Source: CDC Behavioral Risk Factor Surveillance System. The West Virginia CARDIAC Project Coronary Artery Risk Detection In Appalachian Communities “To reduce cardiovascular disease mortality in West Virginia through research and intervention in children”

Health Care Professionals Health Science Students School Nurses RHEP Coordinators School Principals and Teachers

CARDIAC Project Year Within 5 years, CARDIAC began operating in all WV counties! CARDIAC Project present

Percentage Of Youths < 18 Years Expected To Have Fh According To Cholesterol Levels And Closest Relative With Fh Percentage with FH at that Level TC (mg/dl) LDL (mg/dl) Degree of Relative First Second Third General Population Williams, RR. Am J Cardio 1993; 72:

MeganFatherMother TC HDL LDL TG

20,266 Subjects Tested (5 th Graders) 14,468 met NCEP screening Guidelines (71.4%) 5,798 did not meet NCEP Screening guidelines (28.6%) 170 warrant pharmacologic tx (1.2% of those who met NCEP guidelines) (1.7% of those who did not Meet NCEP guidelines) Universal versus Selective Screening: Testing Current NCEP Guidelines 98 warrant pharmacologic tx

“Cholesterol Screens Miss Children, Study Says” By Ron Winslow “Data from a school-based program in West Virginia found that national guidelines regarding cholesterol screening among children would miss 36% of those with seriously high LDL.”

FH Family-based Study (2013) Cascade screening of family members* 50 FH probands in lipid clinics 500 CARDIAC 5th graders LDL > 160mg/dl 100 CARDIAC 5th graders LDL > 190mg/dl *Phenotyping and genotyping

Prevalence Of Obesity BoysGirls

CARDIAC Screening Results 5 th Grade ( ) 76,688 students screened since % BMI > 95 th percentile 18.8% BMI th percentile 23.6% hypertensive 25.9% abnormal blood cholesterol 5.3% have Acanthosis Nigricans 35.5% of AN students were hyperinsulinemic

The West Virginia CARDIAC Project Coronary Artery Risk Detection In Appalachian Communities “To reduce cardiovascular disease, diabetes, and other chronic illnesses in West Virginia through research and intervention in children.”

Exploring the Morbidly Obese Diagnosis RISK FACTORNORMAL OR UNDERWEIGHT OVERWEIGHTOBESEMORBIDLY OBESE Elevated Blood Pressure14.4%20.8%29.8%51.0% Low HDL9.7%18.7%30.5%42.7% Elevated LDL5.9%10.2%13.3%11.4% Elevated Triglycerides4.4%12.4%25.0%31.3% Positive for AN.9%3.5%13.6%39.6% * Ice et al., International Journal of Pediatric Obesity, 2009

↑ unk021 nis unk nis nis unk unk affected male nis lipid profile known but not in sample affected female unk lipid profiles unknown & not in sample ↑ PROBAND (OO1) FAMILY unk unk nis unk

Childhood Hypertension Nearly always secondary to obesity Refer to specialist if BP > 130/85 in normal weight child Rare pathologic causes include: –Coarctation of aorta –Pheochromocytoma –Cushing Syndrome –Chronic kidney disease –Renal artery stenosis –Hyperthyroidism

Childhood Hypertension Normal values based on age, gender, height 11 year olds –Boys > 95% 121/78 –Girls > 95% 120/77 Use large cuff size Diastolic pressure is K5 (disappearance of sound)

School-based Health Promotion “School health education and promotion programs for children and young people constitute the most effective and feasible prevention approach that can be applied immediately in most countries.” World Health Organization Tech. Rep. 792, Pg 73, 1990

CARDIAC Interventions School-based Programs and Resources Web-based Instructional Modules for the School Curriculum –Healthy Hearts 4 Kids –35,743 students served –Take Charge! Be Healthy! –7835 students served Teacher Resources –Active Academics Greenbrier CHOICES Project

Web-based program that focuses on improving teen’s health through impacting knowledge, attitudes, and behaviors as they relate to physical activity, nutrition, and health.

