New York State Prevention Agenda Training Prevent Chronic Disease Action Plan Implementing Nutrition Standards Lessons Learned from Broome County

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Dennis Mathews
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1 New York State Prevention Agenda Training Prevent Chronic Disease Action Plan Implementing Nutrition Standards Lessons Learned from Broome County Mary McFadden, BS, CPH Broome County Health Department

Broome County Snapshot Snapshot of Broome County Population 198,000 Mean household income $45,629 17.

2 Broome County Snapshot Snapshot of Broome County Population 198,000 Mean household income $45, % individuals living below poverty level 24 % children living below poverty level 91% White 5.2 % African American Adult Obesity 63.7% Youth Obesity 32.3% 18.3% individuals age 5 and over, living with a disability Significant racial and health disparities High premature death rates from all cardiovascular diseases Sources: NYS Vital Records Broome County CHA , BRFSS Survey , Broome County Steps YRBS 2007; New York State Prevention Quality Indicators 2011

3 Mobilizing the Prevention Agenda PRIORITY AREA: FOCUS AREA: GOAL 1: OBJECTIVE 1.3: IMPROVEMENT STRATEGY: EVIDENCE-BASE (source): PERFORMANCE MEASURE (source): INTERVENTION STATUS Current New MAJOR ACTIVITIES School Wellness Policies: Establish strong nutrition standards for food sold in schools Establish policies that address mandatory time for active recess and healthier food and beverage options Universal Breakfast: Incorporate Universal Breakfast (UB) as part of school learning time Breakfast in the Classroom: Adopt Breakfast in the Classroom (BIC) for school districts with high free and reduced lunch rates Learning in Motion / BC Walks: Work with school leadership to ensure increased opportunities for physical activity outside of physical education classes Safe Routes to Schools: Education activities and practices adopted in school wellness policies PREVENT CHRONIC DISEASE Reduce Obesity in Children and Adults Reduce the percentage of children who are obese in Broome County By December 31, 2017, reduce the percentage of school-age children who are obese by 5% among children in Broome County public schools Adopt policies and practices that incorporate time into the school day so that students have adequate time to eat a nutritious lunch/snack and engage in physical activity Percentage of children in public schools who are overweight or obese (SOURCE: NYS Student Weight Status Category Reporting System [SWSCRS]) BASELINE: 18.6% ANNUAL TARGET: 1% per year 2017 TARGET: 17.7% RESPONSIBLE ORGANIZATION(S) Broome County School Districts Broome Tioga BOCES Food Services Broome Tioga BOCES Professional Development RESPONSIBLE INDIVIDUAL(S) School District Superintendents Role: Implement policies, provide administrative support for programs BT-BOCES Food Service Director Role: Oversee implementation of Breakfast in the Classroom (BIC) & Universal Breakfast (UB) programs Professional Development Coordinator Role: Oversee implementation of Learning in Motion Broome County School Districts School Health Advisory Council Leader / Wellness Coordinator Broome County Health Department Role: Develop & implement wellness policies Broome County Public Health Director/ Supervising Public Health Educator Role: Facilitator, provide resources & technical assistance as needed PROCESS MEASURES # school districts adopting specific policies and # students impacted: (1) Mandatory active recess (2) Healthier nutrition standards for food and beverages sold in schools (3) Sugary drink policies # school districts with wellness policies that specify support for and # number of students impacted: (1) Healthier food & beverage options (2) Safe Routes to Schools # schools promoting access to free drinking water Individual measures: # students using active transport methods to/from school Systems Change: OUTCOME MEASURES Number of school districts that adopt healthier food and beverage options in school wellness policies Systems Change: Number of school districts whose school wellness policies address mandatory time for active recess for grades K-5 Percentage of children who are overweight [defined as having an age and gender specific BMI at 85th to 95th percentile] Percentage of children who are obese [defined as having an age and gender specific BMI at 95th percentile]

4 Opportunities to Change Food Environment Sector: Schools Rock on Café School Wellness Policies

School Food Service Environment Rock On Café School Food Service Model 15 School districts: 12 school districts in Broome County & 3 school districts in Tioga County ~45 elementary

5 School Food Service Environment Rock On Café School Food Service Model 15 School districts: 12 school districts in Broome County & 3 school districts in Tioga County ~45 elementary schools Range in size from 640 to 6,000 students Serve approximately 20,000 lunches & 8,000 breakfasts across all grade levels daily School districts range from 17% to 70% in free/reduced meals

School Food Service Environment What? Regionally standardized breakfast and lunch menu system and consolidated food service purchasing initiative Why is it important?

