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HealthyMontgomeryObesityWorkgroup:Meeting5 Thursday,September20,2012GreenConferenceRoom,FirstFloor 401HungerfordDrive,Rockville,MD20850 4:00PM6:00PM MEETINGGOALS DiscussFeedbackfromHealthyMontgomerySteeringCommittee(HMSC) FormulationofObesitysubWorkGroup CommenceIdentificationofDesired Goal tasks AssignmentofWorkGroupmember ScheduleadditionalObesityWorkGroup meetingdates WelcomeandIntroductions Welcome,AgendaReview,ApproveMinutes(Co Chairs) DiscussionofCommentsfromHMSCregardingObesity Report(CoChairs) FormationofSubWorkGrouptoIntegrateObesity RelatedEfforts(DHHS) FinalizeObesityActionPlanContents(IPHi) DiscussionofGoalandObjectives ReviewofHMWebsite(DHHS) ReviewGoalDevelopmentWorksheetandDevelop GoalStatement(IPHi) ReviewofFederal,StateandLocalGoalsand Objectives(IPHi)

4:004:10PM

4:104:30PM

4:304:45PM 4:455:25PM

5:255:50PM

5:506:00PM

NextSteps/Adjourn ScheduleUpcomingMeetings(DHHS) ReviewHomeworkAssignments/Duedates Closing/Wrapup(CoChairs) PleaseleaveyourtentcardswithHealthyMontgomeryStaff

The mission of Healthy Montgomery is to achieve optimal health and wellbeing for Montgomery County, Maryland, residents. The Healthy Montgomery process is based upon an ongoing sustainable community and consensusdriven approach that identifies and addresses key priority areas that ultimately improve the health and wellbeing of our community.
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Healthy Montgomery Obesity Work Group Meeting

University of MD Extension Montgomery County Office 18410 Muncaster Road, Derwood, MD 20855 Thursday, September 6, 2012 2:00 4:00 PM Members Present: Linda Ashburn, Clark Beil, Wendy Friar, Carol Garvey, Linda Goldsholl, Jon Smink, Shari Targum, Jacquelyn Williams Members Absent: Marla Caplon, Mary Dolan, Cara Grant, and Jane Harkaway Healthy Montgomery Staff: Jeanine Gould-Kostka, Ruth Martin, Dourakine Rosarion and Colleen Ryan Smith IPHi Staff: Rejane Frederick and Evelyn Kelly Guests: Rammaya Byanjankar, Edeline Charles, Winnefred Ekoja and Janice Fullerton, Washington Adventist University students Materials distributed: Handout packet included: Agenda, Draft Minutes from the August 22, 2012 Obesity Work Group Meeting, HHS/ED Committee Obesity Prevention Discussion Introduction 7/31/12, Commission on Healths Obesity Recommendations Overview, Draft 2-Month Progress Report. Responsible Person/ Timeframe

Topic/Presenter Welcome and Introductions

Obesity Work Group Co-Chairs: Carol Garvey and Jon Smink Healthy Montgomery: Dourakine Rosarion; Ruth Martin; and Colleen Ryan Smith IPHi: Rejane Frederick and Evelyn Kelly

Key Points The meeting was called to order at 2:12 p.m. Mr. Smink welcomed everyone and thanked Ms. Ashburn for providing the space for the meeting. Obesity Work Group (OWG) Co-Chair Dr. Carol Garvey and members Dr. Shari Targum and Mr. Clark Beil joined the meeting by tele-conferencing. Ms. Ryan Smith discussed the availability of selected inpatient and emergency room visit data by zip code now available on the www.healthymontgomery.org.

Follow-up

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Topic/Presenter Minutes

Key Points Mr. Smink asked the Obesity Work Group (OWG) to look at the draft minutes from the August 22, 2012, meeting. MOTION: Dr. Targum made a motion to approve the August 22, 2012, Healthy Montgomery Obesity Work Group minutes. Ms. Jacquelyn Williams seconded the motion, which was approved unanimously by voice vote. Ms. Kelly discussed the agenda, which includes reviewing the current data sources on overweight and obesity and identifying disparities and identifying potential strategic issues based on current obesity prevention efforts in Montgomery County. Ms. Kelly asked the OWG members to break into two groups to identify obesity priority issues and target populations based on the Montgomery County Obesity Data Profile. Group 1: Dr. Garvey, Ms. Goldsholl, Dr. Targum and Ms. Williams focused on pages 3-9 of the obesity section as well as pages 27-33 of the chronic disease section. Group 2: Ms. Ashburn, Ms. Friar and Mr. Smink focused on pages 10-14 of the physical activity section as well as pages 15-26 of the chronic disease section. The groups were given 25 minutes to discuss the data and answer five questions to consider related to the data. 1. What does the data indicate? List any observations as you review the data. 2. Identify any disparities with specific populations. 3. Are there any data gaps? If so, are there any gaps in

