1. Planet Health
By Jill Carter, MA, EdM, Jean L. Wiecha, PhD, Karen E. Peterson, RD, ScD, Suzanne Nobrega, MS, and Steven L. Gortmaker, PhD
A project of the:
Harvard Prevention Research Center on Nutrition and Physical Activity Harvard School of Public Health
Welcome to the Planet Heath Workshop!
Planet Health is an innovative interdisciplinary health curriculum for middle school students. You can use this curriculum to teach students about nutrition and physical activity while building skills and competencies in language arts, math, science, and social studies. Focusing on these common instructional themes will strengthen connections among academic disciplines for students and teachers.
This training is suitable for both classroom teachers and PE teachers. After we go through the background material, we’ll get into how to teach the classroom lessons and how to do the student self-assessment activities in PE. Instructions for teaching the PE microunits are in the text starting on page 444. Attending this training will strengthen PE teachers’ capacity to coordinate with their classroom colleagues.
Planet Health was first created under a grant from the National Institutes of Child Health and Human Development to the Harvard School of Public Health. The curriculum was implemented by more than 100 teachers with about 2,000 students in four Boston-area school districts. During the two-year field-testing period, teachers contributed to curriculum revisions through written evaluations and focus groups. The recommendations made by these teachers helped create the published version of Planet Health.

2. Planet Health Introductory Workshop
Agenda Topics
Introductions
What Is Planet Health? (Presentation)
Are You Concerned About Your Students’ Nutrition and Physical Activity Habits? (Discussion)
The Health of Young People: Trends in Nutrition, Physical Activity, and Inactivity (Presentation)
Turning the Tables: Why Schools Need to Be Part of the Solution (Presentation)
Using the Planet Health Curriculum (Presentation)
Planet Health’s Nutrition and Physical Activity Messages (Activities)
Talking to Youth About Nutrition and Physical Activity Habits (Questions)  
(Note: Comments in italics and between parentheses are notes to presenters.)
Let’s start by going over the contents of your training folder and the agenda. In your folder, you have several documents. (We usually include a pamphlet on the Dietary Guidelines for Americans; fact sheets on nutrition and physical activity; and recent articles on nutrition, physical activity, TV viewing, or obesity from the popular press or scientific publications.)
The training format includes presentations, discussions, and activities out of the book. We want to give you a feel for what it’s like to be a student and experience these activities and give you some chances to move around and talk with your colleagues. Let’s take a look at the agenda.
(Go over the agenda very briefly.)

3. Planet Health Demonstration Lessons
Lesson 1 (introductory classroom lesson) Do You Make Space for Fitness and Nutrition?
Lesson 2 Power Down: Charting Screen Time
Lesson 21 (science) Fat Functions
Lesson 19 (science) Passing the Sugar
Lesson 5 (language arts) The Language of Food
Lesson 34 (social studies) Impact of Technology
Lesson 15 (math) Plotting Coordinate Graphs: What Does Your Day Look Like?
Introduction to FitCheck (physical education)
We will be doing parts of these lessons during the workshop. I’ve tried to choose lessons that give an overview of the range, the background information, and the goals we hope to get across.

4. What Is Planet Health?
An interdisciplinary health curriculum for middle school students that teaches students about nutrition and physical activity
A curriculum that builds skills and competencies in language arts, math, science, social studies, and physical education
Now let’s take a look at Planet Health: its goals and curriculum components. (Read the slide.)

5. Planet Health Goals
Planet Health encourages students and teachers to “make space for nutrition and fitness” in their lives. The curriculum has five overarching health goals. (Read them.)

6. Planet Health Overview
Planet Health’s five health goals are designed to be taught in a variety of ways in 66 classroom and PE lessons in grades 6, 7, and 8. Teaching these concepts across disciplines highlights their importance and establishes peer and teacher support for lifestyle changes.
The 35 classroom lessons include a student self-assessment lesson and eight or nine lessons in each of the major subject areas: language arts, math, science, and social studies. Lesson 2, Power Down, a TV-reduction campaign, can be taught in health, math, science, or computer science class. To expose students to the entire curriculum, each classroom teacher needs to teach only two or three lessons per year.
The PE curriculum is composed of 31 microunits and FitChecks. The microunits are simple five-minute lessons designed to be taught during the warm-up or cool-down period of PE class, leaving as much time as possible for physical activity. The FitCheck is a fun self-assessment tool that encourages students to reflect on their current activity and inactivity levels and set goals for improving or maintaining healthy behaviors. PE teachers teach 10 to 15 microunits each year and two FitChecks, one at the beginning and one at the end of the year.
Ideally, each sixth-, seventh-, and eighth-grade teacher would be involved in the program. However, schools new to the program may choose to pilot the curriculum on a smaller scale, teaching a selection of lessons in one grade only, teaching lessons only in health and physical education settings, or even beginning with classes in just one subject area.
Each lesson is full of specific background information for teachers and readings for students, as well as reproducible overhead transparency masters and activity sheets for students.
Later in the workshop, we’ll discuss different ways you can adapt Planet Health to your particular needs.

7. Planet Health’s Educational Approach
Next I’d like to introduce Planet Health’s educational approach.

8. Planet Health promotes active learning, the Massachusetts Department of Education learning standards, and literacy across the curriculum.
Planet Health is aligned with the Massachusetts Department of Education’s Curriculum Frameworks. Each of the classroom lessons addresses learning standards in one of the four academic subject areas: math, science, language arts, and social studies. The lesson activities use the content or skills outlined in one of the academic subjects to address one of the Planet Health goals.
Each lesson also addresses one or more of the health learning standards.
Finally, the curriculum encourages literacy across the disciplines by incorporating language skills in every lesson: reading, writing, discussion, listening, and vocabulary development.
Please turn to page 571 (in appendix E). This section contains a list of the lessons and the corresponding learning standards addressed in each lesson. On subsequent pages you’ll see examples of some of the learning standards written out for you, and links to the most current Massachusetts Curriculum Frameworks. If meeting these Frameworks is a priority for you, this section should help you select lessons that best suit your curriculum objectives.

9. Planet Health is student centered
Planet Health is student centered. Students read, write, speak, listen, experiment, and reflect on nutrition and physical activity in the various lessons. They actively engage in brainstorming, debates, case studies, demonstrations, games, group projects, and presentations. The lessons foster critical thinking and problem solving.

