1. RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
The relatively steady growth rate and high prevalence of childhood
obesity in the United States over the past few decades is fairly well known
throughout the country. While a variety of programs have been set forth,
the overall effectiveness of most school-based programs on children’s
health in general has been relatively poor. The main limitation in most of
these incidents appears to be that many have not factored in the critical
support from families and communities to allow behavior change to be
consistent and last over a long period of time. Thus, it has been suggested
that a more holistic approach aiming to influence lifestyle behaviors at the
community, school and family levels may in fact prove to be far more
successful in the prevention of childhood obesity.
In 2010, the Healthy People initiative declared overweight and obesity
to be the leading health problem for children and demanded a reduction in
the proportion of overweight and obese children in the United States. Since
1980, obesity prevalence among children and adolescents has almost
tripled, and approximately 17% (12.5 million) of children and adolescents
aged 2-19 years old are obese. These statistics propose a significant need
for the implementing of intervention programs to lower the increasing rate.
As far as childhood obesity prevalence and incidence rates go within
each individual city/region of Oregon, including Portland, the statistics are
minimal, similar to other West Coast states that haven’t yet experienced the
obesity epidemic as intensely as further eastward states. Obesity is the
second leading cause of preventable death in Oregon, causing an estimated
1,500 premature deaths each year. In 2009, 36.1% of Oregon adults were
overweight, and 24.1% were obese. The percentage of adults who were
obese doubled from 11% in 1990 to >24% in 2009. Additionally, according
to the Oregon Child Health 2010 Date and Resource Guide, the percentage
of parents with children ages 0-8 who live in neighborhoods without
infrastructure for physical activity is lower than the United States average.
Background
Process Objective
1) After-School Sessions (Children Only)
While exact dates and times may vary from school to school, there will
be health promotion sessions conducted twice a week (ideally on Tuesdays
& Thursdays) by certified instructors that aim to help children make
healthy food and exercising choices on their own will. Instructors will
teach how a balanced diet and regular exercise are very important to the
children. A balanced diet refers to the selection of foods with appropriate
portions to provide adequate nutrients and energy for the growth of body
tissues, strengthening the immune system, and keeping a healthy body
weight. Apart from taking sufficient fluids everyday, children will be
taught to eat according to the “MyPlate" model to stay healthy.
2) “Learn-at-Home” Materials
The materials to be provided for parents to reinforce healthy habits at
home include many different methods to accommodate different learning
styles. These methods include: modeling positive behaviors, discussing
with children what they know/learned about healthy foods, sitting with
them for a few minutes to play games, using recommended nutrition tools
that are colorful and fun so that parents can use them with their kids,
printing certificates for children and posting them as reminders of the
healthy habits they are learning, setting healthy goals and establishing
trackers for kids, cooking guides for learning about fun and healthy
recipes, having children help out in the kitchen and/or garden, setting
limits on TV and computer usage, and guiding children to approved sites
that will promote education, healthy habits, and positive behaviors.
3) Family/Parent & Child Meetings
Parents and their children will be asked to attend a 2-hour meeting once
per week to teach and promote fun, interactive activities. Some of these
activities include: 1) Bringing in new fruits or vegetables every week and
using them to teach about the five senses (color? shape? smell? feel?
taste?). 2) Exploring how food is grown by building classroom gardens or
taking field trips to local orchards, farms, or fields. 3) Creating BINGO
cards with healthy foods and teaching about the benefits of eating healthy
foods (milk – bones & teeth, carrots – eyes, chicken – muscles, etc.). 4)
Doing healthy cooking demonstrations to show that healthy, fresh food can
be made at home and be fun. 5) Spending time each session to either go
play on playgrounds, take nature walks, dance to music that promotes
movement, or play games involving some sort of movement (Simon Says,
Hide-and-go-Seek, Duck-Duck-Goose, Tag, Four-Square, Kickball, etc.).