Follow-up Approved minutes will be uploaded to the Healthy Montgomery web site

Responsible Person/ Timeframe Ms. Gould-Kostka

Agenda Review

Review of Current Data Sources and Identification of Disparities

Healthy Montgomery: Dourakine Rosarion; Ruth Martin; and Colleen Ryan Smith IPHi: Rejane Frederick and Evelyn Kelly

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Topic/Presenter

Key Points the data that the workgroup can address through their action plan? 4. Based upon your experience, risk-factors identified, and current data sources available, what priority issue (s) and target populations (s) do you recommend the workgroup address? 5. Provide a rationale or justification. List the criteria/factors you considered in arriving at the priority issue (s) and target population(s). There was discussion on the following: limitations on available data; the need for better data to help determine future funding opportunities; the need for a Montgomery County Supplemental Nutrition Program for Women, Infants and Children (WIC) program person to join the OWG; the need for more up-to-date obesity rates in the Latino population; an interest in determining how available data were collected; that Behavioral Risk Factor Surveillance System survey data are self reported; the need to expand the knowledge base of residents on the importance of physical activity and how to measure real physical activity; how presenting Montgomery County data with the state, U.S. data and targets (HP2020 and SHIP) would be useful during the objective development phase for the OWG. Ms. Kelly said that the OWG will be working to develop objectives and strategies in the near future.

Follow-up

Responsible Person/ Timeframe

Discussion

Ms. Ashburn will find the contact information for a WIC representative and share with HM staff.

Ms. Martin will contact the WIC representative.

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Topic/Presenter Overview of Current Obesity Efforts in Montgomery County and Discussion HHS/Education Committee Prevention Memo
Healthy Montgomery: Dourakine Rosarion

Key Points Ms. Kelly said that the OWG asked for presentations from groups within the County that have already been working on obesity issues. Ms. Rosarion discussed the July 30, 2012, information presented during the combined County Council Health and Human Services and Education Committee session on strategies to prevent childhood obesity. The County Council handout packet from that discussion can be found online. Discussion followed: the need for physical activities in Montgomery County to be added to the inventory. Ms. Goldsholl presented an overview of OPSG efforts. The OPSG brochure can be found online. The strategic areas highlighted by the OPSG included data collection, food environment (including their more recent work to offer healthy food options in vending machines within County facilities), focus on children/youth, disadvantaged communities, worksites, and the media. Discussion followed regarding walking routes and public safety; the difficulty of mounting an education campaign without funding; the Prince Georges County Community Transformation Grant (CTG); and the Montgomery County menu labeling and banning of trans fat policies. Dr. Targum presented an overview of the COH obesity prevention recommendations they made to the County Executive and County Council in 2012. Discussion followed regarding the Department of Economic

Follow-up

Responsible Person/ Timeframe

Obesity Prevention Strategy Work Group (OPSG) Linda Goldsholl

Commission on Health
(COH) Shari Targum

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Topic/Presenter

Key Points Development and farms and why children were the focus of physical activity recommendations rather than the entire population.

Follow-up

Responsible Person/ Timeframe

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Topic/Presenter Next Steps/Adjourn

Obesity Work Group Co-Chairs: Carol Garvey and Jon Smink

Status Report to Steering Committee

Obesity Work Group CoChairs: Carol Garvey and Jon Smink

Key Points Ms. Kelly asked the OWG to look at the outline of the 2Month Progress Report provided. She asked the group for final changes to the document, which will be presented to the Healthy Montgomery Steering Committee (HMSC) on September 10, 2012. Discussion followed on transportation issues rather than food desert issues in the county, limitations and gaps in data, and exploring ways the OWG can obtain better data sets; 311 to track questions on nutrition and obesity.
IPHi will make changes to the draft progress report and DHHS will send the document out to the OWG for one final proofreading.

Follow-up IPHi will edit the progress report

Responsible Person/ Timeframe Ms. Martin, DHHS, will circulate the updated progress report on 9/7/12 with final comments due by 3 p.m.

Identification of Key Reports, Strategic Plans, Objectives Homework

IPHi: Rejane Frederick and Evelyn Kelly

Ms. Kelly said that the OWG will next work on developing objectives. It is important for OWG members to prepare by reading all documents prior to meetings.

