start strong walking and breakfast program l.
Skip this Video
Loading SlideShow in 5 Seconds..
Start Strong Walking and Breakfast Program PowerPoint Presentation
Download Presentation
Start Strong Walking and Breakfast Program

Loading in 2 Seconds...

play fullscreen
1 / 62

Start Strong Walking and Breakfast Program - PowerPoint PPT Presentation

  • Uploaded on

Start Strong Walking and Breakfast Program Presentation as part of Public Health Nutrition Outline Background to school breakfast and walking programs Start Strong program description Results and discussion Conclusions and recommendations Background

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Start Strong Walking and Breakfast Program' - Audrey

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
start strong walking and breakfast program

Start Strong Walking and Breakfast Program

Presentation as part of

Public Health Nutrition

  • Background to school breakfast and walking programs
  • Start Strong program description
  • Results and discussion
  • Conclusions and recommendations
what is the need for school interventions in nutrition and physical activity
What is the Need for School Interventions in Nutrition and Physical Activity?
  • Past 30 years, the obesity rate for 6-11 year olds has tripled
  • At least 15% of US children are overweight
  • Childhood obesity influenced by many factors (IOM):
    • Reduced access and affordability of nutritious foods in communities
    • Decreased opportunity for physical activity to and from as well as at school
    • Food insecurity
      • 10% of all American children experience food deprivation
  • Certain populations at highest risk for obesity:
    • Boys – Hispanic-American
    • Girls – African-American
  • Long-term health risks associated with childhood obesity
significance of nutrition in schools
Significance of nutrition in schools
  • Improvement in academic performance
  • Improvement in psychosocial functioning
  • Emphasis of healthy body image
  • Promotion of healthy body weight
  • Promotion of long-term health outcomes
  • Development of optimal lifelong eating habits
importance of school breakfast determined by sbp data
Importance of School Breakfast- determined by SBP data
  • SBP a low-cost health intervention
  • Affect of breakfast consumption on total energy intake
    • Breakfast skippers are more likely to be overweight
    • Higher dinner intake increases risk of overweight
  • Association of food insecurity and obesity
    • Decrease in overweight among food-insecure participants
  • Affect of school breakfast consumption:
    • Fewer hungry children, nurse visits, disciplinary problems
    • Improvement in academic performance, body image, healthy eating practices, and translates to better family eating habits
school breakfast program need and utilization
School Breakfast Program Need and Utilization
  • Offered more in low-income vs. high income neighborhoods
  • Targets groups with free/reduced cost meals
  • Addresses issue of breakfast-skipping
    • ¼ of students fail to eat breakfast
    • Race – black and hispanic adolescents highest rate
    • Age – older age groups more likely to skip
    • Gender – girls more likely to skip than boys
school breakfast program barriers
School Breakfast Program Barriers
  • Time
  • Late buses, school arrivals or long commutes
  • Students not hungry in the morning
  • Stigma associating the SBP with poverty
importance of physical activity in school
Importance of Physical Activity in School
  • ½ of 6-17 year-olds go without daily physical activity
  • 40% decrease in active commuting since the 1970s
  • Only 5% of children walk or bike to school
  • Walking or biking to school is associated with an average of 24 minutes of increased daily exercise
physical activity in school associated with
Physical Activity in School Associated With:
  • Increased physical activity outside of school
  • Decreased BMI
  • Decreased incidence of chronic disease
  • Improved cardiovascular fitness
  • Decreased TV screen-time
  • Decreased consumption of high-fat snacks
  • Improved academic performance
school walking programs and active transportation
School Walking Programs and Active Transportation
  • Improve the health and physical fitness of individuals
    • Increase metabolism and circulation
    • Decrease illness and absenteeism
    • Improve concentration and learning
    • Encourage an overall increase in physical activity
  • Support the health of the community
    • Limit traffic pollution and congestion
    • Encourage parent/teacher involvement
    • Reallocate school transportation resources
utilization of active transportation programs
Utilization of Active Transportation Programs

Demographic disparities:

  • Low SES is a determinant for low overall physical activity
  • Participants of programs are more likely to have lower SES
  • Gender differences
    • Boys more active than girls
barriers to active transportation
Barriers to Active Transportation
  • Unsafe neighborhoods
  • Inclement weather
  • Traffic and congestion
  • Lack of sidewalks and crosswalks
  • Suburban sprawl
purpose of start strong
Purpose of Start Strong
  • Start Strong is a program working to combine walking to school with healthy breakfasts in order to enhance student health and build community involvement in your elementary school.
program objectives
Program Objectives
  • Decrease potential for student injury
  • Increase number of students walking to school
  • Increase number of students consuming a healthy breakfast
  • Improve school breakfasts
logic model
Logic Model