4) Incentives
A variety of free products promoting healthy eating and physical
activity will be utilized as incentives for this program. Different incentives
will be provided for each family/parent-child meeting and each children-
only meeting to avoid redundancy and demonstrate different ways of
addressing healthy lifestyles through proper food consumption and regular
exercise. Some of these incentives include: fruits and vegetables (among
other relevant, healthy foods) on display for participant consumption, gift
cards for restaurants serving high-quality, fresh foods, exercise and sports
equipment, activity booklets incorporating the development of healthy
habits, and toys that require movement to be able to enjoy them.
5) Establish/Improve Recreational Sites
A hired Recreational Construction Crew specializing in the
development of playgrounds and parks is responsible for establishing
and/or improving the quality of at least one recreational site within a 10-
mile radius of each elementary school. For many of the schools, certain
recreational areas will exist within two or more of the schools’ 10-mile
radius, so then the Recreational Construction Crew isn’t overwhelmed with
accommodating a new site for all 58 elementary schools. They will have
plenty of time to simply start their plans by the end of 2013, and are
projected to be finished by the end of 2014.
Program Description – Five Components
Timeline
• July 1st (2013) – Hire Staff and begin planning process for all
components
• August 1st – All Staff trained, begin procuring individual methods to
teach curriculum
• November 1st – All Staff present materials to Program Director for
approval
• December 1st – Finalizations made, begin establishing work places
within each school
• January 1st (2014) – Program Implementation phase begins;
Recreational Construction Crew finalizes plans on areas to
construct/improve
• *Monthly multidisciplinary team meetings conducted on the 1st of
remaining months in 2014 for program evaluation, data analysis, and
corrective measures for improvements*
• December 31st, 2014 – Program Completion, all data collected for final
analysis; Recreational Construction Crew finished with all
new/improved recreation areas
Process Evaluation
Each part of the program will be evaluated: nutrition education,
physical activity, and recreational construction progress. Measures will be
taken at the start and completion of each component. Where standardized
measures are available, they will be used. If measures are not available,
they will be developed in advance. Objective data, such as weight, food
intake, and amount of exercise will be measured daily. All parties involved
will be responsible for completing outcome measures: the children, the
parents/guardians, the Physical Activity Coordinators, and the Licensed
Nutritionists. Cumulative results will be presented at the multidisciplinary
monthly meetings, so if changes are needed, they occur at monthly
intervals.
Evaluation Description Transtheoretical Behavior Model
The Transtheoretical Model illustrates an individual’s progress through
a series of six stages (pre-contemplation, contemplation, preparation,
action, maintenance, termination) in the adoption of healthy behaviors or
cessation of unhealthy ones. These steps represent ordered categories along
a continuum of motivational readiness to change a problematic behavior.
This model has proven successful with a wide variety of simple and
complex health behaviors, including smoking cessation, weight control,
sunscreen use, reduction of dietary fat, exercise acquisition, quitting
cocaine, mammography screening, and condom use.
Within the context of this childhood obesity prevention program, an
obese child experiences pre-contemplation by simply having no intent to
change their behavior due to being unmotivated and tending to avoid
thought with regard to changing their diet and/or incorporating more
physical activity in their life. In the contemplation stage, the child can
openly state their intent to change within the next six months, being more
aware of the benefits of changing yet also remaining keenly aware of the
costs. In the preparation stage, the child can intend to take steps to change,
usually within the next month, and goes through more of a transition rather
than a stabilizing phase. The action stage is when the child has made overt,
realistic behavior modifications, such as working out on a more consistent
basis and cutting down portions of food per meal, for fewer than six
months. In the maintenance stage, the child works to prevent relapse and
consolidate gains secured during the action stage. Finally, in the
termination stage, the child no longer gives into temptation and has total
self-efficacy, no matter what the stressor.