6 School Food Service Environment What? Regionally standardized breakfast and lunch menu system and consolidated food service purchasing initiative Why is it important? Enables districts to leverage their purchasing power Enables districts to purchase more fresh fruits / vegetables at a reduced cost Gives parents and students greater nutritional control

7 Broome & Tioga Counties Approach Menus Bids The Rock on Cafe 15 School Districts Involvement of Every Director Recipe Development Promotion Nutrition Education Community Involvement

8 Program Evaluation Initial Phase Impacts: Cost savings reinvested on purchases of food items having greater nutritional value Purchase of fresh fruits & vegetables increased by ~ 14% Fat content lowered - consistently below mandated 30% for total fat & 10% for saturated fat School lunch participation increased by 3% (similar for all 15 school districts) 6.7% increase in parents perception of school lunch as a nutritious meal option 71.9% of parents had heard about the Rock on Cafe All FSDs rated program as good to excellent FSDs Identified hiring of registered dietician services & consolidation of food procurement as most valuable parts Administrators found program valuable

9 Opportunities to Change the Food Environment Sectors: Schools Public Recreation Venues Trans Fat Ban Patriot Breakfast Program Green Carts Healthy Meeting Policies Worksites Restaurants

10 Trans Fat Ban Broome Trans Fat Ban Operation TRANSition the Kitchen NYC Model Survey Restaurants Champion Legislator Media Legislation Passed /broome-county-takes-trans-fats-off-the-menu/

learn increased from 41% to 79% Ability to focus on learning increased from 31% to 79% Level of alertness &

11 Patriot Breakfast Program Breakfast in the Classroom Pilot High Need School 400 Children K-5 Participation among children eligible for the school lunch program increased from 43% to 88% Teachers reported: Children s readiness to learn increased from 41% to 79% Ability to focus on learning increased from 31% to 79% Level of alertness & attentiveness increased from 35% to 74% Complaints of hunger decreased from 24% to 16%

12 Green Carts City of Binghamton School District Binghamton Mets Stadium Binghamton Senators Hockey Binghamton Zoo and Discovery Center

13 Worksites Healthy Meeting Guidelines: 200 employees Vending Standards: 2400 employees Breastfeeding Policies: 3,000 employees Weight Watchers: 300 lbs lost by Broome County Employees

14 Opportunities to Change Food Environment Sectors: Schools Local Government Municipality Sodium Reduction: Reducing sodium in school lunches Reducing sodium in senior meals Instituting healthier vending standards in county vending machines

Sodium Content in Food Items SANDWICH SODIUM (mg) Top Sources of

Soups Sandwiches Cheese Pasta dishes Meat dishes Snacks Chicken

Cheese 688 Tuna 679 Peanut Butter & Jelly 405 CONDIMENT SODIUM

15 Sodium Content in Food Items SANDWICH SODIUM (mg) Top Sources of Sodium Breads & rolls Cold cuts & cured meats Pizza Poultry Soups Sandwiches Cheese Pasta dishes Meat dishes Snacks Chicken Spiedie Sub 1096 Ham & Cheese 1054 Turkey & Cheese 900 Grilled Cheese 688 Tuna 679 Peanut Butter & Jelly 405 CONDIMENT SODIUM (mg) Mustard 227 Mayonnaise 118 Ranch Dressing 161 Italian Dressing 143

16 Key Elements of Sodium Reduction in School Lunches Nutrition Baseline Procurement System Vendor Shows Menu Planning Recipe Development Taste Testing In-Services for Staff

Key Strategies in Action Reformulation 760 mg 440 mg per serving Individual Round Pizza: Reformulate crust Substitution 1167 mg 688 mg per serving Grilled Cheese Sandwich: Substitute low sodium for

