STRATEGIES FOR ACTION:
INTEGRATING NUTRITION AND PHYSICAL ACTIVITY PROMOTION TO REACH LOW-INCOME CALIFORNIANS

Appendices

I: Physical Activity and Nutrition Integration Committee Members
II: Community Interventions and Communities as Interventions
III: Key Informant Interviews
IV: Expert Panel Presentations
V: Healthy People 2010 Physical Activity Objectives
VI: State of California Physical Activity Partners
VII: California Department of Health Services Physical Activity Programs
VIII: Glossary

Appendix I: Physical Activity and Nutrition Integration Committee Members

Lisa Allen	Mediascope
Terry Bazzarre	American Heart Association
Shene Bowie	Leap for Joy Fitness for Health
Jim Carman	Physical Activity and Health Initiative, California Department of Health Services
Linda Cooper	Daly City Parks and Recreation Department
John Crosby	Escondido Community Health Center
Michael Darnley	Pinn Fund
Jerry Glashagel	Total Health Initiative, West Coast YMCA Shared Projects
Karen Hall	Genentech, Inc.
Ash Hayes	San Diego Chapter, Governor's Council on Physical Activity
Marianne Hernandez	Cardiovascular Disease Outreach, Resources, and Epidemiology, California Department of Health Services
Erica Hertz	Cancer Prevention and Nutrition Section, California Department of Health Services
Arnell Hinkle	California Adolescent Nutrition and Fitness Program
Steve Hooker	Physical Activity and Health Initiative, California Department of Health Services
Judeth Lagrimas	City of Long Beach, Department of Health and Human Services
Brenda Laine	Loveland Church
Gordon Laine	Loveland Church
Sarah Liang	Cancer Prevention and Nutrition Section, California Department of Health Services
Elise Lorenz	San Diego County Health and Human Services Agency
Ruth Manzano	Escondido Community Health Center
Maria Santa Maria	Southern California Public Health Association
Nestor Martinez	California Project LEAN, California Department of Health Services
Monica McCorkle	Indian Health Council
Lori McNicholas	Por La Vida
Chris Morfas	California Bicycle Coalition
Carmen Moreno	Por La Vida
Michelle Oppen	Cancer Prevention and Nutrition Section, California Department of Health Services
Heather Paulsen	California Healthy Cities
Jennifer Peale	American Cancer Society
Greg Roberts	Magic Johnson Foundation
Joan Rupp	Department of Exercise and Nutritional Sciences, San Diego State University
Nicole Singer	Sports, Play, and Active Recreation for Kids, San Diego State University
Gil Sisneros	Cancer Prevention and Nutrition Section, California Department of Health Services
Aurora Sosa	Center for Public Health Advocacy
Mike Stallings	Daly City Parks and Recreation Department
Jamie Strelow	Sports, Play, and Active Recreation for Kids, San Diego State University
Jill Tobacco	Cancer Prevention and Nutrition Section, California Department of Health Services
Beverly Tuzin	County of San Diego Health and Human Services Agency
Tammie Voss	Cancer Prevention and Nutrition Section, California Department of Health Services
Antronette Yancey	Los Angeles County Department of Health Services
Candice Zimmerman	Cancer Prevention and Nutrition Section, California Department of Health Services

Appendix II: Community Interventions and Communities as Interventions
James F. Sallis, Ph.D.
San Diego State University

For the California Nutrition Network and Five-A-Day Programs
Physical Activity Planning Meeting
San Diego, CA
July 13-14, 2000

Community Interventions

Because sedentary lifestyles are a mass phenomenon, it is necessary to intervene with entire communities. The largest research projects to attempt to increase physical activity in whole communities are the heart health projects, particularly the three U.S. studies that were conducted mainly in the 1980s. In addition to theories of individual behavior change, all studies applied theories of communication, diffusion of innovations, community organization, and social marketing. Specific groups such as young people, the elderly, women, employees, ethnic groups, and low-income groups, were targeted with specific interventions. Strategies ranged from behavior change contests, events, and volunteer training, to community coalitions, classes, and mass media for education.

Physical activity was a secondary goal of these multiple risk factor programs, and the Stanford study accounted for only 8 percent of the educational messages. Nevertheless, there was some evidence of effectiveness. The Stanford study reported several significant effects for physical activity, but those results were inconsistent regarding type of physical activity and who made the changes. The Minnesota study also reported significant physical activity outcomes, but only during the first three years. The Pawtucket intervention did not report significant physical activity outcomes. Generally, the results were modest and have been seen as disappointing. The modest outcomes could be due to the complexity of the overall programs, inadequate effort (and budget) devoted to physical activity, or the reliance on educational strategies. All the interventions were dominated by educational and behavioral skills training information presented to many people by a variety of media venues. Little attempt was made to improve the physical environment to make activity more convenient or more pleasant. Combining educational, environmental, and policy interventions may be more effective in increasing physical activity in the community.

Community interventions have not been evaluated for young people. Such studies are needed, because young people obtain most of their physical activity outside of school, often in community programs. Interventions should focus on increasing access to programs and facilities, with the goal of providing a choice of popular programs that appeal to girls and boys of all skill levels, several times a week, throughout the year.

Walkable Communities: The Ultimate Solution?

