Arkansas

1
Arkansass data-driven strategies to effect
change

• Dr Joe Thompson, MD MPH
• Surgeon General, State of Arkansas
• Director, Arkansas Center for Health Improvement

February 2007 www.achi.net
2
Arkansas Center for Health Improvement

• Mission
• Be a catalyst for improving the health of
  Arkansans through evidence-based research, public
  issue advocacy and collaborative program
  development.
• Vision
• To be a trusted health policy leader committed to
  innovations that improve the health of Arkansans
• Core Values
• Trust, Innovation, Initiative, Commitment

3
The national obesity epidemic
4
Obesity Trends Among U.S. AdultsBRFSS, 1990,
1995, 2005
(BMI ?30, or about 30 lbs overweight for 54
person)
1995
1990
2005
No Data lt10 1014
1519 2024 2529
30
5
National childhood obesity trends
NHANES data sources Ogden et al. Prevalence and
Trends in Overweight Among US Children and
Adolescents, 1999-2000. JAMA 2002288(14)1728-173
2. Ogden et al. Prevalence of Overweight and
Obesity in the United States, 1999-2004. JAMA
2006295(13)1549-1555.
6
Strategy to combat childhood obesity in Arkansas
7
84th General Assembly Act 1220 of 2003
An act to create a Child Health Advisory
Committee to coordinate statewide efforts to
combat childhood obesity and related illnesses
to improve the health of the next generation of
Arkansans and for other purposes.

• Goals
• Change the environment within which children go
  to school and learn health habits everyday
• Engage the community to support parents and build
  a system that encourages health
• Enhance awareness of child and adolescent obesity
  to mobilize resources and establish support
  structures

8
Act 1220 requirements

• Elimination of all vending machines in public
  elementary schools statewide
• Requirement of professional education for all
  cafeteria workers
• Public disclosure of pouring contracts
• Establishment of parent advisory committees for
  all schools
• Establishment of a Child Health Advisory
  Committee
• Child health report (CHR) delivered annually to
  parents reporting individual BMI assessments

9
Arkansas Board of Education regulationAccess to
foods and beverages

• Per Act 1220, no vending machines in elementary
  schools
• During school day, vending machines access
  restricted until 30 minutes after last lunch
  period (middle, junior, high schools)
• Addresses both content and habit
• New/renewed vending contracts for beverages
  limited to no more than 12oz
• Exceptions foods provided by parents to
  individual students, school nurses, special needs
  students, school events

10
Arkansas Board of Education regulationStandards
for foods and beverages

• Nutrition standards applied to all
  foods/beverages sold or made available (except
  USDA governed meals)
• Maximum portion sizes
• Choices of fruits and juices available in
  conjunction with competitive foods
• 50 of vended beverages to be healthy choice
  (water, 100 fruit juice, low-fat/fat-free milk)

11
Arkansas Board of Education regulationPhysical
education/activity standards

• Schools to establish strategy to achieve 30
  minutes of physical activity per day (K-12)
• If PE, studentteacher ratio established
• Certification requirements for instructors
• In 20072008
• K6th grade to receive 150 minutes/week of
  physical activity (includes 60 minutes of PE)
• 78th grade to receive 150 min/week of PA
• 912th grade to take one semester of PE and
  receive 150 min/week of physical activity

12
Arkansas health care environment response

• Local school, community and faith-based
  initiatives
• Development of first continuing medical education
  program for clinicians
• Regionalization of secondary and tertiary care
  (e.g., Fitness Clinic at AR Childrens Hospital)
• Elimination of fiscal barriers to reimbursement
  (Medicaid / SCHIP)
• Increased awareness of physical activity needs
  (Mini-marathon)
• Changes to built environment

