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Running head: PROJECT HEALTHY KIDS

Project Healthy Kids Chula Vista


Anna Alejo
Camille Pinano
Michael Sibal
May 31, 2014
COH 380
National University

PROJECT HEALTHY KIDS

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Introduction

Amidst the vast array of health problems seen in America today,


obesity amongst children is perhaps one of the most unfortunate, prevalent,
and deadly public health issues that is affecting a number of populations
nation wide, including many in our own city. According to the County of San
Diego, Health and Human Services Agency (County of San Diego, Health and
Human Services Agency, 2012), obesity generally means to have a body
weight greater than what is perceived as healthy for ones height. However,
it is considered childhood obesity when a childs body mass index is greater
than the 85th percentile, but lower than the 95 th percentile (HHSA, 2012).
Additionally, childhood obesity may result from a number of risk factors
including: age, gender, genetics, socioeconomic status, dysfunctional home
life, or lack of physical activity. Consequently, children who are considered
obese have greater chances of experiencing chronic health complications
such as cardiovascular disease, diabetes, breathing problems, and even
cancer. Taking all of these negative factors into consideration, it is crucial
that health programs are designed to reverse the affects of childhood
obesity, and utilize the right tools to prevent more children from being
affected by this epidemic. It is our job as public health professionals to take
advantage of program models such as the precede-proceed model, in order
to effectively design and implement a program that meets the communitys
needs, accomplishes a goal, allows for intervention, and is clearly evaluated
to ensure quality, progress and success.

PROJECT HEALTHY KIDS

Needs Assessment
Phase1
Phase1inthePrecedeProceedmodeliscomposedofasocialassessmentandfocusesonquality
oflife(Mckenzie,Neiger,Trackeray,2013).Manychildrenwhoareobesehaveapoorquality
of life, thus creating low selfesteem. However, schools are capable of promoting physical
educationprogramsthatmayimprovequalityoflife(Story,Kaphingst,French,2006).Schools
that promote physical activities influence students to want to become fit and improve their
overallhealth.(Story,etal,2006).Withinphysicaleducation,itisimportanttoimprovethe
qualityoflifeamongstudentsespeciallythosewhoareconsideredobese,oratriskofbecoming
obese.Studentslearningaboutgeneralhealthandvariousphysicalactivitieswillboosttheir
knowledge,skills,andconfidencewithinthemselveswhichresultsinhigherselfesteem(Story,
etal,2006).
Phase2
PrecedeProceedPhase2entailstheepidemiologicalassessment,thisstepfocusesonspecific
healthissueswithinacommunityandusesdatatohelpidentifyhealthgoalsorproblemsthat
maydealwithPhase1(Mckenzie,etal,2013).Phase2includesgenetics,environmental,and
behavioralfactorsaswellasmorbidityandmortalitydata(Mckenzie,etal,2013).Accordingto
Centers for Disease Control and Prevention, In 20072008 almost 17% of children and

PROJECT HEALTHY KIDS

adolescentsaged219yearswereobese.Childhoodobesityoftentrackstoadulthoodand,inthe
shortrun,childhoodobesitycanleadtopsychosocialproblemsandcardiovascularriskfactors
such as high blood pressure, high cholesterol, and abnormal glucose tolerance or diabetes,
(CDC,2010).EnvironmentalfactorsfromPhase2playahugeroleonchildhoodobesitydueto
lackofphysicalactivityandlackofaccesstohealthierchoicesoffoods.Therearevarious
communitiesthatdonthaveparksorrecreationcenterswhichmakesitdifficulttoallowfor
physicalactivityamongchildren(CDC,2013).Insomeareas,specificallymoreofthelower
incomeenvironmentsthereislessaccesstohealthieraffordablefoods,causingchildrentohave
toresorttothelesshealthyfoodsthatarebeingsoldinsupermarkets,conveniencestores,and
fastfoodrestaurants(CDC,2013).Therearewaysinwhichobesityinchildrencanbeprevented
asstatedbyCountyofSanDiego,HealthandHumanServicesAgency(HHSA,2012)suchas
building safeenvironments such as parks and playgrounds forchildren that allow access to
exerciseandotherformsofphysicalactivity(HHSA,2012).Anotherfactorthatcanpotentially
helptheenvironmentisbyprovidinghealthierfoodoptionsinsupermarketsandaswellhave
farmersmarketsthathavefreshproduce(HHSA,2012).
BehaviorinPhase2ofthePrecedeProceedmodelfocusesontheactionsthataretaken
amongindividualsthatleadsthemtobeatriskofadisease.Therearebehavioralriskfactorsthat
leadtoobesityinchildren.InmiddleschoolsintheU.S,over50%ofthesecampusesprovide
sugarydrinksandfoodthatisunhealthyandisofferedforpurchase(HHSA,2012).Asaresult,
schoolagedchildrendrinkthesesugarybeveragesandconsumeunhealthyfoods,whichresults
inunhealthyweightgainandotherhealthcomplications.Advertisementsoflesshealthierfoods
arewidelyusedwithinnearlyhalfofmiddleschoolcampuses,whichpreventsstudentstomake

