SummaryHEALTHY (Healthy Eating Active Lifestyles Together Helping Youth) Armstrong, a community-based coalition in rural Armstrong County, PA, adopted elements of the national We Can! Ways to Enhance Children's Activity & Nutrition) program to help children improve their nutritional habits and get more physical activity. The coalition sponsors local marketing that promotes healthy behaviors, assists Armstrong School District elementary schools in providing students and parents with opportunities to learn about and engage in healthy behaviors, and hosts various community events that do the same. The program has significantly increased levels of physical activity and improved the food choices made by students. Based on its success to date, HEALTHY Armstrong is being expanded to middle and high schools in the same district, and to the other four school districts in Armstrong County.Moderate: The evidence consists of pre- and post-implementation comparisons of key measures related to student behaviors, including time engaged in physical activity, purchases of high-calorie foods with low nutritional content as a proportion of all purchases, and school cafeteria expenditures on fresh fruits and vegetables.
Developing OrganizationsHEALTHY Armstrong; We Can!
The HEALTHY Armstrong coalition includes the following organizations:
Other partners include community groups such as the Armstrong County Cooperative Extension/4H, the Armstrong County YMCA, Armstrong Rails to Trails Association, Belmont Complex, the Environmental Learning Center, and the Pennsylvania Department of Health.
- ACMH Hospital
- ACMH Foundation
- Armstrong School District
- Children's Community Pediatrics
- Armstrong County, Pennsylvania
- UPMC Health Plan
Date First Implemented2005
Age > Child (6-12 years); Vulnerable Populations > Children; Rural populations
Problem AddressedChildhood overweight/obesity is a critical public health problem with devastating consequences. Schools can play an important role in addressing overweight/obesity by reinforcing healthy habits throughout childhood, but many schools find it difficult to play this role without appropriate support.
- A growing epidemic: The prevalence of obesity (defined as a body mass index, or BMI, above the 94th percentile) among children and adolescents has increased rapidly in recent decades throughout the nation, in Pennsylvania, and in Armstrong County:
- Nationwide: Between 1976-1980 and 2007-2008, the prevalence of obesity more than tripled, from 5.0 to 19.4 percent in 2- to 5-year-olds, from 6.5 to 19.6 percent in 6- to 11-year-olds, and from 5.0 to 18.1 percent in 12- to 19-year-olds.1
- Pennsylvania: Although trend data are not available, similar increases in overweight/obesity appear to have occurred among Pennsylvania youth in recent decades. In 2008, approximately 17 percent of Pennsylvania eighth graders were overweight (BMI between the 85th and 94th percentiles), and another 18.2 percent were obese.2
- Armstrong County: More than half (52 percent) of Armstrong County residents are overweight or obese, including over a third (35 percent) of elementary school children.3
- Poor health-related behaviors: High rates of overweight/obesity stem from poor health-related behaviors, including unhealthy diets and lack of physical activity. For example, in Pennsylvania, only 20 percent of children consume five servings of fruits and vegetables daily, 79 percent do not attend daily physical education classes in school, and 31 percent watch television for more than 3 hours on school days.4
- Severe health consequences: Overweight and obesity put children at current and future risk of many serious health problems, including cardiovascular disease, type 2 diabetes, and mental health conditions such as anxiety and depression.5
- Failure to assist schools in doing their part: Educators have the opportunity to teach parents and students about the importance of regular physical activity and making good food choices, and can model such behaviors. Schools also can provide students opportunities to engage in such healthy behaviors on a daily basis. But many schools find it difficult to play these roles without appropriate support, often due to competing priorities.
- Lack of physical activity: Schools (especially those in low-income areas) have cut back on recess and physical education in an effort to improve academic achievement through more classroom time. (The effectiveness of such measures remains a matter of debate, with growing evidence that providing more time for physical activity in schools does not undermine—and may even improve—academic performance.6,7 Nationwide, the percentage of students attending a daily physical education class dropped from 42 percent in 1991 to 28 percent in 2003. Opportunities for physical activity decline as students get older; half of schools require physical education in grades 1 through 5, but only about a quarter do so in grade 8 and 5 percent in grade 12.8
- Access to unhealthy foods: Through vending machines and fundraisers, many schools have long promoted and sold high-calorie, low-nutrient foods as a way to generate revenue. In a 2000 survey, 80 percent of American school districts sold “competitive” foods (foods and beverages offered outside of school meal programs) in a la carte lines, school stores, snack bars, and vending machines.9 Many of these foods are low in nutrients and high in calories.10
Description of the Innovative ActivityHEALTHY (Healthy Eating Active Lifestyles Together Helping Youth) Armstrong adopted elements of the national We Can! (Ways to Enhance Children's Activity & Nutrition) program (see Context section for more details) to help children improve their nutrition and get more physical activity. The coalition sponsors local marketing that promotes healthy behaviors, assists Armstrong School District elementary schools in giving students and parents opportunities to learn about and engage in healthy behaviors, and hosts various community events that do the same. Key program elements include the following:
- Community-wide marketing to promote healthy behaviors: HEALTHY Armstrong promotes healthy behaviors through its Web site and social media, written materials distributed throughout the community, ongoing media coverage, and road signs, as outlined below:
- Web site and social media: The coalition’s Web site (http://www.healthyarmstrong.org/) promotes health-related initiatives and activities throughout the community, with a section devoted to We Can! activities. With the help of a student intern, the program will soon begin promoting healthy behaviors through a Facebook page and Twitter account.