There is emerging evidence that the structure of the community itself and the transportation infrastructure have profound effects on physical activity habits of the residents. If we can identify the most important community characteristics, we may be able to guide the construction of communities that naturally stimulate physical activity. Some land-use planners want to increase walking and bicycling to increase the sense of community and quality of life. Some transportation planners want to increase walking and bicycling to reduce the traffic noise and pollution. Thus, strong alliances can be built between health promotion and these other disciplines. Architects and urban planners developed the Ahwahnee Principles to define "Livable Communities," and walkability is a key concept.

Walkable communities have attractive sidewalks on narrow streets with limited traffic. There is a range of destinations within walking distance, so you can shop, go to work, and seek entertainment without having to use a car. Walkable communities shelter pedestrians from weather extremes by using trees for shade and awnings for protection from weather. A value is also placed on having a diversity of residents within neighborhoods to enhance the richness of social contacts.

Residential and job density are highly related to the percent of residents who commute to work. A study of 32 cities worldwide found correlations with active commuting of 0.66 with residential density. These are high correlations showing that if it is possible to commute without cars, people will do so. It is important to note that this international study found the U.S. to have the absolute lowest density and near-zero levels of commuting by walking and biking. Of course, in California millions of people live in very low density suburbs, so this presents a major challenge to physical activity promotion. Some grassroots advocacy is needed to demand more walkable designs for new subdivisions.

Mixed land use that intermingles residences, shops, and commercial buildings also encourages walking and bicycling. A California study found active commuting was negatively correlated with living in a neighborhood of detached single family homes, which rarely have shops and other facilities nearby. However, there was a strong positive association between active commuting and having a commercial building within 100 yards of the home. Simply put, in a mixed-use neighborhood there are places nearby to walk to.

Transportation policies have a major influence on walking and bicycling patterns. Active commuting is correlated -0.78 with gasoline use and +0.71 with use of mass transit use in a worldwide survey. The number of parking spaces in the central city is correlated -0.48 with active commuting. Policies that make it inconvenient to park cars and effectively promote mass transit use should encourage people to use cars less and lead to an increase in active commuting. Right now, virtually all California policies are devoted to making driving as convenient as possible.

Transportation and urban planning researchers have only shown that high density, mixed-use communities with good mass transit have high rates of active commuting to work. The impact on total physical activity is unknown but likely to be substantial. Some of us think that we have engineered physical activity out of lives, and for our health we need to change the current way of building society. One of the most effective ways of increasing physical activity in the population may be to advocate for land use and transportation policies that create communities in which walking and bicycling are naturally part of everyday life. Education efforts may be more fruitfully directed at policy makers than to the population at large. Achieving the necessary policy and environmental changes to create walkable communities is likely to be complex, require the cooperation of multiple governmental and non-governmental agencies, and take a long time to be effective. However, efforts such as this may be necessary to reverse the epidemic of sedentary behavior that characterizes modern societies.

Ecological Approaches to Physical Activity Promotion

While we are advocating for improved land use and transportation policies, the research literature gives us some clues about effective intervention strategies that can be implemented now. Studies of physical activity determinants show that many factors influence physical activity. This means that no single approach is likely to solve the problem of sedentary lifestyles. Ecological models teach us that interventions should operate on multiple levels: psychological, social, and environmental. Here are some key correlates of physical activity and how they can inform intervention design.

Correlates and Interventions for Adults

Men are more active	Most programs and information should target women
Low-income people are less active	Learn how to help low-income people overcome their barriers
People who perceive fewer barriers are more active	Provide information that helps people think differently about barriers and improve problem solving skills
Enjoyment encourages activity	Help people do more of activities they already enjoy; teach them ways of increasing enjoyment
Self-efficacy, or confidence in ability to be active, is a strong correlate	People increase self-efficacy by making gradual increases in activity and being successful in meeting goals
Use of self-change skills is helpful	Teach people effective self-change skills
Physician counseling is effective	Engage physicians in improving their counseling skills
Social support is a powerful correlate	Intervene with existing groups; encourage people to seek out social support
Access to exercise facilities makes activity easier	Help people learn where they can be active safely and conveniently

Correlates and Interventions for Young People

Boys are more active	Girls need additional motivation, encouragement, and programs
Ethnic minorities tend to be less active than whites	Programs are particularly needed in areas with high ethnic representation; information should be appealing to diverse groups
Youth with high athletic competence are more active	Youth with less physical skills need more programs and encouragement
Youth get most activity outside of school	Community programs need to have programs for all kids, every day, year-round
After school hours are peak time for activity	All youth need access to safe physical activity after school. This can be at school, at a community facility, or near home
Reducing TV time can increase activity	Educate parents to limit TV time to 2 hours per day
Parent support is effective at all ages	Parents can be most effective by ensuring that the child has a place to be active every day. This may require the parent to transport the child
Some physical education programs provide substantial amounts of activity	Intervene with schools to make sure they have quality curricula and instruction. Encourage parents to advocate for excellent P.E.
Being outdoors is the best correlate of activity for young children	Make sure children have a place to play outdoors every day

The most effective programs will ensure that people have safe, convenient, and pleasant environments to be active, and the programs will provide motivational information and behavior change instruction. Many programs need to be targeted to specific subgroups, so it is important to know your community and involve community representatives in planning and implementing the programs. Please evaluate your programs so you can get feedback and make improvements over time.

Best wishes on your efforts to promote physical activity among Californians.

Sources and Resources

Centers for Disease Control and Prevention. (1997). Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR, 46 (No. RR-6), 1-36.