10. Planet Health uses a constructivist approach to teaching and learning
Planet Health uses a constructivist approach to teaching and learning. Probably many of you have used this type of approach, but you may not have given it this name. Constructivist thinking emphasizes that students learn best when they actively construct meaning for themselves. Students come to the classroom with different knowledge and experiences. Constructivism encourages teachers to create learning environments that activate and build on this diversity in a manner that is active, inquiry based, and student centered.
Each Planet Health lesson begins by activating and assessing students’ prior knowledge. The lessons then use inquiry-based strategies to build on what they know. This workshop has used the same approach. The discussion of your concerns about your students’ eating and activity habits was included to get you thinking and find out what you know. Once that has taken place, new information is more likely to stick.

11. This word splash (from language arts lesson 4) is an example of how the constructivist approach is used to teach students some detailed information about carbohydrate. To get the students thinking and to assess what they already know, they are asked to predict connections among some of the words in the splash and the topic in the center (carbohydrate). For example: Pasta is a food that contains a lot of carbohydrate. Students then build on what they know by reading and discussing a detailed passage about carbohydrate.
Have any of you used this type of activity before? What other types of strategies aimed at activating and assessing where your kids are have you used?

12. Why Implement THIS Program?
Why should you consider using the Planet Health curriculum? There are many reasons to implement this program.

13. It reduces TV viewing time in both boys and girls.
Planet Health has been evaluated and shown to be effective in a scientific study.
It improves student knowledge of nutrition and physical activity.
It reduces TV viewing time in both boys and girls.
It increases fruit and vegetable consumption in girls.
It reduces obesity in girls.
Planet Health helps schools meet their primary educational objectives and has been shown to be effective. Planet Health’s effectiveness in five intervention schools was evaluated by comparing them with five similar schools that did not receive the curriculum. This research design (a randomized, controlled trial) is the best way to see whether an intervention did its job. At the beginning and end of the two-year project, students at the 10 schools completed a questionnaire about their diet and activity patterns and had their height, weight, and body fat measured. By comparing results in the intervention and control schools, researchers found that Planet Health (Read the slide bullets.)
Planet Health’s impact on obesity seems to be due to reductions in screen time, because girls who reduced their TV time were less likely to be obese at the end of the study. We found that Planet Health prevents disordered weight-control behaviors in girls who were not already dieting. Further research is needed to explain the differences in Planet Health’s impact on boys and girls.
Austin, S.B., Field, A.E., Wiecha, J., Peterson, K.E., Gortmaker, S.L The impact of a school-based obesity prevention trial on disordered weight-control behaviors in early adolescent girls. Arch Pediatr Adolesc Med 159(3):
Gortmaker, S.L., Peterson, K.E., Wiecha, J., et al Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health, Arch Pediatr Adolesc Med 153(4):

14. Teachers report that …
They felt competent teaching the health content.
They were able to choose lessons that fit into their curriculum.
They enjoyed the student-centered teaching techniques.
Planet Health had a positive effect on their own health.
Planet Health helped them to connect with their students.
A separate implementation study found that Planet Health was successfully implemented in six urban middle schools. Teachers reported that (Read the bullets.)
So, in summary:
Planet Health
has been shown to be effective in a scientific study,
uses sound educational strategies,
addresses the Massachusetts Curriculum Frameworks, and
was successfully piloted in six urban middle schools.
There are many reasons to implement the curriculum, but to make it work think about your own motivation. Ask yourself (Read the title of the next slide.)
Wiecha, J.L., El Ayadi, A.M., Fuemmeler, B.F., et al Diffusion of an integrated health education program in an urban school system: Planet Health. J Pediatr Psychol 29(6):

15. Are you concerned about your students’ nutrition and physical activity habits?
Do your students need encouragement and education around the Planet Health messages? (Give teachers time to express their concerns. You will most likely hear about their students’ bad eating habits. Ask teachers about the school’s physical education program and after-school activity options. Do students walk to school? Are teachers worried about students’ screen-watching habits?)

16. The Health of Young People:
Trends in Nutrition, Physical Activity, and Inactivity
It sounds as though many of you are concerned about your students’ eating and activity habits. Let’s take a look at some facts about children’s health.

17. Youth Are at Risk!
Trends in Nutrition, Physical Activity, and Inactivity
Seventy percent of youth eat more saturated fat than experts recommend.
Youth drink twice as much soda as milk.
Eighty percent of youth do not eat 5 or more fruits and vegetables per day.*
Thirty-seven percent of older youth watch 3 or more hours of TV per day.*
Sixty-four percent of high school students do not get the recommended amount of daily physical activity.*
*CDC, Youth Risk Behavior Survey, 2005.
Only about 2 percent of children meet all five federal recommendations, and 40 percent meet only one or none.
Cavadini, C., Siega-Ritz, A.M., Popkin, B.M U.S. adolescent food intake trends from 1965 to Archives of Disease Control in Childhood 83(1):
Centers for Disease Control and Prevention Youth Risk Behavior Survey.
U.S. Department of Health and Human Services Healthy people 2010, conference edition. Washington, DC: USDHHS. Available at Accessed May 5, 2002.
U.S. Department of Health and Human Services. Healthy People Conference Edition. Washington, DC: USDHHS, January Available at Accessed May 5, 2002.

