ProjectHealthySchoolsResearchOverview

AsofFall2015

PHSEnrollment

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2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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NumberofStudentsandSchoolsBenefi6ngfromPHSCurriculumbyYear

#ofStudents

#ofSchools

41,000studentstodate

PHSEnrollment

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2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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NumberofStudentsandSchoolsBenefi6ngfromPHSEnvironmentalProgramsbyYear

#ofStudents

#ofSchools

33,000studentsthisyearalone

41,000studentsfrom68schoolhavebenefiKedfromPHS

• ClagueMiddleSchool• ForsytheMiddleSchool• SlausonMiddleSchool• ScarleKMiddleSchool• TappanMiddleSchool• AnnArborOpenSchool• YpsilanRCommunityMiddleSchool• CorunnaMiddleSchool• OwossoMiddleSchool• St.PaulCatholicSchool• Ovid-ElsieMiddleSchool• PerryMiddleSchool• LaingsburgMiddleSchool• UniversityPreparatoryAcademy• UniversityPreparatoryScienceandMath• WillowRunIntermediateLearningCenter• HenryFordAcademy• DetroitLeadershipAcademy

• RoyalOakMiddleSchool• LincolnMiddleSchool• TyroneElementarySchool• DetroitInternaRonalAcademy• GrandBlancEastMiddleSchool• GrandBlancWestMiddleSchool•  InternaRonalPreparatoryAcademy• PierceMiddleSchool-GrossePoint• MarshallMiddleSchool• SchulzeElementary-MiddleSchool• ChesaningMiddleSchool• MorriceMiddleSchool• ByronMiddleSchool• DurandMiddleSchool• TLHandyMiddleSchool• BryantMiddleSchool• BriKon-DeerfieldMiddleSchool• NobleElementarySchool

• Carman-AinsworthMiddleSchool• RomulusMiddleSchool• SummitAcademyNorth• LarsonMiddleSchool• MasonMiddleSchool• YpsilanRCommunityMiddleSchool• StThomastheApostleCatholicSchool• AllendaleMiddleSchool• ColumbiaMiddleSchool• Delton-KelloggMiddleSchool• DixonEducaRonalLearningAcademy•  JohnsonUpperElementarySchool• PierceMiddleSchool-Waterford• SwartzCreekMiddleSchool• WhitePineMiddleSchool• ClarencevilleMiddleSchool• FatherMarqueKeMiddleSchool• ManisRqueMiddleSchool• MichiganTechnicalAcademy• VistaCharterAcademy

•  EstabrookElementarySchool•  WashtenawInt’lMiddleAcademy•  PowellMiddleSchool•  EFRiKmuellerMiddleSchool•  St.MaryCatholicSchool•  IshpemingMiddleSchool

•  NewberryMiddleSchool•  KalkaskaMiddleSchool•  NewBranchesCharterAcademy•  PiKsfordMiddleSchool•  TuckerMiddleSchool•  St.JohnVianneyMiddleSchool

12moreschoolshavebeenaddedthisyear!

PHSSchoolLocaRons2005-2015

ResearchComponent•  AsofSpring2015:o 15,685studentshavecompletedabaselineandatleastonefollow-upHealthBehaviorQuesRonnaire(HBQ)

o 2,970studentshaveparRcipatedinawellnessscreening

ScreeningParRcipants

HBQParRcipants

PublicaRonstoDate• 14publishedmanuscripts

o  AmericanJournalofPubicHealtho  AmericanJournalofMedicineo  PediatricCardiologyo  Pediatricso  WorldMedicalandHealthPolicyo  ChildhoodObesityo  AmericanHeartJournalo  PublicHealtho  ClinicalEpidemiologyo  AgroFoodIndustryHighTechJournalo  (AmericanJournalofPublicHealth)

• 1moremanuscripthasbeenacceptedforpublicaRonandiscurrentlyinproducRon

PresentaRonstoDate• 47abstractspresentedatnaRonalconferences

o  NaRonalPrevenRonSummito  NaRonalObesityForumo  ObesitySocietyo  AmericanPublicHealthAssociaRono  AmericanDieteRcAssociaRono  MichiganMetabolomicandObesityCentero  ArtandScienceofHealthPromoRono  SocietyofPublicHealthEducaRono  ConferenceonAdolescentHealtho  AmericanSchoolHealthAssociaRono  AmericanCollegeofCardiologyScienRficSessionso  NaRonalIniRaRveforChildren’sHealthCareQualityo  AmericanHeartAssociaRon:QualityofCareandOutcomesResearcho  AmericanHeartAssociaRonScienRficSessionso  AmericanDieteRcAssociaRon:FoodandNutriRonConferenceandExposiRono  MichiganInsRtuteforClinicalandHealthResearcho  AmericanHeartAssociaRon:EpidemiologyandPrevenRon,NutriRon,PhysicalAcRvityandMetabolismo  WeightoftheNaRon:CDC’sConferenceonObesityPrevenRonandControl