Center for Disease Control and Prevention. (1999). Promoting Physical Activity: A Guide for Community Action. Champaign, IL: Human Kinetics.

Sallis, J.F., Bauman, A. and Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15, 379-397.

Sallis, J.F., and Owen, N. (1999). Physical Activity and Behavioral Medicine. Thousand Oaks, CA: Sage.

Sallis, J.F., Prochaska, J.J., and Taylor, W.C. (2000). A review of correlates of physical activity of children and adolescents. Medicine and Science in Sports and Exercise, 32, 963-975.

Appendix III: Key Informant Interviews

The Cancer Prevention and Nutrition Section of the California Department of Health Services initiated a planning process to explore how to significantly increase physical activity and healthy lifestyles among low-income families. As part of this process, Prevention Institute conducted a series of key informant interviews to enrich the knowledge base available for development of the plan. The primary purpose of the interviews was to include the expertise of practitioners outside of California and to learn from the perspectives of other states and national policy organizations.

The fourteen interviews represented the following categories:

• Researchers - synthesis and interpretation of the research
• State and National Approaches - perspectives from other states, national advocacy groups, and the Centers for Disease Control and Prevention
• Worksite Health Promotion - challenges and particular issues facing lower level wage earners
• Pedestrian Issues - strategies for making walking the norm

A list of the interviewees appears at the end of the document. This paper summarizes the interview results.

Researchers

What are the most promising strategies for increasing physical activity?

• There is not simply one approach; a combination of strategies must be used.
• Important elements include thoughtfully designed group- and home-based activity programs, changing the physical environment, promoting organizational changes (e.g., at work) that support being active, and implementing policy changes to support all of these elements.
• Ultimately, we need to change the culture in order to achieve ongoing increases in physical activity.
• Community participation at all levels is key in planning interventions. Each community is different and needs to be involved from the start with any program design.
• We need to reach people where they are, rather than expecting them to come to us. There are two aspects to this: 1) Designing the physical environment to encourage activity throughout the day, e.g., walking to neighborhood stores or taking the stairs. 2) Creating opportunities for physical activity that easily fit into people's routines, e.g., convenient programs at the workplace or in faith institutions.

Are there particular strategies which are most effective for increasing physical activity among families with low incomes?

• Each community is unique. Initiatives must be community-centered. The first step is the examination of community assets (such as existing programs, facilities, and institutions) and barriers (such as access, cost, safety, and transportation).
• Health disparities are a real issue. We must be conscious of the significance of poverty and the racial divide.
• There is limited information in the research literature about successful approaches in low-income communities. However, there are a number of examples of promising approaches from across the country. These include culturally appropriate activity programs, efforts to improve safety, and in one rural area, a project to develop walking trails.

Is it better to focus on increasing physical activity or decreasing inactivity as a programmatic approach?

This question was prompted by a discussion of the issue at a national meeting on physical activity promotion. According to interviewees:

• Most research has focused on attempts to increase activity, therefore there is little data for answering this question.
• It is uncertain whether decreasing specific sources of inactivity (e.g., TV watching) would necessarily lead to more physical activity.
• The bottom line is that adults and children need to increase daily physical activity, whether it be in the form of more activity throughout the day or scheduled workouts.

How should CPNS measure the success of its initiative?

• The ideal measure of success is increased levels of activity and improvement in physical activity-related health parameters (e.g. weight, blood pressure, and cholesterol levels) among California residents.
• Individual activity programs can measure success by whether people stay in the program over time, more participants join the program, and program participants increase and maintain activity levels.
• A portion of program funds should be set aside for evaluation, including process and, if possible, outcome evaluation. (Editor's note: Evaluation was not discussed in detail. Experience in other fields suggests that evaluation resources need to be used strategically and not spread too thinly across every program.)

State and National Approaches

What are the most promising strategies for increasing physical activity?

• The key to successful intervention strategies lies in community involvement. No community intervention would achieve success without identifying and recruiting key community members to spur on the process.
• Building partnerships among many sectors is critical.
• Education cannot be the sole component in a successful initiative; a systematic approach is long overdue. While media and communications play a role, these approaches alone do not change behavior.
• Lifestyle intervention approaches (that is, increasing small amounts of activity throughout the day) can work at least as well as structured programs. In either case, initiatives must address both social and environmental barriers to being active.
• Interventions must build in social support and teach people to develop their own long-term social support.
• Intervention strategies need to begin where people are. For example, community-based organizations, worksites, faith-based organizations, and schools have a unique opportunity to reach groups of people where they frequently congregate. These types of programs tend to be more successful in sustaining participation due to the social networks that are constructed.

What is your state/national organization doing to increase physical activity among residents?

• Forging partnerships with public and private organizations to develop more comprehensive strategies is central to state/national work. Agencies that would not have traditionally worked together are beginning to realize that there are many overlapping factors such as traffic and zoning issues, neighborhood safety, and lack of resources or access that affect a person's ability to be physically active.
• Examples of specific approaches include walking and bicycling initiatives, trail development, Safe Routes to School programs, and various health promotion efforts. While most of what is being done is in the areas of walking and biking, those interviewed were quick to mention that it is important to have a variety of available activities. This should be an important consideration in developing and sustaining new programs.
• It was noted that walking and biking will not necessarily be successful strategies in low-income communities. More comprehensive programs, especially those that include culturally diverse activities, will have a better chance for success.