- Community-wide distribution of printed materials: HEALTHY Armstrong brochures, posters, and other marketing materials are distributed at health fairs and other community events. These materials provide information about overweight/obesity in Armstrong County, the history of HEALTHY Armstrong and its major partners, a description of We Can! activities, and a review of the program’s impact to date.
- Ongoing media coverage: The coalition's programs and events receive regular coverage in the local newspaper, The Leader Times. Coalition representatives have appeared on "Pittsburgh Today Live," a morning show on the CBS affiliate station in Pittsburgh. The program has been profiled on the Armstrong School District television station and a local television station.
- Road signs: Approximately 10 road signs promote the We Can! program throughout the community. The signs highlight Armstrong County as a We Can! county, depict the We Can! logo, and include the HEALTHY Armstrong Web site address.
- Support for schools via implementation guide, wellness coordinator: The coalition currently assists the district’s seven elementary schools in promoting healthy behaviors among students. (The program will soon expand to serve the district’s five middle and high schools as well.) Schools receive a wellness guide that offers general information about health and wellness, describes programs and activities that can easily be adopted, and reviews practical strategies and tips to assist with implementation. As additional support, the coalition’s health and wellness coordinator works with a facilitator within each of the schools (usually a teacher) to implement specific programs and policies designed to give students and parents opportunities to learn about and practice healthy behaviors. Examples of school activities and policies supported by HEALTHY Armstrong include the following:
- Special programs: Students participate in various special programs before, during, and after school, such as Project ACES (All Children Exercise Simultaneously), a program in which children around the world exercise on the same day at the same time; indoor/outdoor walking clubs offered before school; wellness nights; Go-for-the-Greens celebrations to promote consumption of vegetables, and Turn-Off-the-TV Week.
- Classroom education: School-based health classes regularly incorporate We Can! tips into the curriculum, with guest speakers (such as a nutritionist) periodically promoting healthy behaviors.
- Field trips: Children periodically take field trips to the local recreational center (Belmont Recreational Facility), YMCA, and sites offering healthy cooking demonstrations.
- Better food options: Schools have removed soda and “junk food” vending machines from student areas, replacing them with machines offering healthy snacks such as string cheese, low-fat milk, pretzels, and yogurt. School cafeterias have stopped serving almost all deep-fried foods. (French fries are offered on a very limited basis.) Cafeterias give priority to fruits and vegetables and offer only whole-grain foods and skim or 1-percent milk.
- Healthy, positive messages, in accordance with wellness policy: Schools follow the district’s wellness policy, which calls for educators not to use food as a reward or punishment, not to use physical activity as a punishment, and to generally convey positive We Can! messages related to healthy eating and exercise.
- Community activities: Armstrong County and HEALTHY Armstrong sponsor various community events and activities to complement and reinforce the school-based activities; for example:
- Annual events: Each August, a hike-and-bike event encourages families to participate in physical activities; approximately 150 people attend each year. Every September, Healthy Lifestyle Extravaganza draws more than 200 people to a school gymnasium, where they participate in a brief kick-off activity (e.g., low-impact aerobics), followed by rotations through exercise stations staffed by volunteer instructors who lead 10 minutes of activity (e.g., yoga, zumba dancing, weight training, basketball, jump-roping). Participants receive raffle tickets at each station. Culinary school students also offer a healthy cooking demonstration and share snacks with participants.
- Wellness month: The Armstrong County Commissioner declared April as the county’s “Wellness Month.” Each year, the county and HEALTHY Armstrong create a calendar that lists all wellness events to be held by local organizations in April; the calendar is posted in locations throughout the community and on the coalition’s Web site.
- Promotion of healthy recipes: Through the Healthy Recipes of the Week program, five grocery stores and five community sites (e.g., the hospital cafeteria, the YMCA, doctor’s offices, Belmont Recreational Facility) across the county prominently display healthy recipes.