17 Key Strategies in Action Reformulation 760 mg 440 mg per serving Individual Round Pizza: Reformulate crust Substitution 1167 mg 688 mg per serving Grilled Cheese Sandwich: Substitute low sodium for regular cheese Reduce Portion Size 960 mg 480 mg per serving Tomato Soup: Reduce serving size from 8 oz to 4 oz Offer More Fresh 71 mg 0.5 mg per serving Green Beans: Use fresh or frozen instead of canned Remove From Menu 1161 mg 367 mg per serving Ham & Cheese on a Pretzel Roll: Now serving munchables

18 Procurement

19 Food Vendor Shows

20 Vendor Food Shows

21 Menu Planning Fruit 20 Vegetable 20 Milk 20 Average Total Cost = $2.89 Category $ Rate * Free/Reduced 2.94 Utensils 7 Bread 11 Entree 57 Self Pay 2.50

22 Recipe Development Recipe Team Current Focus Low Sodium items Dark Green Vegetables Orange Vegetables Legumes Whole Grains Kid Test Tasted!

23 Taste Testing 152 Yes 48 No

24 Healthier Senior Meals Phase I Healthy Food and Beverage Options: Senior Nutrition Sites and Meals on Wheels 5 Senior Meals Sites Meals on Wheels Enhanced Salad Whole Grain Products New Menus Menu Labeling 900 Seniors Quote

Healthier Senior Meals Phase II ( sodium reduction) 4, 400 Seniors reached (congregate and meals on wheels) Meals on Wheels meal contained 1163mg of sodium at baseline and 2 years later, that amount

25 Healthier Senior Meals Phase II ( sodium reduction) 4, 400 Seniors reached (congregate and meals on wheels) Meals on Wheels meal contained 1163mg of sodium at baseline and 2 years later, that amount was 19% lower, with an average of 944mg of sodium per meal Congregate meals contained 1517mg of sodium at baseline and 2 years later, the sodium was reduced by 22% with an average of 1181mg of sodium per meal

Sodium Reduction Strategies Technical Assistance from Schenectady County and NYSDOH Gain buy in from key decision makers Utilize Broome County school food service partners as a reference Product

26 Sodium Reduction Strategies Technical Assistance from Schenectady County and NYSDOH Gain buy in from key decision makers Utilize Broome County school food service partners as a reference Product substitution Recipe modification no additional salt added Using more fresh and no salt added canned vegetables Scratch cooking Work directly with vendors to identify and procure lower sodium items through municipal bid process

27 Senior Taste Testing

28 Senior Meals: Sample Menu with Reduced Sodium Items

29 Opportunities to Change the Food Environment: Sectors: Schools Government Municipality Healthier Beverage Policies/Practices School Food Procurement Mentoring and Tool Kit Development Community Based Organizations

assessment, policy development 3 policies developed: CCE, Weis Markets,

30 Healthier Beverage Policies/Practices Lead Partner: Cornell Cooperative Extension (CCE) Champion Education Engage leadership Assist with assessment, policy development 3 policies developed: CCE, Weis Markets, City of Binghamton, Boys and Girls Club Value Added: NYS 4H Programs adopted policy

31 Showcase Project Adoption of Nutrition Standards Sectors: Schools Government Municipality Adoption of nutrition standards in municipality, community based organizations Community Based Organizations

32 Key Partners County Executive Public Health Director Office for Aging Director Central Foods Director School Food Service Administration Community Organization Directors Community Organization Boards Food Vendors Food and Health Network Hospital Food Service Reps College Food Service Reps Reps of agencies serving persons with disabilities

Thank You to Our Sponsors: Evaluations 3/19/2013. Sodium Savvy: Salient Public Health Solutions. Disclosure Statements

Thank You to Our Sponsors: Evaluations 3/19/2013. Sodium Savvy: Salient Public Health Solutions. Disclosure Statements Sodium Savvy: Salient Public Health Solutions March 21, 2013 Featured Speakers Julie M. Tucker, RD, CDN, SNS Registered Dietitian Broome Tioga BOCES, Binghamton, NY Food Services June Schuldt, RN, BSN