OBESITY IN MISSISSIPPI - the Mississippi Office of Healthy Schools

OBESITY IN MISSISSIPPIa report compiled by the POWER initiative1

Report compiled by the Mississippi Department of Education’s Office of Healthy Schools.Supported by research from the Center for Mississippi Health Policy.2

TABLE OF CONTENTS4 | Introduction & Executive Summary7 | A GROWING PROBLEM9 | WHAT IS MISSISSIPPI DOING?10| Implementation Efforts12| Evaluation Tools15 | MOVING FORWARD16| Policy Initiatives18| Improve Built Environments to Promote Physical Activity in Communities20| Replace Fryers with Combi-Ovens in School Kitchens22| Increase the Number of School Nurses in the Schools24| Support Comprehensive Fitness Testing in Schools26| Improve State Standards for Day Care Centers& Youth Programs to Promote Healthy Lifestyles28| Encourage Recipients of Public Benefit Programsto Purchase Healthy Foods30| Restrict Advertising of Unhealthy Foods to Children and/orRequire Public Service Announcements that Offer Healthy Messages32| Require Schools to Provide BMI (Body Mass Index) Reports to Parents34| Improve Access to Supermarkets/Produce36| Require Labeling of Menus and Prepared Foods39 | SEEKING ACTION40| DEPARTMENTAL ACTION PLANS44 | APPENDIX A - Participants at the April 25, 2008, Planning Meeting44 | APPENDIX B - BibliographY3

INTRODUCTIONThis report outlines the work supported by a grant from the NationalGovernors Association under the Healthy Kids, Healthy America Program.This program encourages governors and senior state leaders to increasephysical activity, improve nutrition, and prevent obesity among America’s children.Grant funding was made possible by the Robert Wood Johnson Foundation andthe Centers for Disease Control and Prevention.EXECUTIVE SUMMARYThe ProblemAs of July 2009 Mississippi officially has the highest rates of childhood and adult obesity inthe nation. This marks the fifth year in a row that Mississippian adults have topped this list,and the percentage of overweight children in Mississippi is a full 6.9 percent higher thansecond place, the largest margin between state rankings by far.Childhood obesity rates in America have more than tripled since 1980, a statistic thatdoctors have coined, “The Obesity Epidemic.” There is worry among experts that today’syouth will be the first ever to have a shorter life expectancy than their parents.Health issues linked to obesity are numerous and severe. Just to scratch the surface,increased risk for heart disease, stroke, and type 2 diabetes (all major drivers to our nation’sskyrocketing healthcare costs) are all directly associated with weight problems. Additionally,recent studies on overweight children have revealed correlations to depression, increasedlikeliness to miss school, and lowered academic performance in school.4

Finding an AnswerOverweight adolescents have approximately a 80 percent chance of becomingoverweight adults. It is widely accepted that the best method to curb this growingproblem is to encourage healthy behavior in children, because habits formed duringchildhood frequently continue into adulthood. Furthermore, schools serve as acommon community center where children and adults can rally around a healthy cause.Mississippi has received funding through the National Governors Association to addressthe high rates of childhood obesity through a multifaceted and collaborative programcalled Preventing Obesity with Every Resource (POWER). In response, Governor HaleyBarbour appointed a task force of nine organizations and departments, led by the MississippiDepartment of Education’s Office of Healthy Schools, to guide the POWER project.An environmental scan to probe the school, community, and policy initiativesneeded to address childhood obesity was conducted by the State Department of Health.Using the information gathered in this initial study along with coordinated research,interviews, and the cooperation of experts in the field, the task force has compiledand ranked a solution-set of policy proposals that best combats obesity in Mississippi.The proposals are designed to work together and support each other in a coordinatedfront that isolates the problem and tackles it at once from many directions.The SolutionTo raise awareness, encourage better health, and provide healthier environments acrossthe state, government departments need to continue to work together, support each other,and coordinate their efforts to make a lasting impact. We are inviting legislative heads andpolicy makers from all over Mississippi to analyze these findings, review the proposedprograms, select the ones they are best equipped to handle, and direct resources toward thissynchronized goal.This POWER document is a useful reference tool that breaks down Mississippi’s obesityproblem, shares the findings of local studies, and outlines the proposed policy initiatives inorder to inform those capable of making a difference. Please reference this packet to becomeinformed on our BIG problem, and know that efficient coordinated contributions will makea BIG difference to offer our children a better and brighter future.5

640%of Mississippi childrenare overweightor obese.

A GROWING PROBLEMNationally, childhood obesity rates have increased steadily since 1980with Mississippi’s childhood obesity rates continually among the highestin the country. Data from the self-reported 2003 Youth Risk BehaviorSurveillance System (YRBSS) of the Centers for Disease Control andPrevention showed that 31.4 percent of Mississippi’s high school studentswere overweight or obese compared to 28.9 percent nationwide.Eager to improve student health, researchers from the College of Healthat The University of Southern Mississippi decided to develop a moreaccurate test that gathers data through actual measurements rather than byself-reporting. The Child and Youth Prevalence of Obesity Survey (CAYPOS)was developed, and in 2003, it was proved that childhood obesity rates wereeven higher than the rates the students had self-reported on the YRBSS.Mississippi exhibits thehighest rate of adultobesity in the nationand the highest rateof premature death.The state sits at thetop of the list for mostchronic disease rankings,including heart disease,hypertension, diabetes,and stroke, and has highdisability rates. Giventhese striking healtheffects, it is no surprisethat obesity has asignificant impact on theeconomy of the state.When the CAYPOS measurements were collectedagain in 2005, children at almost every grade levelshowed increasing prevalence of overweight and obesity.The problem was growing.Wellness RisksHigh rates of childhood obesity in Mississippicause great concern because overweight children:• Miss more school days and demonstrate lower academic performance• Have a 80 percent chance of becoming overweight or obese adults• Are at increased risk for early development of achronic disease, leading to disability and premature death• Have health indicators that are significantpredictors of coronary heart disease in adulthood.• Are at increased risk for type 2 diabetes, heart disease, hypertension, osteoarthritis,sleep apnea, gallbladder disease, respiratory problems, stroke, endometrial cancer,breast cancer, colon cancer, prostate cancer, depression, and other conditionsThe map above illustratesthe prevalence of obesity(BMI ≥30) among U.S.adults in 2007.Healthcare Cost Consequences• Obesity accounts for approximately 9.1 percentof total U.S. annual medical expenditures.• Mississippi’s estimated annual healthcare cost attributed to adult obesity(in 2003 dollars) is $757 million, of which $223 million is cost to Medicareand $221 million is cost to Medicaid. Nationally, childhood obesity alonecosts Medicaid more than $3 billion annually.• Approximately 8 percent of private employermedical claims are due to overweight and obesity.• About 27 percent of the increase inmedical costs from 1987 to 2001 was due to obesity.• Nationally, obesity accounts for a substantial part of increased disabilityin adults and is expected to result in an increase of 10 to 25 percentin the nursing home population by 2020.7

8Medicare and Medicaidspending would be8.5% and 11.8%lower,respectively, in theabsence of obesity.

What is Mississippi Doing?Thanks to the Child Nutrition and WIC Reauthorization Act of 2004[PL 108-265], each school had to establish a Local School Wellness Policybefore the 2006-2007 school year to continue to receive funding from U.S.Department of Agriculture Child Nutrition Programs. To assist schooldistricts, the Mississippi Department of Education (MDE) createdThe Local School Wellness Policy Guide for Development, including all therequirements necessary to comply with the federal regulations and theMississippi statutes and standards. The guide also offers additional policyoptions that schools are encouraged to use while developing their specificgoals based on data collection and needs assessment.Using the attention from this spotlight on improving the health ofTHREE-STEPAPPROACH TOSCHOOL WELLNESSMDE suggests athree-step approach todeveloping an effectivelocal school wellnesspolicy. Schools areencouraged to1.2.3.Conduct a needsassessment.Develop and approve aschool wellness policy.Implement the policy.Mississippi’s students, a collaborative group of individuals and organizationssucceeded in persuading the state legislature to act further. In 2006, afteragreeing that vending machines play a significant role in the health of students,the legislature mandated that the State Board of Education must adoptregulations defining the products that may be sold in vending machines onschool campuses and when they can be sold. The State Board of Educationsubsequently boldly adopted rules and regulations that phased in restrictionsagainst the selling of unhealthy products in school vending machines.Striving to further the focus on student health, the legislature passed theMississippi Healthy Students Act in April 2007 (amending Mississippi Code of 1972Annotated Section 37-13-134). An advisory committee was formed to assist theState Board of Education in developing the regulations of the MississippiHealthy Student Act.In October 2007, the committee submitted recommended provisions to theState Board of Education. The State Board of Education in due course adoptednutrition standards and rules and regulations for physical and health education.As a result of efforts across the state, Mississippi was recognized in a fall 2009report released by the Centers for Disease Control and Prevention as one of thetop states regarding school health policy implementation.MISSISSIPPIHEALTHY STUDENTS ACTThe Mississippi HealthyStudents Act establishes:• Minimum requirementsfor health and physicaleducation• A physical activitycoordinator at the MDE• Local school healthcouncils as mandatory• That the State Board ofEducation must adoptregulations that addresshealthy food andbeverage choices• The appointment of anadvisory committee toadvise the State Board ofEducation in developingthese regulations• That each local schoolboard must develop awellness policy based on acoordinated approach toschool health9

WHAT IS MISSISSIPPI DOING - Implementation EffortsIn response to the Mississippi Healthy Students Act, the Mississippi Department of Education,aided by local and federal funding has implemented many strategies to meet updated regulationsand to support student health. Some of the most prominent strategies are listed below:Five Star Food GrantNUTRITION INTEGRITYGrantCOMMITTED TO MOVEGRANTHEALTH IN ACTIONThrough funding fromThe Bower Foundation,schools are awarded aFive Star Food Grant toincrease consumption offruits and vegetables inMississippi public schools.This initiative awardsschools monies to purchasesectionizers and slicersfor making food attractivein service lines and forfocusing on healthful foodchoices for children in theschool setting. In addition,the food service managersattend a chef-led trainingsession on how to usethe equipment, includinghands-on demonstrations.Training is disseminatedto other food service staffthrough a partnership withMississippi State ExtensionService professionals.During the 2007-2008 schoolyear, over 46,000 studentswere reached through thisinitiative in 80 schools from25 school districts. Thirtythreeschools from 11 schooldistricts participated in thesecond year of the programduring the 2008-2009school year.The Nutrition IntegrityGrant initiative wasdesigned to remove fryersfrom school kitchensand replace them withcombination ovensteamers. Other goalswere to promote andshare information onthe feasibility and costof removing fryers andinstalling combinationoven steamers, to eliminatefried foods in a period offive years, and to providehealthier school meals byreducing the amount ofcalories, fat, saturated fatand trans fat served. A jointproject of the MississippiDepartment of Education’sOffice of Healthy Schoolsand The Bower Foundation,this grant also includesthe development of astep-by-step guide to asuccessful implementation.Since 2006, the beginning ofthe Nutrition Integrity Project,a total of 104 combinationoven steamers have beenpurchased in 41 districts,impacting approximately64,900 children. Because ofthe project’s tremendous success,schools throughout Mississippiare electing to replace fryerswith combination ovensteamers, even without thebenefit of grant funding.The Committed to MoveGrant project providesschool districts curriculum,training, and up to $9,400to purchase physicaleducation equipmentand resources to assistin complying with theMississippi HealthyStudents Act. The grant,funded by The BowerFoundation, enablesschool districts to purchaseapproved equipment andsupplemental materials tosupport the implementationof a quality physicaleducation programbased on the MississippiStandards for PhysicalEducation. Granteesparticipate in Physical Bestand FITNESSGRAMtraining and conductbiannual fitness assessmentsof their students.Twenty-five schoolsparticipated in the grantduring the 2007-2008school year, and 21 schoolsparticipated during the2008-2009 school year,reaching a total of 13,500students. The evaluationof this program is a componentof the comprehensiveevaluation of the MississippiHealthy Students Act beingconducted by the Center forMississippi Health Policy.Through the Health inAction initiative, teachersnow have free access toan online database of1,300 health educationand physical educationlesson plans. The plans aredeveloped by Mississippiteachers and are aligned tonational and state standardsfor health and physicaleducation and other corecontent areas to providecross-curricula instruction.There are also lesson plansavailable to promote saferoutes to school. The Officeof Healthy Schools has thecapability to communicatewith all Health in Actionregistered guests viamass e-mail.As of June 2009, there were1,900 registered individualsrepresenting 36 states.The lesson plans found onHealth in Action are basedon monthly themes thatsupport the eight componentsof coordinated school health.The Office of Healthy Schoolshas developed sample pressreleases based on these themesto provide school districts withmonthly guides and healthfacts for communicatinglocal school successes.10