Scheduling Next Meetings

Healthy Montgomery: Jeanine Gould-Kostka

Ms. Gould-Kostka announced the upcoming meetings for the OWG. The next three meetings for the Obesity Work Group are as follows: Thursday, September 20, 2012, from 4:00 6:00 p.m. at 401 Hungerford Drive, Green Conference Room Wednesday, October 3, 2012, from 2:00 4:00 p.m. Wednesday, October 17, 2012, time to be determined.

Invitation packets, minutes, handout packets and agendas along with action planning materials are available online. Set up meeting logistics and share with the Obesity Work Group

HM staff will keep the HM web site up-to-date for use by the OWG.

Ms. Gould-Kostka

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Topic/Presenter

Key Points The OWG membership will be asked to determine if meetings can be scheduled for 2:00 4:00 p.m. on a regular basis at the September 20th meeting. OWG members were asked to consider hosting an upcoming meeting. Ms. Rosarion thanked Ms. Ashburn for hosting the meeting at the University of MD Extension Montgomery County Office and for the healthful refreshments. The meeting was adjourned at approximately 4:10 p.m.

Follow-up Set up meeting logistics and share with the Obesity Work Group.

Responsible Person/ Timeframe Ms. Gould-Kostka

Wrap-Up/Adjourn
Healthy Montgomery: Dourakine Rosarion

Respectfully Submitted: Dourakine Rosarion and Jeanine Gould-Kostka

Approved:

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QuestionsandCommentsfromtheHealthyMontgomerySteeringCommitteeMeeting September10,2012
Theitalicizedtextisstaffcomments. BehavioralHealthWorkGroup CouldHIPPAbecomeaconcernforpatientswiththeintegrationofsystemsparticularlyinthe EmergencyRoom?KevinYoungpointedoutthatexchangeofinformationbetweenandamong treatingprovidersisnotaHIPAAviolation. HastheWorkGroupresearchedothersmodelsofsystemintegrationforlessonslearnedand bestpractices?ActionItem:Researchhowotherjurisdictionshavehandledthisissue.Kevin YoungpointedoutthattheWorkGroupisactivelylookingatsolutionsfromotherprograms. WilltheWorkGroupconductamappingofthesystems?Systemmapping/inventoryof resourcesisimportantforallincomelevelsandnotjustlowincome. Howcanweintegrateprimarycareandbehavioralhealth?Canauniversalscreeningbe developed?ThisquestionwasfromSharonZalewskiofthePrimaryCareCoalition,which administerstheMontgomeryCaresProgram.JenniferPauk,whoisresponsibleforthe integrationofbehavioralhealthintotheMontgomeryCaresclinics,isjoiningtheWorkGroup. Expanduponpatientnavigationandtheintegrationofmedicalhomesasitisdifficulttofind behavioralhealthservices.Importanttohavenavigatorstohelptalkaboutresourcesandcost issues.KevinYoungpointedoutthatourpriorityissuesaddressthisconcern. Canolderadultsbeincludedinthediscussionofbehavioralhealthandhowdoyouaddressthe issueofaccesstoservices?ThisquestionwasfromTammyDuell,whoisontheCommissionon Aging.KevinYoungagreedthattheWorkGroupwouldconsiderseniors. Importanttoaddculturaldiversitytodiscussionofbehavioralhealth SCmembersnotedthatstrategieshavetobebroaderthanHHS Therewillbepressurefromoutsidegroupstotakeonallissues.HowwilltheWorkGroup addressthis?Howdowetriage?KevinYoungstatedthattheWorkGroupwillbeaddressingthis inthedevelopmentofactionplans. Howdowecollaborate(e.g.hospitals,CBOsetc.)inorderforthecommongood?

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AretherebarriersthattheWorkGroupmayencounteratthepolicy/systemlevelthatwill preventstrategiesfrombeingimplemented?IstheresomeonewhocouldbecomeaWork GroupmemberorpresenttotheWorkGroupwiththistypeofexpertise?