Context of the InnovationHEALTHY Armstrong is a community-based coalition that promotes physical activity and good nutritional habits for children in Armstrong County, Pennsylvania, with a focus on working through schools. Among the county’s 68,000 residents, roughly a third (35 percent) live in households that earn at or below 200 percent of the Federal poverty level, and as noted earlier, over half are overweight or obese. The Armstrong School District (one of five districts within the mostly rural county) includes seven elementary and five secondary (middle and high) schools serving 5,490 students. In 2005, Kiran Bhat, MD, a pediatrician with Children's Community Pediatrics (a large practice serving most of the county) noticed that many of his patients had “adult” diseases (e.g., hypertension, diabetes, hypercholesterolemia). Dr. Bhat approached leaders at ACMH Hospital (the only county's only hospital) to discuss the problem. Around the same time, Pennsylvania mandated that schools calculate BMI for all children. In addition to revealing that over a third of elementary school students in the district were overweight or obese (as noted earlier), the data showed that BMI tended to be normal in kindergartners but steadily increased over time, suggesting that weight problems began during elementary school.
To address this problem, Dr. Bhat, hospital leaders, and school district administrators decided to design a program targeting elementary school students. They turned to the We Can! program, developed in 2005 as a national education program to assist parents and communities in helping children age 8 to 13 achieve and maintain a healthy weight. Developed jointly by the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Cancer Institute, the program offers educational curricula, tools, and activities that encourage healthy eating, promote physical activity, and limit video, computer and television “screen time.”
ResultsThe program has significantly increased levels of physical activity and improved the food choices made by students, who consume less “junk food” and more fruits and vegetables in school.
Moderate: The evidence consists of pre- and post-implementation comparisons of key measures related to student behaviors, including time engaged in physical activity, purchases of high-calorie foods with low nutritional content as a proportion of all purchases, and school cafeteria expenditures on fresh fruits and vegetables.
- Near doubling of time engaged in physical activity: The annual number of minutes that Armstrong County students spend in structured physical activities (outside of physical education classes) has nearly doubled since program implementation, rising from 402,142 minutes in 2006 to an average of 796,260 minutes during 2007, 2008, and 2009.
- Better food choices: Students purchase significantly less “junk food” (high-calorie foods with little or no nutritional value) than they did when the program began. At present, these foods make up only 11 percent of total food purchases, well below the 19 to 20 percent they represented in 2005 and 2006 (before implementation). Similarly, high-calorie, low-nutrition meals accounted for 37 percent of all entrée purchases in 2009, down from 55 percent in 2006. Finally, school cafeteria expenditures on fresh fruits and vegetables more than doubled between 2002 and 2007, from $60,000 to nearly $140,000.
Planning and Development ProcessSelected steps included the following:
- Pilot program: Dr. Bhat and representatives from ACMH Hospital and the Armstrong School District began a pilot program in Elderton Elementary School; the program included wellness clubs, a nutrition newsletter, and other wellness-related activities.
- Data gathering: The team gathered data on obesity rates from the Pennsylvania Department of Health, along with related county health indicators (e.g., poverty, education, and unemployment rates) to determine possible contributors to the obesity problem.
- Forming executive council: After the initial successes at Elderton Elementary School, UPMC Health Plan and Armstrong County government leaders became interested in participating in and expanding the program. To formulate strategy, the organizations formed a five-person executive council, comprising representatives from the pediatrics practice, the hospital and its foundation, the school district, the health plan, and the county government. This council developed a mission and vision statement for the initiative, which they named HEALTHY Armstrong. The executive council continues to oversee the organization and set strategy based on We Can! programming and other initiatives.
- Adopting We Can! program: The executive council considered how to improve the health education curriculum in schools, particularly with regard to nutrition and physical activity. To address this need and obtain pertinent materials to distribute within the schools, Armstrong County became a We Can! site and introduced the program in all seven elementary schools in the district.
- Creating steering committee: The executive council invited individuals from stakeholder organizations to participate on a steering committee responsible for implementing strategies. The committee—which includes the HEALTHY Armstrong project director, the Armstrong School District’s health and wellness coordinator, and representatives from partner institutions—meets monthly to implement initiatives as set forth by the executive council.
- Hiring program staff: The executive council hired a part-time project director to oversee the HEALTHY Armstrong program. The Armstrong School District hired a health and wellness coordinator to oversee school-district related wellness activities, designating half her time to working with HEALTHY Armstrong.
- Developing marketing materials and wellness guide: The project director worked with a local Web site designer to create the program Web site, launched in April 2009. The UPMC Health Plan marketing department created a media package, including brochures, refrigerator magnets, posters, and other materials. The health and wellness coordinator developed the wellness guide and distributed it to all in-school facilitators.