A project funded by the POWER initiativeHealth Is Academic–John D. Bower, M.D.School Health NetworkExcellence inPhysical EducationCertification Program2007 Team NutritionGrantsTEAM Mississippi:A Partnership forHealthy FamiliesThe John D. Bower, M.D.School Health Networkis a joint endeavor of theMississippi Departmentof Education’s Office ofHealthy Schools and TheBower Foundation. Itspurpose is to providein-depth preparation tolocal school districts forthe implementation of theCoordinated School HealthProgram model. The intentis to enable participants tostrengthen the role of healthcoordinators, establishlocal school health councils,improve school healthinstruction programs for allstudents, reconfigure the useof existing school resources,and nurture broad-basedschool and communitysupport for a coordinatedschool health program.Network participantsare selected through acompetitive process.Since 2005, 20 schooldistricts have received fundsto implement the eightcomponents of coordinatedschool health.The Excellence in PhysicalEducation CertificationProgram is a joint programbetween the Governor’sCommission on PhysicalFitness and Sports andMississippi Departmentof Education’s Office ofHealthy Schools. It is theCommission’s desire tomake this program anincentive for school districts,administrators, andteachers to offer “excellent”physical educationprograms. Presented as anannual award available topublic and private schools,the certification officiallyrecognizes a school’scommitment to a qualityphysical education program.Qualified schools arerecognized with a certificate,web posting on MDE’s site,and press releases sent tolocal publications. Selectedschools are also invited to areception at the Governor’smansion. Recognizedschools serve as examplesto other schools andschool districts throughoutMississippi to inspire othersto strive towards meeting“excellent” standards inquality physical educationprograms.Since 2002, there havebeen 116 gold awards,112 silver, and 32 bronzehave been awarded toschools across the state.The Team Nutrition Grantfocused on the followingstrategies: establishing andmaintaining school healthcouncils, conducting apre- and post-assessmentto determine baselinedata and impact of projectimplementation, developingnutrition and physicalactivity policies to promotestudent and staff wellness,taking the Healthier USSchool Challenge, andconducting nutritionand physical activitiesthat reinforce the TeamNutrition messages.In 2007, The Office ofHealthy Schools’ ChildNutrition Program awarded20 Mississippi schools withTeam Nutrition Grants. Theseschools are expected to promotestudent and staff wellness byinvolving parents, students,school board members, schooladministrators, and thecommunity in the developmentof nutrition and physicalwellness policies.The Mississippi Departmentof Education’s Office ofHealthy Schools and TheUniversity of MississippiMedical Center’s Centerof Excellence partnered toform TEAM Mississippi:A Partnership for HealthyFamilies to promotehealthy eating and physicalactivity in families. Theproject was made possibleby the National Centerof Excellence in Women’sHealth at the University ofCalifornia, San Francisco,and Johnson & Johnson.This partnership is basedon the understanding ofthe relationship betweenthe health of students andacademic achievement andthe role the parent playsin promoting a healthyenvironment in the home.Five hundred 1st-4th gradersfrom two schools participatedin a year-long campaignto promote healthy eatinghabits and physical activityamong families. Resultsproved that students receivinghealth information hadimprovements in the measuredhealth categories comparedto worsening conditions ofstudents not being educated inhealth matters.11

WHAT IS MISSISSIPPI DOING - Evaluation ToolsIn October 2008, the Robert Wood Johnson Foundation(RWJF) awarded the Center for Mississippi HealthPolicy a five-year, $2 million grant to study theimpact of the Mississippi Healthy Students Act onchildhood obesity. The Center uses the RWJF grant inconjunction with a Bower Foundation grant to evaluatethe effectiveness of state policies aimed at preventingchildhood obesity. It also works to coordinate withsimilar projects in five other states (Arkansas, WestVirginia, Delaware, Texas, and New York) to receivefunding under a RWJF initiative to evaluate childhoodobesity prevention policies.Directed by the Center for Mississippi Health Policy,the evaluation project is conducted through acollaboration with researchers at The University ofSouthern Mississippi, Mississippi State University, andthe University of Mississippi. Following is an explanationof the measures that have been taken to assess thecurrent state of childhood obesity in Mississippi.The Youth Risk BehaviorSurveILLANCE SYSTEM (YRBSS)YRBSS is not funded or evaluated through thisevaluation project, but its results will supplement theinformation collected. The YRBSS includes national, state,and local school-based surveys of representative samplesof students in the 9th through 12th grades. These surveystake place every two years, usually during the springsemester. The national survey, conducted by the federalCenters for Disease Control and Prevention, providesdata representative of students in public and private highschools in the United States. The state and local surveys,conducted by departments of health and education,provide data representative of public high schoolstudents in each state or local school district.COMMITTED TOMOVE EVALUATIONCollege of HealthThe University ofSouthern MississippiThe 25 schools selectedto participate in theCommitted to Move QualityPhysical Education Programimplement the PhysicalBest Curriculum andelectronically documentfitness (muscle strengthand endurance, flexibility,aerobic capacity) andbody mass index data onall students through theFITNESSGRAM. Dataare being collected onindividual students over fiveperiods – spring 2008, fall2008, spring 2009, fall 2009,and spring 2010. Data willbe matched with academicperformance records tostudy the relationshipbetween fitness andacademic performance.SCHOOLWELLNESS POLICYPRINCIPAL SURVEYCollege of HealthThe University ofSouthern MississippiPrincipals of all publicschools in Mississippi aresurveyed every two yearsby researchers from theCollege of Health at theUniversity of SouthernMississippi to gauge theimplementation of thefederal Child Nutrition andWIC Reauthorization Actof 2004 and the MississippiHealthy Students Act of2007. The survey assessesthe degree to which schoolshave established schoolwellness policies andimplemented requirementsof the federal and state lawsand associated regulations.12

A project funded by the POWER initiativeSURVEY OFLOCAL & STATE-LEVELPOLICY MAKERSSocial Science Research CenterMississippi State UniversityPARENT SURVEYSocial Science Research CenterMississippi State UniversityMISSISSIPPISCHOOL NUTRITIONENVIRONMENTEVALUATION DATASYSTEM (MS-NEEDS)Department of Familyand Consumer SciencesUniversity of MississippiCHILD AND YOUTHPREVALENCE OFOBESITY SURVEY(CAYPOS)College of HealthThe University of SouthernMississippiThe goal of this survey is toassess state and local policymakers’ knowledge andopinions of the MississippiHealthy Students legislationand their support for it.The study considers stateand local policy makersto include state legislators,members of the State Boardof Health and State Boardof Education, local schoolboard members, schooldistrict superintendents,and local health officials.Assessing the attitudesof local policy makers iscritical in ensuring thatthe intent of state-levelchildhood overweightand obesity school healthpolicies is understood andimplemented in ways thatmaximize the potential ofprimary prevention.The annual ParentSurvey evaluates parentalattitudes, changes infamily environments, andchanges in children’s healthbehaviors throughoutthe evaluation period.The purpose is to betterunderstand how parents feelabout school health policies,how they influence thosepolicies, and to what extentfamily knowledge, attitudes,practices, and constraintsinfluence children’s healthand health behaviors.Documenting nutrition andphysical activity patterns inthe home environment isimportant in determiningthe degree to which healthstatus changes, or a lackthereof, are due to nutritionand physical activitypatterns or to alterations inthe home environment.To obtain an independentassessment of statewideprogress implementingschool nutrition policies,researchers at theUniversity of Mississippiconduct onsite evaluationsof school nutritionenvironments at arepresentative sample ofschools statewide. Theirsurvey tool assessesthe level of nutritionpolicy implementationat each school, providesa comparison betweenschools with differentdemographics, and,through repeatedmeasurement, showsnutrition-relatedenvironmental changesover time.Conducted Conducted every every two two years,years, researchers researchers use height use andheight weight and measures weight gathered measuresgathered through the through Child the and Childand Youth Youth Prevalence Prevalence of Obesityof Survey Overweight to estimate Survey the toestimate prevalence the of prevalence overweightof and overweight obesity among and obesity childrenamong in Mississippi. children The in resultsMississippi. of the 2007 The CAYPOS resultsof provided the 2007 the CAYPOS first signs thatprovided childhood the obesity first signs rates that inchildhood Mississippi obesity may be rates reachingMississippi a plateau. Although may be reaching nota statistically plateau. Although significant, not thestatistically survey showed significant, drops in theobesity survey rates showed in middle drops inschool obesity andrates high school inmiddle students.school andhigh schoolstudents.13

14Healthy, active, and wellnourishedchildren and youthare more likely to attend schooland are more prepared andmotivated to learn.74%of america’s youth werefound to be unfitin 2004 according to the cdc’sanalysiS of Fitnessgram data.