ShortTerm Outcomes

Intermediate Outcomes

Long Term Outcomes





Increased # of students walking to school

Add to evidence base for breakfast and Walk to School Activities

Decreased Obesity Rates

Grant money

Focus Groups

District Wide Policy Change

Increased participation in school lunch program

Breakfast changes District Wide



Healthier students


Nutrition Ed

+ changes in school breakfasts

Increased student academic success

+ changes in Nutrition Services due to increased revenue

Taste Tests

Great evaluation

Develop health champions within schools

Walk to School expansion

Improved knowledge

program schools
Program Schools
  • Maple Elementary:
    • 64.5% participating in free/reduced program, 12.9% breakfast participation
  • Dearborn Park Elementary
    • 75% participating in free/reduced program, 21.6% breakfast participation
  • Emerson Elementary
    • 77% participating in free/reduced program, 46% breakfast participation
  • Wing Luke Elementary
    • 72% participating in free/reduced program, 24.4% breakfast participation
  • Beacon Hill (control)
  • Breakfast taste tests
  • Walking School Bus
  • Monthly walk and breakfast promotions
    • October 2006 start, planned through June 2007
data collection
Data Collection
  • Hands-up Surveys (at Dearborn Park, Emerson, and Beacon Hill)
    • Questions about where/if students ate breakfast and how they traveled to school
  • Parent interviews (at Dearborn Park, Emerson, Maple, and Wing Luke)
    • Questions about opinions on breakfast and walking, perceptions of program, and possible barriers to participation
  • Teacher/staff interviews (at Dearborn Park, Emerson, Maple, and Wing Luke)
    • Questions about perceptions of program, participation, and evaluation of effects
analysis of hands up survey data
Analysis of Hands-Up Survey Data
  • Proportion calculated for each breakfast and transportation category
  • Used a two-sample proportion hypothesis test to compare each intervention school to the control school
  • Significance was defined as a two-sided p-value <.05
analysis of key informant interviews
Analysis of Key Informant Interviews
  • Yes/No questions analyzed quantitatively
  • Qualitative questions analyzed by grouping answers into main themes
  • Relevant responses were quoted in the qualitative results
  • Statistical analysis could not be performed due to small sample sizes
  • Results presented explicitly as fractions
hands up student breakfast and transportation survey
Hands Up Student Breakfast and Transportation Survey

“Please enter the number of students who raise their hand for each of the following”:

hands up survey where did you eat breakfast today
Hands Up Survey: “Where did you eat breakfast today?”

* Significant compared to control (p<.05)

hands up survey how did you get to school today
Hands Up Survey: “How did you get to school today?”

* Significant compared to control (p<.05)