ObesityWorkGroup Mr.LeventhalsuggestedthattheMontgomeryCountyEmployeeWellnessReportbeaddedto theactionplan.ThisreportisnowavailableontheObesityWorkGroupWebPage. Mr.LeventhalisconcernedaboutthelanguageinreportaboutFoodDeserts.Hebelievesthat fooddesertsdontexistandthattheissueistransportation.Suggestedreframingtheissue. TherewasnotanopportunitytopointtotheMr.Leventhalthatthisisaddressedinthereport. RuthMartinwillprovidetheSteeringCommitteememberstheinformationonfooddeserts. Mr.Leventhalrequestedthatthefinalactionplanincorporatecurrentlocalactivitiesto prevent/reduceobesity,suchasOPSGscountyvendingmachineproject.Thiscanbeincludedin thefinalreportinasectiononapproachesalreadyinplaceinMontgomeryCounty.The AppendixontheInventoryofExistingProgramsandPoliciesthatAddressObesityin MontgomeryCountyisincludedintheactionplan.Additionally,theWorkGroupcanhighlightall relevantactivitieswithinthebodyoftheplanasissueareas/strategiesaredescribedinthefinal plan. Suggestiontoincludeworkthatschoolhasbeendoing(e.g.summermealprograms,breakfast programs)Thiscanbeincludedinthefinalreportinasectiononapproachesalreadyinplace inMontgomeryCounty. Suggestiontoincludeworkthatschoolhasbeendoing(e.g.summermealprograms,breakfast programs)Thiscanbeincludedinthefinalreportinasectiononapproachesalreadyinplace inMontgomeryCounty.TheAppendixontheInventoryofExistingProgramsandPoliciesthat AddressObesityinMontgomeryCountyisincludedintheactionplan.Additionally,theWork Groupcanhighlightallrelevantactivitieswithinthebodyoftheplanasissueareas/strategies aredescribedinthefinalplan. Suggestiontoexplorethepossibilityofconductingasurveyregardingtheeffectivenessofmenu labeling.Needtoconsidertheresourcesavailabletodothisinameaningfulway. Arethereotheralliesorentitiesthatcaneducatethepublicaboutsugarconsumptionand beverages(e.g.dentistoffice)

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ForBothWorkGroups GeneralassemblywillbemeetinginJanuaryandtheSCaskedifthereisanythingthattheWork Groupsfeelsthatisimportanttobringupatthattimeforreview?Timeisbeginningtorunshort onthislegislatorswillbegintosubmitproposedlegislationinearlyJanuary.

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ActionPlanTemplate OutlineofSectionsinFinalActionPlan
1) Introduction a) (DescriptionofHealthyMontgomery) 2) SummaryofkeyfindingsonAreaofFocus(Obesity,BH):includedocumentationof identifiedinequities,unhealthybehaviors,andlackofaccess) a) ProvidehighlightsfromHMNeedsassessment b) ProvidehighlightsfromDataProfile c) Providehighlightsfromassetmapping(inventory) 3) Context a) Overviewoftheboundaries/parametersofscopeforthisactionplanningwork group(achievable,outcomeneedstodemonstratechangein35years,no additionalresourcesavailable,etc.) b) Accomplishmentstodateinthisareaoffocus(useinventorytodescribe activitiesunderway/demonstratingsuccess,policies/regulations/lawssupporting change/improvementinthisarea) c) GapsIdentifiedthroughActionPlanningProcess(assetmapping,data, competencies,partners,etc.) d) Otherlimitationsonreachofworkgroup,resources,barrierstosuccess,forces ofchange 4) LocalHealthIssueAreas(LHIA)forImprovement(35LHIAs) a) DescriptionofeachLHIA b) WithineachLHIAidentifyGoal c) IdentifySMARTObjectivestoaccomplishGoal d) Delineateaplantomeetobjectivethatincludes:keymilestones,timeline, specifyactivitiesthatrelateto3lenses,targetedcompletiondate,measuresthat demonstrateprogress,identifyingleadstaff/partnersforeachmilestoneactivity 5) SummaryofHealthyMontgomeryAssetsandResourcesthatSupportActivities DescribedinPlan 6) Appendices a) Membership b) GlossaryofTerms c) InventoryofRelatedMontgomeryCountyProgramsandPolicies d) ActionPlanningToolstoDeriveLHIA e) OutcomeObjectives: i) SummaryofData(Baseline,Updates,Target) ii) Correspondingevaluationplanmetricssupportingeachoutcomeobjective formonitoringandevaluationofplanactivities
DraftSeptember19,2012
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HMObesityActionPlanningStatus
OBESITY:IdentifyingLocalPrioritiesforACTIONPLAN
July Local Priority Issues August
September October Interventions November Intermediate Best 2012 Objectives Practices

Workgroup Formation

Assets &Gaps

Outcome Longterm Goal

Impact

Membership Roles Overview

ProblemAnalysisTools

Asset Mapping, Service Gaps/Policy Barriers

HealthyPeople2020, MDSHIP,etc. DevelopGoals& SMARTObjectives PeerCounty Comparisonof ActionPlans