18. Youth are at Risk! Trends in Overweight
During the past two decades, the percentage of children and adolescents who are overweight has more than tripled. In the United States, 17 percent of children aged 6 to 11 years and 19 percent of adolescents aged 12 to 19 years were overweight in 2002 (BMI > 95th percentile). There is a higher prevalence of overweight among boys than among girls (U.S. Department of Health and Human Services, 2001).
National Health and Nutrition Examination Survey’s (NHANES) overweight estimates suggest that since 1994, overweight in youth has not leveled off or decreased and is increasing to even higher levels. One of the national health objectives of 2010 is to reduce the prevalence of overweight to 11 percent (NHANES, ).
National Center for Health Statistics, Health E Stats: Prevalence of overweight among children and adolescents. Available at
U.S. Department of Health and Human Services The Surgeon General's call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Available from U.S. GPO, Washington, DC. Report and fact sheets available at Accessed May 7, 2002.
Prevalence of overweight among U.S. children and adolescents
NHANES , National Center for Health Statistics

19. Health Consequences of Overweight
Overweight and obese people are at increased risk for the following:
Type 2 diabetes
Depression
High cholesterol
Heart disease
Premature death
Stroke
Hypertension
Asthma
Some cancers
Adapted from: USSDHHS.The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, 2001.
Overweight and obesity in adults is linked to a number of chronic diseases. (Read a few. See more details below if needed.) Children are now experiencing adult-type diseases due to overweight (red bullets). Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Because children and adolescents diagnosed with diabetes may start to see comorbidities as early as age 30, the disease is likely to affect their quality of life for a longer period of time than it would someone who was diagnosed as an adult.
Overweight youth are also more likely to be depressed and have high cholesterol and high blood pressure, risk factors for heart disease. We know that overweight children are more likely to be overweight adults and so may be at greater risk for developing these diseases later in life as well.
Centers for Disease Control. Obesity consequences, Accessed July 20, 2004.
Adapted from U.S. Department of Health and Human Services The Surgeon General’s call to action to prevent and decrease overweight and obesity. Available at

20. Environmental and Social Change Affect Health Behavior
More food available
Growth of the food industry and advertising
More meals away from home
More sugar-sweetened beverages
Large serving sizes
More TV/video games
More car travel
Fewer PE classes
Fewer students walking and biking to school
Lower perception of safety
What is causing this epidemic? Body weight is maintained by balancing energy intake (food) with energy output (physical activity). If you put more in than goes out, you gain weight. Small imbalances add up over a long period of time. A person’s genetic makeup contributes to his or her body size and composition and makes some people more likely to be larger. However, because obesity has increased so rapidly, we know its origin is not genetic. The gene pool did not change in the course of 20 years.
What changed is our environment and lifestyle. Culture can also affect these patterns. The reasons for the recent obesity epidemic have not yet been sorted out, but poor dietary habits, increased consumption of calorie-dense foods, and fewer opportunities for physical activity contribute to the problem.
(Review the bullets on each side of the balance. This is a good slide to provoke discussion about lifestyle changes and the fact that lifestyles of children today are different from those of 20 or 30 years ago, on which many teachers will be able to report from personal experience. Below are some additional facts that may be used to illustrate recent lifestyle changes.)
Americans spend about half of their food budget and consume about one-third of their daily energy intake on meals prepared outside of the home.
In the 1950s, Coca-Cola packaged only 6.5-ounce bottles; single-serving containers expanded to 12 ounces and now 20 ounces. At fast-food restaurants, larger-sized meals can be purchased for a small additional fee—meals are “super-sized.”
Advertising directly affects food choices. The food industry spends $11 billion annually on advertising and $22 billion on trade shows, incentives, and other consumer promotions. In 1998, McDonalds spent more that $1 billion in advertising, while the National Cancer Institute spent $1 million on promoting fruit and vegetable consumption.
Nestle, M, and Jacobson, M.F Halting the obesity epidemic: A public health policy approach. Public Health Reports 115:

21. What do TV viewing and soda consumption have to do with it?
Let’s take a closer look at two factors that are likely to be contributing to the obesity epidemic in youth: an increase in TV viewing and an increase in soda consumption (and other sugar-sweetened beverages).

22. Distribution of Hours of TV per Day: NHES Youth Aged in and NLSY Youth Aged in 1990
Adolescent TV viewing patterns have changed over the last 30 years. This graph illustrates the results of two surveys, one conducted in the late 1960s and one conducted in (Familiarize teachers with the axes.) In 1967 to 1970 the biggest chunk of kids watched two to three hours of TV a day. In 1990 over 40 percent of kids watched five or more hours of TV a day.
NHES = National Health Examination Survey
NLSY= National Longitudinal Survey of Youth
Dietz, W.H., and Gortmaker, S.L Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 75:
Gortmaker, S.L., Must, A., Sobol, A.M., Peterson, K., Colditz, G.A., and Dietz, W. H Television viewing as a cause of increasing obesity among children in the United States, Archives of Pediatrics and Adolescent Medicine 150:
Data from Dietz, W.H., Gortmaker, S.L Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 75:

23. Prevalence of Obesity by Hours of TV per Day: NHES Youth Aged in and NLSY Youth Aged in 1990
This graph illustrates the correlation between obesity and TV viewing. (Familiarize teachers with the axes.) The data from both surveys indicate that youth who watch more TV are at greater risk for obesity. (Point out the difference in obesity prevalence for the 0-1 and 5 or more groups.)
Watching TV is a risk factor for obesity. Why?
Dietz, W.H., and Gortmaker, S.L Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 75:
Gortmaker, S.L., Must, A., Sobol, A.M., Peterson, K., Colditz, G.A., and Dietz, W. H Television viewing as a cause of increasing obesity among children in the United States, Archives of Pediatrics and Adolescent Medicine 150:
Data from Dietz, W.H., Gortmaker, S.L Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 75:

24. Hypothesized Impact of Television Viewing on Obesity
Why does television viewing have an impact on overweight? Researchers suggest some possible reasons. First, watching TV may displace physical activity. Think about it: When you’re sitting down in front of the TV, perhaps there’s something more active that you’re not doing—taking a walk, vacuuming the carpet, playing with your kids. Watching television may also slow down a person’s metabolic rate while they are watching—when you’re watching TV, usually you’re not moving around very much, and you’re not using your brain very much. So, you’re burning less fuel and fewer calories, and that can also contribute to overweight.
The most likely link between television and weight gain has to do with diet quality. We’re not just talking about how people snack while they watch TV. Think about what you see on TV advertisements, especially during children’s programs. Very often snacks foods and sugary snacks and drinks are made to seem very appealing for kids as well as adults. There is evidence that watching food advertisements makes kids more likely to ask their parents for the foods they see advertised, and it makes parents more likely to buy the foods. Television food ads have also been tied to drinking too much soda and eating too much fast food and sugary and salty snacks; they have also been linked to eating too few fruits and vegetables.
Although the exact method by which TV increases obesity risk is not known, several studies have shown reductions in youth obesity when TV time is reduced.
Wiecha, J.L., Peterson, K.E., Ludwig, D.S., Kim, J., Sobol, A.M., Gortmaker, S.L When children eat what they watch: Impact of television viewing on dietary intake in youth. Arch Ped Adol Med 160:
Boynton-Jarrett, R., Thomas, T.N., Peterson, K.E., Wiecha, J., Sobol, A.M., Gortmaker, S.L Impact of television viewing patterns on fruit and vegetable consumption among adolescents. Pediatrics 112:

