1. ASTPHND State Teleconference Healthy Weight Indicator Report Card June 1, 2010 This information is distributed solely for the purpose of pre dissemination public comment under applicable information quality guidelines. It has not been formally disseminated by the Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy. Obesity Prevention and Control Branch Division of Nutrition, Physical Activity & Obesity NCCDPHP, CDC State Indicator Report on Healthy Weight for Youth United States, 2010

2. Contributors Report Card Steve OnufrakKelly Pattillo Beverly KingsleyAshleigh May Holly Wethington Data Advisors Liping PanSohyun Park Karen DaleniusDASH Advisory Members Heidi BlanckBettylou Sherry Meredith ReynoldsTerry O’Toole Tina LankfordMarilyn Batan State Indicator Report on Healthy Weight for Youth

3. General overview Draft outcome indicators Draft environmental and policy indicators Next steps State Indicator Report on Healthy Weight for Youth

4. Division of Nutrition, Physical Activity and Obesity Primary Target Areas – Physical Activity, Fruit & Vegetable, Breastfeeding – Sugar Sweetened Beverages – Television Viewing – Energy Density Environment and Policy

5. Division of Nutrition, Physical Activity and Obesity Primary Target Areas – Physical Activity, Fruit & Vegetable, Breastfeeding – Sugar Sweetened Beverages – Television Viewing – Energy Density Environment and Policy

6. Draft Outcome Indicators – Children Healthy Weight Prevalence – Soft Drink Consumption – Television/Screen Time Draft Environmental and Policy Indicators State Indicator Report on Healthy Weight for Youth

7. Comprehensive Approach for Preventing and Addressing Childhood Obesity (IOM, 2007)

8. Draft Environmental and Policy Indicators – School Environment and Policy – Home Environment – Childcare Environment and Policy State Indicator Report on Healthy Weight for Youth

9. School Environment and Policy – School Competitive Food Environment – School Neighborhood Retail Environment – School Physical Activity Availability and Participation State Indicator Report on Healthy Weight for Youth

10. Home Environment – Television in Bedroom – Meals Eaten with Family State Indicator Report on Healthy Weight for Youth

11. Childcare Environment and Policy – Childcare Nutrition and Physical Activity Regulations State Indicator Report on Healthy Weight for Youth

12. Other Reports – “F as in Fat 2009” Robert Wood Johnson Report http://healthyamericans.org/reports/obesity2009/ – “Child Obesity State Report Cards” - National Survey of Children’s Health http://nschdata.org/Content/07ObesityReportCards.as px – “State Fact Sheets” – Youth Risk Behavior Surveillance System and School Health Profiles http://www.cdc.gov/HealthyYouth/obesity/facts.htm State Indicator Report on Healthy Weight for Youth

13. How is this report different? – More in-depth focus on youth: early childhood through adolescence – Home environment – Soft drink consumption and availability in schools/on campus – Retail food environment State Indicator Report on Healthy Weight for Youth

14. Healthy Weight Report indicators can be used to: – Monitor progress and celebrate state successes. – Identify opportunities for growth and improvement in environmental and policy supports that make promoting healthy weight more feasible at the state level. – Report to be released regularly State Indicator Report on Healthy Weight for Youth

15. Criteria for Inclusion: – Highlighted in multiple expert recommendations and reports: e.g., IOM, DNPAO Guidance Documents – Data measurable, available for most states – Data available from reputable sources:.gov,.org,.edu; transparent methodology in obtaining information State Indicator Report on Healthy Weight for Youth

16. Things to consider during today’s call: Indicator – Is it the right concept? Data source – Additional sources meeting inclusion criteria? Metric – Is this a helpful way to represent the data? Usefulness and feasibility in your state State Indicator Report on Healthy Weight for Youth

17. Draft Outcome Indicators State Indicator Report on Healthy Weight for Youth

18. Healthy Weight Outcome Indicators Prevalence of Healthy Weight Percent of children ages 2-5 with BMI percentile ≥5 th and <85 th Pediatric Nutrition Surveillance System (PedNSS), 2009 State BMI percentile ≥5 th and <85 th, 2009 PedNSS Alabama71.1%* (95% CI) Alaska ┼ Arizona69.4%* (95% CI) Arkansas70.2%* (95% CI) California66.7%* (95% CI) Colorado76.2%* (95% CI) Connecticut68.8%* (95% CI) *Data shown are from 2008 PedNSS; estimates represent prevalence of underweight and healthy weight and are for illustration only ┼ Data not available

19. Healthy Weight Outcome Indicators Prevalence of Healthy Weight Percent of children ages 6-12 with BMI percentile ≥5 th and <85 th National Survey of Children’s Health (NSCH), 2007 State BMI Percentile≥5 th and <85 th, 2007 NSCH Alabama63.9%* (95% CI) Alaska66.1%* (95% CI) Arizona69.4%* (95% CI) Arkansas62.5%* (95% CI) California69.5%* (95% CI) Colorado72.8%* (95% CI) Connecticut74.3%* (95% CI) *Data shown are from 2007 NSCH; estimates represent prevalence of underweight and healthy weight and are for illustration only