Moving forwardWith the measurements reported and the crisis clearly identified, Mississippirecognizes that more needs to be done to truly change the future of the state.This is not a task for a single champion, but one that will take collaborationand cooperation—everyone working together.In 2008, Mississippi began a life-changing course of action when the statereceived funding through the National Governors Association’s Healthy Kids,Healthy America Program for a project entitled Preventing Obesity with EveryResource (POWER). The Mississippi Department of Education’s Office ofHealthy Schools was designated by the Office of the Governor as the leadagency for this project. Leading the way, MDE has continuously sought unitybetween various state departments in an effort to outline a plan of action tocombat the state’s overwhelming obesity problem. Under the POWER project,MDE engaged a wide range of stakeholders to identify additional opportunitiesfor childhood obesity prevention policy development in Mississippi. GovernorHaley Barbour appointed a task force to guide the project. The members ofthe Governor’s Task Force on Childhood Obesity represented key stakeholdersat the state level.At the initiation of the project, the Mississippi State Department of Healthconducted an environmental scan of childhood obesity prevention efforts inMississippi. The report issued by the department presented information fromliterature reviews and key informant interviews, outlining the extent to whichstate and local governments, businesses, and community-based organizationswere collaborating to address childhood obesity in Mississippi.Governor’sTask Forceon ChildhoodObesityCandice WhitfieldHealth Policy Advisor,Mississippi Governor’s OfficeDr. Hank BoundsState Superintendentof Education,Mississippi Departmentof EducationShane McNeillDirector, Office ofHealthy Schools,Mississippi Departmentof EducationDr. Ed ThompsonState Health Officer,Mississippi State Departmentof HealthDr. Robert L. RobinsonExecutive Director,Mississippi Divisionof MedicaidDr. Daniel W. JonesVice Chancellor of HealthAffairs, University of MississippiMedical CenterDr. Sam PollesExecutive Director,Mississippi Department ofWildlife, Fisheries and ParksRepresentative Cecil BrownChair, House EducationCommittee, Mississippi Houseof RepresentativesSenator Alan NunneleeChair, Senate Public Healthand Welfare Committee,Mississippi SenateDr. Victor D. SuttonDirector, Office of PreventiveHealth, Mississippi StateDepartment of HealthWade H. OverstreetDirector, Blue Cross & Blue Shieldof Mississippi FoundationAnne TravisCEO, The Bower FoundationBlake WilsonCEO, Mississippi Economic Counciltitles reflect position attime of appointment in 200715

moving forward - Policy InitiativesVarious representatives of key stakeholdersfrom across the state met on April 25, 2008,at the Mississippi Department of Educationto collectively brainstorm policy strategies(see list of participants in the Appendix). At theplanning meeting, staff from the State Departmentof Health discussed the results of the environmentalscan conducted by the Department that outlined themany ongoing activities in the state targeting childhoodobesity and identified weaknesses in the state’s overallapproach, providing recommendations for improvement.The Center for Mississippi Health Policy provided thebackground information to familiarize participantson current policy initiatives in Mississippi, as well asreviewed policy initiatives in other states. Small groupsessions resulted in a list of potential policy initiatives.Mississippi’s panel of key stakeholders ranked theinitiatives, indicating their top preferences. Three policyoptions were scored as the group’s highest priorities.POTENTIAL POLICY INITIATIVES• Require labeling of menus and prepared foods• Improve access to supermarkets/produce by providingsubsidies to stores selling fresh produce that will locatein underserved areas or, for existing stores, add morespace for produce• Establish state standards for day care centers & youthprograms to promote healthy lifestyles and provide incentivesto adopt standards• Restrict advertising of unhealthy foods anduse public service announcements to offer healthy messages• Improve built environments: require sidewalks innew developments; provide incentives for communitiesto put sidewalks in existing developments; and requirecities/counties to consider promotion of physicalactivity in planning/zoning actions• Provide discounts/additional benefits for purchasing healthyfoods in public benefit programs• Require BMI reporting in schools and track over time• Provide tax incentives to locate farmers’ markets in underservedareas and change barriers in existing farm-to-school policies• Require state government food service to serve healthy foodsThe potential policy initiatives were reviewedwith agency heads or their representatives from theDepartments of Education; Health; Human Services;Wildlife, Fisheries, and Parks; and Transportation; andthe Mississippi Development Authority. Comments andrecommendations were solicited from each agency.• Provide tax incentives to farmers to produce more healthy foods• Restrict trans fats in restaurants• Restrict TV viewing time in after-school programs• Require media to offer programs on nutrition education• Subsidize safety improvements forlocal parks and recreational areas• Encourage YMCA and other youth groups toestablish policies to promote healthy environments• Provide start-up funds to helpcommunities establish boys/girls clubs• Require Medicaid & insurance to cover obesity treatments• Require communities to plan school sites with health in mind16

A project funded by the POWER initiativeIn December 2008, the Healthy Mississippi Summitwas held in downtown Jackson. Governor HaleyBarbour and First Lady Marsha Barbour, along withthe Mississippi Department of Education, hosted theevent. Agency directors shared the stage and voiced theirsupport for cooperative efforts to address childhoodobesity prevention. Over 300 participants from stateagencies, and local communities heard about the manyprograms and initiatives active in Mississippi at boththe state and local levels. At the end of the Summit, allparticipants were provided with a list of policy initiativesand asked to rate their priorities. The list incorporated thehighest rated items from the stakeholders’ meeting as wellas school-based initiatives described at the Summit.A FOCUSED PRIORITYThe resulting ranking of the top 10 policy initiatives from highestpriority to lowest was as follows:• Improve built environments topromote physical activity in communities• Replace fryers with combi-ovens in school kitchens• Increase the number of school nurses in the schools• Support comprehensive fitness testing in schools• Improve state standards for day care centersand youth programs to promote healthy foods• Encourage recipients of publicbenefit programs to purchase healthy foods• Restrict advertising of unhealthy foods to children and/or requirepublic service announcements that offer health messages• Require schools to provide BMI(Body Mass Index) reports to parents• Improve access to supermarkets/produce• Require labeling of restaurant menus and prepared foodsSupporting rationales for the individual POWERpolicy initiatives with case studies demonstratingtheir implementation are on the following pages.17

moving forward - Policy InitiativesPolicy Initiative No. 1Improve Built Environmentsto Promote Physical Activityin CommunitiesToday’s studentslive further fromtheir schoolsthan the youthof 30 years ago.The charts atright illustratethe increase inthe distanceto schoolfor childrenbetween theages of 5 and 18.THE CHALLENGEThere is growing recognition that the built environment—theman-made physical structures and infrastructure of communities—impacts health. Decisions about zoning, transportation, land use,and community design influence the distances people travel to work,the convenience of purchasing healthy foods, and the safety andattractiveness of neighborhoods for walking.Traditionally, the decisions dealing with the built environment havebeen made without the consideration of public health, but over the pastdecade, states and communities have emphasized the importance ofmaking design decisions in the context of the overall community. Statesand local communities are taking action—using zoning rules, requiringsidewalks in new developments, providing capital funding, and improvingtransportation and land use policies—to try to increase walking and bikingopportunities and make these activities more accessible and safe.One may expect more physical activity and healthier diets among personsin communities with convenient, safe walking paths and accessible sourcesof fresh fruits and vegetables. On the other hand, indicators of poorer health,such as obesity, may be expected among residents of communities with highcrime rates, few parks or walking paths, and little access to fresh food.When focusing on children, research shows that being outdoors isstrongly related to the level of children’s physical activity. Studies havefound that children who walk to school are more physically active thanthose who travel to school by car. However, active commuting rates in theU.S. have dropped significantly and currently range from only 5 to 14percent. The lack of sidewalks and bike trails, long distances to schools,and the need to cross busy streets with fast-moving traffic create barriersto active commuting to school.33%< 1 mileIncrease in the distance to schoolfor children between the ages of 5 and 18.1969 200134%50%21%15% 18%15%1.0-1.9 miles2.0-2.9 miles14%3+ milesNATIONAL SUCCESSTwo studies in California haveshown promising results relatedto physical activity and the builtenvironment. An evaluation ofthe Marin County, California,Safe Routes to Schools programthat combined promotionalactivities with built environmentchanges (more sidewalks andimproved street crossings) founda 64 percent increase in walkingand a 114 percent increase incycling to school. Additionally,an evaluation of statewideinvestments in sidewalks,crosswalks, and bike lanes in10 California schools foundthat 15 percent of parentsof children who passed theimprovements on their way toschool reported their childrenwalked or cycled more.MISSISSIPPI’S SUCCESSChildren walking to andfrom several Meridian publicschools will have a safer andmore enjoyable walk, thanks toa sidewalk installation programapproved by the MississippiDepartment of Transportation.The Mississippi TransportationCommission has approvedthe city’s request for nearly$740,000 in federal Safe Routesto Schools funds for the project,which will include sidewalksaround Carver Junior HighSchool, Harris ElementarySchool’s two campuses, and18

A project funded by the POWER initiativeOakland Heights Elementary.New sidewalks will also linkCarver and Harris to the Boysand Girls Club, which manyof the students attend afterschool. The project includesalmost four miles of sidewalks,funding for police officers toserve as crossing guards, and aneducational program throughthe schools to teach studentsabout pedestrian safety.lake in a beautiful woodlandsetting. The path is used bywalkers, joggers, and runners.To further enhance the outdoorexperience, the city is currentlyimplementing a $45,000Wildlife, Fisheries and Parksgrant to install unified trailsignage throughoutBonita Lakes Park.Meridian, Mississippi’s,3,300-acre Bonita Lakes is oneof the largest urban parks in thenation, offering residents andvisitors a myriad of recreationalopportunities just minutes fromanywhere in town. To encouragemore people—young andold—to participate in physicalactivities, the City of Meridianworked with Blue Cross BlueShield of Mississippi to installtwo children’s playgrounds anda series of adult fitness stationsin the park. The two children’splaygrounds, one located behinda picnic pavilion and the othernestled beside the smallerof the park’s lakes, are gearedto fit the skill levels of differentages of children. One is designedfor two- to five-year-oldsand the other is for fivetotwelve-year-olds. The fiveadult exercise equipmentstations are scattered alongthe five-mile path thatmeanders around the large13%of students walked or biked toschool in 2001. That number issignificantly lower than the42 percent of students whowalked or biked to school in 1969.19

moving forward - Policy InitiativesPolicy Initiative No. 2Replace Fryerswith Combi-Ovensin School KitchensMississippi’sSchoolBreakfastProgramhad a totalparticipationof 192,593children,equating to32,444,362breakfastsserved in the2008-2009school year.THE CHALLENGEIn the 2008-2009 school year, Mississippi’s School Lunch Programserved 404,694 students a total of 68,147,157 lunches. Of those lunches,32 percent were paid, 8 percent were reduced price, and 58 percent werefree. Traditionally, schools look for ways to cook large amounts of food thatkids will eat. Typically, this has meant frying food such as French fries andchicken nuggets, contributing to unhealthy eating patterns and failing tointroduce critical vitamins and nutrients school children need in their diets.Combination oven/steamers allow food to be cooked with dry convectionheat, fan-assisted steam, or both, which reduces the number of calories and fatwhile preserving the taste. The exterior of foods can be browned and crisped,much like frying, while still retaining interior moisture without the use ofcooking oils. The ovens also allow multiple items to be “oven fried” at onetime without any flavor transfer between foods. Some combi-oven equipmentoffers significant energy savings compared to traditional cooking methods.According to the Office of Healthy Schools, replacing traditional fryers withcombi-ovens in schools can improve children’s health in several ways:• Food, including vegetables, prepared in combi-ovenslooks appealing, encouraging children to enjoy healthier items.• Popular “kid foods” like French fries andchicken strips are available in healthier and tasty versions.• Serving baked instead of fried foods can make a significantdifference in the calories, fat, and saturated fat that children consume.3 millionis the total number of calories inFrench fries eliminated in one school yearat just two of Starkville’s schools thatswitched from fryers to combi-ovens.NATIONAL SUCCESSTexas was one of the firststates to begin phasing outfryers and switching to combiovens.The Texas Departmentof Agriculture released a TexasPublic School Nutrition Policyto provide a healthier schoolenvironment for children.The policy requires all publicschools to eliminate deep-fatfrying as a method of onsitepreparation for foods servedas part of reimbursable schoolmeals and a la carte options.Fried potato products suchas French-fries that have beenpre-fried by the manufacturermay be served as long as theyare heated by a method otherthan deep-fat frying in theschools. These servings arenot allowed to exceed 3 ounces,may not be offered more thanonce per week, and studentscan only purchase one servingat a time. Baked potatoproducts – such as wedges,whole, or new potatoes,– thatare produced from raw potatoesand have not been pre-fried,flash fried, or deep fat-friedin any way may be servedwithout restriction. For schoolsthat did not need equipmentupgrades, the policy hadto be implemented withina year. A transition periodof four years was granted forthose schools that requiredequipment upgrades.20