What policies at the national or state level are particularly important for supporting increased physical activity?

There were a variety of policy recommendations that emerged:

• Design streets and roadways to protect pedestrians and bicyclists from traffic hazards.
• Support development of convenient, well-designed recreation facilities, and a wide variety of culturally diverse activity programs.
• Take action to reduce neighborhood violence and other crimes.
• Enforce existing statutes, and develop new ones, to ensure regular physical activity in schools.
• Develop schools as multi-use facilities to provide recreational opportunities for the community during non-school hours.
• Utilize state snack food taxes as a funding stream for physical activity initiatives.
• Build effective coalitions of diverse community groups such as those representing health, environmental, crime prevention, transportation, and land use issues.
• Advocate at the national level to get physical activity on the agenda of policymakers and government.

Worksite Health Promotion

What motivates employees to participate in health promotion activities?

• Women care about being healthy for their kids
• Personal health problems or those of family members
• Peer support network
• Convenient location and time for activities

What are the barriers to participation?

• No time after work; women must catch public transportation to get to childcare
• People working two jobs
• Insufficient promotion of culturally appropriate activities
• People get paid by the piece, so they hunch over their sewing machines all day rather than take a break

What are ways people can include physical activity in their workday without the use of formal facilities?

• Walking the stairs
• Parking farther away
• Getting up and stretching, and generally increasing movement during the day

What strategies can be implemented to encourage physical activity among lower-income workers?

• Provide paid time for workers to participate in activities during the workday.
• Provide on-site physical activity equipment.
• Bring in instructors.
• Utilize peer support. Recruit volunteers as champions of activity programs. Promotoras have been very effective in Los Angeles County among Latinas.
• Programs have been more successful in smaller (fewer than 60 employees) operations that can be more flexible about schedules.
• Assess the kind of jobs workers do and emphasize what they are already doing that is really good for them (e.g., physical labor on the job).
• Promote preservation of healthy habits from cultural traditions.
• Hotels can make gyms and pools available to employees during off hours.
• Address pertinent issues like occupational safety and build from this to address the whole work environment.

What are some incentives that would prompt employers to institute worksite activity programs?

• Personal interest in activity
• Concerns about employee's health
• Hard data about the benefits for productivity and decreased absenteeism
• Provides a stopgap since they do not supply health insurance
• Fosters goodwill with employees

What are ways in which companies with limited funds can implement programs to increase physical activity?

• Utilize voluntary health agencies.
• Recruit volunteers to be coordinators/champions.
• Engage groups active in the worksite wellness movement.

Are there policies at the local or state level that could provide incentives to employers?

• Require that worksites over a certain size offer employee health promotion.
• Ensure that occupational health issues are being addressed.
• Offer employer incentives beyond tax credits such as direct subsidies or reductions in worker compensation costs.

Pedestrian Issues

What are the key strategies for increasing walking and biking in communities?

• Establish a committee with the political muscle to promote these issues.
• Develop strong partnerships between community groups and city government that include public health, traffic engineering, parks and recreation, the city council, and police.
• Institute traffic calming to decrease fatalities and complement neighborhood commercial revitalization.
• Emphasize walkable routes to school.
• Establish good places to wait for the bus.
• Identify the top ten intersections where people are being hit and take action.
• Develop a master plan by reviewing existing traffic engineering, building, and zoning codes to ensure that design meets pedestrians needs.
• Ensure new commercial interests take into account pedestrian safety and interests, e.g., by providing adequate lighting after dark, creating interesting commercial display windows, and placing parking lots behind buildings.
• Use events such as Walk Your Child to School Day to build momentum for longer-term outcomes.

What issues are particular concerns in low-income neighborhoods?

• Recent immigrants are not prepared for high velocity traffic.
• Neighborhoods are not designed to respect traditional active street cultures. For example, recent Latino immigrants are particularly at risk for being hit as pedestrians. Wide sidewalks, parks, slower streets, and "bulk outs" can all be used to make the environment more inviting and safer for pedestrians.
• Noisy, dusty arterials near highways increase injuries and reduce walkability.
• Streets in lower-income neighborhoods are designed to accommodate people coming from outside of the city, encouraging speed and subsequent fatalities.
• State highways frequently traverse low-income neighborhoods. These streets are much wider than they need to be given that traffic is now carried on parallel freeways. They deserve traffic calming, streetscaping, and commercial development.
• Fifteen percent of streets are state roadways yet forty percent of the fatalities occur on these thoroughfares. There is opportunity for city/state partnerships to redesign these roadways.

If you had $1,000,000 to improve walkability in a low-income neighborhood, how would you spend it?

• Institute traffic calming in residential neighborhoods.
• Address the speed and condition of the arterial roadways.
• Invest in commercial districts.