25. Beverage Intake Among Adolescents Aged 11-18, 1965-1996
Youth consumption of soda and other sweetened beverages is on the rise in the United States. Sugar-sweetened beverage consumption is replacing milk consumption, as is shown in the graph. According to the 2005 Youth Risk Behavior Survey, only 17.1 percent of high school students reported drinking the recommended three or more glasses of milk a day.
Cavadini C. et al U.S. adolescent food intake trends from 1965 to Arch Dis Child 83:
Data from C. Cavadini et al., U.S, “Community child health, public health, and epidemiology,” Archives of Disease in Children 83: (based on USDA surveys).

26. Soft Drink Consumption and Overweight
Sugar-sweetened beverages (SSB) contribute to childhood obesity incidence.
A recent study found that for each additional serving of SSB consumed per day, the incidence of obesity increased.
Reducing the intake of sugar-sweetened beverages can reduce overweight among youth.
A recent study found that the intake of carbonated drinks could be decreased, and that this change was accompanied by a decrease in the percentage of overweight and obese children.
A pilot study found that when teens reduced SSB consumption by replacing SSBs with noncaloric beverages, they lost a pound a month.
A recent study demonstrated a strong link between sugar-sweetened beverage consumption and childhood obesity. It found that middle school students who increased their consumption of soft drinks also increased their chance of becoming obese over the 18-month study. For each additional serving consumed per day over the baseline intake, the odds of obesity increased 60 percent (Ludwig, Peterson, and Gortmaker, 2001). Sugar-sweetened beverage consumption has also been linked to weight gain and diabetes incidence in adult women (Schulze, Manson, Ludwig, et al., 2004).
Reducing or avoiding empty calories from sugar-sweetened beverages may help with weight control. A school-based randomized controlled trial found that reducing the intake of sugar-sweetened beverages reduced overweight among youth (James et al., 2004). Another study found that when teenagers reduced their sugar-sweetened beverage consumption by replacing sugar-sweetened beverages with noncaloric beverages, overweight teenagers lost about one pound per month (Ebbeling, Feldman, Osganian, et al., 2006).
Harvard Prevention Research Center recommends that parents limit sugar-sweetened beverage consumption in children to two 8-ounce (250-milliliter) servings per week at home.
Ebbeling, C.B., Feldman, H.A., Osganian, S.K., et al Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study. Pediatr 117(3):
James, J., et al Preventing childhood obesity by reducing consumption of carbonated drinks: Cluster randomized controlled trial. British Medical Journal 328(7450): 1237.
Ludwig, D., Peterson, K., and Gortmaker, S Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. The Lancet 357:
Schulze, M.B., Manson, J.E., Ludwig, D.S., et al Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Jama 292(8):

27. Turning the Tables: Why Schools Need to Be Part of the Solution
What can we do to reverse the trends we’ve just discussed? Why do schools need to be part of the solution?

28. Promoting Healthy Eating and Active Living
Physical activity and eating behaviors are clearly individual choices. However, they are also clearly influenced by the environment we live in, as well as policies, cultural norms, and lifestyles.
Most interventions that are aimed at getting people to eat healthy food and be physically active focus on changing individual behaviors. They educate people—give people the facts: What is healthy eating? Why is it important? People join health clubs or weight watchers, get personal trainers. These types of interventions give people an opportunity to practice healthy choices with the hopes that they will change their habits and incorporate healthy eating and activity into their everyday lives. In most cases this doesn’t work. Fifty percent of the people who start an exercise program quit after six months.
As the United States continues to fight an obesity epidemic, scientists have recently begun to realize that we need to take a public health approach to encourage people to eat well and keep moving and to prevent obesity. We need to create environments and enact policies that support healthy lifestyles at home, in school, and in the community. Then we need to encourage people to live healthy lifestyles by increasing their routine physical activity, walking to school, taking the stairs, watching less TV, and drinking water instead of soda. We need to encourage these behaviors in children, so that we help them establish lifelong health habits.
In schools, “curricula can influence parent and child knowledge, attitudes, and beliefs (KAB) related to sound nutrition and physical activity. Likewise, school policies can influence how food is prepared, whether vending machines are available, and when alternative foods are available, as well as whether physical education programs are offered” (Dietz and Gortmaker, 2001). This approach has already seen success in tackling other public health problems, such as smoking.
Dietz, W.H., and Gortmaker, S.L Preventing obesity in children and adolescents. Annual Rev Public Health 22:
Nestle, M and Jacobson, M.F Halting the obesity epidemic: A public health policy approach. Public Health Reports 115:

29. Healthy Eating and Physical Activity Are a Critical Part of Learning and Achievement
Eating breakfast increases academic test scores, daily attendance, concentration, and class participation.
Children learn through movement.
Physically fit kids perform better academically.
Gross motor development is an important precursor for the fine motor skills needed for writing and the eye coordination needed for smooth tracking during reading.
Children spend more time reading and doing homework when parents set limits on TV viewing.
(Read bullets.)
Another report showed that Boston Public School students in grades 8 and 10 who were heavy viewers (two or more hours per day) of TV were likely to score lower on English language arts and math achievement tests than were students who viewed little or no television each day.
Center on Hunger, Poverty, and Nutrition Policy Statement on the link between nutrition and cognitive development in children. Medford, MA: Tufts University School of Nutrition.
Meyers, A.F., et al School breakfast program and school performance. American Journal of Diseases of Children 143:
MCAS results and TV watching behaviors: A preliminary analysis of May 2001 English language arts and math results in grades 4, 8, and Accessed May 14, 2007.
Pollitt, E., Leibel, R.L., and Greenfield, D Brief fasting, stress, and cognition in children. American Journal of Clinical Nutrition 34:

30. Using the Planet Health Curriculum Guide
In the next part of the training, I’ll give you some tips on using the curriculum guide.