PeerCounty ComparisonofAction Plans BestPractices, Interventions, Impacts

ProgressReporttoHealthy MontgomerySteeringCommittee

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Healthy Montgomery Workgroup Goal Development Guide and Worksheet

Goals, Objectives, and Strategiesi
The differences among goals, objectives, and strategies can be confusing, in large part because different individuals and groups define them differently. For the purposes of this action plan: A goal is a broadly stated, non-measurable change in health status An objective is a specific, measurable change in health status or behavior A strategy is the method, approach, or process used to achieve the change

Goalsii
A goal is a broad, general statement about a desired outcome or outcomes for an initiative, program, or action plan. It represents a clear statement of what you want to accomplish the eventual destination you hope to reach. Goals often are written to sound like more detailed mission statements. Whereas a mission statement pertains to the overall purpose of the workgroup, goals pertain to the priority areas outlined within the workgroups action plan. Characteristics of Goals: Global in nature; provides general direction Non-specific Non-measurable; cannot be quantified Long-term Can be lofty and idealistic as it is not necessary that a goal be reached during a specific timeframe

Examples of Goals Improve health, fitness, and quality of life through daily physical activity (Healthy People 2020) Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights (Healthy People 2020)
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Improve mental health through prevention and by ensuring access to appropriate, quality mental health services (Healthy People 2020) Increase the quality, availability, and effectiveness of educational and communitybased programs designed to prevent disease and injury, improve health, and enhance quality of life (Healthy People 2020)

Healthy Montgomery Work Group Goal:

Bower,Carol.Guide and Template for Comprehensive Health Improvement Planning. Connecticut Department of Public Health. Ver. 2.1. 2009. http://www.ct.gov/dph/lib/dph/state_health_planning/planning_guide_v2-1_2009.pdf. Accessed 9/10/12. ii Ibid.

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Healthy Montgomery Workgroup Objectives Development Guide and Worksheet

Objectivesi
Objectives articulate goal-related outcomes in specific and measurable terms. Whereas goals are broad, general, intangible, and abstract, objectives are narrow, precise, tangible, and concrete. One goal may have many objectives. Example: A goal to reduce heart disease deaths might have objectives related to smoking cessation, weight reduction, and physical activity. Conversely, a single objective may relate to more than one goal. A smoking cessation objective, for example, would be appropriate for goals concerning stroke, certain cancers, emphysema, and any of the other diseases and conditions for which smoking is a known risk factor. Objectives add specificity to goals by stating who, what, when, and where, and by stipulating how many, by how much, and how often. They typically begin with active verbs such as increase, decrease, reduce, create, and establish.

SMART Objectivesii
When writing an objective, it is critical to word it in such a way that you will be able to gauge whether or not it has been achieved, if progress has been made even if the objective was not achieved. Such types of objectives are deemed SMART. SMART is the acronym for objectives that meet the following criteria: Specific - What will be achieved- a behavior or outcome, by whom, how much, and when? Measurable Progress or accomplishment can be determined qualitatively or quantitatively Achievable Taking into account available time, staffing, and resources; it doesnt make sense to set your initiative for failure by creating objectives that are impossible to achieve Realistic Is the objective relevant to the mission, goals, needs, and interest of the workgroup? Are sufficient resources available to achieve the outcome? Time-Bound Includes a time frame for achieving the stated objective

Writing a SMART objective requires the identification and inclusion of certain factors: 1. Target Population The target population is the group to which the objective pertains (e.g. all Montgomery County residents; Hispanic women; African Americans 65 years of age and older). When defining a population, consider first what sources of data are available for that population.
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2. Time Frame The time frame is the deadline for achieving an objective. It needs to be realistic. At a minimum, is it aligned with the time frame of the action plan, itself (3 years, 5 years, 10 years, etc.) 3. Baseline Value Before you can determine where you want to be, you need to know where you are. The baseline value is the current situation: the starting point from which improvement or worsening conditions will be measured; the first data point in the tracking series. Baseline values are always given for outcome objectives. They are not stipulated for process objectives such as policy or organizational changes, or for developmental objectives, for which no systems of measurement currently exist. Along with the value, itself, include the following information: Unit of Measurement Choose a unit of measurement for which the data are available. For calculating rates and percentages, it is sometimes helpful to specify what will be used as the numerator and denominator when more than one option exists. Data Source and Year Indicate the year and data source along with the value itself. If no data source currently exists, indicate the potential data source. 4. Target Value The target value is where you want to be at the end of the specified period. It is the desired amount of change, measured in the same units as the baseline data (numbers of individuals, percentages, rates, etc.) Targets are particularly important because the difference between the baseline and target values is commonly used to evaluate progress or achievement of the objective. The process of setting targets can be difficult thus they should be developed carefully or they will not be effective. Target levels can be chosen by the workgroup using the following methods: Using national, state, or local targets (e.g. Health People 2020) Retaining targets from earlier plans Computing a statistical regression (using past and current values to project a future value) Using knowledge of existing programs and expected change based on prior experience Relying on expert judgment