ProjectHealthySchoolsResearchSummary

2005–2015“PHS:10Yearsin10Minutes”

Presentedby:EvaKline-RogersMS,RNonbehalfofPHS

10YearsofPHS:WhatHaveWeLearned?

•  5Goals•  BehavioralChanges:screenRme,sports,food/drinkchoices

•  PhysiologicChanges:lipids,glucose,BMI,HR,BP•  InfluenceofEconomics:HouseholdIncomeandPHS

•  DifferencesbyGenderandRace•  ParentalInfluence

5Goals

PrevalenceofHighHealth-HabitAchieversAmongMiddleSchoolChildrenandAssociatedMeasuresof

CardiovascularHealth

•  StudyObjecBve:Reporttheprevalenceof“highhealth-habitachievers”(HHHA)andcomparecardiovascularhealthparametersbetweenHHHAandtheirpeers.

HHHA Criteria

Screen Time ≤ 2 Hours / Day

Exercise ≥ 5 Sessions of Moderate (30 min) and/or Vigorous (20 min) Activity / Week

Unhealthy Beverages ≤ 1 High Sugar Beverage / Day

Fried, Fatty and Sweet Foods ≤ 1 Fried, Fatty, or Sweet Food / Day

Fruits and Vegetables ≥ 5 Servings / Day

Mustmeet4of5HHHACriteria

AHAQCOR2013 AshleyStasiak

Other2687 (67%)

3/5 Goals897 (23%)

HHHA4/5 Goals415 (10%)

HHHA1312 (33%)

Baseline Percentage of PHS Students Achieving at Least 3/5 Goals vs. Students Who Did Not Achieve These Goals

PrevalenceofHighHealth-HabitAchieversAmongMiddleSchoolChildrenandAssociatedMeasuresof

CardiovascularHealth

AHAQCOR2013 AshleyStasiak

•  Prevalenceofstudentsachievingfouroutoffiveofthehighheathgoals,atbaseline,wasextremelylow(10.4%).

•  Comparedtonon-HHHA,HHHAhado RecoveryHeartRateo RandomGlucose

o BMI

o HDLCholesterol

PrevalenceofHighHealth-HabitAchieversAmongMiddleSchoolChildrenandAssociatedMeasuresof

CardiovascularHealth

AHAQCOR2013 AshleyStasiak

BehavioralFactorsasPredictorsofPoorCardiovascularHealthinMiddle-SchoolStudents

•  StudyObjecBve:Reporttheprevalenceof“lowhealth-habitachievers”(LHHA)andcomparecardiovascularhealthparametersbetweenLHHAandtheirpeers.

LHHA Criteria

Screen Time ≥ 5 Hours / Day

Exercise 0-1 Sessions of Moderate (30 min) and/or Vigorous (20 min) Activity / Week

Unhealthy Beverages ≥ 2 High Sugar Beverage / Day

Fried, Fatty and Sweet Foods ≥ 2 Fried, Fatty, or Sweet Food / Day

Fruits and Vegetables 0-1 Servings / Day

MustmeetALL5LHHACriteria

AHAQCOR2013 MichelleMarch

•  Low Health-Habit Achievers were more likely to be: o  Male o  African American or Hispanic o  Enrolled in a lower income school district.