20. Healthy Weight Outcome Indicators Prevalence of Healthy Weight Percent of high school students with BMI percentile ≥5 th and <85 th Youth Risk Behavior Surveillance System (YRBSS), 2009 StateBMI Percentile ≥5th and <85th, 2009 YRBSS Alabama67.4%* (95% CI) Alaska72.7%* (95% CI) Arizona74.1%* (95% CI) Arkansas70.3%* (95% CI) California ┼ Colorado79.9%* (95% CI) Connecticut74.4%* (95% CI) *Data shown are from 2005 or 2007 YRBSS; estimates are for illustration only and do not account for underweight prevalence ┼ Data not available

21. Sugar Sweetened Beverage Outcome Indicators Soft Drink Consumption Median soft drink consumption for high school students Youth Risk Behavior Surveillance System (YRBSS) State Median Soft Drink Consumption, 2009 YRBSS Alabama* Alaska* Arizona* Arkansas* California* Colorado* Connecticut* *Data currently not available

22. Television Outcome Indicators Television Viewing % of children ages 2-5 meeting American Academy of Pediatrics recommendations of ≤2 hours of TV per day National Survey of Children’s Health (NSCH), 2007 State % Children Ages 2- 5 Meeting AAP Recommendations Alabama67.9% (95% CI) Alaska75.8% (95% CI) Arizona66.7% (95% CI) Arkansas67.4% (95% CI) California77.8% (95% CI) Colorado82.3% (95% CI) Connecticut70.9% (95% CI)

23. Television Outcome Indicators Television Viewing % of children ages 6-10 meeting American Academy of Pediatrics recommendations of ≤2 hours of TV per day National Survey of Children’s Health (NSCH), 2007 State % Children Ages 6- 10 Meeting AAP Recommendations Alabama71.1%* (95% CI) Alaska79.6%* (95% CI) Arizona76.9%* (95% CI) Arkansas73.2%* (95% CI) California77.9%* (95% CI) Colorado83.5%* (95% CI) Connecticut81.7%* (95% CI) *Data shown are from 2007 NSCH; estimates indicate % of children 6-17 meeting AAP recommendations and are for illustration only

24. Television Outcome Indicators Television Viewing % of middle school students meeting American Academy of Pediatrics recommendations of ≤2 hours of TV per day Youth Risk Behavior Surveillance System (YRBSS), 2009 State % Middle School Students Meeting AAP Recommendations Alabama61.6%* (95% CI) Alaska77.0%* (95% CI) Arizona71.8%* (95% CI) Arkansas65.7%* (95% CI) California ┼ Colorado73.2%* (95% CI) Connecticut69.9%* (95% CI) *Data shown are from 2005 or 2007 YRBS; estimates reflect % of middle and high school students watching 3 hours or less of television each day and are for illustration only ┼ Data not available

25. Television Outcome Indicators Television Viewing % of high school students meeting American Academy of Pediatrics recommendations of ≤2 hours of TV per day Youth Risk Behavior Surveillance System (YRBSS), 2009 State % High School Students Meeting AAP Recommendations Alabama61.6%* (95% CI) Alaska77.0%* (95% CI) Arizona71.8%* (95% CI) Arkansas65.7%* (95% CI) California ┼ Colorado73.2%* (95% CI) Connecticut69.9%* (95% CI) *Data shown are from 2005 or 2007 YRBS; estimates reflect % of middle and high school students watching 3 hours or less of television each day and are for illustration only ┼ Data not available

26. Draft Environmental and Policy Indicators State Indicator Report on Healthy Weight for Youth

27. School Environment and Policy Sugar Sweetened Beverages % middle and high schools in which sugar sweetened beverages (including sports drinks and juice drinks that are not 100% juice) are not available School Health Profiles (Principal Questionnaire), 2008 State % Schools Where SSBs Were Not Available Alabama68.3%* (95% CI) Alaska66.0%* (95% CI) Arizona81.0%* (95% CI) Arkansas52.3%* (95% CI) California ┼ Colorado ┼ Connecticut92.8%* (95% CI) *Estimates reflect % of middle and high schools where soda and fruit drinks (not 100% juice) were not available and are for illustration only; sports drinks are not included in this calculation ┼ Data not available

28. School Environment and Policy High Energy Density Snacks % middle and high schools in which candy, salty snacks, ice cream, and cookies/baked goods are not available School Health Profiles (Principal Questionnaire), 2008 State % Schools Where High Energy Density Snacks Were Not Available Alabama73.9%* (95% CI) Alaska63.6%* (95% CI) Arizona71.7%* (95% CI) Arkansas70.8%* (95% CI) California ┼ Colorado ┼ Connecticut80.4%* (95% CI) *Estimates reflect % of middle and high schools where candy or salty snacks were not available, and are for illustration only ┼ Data not available