31. Book Organization Section 1: Implementing Planet Health in Your School
Section 2: Classroom Lessons
Foundation lessons
Language arts
Math
Science
Social studies
Secton 3: Physical Education Microunits
Open your books to the table of contents. You’ll notice that the book is divided into three sections. Section 1 explains how to implement Planet Health in your school. Section 2 contains the classroom lessons (foundation lessons, language arts, math, science, and social studies). Section 3 contains the PE microunits and FitCheck. You should plan to read section 1 and the introduction to either the PE curriculum or the classroom lessons before you teach this curriculum. The section introductions provide tips on how to coordinate, select, and teach the Planet Health lessons. (Use the slide to review the layout of the book.)
Let’s flip through section 1 so that I can show you some of the planning tools available to you there. On page 10 you will find the middle school planner, and on pages 15 and 16 you will find the monthly and weekly planners, respectively.

32. As is true with all interdisciplinary curricula, implementing Planet Health in your school will take some initial planning. You may want to appoint one person to coordinate the initial planning process. We recommend that each department meet to review the lessons specific to its subject areas and decide which lessons should be taught at each of the three grade levels. The Middle School Planner in section 1 can help organize this process. We recommend that you talk with other teachers to learn what lessons they are using and when they will be introducing them. At the end of each school year, the Middle School Planner should be passed around to each of the teachers involved with the curriculum, so that they can document the lessons they taught. During year 2 of the implementation, you will need to be aware of which lessons teachers introduced to your students the previous year.

33. Appendixes Appendix A: Nutrition Resources
Appendix B: Physical Activity Resources
Appendix C: Television and Other Screen Time Resources
Appendix D: Social Studies Resources
Appendix E: Massachusetts Curriculum Frameworks
There are a number of appendixes at the back of the book that I’d like to point out to you. If you flip to page 557 you can glance at the appendixes while I review what’s there. (Review the bullets.)

34. Implementation Overview
We will be focusing on classroom lesson implementation today.
Ideally each sixth-, seventh-, and eighth-grade classroom teacher should teach two or three lessons per year, and PE teachers should do two FitChecks and 10 to 15 microunits. However, as we mentioned at the beginning of the workshop, schools new to the program may choose to pilot the curriculum on a smaller scale, teaching a selection of lessons in one grade only, teaching lessons only in health and physical education settings, or even beginning with classes in just one subject area. This is fine, but keep in mind that effectiveness is likely to increase when school involvement increases.
The lessons within each subject can be taught in any sequence. However, we strongly recommend that clusters or departments coordinate to ensure that students first complete the introductory self-assessment lesson (lesson 1).

35. To help you identify lessons that best fit your curriculum objectives, consult the part openers in section 2. Let’s take a look at the one on page 70. Each of these charts includes a list of lesson titles, themes, levels of difficulty, subject-specific skills, and materials needed. You may also want to review the Massachusetts Curriculum Frameworks for each unit (see appendix E). As I mentioned earlier, these tables list the health, language arts, and subject-specific learning standards addressed by each lesson.
Let’s take a look at how the lesson plans are organized. Please turn to page 71.

36. Impact of Techology
Each lesson plan begins with a summary paragraph that describes the lesson goals and activities. This is followed by behavioral objectives, learning objectives, lesson materials, teaching procedure, and teacher background information. Some lessons include student resources and overhead transparency masters after the teacher information. Student activity sheets are located at the end of the lessons. Student activity sheets and overhead transparencies can also be found on the CD-ROM for easy printing and duplication.

37. Impact of Techology (continued)
Once you’ve chosen a lesson, it’s important to familiarize yourself with the teaching procedure. It’s here that we describe how to approach the material in a way that engages and connects with students (the constructivist approach we discussed earlier). If you just look at the student activity sheets, you will be missing out on a lot. Many of the lessons offer a choice of activities. Adapt the lesson procedure to fit your teaching style, students’ skills, and time constraints. Before you teach the lesson for the first time, it’s very important to read the lesson background material. We want to make sure that the health information you’re conveying to students is accurate. The answer keys for the student activity pages are located at the end of the background material as well.

38. Do You Make Space for Fitness and Nutrition
Do You Make Space for Fitness and Nutrition? Lesson 1 Introduction: Student Self-Assessment
Before you start the lessons in Planet Health, it’s good to get your students to reflect on their own nutrition and physical activity habits. We suggest that you use the student self-assessment lesson (lesson 1) to introduce your students to the Planet Health curriculum. The self-assessment should be repeated at the end of the school year to help students and teachers reflect on changes in student behavior over the year. This lesson can be taught in any subject, but its content makes it well suited for health classes. The graphing component fits nicely into math or computer classes, and the open-ended questions make it well suited for language arts classes.
We’re going to begin today’s workshop by going over the format of the lesson and doing activities 1 and 2. (Give a brief overview of the parts of the lesson by reading the slide.)
Begin the lesson by telling your students that Planet Health is all about encouraging healthy eating and physical activity habits. Don’t give them too many details about the specific health messages until they’ve completed the self-assessment questions. Just emphasize that they will be involved in all kinds of fun Planet Health activities in math, science, social studies, language arts, and physical education—things such as debates, food tasting, making advertisements, surveying their relatives and classmates, and writing poetry. It will give them a lot of opportunities to think about themselves and their habits and the chance to practice making healthy choices. Planet Health will help them become experts in this area, and hopefully they can pass on their knowledge by being healthy role models for others.

39. Let’s take a look at activity 1
Let’s take a look at activity 1.1 (page 41), the self-assessment questions, in lesson 1. Explain to students that the purpose of this activity is to think about their own eating and physical activity patterns. Point out that there are six questions total. Read the directions at the top for them, emphasizing that there are no right or wrong answers. Let’s go over the directions now together, and then you will have a chance to answer the questions.
(Read the directions and the first question.) Students may ask you what it means by how many “times” they ate fruit yesterday. The best way to explain this is with an example: Let’s say that yesterday you had a glass of orange juice and a banana for breakfast and an apple for a snack. You would then say that you ate fruit three times yesterday. If you had two glasses of orange juice at breakfast, you would say that you ate fruit two times. Encourage students to do their best job of remembering and estimating. We used the word times because most students are not familiar with food serving sizes.
(Read the directions that precede the physical activity questions before asking them to begin answering the questions.)
Please go ahead now and answer the six questions.
(After they’ve had time to complete the questions, ask the teachers if they need clarification of what any of the questions are asking.)

