2007 Model Practice Application (Public)

The Power of Healthy Choice Project

Delaware General Health District

The Power of Healthy Choice Project targets high School students, faculty and staff and addresses the public health issues of improving student food choices, improving student nutrition and fitness education, and child overweight and obesity prevention. The Power of Healthy Choice Project is adapted from the University of Minnesota School of Public Health TACOS Project, a two-year research project successful at increasing secondary school student consumption of lower fat foods. The Delaware General Health District (DGHD), in partnership with the Delaware City School District and its Hayes High School administrators and faculty, developed The Power of Healthy Choice Project aimed at empowering Hayes High School students to make healthier lifestyle choices. The Project has multiple components when implemented together will positively impact student food choices, student nutrition and fitness education and knowledge, and ultimately help in the prevention of child obesity.

The project components include:

• The makeover of the high school cafeteria serving lines using the "Power of Healthy Choice" theme and the look of a fresh farmer's market with vibrant colors and signage to focus student attention on healthier cafeteria selections.
  
  
• The creation of classroom, cafeteria and Power Project links in the area of nutrition & fitness education.
  
  
• In-class marketing education and the on-going development of student peer-to-peer marketing campaigns aimed at improving student cafeteria and vending food choices.
  
  
• Developing student leadership in choosing healthier vending and cafeteria a la carte foods.

Outcomes of the practice include:

• The completion of the cafeteria makeover with fresh Farmer's Market decor and new Power of Healthy Choice signage and unveiling to students, faculty and staff.
  
  
• The production of 5 student-created project name recognition marketing “scrollers” that were shown throughout the high school campus and created school-wide attention and “student buzz” about the project.
  
  
• The production of 25-30 student-created marketing scrollers on healthier eating that are to be shown throughout the high school campus to influence student food buying choices.
• The implementation of three healthy food purchase incentives for students--salad entree/pedometer giveaway; healthy soup/ipod give-away; healthy cold foods (salads, yogurt, raw veggies)/prize give-away.
  
  
• The significant linking of classroom lessons to the project – in the first year of the project, almost 93% of Hayes students participated in at least one classroom lesson connected to the Power Project.
  
  
• A change in school procedures for the selection of ala carte snack foods for sale including the student-led software nutritional analysis ("Snackwise") and taste testing of vending and cafeteria-line ala carte foods by a representative group of students working directly with the vendor, and the student-led creation of a healthier snack food preference list from which the vendor is to stock healthier ala carte snack food choices.
  
  
• A positive impact on student cafeteria food purchases---in the first year of the project there was a 39% increase in student purchases of fresh vegetable and fruit side dishes and a 68% increase in student purchases of entree salads (based on analysis of weekly food production records; comparison of 1st 9 week purchases to 3rd 9 week purchases). 2nd year data is yet to be collected and analyzed.
  
  
• The development and administration of pre- and post-intervention student nutrition and fitness surveys. Comparison of 1st year pre- and post-survey data shows statistically significant increases in the number of students who reported eating 3+ servings of yougurt and/or cottage cheese on the day before the survey, almost always or always eating breakfast, almost always or always eating the school l

Child obesity is the overarching public health issue that this practice was developed to help address--an obvious community health and social issue given the national epidemic of family obesity. Local Delaware County data confirm child obesity is a problem. A 2002 Body Mass Index measurement of a convenience sample of 2,781 Delaware County students showed 28% of the students were either overweight or at risk of becoming overweight. In 2005, the Delaware County Youth Health Assessments of a representative sample of middle school students showed 22% are either at-risk for overweight or overweight. One intervention helpful in preventing child obesity, is to create a healthier school environment that models healthy behaviors to students and empowers those students to practice making healthy lifestyle choices. The Power of Healthy Choice Project was adapted from successful student behavior change research and developed as a pilot project to understand how a partnership between a local health department and school district can positively impact a school health environment and its students' nutrition and fitness behaviors.

Concepts studied and reported in the University of Minnesota's School of Public Health TACOS Project (increasing student lower fat foods selection using peer-to-peer marketing techniques). How the Power Project differs from the TACOS Project is the partnership developed is between the local health department and local school district, (versus a University and multiple school districts) and with funding from a local United Way impact grant for health and obesity prevention. The Power Project is an inventive local project that builds on the TACOS Project concepts in multiple ways: 1) changing the look of the cafeteria service lines to a fresh Farmer's Market, 2) changing the cafeteria food placement and signage to help focus student attention on the healthiest choices, 3) linking multiple classroom lessons (beyond health and PE) to the project and cafeteria makeover, 4) providing district and classroom nutrition & health resources, 5) developing sophisticated student peer-to-peer marketing campaigns through the graphics communication classes and shown throughout the high school campus, and 6) developing student leadership in the selection of healthier ala carte foods sold on campus.