Key Informants

Researchers

Ross Brownson, St. Louis University
Tom Prohaska, University of Chicago
Wendell Taylor, University of Texas - Houston

State and National Approaches

Allen Abraham, California Alliance for Physical Education, Recreation and Dance
Michael Arthur, Nova Scotia Sport and Recreation Commission
Barbara Fraser, Nebraska Department of Health and Human Services
Refilwe Moeti, Centers for Disease Control and Prevention
Russell Pate, National Coalition for Promoting Physical Activity
Cindy Porteous, National Association for Health and Fitness
Rosemary Thackeray, Utah Department of Health
Holly Van Houten, National Park Service

Worksite Health Promotion

Barbara Fain, Wellness Program - Santa Clara County
Liz Torres, Worksite Wellness Project

Pedestrian and Bicycling Issues

Zac Wald, BayPeds

Appendix IV: Expert Panel Presentations

Presentations were made by:

• Dr. Antronette Yancey, Director of Chronic Disease Prevention, County of Los Angeles, Department of Health Services
• Steve Hooker, Ph.D., Director of the Physical Activity and Health Initiative (PAHI), California Department of Health Services
• Thom McKenzie, Ph.D., Professor, San Diego State University

They are summarized here briefly:

• Dr. Antronette Yancey, in her talk, "Recapturing Recess," shared her approach to promoting physical activity in Richmond, Virginia and Los Angeles, California. She believes there are five lessons - institutionalizing opportunities, creating social support, making physical activity enjoyable, ensuring facilities are available and accessible, and teaching life-long skills - that should be applied from the concept of recess to physical activity promotion. Within these five lessons, creating environments conducive to physical activity, recruiting people of color to serve as role models, and encouraging positive communication through both word of mouth and social marketing are all key in successfully promoting physical activity.

• Dr. Steve Hooker, in his talk, "Lessons Learned from the On The Move! Physical Activity Promotion Program," discussed strategies for promoting physical activity among sedentary, ethnically and sociodemographically diverse adults. Community capacity building approaches, the Stage of Change Model, and the Spectrum of Prevention were used to inform On The Move!'s project design. The lessons learned included the importance of support from community members and local leaders, the inclusion of community outreach workers and culturally appropriate activities, and the notion that policy change may be easier to sustain than other types of change.

• Dr. Thom McKenzie shared data about the activity levels of children and the increasing rate of children being overweight. Helping youth to become active early is important not only for reducing the risks of obesity, but also because children are more likely to encourage adults to be active. The skills youth learn help prevent the onset of chronic disease during adulthood and are key in building self-confidence. For the most part, "women, the 'non-elite,' poor, and ethnic minorities have been 'left out' and as a consequence, are less active than men, the non-low-income, and whites, respectively." Schools provide opportunities for reaching youth and garnering the support and involvement of parents. McKenzie's project, Sports, Play, and Active Recreation for Kids (SPARK), encourages quality physical education in schools and supports increased activity among youth by advising curricula, supporting staff development, and providing on-site consultation.

Appendix V: Healthy People 2010 Physical Activity Objectives

BACKGROUND: The goal of Healthy People 2010 with respect to physical activity is to "improve the health, fitness, and quality of life through daily physical activity" (Healthy People 2010). In order to reach this goal, the Healthy People 2010 report contains 15 specific physical activity objectives. The objectives are divided into the following four groups: Physical Activity in Adults, Muscular Strength/Endurance and Flexibility, Physical Activity in Children and Adolescents, and Access. The authors of Healthy People 2010 also recognize disparity in the levels of physical activity with lower rates seen for women, African-Americans and Latino/as, older individuals, and lower-income individuals.

Physical Activity in Adults

22-1 Reduce the proportion of adults who engage in no leisure time physical activity.

22-2 Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day.

22-3 Increase the proportion of adults who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Muscular Strength/Endurance and Flexibility

22-4 Increase the proportion of adults who perform physical activities that enhance and maintain muscular strength and endurance.

22-5 Increase the proportion of adults who perform physical activities that enhance and maintain flexibility.

Physical Activity in Children and Adolescents

22-6 Increase the proportion of adolescents who engage in moderate physical activity for at least 30 minutes on five or more of the previous seven days.

22-7 Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness three or more days per week for 20 or more minutes per occasion.

22-8 Increase the proportion of the nation's public and private schools that require daily physical education for all students.

22-9 Increase the proportion of adolescents who participate in daily school physical education.

22-10 Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active.

22-11 Increase the proportion of adolescents who view television two or fewer hours on a school day.

22-12 (Developmental) Increase the proportion of the nation's public and private schools that provide access to school physical activity spaces and facilities for all persons outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations).

Access

22-13 Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.

22-14 Increase the proportion of trips made by walking.

22-15 Increase the proportion of trips made by bicycling.

Note: Additional information on the Healthy People 2010 Objectives can be found on their web site.

Appendix VI: State of California Physical Activity Partners

• American Cancer Society
• American Heart Association
• California Association for Health, Physical Education, Recreation and Dance (CAHPERD)
• California Cardiovascular Disease (CVD) Prevention Coalition
• California Parks and Recreation
• California Physical Activity and Health Initiative (Active Community Environments, Active Aging, Worksite Health Promotion)
• California Project LEAN
• California Department of Education
• Coalition for Healthier Cities and Communities
• National Association for Sport and Physical Education
• National Coalition for Promoting Physical Activity
• SHAPE UP America
• Sports, Play, and Active Recreation for Kids (SPARK)
• Sports4Kids (based in Oakland)
• Women's National Basketball Association (WNBA)

Appendix VII: California Department of Health Services Physical Activity Programs