A project funded by the POWER initiativeMISSISSIPPI’S SUCCESSDuring spring 2007, theStarkville School District,through support from theOffice of Healthy Schoolsand the Bower Foundation,conducted a pilot projectexamining the feasibility ofreplacing fryers with combiovens.The school chosen wasStarkville High School, withan enrollment of 1,187, a free/reduced meals rate of 62 percent,and french fries served 180 daysper school year.The Starkville School Districtreported that the benefits ofreplacing the fryers with combiovenshave been outstanding.For starters, the combi-ovenssubstantially reduce the amountof calories and fat that thechildren consume withoutweakening the appeal or flavorof the food. In fact, the reportsclaim that a greater variety ofdishes look more appetizing forlonger, because food preparedin combi-ovens stay moist insideand hold well on the serving line.Also, the overall quality of schoolbreakfast and lunch mealsnoticeably improved, thoughmeal participation and extrafood sales were not affected.The kitchen staff enjoyed theadditional safety and sanitationof removing the fryers, becausethey no longer had to worryabout vats of grease, slipperyfloors, or getting burned bysplattering oil. The project wasan incredible moral boosterfor the kitchen staff andemployees concerned withstudent health. The staffwas proud to play a rolein improving studentnutrition and providinghealthier choices.At the end of the2008 school year,the district’s childnutrition departmentwas so pleased withthe results from thepilot project thatall fryers in theschool districtwere replacedwith combi-ovens.One serving (1/2 cup) ofFrench fries cooked usingcombi-ovens contains1/2the total number of fat gramsas fries cooked in atraditional fryer.21

moving forward - Policy InitiativesPolicy Initiative No. 3Increase theNumber of SchoolNurses in the SchoolsIn 2009, fundingfor school nursesin Mississippicame fromthe followingsources:District Funds(34%), FederalFunds (27%),HospitalFunding (16%),School NurseInterventionProgram (16%),and other (7%).THE CHALLENGESchools are a natural setting to influence the health and well-being ofstudents, and the school nurse is often a child’s main provider of health care.Nationally, 12 percent of students served by school nurses have no othersource of regular medical care. The nature of the services provided by schoolnurses has become more technical and intense with the rapid increase inthe number of children with highly specialized health care needs, such asobesity, attending public school.School nurses can provide leadership in helping students develop andmaintain a healthy lifestyle through the clinical setting, educational setting,and through policy development in the school environment. The schoolnurse can also help students deal with the problem of being overweight ina proactive manner and work to eliminate the impact of poor nutrition onlearning outcomes. Mississippi’s current ratio of one school nurse for every1,136 students has improved from previous years, but it is still well shortof the nationally recommended ratio of 1:750. As of 2009, 12 schooldistricts in Mississippi still do not have any school nurses.The National Association of School Nurses points out that school nurseshave the expertise to meet the needs of children at risk of being overweightand to assist those students who are overweight in the following ways:• Assisting students in developing good decision-makingskills related to nutrition and in establishing activity patternsto maintain normal body mass indices throughout their lives• Educating students, faculty, and parents on the following:- Dietary guidelines for balanced meals that are low in dietary fat- The need for daily physical activity- Reading and interpreting dietary information on food products- Relating dietary guidelines to food preparation• Initiating school policies that relateto providing a healthy school environment• Supporting families as they assist their childrenin achieving and/or maintaining a healthy weight• Identifying students who are overweight for education andencouragement in finding and using acceptable weight-loss programs• Implementing and managing school-based weight-reduction programsMISSISSIPPI’S SUCCESSOne of the key goals in the2007-2012 Pascagoula SchoolDistrict Strategic Plan is to meetthe health and psychologicalneeds of all students. To achievethis goal, one of the actionsplanned was to establish a healthservices program that would atleast meet the national standardof one nurse for every 750students. The Pascagoula SchoolDistrict has increased its schoolnursing staff from two schoolnurses for the 2001-2002 schoolyear to eight school nurses forthe 2009-2010 school year.The addition of morenurses provides an opportunityto identify many more healthproblems that are barriersto learning and to implementinterventions that assiststudents in becoming successful.A great success has been thedevelopment of communitypartnerships. The district’shealth services departmentpartnered with theMississippi Gulf CoastChildren’s Health Project.Twice a month, a medicalmobile unit comes to thedistrict to provide healthcare touninsured students and studentswithout a medical home.22

A project funded by the POWER initiativeThe nurses identify studentsin need of referral and makeappointments for them andtheir parents. The mobileunit provides a pediatrician,a pediatric nurse practitioner,and a social worker at no cost tothe families. Last year, the GulfCoast Children’s Health Projectalso supported a CommunitySupport and Resiliency MobileUnit, staffed by two full-timemental health counselors anda child psychologist. Thesestaff provided group, family,and individual counseling inthe middle and high schools,as well as group counselingin the elementary schools.The school nurses coordinatedall of these services.The Cleveland School Districthad been without a school nursefor approximately 20 years.The district has 10 schoolsand educates 3,700 childrenincluding numerous childrenwith chronic diseases andphysical and mental limitations.Through a grant from The Officeof Healthy Schools, the districtwas able to employ a schoolnurse in 2008-2009.In the past year, the Clevelanddistrict set up a clinic toprovide wellness screenings inassociation with Medicaid’sCool Kids program and educateteachers and staff on numerouschronic and communicablediseases. HIPPA-compliantmedical software with a biosurveillance component waspurchased to make it easier tomonitor children with asthma,diabetes, food allergies, seizuredisorders, and commoncomplaints such as sore throat,and headache. These childrennow have an individualizedhealth plan designed to meettheir healthcare needs.The screenings providedby school nurses speeddiagnosis and treatment,decreasing the potential forfurther medical complications.The school nurse has beena true child advocate forimproved medical care inthe school system, and theCleveland school board recentlyapproved the hiring of anotherschool nurse for the district,pending funding.85%of students who see a school nurseare able to return to class.Having access to a school nurse keepskids in school, strengtheningthe Average Daily Attendanceon which school fundingis based.23

moving forward - Policy InitiativesPolicy Initiative No. 4SupportComprehensive FitnessTesting in SchoolsIn March 2006, theAmerican HeartAssociation (inconjunction witha fitness testingprogram sponsoredby the Chrysler FundAmateur AthleticUnion) reported that9.7 million youngstersbetween the agesof six and 17, aregetting slower inendurance runningand weaker overall.The CaliforniaDepartment ofEducation studiedthe relationshipbetween physicalfitness and academicachievement, andthe data showedthat higher academicachievement wasassociated withhigher levels offitness at each ofthe three gradelevels measured.24THE CHALLENGEThe goal of Comprehensive Fitness Testing is to assist students inrecognizing good health and establishing lifelong habits of regularphysical activity. The tests are a mechanism for teaching studentshow to apply behavioral skills such as self-assessment, goal setting,and self-monitoring and provide feedback to students, parents, andschools about students’ physical fitness.As a result of previous comprehensive fitness testing in areas acrossthe country, studies such as the National Health Education Standards:Achieving Health Literacy and Moving into the Future: NationalStandards for Physical Education have already determined objectivesto help guide teachers and students throughout this program. The students’knowledge of fitness is measured through pencil-and-paper examinations,while physical performance measurements are recorded on their aerobiccapacity, body composition, strength, endurance, and flexibility.Some school districts may opt to require that each student’s test resultsare sent home to parents and guardians, but the test results are notintended to be factored into report card grades.The tests are beneficial for many reasons. They provide students withan opportunity to gain knowledge, attitudes, motor skills, behavioral skills,and confidence to participate in physical activity, which may establishactive lifestyles that young people will continue into and throughouttheir adult lives. If parents and guardians are involved, they can helpenforce fitness plans at home to meet each child’s individual needs.School districts and individual schools gain informative results thatdetermine the fitness levels of their students in order to provide effectivedirection for physical education programs.NATIONAL SUCCESSTexas was the firststate to require an annualphysical fitness assessmentof public school students.The Texas Education Agencyhas been using the results toresearch various correlationsbetween health and academicperformance. Research hasconsistently shown thatincreasing time in physicaleducation and other physicalactivity programs in schoolsmade a positive impact onacademic performance.The results proved thatadvancing children’s physicalfitness benefits both the kidsand the schools.California requires eachschool district to administera Physical Fitness Test (PFT)annually to all students ingrades five, seven, and nine.The State Board of Educationdesignated the FITNESSGRAMas the required PFT forCalifornia public schools.FITNESSGRAM usesobjective criteria to evaluatefitness performance. Twolevels of performance havebeen established for each teastoption: (1) in the HealthyFitness Zone and (2) needsimprovement, with the zonesvarying according to gender andage. The California Department

A project funded by the POWER initiativeof Education used the resultsto study the relationshipbetween physical fitness andacademic achievement. The datashowed that higher academicachievement was associated withhigher levels of fitness at each ofthe three grade levels measured.MISSISSIPPI’S SUCCESSAt Walls Elementary Schoolin Desoto County, Mississippi,physical education teacher,Allison Taylor implementedthe President’s Challengenational fitness test in October2008, determined to findways to motivate many ofher students to get in betterphysical condition. She decidedto integrate 10 minutes ofProject Fit during each physicaleducation class and focused onexercises such as sit-ups, pullups,and flexed arm hangs toincrease strength and endurance.Students also ran together inclass to prepare for the milerun and shuttle run.In the fall, 70 studentsqualified for the President’sChallenge National FitnessAward. Showing improvement,150 students qualified in thespring. The students expressedthat their hard work paidoff in the end.The State Board of EducationPolicy currently requires fitnesstesting in grade five and thenone year of high school.only36%of Mississippi high schoolstudents meet recommendedlevels of physical activity.25

moving forward - Policy InitiativesPolicy Initiative No. 5Improve State Standards forDay Care Centers & Youth Programsto Promote Healthy LifestylesThe NationalAssociationfor Sportand PhysicalEducationrecommendsthat toddlersget at least30 minutesof structuredphysicalactivity eachday as well asan additionalhour ormore ofunstructuredphysicalactivity. Theyalso statethat toddlersshould notbe sedentaryfor more than60 minutesat a timeexcept whensleeping.THE CHALLENGENational research suggests that approximately one-fourth of 2- to5-year-old children are obese or overweight. In Mississippi, researchconducted by the University of Southern Mississippi showed that morethan one-third of 3- and 4-year-olds and almost half of 5-year-oldsin Head Start programs were obese or overweight. For many preschoolchildren in day care centers and youth programs, there are no dietaryrules or policies, whereas the food children eat in kindergarten through12th grade in public school is regulated for fat and salt content, amongother things. Currently, an estimated 97,741 Mississippi children areenrolled in day care centers, and approximately 77,603 of these childrenare 5 years of age or younger. There are 1,720 current day care centersthroughout the state with a combined maximum enrollment of 135,567.Standards regarding nutrition and physical activity for children atday care centers and youth programs can offer a healthy environmentthroughout the day, and can encourage families to adopt healthierbehaviors when children are at home.NATIONAL SUCCESSA great example of an incentiveprogram for day cares topromote healthy lifestyles andmeet recommended standardsmight be the state of Tennessee’s“Gold Sneaker Initiative.” Thisprogram is sponsored by theNational Governors Associationwith funds from the RobertWood Johnson Foundation.The purpose of the programis to enhance policy related tophysical activity and nutritionwithin licensed child carefacilities across Tennesseewith the intent of buildinglifelong skills for healthy living.The Gold Sneaker Initiativeencourages child care providersfrom both the private and publicsectors to voluntarily adoptphysical activity and nutritionpolicies established through thestate licensing program.The policies promoted under theGold Sneaker Initiative includetime allotments for physicalactivity, limits on sedentaryactivities, guidelines regardinginfant and child feeding patterns,and limits on using food, candy,or drink as a child’s reward.Facilities are rewarded withcertificates of achievement andprominent displays of theiraccomplishments, establishingthem as a Gold SneakerInitiative certified facility.26

