Participatory Policy Study in a Northern New Mexico Community New Mexico Healthier Weight Council Quarterly Meeting March 31,

Victoria Sánchez 1, Yolanda Cruz 2, Ron Hale 3, Perdita Wexler 4, Vonnell Bettencourt 4, Corazon Halasan 4 1 Master of Public Health (MPH) Program University of New Mexico 2 San Miguel County Family and Community Health Council 3 Office of Health Promotion/Community Health Improvement, Public Health Division 4 Diabetes Prevention and Control Program, Chronic Disease Bureau, Public Health Division

Funded by the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico Faculty Research Grants Program 3

Community Diabetes Collaborative (CDC 2 ) San Miguel County Family & Community Health Council Office of Health Promotion and Community Health Improvement (OHPCHI), NM Dept. of Health Diabetes Prevention and Control Program (DPCP), NM Dept. of Health Evaluation Team, University of New Mexico (UNM) Health Sciences Center 4

Partnership Background Initial meeting: mid 2008 –Model a planning and evaluation process that can work in other health priority areas MOU (UNM/DOH/SMCHC): fall 2008 Statewide planning framework – Jan 2009 RWJF Grant: April 2009 – April 2010 –Develop and pilot a participatory research process to build upon community identified needs and our ongoing partnership 5

Purpose of Study Pilot study  Examine school nutrition and physical activity policies in two school districts in one community Intended result  Analyze success, gaps, and policy areas to serve as a foundation for community mobilization to reduce youth obesity in partnership with Las Vegas schools 6

New Mexico Department of Health Regions Policy Study Site 7

Study Team San Miguel Health Council Yolanda Cruz Lacey Houdek Adam Metcalf Darla Tenorio Master of Public Health Program: UNM Mark Andrews Victoria Sánchez Office of Health Promotion and Community Health Improvement * Ron Hale Diabetes Prevention and Control Program* Vonnell Bettencourt Cora Halasan Perdita Wexler * Public Health Division New Mexico Department of Health 8

Research Protocols UNM/HSC Human Research Review Committee (HRRC) approval –Collaborative Institutional Training Initiative (CITI) training 9

Principles Co-learning process Local capacity building Long-term commitment Balance research and action Israel, et al., 1998;

Methods Policy Scan Key Informant Interviews (n = 9)  Learn about the implementation (facilitating factors and barriers) of the physical activity and nutrition policies at the district and school level Focus Group (n = 2)  Learn about students’ experiences with physical activity and nutrition policies 11

Results Implementation Facilitating Factors Barriers/Challenges Recommendations 12 Policy Creation Policy Adoption Policy Implementation Policy Evaluation

Facilitating Factors Physical ActivityNutrition Additional PE instructors funded Exercise equipment purchased Increased PE at elementary school level Administration support for initiatives (e.g. recess before lunch, two recess periods per day) PE or Wellness curriculum 3 times a week in elementary schools Compliance with 50/50 rule Parental compliance with food requirements for class parties Increased availability of fresh fruit Elimination of vending machines selling sodas, candy, and high calorie snacks Free or reduced cost lunches available to all students Food service program complies w/school nutrition guidelines at every site 13 General Facilitating Factors: Individual Champions/Advocates Grants - e.g. 21 st Century, Carol White, International Food Grant, Coordinated Approach to Children's Health (CATCH)

Barriers/Challenges Physical ActivityNutrition PE only required twice between 6 th and 12 th grades Competing demands (e.g. No Child Left Behind, general academic requirements) More sports needed for girls Taste/appearance/ variety of cafeteria food Vendors compete with cafeteria Open campus Food sent from home Students skipping lunch Bake sales everyday 14 General Barriers/Challenges: Lack of funds Lack of time in schedules Gaps in understanding of written policies among staff and parents Lack of knowledge about the function of the SHAC

Barriers: Nutrition In reference to food vendors who sell food directly adjacent to the campus: …it is creating a competing interest for the district in which we can’t compete …because we can’t sell the sugar and the cokes and those kinds of food items. So, that’s a big inhibiter to full implementation to this policy. Until we get support from the City there is nothing the district can do. 15

Results Accountability 16 Needs Analysis Create Implementation Evaluation

Accountability –Tied to understanding policy –No shared understanding of who is responsible for enforcement 17

Accountability I believe that there is not sufficient enforcement of it. It’s kind of left up to each administrator, left up to almost down to the individual teacher. Nobody comes over and asks “are you doing this…are you meeting this and that goal?” 18

Recommendations Physical ActivityNutrition Increase physical activity across all grades  Physical Education  Integrate activity in classroom  More after school activities Review vending policies and practices Improve taste and variety in cafeteria food More choices in cafeteria More fresh fruit and vegetables 19 General Recommendations: Policy training for administrators, teachers, and staff Make wellness policy a working document Increase outreach to parents and students Increase communication with the SHAC

Recommendations I think teachers need to be given more trainings on how to carry out the policy so that there is no question or any doubt as to how to go about it and so that they can be models for the program. 20

What can the Health Council Do? Help increase or strengthen facilitating factors  Outreach and education to parents and community  Continue to work with SHAC to find new communication linkages with PTA, local businesses, school board, city council  Seek funding for school initiatives 21

Discussion Successes in policy implementation may reflect areas of activity over which the schools have direct control (e.g., vending machine changes, recess time) 22

Discussion Nutrition policy barriers reflected larger community norms and practices: – Autonomy of food vendors –Community parental attitudes/ practices May require different strategies than physical activity policies 23

Questions? 24

Yolanda Cruz Ron Hale Victoria Sanchez Perdita Wexler Contacts 25