI Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems. The formula to calculate adult BMI (18 years or older): weight (kg) / [height (m)] 2. For persons under the age of 18, BMI is calculated and then plotted on a BMI for age growth chart constructed by the Centers for Disease Control and Prevention (CDC). What%20is%20BMI Adults (18 or older): BMI Status overweight 30+ obese Children and Youth (under 18 years old): BMI Status 85th to <95th percentile overweight 95th percentile obese

53 53 Breastfeeding a mother who feeds her child human breast milk; the preferred method of feeding an infant according to the American Academy of Pediatrics; exclusive breastfeeding is ideal nutrition for infants and it is sufficient to support optimal growth and development for the first 6 months after birth, according to the American Academy of Pediatrics. Built Environment a term referring to the human made surroundings which provide the infrastructure for basic human activity; can be anything from homes, neighborhoods, and schools, to parks, road networks, and subway lines c50 711cf1b6d1a5.asset Care Management Organizations (CMO s) CMO s, or care management organizations, are agencies that provide a full range of treatment and support services to patients with extreme needs by developing individualized service plans specific to each patient. Child Nutrition Reauthorization Act of 2010 authorizes funding for federal school meal and child nutrition programs and increases access to healthy food for low income children Clean Air Campaign in partnership with the GA Department of Transportation, the campaign works to invest, design, and implement commuting options to help protect public health, reduce pollution, reduce traffic congestion, and improve our air quality. Us Community a social unit that usually encompasses a geographic region in which residents live and interact socially such as a political subset (county, city, town), social organization, faithbased organizations, community based organization, schools, neighborhoods, public health districts, health departments, worksites, healthcare agencies, early care organizations, nonprofit organizations, colleges and universities. Community Based Organization (CBO) non profit agencies created by communities to address local needs. Typical community organizations fall into the following categories: community service and action, health, educational, personal growth and improvement, social welfare and self help for the disadvantaged. Community Gardens any piece of land gardened by a group of people; more specifically, the American Community Garden Association states that a community garden can be urban, suburban, or rural. It can grow flowers or vegetables or both. It can be one large garden or many smaller plots.

54 54 Community Health Workers (CHW) also known as community health advocates, lay health advisors, lay health educators, community health representatives, peer health promoters, community health outreach workers, and promoters de salud (Latino Community Health Advisors) are frontline public health workers who are a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and selfsufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. Connectivity the ease of travel between two points and the degree to which streets or areas are interconnected and easily accessible to one another. An example of high connectivity would be a dense grid pattern in a downtown area. Dietary Guidelines for Americans every five years, the United States Department of Agriculture (USDA) and Health & Human Services (HHS) issue these guidelines to advise Americans on how to make better food choices, engage in more physical activity, reduce their risk of chronic disease, and improve overall health. Environmental change changes to economic, social, or physical environments. Faith Based Organization the general definition is an organization, group, program or project that provides human services, and has a faith element integrated into their organization. Farmers Market where a group of farmers can gather in a local public place to sell their products so members of the community can purchase fresh, local produce. markets/ Farm to School connects schools (K 12) and local farms with the objective of serving healthy meals in school cafeterias, improving student nutrition, providing agriculture, health and nutrition education opportunities, and supporting local farmers. Food Policy any decision made by a government agency, business, or organization which affects how food is produced, processed, distributed, purchased and/or protected. food policy