A project funded by the POWER initiativeStaff attitude toward theenhanced policy implementationand maintenance of knowledgeis assessed through a follow upvisit. Day care facilities with ahigh rate of unsatisfied staff andthose facilities whose staff mayhave shown a lack of knowledgeregarding the enhanced policyimplementation are identifiedand targeted by the Child CareResource & Referral Networkfor additional assistance toensure the facility’s success.Accountability of the GoldSneaker Initiative is assuredthrough monitoring; theDepartment of Health performssite visits on at least 20 percentof all Gold Sneaker child carefacilities annually.MISSISSIPPI’S SUCCESSThe Mississippi StateDepartment of Health realizedthat to fight the obesity issue,it needed to start with youngchildren. The department wasable to secure 150 free ColorMe Healthy toolkits, to usewith preschools. Designed toengage children through all fivesenses, the Color Me Healthyprogram contains lesson plansto be used by teachers, alongwith posters, stamps, games,music, and songs for lessonsand activity times. The toolkitalso has newsletters providingparents with kid-friendly recipesand tips on nutrition andphysical activity. The ChildcareLicensure Division has beenable to distribute these toolkitsto facilities throughout the stateduring a four-hour training class.Menu Writing 101 is a threehourclass offered throughMississippi’s ChildcareLicensure Division that isdesigned to help preschoolfacilities improve the qualityof meals without adding costs.During the class, licensureregulations are reviewed, pastmenus are modified for healthiermeal options, and participantsengage in group discussionsto plan several days of menusincorporating healthy fooditems that they may have notused in the past.The Color Me Healthy programand the Childcare LicensureDivisions classes, have reachedmore than 150 childcare centersacoss the state.1,000is the total number ofcalories a toddler shouldconsume daily.One medium chocolate chipcookie can easily contain50 calories or more.27

moving forward - Policy InitiativesPolicy Initiative No. 6Encourage Recipients ofPublic Benefit Programs toPurchase Healthy FoodsChildrenparticipatingin SNAP hada significantlygreater meanBody MassIndex and weresignificantlymore likely tobe obese.Starting inOctober 2009,WIC will allowparticipants tobuy soy-basedbeverages,tofu, fruits andvegetables,baby foods,whole-wheatbread andother wholegrainoptionsto better meetthe nutritionalneeds of itsparticipants.THE CHALLENGEThe cost of certain foods can put healthier choices out of reach for many.Research has shown that on a per-calorie basis, high-calorie, low-nutrition“junk” foods tend to be less expensive than more nutritious foods such asfruits and vegetables. The cost of “junk” foods also has increased moreslowly over time. Between 1985 and 2000, the real (inflation-adjusted)cost of fresh fruits and vegetables rose nearly 40 percent, while realcost of soft drinks, sweets, fats, and oils decreased in the United States.Particularly for those with limited food budgets, such as SupplementalNutrition Assistance Program (SNAP) recipients, economicallysmart food choices and healthy food choices may conflict. Nationally,2.4 million people rely on the SNAP program. In fiscal year 2008,the average number of participants per month in Mississippi’sSNAP program was 447,181.Many of the federal food assistance and nutrition programs distributesurplus foods, which are not necessarily chosen for health benefits. Budgetconstraints can also necessitate the purchase and distribution of cheaperfoods. Additionally, while farmers’ markets and small local businesses areallowed to take SNAP benefits, it is often not economically feasible forthem to purchase and maintain the equipment required to do so.More than 20 percent of U.S. SNAP participants live in ruralcommunities. Making sure that locally grown foods are among thoseavailable through food assistance and nutrition programs would increaseaccess to fresh, healthy foods and help rural communities create marketsto support increased production of local foods.The fact that SNAP benefits can be used to purchase nearly any food item—except alcohol, tobacco, and dietary supplements—including “junk” foodhas led to discussion of stricter regulations on SNAP spending. Furthereducation on proper nutrition and healthy choices could also providerecipients more independence and useful knowledge, should benefits nolonger be available.A policy option to consider is to eliminate “junk food” as an approvedpurchase for SNAP recipients. An alternative policy option is to providediscounts to SNAP partcipants when purchasing healthy foods with publicnutrition assistance benefits, encouraging people to make healthy choices.MISSISSIPPI’S SUCCESSOn June 15, 2009, theWashington County, Mississippi,Health Department sponsoredits first of many nutrition andphysical activity classes forparticipants of federal assistanceprograms who were single headsof household and diabetic or atrisk for diabetes. Classes werescheduled three days per weekfor two weeks. Participants whoattended four of the six classesqualified for a free $25 gift cardto use at their local grocery.Topics for classes includeddiabetes and diabetes prevention,meal planning, incorporatingphysical activity into each day,grocery shopping, cooking,and reading food labels.The National Food ServiceManagement Institute andDepartment of Family andConsumer Sciences at theUniversity of Mississippi arecurrently partners in EatingGood… and Moving Like WeShould, a project funded bythe Delta Health Alliance.The program teaches schoolstaff, parents, and caregivershow to provide healthy foods tochildren. It teaches children tomake healthy food choices basedon their individual food andnutrition needs and encouragesthem to engage in a more activelifestyle. Nutrition counseling28

A project funded by the POWER initiativewith individual families is alsoprovided. Topics discussed incounseling sessions includegeneral nutrition principles thatcorrelate directly to decreasingthe risk of developing chronicdiseases associated with obesity.Communication resourcesare provided for school andnutrition directors to presentto teachers, parents, and foodservice staff.At the close of the 2008-2009school year, Eating Good…and Moving Like We Shouldhad served more than 1,200residents in Panola andQuitman counties. Preliminaryresults showed that 58 percentof the 561 children whoparticipated in the programshared with their family whatthey had learned in the program,and 88 percent of the childrensurveyed said they had learnedthings in the program that willinfluence their eating habits asan adult.Because of what they learnedin the program, 53 percent ofparticipants claimed they weredecreasing the amount of foodthey were eating, and 65 percentof respondents reported theyhad increased their intake offruits and vegetables. Seventysevenpercent of the childrenwho participated in thesurvey said they either startedexercising or increasedtheir physical activityafter completingthe curriculum.Achieving remarkableresults in theMississippi Delta,the collaboration ofpartners has been thekey to the program’ssuccess. The resultsare gratifying andconfirm that nutritioneducation is a criticalweapon in the fightagainst obesityand disease.approximately12.1%of total food dollars arespent on fruits and vegetablesby lower income families.For those with income levels of$70,000 and above, thispercentage is only 8.7.29

moving forward - Policy InitiativesPolicy Initiative No. 7Restrict Advertising of Unhealthy Foodsto Children and/or Require Public ServiceAnnouncements that Offer Healthy MessagesFast-foodmarketing isone contributorto obesityin children.Americanchildren see27 food ads onTV for everypublic serviceannouncementpromotinghealthy eating.Over half oftelevisionadvertisementsdirectedat childrenpromote candy,fast food,snacks, softdrinks, andsweetenedbreakfastTHE CHALLENGEThe prevalence of childhood obesity has been increasing over the yearsand the volume of media aimed at children through TV shows, videos,video games, computer activities, and web pages has steadily increasedas well. The average time spent using media is 5.5 hours per day.Preschoolers who are six and younger will spend just as many hours withscreen media as they spend playing outside.Research indicates that the amount of weekly television viewing bychildren is significantly related to their caloric intake as well as to theirrequests for and their parents’ purchases of foods advertised on television.It is estimated that advertisers spend more than $12 billon per year onadvertising messages aimed at youth and that the average child watchesmore than 40,000 television commercials per year. Children under theage of eight are unable to critically comprehend televised advertisingmessages and are prone to accept advertiser messages as truthful, accurate,and unbiased, which can lead to unhealthy eating habits. A task force ofthe American Psychological Association recommended that advertisingtargeting children under the age of eight be restricted. Other suggestedpolicy changes include the following:•••••A prohibition of food advertising inschool-based TV programs such as Channel OneA ban on advertising of “junk” food in children’s programmingThe provision of equal time for messages on nutritionor fitness to counteract food ads in children’s showsBroadcasting parental warnings aboutthe nutritional value of advertised foodsThe development of programming that promotes healthy lifestylescereals98%of food advertisementsviewed by children are forproducts high in fat,sugar, or sodium.NATIONAL SUCCESSFour cities in West Virginiaand the Centers for DiseaseControl and Prevention(CDC) participated in a pilotstudy that measured the costeffectivenessof using variousmass-media campaign strategiesto promote a switch from milkwith 2 percent fat to 1 percentor less. The media campaigntitled 1% or Less was directedtoward adults and childrenover the age of two, and it wasintended to decrease the amountof saturated fat consumed inthe population. Four differentcombinations of strategies wereused in the four different townsover three consecutive years.Milk sales and telephone surveysconducted along the way andtwo years after the campaignsmeasured the effectiveness ofeach strategy. The results foundthat all campaigns effectivelyencouraged people to switchfrom high- to low-fat milk, butthe most cost-effective was acombination of paid advertising(television, newspapers, andradio) reinforced by mediarelations (events designed togenerate coverage by the localnews) as was conducted inWheeling, West Virginia. Thecampaign in Wheeling showedan increase of low-fat milk salesfrom 29 percent to 46 percent,a change that was sustained at30