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Example of SMART Objectivesiii

The following SMART objectives were taken from the American Cancer Society example stated in the previous goal worksheet: GOAL: Increase the early detection of cancers where there are proven screening methods available. Objectives: 1. By 2010, increase to 85% proportion of women 50 years of age and older who have annual clinical breast exams and mammograms. 2. By 2010, decrease the prostate cancer death rate of African Americans by 50%. 3. By 2010, establish a free statewide colorectal cancer screening program for people 50 years of age and older who do not have health insurance. SMART Objectives Checklist* The following checklist is helpful for assessing whether draft objectives meet the SMART criteria: *Complete one column for each objective under a particular goal. Create a new chart for each goal.* Goal: Increase the early detection of cancers where there are proven screening methods available. Test Questions 1. Will achievement of the objective help to reach the goal? 2. Does the goal have at least one objective? 3. Is the objective evidence-based (supported by data and theory)? 4. Does the objective specify a starting (baseline) value or condition and a desired accomplishment (target value or condition)? 5. Can progress toward achieving the objective be measured? 6. Is the objective attainable and realistic, given the planning period and available resources? Assigned Objective Number (Y/N) 1 Y Y Y 2 Y Y Y 3 Y Y Y 4 5 6

Y Y

Y N

Y N

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7. Does the objective specify a realistic result, rather than an activity? 8. Is a time frame given for achieving the objective or is it implied in the action plan, itself? 9. Would someone unfamiliar with the planning group understand what the objective means? 10. Have you identified who will be accountable for achieving the objective?

Y Y

N N

Y Y

N Y

Y Y

Y Y

* Adopted from Carol E Bowers Guide and Template for Comprehensive Health Improvement Planning. Connecticut Department of Public Health. Ver. 2.1. 2009.

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Healthy Montgomery Objective Development Worksheet

GOAL: Objectives: 1.

SMART Objectives Checklist

Goal: (Write goal statement here) Test Questions 1. Will achievement of the objective help to reach the goal? 2. Does the goal have at least one objective? 3. Is the objective evidence-based (supported by data and theory)? 4. Does the objective specify a starting (baseline) value or condition and a desired accomplishment (target value or condition)? 5. Can progress toward achieving the objective be measured? 6. Is the objective attainable and realistic, given the planning period and available resources? 7. Does the objective specify a realistic result, rather than an activity? 8. Is a time frame specified for attainment of the objective or implied in the action plan, itself? 9. Would someone unfamiliar with the planning group understand what the objective means?

Assigned Objective Number (Y/N) 1 2 3 4 5 6

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10. Have you identified who will be accountable for achieving the objective?

Bower,Carol.Guide and Template for Comprehensive Health Improvement Planning. Connecticut Department of Public Health. Ver. 2.1. 2009. http://www.ct.gov/dph/lib/dph/state_health_planning/planning_guide_v2-1_2009.pdf. Accessed 9/10/12. ii Ibid. iii Ibid.

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Examples of Nutrition, Weight Status and Physical Activity Objectives

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Examples from Healthy People 2020

Note: These are national objectives and targets

Nutrition and Weight Status NWS1: Increase the number of States with nutrition standards for foods and beverages provided to preschool-aged children in child care. Target: 34 States (can include the District of Columbia). Baseline: 24 States had nutrition standards for foods and beverages provided to preschool-aged children in child care in 2006. Target setting method: 1 State per year improvement (can include the District of Columbia). Data sources: National Resource Center for Health and Safety in Child Care and Early Education, and child care licensing websites from each State government and the District of Columbia. NWS2: Increase the proportion of schools that offer nutritious foods and beverages outside of school meals. NWS2.1 Increase the proportion of schools that do not sell or offer calorically sweetened beverages to students. Target: 21.3 percent. Baseline: 9.3 percent of schools did not sell or offer calorically sweetened beverages to students in 2006. Target setting method: Modeled on previous data: 12 percentage point increase. Data source: School Health Policies and Programs Study, CDC. NWS2.2 Increase the proportion of school districts that require schools to make fruits or vegetables available whenever other food is offered or sold. Target: 18.6 percent. Baseline: 6.6 percent of school districts required schools to make fruits or vegetables available whenever other foods are offered or served in 2006. Target setting method: 12.0 percentage point increase. Data source: School Health Policies and Program Study, CDC.