40. After completing activity 1
After completing activity 1.1, students are asked to make graphs of the class’s responses to the questions. There are six sheets for graphing information, one for each question. (Go over the axes of the histogram on the slide.) There are several ways you can organize this activity: (1) You could pass around the graphs on pages 43 to 48 so students can fill in their own responses by shading in the appropriate block on each histogram. (2) You could collect individual self-assessments and graph the data yourself. (3) You could use a show of hands to tally students’ responses, then have a volunteer or volunteers graph the information. However, anonymity is important for students to feel comfortable sharing their results, so this may not be the best approach.
We’ll try another way (with self-stick notes) that is quick and maybe less complicated than the others, though again not anonymous. Give each student a small self-stick note and ask them to write their answer to question number one on it (0,1,2,3,4,5,6+). (Do this with the teachers.) Draw the axes of graph one on the board (Do this.) Have everyone come up and stick their self-stick note in the column that corresponds to the number of times they ate fruit yesterday. (Do this.) This creates a class graph very quickly. You’ll want to have someone copy it onto a paper copy of the graph so that you can reflect back on them at the end of the year.

41. Planet Health Goals
Ask students to compare the class data with the Planet Health messages.

42. What conclusions can they draw? What goals can the class set as a whole? Save the conclusions and goals to compare with the year-end graphs.
Finally, ask students what they think the benefits are of a healthy diet and physical activity. Give them plenty of time to tell you what they know. You might want to organize their answers in a KTW chart like on pages 50 and 51. The background material in lesson 1 provides all that you need to know to discuss this question. What do you think are some of the benefits of a healthy diet and physical activity?

43. Healthy Eating and Active Living:
Make you strong and fit.
Brighten your mood and build a positive self-image.
Help you maintain a healthy weight.
Are important for learning.
Are fun!
(Review the bullet items not mentioned by teachers.) These are the benefits you need to drive home to your students. Of course, benefits for adults include a lower risk of chronic diseases such as heart disease, diabetes, osteoporosis, and cancer.

44. At the end of this lesson, on page 53, there is a parent letter
At the end of this lesson, on page 53, there is a parent letter. We encourage you to send this home to parents at the beginning of the year. Family members play an important role in influencing and modeling healthy behaviors. Therefore, Planet Health provides a number of opportunities to bring parents and other adult caregivers and family members into discussions and activities with students around the goals of “making space for fitness and nutrition.”

45. Curriculum Connections Existing parent/family connections in the Planet Health curriculum:
Lesson #
Subject
Lesson Name
Type of Activity
Description
Page # 1
Introduction
Do You Make Space for Fitness and Nutrition?
Teacher-parent correspondence
Info letter to parents asks them to reinforce Planet Health messages at home. 7
Language arts
Write a Fable: Important Messages About Activity
Teacher resources: specific background material
Example of playing catch with a friend or parent to increase student activity.
Reading comprehension
Text advises students to talk with parents if they notice any signs of too much exercise. 8
Go for the Goal
Extension activity
Students interview a member of their family to find out whether they have any goals for themselves. 9
Lifetime Physical Activities: Research One, Describe One, Try One!
Extension activity 9.1
Publish a Planet Health newsletter and send copies home to parents. 10
Choosing Healthy Foods
Extension activity, 2nd question
Besides TV, what other parts of your life influence your food choices? (Examples: family, friends, etc.)
This grid (include copies in folders) lists the types of activities that the curriculum suggests for engaging families, along with a description of each, and a place to add page references for the full text of each activity. Perhaps this will give you ideas for making your own extensions and connections to reach out to parents and families through homework assignments and projects.
The CD-ROM also contains lots of material for making parent connections.
Curriculum activities that engage family members give children a chance to teach their parents what they learn from Planet Health and give parents the opportunity to support positive eating and physical activity behaviors in their homes. By connecting with parents, Planet Health aims to improve the wellness of the whole family.

46. Let’s briefly take a look at the FitCheck (page 466)
Let’s briefly take a look at the FitCheck (page 466). The FitCheck is a self-assessment tool that PE teachers can use to help students identify and reflect on their own physical activity and inactivity patters in greater detail than they did in the student self-assessment lesson (lesson 1). Students keep track of their physical activities and screen time activities over a seven-day period and calculate their FitScore and SitScore. If you look at the FitScore sheet, you can see that students are encouraged to give themselves credit for all types of activity. If they do 60 or more minutes of activity in a day, they get a check mark. If at least 20 minutes were spent doing a vigorous activity, they get a star. They’re encouraged to aim for at least five check marks and three stars in the week. This is completed at home.

47. The SitScore sheet (page 467) asks kids to list their screen time activities each day. If they spend two hours or less on screen time in a given day, they get a check mark. Their goal is to get at least five check marks. Based on the results of the FitScore and SitScore, they set activity goals. Teachers have used this lesson successfully in health classes as well as PE classes.
PE teachers are encouraged to begin the year by having students do a FitCheck.

48. Let’s take a break!
(Consider giving teachers a break prior to beginning the next section.)

49. Planet Health’s Nutrition and Physical Activity Messages
Next, we will use some lesson activities to review Planet Health’s nutrition and physical activity messages. Can anyone tell me one or more of the messages? (Allow adequate wait time to encourage teacher responses.)

50. Planet Health Goals
(Check to see how many messages teachers remembered.)

51. The lessons also emphasize the importance of eating a balanced diet
The lessons also emphasize the importance of eating a balanced diet. Each food group provides nutritional benefits, so foods from each group (grains; vegetables; fruits; meat, fish, and beans; and milk) should be consumed each day. The “sometimes foods,” such as sugar-sweetened beverages or snacks high in saturated fat, should only be consumed occasionally.
The key to a balanced diet is to recognize that grains (especially whole grains), vegetables, and fruits are needed in greater portions than foods from the meat, fish, and beans and milk groups. This principle is illustrated by the Balanced Plate for Health diagram that is used in several Planet Health lessons.
A healthy and balanced diet also contains a variety of foods from within each food group because each food group provides different macronutrients (the energy-providing nutrients, namely carbohydrate, protein, and fat) and micronutrients (vitamins and minerals).
Let’s move on to discussing some of the classroom lessons in detail.