55 55 Health Impact Assessment (HIA) according to the CDC, health impact assessment is defined as a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population ; used to evaluate the potential health effects of a policy before it is implemented. HMOs a kind of health insurance offering various kinds of health care services to its members; members pay a fixed cost each month to have access to these services. Incentive Program a formal scheme used to promote or encourage specific actions or behavior by a specific group of people during a period of time. Joint Use Agreement a way to increase opportunities for children and adults to be more physically active; two or more entities, usually a school and a city or private organization, share indoor and outdoor spaces like gymnasiums, athletic fields and playgrounds in order to keep costs down while still keeping communities healthy. joint use/ Lactation Consultant a health care professional who is knowledgeable, skilled, and experienced in lactation (breastfeeding); the primary focus is to provide education, assistance and support to breastfeeding women. Livable Centers Initiative (LCI) an investment policy study for activity and town centers to create communities and corridors where we can live, work, and play. The results can maximize growth by utilizing such practices as mixed use development and higher densities concentrated around transportation facilities and employment centers /glossary terms Live Healthy Georgia Campaign an outreach initiative that aims to raise awareness about the risk factors associated with chronic diseases and to provide Georgians with information about ways to live healthier, and reduce their risk of developing chronic diseases; focused on both individual behavior change as well as changes made to the policies, systems and environments that impact our healthy choices. Metropolitan Planning Organization (MPO) a federally required planning body responsible for transportation planning and project selection in its region. The governor designates an MPO in every urbanized area with a population of 50,000 or more people. The MPO is responsible for developing the Regional Transportation Plan (RTP) and the Transportation Improvement Program (TIP) in its jurisdiction /glossary terms

56 56 Mixed Land Development a juxtaposition of land classifications, such as residential, office, commercial, industrial, park, and flood plain within a given area. Land use is controlled by zoning ordinances that reflect political decisions often made at the local level. Mixed Land Use mixed land use combines residential, commercial, and industrial land in an integrated way with sustainable forms of transport such as public transportation systems, walking and cycling. Moderate Intensity Activity noticeably increases your heart rate and breathing rate; brisk walking, light jogging, biking, swimming, volleyball, line dancing, etc. Modified Retail Food Environment Index measures the number of healthy and less healthy food retailers within a census tract. For this indicator, healthy food retailers include supermarkets, supercenters, and produce stores. Less healthy food retailers include convenience stores, fast food restaurants, and small grocery stores with 3 or fewer employees. Higher mrfei scores indicate more access to healthy food retailers and fewer less healthy food retailers. The scores ranges from zero (no food retailers that typically sell healthy food) to 100 (only food retailers that sell healthy food), National Association of School Boards of Education (NASBE) aims to strengthen State Boards as the preeminent educational policymaking bodies for students and citizens. Nutrient Dense Foods Nutrient dense foods and beverages provide vitamins, minerals and other substances that may have positive health effects, with relatively few calories. Overweight/Obesity overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. Physical Activity any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level. Physical Activity Guidelines to help introduce regular physical activity into everyday lifestyles, these guidelines are each geared toward a specific age group: children (6 17), adult (18 64), and older adults (65+).

57 57 Physical Education (PE) aims at physical development and education of the student through physical activity. and definition of physical education/ Point of Decision Prompt (for physical activity) point of decision prompts are often used as visual cues to guide individuals in adopting healthy behaviors. Point of decision prompts for increasing physical activity include signs or banners posted near elevators, escalators, or moving walkways with the intention of encouraging individuals to use stairwells or climb/walk rather than standing still. ofdecision_prompts_for_stairwell_use.pdf Policy change Interventions that use laws, ordinances, rules, regulations and or mandates to effect change in population behavior. Preventative care services and measures, such as screenings, vaccinations and counseling taken to help prevent illness and improve overall health rather than simply treating symptoms. Regional Faith Network a collaboration of ministries, community based organizations, individuals, businesses, educators and civic leaders mobilized to invest their time and other resources to improve the overall health of children and families. Rural Community any territory, population, and housing units that the Census Bureau does not classify as urban are considered rural. Safe Routes to School (SRTS) A program created by the federal transportation bill that aims to increase the number of students in grades K 8 who bike and walk to school. School Gardens A way to use the schoolyard as a classroom, reconnect students with the natural world and the true source of their food, and teach them valuable gardening and agriculture concepts and skills that integrate with several subjects, such as math, science, art, health and physical education, and social studies, as well as several educational goals, including personal and social responsibility. gardens.html School Wellness Policy each school district must form a committee and draft a wellness policy which is to include: 1. Goals for nutrition education, physical activity, and other school based activities that promote student wellness. 2. Nutrition guidelines for all foods available on campus during the school day with the objectives of promoting student health and reducing childhood obesity.