Student Pre/Post Knowledge Paired t-test; t=-55.25; p<0.001 for overall and all three topics N=2980

Web-based resource for PreK – 5 th grade teachers that provides activity ideas to enhance the learning of math, reading, language arts, science, social studies, PE and health. Also provides ideas for energizers, recess and lunch breaks

AAP Campaign

Obesity Prevention & Treatment: The Medical Home and Chronic Care Model Health Systems Organization and Health Care Community Resources and Policies Productive Interactions Prepared, Proactive Practice Team Informed, Activated Patient Improved Outcomes

Population-based Intervention ActiveWV 2015: The WV Physical Activity Plan

The AIM of the WVPAP To create a statewide culture that facilitates physically active lifestyles in every societal sector and in every region of the state, regardless of socio-demographic factors, or other barriers we may face Intended Outcomes Buy-in and support from sector-specific leaders at both the state and local levels (short term) Policy, environmental, and programming changes at the state and local levels (intermediate term) Increase/maintain the physical activity levels of both children and adults to meet or exceed the national physical activity recommendations (long term)

London Transport Workers (1950) Conductors outlive drivers

Collaboration between Central WV Medical Society and Stonewall Resort

Greenbrier CHOICES Project Children’s Health Opportunities Involving Coordinated Efforts in Schools Funded by a Carol M White Physical Education Program (PEP)Grant, US Dept of Education, (Awarded 9/29/2011, in Year 2) 76 recipients nationwide $890, over three years Focus on making Greenbrier County (WV) youth healthier and more physically active! –Two middle schools – approx students

McDowell CHOICES Project Children’s Health Opportunities Involving Coordinated Efforts in Schools 6-month Planning Grant funded by the Highmark Foundation (Awarded 10/19/2012) In Preparation for a two-year Intervention Grant, June 2013 Focus on making McDowell County (WV) youth healthier and more physically active! –All 10 schools in McDowell County (PK-12) (programming, equipment, faculty development, after-school opportunities) –New Community Play Space –Community Programming and Joint Use Agreements for more availability of environments that promote PA

Health Status of WV School Children is Improving* 5th graders –Hypertension decreased from 23.9% to 20.3% –Obesity declined from 28.9% to 27.8% –Abn. cholesterol declined from 26.1% to 23.5% Kindergarten –Obesity declined from 17.5% to 13.6% * vs

Year of screening Mean of non-HDL

PRESTON MONONGALIA MARION TAYLOR HARRISON DODDRIDGE WETZEL MARSHALL OHIO BROOKE HANCOCK TYLER PLEASANTS WOOD JACKSON RITCHIE WIRT ROANE CALHOUN GILMER LEWIS UPSHUR BARBOUR TUCKER GRANT MINERAL HAMPSHIRE MORGAN BERKELEY JEFFERSON HARDY PENDLETON RANDOLPH WEBSTER BRAXTON POCAHONTAS NICHOLAS CLAY GREENBRIER FAYETTE RALEIGH SUMMERS MONROE MERCER MCDOWELL WYOMING MINGO LOGAN BOONE KANAWHA PUTNAM MASON CABELL WAYNE LINCOLN VI VIII VII I V II III IV RESA Regions

Coordinated School Wellness Programs

PRESTON MONONGALIA ROANE CALHOUN GILMER WEBSTER BRAXTON NICHOLAS CLAY Kathryn Greenlief Program Manager - Northern 16+ DODDRIDGE WETZEL MARSHALL OHIO BROOKE HANCOCK TYLER PLEASANTS RITCHIE WIRT Dalena Riggs TUCKER GRANT MINERAL HAMPSHIRE MORGAN BERKELEY JEFFERSON HARDY PENDLETON Robin VanFleet FAYETTE RALEIGH KANAWHA Tammy Pyle-Vicars Program Manager - Southern WOOD JACKSON PUTNAM MASON CABELL WAYNE LINCOLN Tina Whitt GREENBRIER Nahied Haidar Greenbrier CHOICES Project MARION TAYLOR BARBOUR Valerie Minor CARDIAC LEWIS UPSHUR RANDOLPH POCAHONTAS HARRISON SUMMERS MONROE MCDOWELL WYOMING MINGO LOGAN BOONE Janetta Massie MERCER declined

RESA and CARDIAC Potential for collaboration 1.Health promotion (education) 2.Interventions 3.Facilitate Medical Home model

CARDIAC Team

CARDIAC and CPASS* ActiveWV 2015 (WV PAP) Rx for Health: A Healthcare and State Parks Collaborative Greenbrier County CHOICES (USDE) McDowell County CHOICES (Highmark Foundation) * WVU College of Physical Activity and Sports Science

CPASS Colleagues Eloise Elliott PhD Emily Jones Ph.D. Sean Bulger ED.D

School of Public Health Colleagues Alfgeir L. Kristjansson Ph.D.Christa Lilly Ph.D.