52. Let’s go over the five specific health messages, starting with Planet Health’s fat message. (Ask teachers to turn to lesson 21, Fat Functions, on page 282.) In this lesson, students read about the different types of fat and then conduct an experiment to see what types of food test positive for fat. (Optional: Teachers can try this experiment.) I’d like you to read What’s the Rap on Fat? carefully. Then I will ask you questions to see what you learned. (Give teachers about five minutes to read the passage on page 290.)

53. Not All Fat Is Created Equal
What’s the Rap on Fat?
Not All Fat Is Created Equal
(Use a piece of paper to cover up the bottom portion of this overhead. Move the paper down to reveal the answers to the following questions. If you present this on a computer, you may want to make this into three slides, so that you can reveal pieces of the flow chart separately.)
What are the two categories of fat? Which one contributes to heart disease? Which types of foods are high in saturated fat? Unsaturated fat? What’s the maximum proportion of calories that experts recommend we get from saturated fat? Unsaturated fat?
What are the exceptions to the rule that animal products are high in saturated fat and plant products are high in unsaturated fat?
Through a commercial process called hydrogenation, more healthy liquid plant fats can be converted into solids called trans fats.This is how some margarines are made. Not surprisingly, foods high in trans fat also have been found to increase the risk of heart disease. To avoid these fats, check the ingredient list on packaged foods like cookies and crackers. (Option: Have teachers examine the food labels from various types of cookies, crackers, and margarines. Which ones are trans fat free?)

54. Planet Health Fat Message
Eat a diet low in saturated fat and containing no trans fat.
10% saturated fat
25-35% total fat
Try to eliminate trans fat.
To summarize, Planet Health encourages students to (Read the slide.) Less than 10 percent of their calories should come from saturated fat. The most recent recommendations state that no more than 35 percent of their calories should come from all types of fat (Total fat = saturated fat + unsaturated fat + trans fat). Limit trans fat intake by reading food labels.

55. Planet Health Carbohydrate Message
Choose whole-grain foods and limit foods and beverages with added sugars.
Make at least half of your grains whole grains.
Sugar-sweetened beverages and high-sugar snacks are “sometimes” foods, not everyday foods.
The second nutrition message is to choose healthy carbohydrate, specifically by choosing whole-grain foods whenever possible and by limiting foods and beverages with added sugars.
There are several reasons why whole grains are better choices than refined grains. Whole grains have fiber, vitamins, and minerals, and the refining process strips many of these beneficial nutrients away. The less processed the better. Even though some refined grains are fortified with vitamins and minerals, fortification does not replace all of the lost nutrients. In addition, refined grains get absorbed very quickly, which can cause sugar levels in the blood to spike. The body quickly takes up sugar from the blood to bring sugar levels down to normal levels, but it may overshoot things a bit, making blood sugar levels low, and this can actually cause feelings of false hunger even after a big meal. Whole grains are emphasized through the Planet Health classroom lessons, but lessons 4 and 19 have an especially strong focus on this topic.
In addition to selecting whole-grain foods, it is important to limit sugary beverages such as soda and limit foods with added sugar. As we discussed earlier, research suggests that sugar-sweetened beverage consumption is associated with excess weight gain in children and adults. Sugary foods are also full of empty calories; they provide lots of calories but give us few of the nutrients we need to stay healthy and strong. Lesson 19, Passing the Sugar, focuses on sugar-sweetened beverages. (Distribute lesson 19, activity 19.1, Soda and Sports Drinks: How Many Do You Drink?)

56. Activity 1 Soda and Sports Drinks: How many do you drink?
Number in last 7 days
Grams per serving
Grams per container
Total grams
Total teaspoons
12-ounce soda
10-ounce soda
10-ounce sports drink
Bottled water
Other
Total
Turn to page 251 to see activity 19.1, Soda and Sports Drinks. If time permits, allow teachers to fill in the chart and briefly discuss (1) what they learned about their own habits individually and as a group and (2) what their students might learn from this!

57. Planet Health Fruits and Vegetables Message
Eat five or more fruits and vegetables each day.
Eat at least two fruits each day.
Eat at least three vegetables each day.
- At least one should be orange or dark green.
Planet Health encourages students to (Read the slide.)
Why is it important to eat plenty of fruits and veggies? They are a good source of vitamins and minerals, important sources of fiber, and low in fat, and they reduce the risk of certain forms of cancers.
Variety is important. No food supplies all the necessary nutrients. However, in many cases, the brighter the color is, the higher the vitamin and mineral content is—so encourage students to try many colors and kinds. Lesson 5, The Language of Food, does just that.

58. Language arts lesson 5: The Language of Food
Something Green for Dinner
They served something green for dinner
And we wondered what it was.
Kenny whispered that it looked like
Someone’s old lawn-mower fuzz.
Dad said, “Try a bite, you’ll like it!”
We said, “Tell us, please, what is it?”
Dad said, “Ground up alien fern-tips
From the Martian spaceship’s visit.”
(They tasted great with the burgers.)
Jeff Moss
(Ask teachers to turn to page 105 in their books.) This lesson encourages students to try new and different varieties of fruits and vegetables and is designed to be integrated into a poetry unit. Students read and interpret poems (such as the one in this lesson or Dr. Seuss’s Green Eggs and Ham) that describe the feeling associated with trying new foods.

59. Then students take an inventory of all the fruits and vegetables they have eaten. For homework, students are asked to try one fruit or vegetable that they have never tasted before. (Optional: Pass around an unusual selection for teachers to try.) They list adjectives that describe the appearance, taste, feel or texture, and smell of the food.
Finally, they use their adjectives to write a poem describing the experience.

60. Planet Health Inactivity Message
Limit screen time to no more than two hours each day.
Screen time = TV + videos + movies + video and computer games
(Doesn’t include schoolwork completed on a computer.)
Now let’s review Planet Health’s inactivity message. Planet Health encourages students to (Read slide.) Earlier I mentioned that Planet Health’s impact on obesity seems to be due to reductions in screen time, because girls who reduced their TV time were less likely to be obese at the end of the study. A reduction in screen time of 35 minutes per day was associated with obesity remission and with reduced obesity prevalence. Consequently, the message of limiting screen time to no more than two hours each day is important to get out to your students. Keep this in mind later in the workshop when you’re choosing lessons to teach. Let’s take a look at two lessons that address screen time: Impact of Technology and Power Down.