PROGRAM	GOAL	FUNDING	TARGET	KEY ACTIVITIES	CONTRACTORS Partners	REPORTS/ RESOURCES
Physical Activity Health Initiative (PAHI) A) Active Aging ProgramSteve Hooker(916-324-7758) (NOTE: PAHI is the lead agency for PA at DHS)	Enable and encourage Californians over 50 years of age to have healthier lives by promoting physical activity and creating social and physical environments that support active aging	Federal Prevention Block Grant, Robert Wood Johnson Foundation	Californians over 50 years of age	Educate public about physical activity; increase accessibility, affordability and availability; develop community-based programs; implement direct mail interventions; modify existing or develop new environments;initiate policy within health care plans; conduct surveillance and evaluation activities	CONTRACTS FUNDED: 14 community mini-grants, 18 month cycle, $6-10K per grant, Also No More Falls Program, ($900K) Key Partners: California Dept. on Aging, Area Agencies on Aging, Local Health Depts.	California Active Living; PAHI's Approaches to Promoting Physically Active Lifestyles
PAHI B) Active Community Environments & Safe Routes to School Anne Seeley (916-445-0472)	Facilitate changes in physical and social environments that will increase naturally occurring physical activity, such as walking and bicycling, as a part of recreation, work, transportation and family life	For ACE & SR2S: block grant + Office of Traffic Safety, Caltrans	Local Government Officials Walk & Bike Advocates Traffic Safety & Transportation professionals	Safe Routes to School Program (SR2S) SLIC Collaborative Project Transportation Resources Center Build capacity of local bike and walk advocacy groups Walk to School Day (W2SD)	CONTRACTORS: SR2S -10 projects, $25k per project, 17 months. 1) $1.6M to contract for marketing research and skill-building of local government and local advocates 2) Local Government Commission: $50K to develop education/training materials for local government officials and staff. 3) CA Bike Coalition: $35K to provide TA to local bike advocacy groups 4) RTC: $3K as partner in development & maintenance of website On Trails Advocacy KEY PARTNERS: Local Government Commission, CA Bicycle Coalition & local bicycle advocacy coalitions, Rails to Trails Conservancy (contractors), Surface Transportation Policy Project, Caltrans, America Walks & local pedestrian advocacy coalitions in California, DHS-State & Local Injury Control, CA Highway Patrol, Federal Highway Administration (National Bike/Walk Resource Center), CDC Division of Nutrition & Physical Activity	REPORTS/ SR2S & W2SD websites SR2S Fact Sheets Livable Communities Fact Sheets (5)
PAHI C) Employee Health Promotion Jim Carman (916-324-3996) Web site	Assist California's workforce (employed population, their families, and retirees) in becoming the healthiest and most productive in the world by increasing the level of regular physical activity and other healthy lifestyles.	Federal Prevention Block Grant	Californians through worksites	Centralize the gathering of information; develop policy and legislation; promote EHP programs to employers; increase the prevalence of EHP to employers; improve existing EHP programs; partner with existing EHP programs	Contractors: Axiom, Inc Key Partners: Calif. Health Promotion Collaborative, Assoc. for Worksite Health Promotion, CPNS (Nutrition Network/5 a Day)	Website 10 Week Worksite Program
California Obesity Prevention Initiative (COPI) Geanne Lyons(916-455-7054)	Obesity Prevention	CDC	Children & adolescents	Develop a statewide strategic plan Using Social Marketing develop 2 pilot interventions Review surveillance data gathering systems to track obesity and related risk behaviors	Internal & External Planning Groups Key Partners: UC Berkeley Center for Health & Weight, UC San Francisco	Literature Review
California Heart Disease and Stroke Prevention Program (CHDSPP) Liana Lianov (916-322-1523) Web site	The California Heart Disease and Stroke Prevention Program aims to prevent and control premature death and disability from heart disease and stroke.	Federal Block Grant	All Californians; especially where there is disparity in health among Latinos, African Americans, Asian Americans, Pacific Islanders and Native Americans	Surveillance, linking existing programs, developing a clearinghouse (database with materials, activities, projects, websites, organizations, research, and experts), convening a Heart Disease and Stroke Prevention council, developing a state action plan, educating public health workers and interested groups, working with AHA's "get with the guidelines" program for hospitals, and seeking funding for demonstration projects.	CONTRACTS FUNDED: Heart Smart Cities grants 2-10 per year $60K per grant KEY PARTNERS: AHA, California Conference of Local Health Officers, National Stroke Association, California Medical Review	Californians' attitudes & knowledge of CVD Deaths From Heart Disease and Stroke Cardiovascular Risk among California Adults CVD Risk Factors among California Adults, 84-96. Web site