PROJECT HEALTHY KIDS

healthier decisions (HHSA, 2012). Advertising of non healthy foods influences a students
behavioronchoosingahealthieroptionbecauseitenticestheminchoosingsomethingunhealthy
oversomethingthatcanbenefittheirbodies.Anotherreasonfortheincreaseinobesityamong
childrenistheuseoftechnologysuchascomputersystemsandtelevision,becauseitcreatesa
sedentary lifestyle (HHSA, 2012). There are prevention strategies in order to change the
behavioramongchildrenwhoarebecomingobese.Parentsarecapableoflimitingthetimespent
ontechnologyto1or2hoursaday(HHSA,2012).Inaddition,parentscanensurethatany
childcarefacilityisservingtheirchildhealthyfoodsandarrangingsomesortofphysicalactivity
foratleastonehouraday(HHSA,2012).
GeneticsisanotherportioninPhase2ofthePrecedeProceedmodel.Geneticfactorsas
wellasfamilyhistoryplayalargeroleonobesityinchildren(HHSA,2012).Unfortunatelywith
geneticsthereisnopossibleprogramsthatcanbeusedtochangebiologicalfactors,however,it
ispossibletochangeachild'soutlookonunhealthyeatinginordertobenefitthemselves.By
educatingyoungstudentsabouthealthiereatinghabitsandinformingchildrenaboutriskfactors
thatpotentiallymayhappen,wecanencourageahealthyeatinglifestyle.Obesityleadstothe
riskofcardiovasculardisease(CVD)inchildrenanditmayincreaseachildsbloodpressureata
young age (HHSA, 2012). Diabetes is another risk factor that comes along with childhood
obesityaswellasvarioustypesofcancerthatmaydevelopinadulthood(HHSA,2012).There
areadditionalhealthproblemsthatmayleadtoobesityamongchildrensuchasbreathingissues
likeasthma,fattyliverdisease,jointproblems,andirondeficiency(HHSA,2012).Byeducating
studentsabouttheseriskfactors,wemaybeabletohelpmodifyeatinghabitsandencourage
morephysicalactivityconsideringgeneticscannotbechanged.

PROJECT HEALTHY KIDS

Phase3
Eating unhealthy food and lack of physical activity are often recognized during childhood.
Luckily, the home environment can encourage healthy habits and modify unhealthy habits.
Parentshaveadeepinfluenceonchildrenbypromotingpositiveprinciplesandattitudes,by
gratifyingorreinforcingparticularbehaviors,andbeinggoodrolemodels.Parentsarethepolicy
makersforthehome.AccordingtoStory,Kaphingst,andFrench,parentsmakedailydecisions
onfood,especiallyfoodsbroughtintothehome,andwhatmealsareeatenoutsidethehome.In
addition,theymayimplementnumerousrulesandpoliciesthatinfluencehowmuchdiverse
membersofthefamilycanengageinhealthfuleatingandphysicalactivity.
Parentsshouldencouragephysicalactivityinterests,andimproveanycircumstancesfor
themtoplayoutsideandbecomeinvolvedinbothrecreationalactivities,aswellasincorporating
anactivelifestyleintotheirdailyroutines.Furthermore,parentsshouldsetboundariesontheir
childrens TV viewing and other leisure time such as video or computer game playing.
AccordingtoWechsler,Mckenna,Lee,andDietz,besidesparents,schoolsplayasignificantrole
becauseover95percentofyoungpeopleareenrolledinschools.Schoolshavetheabilitytofit
manyintotheschoolday,andmustbalancestateandlocalresources,priorities,andneedsfor
education(Story,etal,2006).Schoolscanencouragestudentstoparticipateinphysicalactivity
throughtheirschoolprogramssuchasrecess,classroombasedphysicalactivity,recreational
sportsclubs,interscholasticsports,andphysicaleducation.Theseactivitieskeepchildrenactive
inschool,allowingthemtoparticipateinphysicalactivity.Physicaleducationcanhelpimprove
skills,developknowledge,andhaveconfidencetobephysicallyactivebothinandoutofschool
andthroughouttheirlives(Story,etal,2006).