hands up survey limitations
Hands Up Survey Limitations
  • Unequal counts between walking and breakfast questions
  • Some children (especially younger ones) did not understand the question about walking more than 2 blocks to school
  • Many classes were taking a field trip that day
  • At Emerson, day care across the street affected children’s answers
parent interviews
Parent Interviews
  • 32% participation rate (8 of 25)
  • All the parents had heard of Start Strong
  • 7 of 8 had met other parents
  • 6 of 8 had met teachers
  • 5 of 8 had helped with nutrition homework
parent responses breakfast
Parent Responses - Breakfast
  • Eating breakfast is very important to all the parents
  • 3 of 8 have children eating breakfast at school
  • 5 parents knew that parents can come to school breakfast, but only 3 have done it
  • Half the parents like the breakfast served
  • Half the parents think communication has improved
qualitative breakfast data
Qualitative Breakfast Data
  • Breakfast is important
    • Provides energy
    • Improves learning
    • 1st meal of the day
  • Breakfast at home
    • Family eats together
    • Late bus arrival
    • Food isn’t good enough at school
how to improve breakfast participation
How to Improve Breakfast Participation
  • Parents would participate if
    • More nutritious food
    • More organic food
    • Better quality food
  • Don’t participate because
    • Time constraints
    • Lack of trust
parent responses walking
Parent Responses - Walking
  • All the parents support the walking program
  • 3 of 8 parents said their children walk to school and 2 responded that they sometimes walk
  • All the parents think the walking program is safe
  • Results were mixed if it improves communication (5 of 8 said yes)
qualitative responses walking
Qualitative Responses - Walking
  • Parents think walking is important for themselves and their children
  • They think walking
    • Encourages socialization
    • Benefits health
    • Improves concentration
  • More students walk to school when it is “Walking Wednesday”
barriers to walking participation
Barriers to Walking Participation
  • Distance – Biggest barrier
  • Safety
  • Weather
  • Lack of sidewalks and construction
parents suggestions
Parents’ Suggestions
  • All would like to participate
  • Ride the bus with child
  • Designate a point to drop off children at the walking school bus
  • Better communication with promoters of the program
  • Better communication between parents
  • Parents need more time to participate
  • Low participation because of non-response
  • Possibility of misinterpreting questions
  • Disconnected numbers
  • Short timeframe for conducting interviews
  • Questions were sometimes vague and confusing to the parents
teacher staff interviews
Teacher/Staff Interviews
  • 48% (17/35) staff members participated in survey
  • Of those who participated in survey:
    • All 17 were familiar with the program
    • All 17 had students participate in the program
    • All 17 believed the program was beneficial for students
    • 13 conducted classroom interventions on health, nutrition, and/or exercise
    • 7 had parents/guardians involved in students’ class work
teacher staff responses breakfast
Teacher/Staff Responses - Breakfast
  • 12 of 17 thought parents were participating
  • 5 of 17 thought that communication was improved with parents
  • 10 of 16 thought students’ knowledge of healthy eating changed
  • 9 of 17 thought students’ attitude towards breakfast eating had changed
  • 12 of 17 thought students doing better academically because of breakfast
qualitative breakfast data43
Qualitative Breakfast Data
  • Kids liked the taste tests
  • More likely to try new foods introduced
  • Enjoy variety
  • New foods healthier
  • Kids eat more fruit when it is offered
  • Kids more alert when eat breakfast
  • Kids more aware of what healthy eating means
how to improve breakfast participation44
How to Improve Breakfast Participation
  • Implement more frequent taste tests
  • Getting kids back to class on time
  • Permanent nutrition program aside from PE instruction
teacher staff responses walking
Teacher/Staff Responses - Walking
  • 7 of 17 thought it improved school communication and trust
  • 9 of 15 believed the walking program is safe
  • 12 of 17 believed students more aware of health benefits of walking
  • 7 of 17 believed students’ attitude towards walking had changed
  • 4 of 17 thought children doing better academically
qualitative walking data
Qualitative Walking Data
  • Parent participation declined in the winter
  • More opportunities to interact with parents during a walk
  • Making a connection is hard
  • Program is too small to make a difference
  • Kids are excited about the program
  • Prizes and incentives help
  • Program considered safe with adult supervision
how to improve walking participation
How to Improve Walking Participation
  • Staff participation is currently keeping the walking program afloat
  • Get more parents to participate
  • Staff is overburdened and want this to be parents’ responsibility
barriers to walking participation48
Barriers to Walking Participation
  • Bad weather
  • Lack of crosswalks
  • Lack of neighborhood street safety
  • Confusion about responsibility
  • Too much burden placed in teachers
  • Too much burden/expectation placed on adults who volunteered at the start
teacher staff suggestions
Teacher/Staff Suggestions
  • Use school assemblies for nutrition ed
  • Receive materials from Start Strong to build a curriculum
  • Sending letters home ineffective
  • Materials should be multilingual
  • Dedicated trails contribute to safety and ease
  • More incentives
  • 52% of staff members did not participate
    • Scheduling conflicts
    • Feeling they had nothing to contribute
  • More staff than teachers interviewed
  • Questions about academic performance not relevant to all interviewed
  • Difficulty in assessing cognitive improvement from breakfast
discussion of limitations
Discussion of Limitations
  • Ideal study design would be an RCT
  • Assumption that control and intervention schools were identical in:
    • Student populations
    • Family SES
    • Surrounding physical environments
  • Limited timeframe for conducting:
    • Hands-up surveys
    • Key informant interviews
potential sources of error
Potential Sources of Error
  • Observers not blinded toward control or intervention schools
  • Self-reported data
  • Students may not have understood survey questions
  • Parents may not have understood questions
  • Self-selection of key-informant interviewees
  • Start Strong program positively impacts:
    • Students’ breakfast consumption habits and attitudes toward healthy eating
    • Students’ attitudes toward walking to school
  • Built environment must be conducive for students to walk to school (weather, distance, safety, cross-walks)
  • Further research required to determine the impact of this program on the community
  • Research will help support school policies and programs that can further positively impact the healthy eating behavior and physical activity of children
recommendations future research
Recommendations: Future Research
  • Establish larger sample sizes
  • Collect data at multiple time points
  • Longer timeframe for data collection
  • Consideration of weather and distance in assessing feasibility of walking programs
  • Improve teacher/staff and parent participation
  • Offer more opportunities for incentives
  • Clarify roles for teachers/staff and parents
  • Improve communication
  • Relationship-building opportunities
  • Implement walking program during a warmer season
  • Create drop-off points for walking school bus
  • Conduct school bus weekly rather than monthly
  • Donna Johnson
  • Mary Podrabsky
  • Katie Busby
  • Mollie Greves
  • Kirsten Frandsen
  • Ask, Anne S. Changes in dietary pattern in 15 year old adolescents following a 4 month dietary intervention with school breakfast, Nutrition Journal 2006, 5:33.
  • Berrigan et al. Active transportation Increases Adherence to Activity Recommendations. American Journal of Preventative Medicine. 2006: 31 (3).
  • Bickel G, Carlson S, Nord M: Household Food Security in the United States 1995–1998; Advanced Report. Alexandria/Va, Food and Nutrition Service, United States Department of Agriculture, 1999
  • Carter, The Impact of Public Schools on Childhood Obesity. JAMA 2002.
  • Cooper, R, et al, Active travel to school and cardiovascular fitness in Danish children and adolescents. Med Sci Sports Exerc. 2006 Oct;38(10):1724-31)
  • Cooper, A.R. et al. Physical Activity Levels of Children who walk, cycle, or are driven to school. American Journal of Preventative Medicine. 2005: 29 (3) 179-184.
  • Center for Disease Control and Prevention (CDC):


