Deborah Burnet, MD, MA; Lorri McClinton-Powell, BS;

Rebecca Lipton, PhD; Michael Quinn, PhD Kweku Embil, MA; Dawnavan Davis, PhD; Althera Steenes

Marla Solomon, RD, LD/N, CDE; Shahid Choudhry, MPH

and

Power-Up Afterschool Program to Prevent Obesity:

A Case Study from Chicago’s South Side

Woodlawn Community

School

Chicago’s South Side 1.1 million, Primarily AA Very high rates of obesity, diabetes and complications Practical, real-world solutions needed

The REACH-OUT Program: YMCA, Co-op Food Market

REACH-OUT Children’s Diabetes Prevention Program

14 week nutrition & exercise program Obese 9-12 yr old kids and their parents Lay health leaders – successfully engaged Realistic goal setting, group activities & skills Improved dietary and PA behaviors No significant changes in BMI, z-scores More sustainable partnerships needed After-school programs provide opportunity

CBPR Principles in Power-Up Woodlawn Community

School (CPS) Relationship grew out of

existing network of community partners

Developed partnership

over a year and a half, before research began

Dr. Davis with Principal Embil

*CBPR = Community-Based Participatory Research (Israel, Ann Rev Pub Health, 1998)

CBPR Approach Attended PTA meetings &

coffees to gain parents’ input

Collaborated with teachers on curriculum

Involved staff in program implementation

Iteratively refined program with teachers & parents

Shared grant $ with WCS Mr. Hubbard (WCS Security) and Dr. Burnet

Power-Up Program

Adapted from Reach-Out curriculum Collaborative iterations with WCS teachers Curricular expert as consultant

14 weekly interactive sessions for grades K-2, 3-4, 5-6 (later expanded to 20 sessions)

All after-school kids participated; some as subjects (if consented)

Lay Health Leaders

Lorri McClinton After School Coordinator

Renee Salahuddin After-School Teacher Lornee Love After-School Teacher

CPS after-school teachers Trained by behavioral psychologist and research staff Continued support throughout program

Data Collection Pre- and post- data collected

on-site, user-friendly Parent and child outcome

measures: BMI (z-scores for children) Blood pressure Self reported dietary

intake, physical activity, health knowledge, beliefs and attitudes

Power-Up Kids with Medical Students

Drs. Burnet & Daru with a Power-Up Parent

Power-Up Results 70 children in after-school

program; 40 enrolled 16 boys and 24 girls, all

African American Age range: 5 – 12 years

(mean=8) 28 parents - all women,

ages 24 – 62 years (mean=37)

Power-Up logo contest winner and Dietitian Marla

Power-Up Baseline BMI

These data mirror figures for CPS overall, and other urban areas

BMI Z-Score Change

-0.244

-0.372

-0.206

-0.068

-0.4

-0.35

-0.3

-0.25

-0.2

-0.15

-0.1

-0.05

01 2 3 4

Series1

Overall Normal wt Overweight Obese

p<0.005 p<0.005 p=0.01 p=0.166

(Paired t-tests)

Limitations & Challenges Small sample size, short term follow-up One school on Chicago’s South Side No control condition

Heaviest kids need referral for more intensive

management Hard for parents to participate after-school due

to competing commitments

Cell-phone Texting for Parents Cellphones ubiquitous (Pew Rsch Ctr, 2010) Promising interventions: Diabetes, weight control, sexual health, smoking, asthma Tailored to participant preferences, interactive UC experience with diabetes (Peek, Nundy): high satisfaction, improved self-management

Texting already embedded in WCS culture: CPS 2011 First Day Attendance Award! Adapted for Power-Up parents – messages twice a day

Sample Text Messages Awareness: ‘USDA Food & Activity Pyramid was discussed at Power-Up today’

Information: ‘5 servings of fruits or vegetables are recommended per day for children and adults’

Behavioral cues: ‘Include at least one fruit or veggie in each of your child’s meals today’

Questions: ‘What kind of exercise did you do with your child today?’

Texting Experience 10 families with 3rd-4th graders enrolled 9/10 had unlimited texting plans

All parents reported “complete comfort” texting 55% of texted questions answered by parents, within 5 minutes on average “Very easy to use…and educational” “Helped me change to healthier snacks”

Breaking Ground Power-Up collaboration led to sustainable impact at WCS: New playground equipment Greenhouse for growing veggies Healthy snack choices after-school School newsletter highlights “Veggie or Fruit of the Month”and healthy recipes Produce van comes weekly

Proud WCS students

Principal Embil digs a site for playground equipment

Next Steps Continuing relationship

between UC and WCS

Planning randomized trial across multiple CPS after-school programs

White Sox partnership & social marketing to promote healthy lifestyles!

Proud students after installation of the fun-hoop

White Sox mascot Southpaw at WCS

Lessons Learned Time & effort invested in relationships pay off in sustainability – Build on existing culture Creative use of technology (texting) can address time constraints, scalability Refer heaviest kids for more intensive care Partnerships can lead to policy changes (CPS Task Force on vending machines) Dovetail with policy, social trends – help partners succeed

Policy Alignment USDA “Healthy Schools Challenge” CPS Wellness Initiative “Go for the Gold” campaign CDPH “Healthy Chicago” initiative Increased need & opportunities for obesity research in schools

Acknowledgements Funded by NIH UChicago CTSA award: U1 RR024999 Power-Up Children and Parents! Woodlawn Community School

Principal/ Co-Investigator: Kweku Embil Lay Health Leaders: Lorri McClinton, Renee Salahuddin,

Lorne Love; Staff: Jackie Greere, Mr. Hubbard Power-Up staff & investigators:

Resident, Fellow: Alyson Myers, Amy Darukhanavala Medical Students: Kavitha Selvaraj & Katie Gliessen Marla Solomon, Mike Quinn, Shahid Choudhry Dawnavan Davis, Becky Lipton, Althera Steenes

Thank You

For further information contact :

Deborah Burnet dburnet@medicine.bsd.uchicago.edu Althera Steenes asteenes@medicine.bsd.uchicago.edu

Power-Up Session Topics

1) Kick Off-Power Up to a Healthy Life 11) Fats: Healthy Choices

2) Fruits & Vegetables: 5-a-Day, Part I 12) Project Week

3) Fruits & Vegetables: 5-a-Day, Part II 13) Let’s Start with a Good Breakfast

4) Project Week 14) Water, Water, Everywhere

5) Grains: The Get Going Group, Part I 15) Snacks for Healthy Eating

6) Grains: The Get Going Group, Part II 16) Project Week

7) Great Combo: Milk, Bones, Teeth 17) Physical Fitness/Muscle Mania

8) Project Week 18) Mix it Up-Cooking Healthy

9) Mighty Meat to Grow 19) Final Review

10) Being Heart Smart 20) Celebration-Welcome Home!

CTSAs - Resources for CEnR University of Chicago Institute for Translational

Medicine 60 CTSA awards nationally – mandate, training and

supports for community-engaged health research (CEnR)

C3 Collaboration (UChicago, Northwestern, UIC, Rush,

ACCESS)