A project funded by the POWER initiative42 percent two years after thecampaign ended. In addition, 34percent of high-fat milk drinkersswitched to low-fat milk, with atotal cost of $0.57 per person.MISSISSIPPI’S SUCCESSSince 2003, the Mississippi StateExtension Service has partneredwith Dr. Michelle Lombardo,co-founder of The OrganWiseGuys, Inc. of Duluth, Georgia,to promote the benefits of goodnutrition and preventive healthcare practices to elementarystudents. Award-winning,science-based, and curriculumlinked,The OrganWise Guysresources engage children ingrades K-5 with entertainingmaterials and activities thatencourage students to adopthealthy lifestyle habits. Thisgives schools a great opportunityto market healthy choices inthe classroom as well as thecafeteria. The OrganWise Guys’message—lowfat, high fiber,lots of water, and exercise—isincorporated in all subject areasof the curriculum. The studentsalso engage with puppets thatrepresent parts of the body andtalk about how what they eataffects their organs. Studentstake this message home andencourage their parents toalso make healthy choiceswhen preparing meals andgrocery shopping.Beverage companies anddistributors across the state arealso cooperating with schools tomake appropriate changes to theimages on the front of vendingmachines to reinforce healthy,active lifestyles, and/or a positiveschool climate.121.5hours of food adsare viewed yearlyby childrenages 2-17.31

moving forward - Policy InitiativesPolicy Initiative No. 8Require Schools to ProvideBMI (Body Mass Index) Reportsto ParentsAt time ofpublication, 16states screenstudents’BMI or fitnessstatus andconfidentiallyprovideinformationto parents orguardians.THE CHALLENGEBody Mass Index (BMI) is a ratio of weight and height thatalso accounts for gender and age. A BMI assessment classifies achild as underweight, normal weight, overweight, or obese. It is auseful screening tool and a relatively efficient method for estimatingrates of overweight and obese children.The CDC advises that to reduce the risk of harming students, BMImeasurement programs should adhere to the following safeguards:• Introduce the program to school staff and community members andobtain parental consent.• Train staff in administering the program (ideally, implementation willbe led by a highly qualified staff member, such as the school nurse).• Establish safeguards to protect student privacy.• Obtain and use accurate equipment.• Accurately calculate and interpret the data.• Develop efficient data-collection procedures.• Avoid using BMI results to evaluate student or teacher performance.• Regularly evaluate the program and itsintended outcomes and unintended consequences.NATIONAL SUCCESSArkansas pioneered the useof annual, confidential reportingof students’ BMI to parents.The Arkansas Center for HealthImprovement (ACHI) developeda system for gathering BMIassessments and deliveringindividualized, confidential ChildHealth Reports to parents ofchildren in public schools. Thefirst year data collection was apaper-based system, and ACHIeventually developed a web-baseddata entry system for schools touse. ACHI then took the electronicentry of data and automatedgeneration of Child HealthReports statewide, eliminatingdependence on paper exchangeof information and reducing costsand potential error rates.66%of Mississippi adultssupport requiringBMI assessmentof children.A number of concerns had beenexpressed about school-basedBMI screening, including that itmight stigmatize students, leadto harmful behaviors, couldbe ineffective, and distractattention from other school-basedobesity prevention activities. In2007, Arkansas modified statelaw to specify the protocolto be followed by school andnursing staff in performing theassessments. Now, parents areprovided a way to opt out of theassessments in writing if they donot wish to have their childrenparticipate. The new protocolalso reduces the frequency ofassessments to biennially in evengrades K-10.32

A project funded by the POWER initiativeThe methods and charts used forcalculating BMI in children ages 2 to 19differ greatly from those used for adults.Children’s measurements must take theircontinued growth into account.Growth charts and BMI informationfor children can be found on theCenters For Disease Control and Prevention websitewww.cdc.gov/growthcharts/clinical_charts.htm33

moving forward - Policy InitiativesPolicy Initiative No. 9Improve Access toSupermarkets/ProducePersons livingin “fooddesert”counties inrural Mississippiwere found tobe 23.4 percentless likelyto consumerecommendedamounts offruits andvegetables.THE CHALLENGEConsumption of fruits and vegetables is an important component of ahealthy diet. Only one in five Americans actually consumes the dailyrecommended level of five to nine servings of fruits or vegetables establishedby the Dietary Guidelines for Americans. Studies have demonstrated arelationship between low income and a poor diet. According to the Centersfor Disease Control and Prevention, people with incomes of less than$15,000 are the least likely to consume fruits or vegetables. Additionally,many low-income neighborhoods lack healthy, affordable retail food options,and purchasing healthy food often involves transportation thatis inconvenient or unavailable to many residents.Upper- and middle-income neighborhoods have about three times asmany supermarkets per capita as do low-income neighborhoods, andoften fast food chains and corner stores are the only sources of food inlow-income neighborhoods. One of the barriers to healthy eating is thelack of convenient access to supermarkets and stores that have fresh fruitsand vegetables. Supportive policies related to economic development, landuse, water, and transportation can help. Strategies that increase access tohealthy foods include the following:•••••Subsidizing supermarkets that will locate in low-incomeneighborhoodsCreating economic stimulus programs and public privatepartnerships to promote the creation of farmers markets and theexpansion of retail grocery operations in low-income neighborhoodsDeveloping land-use policies and joint-use agreements that supportthe creation of community gardens in areas lacking supermarketsDeveloping transportation policies that ensure public transit canconveniently transport riders to supermarkets or farmers markets,and creating economic incentives for free or low-cost transportationCreating local zoning ordinances to support the development ofmixed-use neighborhoods and the creation of small markets thatoffer healthy foodsMississippi has thesecond lowest rateof fruit and vegetableconsumption in the nation.NATIONAL SUCCESSIn April 2003, Pennsylvaniapassed the nation’s firststatewide economicdevelopment initiative aimed atimproving access to markets thatsell healthy food in underservedrural and urban communities.The legislation was passedas a $2.3 billion economicstimulus package and $100million of these funds wereused for agriculture projects,including the development ofgrocery stores and farmersmarkets. During this time,Pennsylvania’s governor alsocreated an innovative new fundfor the Fresh Food FinancingInitiative, which supportedthe development of 10 newstores by offering an $80million financing pool for freshfood retailers that locate inunderserved communities. Theinitiative provides a range offinancing resources such aspre-development grants andloans, land acquisition andequipment financing, capitalgrants for project fundinggaps and construction, andpermanent financing. Thispioneering program resultedin more than 65 grocery storesbeing built in low-income areasacross the state, creating morethan 3,700 jobs, and supplyingspinach, tomatoes, and otherhealthy produce and foods tounderserved areas.34

A project funded by the POWER initiativeMISSISSIPPI’S SUCCESSMayor Chip Johnson ofHernando, Mississippi, hasbecome a spokesperson for localgovernment officials interestedin improving the health ofcitizens. Under his leadership,Hernando is working towardthe development of a healthiercommunity by adding parksand other green spaces, as wellas recreational equipment andprograms. The city has alsoadopted design regulations thatmandate sidewalks in all newand renovated developmentsto reduce barriers to walkingfor exercise and transportation.Hernando has just completed around of sidewalk improvementsthat transformed old crumblingsidewalks into wide, safe, andaccessible pedestrian ways.The city is also part of theDeSoto Greenways project,seeking to one day connectthe city’s greenways andsidewalks to a countywideand regionwide network ofgreenways and blueways.1 in 5Americans consume thedaily recommended level of5-9 servings of fruits andvegetables.Hernando also participatedin the development of asuccessful local farmers marketand developed a communitygarden. Both are designed topromote local, fresh, healthyeating and are located withinwalking distance of the mostdisadvantaged residents.35

moving forward - Policy InitiativesPolicy Initiative No. 10Require Labelingof Menus andPrepared FoodsToday, wespend almosthalf (46percent) ourfood dollarsat restaurants.Adults andchildren aregetting abouta third of theircalories fromaway-fromhomefoods.Children eatalmost twice asmany calorieswhen theyeat a meal ata restaurant(770 calories)compared to ameal at home(420 calories).THE CHALLENGEAnother area of recent interest as a potential strategy to reduce theobesity epidemic is the provision of nutritional information on restaurantmenus and menu boards at fast food and full-service chain restaurants.Research has shown that the increase in obesity is associated withthe increase in the consumption of restaurant foods over the past fewdecades. Additionally, increasing portions of food and beverages servedat restaurants (e.g. “super-sizing”) has become more and more commonin the United States. The restaurant industry is currently not mandatedby federal regulation to provide calorie and other nutrition informationwith food served, in contrast to packaged food products sold in grocerystores and supermarkets. Two-thirds of the largest chain restaurants donot provide any nutrition information to their customers. Some restaurantchains offer information on their web sites, requiring consumers to read theinformation prior to their visit to the restaurant.Today, we spend almost half (46 percent) our food dollars at restaurants.Adults and children are eating about a third of their calories from awayfrom-homefoods. Research shows that children eat almost twice as manycalories when they eat a meal at a restaurant (770 calories) compared toa meal at home (420 calories).Most people significantly underestimate the caloric content of restaurantmenu items and, could benefit from having information about calories,fat content, carbohydrates, etc., for menu items readily accessible.Because menu labeling ordinances have only recently been adoptedin some jurisdictions, there is little research published to document thepossible impact of menu labeling on obesity.NATIONAL SUCCESSRecently, New York City becamethe first major city to implementa menu labeling ordinancethat affects chains with 15 ormore locations. Restaurants likeSubway, Quizno’s, IHOP, andothers are now posting calorieinformation on menu boards inat least some locations.On September 30, 2008,California passed SB 1240 andbecame the first state in the U.S.to require nutrition labelingin restaurants. The legislationrequires that restaurant chainswith 20 or more locations mustpost calorie information on theirmenus and indoor menu boardsby January 1, 2011. BeginningJuly 1, 2009, brochurescontaining either caloriecontent information or othernutritional information, such asgrams of saturated fat, grams ofcarbohydrates, and milligramsof sodium, will be at the pointof sale for consumers.85%of Mississippians support requiringrestaurants to list nutrition information,such as calories, on menus.Maine legislation, HP 878,was passed in 2009 requiring achain restaurant, a restaurantwith 15 or more restaurantsnationwide, to provide accuratecalorie information on its menus,menu boards and food displaylabels for the food and beverageitems it regularly sells. The billalso requires a chain restaurant36

A project funded by the POWER initiativeto state on its menu andmenu boards: “To maintaina healthy weight, a typical adultshould consume approximately2,000 calories per day; however,individual calorie needs mayvary.” The legislation alsoallows a chain restaurant tostate, “Nutrition informationis based upon standard recipesand product formulations;however, modest variationsmay occur due to differencesin preparation, servingsizes, ingredients,or special orders.”MISSISSIPPI’S SUCCESSIn an attemptto facilitatenutrition education, schoolmenus including nutritionalinformation are posted at thebeginning of each servingline in all schools in theMcComb, Mississippi, SchoolDistrict. Students and teacherstake advantage of the usefulinformation to make healthierchoices from the day’s offerings.In addition, the menu is postedon the school’s website. At thebottom of each day’smenu is a link toview nutrients.A click onthis link brings up a windowwith the nutritional analysis forthat day’s menu. This feature isnot only helpful for teachers andstudents who are attempting tomake healthier choices, it is alsoutilized by parents of childrenwith diabetes and other healthproblems. The detailed analysisgives the parent the opportunityto review the menu in advanceand guide the child in makingthe right choices for his/herdietary situation.10pounds a year are gainedby eating just 100 extracalories every day.37

3856%of Mississippians think thatgovernmentshouldplay a significant role inreducing obesity.