13
Three years of statewide BMI assessments 2004 to
2006
14
Child Health Report (2004)
Source Arkansas Center for Health Improvement,
Little Rock, AR, 2004.
15
Spanish Child Health Report (2005)
Source Arkansas Center for Health Improvement,
Little Rock, AR, 2005.
16
Participation in Arkansas BMI assessments
Results include all data available for years 1
and 2 and data received by June 14, 2006 for year
3 analysis. Some public schools and districts
merged after year 1 and after year 2. Data
source ACHI. The Arkansas Assessment of
Childhood and Adolescent ObesityTracking
Progress (Year 3 Fall 2005Spring 2006). Little
Rock, AR ACHI September 2006.
17
Reasons for unable to assess
Source Arkansas Center for Health Improvement,
Little Rock, AR, 2006.
18
Percentage of students classified as overweight
or at risk for overweight by Arkansas public
school district (20052006)
Source ACHI. The Arkansas Assessment of
Childhood and Adolescent ObesityTracking
Progress (Year 3 Fall 2005Spring 2006). Little
Rock, AR ACHI September 2006.
19
National and Arkansas childhood obesity trends
Ave N152,052
Ave N209,536
03-04 N981
03-04 N2,159
NHANES data sources Ogden et al. Prevalence and
Trends in Overweight Among US Children and
Adolescents, 1999-2000. JAMA 2002288(14)1728-173
2. Ogden et al. Prevalence of Overweight and
Obesity in the United States, 1999-2004. JAMA
2006295(13)1549-1555.
Arkansas data source Arkansas Center for Health
Improvement, Little Rock, AR, August 2006.
20
Percentage of Arkansas students by weight
classification
Category Year 1 Year 2 Year 3 (0304) (0405
) (0506)
Results include all data available for years 1
and 2 and data received by June 14, 2006 for year
3 analysis. Data source ACHI. The Arkansas
Assessment of Childhood and Adolescent
ObesityTracking Progress (Year 3 Fall
2005Spring 2006). Little Rock, AR ACHI
September 2006.
21
Percent by gender and ethnic group (20052006)
Source ACHI. The Arkansas Assessment of
Childhood and Adolescent ObesityTracking
Progress (Year 3 Fall 2005Spring 2006). Little
Rock, AR ACHI September 2006.
22
Percent by grade (20052006)
Source ACHI. The Arkansas Assessment of
Childhood and Adolescent ObesityTracking
Progress (Year 3 Fall 2005Spring 2006). Little
Rock, AR ACHI September 2006.
23
Percent by gender and grade (20052006)
Source ACHI. The Arkansas Assessment of
Childhood and Adolescent ObesityTracking
Progress (Year 3 Fall 2005Spring 2006). Little
Rock, AR ACHI September 2006.
24
UAMS College of Public Health Evaluation of Act
1220 (2006)

• Surveys school personnel, parents, teens
• Change is beginning to occur
• Parents awareness of obesity-related health
  problems continued to increase
• The majority of parents continue to report that
  they are comfortable receiving Child Health
  Reports from the school.
• Students comfort with the Child Health Report
  from school has increased

Fay W. Boozman College of Public Health.
Evaluation of Act 1220 of 2003 Highlights of
Third Year Evaluation Findings. Presented to
Public Health, Welfare, and Labor Committee
Arkansas House of Representatives January 23,
2007.
25
UAMS College of Public Health Evaluation of Act
1220 (2006)

• Majority of parents continue to believe vending
  machines should not be located in middle and high
  schools
• The average number of student purchases from
  vending machines declined and there has not been
  a substantial decline in vending revenues for
  most schools
• Parents did not report significant changes in
  individual or their families nutrition or
  physical activity patterns
• Neither parents nor students reported any of the
  feared negative consequences of BMI measurements,
  such as teasing, misuse of diet pills, or
  excessive concern about weight

Fay W. Boozman College of Public Health.
Evaluation of Act 1220 of 2003 Highlights of
Third Year Evaluation Findings. Presented to
Public Health, Welfare, and Labor Committee
Arkansas House of Representatives January 23,
2007.
26
ACHIs future activities
27
Planned research activities

• Longitudinal analyses of BMI data using
  individually matched students
• Overall change in BMI classification for matched
  3-year cohort
• Individual transitions across BMI categories
• Group change scores by BMI classification, age,
  gender, ethnic group, geographic location, school
  environment, etc.
• Child Obesity Risk Classification System
• Longitudinal analyses
• Disease prevalence
• Identification strategies for high risk children
• Risk Communication Strategies
• Parents
• Clinicians
• Impact of obesity on Medicaid / SCHIP
• Disease burden
• Utilization impact
• Associated costs

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