The Delaware General Health District (DGHD) partnered with the Delaware City School District and its Hayes High School administration and applied for 2-year local funding from the Delaware County United Way through its grant impact area--"Promoting physical and behavioral health and wellness--preventing obesity." The United Way grant funding pays for a portion of the DGHD Public Health Dietitian and the DGHD Epidemiologist time on the Power of Healthy Choice Project. The DGHD Public Health Dietitian coordinates the project for the health district and brings to the project expertise in nutrition, fitness and school health. The Delaware City School District has some 23 teachers, 8 administrative & support staff and students from the high school giving their time to the project on an in-kind basis. Health district staff in-kind includes additional time spent by the PH Dietitian and health district management. Health district and school district staff project work includes 1) the cafeteria makeover and creating new graphic designs, 2) creating and administering a student pre- & post- nutrition and fitness survey, and 3) creating and teaching classroom lessons linked to the cafeteria and the project, including the creation of ongoing student peer-to-peer marketing campaigns.

Funding sources included: United Way of Delaware County-Impact Grant: Promoting Physical and Behavioral Health and Wellness-- Obesity Prevention and Local Health District Levy funds. The Power of Healthy Choice Project is only one part of a larger three-part Delaware County United Way (DelCoUWay) Child Obesity Prevention grant. This larger grant initiative funds 20% of the FT DGHD Public Health Dietitian position, 10% of the DGHD Epidemiologist position, contract RN time, as well as equipment & supplies for the multiple grant components. As one part of the larger DelCoUWay Obesity Prevention grant, The Power of Healthy Choice Project component costs include:

Health district and school district staff time: Approximately 10% of the 20% UWay funded portion of the DGHD PH Dietitian position and even less of the 10% UWay funded portion of the DGHD Epidemiologist position goes toward the Power of Healthy Choice Project. School district staff time on the Power Project is 100% in-kind. Overall, some 23 teachers, 8 administrative & support staff and students from the high school give their time to the project on an in-kind basis. Health district staff in-kind includes additional time spent on the Power Project by the PH Dietitian and health district management and support staff time spenton the project. Health district and school district staff project work includes 1) the cafeteria makeover and creating new graphic designs , 2) creating and administering a student pre- & post nutrition and fitness survey, 3) creating and teaching classroom lessons linked to the cafeteria and the project, including the creation of ongoing student peer-to-peer marketing campaigns, 4) student analysis and selection of healthier vending snack foods, and 5) project evaluation, including statistical analysis and reporting.

Project equipment & supplies: Cafeteria sign production by a local sign company and other cafeteria decorations for two cafeteria serving lines (approx. $1,200.00); duplication of the student nutrition & fitness pre- & post-surveys (approx. $ 500.00); classroom teacher resources (approx. $100.00) and district food service nutrition software support and training (approx. $700.00).

Power Project implementation has been over a 2-year period. The following are key tasks:

• Developing the health and school districts’ partnership and key project concepts: Multiple meetings held with the Public Health Dietitian, school district Food Service Director, school district graphics staff, High School Assistant Principal over classroom curricula and teachers. (January - June 2005)
  
  
• Beginning development and implementation: School district administrators, faculty, technical staff, and the Public Health Dietitian, completed the following: 1)team meetings to develop project details, including tracking student food purchases; 2) the health district developed a pre- & post-student surveys to be administered by school faculty; 3) the school district Food Service Director and the Architectural Engineering Class repositioned equipment for the cafeteria "makeover;" 4) the school district Food Service Director and the Public Health Dietitian ordered cafeteria makeover supplies and new Power signage--signs were made by a local company using the team's graphic designs; 5) the cafeteria serving lines were transformed to look like a Farmer’s Market; 6) faculty began preparing students to develop marketing campaigns; and 7) faculty began preparing lesson plans linked to the Power Project. (August - mid December 2005)
  
  
• Classroom work: Art, Biology, CAD Design, Chemistry, German, French, Health Education, IT Lab, Journalisim, Library Sciences, PE, Social Issues English, Social Studies, and Work and Family faculty taught lessons linked to nutrition, fitness and the Power Project (in Project Year 1 almost 93% of the students participated in at least one in-class activity linked to the Power Project). The graphics communications students developed 5 project name-recognition peer-to-peer marketing scrollers that created school-wide project "buzz." in Project Year 1, and 25-30 healthier food choice peer-to-peer marketing scrollers to be shown throughout the remainder of Project Year 2. (November 2005 - June 2007)
  
  
• Student leadership in selecting healthier ala carte/vending foods: In project year 2, the high school health education students are participating in a student-led process to analyze (using "Snackwise" software) and taste-test healthier ala carte foods. The students are developing an ongoing ala carte food preference list and working directly with the vendor to stock healthier items on campus. (September 2006 -June 2007)
  
  
• Evaluation: Tracking student cafeteria and vending purchases, including cafeteria cashier and food service production data is led by the school district Food Service Director. Pre- and post-student survey tasks are led by the health district, with data entered at the health district and analyzed by the epidemiologist statistically and interpreted and reported by the Pubic Health Dietitian. Year 1: 2nd to 3rd 9 weeks for data collection; 4th 9 weeks for preliminary analysis of pre-survey data; January 2007 in-depth analysis of pre- and post-survey data due to delay with health district staff change. Year 2:1st through 3rd 9 weeks for student food purchase tracking and student pre-survey administered to new 9th grade students; 4th 9 weeks for final all student post-survey and food purchase analysis.