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Physicalactivityismoreeffectiveasapreventativemeasurethanatreatmentofobesity.
Lackofphysicalactivityatschoolorathomeinchildrenisoneoftheprimaryfactorsthatlead
to childhood obesity. There areways that the school andcommunities canoffer important
resourcesforthefamilies.Story,etal,(2006),statedthat,communities,families,schooldistricts,
andgovernmentatalllevelhadbegunassemblingtoassistfamiliestohaveanactivecommunity
by improving pedestrian and biking safety, adding crossing guards, mapping safe routes to
schools,formingsuchprogramsliketheWalkingSchoolBus,NationalWalkOurChildrento
SchoolDay,andanyothercampaignsthatpromotehealthylifestyle.
Program Goal & Objectives
Goal
The goal of our program is to reduce the prevalence of childhood obesity
amongst Latino and Black minorities in the Chula Vista area of San Diego,
California.
Objectives

Objective 1 (Process Objective): By the start of our program, July


28th, 2014, program planners will take an inventory of all media
materials specific to obesity, nutrition and fitness, that are distributed
in the Chula Vista Elementary School District.

Objective 2 (Learning Objective): By the midpoint of our program,


25 percent of children participating in our program will understand and
be aware of the severity of obesity.

Objective 3 (Behavioral Objective): By the end of our program, 50


percent of children participating in our program will have changed their
eating habits to more healthier food options.
Behavioral Objective 2: By the end of our program, 25 percent of
children participating in our program will have assisted in preparing
meals at home.

PROJECT HEALTHY KIDS

Behavioral Objective 3: By the end of our program, 15 percent of


the parents of the children who have participated in our program will
have attended 5 nutritional meal-planning classes offered at
participating elementary schools.

Objective 4 (Environmental Objective): By the start of our


program, July 28th, 2014, ten participating schools will work with Chula
Vista Elementary School District transportation services, to provide
buses for participating children to recreational centers, and community
parks after school, within the neighborhood.

Objective 5: (Outcome Objective) By the end of our program (when


children reach the 7th grade), 50% of children participating in our
program will have reduced their BMI levels, their cholesterol, and blood
sugar levels. Good. Although you might turn these into 3 objectives if
your activities are different for each.
Interventions & Strategies

As with any health promotion program, specific interventions and strategies


are necessary for ensuring results, and ultimately, success. Now that our
goal and objectives have been established, it is important to have effective
and efficient activities that will fulfill them. Additionally, in order to ensure
good outcomes, our program utilized the Social Cognitive Theory to be a
foundation of our interventions and activities. Established by Albert Bandura
in the 1960s, the Social Cognitive Theory, or the SCT focuses on the
interaction between individuals, and their immediate environments (Edberg,
2015).

Furthermore, the SCT highly emphasizes the importance of self-

efficacy, which is the level of confidence that an individual can change or


perform a behavior, and vicarious learning, which is when an individual
learns by observing the behavior of others. Both are key components in
behavior change, especially when dealing with changing health behaviors
that lead to obesity. Through the interventions of our program, we want to

PROJECT HEALTHY KIDS

increase self-efficacy amongst both children, and their parents, while also
promoting vicarious learning, considering children are likely to learn best by
observing the behavior of others.
Process Objective Activity
In order to fulfill our programs process objective, program planners and
trainers will take an inventory of all educational materials that will be
distributed throughout the Chula Vista Elementary School District for our
program. These materials will include age, and reading level appropriate
charts, pictures, posters, videos, models, and take home information packets
for parents. By taking an inventory of all our educational materials, we will
be able to measure how effective, or ineffective they were at the various
schools they were used at. Additionally, through this activity, we will be able
to establish a better relationship with the schools we are working with.