58 58 3. Assurance that guidelines for school meals provided under the federal reimbursement program will, at a minimum, meet regulations and guidance issues by the Secretary of Agriculture. 4. A plan for measuring the impact and implementation of the policy. 5. Involvement from parents, students, and representatives of the school authority, school board, school administrators, and the public, in development of the policy. Screen Time the amount of time spent in front of a screen TV, computer, or videogame does screen time mean Sugar sweetened Beverages liquids that are sweetened with various forms of sugars that add calories. These beverages include, but are not limited to, soda, fruit drinks, sports drinks and energy drinks. Sustainability meeting the needs of the present without depleting resources or harming natural cycles for future generations. Systems Change Interventions or changes that leverage the functional components of an organization, institution, or system. The Business Case for Breastfeeding a comprehensive program designed to educate employers about the value of supporting breastfeeding employees in the workplace. programs/business case forbreastfeeding/ Toolkit contains introductory material on public health topics, education and training material relevant to public health practitioners, state and federal public health resources, and an index of pressing public health topics. health.uiowa.edu/umphtc/education/phtoolkit/ Urban Community the Census Bureau defines urban as comprising all territory, population, and housing units located within an urbanized area and in places of 2,500+ people outside of those urbanized areas; an urbanized area is defined as a continually built up area of 2,500+ people comprising one or more places, as well as the densely settled surrounding areas. Urban Planning the branch of architecture that deals with the design and organization of urban space and activities.

59 59 Vigorous Intensity Activity breathing rapidly, sweating, can only speak in short phrases, and heart rate is increased. Walkability how safe the walking environment in a particular neighborhood or community is; considers factors such as sidewalks, crosswalks, drivers, etc. Walkable Community A community where people can walk safely; a walkable environment that has the following characteristics: Well maintained and continuous wide sidewalks Ramped curbs Safe and easy street crossings A level terrain Well lighted streets A grid patterned street design High street connectivity A safety buffer between pedestrians and motorized vehicles (such as trees, shrubs, street side parked cars, green space between pedestrians and cars) A slow traffic pattern Minimal building setbacks Cleanliness Land use patterns characterized as mixed use with high unit density Wellness Center (faith based) faith based ministries that have programs that integrate physical, mental, spiritual, and environmental wellness through methods such as holding wellness seminars and providing wellness screenings. School Wellness Policies combine education with practice to create healthful school environments and encourage healthy behavior As required by law, a local wellness policy, at a minimum, shall include: Goals for nutrition education, physical activity and other school based activities that are designed to promote student wellness in a manner that the local educational agency determines is appropriate; Nutrition guidelines selected by the local educational agency for all foods available on each school campus under the local educational agency during the school day with the objectives of promoting student health and reducing childhood obesity; Guidelines for reimbursable school meals this requirement implies that districts must ensure that reimbursable school meals meet the program requirements and nutrition standards set forth under the 7 CFR Part 210 and Part 220;

60 60 A plan for measuring implementation of the local wellness policy, including designation of 1 or more persons within the local educational agency or at each school, as appropriate, charged with operational responsibility for ensuring that each school fulfills the district's local wellness policy; Community involvement, including parents, students, and representatives of the school food authority, the school board, school administrators, and the public in the development of the school wellness policy Worksite an area where an industry is located or where work takes place. Zoning local codes regulating the use and development of property within specific categories.