SEEKING ACTIONEach of Mississippi’s state agencies assigned to the POWER projecttask force by Governor Haley Barbour have already committed to makinga stand against childhood obesity. Each agency is developing action plansoutlining their support and identifying the ways they will collectivelyaddress the ten policy priorities agreed upon by the stakeholders at theHealthy Mississippi Summit.The following pages contain the action plans that have been submittedto date and represent only a portion of the actions being taken by all stateagencies to prevent childhood obesity. Often by simply continuing theircurrent ongoing projects and directing their existing resources toward acommon goal, a diverse web of support is created through the collaborationof agencies. This support system forms a strong foundation to be furtherbuilt upon, guaranteeing success. Through teamwork, the commitments aremanageable, reasonable, and most importantly, effective when coordinatedwithin the POWER project.When planned and coordinated together, individual efforts will effectivelyisolate and surround each issue, tackling it from all sides at once, havinga lasting life-saving impression on Mississippi.39

SEEKING ACTION - Departmental Action PlansMississippi Department of EducationAgency Contact:Shane McNeillDirector of theOffice of HealthySchools601.359.1737ACTIONSThe Office of Healthy Schools will:• Provide support for developing joint-use agreements between local school districts andcommunity organizations to increase access to playgrounds, walking tracks, gymnasiums,parks and other facilities during and outside of the regular school day that promote healthylifestyles and family/community involvement in the school setting• Continue to provide technical assistance on playground development and safety to schools• Continue to identify, secure, and award funds to local school districtsas possible to support the implementation of combination oven steamers• Continue to support policies that improve the nutritional quality of school meals• Provide an annual report to the state legislature that explains the manyresponsibilities and services that school nurses provide to meet the needs of kids• Continue to partner with the Mississippi Division of Medicaid to implement the Early,Periodic, Screening, Diagnosis, and Treatment Program (EPSDT/Cool Kids Program)• Continue to collect data through the Committed to Move project• Continue to provide support for comprehensive fitness testing thatprovides a broad assessment of fitness including body composition• Continue to identify, secure, and award funds to local districts as possible tosupport the purchase of software and equipment necessary for conducting fitness testing• Maintain partnership with the Mississippi State Extension Service to provide technicalassistance and support to school districts when conducting fitness testing requirements.• Partner with HeadStart, Department of Human Services, Division of Medicaid,and the Mississippi State Department of Health to provide training on the recentlydeveloped Birth to Five Benchmarks• Provide technical assistance to the Building Blocks Pilot Program tosupport the implementation of health initiatives in the early childhood programs• Continue to partner with the Mississippi Division of Medicaid and theMississippi Department of Human Services to provide radio and televisionannouncements that provide consistent messaging and support for healthy lifestyles• Continue to work with the Beverage Association of Mississippi to change and createfaceplates on vending machines in Mississippi public schools to promote healthylifestyles and/or a positive school climate. Faceplates will include pictures promotingphysical activity, hydration through consumption of water and/or other approved beverages,recycling, educational goals, and/or a school logo or mascot. The Beverage Associationof Mississippi and the companies it represents are to be commended for this proactiveapproach to promote healthy lifestyles.40

A project funded by the POWER grant• Develop and disseminate a school health report card thatprovides a summary report of the implementation of school health programs• Develop resources to support partnerships between schools andsupermarkets (i.e. healthy scavenger hunts, healthy supermarket sweeps,coordinated vegetable-of-the-month promotions) to encourage purchasingof fresh fruits and vegetables and other healthy lifestyle choices• Continue to provide resources for child nutrition programs to shareschool lunch and breakfast menus with parents and teachers for assistingchildren/students with making the healthiest choices• Provide additional resources and support to teachers for instruction on readingand understanding the information provided on a food label, portion size, andthe nutritional components of the mealMississippi State Department of HealthAgency Contacts:Victor SuttonDirector ofthe Office ofpreventive health601.576.7781ACTIONSThe Mississippi State Department of Health will:• Build capacity at the community level by establishing coalitions to address physical andnutritional activities. Collaboration with local communities via coalitions uses the power ofnumbers to accomplish more in addressing modifiable risk factors related to most chronicillnesses. The Chronic Disease Bureau supports coalitions in identifying strategies andimplementing activities to reduce risk factors among the targeted population.• Improve built environments to promote physical activity in local communities. MSDH’sDelta Health Collaborative, Division of Injury and Violence Prevention, and the Bureau ofCommunity and School Health are combining their resources and skills to target cities andtowns in the Mississippi Delta. City and town officials, local businesses, community leaders,and local residents will be involved in conducting assessments of current built environmentissues. Projects, programs, and/or policy and environmental changes will be suggestedbased on objective outcomes from the assessment, according to current best practices andempirical evidence for intervention.• Continue to provide Bodyworks, an obesity prevention program for ages9-12 and their caregivers to promote good nutrition, increased physical acitivity,and decreased screen time• Implement interventions to address physical and nutrional activities in local communities.MSDH will identify, secure, and award funds to universities, civic organizations, and localcommunity organizations to support the implementation of evidence-based interventionsto reduce risk factors that are directly linked to most chronic diseases: physical inactivity,poor nutrition, and tobacco use. MSDH awarded funds to Jonestown Family Center forprojects to increase the physical activity and health literacy of children, adolescents andadults in Jonestown, Mississippi.41

SEEKING ACTION - Departmental Action Plans• Collaborate with employers to promote worksite wellness programs to help employeesdevelop healthy behaviors and lower their risk of developing chronic diseases. The MSDHOffice of Preventive Health supports increasing access to physical activity and nutritionprograms. The MSDH Office of Preventive Health Community and School HealthBureau is collaborating with state agencies to create active worksite wellness councils.• Establish faith-based programs to assist congregational members in increasingtheir physical activity and eating more fruits and vegetables. The Office of PreventiveHealth collaborates with faith-based communities on ways to improve the health of theirconstituents through two programs. Congregational Health Nurses supports congregationswith a registered nurse, to establish a health ministry to assist members with navigating thehealthcare system. The Healthy Congregation Program provides technical assistanceto congregations to improve the health of their communities.• In addition to efforts to provide Color Me Healthy Toolkits, the MSDH andMississippi Department of Human Services have formed a partnership to providean additional 1,500 toolkits so every licensed childcare center will receive a toolkitand training to support implementationMississippi Department of Human ServicesAgency Contacts:Cheryl SparkmanDirector ofthe Divisionof economicassisstance601.359.4809ACTIONSThe Division of Economic Assistance will:• Promote healthy life choices within the MDHS county offices. Health-relatedinformation will be provided on-line for MDHS staff to access in the same waythat policy information updates are currently provided. Staff will then distributethis information to their clients in the SNAP and TANF programs. New, relevanthealth information can be distributed through this system.• Work with the Mississippi State Department of Health and Mississippi State University toprovide health and nutrition-related training to the MDHS county directors, with the firsttraining held October 3, 2009, in Meridian. All 82 county directors, as well as the sevenregional directors and the majority of the a of Economic Assistance state office directorswere included.• Work with the Mississippi Department of Education and Mississippi StateUniversity Extension Service to provide nutrition education in Mississippischools through the SNAP Ed Program42

A project funded by the POWER initiativeMississippi Division of MedicaidAgency Contacts:Phyllis WilliamsDeputy Directorfor healthServicesFrances RullanCommunications601.359.6050ACTIONSThe Division of Medicaid will:• Continue the Cool Kids program that is a free healthcare program for Mississippi’schildren ages birth to 21 who are eligible for Medicaid. It provides a way for childrento get the medical exams, check-ups, follow-up treatment, and special care needed toenjoy the benefits of good health. It is sponsored by the Office of the Governor, Divisionof Medicaid, and is designed to pro-actively encourage healthier lifestyles for our children.• Distribute “The Road to Good Nutrition for Everyone” and “The Road toPhysical Activity” along with other literature to the 600,000+ Medicaid beneficiaries• Continue airing healthier lifestyle radio announcements statewide inpartnership with the Department of Education and the Department of Human ServicesMississippi State Department of TransportationAgency Contacts:Cookie LefflerSafe routesto schoolcoordinator601.359.1454ACTIONSThe Mississippi State Department of Transportation will:• Continue to award Safe Routes to School grants toenable and encourage kids to walk and bike to school safely• Continue to award Transportation Enhanceement funds tosupport bicycle and pedestrian projects that promote physical activity• Support awareness campaigns, on the local level,centered around the built environment in Mississippi communities• Provide funding through Safe Routes to School program to developmulti-media public awareness campaigns that promote physical activity and safetyMississippi State Department of Wildlife, Fisheries, and ParksAgency Contacts:Amanda MillsSpecial projectsofficer & Co-hostof MississippiOutdoors601.432.2400ACTIONSThe Mississippi State Department of Wildlife, Fisheries, and Parks will:• Continue to provide grants to city and county parksthat promote physical activity such as unified signage or walking trails• Continue to maintain and provide additionalwalking trails and areas in all Missisissippi State Parks• Continue to offer resources for teaching archery in schools• Conduct Fishing Rodeos to encourage youth to engage in outdoor activities43

APPENDIXAppendix A- Participants at the April 25, 2008, Planning MeetingValerie HawkinsAlliance for a Healthier GenerationWade OverstreetBlue Cross & Blue Shield of Mississippi FoundationAnne TravisBower FoundationJohn SturdivantBower FoundationAmy Radican-WaldCenter for Mississippi Health PolicyCheri SimpsonCenter for Mississippi Health PolicyTherese HannaCenter for Mississippi Health PolicyWesley PraterCenter for Mississippi Health PolicyTom PittmanCommunity Foundation ofNorthwest MississippiEllen JonesConsultantJohnny FranklinGovernor’s OfficeDr. Ted AlexanderLower Pearl River Valley FoundationLibby LynchMississippi Division of MediciadDonna WestMississippi Department of AgricultureAmanda WilliamsMississippi Department of EducationChristine PhilleyMississippi Department of EducationDale DieckmanMississippi Department of EducationLea Ann McElroyMississippi Department of EducationMary Ann SimpkinsMississippi Department of EducationShane McNeillMississippi Department of EducationCarol ParkerMississippi DepARtMENT ofFinance & Administration (Insurance)Karen WestMississippi Department of Mental HealthCookie LefflerMississippi Departmentof TransportationAmanda MillsMississippi Departmentof Wildlife Fisheries and ParksSteve MartinMississippi Development AuthorityBrent FountainMississippi Dietetic Association/Mississippi State ExtensionRenee StiefenhoefeMississippi Division of MedicaidKim EricksonMississippi Family PhysiciansGwen WintersMississippi State Departmentof Health (Child & Adolescent Health)Danita MundayMississippi State Department of Health (First Steps)Donna SpeedMississippi State Department of Health (Nutrition)Victor SuttonMississippi State Departmentof Health (Preventive Services)Diana TillatonMississippi State Department of Health (WIC)Joyal MulheronNational Governors AssociationAppendix B- BibliographyBaker, J., Olsen, L., & Sorensen, T. (2007). Childhood body-massindex and the risk of coronary heart disease in adulthood. NewEngland Journal of Medicine, Dec. 6, 2007. 357(23):2329-2337.Blanchard, T. & Lyson, T. (2006). “Food Availability & FoodDeserts in the Nonmetropolitan South.” Foos Assistance Needs ofthe South’s Vulnerable Populations, No. 12, April 2006. SouthernRural Development Center, Social Sciences Research Center,Mississippi State University.Boarnet, M., et. al. (2001). Evaluation of the California safe routesto school legislation: Urban form changes and children’s activetransportation to school. American Journal of Preventive Medicine,28(2), 134–40.Cawley, J. (2006). Markets and childhood obesity policy. TheFuture of Children, 16(1), 69-88.Center for Science Public Interest. Menu labeling. (2008).Retrieved April 18, 2008, from http://www.cspinet.org/menulabeling/.Centers for Disease Control and Prevention. (2004.) YouthRisk Behavior Surveillance – United States, 2003. Morbidityand Mortality Weekly Report. May 21, 2004, 53(SS02);1-96.Centers for Disease Control and Prevention. (2008). KidsWalkto-School.Retrieved September 15, 2009, from http://www.cdc.gov/nccdphp/dnpa/kidswalk/then_and_now.htm.Bolen, E., & Hecht, K. (2003). Neighborhood groceries: New accessto healthy food in low-income communities. Retrieved, January 6,2009, from http://www.healthycornerstores.org/resources.html.44