California Project LEAN Peggy Argon (916-323-4742) Web site	LEAN's (Leaders Encouraging Activity & Nutrition) mission is to increase healthy eating and physical activity to reduce the prevalence of chronic diseases.	TCE USDA, Federal Block Grant, Cancer Research Program	All Californians	California Project LEAN (CPL) works with state and local physical activity and nutrition leaders to conduct programs throughout California.	12 local regions based in county health departments, universities, and non-profit CBOs.
California Project LEAN Food on The Run Amanda Purcell (916-323-4742)	To increase physical activity and healthy eating behavior among teens as a way to improve health and reduce the risk of chronic disease	TCE, USDA, Federal Block Grant	Multiethnic, underserved high school students	Increase advocacy for physical activity & healthy food options Advance policy & environmental changes that support physical activity & healthy eating Motivate adolescents to engage in more physical activity & to eat healthier	Food on the Run is active in 30 California high schools.	JUMP START Curriculum Jump Start's real-life, cross-curricular lessons encourage students to eat healthy, keep moving and take action! Playing the Policy Game Kit, a guide to physical activity & healthy eating policy change game. Simple Solution campaign materials Teen Web Site
California Project LEAN Bone Health Campaign Elizabeth Bell (916-327-1421)	To prevent osteoporosis	USDA	Spanish-speaking Latino mothers	Paid radio campaign Promotora program Community events	2 intervention sites 2 control sites	Promotora curriculum with physical activity lessons
CANCER PREVENTION & NUTRITION SECTION (CPNS) A) California 5 a Day plus Physical Activity Campaign Desiree Backman (916-445-7031) Web site	Statewide public health campaign aimed at increasing daily consumption of fruits and vegetables to a minimum of 5 per day and physical activity to 30 minutes a day.	TCE USDA	California children, adolescents, and adults	Five targeted 5 a Day Campaigns: Children's 5 a Day - Power Play! Campaign; Latino 5 a Day Campaign; 5 a Day Retail Campaign; 5 a Day Work-site Campaign; 5 a Day Physical Activity Integration Campaign	Local community grants	Web site
CPNS B) Children's 5 a Day Power Play! Campaign Tanya Garbolino (916-327-2918)	Encourage consumption of at least 5 servings of fruits and vegetables every day as part of a low-fat, high-fiber diet and a physically active lifestyle	TCE USDA	9, 10 and 11 year old children in California, as well as educators and other adult intermediaries who can bring the 5 A Day message to children	Multi-channel, community-based approach Technical assistance to lead agencies in 10 regions Lead agencies oversee coalition development and implementation of Power Play!	Funds 10 regional coalitions	School Idea & Resource Mini Kit, Community Youth Organization Idea & Resource Kit, Farmers' Market Idea & Resource Kit, Retail Power! Kit
CPNS C) Latino 5 a Day Rosie Sotelo-Armijo (916-445-8068)	Encourage Latinos to consume 5 or more servings of fruits and vegetables every day as part of a healthy lifestyle to reduce the risk of diet-related chronic diseases, especially cancer and heart disease.	TCE/USDA	Spanish-language dominant and acculturated Latino adults and their families in California	Culturally relevant, linguistically appropriate, and community-based social marketing interventions Disseminates 5 A Day message through communication channels such as bilingual television and radio advertisements, media tours, festivals, farmers' and flea markets, and community education programs Educational materials and promotional items	Regional Outreach Grants to lead agencies	Latino 5 a Day cookbook, posters, bingo game, signage, and prize wheel, Latino 5 a Day brochure, and a Latino Community Kit (Physical Activity & Nutrition Activities)
CPNS D) 5 a Day Physical Activity Integration Campaign Gil Sisneros (916-445-6727)	A) Promote 30 minutes of daily, physical activity with CPNS target population B) Integrate physical activity message via social marketing into existing CPNS programs	USDA	Low-income families	Conducting formative research (literature reviews, focus groups, environmental scan, etc.) Developing a social marketing campaign to be piloted in 1-2 regions in 2002 Developing a marketing promotion kit for local projects	Contractors: CPNS LIA Contracts (150) Prevention Institute, SPARK, YMCA, Media-BMC, LMP, H7K Key Partners: YMCA, SPARK, SPORTS4KIDS, CPNS LIA Contracts (150)	Strategies for Action Framework Promotion Kit for CPNS Contractors (Fall 2002)
CPNS E) California Nutrition Network For Healthy, Active Families Susan Foerster (916-322-1520)	Network of over 200 agencies seeking to improve dietary and physical activity behaviors among Californians, specifically 5 fruits & vegetables a day and 30 minutes of physical activity via Social Marketing model	USDA Food Stamp Program, CDC Block Grant	Low-income families in California	Statewide social marketing campaign promoting nutrition and physical activity.	Contractors: 150 agencies funded, 12 month contracts, funding amount based on submitted in-kind. $19 million / Media Program funded for 3 years. Partners: Numerous types of agencies are represented on the Joint Steering Committee	Research reports include 1) California Dietary Practices Survey, 2) California Teen Eating, Exercise and Nutrition Survey, 3) California Children's Healthy Eating and Exercise Practices Survey.