61 APPENDICES 61

62 62 APPENDIX I. TASKFORCE MEMBERS Name Leila Anderson Mark Anderson Kathleen Ashley A Keti Avila John Bare Katie Barnes Monica Barnett Anthon Barron Mary Daise Basil Wintana Berhe Hansa Bhargava Lindsay Bishop Ericka Borrero Marsha Britton Alicia Cardwell Brown Cheryl Burnette Robbie Burlas Vickie Callahan Karen Callen Jimmy Calloway Howard Campbell Agency/Organization Community Health Works Cobb County Schools/Georgia Action for Healthy Kids Community Health Works SWAH Empowerment Atlanta Falcons Foundation University of Georgia Cooperative Extension Georgia Department of Public Health Your Health America, Inc. DeKalb County Board of Health WellCare Health Plans, Inc. Web MD Children s Healthcare of Atlanta Department of Public Health Southside Medical Center DeKalb County Board of Health City of Decatur Data Driven Healthcare Solutions United Healthcare Children s Healthcare of Atlanta Georgia Coalition for Physical Activity and Nutrition DeKalb County Board of Health

63 63 Kathleen Chiu Mary Lu Christiansen Laura Colbert Eugene Cooke Liz Coyle Kylia Crane Erin Crooms Desdimonia Cross Sonya Crutchfield Barbara Curl Anjulyn Davis Sabrina Davis Donna DeCaille Ruchi Desai Claire Drogula Cathi Durham Anne Dunlop Claire Eden Lauren Farnum Sabrina Fernandez Dan Fesperman Monica Fink Laura Fiveash Sherrita Frazier Hygeia II Medical Group Amerigroup Children s Healthcare of Atlanta Providence Missionary Baptist Church Garden PEDS Georgia Chapter of the American Academy of Pediatrics Georgia Organics Office of Senator Donzella James Georgia Department of Public Health Healthy Mothers Healthy Babies Georgia Department of Early Care and Learning Centers for Medicare & Medicaid Services Georgia Department of Public Health Office of Women s Health Georgia Department of Community Health Georgia Academy of Family Physicians Emory University, School of Medicine LaLeche League Georgia Department of Public Health Good Samaritan Health Center Children s Healthcare of Atlanta Georgia Department of Early Care and Learning South Georgia Medical Center Mount Early Baptist Church

64 64 Anna Fulton Gretchen Gigley Jimmy Gisi Adrienne Gil Gary Green Wendy Greenberg Samuel Gold Elizabeth Hagan Rosetta Hall Marissa Hamm Gail Hanula Patricia Hardesty Trisha Hardy Leonie Harris William Harris Charmaine Heard Carole Helms Jeffery Hicks Johanna Hinman Wanda Holder Jennifer Hopkins Debbie Huckaby Marcia Hunter Rhonda Hunter Americorp Georgia Clean Air Campaign Georgia Recreation and Park Association Alliance for a Healthier Generation University of Georgia Northside Pediatrics Towne Lake Pediatrics DeKalb County Board of Health Tiny Babies Foundation Georgia Department of Early Care and Learning University of Georgia Cooperative Extension Generation Next Sports Performance Facility United Healthcare Essence in Nutrition Consultants LLC International Christian Fellowship Ministries United/AmeriChoice American Diabetes Association Providence Missionary Baptist Church Emory Prevention Research Center Greenforest Community Baptist Church Antioch Baptist Church Gwinnett Medical Center Georgia Department of Public Health Centers for Medicare & Medicaid Services

65 65 Jacquline Ingram Tawonna Ingram Martha Jackson Mary Nicholson Jackson Linda Johnson Beth Jones Chevonnia Jones Renea Jones Patricia Jones Christi Kay Vanetta Keyes Debra Kibbe Karen Kierath Ruth Kitchen Lucy Klausner Sarah Knight Donna Kremer Lincoln Larson Frank Lawrence Tomasine Leachman Naima Lewis Vamella Lovett Rodney Lyn DeKalb County Board of Health Amerigroup Faith Based Consultant Georgia Breastfeeding Coalition/ Grady WIC Lactation Services Fort Valley State University North Central Health District North Central Health District Lactation Consultant Georgia Department of Public Health HealthMPowers C.H.O.I.C.E.S. ILSI Research Foundation Georgia Coalition for Physical Activity and Nutrition Greening Youth Foundation Children s Healthcare of Atlanta Georgia Safe Routes to Schools WellStar University of Georgia Georgia Department of Public Health YWCA Hyer Dynamic Health Discovery Dougherty County Health Department Georgia State University

66 66 Maurice Madden Eryn Marchiolo DeWan McCarty Therese McGuire Cecil Merett Keith Mitchell Felicia Mobley Eduardo Montaña Kyla Zaro Moore Maxine Moore Kiley Morgan Adilah Muhammad Mary Muhammad Kathy Mullen Arlene Murrell Chad Neilsen Lavonia Nelson Stephanie Orlando Toyo Oshogwemoh Beth Passhel Larry Paul Stephanye Peek Pamela Perkins Mary Ann Phillips Medicare Diabetes Screening Project DeKalb County Board of Health Georgia Department of Public Health Georgia Department of Education Hart County Schools Georgia Department of Public Health Georgia Medical Care Foundation Children s Cardiovascular Medicine Southeastern Horticulture Society Liburn WIC Clinic Georgia Department of Public Health Grady Hospital Health System Atlanta Masjid of Al Islam Green Team Farmers Market, Inc. Southeast United Dairy Industry Association, Inc Georgia Department of Public Health Tiny Babies Foundation College of Charleston Centers for Disease Control and Prevention Healthcare Consultant FACES Fitness and Conditioning, Inc. Georgia Health, Physical Education, Recreation, and Dance Interfaith Children s Movement Georgia State University

67 67 Marsha Pierce Andy Pittman Loraine Pitts Kalin Prevatt Joanna Pritchard Rusty Pritchard Marcia Rafig Joyce Reid Tanya Roberts LaToysa Scaife Rooks Lynn Roundtree Angelina Ruffin David Russell Cheryl Scales Candice Scott Holly Sealer Ann Sears Rebecca Serna Wilma Sexton Rashida Shoemaker Amy Spangler Della Spearman Kim Stillwach Georgia Department of Public Health Georgia Safe Routes to Schools Columbus/Cordele District of CME Church Haralson County Health Department Flourish Ministries Flourish Ministries Georgia Coalition for Physical Activity and Nutrition Georgia Hospital Association Research and Education Foundation C.H.O.I.C.E.S. Clayton County Board of Health Centers for Medicare & Medicaid Services Emory University Tenacious Fitness Magnificent Woman Organization North Central Health District Children s Healthcare of Atlanta Northeast Health District Atlanta Bicycle Coalition Northwest Health District Southeast United Dairy Industry Association, Inc. Baby GooRoo Interdenominational Theological Center Good Samaritan Health Center

68 68 Todd Stormant Molly Szymanski Lauren Tanase Robin Tanner Jonathan Tescher Robert Thompson Jilo Tisdale Cynthia Tucker Eric VanDeGenachte Marcelo Vazquez Meghana Vellanki Cheryle Ward Patricia Ward Judy Weaver Brandi Whitney Mark Wilson Georgia Department of Public Health Southeast United Dairy Industry Association, Inc. Georgia Department of Education Nutrition and Physical Activity Consultant Georgia Organics Southwest Atlanta Growers Co op United Way Head Start Consultant Department of Natural Resources The Trainer, LLC Good Samaritan Health Center Greenforest Academy Foundation Department of Public Health Centers for Medicare & Medicaid Services DeKalb County Board of Health University of Georgia C. Williams Department of Community Health Joann Yoon Priscilla Young Jo Zurbrugg Voices of Georgia Children Nutrition and Physical Activity Consultant Healthy Futures Healthy Lifestyles