29. School Environment and Policy Data compilation in process Question Is this a useful and meaningful indicator? Retail Food Environment Index in 1 Mile Radius Surrounding Schools Derived from GIS Analysis of Homeland Security Retail Database

30. School Environment and Policy Physical Activity Opportunities % middle and high schools in which intramural sports or physical activity clubs are available to all students School Health Profiles (Principal Questionnaire), 2008 State % Middle and High Schools Offering Intramural Sports or PA Clubs Alabama57.4% Alaska83.3% Arizona71.2% Arkansas54.5% California79.7% Colorado72.3% Connecticut74.6%

31. School Environment and Policy Data compilation in process Question Is this a useful and meaningful indicator? Sports Participation % of children participating on a sport team or taking sports lessons during the past 12 months National Survey of Children’s Health (NSCH), 2007

32. Home Environment Family Meals Eaten Together % of families that eat together as a family most (≥4) days of the week National Survey of Children’s Health (NSCH), 2007 State % Families Sharing Meal Together Most Days of the Week Alabama44.2*% Alaska50.2*% Arizona50.0*% Arkansas46.7*% California49.7*% Colorado44.7*% Connecticut40.3*% *Estimates indicate % of children 6-17 eating meals together every day during week preceding survey and are for illustration only

33. Home Environment Television in Bedroom % of children meeting American Academy of Pediatrics recommendations of no TV in bedroom National Survey of Children’s Health (NSCH), 2007 State % Children Without TV in Bedroom Alabama32.3% Alaska67.0% Arizona52.7% Arkansas34.1% California53.6% Colorado63.4% Connecticut57.1%

34. Childcare Environment and Policy Recommended* Childcare Nutrition Regulations Foods of low nutritional value served infrequently Sugar sweetened beverages not served Children older than two years served reduced fat milk Drinking water available for children to serve themselves throughout day Nutrition education offered to child care providers Juice limited to 4-6 ounces per day for children over age one Child care providers do not use food as a reward / punishment Nutrition education offered to children Child care provider sits with children at table and eats same meals and snacks Providers encourage, but do not force, children to eat *Report: Preventing Obesity In The Child Care Setting: Evaluating State Regulations http://cfm.mc.duke.edu/modules/cfm_ehs_resrch/index.php?id=6

35. Childcare Environment and Policy Childcare Nutrition Policy # of recommended* nutrition regulations (out of 10 total) currently enacted in both home childcare and childcare center settings *Source: Preventing Obesity In The Child Care Setting: Evaluating State Regulations http://cfm.mc.duke.edu/modules/cfm_ehs_r esrch/index.php?id=6 State # of Recommended Childcare Nutrition Policies Enacted Alabama1 Alaska2 Arizona2 Arkansas2 California2 Colorado4 Connecticut1

36. Childcare Environment and Policy Recommended* Physical Activity Regulations Children are provided with 60 minutes of physical activity per day TV/video/computer time limited to once per week and ≤ 30 minutes each time Child care providers do not withhold active play time as punishment Special needs children provided active play opportunities while other children are physically active Children provided outdoor active play time at least two times per day Physical activity education offered to child care providers ≥ 1 time per year At least one provider joins children in active play at least one time per day Shaded area provided during outdoor play Children not seated for periods > 30 minutes except when sleeping or eating Physical activity education is offered to children at least three times per year *Report: Preventing Obesity In The Child Care Setting: Evaluating State Regulations http://cfm.mc.duke.edu/modules/cfm_ehs_resrch/index.php?id=6

37. Childcare Environment and Policy Childcare Physical Activity Policy # of recommended* physical activity regulations (out of 10 total) currently enacted in both home childcare and childcare center settings *Source: Preventing Obesity In The Child Care Setting: Evaluating State Regulations http://cfm.mc.duke.edu/modules/cfm_ ehs_resrch/index.php?id=6 State # of Recommended Childcare PA Policies Enacted Alabama3 Alaska5 Arizona3 Arkansas2 California0 Colorado5 Connecticut0

38. MAPPS Focal Areas to Consider – Access (e.g., neighborhood retail environment) – Price (e.g., school competitive food environment) – Social support (e.g., family meals) – Media – Point of decision information State Indicator Report on Healthy Weight for Youth

39. Next Steps – Post-call feedback from you Additional Indicators? Addressing Disparities? Errors and Omissions? General Comments? State Indicator Report on Healthy Weight for Youth

40. Send comments to: healthyweightreport@cdc.gov by June 23 rd This information is distributed solely for the purpose of pre dissemination public comment under applicable information quality guidelines. It has not been formally disseminated by the Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy. State Indicator Report on Healthy Weight for Youth