Learning Objective Activities


To effectively utilize the vicarious learning aspect of the SCT in our
interventions, our program will provide educational classes on the health
risks, and consequences of being obese. Through this intervention, which is a
health education strategy, our program will utilize guest speakers who were
previously obese, who will encourage the participants to live healthier
lifestyles, in order to avoid the health complications that come with obesity.
Additionally, our program will utilize educational materials such as posters

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and cartoon videos on what obesity really is, and the various health
problems associated with this disease. Moreover, our health educators will be
trained to associate being healthy with being cool, in order to allow the
children to learn vicariously through them, who will be perceived as cool
role models. Through this intervention, we will be able to expand our
participants knowledge and awareness of the consequences of obesity.
Behavior Objective-Activity 1
Our first activity to change behavior is a health communication strategy, in
which we will introduce our participants to healthier foods and eating habits
by

distributing

choosemyplate.gov

plates

that

clearly

demonstrate

recommended healthy foods and ideal daily serving sizes. With these plates,
children will be able to take them home to their families, and use them as a
guide for how much food is healthy to eat per meal. By providing this health
tool for children, we will be able to increase their self-efficacy to change how
much food they are eating, and more importantly, to change what types of
food they are eating.

Behavior Objective-Activity 2
Our second behavior change activity is to further educate children about
changing their eating habits by live food and cooking demonstrations in
class. Local farmers market representatives will bring in samples of fresh
organic fruits and vegetables, in order to teach the participants about the

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health benefits of eating fresh produce, as opposed to the unhealthy benefits


of processed fast food. Additionally, children will be able to participate in live
cooking demonstrations by local cooks, which will provide the children with
hands on experience with fresh food, and meal preparation. Through these
activities, children will gain more self-efficacy in making healthier food
choices, while also giving them the confidence to prepare healthy snacks
that are easy enough for them to make on their own. Furthermore, the
participating children will be encouraged to be more involved with food
preparation at home, and will be able to assist in picking healthier food
options for their families.
Behavior Objective-Activity 3
Our third behavior change activity is aimed at allowing the parents of our
participants to learn more about healthy meal preparation, in order for them
to alter the way they are cooking at home. Our program will offer healthy
cooking classes for parents two nights a week, at their childrens schools.
These classes will demonstrate how to cook healthy alternatives to
traditional dishes, while also educating them on the healthy benefits of
shopping at local health food stores, as opposed to buying fast food for their
children. Moreover, parents will be educated on how to read labels properly,
so that choosing healthier items at the grocery store will be easier to do.
Additionally, the cooking classes will be instructed by parents who are
experienced in preparing healthy meals for their families, in order to
encourage vicarious learning for the parents who are attending the classes.

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We want to show the parents of our participants that cooking healthier meals
is not only beneficial for their familys health, but it can also be very easy,
and more convenient than they think.
Environmental Objective Activities
For our environmental objective, we will utilize an environmental change
strategy in which our program will work with ten campuses of the Chula Vista
Elementary School District to ensure that their transportation services will
provide bus rides to participating children to and from local recreational
centers, and neighborhood parks after school. At the recreational centers and
parks, our program will offer free sporting activities, dance lessons,
gymnastic sessions, and swimming exercises, in order to provide our
participants with a healthy, adequate amount of physical activity. Through
this intervention, we want our participants to build their self-efficacy in
changing their usual sedentary afterschool behavior, to active, healthy
behavior, while still keeping it enjoyable for them. Additionally, children who
initially refuse to make use of our after school physical educational program,
will most likely learn vicariously from children who do participate in this
activity, and hopefully will decide to participate as well.
Outcome Objective Activity
Lastly, for our outcome objective, we would like to see all of our objectives
produce positive, successful results. By the time our participants are in the
7th grade, our program staff will measure BMI levels, cholesterol, and blood

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sugar levels, in order to assess if our interventions were effective, or


ineffective.

Program Considerations
Resources
In order to achieve the goals and objectives of our Project Healthy Kids Chula
Vista program there are specific resources that are needed in order to have a
running program. Resources include program planners and trainers that
supply necessary materials to schools in the Chula Vista Elementary School
District. Another resource used will be guest speakers who were previously
obese and have changed their lives for the better. Farmers Market
representatives as well as grocery stores like Sprouts, will educate on
preparing easy nutritional foods and offering classes for healthy cooking. The
transportation services of the Chula Vista Elementary School District will
arrange for rides to and from recreation centers and parks. Kaiser
Permanente will allow the program to use their staff to measure BMI levels
among the children as well as educate on weight management and teach on
how to use a food log.
Marketing
PHKCV does not require the participants to pay for our services. Our
program will provide specific needs and aspiration for the children from
grades kindergarten to the 7th grade that are at risk of childhood obesity.
Some of the specific needs that our program will provide include educational

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materials, transportation services, nutrition classes, and physical activity


classes.

PHKCV will offer the students and parents the education and

support they will need and will obtain data to find out what is important to
them. PHKCV will make it easier for at risk children to become healthy eaters
and practice good behavior because we will also offer counseling services.
Changing the children and parents unhealthy eating and physical activity
behaviors, will send a strong message to other people in the community.
Getting the community more involved will encourage more widespread
success. Lastly, our program will be promoted to other schools and and
communities by word of mouth, social networking websites such as
Facebook, and Twitter, and by utilizing local radio and TV news stations.
Additionally, marketing materials that will be handed out in the community
will include pamphlets, brochures, and mini information packets that are all
age appropriate, culturally competent, and relevant to our program.
Program Evaluation
Phase 6- Process Evaluation
In order to successfully process evaluate Project Healthy Kids Chula Vista
(PHKCV), our program planners will first interview key informants from similar
programs that have been successful in reversing childhood obesity in
neighboring communities. Fortunately, our program planners have close
connections with Ashley Hyman MPH, who is the coordinator/validation
sample coordinator of The Healthy Smiles Program in La Mesa, California.
Through interviewing Hyman, our program planners will be able to adopt

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some of the strategies and methods of her program, to aid in the success
and quality for our program. Additionally, our program will conduct a pilot
test with smaller focus groups from our population to evaluate the quality of
our interventions. However, before beginning our pilot tests, they must first
be presented and approved by our stakeholders. During our pilot tests, we
will have children and their parents participate in our food preparation
activities (behavior change interventions) in order to see how they like them.
After our pilot test, we will have parents and their children fill out surveys,
asking what aspects they liked about our activity, what they would want to
be included to our activity, and what areas we could improve. These surveys
will then be interpreted by our evaluators, and presented in our monthly staff
meetings. Each month, staff meetings will be held, in order to assess the
quality and effectiveness of the current methods we are using for our
program, while also allowing for suggestions, recommendations, and general
feed back from both program planners and participants. Lastly, our program
will recruit an expert panel, consisting of members from other successful
health

promotion

programs

like

The

Healthy

Smiles

program,

and

experienced specialists on obesity, to provide our program with some last


pointers that will ensure quality, accuracy, and success for PHKCV.
Phase 7: Impact Evaluation
Assessing the knowledge, behavior, attitudes and skills of the participating
children and parents will be seen if the questionnaires, surveys, and
counseling had an impact on them. As programs planners of PHKCV, we will

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collaborate with the primary care, public health, schools, and community
organizations working with the parents and participating children in a target
population. In order to evaluate our behavioral objectives we will take
surveys of what children and their parents have been eating before our
program began and after our program ended. Team members will educate
both participating children and parents on the recommended healthy food
and ideal serving sizes. Furthermore, we will create laminated charts to
discuss BMI level, cholesterol levels, and blood sugar levels with the
participants.

Also we will also place bilingual health education materials,

posters, and prescription pads in all exam rooms. Primary care physicians will
promote a greater commitment to quality improvement efforts. In order to
evaluate our environmental objective, we will be handing out questionnaires
to children asking about how they like the after school activities and bus
services. Changes will be tested on small scale to analyze their impact
before adding in the change on a larger scale. In further research for similar
intervention in the community, a number of evidence-based questionnaires
were reviewed from the literature to measure their healthy eating habits and
physical activity behavior.
Phase 8: Outcome Evaluation
By the end of the PHKCVs program, when the children reach the 7 th grade,
approximately 50% of the children who participated will have decreased their
BMI levels as well as cholesterol and blood sugar levels. With our target
population being minority children in the Chula Vista, San Diego area we

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concentrated our focus on the Chula Vista Elementary School District. This
district was chosen due to its low socioeconomic location and the amount of
minority students that attend these schools who are obese. The evaluation of
this program will consist of the long-term benefits such as further education
of healthier eating habits, increase of physical activity and decrease of
sedentary activity, as well as determining if the programs set goals were
made. By the end of the program we intend to decrease the prevalence of
obesity among minority children in the Chula Vista Elementary School district
by lowering the risk factors with education on both healthy eating and
physical activity.

To determine if the programs goals and objectives were

met, participants will be provided surveys, questionnaires, and tests,


particularly through an experimental design in which our program will utilize
pretest and posttests. By using an experimental design, we can ensure
randomization,

and

strong

control

over

confounding

variables,

while

producing defensible evidence of effectiveness. Additionally, we will have a


final discussion on the over all effectiveness of our program and acquire the
services of an external evaluator. Since the external evaluator will be an
outside source and will not have any association with the program, this will
allow for unbiased feedback and accurate test results from our participants.
Once attaining answers from questionnaires, surveys, pretests/postests, and
our external evaluator, the results will determine how effective PHKCVs
program is either positively or negatively. The stakeholders, primarily the
school district, recreation centers, the volunteers, and organizations that

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donated to this program, will receive the evaluation from participants for
final assessments.
Conclusion
In conclusion, it is important to remember that we as public health
program planners, and evaluators need to design programs that are
effective, successful, and that meet all the needs of the communities we are
working with. Considering childhood obesity is a growing epidemic that is
impacting our youth worldwide, nationwide, and in our own city, it is crucial
that more programs like Project Healthy Kids Chula Vista are thought of and
implemented. By designing programs that target childhood obesity, we will
be able to work together ecologically to build healthier, safer, environments
that encourage physical activity, and promote healthy eating. Lastly, by
education and prevention, we will be able to instill in children and their
families the knowledge, and motivation that they need to reverse unhealthy
behaviors, and live healthier lives. Programs like Project Healthy Kids Chula
Vista will most definitely ensure a healthier Chula Vista, a healthier San
Diego, and ultimately a healthier world.

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July 28,
2014

Program planners will


take an inventory
material

Participants will change


their eating habits to
healthier food options

Participants will have


assisted meal-prepping

Parents of the
participants will have
attended 5 nutritional
meal-panning

Participants will have


reduced their BMI level,
cholesterol, and blood
sugar levels

July 28,
2020

Participants will be
aware of severity of
obesity

Participating schools
will provide
transportation for the
participating children

2017

Our Gantt chart covers the timeline of program objectives for Project Healthy
Kids Chula Vista

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References

CentersforDiseaseControlandPrevention(2010,December1).Obesityand
SocioeconomicstatusinChildrenandAdolescents:UnitedStates,20052008.
Retrievefromhttp://www.cdc.giv/nchs/data/databriefs/db51.htm
CentersforDiseaseControlandPrevention(2013,April17).OverweightandObesity.
Retrievedfromhttp://www.cdc.gov/obesity/childhood/problem.html
CountyofSanDiego,HealthandHumanServicesAgency,PublicHealthServices,
CommunityHealthStatisticsUnit.(2012,January).ChildhoodObesityBrief.
Retrievefromhttp://www.sdcounty.ca.gov/hhsa/programs/phs/documents/CHS
Criticalpathways2012.pdf
Edberg, M. (2015). Essentials of health behavior social and behavioral theory
in public health.
(2nd ed.). Burlington, MA: Jones & Bartlett Learning
McKenzie,J.,Neiger,L.B.,Thackeray,R.(2013).HealthPromotionsProgramsaprimer.
TheFutureofChildren.Story,M.,Kaphingst,K,M.,French,S.(2006).TheRoleof
SchoolinObesityPrevention.Retrivedfrom:www.futureofchildren.org
TheStateEducationStandard.,Wechsler,H.,Mckenna,M,L.,Lee,S,M.,DietzW,H.
(December,2004).TheRolesofSchoolinPreventingChildhoodObesity.
RetrivedonMay15,2014.Retrivedfrom:
http://www.cdc.gov/healthyyouth/physicalactivity/pdf/roleofschools_obesity.pdf

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