69 69 APPENDIX II. WORKGROUP CO CHAIRS & CONTRIBUTING PARTNERS Healthcare Internal Chair Patricia Jones Department of Public Health Health Promotion Disease Prevention External Chair Holly Sealer Children s Healthcare of Atlanta [email protected] [email protected] Contributing Partners: The Obesity Action Network (OAN), The Georgia Chapter of the American Academy of Pediatrics (GA AAP), The Georgia Academy of Family Physicians (GAFP), International Life Sciences Institute (ILSI), Children s Healthcare of Atlanta (CHOA), The Georgia Dietetic Association, The Georgia Department of Community Health/State Health Benefits Plan, The Georgia Department of Public Health/Nutrition and Physical Activity Initiative Schools Internal Chair Monica Barnett Department of Public Health Nutrition and Physical Activity Initiative External Chair Mark Anderson Cobb County Schools [email protected] [email protected] Contributing Partners: Safe Routes to School, Cobb County Schools, Georgia Department of Public Health Maternal and Child Health and Health Promotion and Disease Prevention Programs, Georgia Breastfeeding Task Force, LeLeche League, Baby GooRoo, North Health District Public Health, GA Action for Healthy Kids, The Trainer LLC, Southeast United Dairy Industry Association, Inc, GA Department of Community Health State Health Benefit Plan, GA Organics Farm to School Program, GA Department of Education, HealthMPowers, and Children's Healthcare of Atlanta (CHOA)

70 70 Early Childcare Internal Chair Donna DeCaille Department of Public Health Nutrition and Physical Activity Initiative External Chair Marissa Hamm Department of Early Care and Learning Contributing Partners: Bright from the Start, Department of Early Care and Learning (DECAL), Department of Community Health (DCH), Department of Public Health (DPH), United States Department of Agriculture(USDA), Child Care Resource and Referral Agency (Southwest Region ) Community Internal Chair Monica Barnett Department of Public Health Nutrition and Physical Activity Initiative [email protected] External Chair Karen Kierath Director of Communication Georgia Physical Activity and Nutrition Coalition (G PAN) k.kierath@g pan.org Contributing Partners: Department of Public Health, Georgia Department of Natural Resources State Parks and Historic Sites, University of Georgia Warnell School of Forestry & Natural Resources, Georgia Physical Activity and Nutrition Coalition (GPAN), Hyer Dynamics Health Discovery, Inc., Fort Valley State University, Community Health Works, Children's Healthcare of Atlanta (CHOA).

71 71 Faith based Internal Chair Lauren Farnum Department of Public Health External Chair Martha Jackson Health Promotion Disease Prevention Contributing Partners: C.H.O.I.C.E.S., Georgia Free Clinic Network, Providence Missionary Baptist Church, Good Samaritan Health Center, Women Missionary Society, National Council of the Missionary Society, Rainbow Baptist Church, SWAH Empowerment, Georgia Coalition for Physical Activity and Nutrition (GPAN), Emory Prevention Research Center, North Central Health District, Tiny Babies Foundation, Centers for Medicare/Medicaid, Grady Health System, Atlanta Masjid of Al Islam, Beulah Missionary Baptist Church, North Central Education Taskforce, Greenforest Community Baptist Church, American Diabetes Association, Georgia Cardiovascular Health Initiative, Georgia Tobacco Use Prevention Program Worksite Internal Chair Kiley Morgan Department of Public Health Health Promotion Disease Prevention External Chair Cheryl Scales Magnificent Women Organization Contributing Partners: University of Georgia, Georgia Breastfeeding Coalition, Tiny Babies Foundation, Magnificent Women Organization, State Health Benefit Plan, Georgia Association of Occupational Health Nurses, CIGNA, Data Driven Health Care Solutions, South Eastern Lactation Consultants, Georgia Coalition for Physical Activity and Nutrition (GPAN), Healthy Mothers Healthy Babies, Cardiovascular Health Initiative (CVHI), Maternal and Child Health, Live Healthy Georgia

72 72 APPENDIX III. NUTRITION AND PHYSICAL ACTIVITY INITIATIVE Principal Investigator Dr. Kimberly Redding Program Manager Sonya Crutchfield Nutrition Coordinator Donna DeCaille Physical Activity Coordinator Monica Barnett Program Evaluator Frank Lawrence Program Epidemiologist Chad Neilsen Faith Based Coordinator Lauren Farnum Program Associate Tamiko Pickett