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NWS5: Increase the proportion of primary care physicians who regularly measure the body mass index of their patients. NWS5.1 Increase the proportion of primary care physicians who regularly assess body mass index (BMI) in their adult patients. Target: 53.6 percent. Baseline: 48.7 percent of primary care physicians regularly assessed body mass index (BMI) in their adult patients in 2008. Target setting method: 10 percent improvement. Data source: National Survey on Energy Balance Related Care among Primary Care Physicians. NWS5.2 Increase the proportion of primary care physicians who regularly assess body mass index (BMI) for age and sex in their child or adolescent patients. Target: 54.7 percent. Baseline: 49.7 percent of primary care physicians regularly assessed body mass index (BMI) for age and sex in their child or adolescent patients in 2008. Target setting method: 10 percent improvement. Data source: National Survey on Energy Balance Related Care Among Primary Care Physicians. NWS8: Increase the proportion of adults who are at a healthy weight. Target: 33.9 percent. Baseline: 30.8 percent of persons aged 20 years and over were at a healthy weight in 200508 (age adjusted to the year 2000 standard population). Target setting method: 10 percent improvement. Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. (BRFSS for Montgomery County) NWS9: Reduce the proportion of adults who are obese. Target: 30.6 percent. Baseline: 34.0 percent of persons aged 20 years and over were obese in 200508 (age adjusted to the year 2000 standard population).

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Target setting method: 10 percent improvement. Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. (BRFSS for Montgomery County) PA3: Increase the proportion of adolescents who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity. PA3.1 Aerobic physical activity. Target: 20.2 percent. Baseline: 18.4 percent of adolescents met current physical activity guidelines for aerobic physical activity in 2009. Target setting method: 10 percent improvement. Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. PA3.2 (Developmental) Muscle-strengthening activity. Potential data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. PA3.3 (Developmental) Aerobic physical activity and muscle-strengthening activity. Potential data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

The complete set of Healthy People 2020 Objectives for Nutrition, Weight Status, and Physical Activity can be viewed at http://www.healthypeople.gov/2020/topicsobjectives2020/

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Objectives and Targets for Nutrition and Weight Status Maryland State Health Improvement Process
County Baseline* 47.7% MD Baseline* 34.0% National Baseline 30.8% Racial/Ethnic Groups White/NH 50.4% Black- 33.9% Asian- 67.1% Hispanic- 35.9% Maryland Target 2014 35.7%

Measure Percentage of adults who are at a healthy weight (not overweight or obese) (BRFSS 20082010) 31 Percentage of youth (ages 1219) who are obese (MYTS 2008)

8.4%

11.9%

17.9%

Not provided

11.3%

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Eat Smart, Move More North Carolinas Five-Year Statewide to Prevent Overweight, Obesity and Related Chronic Disease, 2007-20121 Goals and SMART Objectives
GOAL #1: Increase healthy eating and physical activity opportunities for all North Carolinians by fostering supportive policies and environments. Objective A: By December 31, 2012, increase yearly the number of policies, practices and incentives to promote healthy eating and physical activity wherever North Carolinians live, learn, work, play and pray. Objective B: By December 31, 2012, increase yearly the number of facilities/environments to promote healthy eating and physical activity where North Carolinians live, learn, work, play and pray. BaselineState level data gathering mechanisms are capturing new and/or enhanced policies and environmental changes. These mechanisms include indicators that capture a variety of policy and environmental changes in multiple settings. GOAL #2: Increase the percentage of North Carolinians who are at a healthy weight. Objective: By December 31, 2012, there will be no increase in the percentage of North Carolina adults, youth and children who are classified as overweight or obese. Baseline*BRFSS, 2000: 35.9 percent of adults were overweight, and 21.8 percent were obese. YRBS, 2001: 16.2 percent of middle school students were at risk for overweight, and 13.2 percent were overweight; 14.3 percent of high school students were at risk for overweight, and 12.9 percent were overweight. NC-NPASS, 2001: 14.4 percent of public health department clients between ages 2-18 were at risk for overweight, and 14.4 percent were overweight. (Note: in previous years the percentage at risk exceeded the percentage overweight; in 2001 they are the same; in 2005 the percentage overweight exceeds the percentage at risk.) GOAL #3: Increase the percentage of North Carolinians who consume a healthy diet. Objective A: By December 31, 2012, 14 percent more North Carolina adults, youth and children will consume five or more servings of fruits and vegetables each day. Baseline*BRFSS, 2001: 22.1 percent of N.C. adults consumed at least five or more servings of fruits and vegetables. YRBS, 2001: 17.8 percent of high school students consumed five or more servings of fruits and vegetables per day during the past seven days. BRFSS, 2005: 22.5 percent
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To see the complete action plan, go to http://www.eatsmartmovemorenc.com/ESMMPlan/Texts/ESMMPlan_ProPrint.pdf