The Delaware General Health District is committed to expanding the successful Power of Healthy Choice Project concepts in school districts throughout Delaware County. The Delaware City School District and current Hayes High School Administration have indicated a high level of interest in sustaining the Power of Healthy Choice Project at the high school. Additional Power signage for the entire campus will be ordered before the end of this project year. After this year the high school will also receive some continued technical and financial support from the local health district to sustain the Power Project and develop future activities. This funding will come from a 2007-2008 local United Way impact grant, if the health district is once again funded in the area of child obesity prevention. The expansion of the Power Project to this school district's middle school is a key objective in this new United Way Obesity Prevention application for 2007-2008. If the health district does not receive another year of United Way funding, the Public Health Dietitian will continue to provide technical assistance and help the school using a small amount of public health levy funds. The Public Health Dietitian will also serve on the district's USDA-mandated Wellness Policy Group and advocate for continued Power Project activities at the high school, as well as expansion into the middle school.

Objective 1: Before the beginning of the 2nd 9 week session of the 2005-2006 school year, complete a makeover of the two Hayes HS cafeteria serving lines with a fresh Farmer’s Market look and Power of Healthy Choice signs positioned to focus student attention on the healthiest cafeteria food items.

Performance Measure: To have the cafeteria makeover completed before the beginning of the 2nd 9 week period of the 2005-2006 school year.

Outcomes: The cafeteria makeover with fresh Farmer's Market décor and new Power of Healthy Choice signage and unveiling to students, faculty and staff was completed on-time. Student anecdotal reaction to the makeover was positive with the bulk related to students liking the look esthetically, more likely to use the cafeteria and students now able to more easily locate the healthier cafeteria food items. Comparing pre- and post-student survey responses from Project Year 1, there was a statistically significant increase (6 percentage points) in the number of students who reported they almost always or always eat the school lunch in the cafeteria. In Project Year 1 there was a 39% increase in student purchases of fresh vegetable and fruit side dishes and a 68% increase in student purchases of entree salads (based on analysis of weekly food production records; comparison of 1st 9 week purchases to 3rd 9 week purchases). 2nd year data is yet to be collected and analyzed. In comparing the pre- and post- student survey responses from Project Year 1, there was a statistically significant increase (6 percentage points) in the number of students who reported they almost always or always eat the school lunch in the cafeteria.

Objective 2: Create and implement new classroom lesson links to the Power Project and the cafeteria makeover.

Performance Measure: To have multiple faculty create and teach classroom lessons and activities linked to the Power Project in Year 1 and Year 2 of the Project.

Outcomes: The significant linking of classroom lessons to the project – in the first year of the project, almost 93% of Hayes students participated in at least one classroom lesson connected to the Power Project. Health Education classes have shifted more of their class time to the subject of nutrition and fitness, including an ongoing "Wellness" class where Power Project funds were able to support a student-led healthy eating incentive program.

Objective 3: Create ongoing student peer-to-peer Power Project marketing campaigns.

Performance Measure: To have ongoing student created Power Project peer-to-peer marketing shown throughout the Hayes HS campus.

Outcomes: In comparing the pre- and post-student survey responses from Project Year 1, there was a statistically significant increase (from 15% to 53%) in the number of students who reported seeing information or campaigns about food and nutrition posted around their school. The Power Project name recognition peer-to-peer scroller campaign created such a student "buzz" across the campus, that even those teachers who taught subjects that could not be linked to the Power Project, had to stop and discuss the project and it's purpose before they could proceed with their usual classroom activities.

Lessons learned include:

• The cafeteria makeover was unveiled 11/1/2005 and positive student feedback was immediate with comments given to food service staff, faculty and administration. The Assistant Principal tracked this anecdotal information overall.
  
  
• Cashier key pad data turned out to not be reliable; the change was made to use kitchen production record data only to track student food purchases.
  
  
• The number of post- student surveys completed was less than the pre-surveys completed, possibly due to the lateness in the school year. The post-survey for Project Year 2 will be administered earlier in the 4th week period.
  
  
• Multiple teachers beyond Health Education and PE were able to link their classroom activities to the Power fo Healthy Choice Project.
  
  
• The Health Education teachers indicate even their classroom lessons changed with an increased empahsis on nutrition and fitness.
  
  
• Teaching the Graphics Communications students how to develop a marketing "campaign" took a greater amount of time than the teacher anticipated. Project Year 1 resulted in the creation of only a Power Project name recognition campaign and the development of healthier eating scrollers was tabled until Project Year 2.
  
  
• Even the Power Project name recognition campaign created a great amount of "buzz" across the campus.