73 73 APPENDIX IV. COLLABORATIONS Collaborative Stakeholders Key Recent or Ongoing Activities Governor s Office, DOE, DCH, Fitness Assessment Pilot in children GDPH, Arthur Blank Foundation, S.H.A.P.E Atlanta Falcons Youth Foundation, Atlanta Braves Foundation, CHOA, HealthMPowers, Georgia State University, Georgia Health Policy Center (GPAN), YMCA, Georgia Southern University, GAHPERD, local school systems Georgia Action For Healthy Kids Childhood Obesity Action Network (GA Chapter) Georgia Coalition for Physical Activity and Nutrition Policy Leadership for Active Youth Cobb County Schools, Georgia Department of Public Health, Georgia Department of Community Health, Georgia Department of Education, Georgia Nutrition and Physical Activity Coalition (GPAN), Southeast United Dairy Industry Association, Inc., Georgia Association of Health, Physical Education, Recreation and Dance, CHOA, Alliance for a Healthier Generation, Fitness/Physical Activity Consultants, Nutrition Consultants Network of providers in Georgia Business & industry, the academic community, service organizations and foundations, education, government entities public health, family & children services Georgia State University Institute of Public Health, Georgia Center for Obesity and Related Disorders (UGA,GHSU), HCGF School Wellness Summits Collaborate for Healthy Weight (prevention and treatment of childhood obesity) Cooking Matters Statewide Leadership Council; childhood obesity prevention and treatment research; Healthy Schools, Healthy Communities Guide

74 74 Georgia Children s Health Alliance Philanthropic Collaborative for a Healthy Georgia Voices for Georgia's Children Georgia Food Policy Council Live Healthy Baldwin Live Healthy Columbus Healthy Savannah Coalition Public and private sector organizations Philanthropic foundations Georgia Birth to Five Coalition, Georgia Child Advocacy Network and JUST Georgia Public and private sector organizations Baldwin County, Georgia College and State University, Oconee River Greenway Authority, Milledgeville Community Garden Association Public and private sector organizations Public and private sector organizations Stop Childhood Obesity Media Campaign; Strategic Planning Georgia Youth Fitness Assessments (Fitnessgrams) Healthy Steps Development of Nutrition Standards RWJF Healthy Kids, Healthy Communities implementation: Safe Routes to School, walking/bike paths, community gardens, farmer s markets, afterschool programming Strong4Life Implementation and Urban Adventure fundraising race Savannah Health Summit, Rock n Roll marathon, fitness programs, smoking ordinances, SoGreen Network

75 75 APPENDIX V. PARTNER ORGANIZATIONS Action for Healthy Kids Georgia Team AIM 2010 Albany Area Health Care, Inc. Albany Area YMCA Alliance for a Healthier Generation Alpharetta Parks & Recreation American Academy of Pediatrics, GA Chapter American Cancer Society American Heart Association SE Affiliate Armstrong Atlantic State University Atlanta Bicycle Coalition Atlanta Intercultural Ministries Augusta State University Bethel AME Church, Inc. Bibb County Schools Boys & Girls Clubs of Albany, Inc. Burke County Schools Camden County Schools Carrollton Parks & Recreation Carrollton Cultural Arts Department Center for Youth Leadership and Family Development Chattahoochee Valley Region Library System Children s Healthcare of Atlanta Coastal Health District 9 1 Cobb County School District Cobb/Douglas Health District 3 1 Colquitt County Extension Service Colquitt Regional Medical Center Columbia County Board of Education Columbus Parks & Recreation Communities in Schools Community Healthcare Center, Savannah Central Savannah River Area Partnership for Community Health Dearing Elementary School DeKalb Health District 3 5 DeKalb YMCA Dougherty County School System Dougherty for Children/Family Connection East Central Health District 6 0 East Metro Health District 3 4 Economic Development for McDonough Effingham County Department of Parks & Recreation Ellaville Primary Medicine Center Emory University, Department of Health, Emory University, Physical Education and Dance Emory University, Rollins School of Public Health Enterprise Community Healthy Start Family Connection Partnership Fit II Play Health and Performance Academy