•  Low Health-Habit Achievers had:

o  RecoveryHeartRate

o  TotalCholesterol

o  LDLCholesterol

BehavioralFactorsasPredictorsofPoorCardiovascularHealthinMiddle-SchoolStudents

AHAQCOR2013 MichelleMarch

BehavioralChanges

HighMobileDeviceUsageAssociatedwithSedentaryBehaviorsand

LessPhysicalAcRvityin6thGradeStudents

•  StudyObjecBve:Determinetheprevalenceofmobiledeviceusein6thgradersandexaminetherelaRonshipbetweenmobiledeviceusage,physicalacRvity,andothersedentaryscreenRmehabits

Hours of Screen Time Low Mobile Device Users (LMD) ≤2 hours High Mobile Device Users (HMD) >2 hours

AHAEPI2015 LaurenGordon

•  Ahighpercentage(20.7%)ofmiddleschoolstudentsspentmoreRmeonmobiledevicesthanrecommendedbytheAAP

•  Highmobiledeviceusersweremoreorenfemale

•  Highmobiledeviceusersreported:–  ExerciseTime

–  SportsTeamParRcipaRon

–  SedentaryHabits

HighMobileDeviceUsageAssociatedwithSedentaryBehaviorsand

LessPhysicalAcRvityin6thGradeStudentsAHAEPI2015 LaurenGordon

Passive Screen Time Associated with Unhealthy Dietary Consumption and

Physiological Characteristics

•  StudyObjecBve:TocomparephysiologicalmeasuresandratesofunhealthysnackconsumpRonbetweenstudentsthatparRcipatein“passive”(i.e.TV)or“acRve”(i.e.computerorvideogame)screenRme

ACC2014 BelindaVuong

HoursofScreenTime NumberofStudents

HighTV 2-6hoursTVRme 477

HighComputer/VideoGames 2-6hoursComp/VGRme 296

LowScreenTime 0-0.5hourstotalscreenRme 230

•  TVscreenRmeisassociatedwithgreatercardiovascularriskthancomputer/videogamescreenRme

•  Comparedtohighcomputer/videogameusers,highTVviewershad:o UnhealthySnackConsumpRon

o SystolicandDiastolicBloodPressureo BMI

Passive Screen Time Associated with Unhealthy Dietary Consumption and

Physiological CharacteristicsACC2014 BelindaVuong

PhysiologicChanges

HealthStatusandBehaviorAmongMiddle-SchoolChildreninaMidwestCommunity:WhataretheUnderpinningsofChildhoodObesity?

•InAnnArbor/YpsilanR,15%of6thgradestudentsareobese(BMI≥95thpercenRle).•Obesestudentshavelessfavorablehealthasassessedbylipidprofile,bloodpressure,fitness,andbloodsugar.•ObesestudentshavelessfavorabledietaryandacRvitypaKerns.

InternalMedicineResearchDay2011 TaylorEagle

PHSIntervenRonandtheReducRonofCardiovascularRisk

• Overweightandobesestatusispresentinnearly1/3ofSEMI6thgradestudents.• Post-PHSintervenRon,studentsshowed:

o  TVandvideogameRme,BP,totalcholesterol,LDLcholesterol,triglycerides,andrandomglucose

o  intramuralsports,moderateexercise,andfruit/vegetableconsumpRon

ACC/AHAQCOR2012 TaylorEagle

Schoolv.HomeLunchesSubmiKedtoAHAEPI2016 RosadeVisser

3.4

3.6

3.8

4

4.2

4.4

4.6

4.8

LowSES HighSES

Sessions/W

eek

VigorousPhysicalAcBvity

HomeLunch

SchoolLunch

*

**

0

0.5

1

1.5

2

2.5

3

3.5

Fruits/Vegetables (Fried)Meat SugaryBeverages

Servings/D

ay

DietaryHabits

LowSESHomeLunch

LosSESSchoolLunch

HighSESHomeLunch

HighSESSchoolLunch

*

**

****

****

0

0.5

1

1.5

2

2.5

3

LowSES HighSES

Hours/Da

y

TVandVideoGameScreenTime

HomeLunch

SchoolLunch

**

**

*p<0.05**p<0.001

Students(inbothlowandhighSESregions)whoateschoollunchesdemonstratedsignificantlyworsehealthbehaviorsthanstudentswhoatelunchesbroughtfromhome.

Schoolv.HomeLunchesSubmiKedtoAHAEPI2016 RosadeVisser

0%

5%

10%

15%

20%

25%

30%

35%

40%

LowSES HighSES

PercentageofOverweight/Obese

HomeLunch

SchoolLunch**

106.0

106.5

107.0

107.5

108.0

108.5

109.0

109.5

LowSES HighSES

mmHg

SystolicBloodPressure

HomeLunch

SchoolLunch

*

95

100

105

110

115

LowSES HighSES

Beats/Minute

RecoveryHeartRate

HomeLunch

SchoolLunch*

*p<0.05**p<0.001

StudentsinhighSESregionswhoateschoolluncheshadsignificantlyworsephysiologicalmeasuresthanstudentswhoatelunchesbroughtfromhome.