Healthy School Program:

  • Crepinsek, M.K. et. al., J Am Diet Assoc. 2006;106:1796-1803
  • Eisenmann JC, Physical activity, TV viewing, and weight in U.S. youth: 1999 Youth Risk Behavior Survey. Obes

Res. 2002 May;10(5):379-85).

  • Evenson, K.R. et al. Girls’ perception of physical environmental factors and transportation: reliability and association with activity and active transport to school. International Journal of Behavioral Nutrition and Physical Activity. 2006; 3:28.
  • Erickson, SJ et al, Are overweight children unhappy?: Body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med. 2000 Sep;154(9):931-5).
  • FRAC websites:

FRAC Wellness Guide 2006: 2006.pdf

FRAC USBP Pilot Summary

FRAC School Breakfast Program

  • Fulton JE, Shisler JL, Yore MM, Caspersen CJ. Active transportation to school: findings from a national survey. Res Q Exerc Sport. 2005;76:352–7.
  • Injury Free Coalition For Kids of Seattle: Breakfast and child obesity: What’s the link?

  • IOM Fact sheet – Childhood obesity in the United States (2004). Available at: Accessed 3-1-07.
  • Kids Count: State-level data online. Available at: Accessed 3-1-07.
  • Kleinman RE, Murphy JM, Little M, Pagano,M, Wehler CA, Regal K, Jellinek MS: Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics 1998;101:100–111.
  • Miech, R.A et al. Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA 2006.
  • Position of the ADA: Local Support For Nutrition Integrity In Schools. J Am Diet Assoc. 2006;106:122-133.
  • Safe Routes To School:
  • Radcliffe, B et al. The Queensland School Breakfast Project: A health promoting schools approach. Nutr Diet 2005; 62:33-40.
  • Recommendations for Strengthening Community Programs for Youth. New York, NY: Carnegie Corporation of New York, 1994.
  • M. Sharma et al, School-based interventions. The International Association for the Study of Obesity. Obesity Reviews 7, 261-269 (2006).
  • Sirard JR, Ainsworth BE, McIver KL, Pate RR. Prevalence of active commuting at urban and suburban elementary schools in Columbia, SC. Am J Public Health. 2005;95:236–40.
  • Sirard JR, Riner WF Jr, McIver KL, Pate RR. Physical activity and active commuting to elementary school. Med Sci Sports Exerc. 2005 Dec; 37(12):2062-9.
  • Tudor-Locke C, Ainsworth BE, Popkin BM. Active commuting to school: an overlooked source of children’s physical activity? Sports Med. 2001;31:309 –13.
  • Tudor-Locke, C, et al. Omission of active commuting to school and the prevalence of children's health-related physical activity levels: the Russian Longitudinal Monitoring Study. Child Care Health Dev. 2002 Nov;28(6):507-12).
  • United States Department of Agriculture (USDA):

USDA Nutrition Insights: Eating school breakfast greatly improves schoolchildren’s diet quality.

USDA School Breakfast Program.

USDA SBP Fact Sheet:

  • US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000].

  • Walking School Bus: