Nutrition and Physical Activity

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					Week 8: Nutrition and Physical Activity                                                               Pg 1

                            Suggested Concepts to be Covered
While we have outlined some core objectives for a unit on nutrition and physical activity, we
realize there is much more that can be included. Within this broad topic, the following are some
additional concepts that might be covered in a unit. Many of these topics can be explored
through class assignments (see Case Studies and Class Assignments section).

       Discuss normal nutrition guidelines, as well as the definition of overweight and obesity,
        their origins, and how these concepts have changed over time.
       Discuss how overweight and obesity are measured, the limitations of measurement
        schemata, and how data regarding overweight and obesity in middle childhood and
        adolescence are collected.
       Examine how nutrition and physical activity behaviors change over time as children
        move from middle childhood to adolescence and into adulthood.
       Examine the impact of environmental/contextual factors, such as neighborhood safety,
        schools, the media, technology, the competitive food industry, and access to grocery
        stores that sell fresh fruits and vegetables, on nutrition and physical activity.
       Discuss the trends and the relationships between income and overweight and obesity.
        Discuss how cultural values towards food and physical activity also shape the issue of
        overweight and obesity.
       Discuss the relationship between nutrition, physical activity, and the development of
        chronic diseases later in life.
       Discuss eating disorders, their risk factors, and their relationship to health outcomes both
        in adolescence and adulthood. (This topic should also be covered in the unit on mental
       Review different types of policy approaches for improving nutrition and physical activity
        among young people, including transportation, urban planning, agriculture, physical
        activity requirements in school, community safety.
       Discuss the roles of schools, families, and communities (e.g., neighborhoods in which
        residents can walk and play safely, food stores that sell fresh, high quality, low cost
        produce in inner-city neighborhoods) in identifying and preventing overweight and
        obesity. Also consider the political and funding issues that influence the availability and
        quality of school-based programs.
       Examine the relationship between adolescent health and nutrition and educational
        outcomes. Study policies that are meant to impact this relationship such as school lunch
        and breakfast programs.

Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health and
National Adolescent Health Information Center, UCSF
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                                    Recommended Readings
       Boutelle K, Neumark-Staziner D, Story M, & Resnick M. (2002). Weight control
        behaviors among obese, overweight, and nonoverweight adolescents. Journal of Pediatric
        Psycholog, 27(6), 531-540.
       Gordon-Larsen P, Adair LS, Popkin BM. (2002). Ethnic differences in physical activity
        and inactivity patterns and overweight status. Obesity Research, 10(3):141-149.
       Lowry R, Wechsler H, Kann L, Collins JL. 2001. Recent trends in participation in
        physical education among US high school students. Journal of School Health, 71(4):145-
       Neumark-Sztainer D, Story M, Hannan PJ, Croll J. (2002). Overweight status and eating
        patterns among adolescents: Where do youths stand in comparison with the Healthy
        People 2010 Objectives? American Journal of Public Health, 92(5):844-851.
       Ogden CL, Flegal KM, Carroll MD, Johnson CL. (2002). Prevalence and trends in
        overweight among US children and adolescents, 1999-2000. Journal of the American
        Medical Association, 288(14):1728-1732.
       Olshansky SJ et al. (2005). A potential decline in life expectancy in the United States in
        the 21st Century. NEJM, 352(221):1138-1145.
       Preston SH. (2005). Deadweight? The influence of obesity on longetivity. NEJSM,
       Ritchie L, Ivey S, Masch M, Woodward-Lopez G, Ikeda J, Crawford P. (2001). Pediatric
        overweight: A review of the literature. Berkeley, CA: Center for Weight and Health,
        University of California at Berkeley.
       Thompson JL, Davis SM, Gittelsohn J, Going S, Becenti A, Metcalfe L, et al. (2001).
        Patterns of physical activity among American Indian children: An assessment of barriers
        and support. Journal of Community Health, 26(6):423-445.

       Alaimo K, Olson CM, Frongillo EA Jr. (2001). Low family income and food
        insufficiency in relation to overweight in US children: Is there a paradox? Archives of
        Pediatrics and Adolescent Medicine, 155(10):1161-1167.
       Booth SL, Sallis JF, Ritenbaugh C, Hill JO, Birch LL, Frank LD, et al. (2001).
        Environmental and societal factors affect food choice and physical activity: Rational,
        influences, and leverage points. Nutrition Reviews, 59(3 Pt 2):S21-S39; discussion S57-
       Crespo CJ, Smit E, Troiano RP, Bertlett SJ, Macera CA, Andersen RE. (2001).
        Television watching, energy intake, and obesity in US children: Results from the third
        National Health and Nutrition Examination Survey, 1988-1994. Archives of Pediatrics
        and Adolescent Medicine, 155(3):360-365.
       Frazao E. (1999). The high costs of poor eating patterns in the United States. In E. Frazao
        (Ed.), America’s eating habits: Changes and consequences (pp. 5-32). Washington DC:
        U.S. Department of Agriculture, Economic Research Services.

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       Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. (2001). Relationship
        of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa
        Hearth Study. Pediatrics, 108(3):712-718.
       French SA, Leffert N, story M, Neumark-Sztainer D, Hannan P & Benson PL. (2001).
        Adolescent binge/purge and weight loss behaviors: Associations with developmental
        assets. Journal of Adolescent Health, 28, 211-221.
       French SA, Story M, Jeffery RW. (2001). Environmental influences on eating and
        physical activity. Annual Review of Public Health, 22:309-335. Review.
       Goodman E, Whitaker RC. (2001). A prospective study of the role of depression in the
        development and persistence of adolescent obesity. Pediatrics, 110(3):497-504.
       Kalakanis LE, Goldfield GS, Paluch RA, Epstein LH. 2001. Parental activity as a
        determinant of activity level and patterns of activity in obese children. Research
        Quarterly for Exercise and Sport, 72(3):202-209.
       Mellin AE, Neumark-Sztainer D, Story M, Ireland M, Resnick MD. (2002). Unhealthy
        behaviors and psychosocial difficulties among overweight adolescents: The potential
        impact of familial factors. Journal of Adolescent Health, 31(2):145-153.
       Romero AJ, Robinson TN, Kraemer HC, Erickson SJ, Haydel KF, Mendoza F, Killen JD.
        (2001). Are perceived neighborhood hazards a barrier to physical activity in children?
        Archives of Pediatrics & Adolescent Medicine, 155(10):1143-1148.
       Sallis JF, Conway TL, Prochaska, JJ, McKenzie TL, Marshall SJ, Brown M. (2001). The
        association of school environments with youth physical activity. American Journal of
        Public Health, 91(4):618-620.
       Schmitz KH, Lytle LA, Phillips GA, Murray DM, Birnbaum AS, Kubik MY. (2001).
        Psychosocial correlates of physical activity and sedentary leisure habits in young
        adolescents: The Teens Eating for Energy and Nutrition at School study. Preventive
        Medicine, 34(2):266-278.
       Wang G, Dietz WH. (2002). Economic burden of obesity in youths aged 6 to 17 years:
        1979-1999. Pediatrics, 109(5):E81-E81.
       Wetter AC, Goldberg JP, King AC, Sigman-Grant M, Baer R, Crayton E, et al. (2001).
        How and why do individuals make food and physical activity choices? Nutrition
        Reviews, 59(3 Pt 2):S11-S20;discussion S57-S65.

Programs and Policies

       Agron P, Takada E, Purcell A. (2002). California Project LEAN’s Food on the Run
        Program: An evaluation of a high school-based student advocacy nutrition and physical
        activity program. Journal of the American Dietetic Association, 102(3 Suppl):S102-S105.
       Baskin ML, Ahluwalia HK, Resnicow K. (2001). Obesity intervention among African-
        American children and adolescents. Pediatric Clinics of North America, 48(4):1027-
        1039. Review.
       Burgeson CR, Wechsler H, Brener ND, Young JC, Spain CG. (2001). Physical education
        and activity: Results from the School Health Policies and Programs Study 2000. Journal
        of School Health, 71(7):279-293.
       Deitz WH, Gortmaker SL. (2001). Preventing obesity in children and adolescents.
        Annual Review of Public Health, 22:337-353. Review.

Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health and
National Adolescent Health Information Center, UCSF
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       Dwyer J, Cosentino C, Li D, Feldman H, Garceau A, Stevens M, et al. (2002). Evaluating
        school-based interventions using the healthy eating index. Journal of the American
        Dietetic Association, 102(2):257-259.
       Hoelscher DM, Evans A, Parcel GS, Kelder SH. (2002). Designing effective nutrition
        interventions for adolescents. Journal of the American Dietetic Association, 102(3
       McKenzie TL, Stone EJ, Feldman HA, Epping JN, Yang M, et al. (2001). Effects of the
        CATCH physical education intervention: Teacher type and lesson location. American
        Journal of Preventive Medicine, 21(2):101-109.
       Patrick K, Sallis JF, Prochaska JJ, Lydston DD, Calfas KJ, Zabinkski MF, et al. (2001).
        A multicomponent program for nutrition and physical activity change in primary care:
        PACE+ for adolescents. Archives of Pediatrics & Adolescent Medicine, 155(8):940-946.
       Story MT, Neumark-Sztainer DR, Sherwood NE, Holt K, Sofka D, Trowbridge FL,
        Barlow SE. (2002). Management of child and adolescent obesity: Attitudes, barriers,
        skills, and training needs among health care professionals. Pediatrics, 110(1 Pt 2):210-
       U.S. Office of the Surgeon General. (2001). The Surgeon General’s call to action to
        prevent and decrease overweight and obesity. Rockville, MD: U.S. Office of the Surgeon

Other web sites with up-to-date readings: The following web sites are sources of the most current
publications on middle childhood and adolescence:

       MCH Library,
        The MCH Library is a virtual guide to Maternal and Child Health information compiled
        by library staff as well as pathways to MCH information available on other web sites,
        from organizations and in libraries.
       PubMed,
        PubMed, a service of the National Library of Medicine provides access to over 12 million
        MEDLINE publications. It provides links to many sites providing full text articles.

Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health and
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                          Case Studies and Class Assignments
The following assignments were designed to allow students to explore course topics in further
depth and encourage practical application of public health competencies to the topic of nutrition
and physical activity for middle childhood and adolescent health. Activities can be adapted for
either long or short-term assignments. Some activities can be implemented during class time.

    1. Choose a state or federal level bill related to preventing overweight and obesity among
       children and adolescents (e.g., banning soda contracts in schools, school lunch
       requirements, school physical education requirements, sale of competitive foods,
       corporate sponsorship of soft drinks in vending machines). Research the history of the
       bill including the impetus for its creation, who authored the bill, advocates involved in
       getting the bill passed, and proceedings of the hearings as the bill moved through the
       Legislature’s committees. Prepare a 3 to 5 page summary of how the bill went from
       inception to passage into law, including challenges to the bill along the way and a
       summary of arguments against the bill. Also include any information about
       implementation of the new policy and any resulting challenges or unexpected benefits.

    2. You are a County Maternal, Child and Adolescent Health Director in the process of
       conducting your local Title V needs assessment which will be incorporated into the
       statewide Title V proposal. The state has decided to focus on childhood overweight and
       obesity during this planning process.
           a. It is your responsibility to look at overweight and obesity rates, and physical
              activity and dietary behaviors among young people in your county. Gather
              information and make a compelling argument why the data demonstrates a need
              for a focus on this area.
           b. Conduct an assessment of your county’s capacity to address the issue of
              childhood overweight and obesity. In your capacity assessment, determine what
              school policies are in place to promote physical activity and nutrition, the
              organizations and programs available in your county, coalitions aimed at
              improving resources and coordination for overweight and obesity prevention,
              barriers young people face related to nutritious eating and engaging in physical
              activity, funding streams, availability of trained professionals, best practices being
              used in school and community programs, etc. You may need to interview
              professionals in the community in order to obtain some of the information for
              your capacity assessment.
           c. Gather the appropriate information and prepare a report that makes
              recommendations for how Title V funds should be used for the prevention of
              childhood overweight and obesity.

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    3. Over the last decade, overweight and obesity has been increasing rapidly among children
       and youth in the United States. A great deal of attention is being paid to this issue and the
       federal government has created new funding streams to support programs aimed at
       obesity prevention. There is some research about programs that have proven effective at
       reducing obesity among youth of different ages and ethnicities. You work in a rural
       community with many Latino and African American families. Your community has
       recently received a planning grant for a three-year obesity prevention initiative. The
       coalition you have put together has conducted a needs assessment, identified improving
       dietary practices and increasing physical activity as priorities, and is ready to design an
       intervention. Some research is available on programs that have been effective at
       increasing good nutrition and exercise behaviors and decreasing obesity. However, many
       of these programs were implemented with young children or in urban settings.
           a. Review the most current literature and write a summary of what programs have
               been found to be effective at achieving the outcomes your community has
               selected, strategies used, and populations and settings for which they have been
           b. Provide an analysis of what would be the most appropriate set of interventions for
               your community. Be sure that your interventions address overweight and obesity
               prevention at multiple levels (individual, family, school/community, and policy).
           c. Describe how you would engage the community in selecting or designing a
               culturally appropriate intervention.
           d. Describe how your strategies would address the issue of the built environment.
           e. Describe what evaluation strategies and indicators you would use to monitor

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       AGRICultural OnLine Access (AGRICOLA),
        AGRICOLA is the National Agricultural Library’s (NAL) online database. Publications
        and resources in the database encompass all aspects of agriculture and allied disciplines,
        including nutrition. The database includes sources from the NAL collection as well as
        items cataloged by other libraries. Bibliographic records are organized into two data sets
        (books and journal articles) that must be searched separately.
       American Academy of Pediatrics,
        This web site allows you to search abstracts of articles from the periodical Pediatrics, the
        peer-reviewed scientific journal of the American Academy of Pediatrics. The web site
        also contains policy statements, clinical practice guidelines, and educational materials on
        nutrition and fitness.
       American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD),
        This is a professional organization for health, physical education, recreation and dance
        professionals and educators. The sight contains information on current legislation related
        to recreation and physical activity.
       American Dietetic Association,
        This site contains educational resources for professionals and consumers on nutrition,
        including fact sheets and tips, guidebooks, policy information, position papers, and
        professional practice guidelines.
       American School Food Service Association,
        This site contains information, research and policy updates about school food service
        programs and school based nutrition education. Resources available on the site include
        tools for administering the National School Breakfast and Lunch Programs; sample
        school nutrition policies, meal pattern requirements, nutrition education lessons, and
        information about starting a nutrition advisory council in schools.
       Bright Futures,
        Bright Futures offers materials and practical tools for health professionals, families and
        communities to promote the health of infants, children and adolescents. Bright Futures is
        funded by the US Maternal and Child Health Bureau. Fact sheets and guidebooks on
        physical activity and nutrition are available on the web site.
       Center for Weight and Health (UC-Berkeley),
        This web site contains research and policy analysis related to physical activity and
        nutrition, information about model programs, educational tools and materials, national
        data on obesity, hunger, physical activity, and diet.

       Centers for Disease Control and Prevention:
           o Data2010: The Healthy People 2010 Database,
               This web site contains the most recent monitoring data for tracking Healthy
               People 2010 objectives. Data can be sorted by focus area, population, objective
               and data source.
           o Division of Adolescent and School Health (DASH),
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                DASH contains a wealth of information about nutrition and physical activity,
                including data and statistics on school health policies and programs, and relevant
                youth behaviors monitored by the Youth Risk Behavior Survey. The site also
                contains school health guidelines for nutrition and physical activity, and self-
                assessment and planning tools.
            o Guide to Community Preventive Services,
                The Community Guide is a resource being developed by a non-federal Task Force
                on Community Preventive Services, appointed by the Director of the Centers for
                Disease Control. The online resource provides a systematic review of the
                effectiveness of strategies aimed at increasing physical activity.
            o National Center for Health Statistics, National Health and Nutrition Examination
                Survey (NHANES),
                NHANES is a survey that collects information about the health and diet of people
                in the United States. It combines a home interview with a physical examination
                that is conducted in a Mobile Examination Center. Data sets, data briefs, fact
                sheets, reports and charts are available on the web site.
            o Growth Charts,
                These growth charts consist of a series of percentile curves that illustrate the
                distribution of selected body measurements in U.S. children. The growth charts
                consist of 16 charts (8 for boys and 8 for girls) and include two new body mass
                index-for-age (BMI) charts for boys and girls ages 2 to 20 years. BMI is
                calculated from weight and height measurement and is used to judge whether an
                individual is overweight or obese. The Growth Chart web site provides access to
                the growth charts and educational materials about how to use them.
       Children’s Nutrition Research Center (CNRC),
        This web site contains child and adolescent obesity resources for health professionals,
        parents, and educators including research and training information, consumer news
        articles and facts, a newsletter, and links to other web sites. CNRC is a project of the
        Baylor College of Medicine, Texas Children’s Hospital, and the US Department of
        Agriculture/Agricultural Research Service.
       Education Resources Information Center (ERIC) Database,
        ERIC is a clearinghouse of information and resources related to education. Journal
        articles, lesson plans and other resources related to nutrition and physical activity can be
        accessed using ERIC’s simple search system.
       Food Research and Action Center (FRAC),
        FRAC is a national organization that aims to improve policies to eradicate hunger and
        undernutrition in the United States. Their web site contains news and analyses, research,
        state profiles and program information and materials about hunger and its impact on low-
        income families with children. It also contains information about food assistance
       Healthier US,
        Healthier US is a federal initiative to reduce obesity, diabetes, and smoking. The web site
        contains information for the general public on nutrition, physical activity, smoking
        cessation and preventive screening. The web site also includes information about the
        Steps to a Healthier US Initiative. Steps to a Healthier US is a 5-year Initiative sponsored
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        by the Department of Health and Human Services to sponsor community-based chronic
        disease prevention and control programs.
       Healthy Kids Challenge,
        The Healthy Kids Challenge web site is a guide for schools, families and communities to
        create solutions that promote the health of children. Cooking Light staff and volunteers
        created the challenge to raise awareness and encourage healthy changes in the eating and
        activity habits of school children. The web site offers tips and tools schools, parents and
        communities for improving nutrition and increasing physical activity among children.
       Maternal and Child Health Library, Knowledge Paths,
        The MCH Library maintains web based lists of the most recent resources and tools on a
        variety of topics related to maternal and child health, including adolescent nutrition,
        obesity, and physical activity. Each knowledge path contains web sites, electronic
        publications, journal articles, books, reports, publications, databases and electronic
        newsletters and discussion groups.
       National Association of State Boards of Education,
        NASBE is an association that represents school boards and seeks to strengthen state
        leadership for educational policy-making and promote excellence in education. The web
        site includes policy briefs on topics such as school physical activity and nutrition
        education programs, including “Fit, Healthy and Ready to Learn: Physical Activity,
        Healthy Eating and Tobacco Use Prevention (Parts 1 and 2)” and “State Policies on the
        Sale of Food and Beverages at School”.
       National Coalition for Promoting Physical Activity (NCPPA),
        NCPPA is a partnership between the American College of Sports Medicine, the
        American Heart Association, and the American Alliance for Health, Physical Education,
        Recreation and Dance. The web site contains facts, legislative information, Web
        resources, contact information for state coalitions, and other resources aimed at
        improving the nation’s health by increasing physical activity at the national, state, and
        local levels.
       National Governor’s Association Center for Best Practices,
        The NGA Center for Best Practices helps Governors and their policy staff develop and
        implement innovative solutions to challenges facing their states by providing technical
        assistance, identifying and sharing best practices, and exploring emerging national trends.
        Their web site includes a policy brief on what states can do to prevent obesity, entitled
        “The Obesity Epidemic – How States can Trim the Fat.”
       National Heart, Lung, and Blood Institute (NHLBI),
        NHLBI provides health information for providers and the general public, research,
        publications, grant information, and clinical guidelines on a variety of topics including
        obesity. NHLBI supports several programs aimed at increasing physical activity levels
        including Hearts N’ Parks that helps park and recreation agencies encourage heart-
        healthy lifestyles and JumpSTART which is a school based program that offers
        elementary school teachers activities to promote active healthy lifestyles for children in
        grades 3-5.
       National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),

