1. A Child Care Center Intervention Promoting Policy and Menu Change in Early Care and Education in Ohio Autumn Trombetta MS, RD, LD Cheryl Graffagnino MS, RD, LD

2. Obesity In Ohio (BMI > 95% %ile) ¹ Pediatric Nutrition Surveillance System (PedNSS), CDC and ODH, 2006 2 Ohio Family Health Survey (OFHS), ODJFS/ODH/ODI/ODMH, 2008 Newborns 2-5 yr olds 1 Adults 2 10-17 yr olds 2 <5%5-9.9%10-14.9%15-19.9%20-24.9%25-29.9%≥30%NS

3. Program Development Began in 2004 Focus groups with parents –Identified child care providers as trusted source of health information Created training & toolkit for child care provider staff

4. Evolution of a Statewide Initiative Began in 2010 Voluntary designation Provides Step Up To Quality Education CEUs Monitored through Professional Development Registry

5. Becoming an Ohio Healthy Program.. 1.Attend Step Up To Quality approved trainings 2.Implement a healthy policy 3.Increase the nutritional content of menus 4.Include parent participation

6. Becoming an Ohio Healthy Program… 1. SUTQ-Approved Trainings Session 1: Healthy Habits (10 Hour series) – Healthy Activity – Healthy Eating and Feeding – Healthy Growing – Healthy Families Session 2: Healthy Menus (2.5 hours) Session 3: Healthy Policies (2.5 hours)

7. Becoming an Ohio Healthy Program… 2. Implement a Healthy Policy “Television, video, computers and other visual recordings shall not be used with children under two years of age.” “Breastfeeding mothers shall be provided a private and sanitary place to breastfeed their babies or express milk. The area will have an electrical outlet, comfortable chair, and nearby access to running water.” “Staff members consume the same food and drinks as the children. Staff members do not consume other foods and drinks in front of the children. “

8. Becoming an Ohio Healthy Program… 3. Ohio Healthy Programs Menu Includes variety every day of the week –Non-fried Vegetables –Whole Fruit –Whole Grain Food Offers fried foods no more than twice a week Offers only low fat milk (1% or skim) to children ages 2 and up (adapted from Healthier US School Challenge 2010)

9. Becoming an Ohio Healthy Program… 4. Parent Participation Parent Bulletin Board Parent Newsletter

10. Statewide Train-The-Trainer Local Resource and Referral agencies –27 Education Specialists Ohio Department of Health’s Healthy Child Care Ohio –37 Nurses –1 Dietitian

11. Ohio Healthy Programs Results January 2010 – March 2011 –65 statewide trainers –349 trainings –1300 child care staff –608 centers –13 Ohio Healthy Programs

12. Local Programming Recruiting child care centers Technical assistance –RD and/or DTR –2 week menu review and recommendations –Parent/Policy Handbook review and recommendations –Environmental Assessment

13. Local Programming Sustainable Supporting Materials –$100 for Ohio Healthy Program Menu –$100 for Ohio Healthy Program designation –$100 per policy maximum of $300

14. Intervention Measure Center Policies Since January 2011 26 licensed centers 404 policies(mean=15): –284 nutrition 9 breastfeeding –110 physical activity –10 Nutrition and physical activity promotion for parents

15. Child Care Centers & Number of Policies by Zip, Columbus, OH

16. Adult Obesity by Zip Code Columbus, Ohio

17. 29.0% 53.2% 27.7% 287.6% Pre- & Post Intervention Measures Menu Changes

18. 50.1% 56.6% Pre- & Post Intervention Measures Menu Changes

19. Next Steps Statewide: –Incorporate Ohio’s Healthy Program criteria into statewide voluntary quality rating systems –Enhance parent engagement efforts Local: –Ongoing evaluation of long-term, sustained environmental change –Continue to seek sustainable funding source

20. Questions? Autumn Trombetta altrombetta@columbus.gov Cheryl Graffagnino clgraffagnino@columbus.gov http://publichealth.columbus.gov/healthy-children-healthy-weights.aspx