BreakfastHabitsandCardiovascularDiseaseRiskFactorsinMiddle-SchoolChildren

•  StudyObjecBve:Tocomparephysiological,

nutriRonal,andhealth-relatedbehavioralmeasuresinstudentswhoeatanddonoteatbreakfast

(n=1410)85%

(n=241)15%

BreakfastEaters

Non-BreakfastEaters

AHAQCOR2013 AnneJones

•  Comparedtothosewhodidnoteatbreakfast,studentswhoatebreakfasthad•  BMI•  BloodPressure•  LDLCholesterol•  SedentaryBehaviors•  Fruits,Vegetables,andMilk•  PhysicalAcRvity

BreakfastHabitsandCardiovascularDiseaseRiskFactorsinMiddle-SchoolChildren

AHAQCOR2013 AnneJones

HeartRateRecoveryasaFitnessIndicator

ACC2011 DanielSimhaee

Higher heart rate recovery levels were associated with a less favorable lipid profile.

HDL*

48 50 52 54 56 58

Quartiles of HRR

Triglycerides*

Cholesterol**

80 84 88 92 96

Quartiles of HRR

LDL**

100 110 120 130 140

Quartiles of HRR

156 160 164 168 172

Quartiles of HRR

1Q2Q3Q4Q

DecreasedHDL-CandCardiovascularRiskFactors

60.24 55.7 50.1 45.2

0

50

100

Underweight Overweight

Mean HDL-C by BMI Percentile

HD

L-C

(mg/

dL) %

P-value for trend = 0.001

AhighprevalenceoflowHDL-CwasfoundinthepopulaRon,whichtendedtoclusterwithinacRve,overweight,lessfitgirlswithhightriglyceridesandhigherbloodpressure.

Variable N HDL-C ≤ 40mg/dL

HDL-C > 40mg/dL

P Value

N(%) 1104 177 (16.03)

927 (83.97)

BMI (kg/m2)-mean 1099 22.93 ±5.05

19.54 ±3.70 0.001

BMI>85th percentile (%) 1090 105

(60.3) 264

(28.8) 0.001

Systolic BP (mmHg)-mean 1101 110.88

±11.47 107.98 ±11.16 0.002

Diastolic BP (mmHg)-mean 1101 66.01

±8.90 63.67 ±7.74 0.001

Resting HR (beats/min)- mean 1101 84.34

±11.30 80.22 ±10.81 0.001

Recovery HR (beats/min)-mean 1040 110.72

±18.13 103.39 ±17.38 0.001

Triglycerides (mg/dL)-mean 1064 175.01

±102 111.88 ±67.16 0.001

Low density lipoprotein cholesterol (mg/dL)-mean

1000 93.53 ±27.32

87.90 ±24.72 0.009

# days strenuous exercise/week-mean

1025 4.02 ±2.13

4.53 ±2.01 0.004

# days moderate exercise/week-mean

1029 2.99 ±2.39

3.41 ±2.29 0.019

ACC2011 ShannonFlynn

PhysiologicandBehavioralResultsSummary

•  Totalcholesterol,LDL,BPalldecreasedarerintervenRon

•  Longerheartraterecoveryassociatedwithlessfavorablelipidprofile,higherBMI,decreasedphysicalacRvity

•  LowHDLassociatedwithinacRvity,overweight,increasedtriglyceridesandBP

•  Strongestcorrelatesofobesity:screenRme,lackofmoderateexercise,schoollunches

•  Overweight/obese(1/3ofstudents).Post-intervenRonimprovements:–  LessscreenRme–  IncreasedacRvity–  Favorablephysiologicchanges–  Increasedfruitsandvegetables

InfluenceofEconomics

ResponsetoaSchool-basedHealthIntervenRoninHigh-andLow-IncomeCommuniRes

•  StudyObjecBve:Tocomparetheefficacyofschool-basedintervenRonsinhigh-andlow-incomecommuniRes