References
1. CDC. (2013). Obesity facts. Retrieved from Centers for Disease
Control and Prevention website
2. CDC. (2012). Budget preparation guidelines. Centers for Disease
Control and Prevention, Procurement and Grants Office
3. De Silva-Sanigorski, A. M., Bell, A. C., Kremer, P., Nichols, M.,
Crellin, M., Smith, M., Sharp, S., de Groot, F., Carpenter, L., Boak, R.,
Robertson, N., & Swinburn, B. A. (2010). Reducing obesity in early
childhood: Results from romp & chomp, an australian community-wide
intervention program. The American Journal of Clinical Nutrition,
91(4), 831-840
4. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2013). Planning,
implementing & evaluating health promotion programs: A primer. (6th
ed.). Glenview, IL: Pearson Education, Inc.
5. NCSL. (2013). Retrieved from National Conference of State
Legislatures website
6. Oregon Department of Human Services; Office of Family Health.
(2010). Oregon child health 2010 data and resource guide
7. Oregon Public Health Division. (2012). State health profile: September
2012. Oregon Health Authority
8. Sacher, P. M., Kolotourou, M., Chadwick, P. M., Cole, T. J., Lawson,
M. S., Lucas, A., & Singhal, A. (2010). Randomized controlled trial of
the MEND program: A family-based community intervention for
childhood obesity. Obesity, 18(S1), S62-S68
9. Taylor, R. W., McAuley, K. A., Barbezat, W., Strong, A., Williams, S.
M., & Mann, J. I. (2007). APPLE project: 2-y findings of a community-
based obesity prevention program in primary school-age children. The
American Journal of Clinical Nutrition, 86(3), 735-742
10. The Finance Project. (2004). Financing childhood obesity prevention
programs: Federal funding sources and other strategies. Retrieved
from The Finance Project website
11. U.S. Department of Health and Human Services. (2013). Healthy
people 2020. Retrieved from USDHHS website
To provide educational values and active opportunities to minimize
obesity for children of elementary school status and their parents/guardians
residing in Portland, OR, so that the promotion of being healthy and
staying physically active will encourage participants to independently
engage in lifestyles as such. For this relatively new planning model, the kind of program that it
addresses has to be based on theory and evidence. Due to the high success
of other similar programs conducted around the country and
internationally, it is fair to say that the theory of multi-level community
collaboration for decreasing the prevalence of overweight/obese children
over a significant time period can serve as the foundation for the Rip City
Youth Fitness Program.
The six steps of the Intervention Mapping Planning Model are as follows:
1. Needs Assessment (Identify disparities, health issues, obstacles, etc.;
for each school)
2. Matrices of Change Objectives (Develop realistic timeframe to achieve
desired change)
3. Theory-based Methods and Practical Strategies (See Transtheoretical
Behavior Model)
4. Program (Ensure all components correctly planned, adhering to
timeline; staff trained)
5. Adoption and Implementation (Acquire interest and financial support;
validate program)
6. Evaluation Planning (Set monitoring system to analyze data; make
necessary changes)
By the end of 2013, the designated Recreational Construction Crew will
have begun the preliminary steps in developing areas for recreation and
substantial physical activity to benefit communities with insignificant
infrastructure for exercise, and finish by the end of 2014.
By the end of 2014, 75% of elementary school children who participate
will have both increased their daily rate of physical activity and reduced
their average caloric intake by statistically significant amounts.
By the end of 2013, the Program Director will have established methods
for preventing childhood obesity and eradicating it within Portland’s youth,
and individual school-based implementation within the school district will
begin during first week of January 2014.
For as many of Portland’s youth as possible to adopt the practices of a
healthy lifestyle at an early age, minimizing the prevalence of obesity, in
hope that they continue through adulthood, passing down their experience
to further generations.
Environmental Objective
Behavioral Objective
Intervention Mapping Planning Model
Program Director: Casey J. Fields
Preventing Childhood Obesity in the Portland Public Schools District
The Rip City Youth Fitness Program
Mission Statement
Goal