- Training teachers: Armstrong School District teachers participated in an online “We Can! Energize Our Families” parent program training session as part of an inservice training day. They also received training on the SPARK program (a We Can!–endorsed initiative), as did in-school facilitators and representatives from community organizations. This training focused on activities to increase physical activity during recess.
- Expanding to additional schools: In 2010, HEALTHY Armstrong won a U.S. Department of Education Carol M. White Physical Education Program grant that will allow expansion of the program to secondary schools within the Armstrong School District. In addition, HEALTHY Armstrong is working to expand its reach to schools in the four other districts within Armstrong County.
- Possible designation as separate legal entity: Currently, HEALTHY Armstrong operates under the auspices of the ACMH Hospital Foundation, a 501(c)(3) nonprofit organization. The executive council is debating whether to make HEALTHY Armstrong a stand-alone 501(c)(3) organization.
Resources Used and Skills Needed
- Staffing: HEALTHY Armstrong staff includes an independent contractor who serves as part-time (32 hours/week) project director. The Armstrong School District’s health and wellness coordinator (an elementary school health/physical education teacher) spends half her time on HEALTHY Armstrong activities. Each participating school has a teacher who oversees implementation of HEALTHY Armstrong programs.
- Costs: The program’s annual operating budget totals approximately $80,000, which covers community events and the project director’s salary. Partner organizations contribute an equal amount through in-kind donations. The hospital provides rent-free office space and donates program-related equipment and materials. The school district pays the wellness coordinator’s salary and stipends to facilitators in the schools. Schools offer their facilities for HEALTHY Armstrong activities free of charge, and the county government paid for the We Can! road signs.
Funding SourcesHEALTHY Armstrong
UPMC Health Plan provided initial funding, with in-kind support from all founding members. The program also received a $5,000 Pennsylvania Department of Health Active Schools Grant and small grants from other sources. A 3-year, $1 million US Department of Education Carol M. White Physical Education Program grant will allow expansion of the program to secondary schools. A $3,200 grant from The Armstrong County Community Foundation is supporting the expansion of HEALTHY Armstrong to three additional school districts and to technical schools in Armstrong County.
Tools and Other ResourcesWe Can! tools and resources are available at:
Information about the SPARK program (a We Can!–endorsed initiative) is available at: http://www.sparkpe.org/.
Information about the CATCH program (a We Can!–endorsed initiative) is available at: http://www.catchinfo.org/.
Getting Started with This Innovation
- Find program champion: This type of program needs a passionate champion who is well-respected and well-connected within the community. The champion needs to bring together key stakeholders to build support and enthusiasm throughout the community.
- Involve key leaders in decisionmaking: Executive council members should not just represent their organizations, but also have the authority to make decisions and commit resources on their behalf. For example, the HEALTHY Armstrong executive council includes the hospital’s director of medical affairs and Armstrong County commissioner.
- Cultivate school district support: The superintendent of Armstrong School District avidly supports HEALTHY Armstrong, as does the district’s food service director. Such support will be critical, given that the school district will likely experience revenue losses from the elimination of unhealthy items from the cafeteria menu and vending machines (see below).
- Expect and prepare for revenue losses: Changes in school food services may reduce revenue. The Armstrong School District has lost revenue due to reduced sales of unhealthy items in vending machines (although the machines are still profitable) and school cafeterias. For example, eliminating french fries costs the district $66,000 in revenues each year. District leaders, however, are willing to accept these losses.
- Hire experienced program director: An inexperienced program director will not have the requisite skills to build and sustain a complex program involving multiple stakeholders and activities.
- Play to individual strengths: Determine the various strengths of individuals on the executive council and steering committee, and assign tasks accordingly. For example, some people feel comfortable soliciting grant funding, while others are good at organizing events.
- Identify and make use of available resources: Identify available community resources and approach relevant stakeholders about using them for the program. For example, universities and community colleges might be willing to provide a summer or year-round intern to staff the program or run school-based programs. Schools and community centers may be willing to donate space (e.g., gymnasiums, auditoriums) for program activities.
Sustaining This Innovation
- Seek diversified funding base: Program developers should attempt to secure core funding from several major stakeholders, along with additional funds from as many other sources as possible. Having multiple funding sources makes the program’s ongoing sustainability less subject to the whims of any single supporter.
- Actively manage leadership transitions: Invariably, changes will occur in the composition of the executive council. To the extent possible, program leaders should anticipate and manage these transitions. For example, to plan for an upcoming change in the county commissioner at the next election, the HEALTHY Armstrong project manager is contacting candidates to discuss the program and its value to the county.
- Encourage collaborative spirit: Any time multiple organizations become involved in a coalition, representatives may become territorial or seek credit for activities. Keeping all parties focused on the main mission of the initiative helps prevent turf wars.
Original publication: July 20, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: April 23, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: July 10, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.