61. Social studies lesson 34: Impact of Technology
(Ask teachers to turn to page 426 in their books.) Lesson 34, Impact of Technology, is designed to be used while teaching a unit on the Industrial Revolution. It asks students to examine the impact of technological advances on the lifestyles of people living in the 19th century and the present. First students are asked to think about the impact of inventions such as the cotton gin, the steel plow, and the telegraph.

62. Social studies lesson 34: Impact of Technology (continued)
Students then think about the impact of new technologies, such as personal computers, TVs, and the Internet.

63. Social studies lesson 34: Impact of Technology
How do computers, TV, the Internet, and DVDs affect the daily physical activity of children your age?
Compare your physical activity to the physical activity of children living in the early 1800s. Give several details to support your answer. How do you account for the difference?
Compare your free time to the free time of children living in the 1800s. How do you account for the difference?
Finally, students consider the impact technology has had on their leisure-time interests. For much of the world, everyday existence now requires far less physical energy because transportation, household chores, and food gathering have become easier through industrialization and mechanization. New technologies such as TVs, computers, and DVDs encourage inactive leisure-time interests. To be physically fit, many people in developed countries now have to set aside time for physical activities.

64. Social studies lesson 34: Impact of Technology
I’d also like to point out a fun extension activity in lesson 34. Students interview a grandparent, great-aunt or -uncle, neighbor, or friend who was 11 to 14 years old during the 1930s, 1940s, or 1950s. By asking questions such as, “What did you do after school?,” “What did you do for fun in the summer?,” and “What kind of chores did you do?” students gain an understanding of how children spent their free time 60 to 80 years ago and how things have changed.
I’d like to describe another lesson that addresses the inactivity message, lesson 2. This lesson is called Power Down and is located on page 54.

65. Power Down: Charting Screen Time
This screen-time-reduction campaign is designed to be taught in math, health, or science class. Students track their own viewing time for one week and then set goals for decreasing it during the second week. This includes a brainstorming session that encourages kids to come up with alternative activities that they could do to replace screen time.
It’s important to do Power Down and the other Planet Health lessons that address screen time. As you now know, too much screen time increases a child’s risk for obesity. As mentioned earlier, the Planet Health study showed that reductions in TV viewing were linked to reducing obesity risk.

66. Lesson 2 Power Down: Charting TV Viewing Time
Weekly TV Viewing Histogram
In Power Down, students graph their results from week 1 and week 2 and interpret the results. Questions such as, “What is the role of TV and computers in your life?” encourage students to reflect on how they spend their leisure time. There are many extension activities that could be done in other subject areas. To make this part of a schoolwide campaign, each class could graph its average daily viewing time for week 1 and week 2 and display the results in a central location in the school. This lesson works well in math classes.

67. Planet Health Activity Message: Be active daily or nearly every day.
Be moderately to vigorously active for at least 60 minutes each day.
As part of the 60 minutes, be vigorously active for at least 20 minutes three times a week.
The last message we need to discuss is the physical activity message. Planet Health encourages students to be active every day or nearly every day. But how much activity do they need to do, and at what intensity do they need to be working? New physical activity guidelines for adolescents say they should aim for a total of 60 minutes or more of moderate to vigorous activity each day. As part of the 60 minutes, they should participate in vigorous activity for at least 20 minutes, three times a week. The 60-minute minimum has been reinforced since Planet Health was first published. Kids tend to think that sports are the only type of activity that counts. It’s important to help them understand that many kinds of movement can improve their health and fitness level: dancing, jumping rope, walking the dog, climbing stairs, swimming, and walking to and from school. Even low-intensity activities are better than sitting in front of the TV.
New U.S. Dietary Guidelines for adults are slightly different: 30 minutes to reduce the risk of chronic disease, 60 minutes to avoid weight gain, 90 minutes for weight loss.
How do you know the difference between a moderate- and a vigorous-intensity physical activity? Intensity refers to how hard you exercise; for example, how fast your heart beats. You should be able to carry on a conversation while participating in an activity of light to moderate intensity. Vigorous activities make you breathe hard. You should still be able to talk, but you may not want to have an extensive conversation. To help you get a better sense of how to classify different types of physical activities.
Strong, W.B., et al Evidence based physical activity for school-aged youth. Journal of Pediatrics 146(6):

68. Physical Activity Intensity
Sedentary
activities
Low-intensity activities
Moderate-intensity activities
Vigorous activities
Playing video games
Watching TV
Sleeping
Talking on phone
Bowling
Playing catch
Stretching
Washing dishes
Shooting baskets
Skateboarding
Hopscotch
Raking
Running
Biking
Lap swimming
Push-ups
Sit-ups
Shoveling snow
(Go over the slide. Use this as an opportunity to review the Planet Health activity and inactivity recommendations. Emphasize the fact that making small behavior changes such as taking the stairs, parking at the far end of the parking lot, and walking to school can have positive health benefits.)

69. (If you have time, ask teachers to turn to lesson 15, Plotting Coordinate Graphs: What Does Your Day Look Like, on page 204.)

70. (Read the definition of METs and the introduction to activity 15. 1
(Read the definition of METs and the introduction to activity Ask teachers to interpret the graph as a group. Briefly describe how students estimate their own physical activity for a 24-hour period.)

71. (Describe how students plot their data on a coordinate graph
(Describe how students plot their data on a coordinate graph. Have the teachers do the graph, and make copies of the three student lesson pages.)

72. Talking to Youth About Nutrition and Physical Activity Habits
Group Discussion Activity
When you first introduce the curriculum to students, you may get asked some questions about why they’re doing this. As you know, kids at this age want to know why things are important and how things are relevant to their lives. So, what we’ll do next is a role play activity in which you’ll get to answer some of these questions. I’ll break you up into groups of four. Each group will get an envelope. Each person should choose a question from the envelope. You will take turns being the student (asking your question to one of the other members of the group). Everyone should get a chance to ask and answer a question.
A document containing students’ frequently asked questions is available on the CD-ROM and should be included in the training packet for this teacher discussion (if time permits) at the end of the training. The FAQs can be cut into strips and placed in the envelopes for this slide’s activity.

73. For more information, please go to www.planet-health.org.