Community MedianFamilyIncome

HighSES(n=1840) AnnArbor $53,377

LowSES(n=1307) YpsilanR;Detroit $33,699;$27,862

AHAEPI2014 RobertRogers

ChildhoodObesityinTwoCommuniRes:RelaRontoHealthHabitsandResources

AcBvityCharacterisBcs AnnArbor,MI YpsilanB,MI p-value

Inthepast7days

ExerciseRme≥20min/dayfor≥5days 292(53.3) 64(48.1) 0.17

ExerciseRme≥30min/dayfor≥5days 200(36.4) 46(34.6) 0.18

NumberofPEclasses(≥1perweek) 499(89.7) 78(58.6) <0.001

SchoolSportTeams(≥1teams) 346(62.8) 46(34.6) <0.001

OrganizedSportsTeams(outsideschool,≥1teams) 362(65.2) 78(58.6) 0.16

Inthepast24hours

TVwatching(≥2hours) 230(41.7) 97(72.9) <0.001

ComputerBme(≥2hours) 122(22.0) 54(40.6) <0.001

Playingvideogames(≥2hours) 83(15.0) 52(39.1) <0.001

•  Weobservedamarkeddifferenceindiet,physicalacBvityhabits,andcardiovascularparametersamongchildrenfromtwoneighboringcommuniBeswithvaryingresources.

•  Webelievethattheincreasedriskofobesityinonecommunitycorrelatesdirectlywiththatcommunity’saccesstohealthyfoodandfaciliBesandprogramswhichpromotephysicalfitness.

AHA2008 TaylorEagle

ComparisonofAnnArborandYpsilanRPopulaRons

3. Did anything in your life change because of something you learned from Project Healthy

Schools classroom activities?

11.8%

30.5%

31.0%

44.4%

47.6%

55.1%

0% 10% 20% 30% 40% 50% 60%

No Changes

Less Screen Time

Healthier Drinks

Less Fast Food

More PA Minutes

More Fruit & Veggies

3. Did anything in your life change because of something you learned from Project Healthy

Schools classroom activities?

22.0%

26.5%

27.2%

37.4%

39.7%

39.8%

0% 10% 20% 30% 40% 50% 60%

No Changes

Less Screen Time

Healthier Drinks

More PA Minutes

Less Fast Food

More Fruit & Veggies

YPSILANTI ANNARBOR

YpsilanRschoolshadgreaterself-reportedbehavioralimprovementspost-PHSintervenRonthanAnnArborschools.

APHA2008 JeanDuRussel-Weston

Income/ResourceDifferencesandResponsetoIntervenRon

ACC2012 SathishMohan

Post-PHSIntervenBonLowMedianIncomeCommuniBes:

• Detroitschools:-Decreaseinvideogameuse(p=0.053)-DecreaseinTV/videoRme(p=0.003)-Increaseinmoderate(p=0.058)andvigorous(p=0.012)physicalacRvity.-Decreaseintriglycerides(p=0.009)-DecreaseinmeansystolicBP(p=0.003)andmeandiastolicBP(p=0.029).

• YpsilanRschools:-DecreaseinTV/videoRme(p=0.035)-Decreaseincholesterol(p=0.031)-IncreaseinfruitconsumpRon(p=0.05).

HighMedianIncomeCommuniBes:• AnnArborschools:

-IncreasedparRcipaRoninintramuralteams(p<0.001)• Corunnaschools:

-IncreasedparRcipaRoninintramuralteams(p=0.006)

TrendsinBMIBasedonSocioeconomicStatus

•  StudyObjecBve:ReporttrendsinBMIfor6thgradestudentsovertenyearsandcomparedifferencesbetweenstudentsofvarioussocioeconomicstatuses(SES)

SocioeconomicStatus MedianHouseholdIncome Low <$35,000

Middle $35,000-$50,000 High >$50,000

AHAQCOR2015 AlexisCoolidge

•  ThemeanBMIofhighSES6thgradersremainedconsistentlylowerthanthatofmiddleandlowSES6thgradersovertenyears.

•  In2007,themeanBMIoflowincomestudentswas21.24.By2012,themeanBMIofthisgroupofstudentshadincreasedto22.85.