76 76 Floyd Medical Center Forsyth County Schools Fort Valley State University Georgia Recreation and Park Association Georgia Rural Health Association Georgia State Games Commission Fulton County Department of Health & Wellness Gainesville Parks & Recreation Georgia Academy for Family Physicians Georgia Association of Health, Physical Education, Recreation and Dance Georgia Bikes! Georgia Coalition for Black Women Georgia Coalition for Physical Activity and Nutrition Georgia Department of Community Health Georgia Department of Early Care and Learning Georgia Department of Education Georgia Department of Human Services Division of Aging Services Georgia Department of Human Services Division of Family and Children s Services Georgia Department of Public Health Georgia Department of Natural Resources Georgia Department of Transportation Georgia Dietetic Association Georgia Dietetic Foundation Georgia Hospital Association Georgia Institute of Technology Georgia Partnership for School Health Georgia Prevention Institute Georgia State University Girl Scout Council of Savannah, Georgia Inc Girl Scouts of Southwest Georgia Grady Health System Gwinnett County Parks and Recreation Hall County Parks and Leisure Services Hall County Schools HealthMPowers HealthSTAT Healthy Mothers, Healthy Babies Hispanic Health Coalition of Georgia Houston County School Food Service Hy Dy, Inc. I4 Learning ILSI Center for Health Promotion Interfaith Health Initiative Partners JuicePlus Kaiser Permanente Kid s Journey Kids Health Inc. L.E.A.P. of West Georgia LaGrange Health District 4 0 Lanier Elementary School Lee County Library

77 77 Legacy Link, Inc. Macon Central School District Medical Center of Central Georgia Medical College of Georgia Mercer University School of Medicine Phoebe Worth Medical Center Policy Leadership for Active Youth Initiative Project Open Hand Richmond County Board of Education Richmond County Recreation Department Metro Atlanta Safe Routes to School Coalition Metro Atlanta Skate School Monroe Comprehensive High School Morehouse School of Medicine Mt. Hebrew Baptist Church Muscogee County School District Neighborhood Improvement Project Newnan Hospital, Health & Fitness Center North Central Health District 5 2 North Georgia Health District 1 2 North Health District 2 0 Northeast Georgia Medical Center Northeast Health District 10 Northside Hospital Northwest Health District 1 1 Obesity Action Network Palmyra Medical Center Partnership for Community Action Pastoral Institute Perimeter North Family Medicine Philanthropic Collaborative for a Healthy Georgia Roswell Recreation and Parks Department Safe Routes to School Saint Joseph s Mercy Care Services Satilla Regional Medical Center Slim and Tone Snellville Parks and Recreation Department South Central Health District 5 1 South Health District 8 1 Southeast Health District 9 2 Southeast United Dairy Industry Association, Inc. Southside Health Center Southwest Georgia Area Health Education Center Southwest Health District 8 2 Spalding County Parks & Recreation Speaks & Associates Spring Creek Health Cooperative St. Francis Hospital St. Teresa s School Stephens County Schools Teen Plus Resource Center Teens Exercise

78 78 Terrell County Family Connection The Trainer, LLC Trowbridge & Associates, Inc. Union Mission University Hospital University of Georgia Cooperative Extension, Dougherty County University of Georgia, College of Family and Consumer Sciences University of Georgia, Warnell School of Forestry & Natural Resources University of Georgia, Department of Foods and Nutrition University of West Georgia Urban League of Greater Columbus US Food and Drug Administration Valdosta State University Verizon Wireless Walker County Department of Education Wayne Memorial Hospital West Central Health District 7 0 West End Medical Center West Georgia Health System West Georgia RESA Wilkes Wild about Wellness Worth County Board of Commissioners Worth County Board of Education YMCA of Metropolitan Atlanta Your Health America, Inc. USDA/FNS/WIC Southeast Region

79 79