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        Provides health professionals and consumers with science-based information on obesity,
        weight control, and nutrition as part of its Weight-Control Information Network (WIN).
        Resources include fact sheets, article reprints, research program descriptions, clinical
        nutrition and obesity lecture series videotapes, and a quarterly newsletter.
        Contains links to federal government Web sites about nutrition, dietary guidelines,
        physical activity, food safety, and food assistance programs. There are also links to
        federally sponsored research, reports and brochures.
       PE Central,
        This web site for physical education (PE) teachers, parents and students provides the
        latest information about developmentally appropriate physical education. The web site
        includes lesson plans, assessment ideas, instructional resources, guidelines for adapting
        programs for students with disabilities, PE standards and guidelines, grant information
        and listservs.
       President’s Council on Physical Fitness and Sports (PCPFS),
        Includes information for school professionals, health care and fitness professionals,
        students and the general public. Also includes summaries of the latest scientific research,
        federal publications on physical fitness, and information about the President’s Challenge
        and the President’s Sports and Fitness Award.
       Project LEAN,
        Project LEAN conducts policy advocacy and public education to promote physical
        activity and nutritious eating among Californians. Their web site contains educational
        materials, lesson plans and policy guides such as the Healthy Food Policy Resource
        Guide for school boards and a guide for taking community action against school soda
        contracts. A wealth of other reports can also be found on the web site including literature
        reviews and program evaluations. Their web site also features a geomapping program
        which is an interactive internet-based Geographic Information System (GIS) that allows
        users to view and query mapped nutrition data in California.
       Surgeon General’s Home Page,
        The web site for the Office of the Surgeon General makes available the following reports:
        The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity
        and Physical Activity and Health: A Report of the Surgeon General.
       US Department of Agriculture
            o Eat Smart. Play Hard.
                 Eat Smart. Play Hard. is a national nutrition education and promotion campaign of
                 the USDA Food and Nutrition Service. The campaign is aimed at children ages 2-
                 18 and seeks to encourage families to adopt behaviors that are consistent with the
                 Food Guide Pyramid and Dietary Guidelines for Americans, communicate
                 behavioral and motivational nutrition education and physical activity messages to
                 children and caregivers, foster positive behavior change to promote nutrition and
                 health, and reduce the risk for obesity and chronic diseases. The site contains
                 educational materials for children, parents and professionals.
            o Food and Nutrition Information Center (FNIC) Databases,
                 FNIC collects and disseminates information about food and nutrition. The site
                 contains information and links for day care providers, school personnel, and
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                health and nutrition personnel. The site also has a searchable database of print
                educational materials, audiovisuals, research and reports, games and activities and
            o Child Nutrition Program,
                This web site explains the USDA’s programs for children, including the National
                School Lunch Program, the School Breakfast Program, the Special Milk Program,
                the Summer Food Service Program, and the Child and Adult Day Care Food
       U.S. Department of Health and Human Services, Health Resources and Services
        Administration, Maternal and Child Health Bureau,
        The Maternal and Child Health Bureau hosts a series of live, interactive internet webcasts
        on a variety of Adolescent Health topics, including physical activity and nutrition.
        Experts in the field give live presentations and respond to questions submitted via email.
        Transcripts, Power Point slides and audio files of webcasts are archived on the web.

Sample PowerPoint Presentation
Presentation overview

       Discuss overweight and obesity
       Show current trends in data
       Discuss nutrition and its link to overweight and obesity
       Discuss physical activity and its link to overweight and obesity
       Provide an overview of environmental factors that affect adolescents’ nutrition/physical

For more information on this presentation, please download the PowerPoint presentation by

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