TrendsinBMIBasedonSocioeconomicStatusAHAQCOR2015 AlexisCoolidge

DifferencesbyGenderandRace

Gender Differences in Physiologic Markers and Behavior Predictors of Obesity

•  RegularlyeaRngschoollunchesandwatching>2hoursofTV/daycorrelatedwithobesityinbothgirlsandboys

•  PhysicalacRvityappearsprotecRveagainstobesityinboys

•  MilkconsumpRonappearsprotecRveagainstobesityingirls

AHAQCOR2012 MorgenGovindan

RacialDifferencesinPhysiologicalandBehavioralResponsetoSchoolBasedWellnessProgram:AnInsightfromProjectHealthySchools

•  Atbaseline,blackstudentshadhigherHDLandlowertriglycerides,buthadhigherHRRandahigher%ofobesestudents

•  TheyalsohavelowerconsumpBonoffruitsandvegetables,lowerparBcipaBoninphysicalacBvityandmoresedentarybehavior.

•  Atfollow-up,blackstudentsdecreasedcholesterol,LDL,andHRRthemost.Non-blackstudents(highertriglyceridesatbaseline)decreasedtriglyceridesthemost.

•  Thisdatasuggestsmorebenefitisseeninthegroupwiththemostroomforimprovement.Atbaseline,blackstudentsaremoreoheninthesegroups.

AHAQCOR2012 TaylorJamerson

GenderandRaceResultsSummary

•  Predictorsofobesitybygender–  Both:

•  Regularschoollunches•  TVRme≥2hours/day

–  Boys:•  PhysicalacRvity(vigorousorschoolteamsports)decreasedobesity

–  Girls:•  MilkconsumpRondecreasedobesity

•  RacialDifferences(blackvsnon-black)–  Blacksimproveddiet,increasedphysicalacRvity,loweredLDL–  Non-blacksloweredtriglycerides

ParentalInfluence

LevelofParRcipaRoninHealthScreeningsasaPredictorofBehavioralOutcomesinMiddleSchool

Children•  StudyObjecBve:To determine whether students

who (with parental consent) fully consented to a health screening reported better health behaviors than students who consented to a behavioral health survey only.

Behavioral Survey

Blood Pressure

Resting/ Recovery Heart Rate

Lipid Profile

Group 1- FULL

Consent

Group 2- PARTIAL Consent

Group 3- SURVEY Consent

AHAQCOR2013 RachelSylvester

•  Group1studentswithconsent(bothstudentandparent)toafullhealthscreeningreported:

•  vegetables

•  parRcipaRoninschoolsports

•  high-sugar(non-soda)beverages

•  screenRme(TV,computer,videogames)•  Group3studentsreportedthegreatestimprovementin:

•  SodaconsumpRon•  ScreenRme

LevelofParRcipaRoninHealthScreeningsasaPredictorofBehavioralOutcomesinMiddleSchool

ChildrenAHAQCOR2013 RachelSylvester

InfluenceofParentalEducaRononNutriRonalandLifestyleChoicesofProjectHealthySchools

StudentsSubmiKedtoAHAQCOR2016 RyanRogers

•  StudyObjecBve:To determine whether parental education level influences the dietary and lifestyle behaviors of 6th grade students.

Group LevelofEducaBon

MoreEducated Atleastoneparentcompletedacollegedegree

LessEducated Neitherparentcompletedacollegedegree

InfluenceofParentalEducaRononNutriRonalandLifestyleChoicesofProjectHealthySchools

StudentsSubmiKedtoAHAQCOR2016 RyanRogers

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Vegetables Fruit RegularSoda

ChocolateDesserts

Servings/D

ay

DietaryHabits

LessEducated

MoreEducated*

**

****

00.51

1.52

2.53

3.54

4.55

VigorousExercise

ModerateExercise

WeightTraining

Sessions/W

eek

PhysicalAcBvity

LessEducated

MoreEducated

**

**

*

0

0.5

1

1.5

2

2.5

TV Computer VideoGame MobileDevice

Hours/Da

y

ScreenTime

LessEducated

MoreEducated

*

*

**

*p<0.05**p<0.001

•  StudentswithmoreeducatedparentsreportedeaRngmorefruitsandvegetables,exercisingmorefrequently,andspendinglessRmeinfrontofascreen

•  TheywerealsomorelikelytoeatbreakfastandlesslikelytoeatschoollunchandhaveaTVintheirbedroom.

School-basedIntervenRonLeadstoSustainedBenefitoverTime:FourYearFollow-UpReportfromProjectHealthySchools

•  FouryearsarertheiniRalintervenRon,PHSstudentsconRnuedtoshowimprovementinthegoalareasevaluated.

•  ThesechildrenareeffecRvelydecreasing

theirriskofCVdiseaseanddiabetes.

AHA2011 NicoleCorriveau