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of adults consumed at least five or more servings of fruits and vegetables per day. YRBS, 2005: 26 percent of high school students ate fruit three or more times, and 28 percent ate vegetables three or more times on a typical day. YRBS, 2005: 40 percent of middle school students ate fruit three or more times, and 33.5 percent ate vegetables three or more times on a typical day. CHAMP, 2005: 25.6 percent of children ate three or more servings of fruit, and 25.8 percent ate three or more servings of vegetables each day. Objective B: By December 31, 2012, the proportion of North Carolina infants who are breastfed will increase to 75 percent and the proportion of infants who are breastfed for at least six months will increase to 50 percent. Baseline*PedNSS, 2001: 50.4 percent of infants and children under five were breastfed. PedNSS, 2001: 16.6 percent of infants and children under five were breastfed for at least six months. PedNSS 2004: 53 percent of infants and children under five were breastfed. PedNSS, 2004: 18.7 percent of infants and children under five were breastfed for at least six months. CHAMP, 2005: 65.7 percent had breastfeeding initiated, and 25.4 percent were breastfed for at least six months. Objective C: By December 31, 2012, when eating out, more North Carolina adults and children will choose foods and beverages generally considered to be healthier. Healthier will be defined by: lower in fat, sugar, calories; fast-food meals once per week or less often and labeled as healthy. BaselineBRFSS 2006 data will be available in early 2007 for baseline on the percentage of NC adults who report choosing foods or beverages labeled as healthy. BRFSS 2008 data will be available indicating the percentage of adults who choose foods and beverages that are labeled as healthy. PAN Behaviors 2005: Insufficient numbers of adults to provide reliable data. Objective D: By December 31, 2012, 25 percent fewer North Carolina children ages 2-17 will eat fast food three or more times per week. BaselineCHAMP 2005: 12.3 percent of children ages 2-17 ate fast food at least three times per week. Objective E: By December 31, 2012, at least 70 percent of North Carolinians will prepare and eat their main meal at home at least five times per week. BaselineYRBS, 2005: 78.2 percent of middle schools students ate dinner at home with their families four or more times during the past seven days. YRBS, 2005: 62.5 percent of high school students ate dinner at home with their families four or more times during the past seven days. CHAMP, 2005: 66.9 percent of children ages 2-17 ate dinner together with family at home more than four times per week. No meals at home measure for adults is available at this time.

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Objective F: By December 31, 2012, the percentage of North Carolina adults, youth and children who typically consume more than one 12-ounce serving of sugar-sweetened beverages per day will not exceed 50 percent. BaselineYRBS, 2005: 95.6 percent of middle school students report drinking a soft drink or sweetened beverage one or more times on a typical day. YRBS, 2005: 90.9 percent of high school students report drinking a soft drink or sweetened beverage one or more times on a typical day. CHAMP, 2005: 19.9 percent of parents report their children drink sweetened beverages three or more times on a typical day. GOAL #4: Increase the percentage of North Carolina adults, youth and children ages 2 and up who participate in the recommended amounts of physical activity. Objective A: By December 31, 2012, at least 46 percent of adults will get recommended amounts of physical activity each week and fewer than 15 percent will report no leisure time physical activity. Baseline*BRFSS, 2001: 42.4 percent of adults in N.C. had recommended amounts of physical activity; 30.4 percent had no leisure time physical activity. Objective B: By December 31, 2012, at least 52 percent of youth and children will participate in at least 60 minutes of physical activity every day. Baseline*YRBS, 2001: 23.5 percent of high school youth participated in moderate physical activity for at least 30 minutes per day, and 47.5 percent of middle school youth participated in moderate physical activity for at least 30 minutes per day. CHAMP, 2005: 73 percent of children ages 2-17 spent one hour or more in physically active play, and 96 percent of children ages 2-17 never walk or ride a bike to school.

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