Appendix VIII: Glossary

Aerobic activity: Physical activity that stimulates the heart, thus increasing its overall functional capacity.

Bikeability: A measure of how conducive a particular environment is to bike riding.

Bulk-outs: An alteration to a sidewalk, providing pedestrians with less distance to cross the street while slowing traffic.

California Behavior Risk Factor Survey (BRFS): A statewide survey conducted annually to research health behaviors of Californians. It is part of the national Behavior Risk Factor Surveillance System (BRFSS).

California Children's Healthy Eating and Exercise Practices Survey (CalCHEEPS): The only statewide survey that identifies dietary and physical activity practices, knowledge, attitudes, beliefs, and exposure to nutrition messages of children in the upper elementary grades of school; conducted by the Cancer Prevention and Nutrition Section of the California Department of Health Services.

California Dietary Practices Survey (CDPS): The largest dietary assessment of adults in California, the CDPS is conducted by the Cancer Prevention and Nutrition Section of the California Department of Health Services.

California Nutrition Network for Healthy Active Families (a.k.a. Nutrition Network): The state's largest nutrition coalition. The Nutrition Network blends various social marketing techniques, incorporating consumer empowerment and community development, to promote nutrition education, address and improve the health of low-income Californians.

California Teen Eating Exercise and Nutrition Survey (CalTEENS): The only large-scale dietary and physical activity survey conducted in California with youth age 12-17. CalTEENS measures progress toward reducing the prevalence of overweight/obesity in youth and increasing the percentage of these youth meeting most of the dietary guidelines; conducted by the Cancer Prevention and Nutrition Section of the California Department of Health Services.

Cancer Prevention and Nutrition Section (CPNS): A section of the California Department of Health Services. The section promotes healthy eating, physical activity, sun safety and other protective behaviors that prevent cancer and other chronic diseases while improving the health of all Californians.

Centers for Disease Control and Prevention (CDC): An agency of the U.S. Department of Health and Human Services. CDC is the lead federal agency designed to protect Americans' health and safety. CDC serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities.

Department of Health Services (DHS): A department within California State government. The mission of DHS is to protect and improve the health of all Californians.

Employee Assistance Program (EAP): EAPs are work-based programs. They are designed to assist in the identification and resolution of productivity problems associated with employees impaired by personal concerns including: health, marital, family, financial, alcohol, drugs, legal, emotional, stress, or other concerns which may adversely affect an employee's job performance.

Healthy People 2010: Healthy People 2010 is a report that was produced by the U.S. Department of Health and Human Services. The report outlines a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a roadmap for improving the health of all Americans by establishing a set of health objectives for the Nation to achieve over the first decade of the new century.

Incidental physical activity: Any physical activity obtained indirectly in the course of daily living (e.g. physical activity achieved while walking to the store or work).

Memorandum of Understanding (MOU): A document outlining specific agreements between two parties.

Moderately intense physical activity: Physical activity that causes only light sweating or a slight to moderate increase in breathing or heart rate.

National Health Interview Survey (NHIS): The National Health Interview Survey is the principal source of information on the health of the civilian non-institutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS). The NHIS monitors the health of the United States population through data collection and analysis on the amount, distribution, and effects of illness and disability in the U.S. and the services rendered for or because of such conditions. The NHIS is sponsored by the U.S. Department of Health and Human Services, the CDC, and the National Center for Health Statistics (NCHS).

Nutrition Network: (see California Nutrition Network for Healthy Active Families)

On The Move!: A California physical activity initiative that funded nine local projects, primarily serving ethnically and sociodemographically diverse communities. It promoted community-based physical activity programs using an ecological approach, with a focus on activities along the Spectrum of Prevention.

PA: Physical activity.

Physical Activity (PA): Any movement of the body that results in some energy expenditure.

Physical Activity Breaks: Short breaks from daily tasks during which one performs physical activity.

Physical Activity Collaboration Team (PACT): A team made up of California Department of Health Services staff. This team provides a center for collaboration among Department of Health Services staff involved in physical activity promotion.

Physical Activity and Nutrition Integration Committee (PANIC): A committee established by the Cancer Prevention and Nutrition Section of the California Department of Health to guide the Strategies for Action framework from strategy to action. This will be accomplished by advising CPNS on potential actions to integrate the promotion of nutrition and physical activity, through the implementation of Strategies for Action.

Promotoras: Non-professional community members trained to provide health education and outreach to residents in their neighborhood. The term literally translates into "women who promote," but is now used more generally to refer to any community leader.

Safe Routes to School: Programs to promote walking and biking to school by improving the safety of routes between homes and schools.

Sedentary lifestyle: A lifestyle without significant physical activity.

Social-Ecological Model: A theoretical framework for understanding the multiple factors influencing behavior. It conceptualizes the social world in five spheres of influence (individual, interpersonal, institutional/organizational, community, and public policy) and suggests interventions impacting more than one sphere of influence will have greater impact.

Social Marketing: Social marketing is the application of commercial marketing techniques to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences. Its goal is to use marketing techniques to improve the welfare of individuals and their society.

Spectrum of Prevention: This framework identifies six levels of intervention which encourage practitioners to move beyond a primarily educational or individual skill building approach to a more community-wide, systems change focus. Each level targets successively broader arenas for change. The levels are: 1) Strengthening Individual Knowledge and Skills; 2) Promoting Community Education; 3) Educating Providers; 4) Fostering Coalitions and Networks; 5) Changing Organizational Practices; and 6) Policies that Support Prevention. By carrying out action steps at each level, interventions have the potential to produce greater change than would be possible by implementing a single strategy.

Stages of Change Model: This theory describes the five stages (Precontemplation, Contemplation, Preparation, Action, Maintenance) people go through on their way to making a behavioral change.

Vigorous physical activity: Physical activity that causes heavy sweating and large increases in heart rate.

Walk Your Child to School Day: An international event during which parents are encouraged to walk with their child to school and to get involved in efforts to improve neighborhood conditions that impede walking to school.

Walkability: A measure of how conducive a particular environment is to walking.

Women, Infants, and Children Program (WIC): A supplemental nutrition program that is run by the California Department of Health Services. WIC helps pregnant women, new mothers, and young children eat well and stay healthy. The WIC program offers special vouchers to buy healthy foods, information about nutrition and health, support and information about breastfeeding, and help in finding health care and other community services.

United States Department of Agriculture (USDA): A sector of the U.S. Government. The mission of USDA is to enhance the quality of life for the American people by supporting the production of agriculture.

For more information, contact Prevention Institute. Phone: 510-444-7738; Fax: 510-663-1280; E-Mail prevent63.134.213.124

Return to top of page

Putting Prevention at the Center of Community Well Being
preventioninstitute.org