A project funded by the POWER initiativeCenters for Disease Control and Prevention. (2009). AboutBMI for children and teens. Retrieved August 5, 2009, fromhttp://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.Centers for Disease Control and Prevention. Prevalence ofObesity among U. S. Children and Adolescents (Aged 2 – 19Years). Retrieved May 21, 2009, from http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/prevalence.htm.Cooper, A.R., et al. (2003). Commuting to school: Arechildren who walk more physically active? American Journal ofPreventive Medicine, 25(4), 273–76.Datar, A., & Sturm, R. Childhood overweight and elementaryschool outcomes. International Journal of Obesity, September2006, 30(9):1449-1460.Datar, A., Sturm R., & Magnabosco, J.L., Childhoodoverweight and academic performance: national study ofkindergartners and first-graders. Obesity Research, Jan. 2004,12(1):58-68.Drewnowski, A., & Spencer, S.E. (2004). Poverty and obesity:The role of energy density and energy costs. American Journalof Clinical Nutrition, 79(1).Ewing, R., Schroeer, W., & Greene, W. (2004). School locationand student travel: Analysis of factors affecting mode choice.Transportation Research Record, 1895, 55–63. Retrieved April4, 2008, from http://www.icfi.com/Markets/Transportation/doc_files/school-location.pdf.Finkelstein, E. A., Fiebelkorn, I. C., & Wang, G. (2003).National medical spending attributable to overweight andobesity: how much and who’s paying? Health Affairs, WebExclusive, May 2003.Finkelstein, E. A., Fiebelkorn, I. C., & Wang, G. (2004). Statelevelestimates of annual medical expenditures attributable toobesity. Obesity Research, 12 (1), 18-24.Fox, M.K. & Cole, N. (2004). Nutrition and HealthCharacteristics of Low-Income Populations: Vol. 1, Food StampProgram Participants and Non-participants, E-FAN-04-014-1.Washington, DC: U.S. Department of Agriculture, EconomicResearch Service.Glanz, K., & and Hoelscher, D. (2004). Increasing fruit andvegetable intake by changing environments, policy, and pricing:Restaurant-based research, strategies, and recommendations.Preventive Medicine 39(2), 75-80.Grantmakers in Health. Executive summary. Reversing theobesity epidemic: policy strategies for health funders. (2007).Retrieved April 4, 2008, from http://www.gih.org/usr_doc/Reversing_the_Obesity_Epidemic_no_28.pdf.Green, S. (2008). T.O. health officer: ban surgery ads thattarget kids under 13. Toronto Sun. Retrieved September 15,2009, from http://www.commercialfreechildhood.org/news/tohealth.htm.The Henry J. Kaiser Family Foundation. Kaiser FamilyFoundation. (2004). The role of media in childhood obesity.Retrieved April 7, 2008, from http://www.kff.org/entmedia/upload/The-Role-Of-Media-in-Childhood-Obesity.pdf.Jerome R. Kolbo, PhD, ACSW; School of Social Work, Collegeof Health, University of Southern Mississippi.Kentucky: Cabinet for Health and Family Services. FoodMarket Nutrition Program. Retrieved April 18, 2008, fromhttp://chfs.ky.gov/dph/ach/(FMNP).htm.Kolbo, J.R., Armstrong, M.G., Blom, L.C., Bounds, W.,Dickerson, H., Harbaugh, B., Molaison, E.F., & Zhang, L.(2008). Prevalence of obesity and overweight among childrenand youth in Mississippi: Current trends in weight status.Journal of the Mississippi State Medical Association 49(8):231 – 237.Kolbo, J.R., Penman, A.D., Meyer, M.K., Speed, N.M.,Molaison, E.F., & Zhang, L. (2006). Prevalence of overweightamong elementary and middle school students in Mississippicompared with prevalence data from the Youth Risk BehaviorSurveillance System. Prevention of Chronic Disease, 3(3), July2006. (http://www.cdc.gov/PCD/issues/2006/jul/05_0150.htm).Lakdawalla, D.N., Bhattacharya, J., & Goldman, D.P. (2004).Are the young becoming more disabled? Health Affairs,23(1):168-176.Lakdawalla, D., Goldman, D.P., Bhattacharya, J., Hurd, M.D.,Joyce, G.F., & Panis, C.W.A. (2003). Forecasting the nursinghome population. Medical Care 41(1):8-20.Ludwig, D.S., Ebbeling, C.B. Type 2 Diabetes Mellitus inChildren: Primary Care and Public Health considerations,JAMA, Sept. 26, 2001, 286(12):1427-1430.Mikkelsen, L. & Chehimi, S. (2004). The links between theneighborhood food environment and child nutrition. PreventionInstitute. Issue paper for the Robert Wood Johnson Foundation.Retrieved April 3, 2008, from http://www.rwjf.org/files/research/foodenvironment.pdf.Mississippi State Department of Health. (2007). AnEnvironmental scan of childhood obesity efforts in Mississippi.November 2007.Mississippi Department of Education. (2007). ReplacingKitchen Fryers with Combination Oven Steamers: SixSteps to Success. Retrieved June 23, 2009, from http://www.healthyschoolsms.org/ohs_main/documents/FryertoOvenGUIDEapril608.pdf.Molaison, E. F., Kolbo, J. R., Speed, N., Dickerson, E., & Zhang,L. (2007). Prevalence of overweight among children andyouth in Mississippi: A comparison between 2003 and 2005.December 2007. Retrieved April 3, 2008, from http:/www.mshealthpolicy.com/documents/CAYPOS2003v2005Dec07.pdf.Morland, K., Wing, S., & Rouz, A.D. (2002). The contextualeffect of the local food environment on residents’ diets: Theatherosclerosis risk in communities study. American Journal ofPublic Health, 92(11), 1761-67.Mulheron J. & Vonasek K. (2009). Shaping a HealthierGeneration: Successful State Strategies to Prevent ChildhoodObesity. Washington, DC: National Governors’ Association,September 2009.Narayan, K.M., Boyle, J.P., Thompson, T.J., Sorensen, S.W., &Williamson, D.F. (2003). Lifetime risk for diabetes mellitus inthe United States. JAMA, October 8, 2003, 290(14):1884-1890.National Conference of State Legislatures. (2007). Childhoodobesity – 2007 update of legislative policy options. RetrievedApril 7, 2008, from http://www.ncsl.org/programs/health/ChildhoodObesity-2007.htm#nut.National Conference of State Legislatures. Food policy councils.(2007). Retrieved April 7, 2008, from http://www.ncsl.org/programs/health/publichealth/foodaccess/foodpolicycouncil.htmNational Conference of State Legislatures. Trans fat and menulabeling legislation. (2007). Retrieved April 7, 2008, fromhttp://www.ncsl.org/programs/health/transfatmenulabelingbills.htm.National Heart, Lung, and Blood Institute. (2000). ThePractical Guide: Clinical Guidelines on the Identification,Evaluation and Treatment of Overweight and Obesity in Adults,2000.45

APPENDIX B - BibliographyNihiser, A.J., et al. (2007). Body mass index measurement inschools. Journal of School Health. 77, 651-671.Pennsylvania Food Merchants Association and PennsylvaniaConvenience Store.Economic stimulus bill to attractsupermarkets to underserved urban areas. Retrieved April 16,2008, from http://www.pfma.org/gr-economicstimulus.html.Rand Corporation. (2004). Obesity and Disability: The Shapeof Things to Come. Santa Monica, CA. 2004.Robert Wood Johnson Foundation. (2007). Improving accessto healthy foods. A guide for policymakers. Retrieved April 7,2008, from http://www.activelivingleadership.org/uploads/PDFs/healthyfoodprimer2007.pdf.Robert Wood Johnson Foundation” Commission to Build aHealthier America http://www.commissiononhealth.org/Post.aspx?Blog=78283Robert Wood Johnson Foundation. (2009). Walking andBiking to School, Physical Activity, and Health Outcomes.Active Living Research Brief, May 2009. Accessed June 10,2009, at http://www.rwjf.org/files/research/20090519alractivetransport.pdfSallis, J. F., & Glanz, K. (2006). The role of built environmentsin physical activity, eating, and obesity in childhood. The Futureof Children, 16(1), 89-108.Schwimmer, J.B., Burwinkle, T.M., & Varni, J.W. Health-relatedquality of life of severely obese children and adolescents.Journal of the American Medical Association, April 9, 2003,289(14):1813-1819.Shils ME, Shike M, Ross AC, Caballero B, Cousins, RJ (Eds.)Modern Nutrition in Health and Disease (10th Edition).Lippincott Williams & Wilkins, 2006.Simon, P., et al. (2008). Menu labeling as a potential strategyfor combating the obesity epidemic. A health impact assessment.Retrieved May 29, 2008, from http://www.lapublichealth.org/docs/Menu_Labeling_Report_2008.pdf.Sirard, J.R., et al. (2005). Prevalence of active commutingat urban and suburban elementary schools in Columbia, SC.American Journal of Public Health, 95(2), 236–37.Smith, K., & Savage, S. (2007). Food stamp and school lunchprograms alleviate food insecurity in rural America. CarseyInstitute. Retrieved on January 8, 2009, from http://www.carseyinstitute.unh.edu/publications/FS_foodinsecurity.pdf.Staunton, C.E., Hubsmith, D., & Kallins, W. (2003). Promotingsafe walking and biking to school: the Marin County successstory. American Journal of Public Health, 93(9): 1431–34.State and Local Food Policy Councils. Retrieved April 16, 2008,from http://www.statefoodpolicy.org/.USDA Economic Research Service. (2002). Food Review.25(3). Converted to real dollars. Retrieved January 7, 2009,from http://www.ers.usda.gov/publications/FoodReview/dec2002.USDA Food and Nutrition Service. (2009). Program annualState data: FY 2004 – 2008. Retrieved August 5, 2009, fromhttp://www.fns.usda.gov/pd/snapmain.htm.U. S. Department of Agriculture Economic Research Service.(2007). Food Spending Patterns of Low-Income Households:Will Increasing Purchasing Power Result in Healthier FoodChoices? Economic Information Bulletin Number 29-4.Calculations by the Center for Mississippi Health Policy.Wakefield, J. (2004). Environmental Health Perspectives.112(11): A616–A618.Washington State Department of Health. Washington statenutrition & physical activity plan. Policy & Environmental Plan.(2003). Retrieved April 18, 2008, from http://www.doh.wa.gov/cfh/NutritionPA/publications/npa_state_plan_2.pdf.Zoumas-Morse C., Rock C.L., Sobo E.J., & Neuhouser M.L.(2001). Children’s patterns of macronutrient intake andassociations with restaurant and home eating. Journal of theAmerican Dietetic Association, 1, 923-925Additional Resources and ReferencesCenters for Disease Control & Preventionhttp://www.cdc.gov/Center for Mississippi Health Policyhttp://www.mshealthpolicy.com/Institute of Medicinewww.iom.eduMississippi Department of Education’sOffice of Healthy Schoolswww.healthyschoolsms.orgMississippi State Department of Healthwww.healthyms.comNational Governor’s Associationwww.nga.orgRobert Wood Johnson Foundationhttp://www.rwjf.org/Surgeon General’s Call to Action to Prevent and DecreaseOverweight and Obesity, 2001.Tennessee Department of Health. The gold sneaker initiative.(2008). Retrieved April 18, 2008, from http://health.state.tn.us/goldsneaker.htm.Thorpe, K.E., Florence, C.S., Howard, D.H., Joski, P. Theimpact of obesity on rising medical spending. Health Affairs,Web Exclusive, October 29, 2004.Trust for America’s Health. F as in Fat: How Obesity PoliciesAre Failing in America. Washington, D.C.: Trust for America’sHealth, July 2009.Graphic Design and text editingby Communication Arts CompanyJackson, Mississippi | www.commarts.net46

Report compiled by theMississippi Department of Education’s Office of Healthy Schools.

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