Improving Kentucky's mental health calls for the action of schools and doctors to identify children's mental health needs early

Many people may think that addressing mental health needs in Kentucky relies mostly on more funding, but its effectiveness hinges more on the ability to identify children who need help and make sure they get it early, two experts said on cn|2's "Pure Politics" Tuesday.

About half of mental illnesses begin to appear before a person turns 14, reports cn|2's Ryan Alessi. Mental-health experts say it’s often more effective and efficient to treat children, and it’s easier for parents to make sure their children get help than it is for someone to convince or coerce an adult exhibiting symptoms that he needs treatment, said Dr. Allen Brenzel, a child psychiatrist.


Encouraging school officials and doctors to identify children with these needs can be a challenge, Brenzel said, because it is difficult for a teacher to have tough conversations with parents about this topic. Also, while doctors may be most important in this process, obstacles exist because our current "system of care doesn't promote the amount of time and effort and importance on these issues," he said.

When a primary-care doctor's offices are jammed with sick patients and a parent comes in to discuss problems their child is having in school, "That’s a challenging environment in primary care,” Brenzel said. “But people trust their primary care providers very often, and that is where they go. So some of what we need to look at is co-location of services.”

Brenzel said we need a system with a single point of access, where a family can be greeted, there is a period of engagement and a reimbursement structure that supports the time and efforts required by behavioral health.

"We need to integrate behavioral health into the overall health care system," he said. "We have a very fragmented and inefficient system that leads to confusion when a family identifies that their child needs help and this isn't going to be fixed by a medical model.  We now know that the kinds of services need to be much more comprehensive and supportive. A system that allows a comprehensive mental and behavioral health assessment of needs will allow us to triage many kids out of the juvenile justice system."

Benzel said this is a societal issue and for every $1 that we spend in supportive services, we can avoid spend $5 later on adult incarcerations and adult prison. On average, it was more than $2,000 cheaper per person to treat a child than an adult. It amounted to $4,328 per child compared to more than $6,500 for each adult treated, Alessi reports.

Families may be fearful of the cost of mental-health services, but there are resources for people without mental-health insurance coverage at the 14 mental health centers in Kentucky, said Steve Shannon, executive director of the Kentucky Association of Mental Health/Mental Retardation Programs.

In terms of resources, Kentucky spent nearly a half billion dollars on mental health for people under 21 in the 2010-11 fiscal year. For adults, the state spent more than $730 million, according to figures from the Cabinet for Health and Family Services. (Read more)

Ky. parents strongly favor increasing school dropout age, a step that could make future high-school students healthier

A statewide poll has found that Kentucky parents overwhelmingly favor increasing the state’s school dropout age, and doing so might help future high-school students' health, according to the Foundation for a Healthy Kentucky, which sponsored the poll.   

After being told the legislature may raise the dropout age to 18 from 16, 85 percent of Kentucky parents said they favor the move, and 77 percent of parents said they strongly favored it.

Besides their homes, school is where children spend most of their time, and the overall health and well-being of students affect their ability to learn.  Healthy kids learn better and students’ academic achievement in turn affects their ability to be healthy and stay well in the future.

“People may not realize that education is a health issue, but research tells us that completing high school is directly related to our health status in later life,” said Dr. Susan Zepeda, President and CEO of the foundation. “Increasing the dropout age is one strategy aimed at improving the graduation rate in the state. We hope this polling data will encourage a deeper conversation among parents, education experts and policy makers to explore this and other strategies to help our children succeed at school and lead a more healthy life.”

The dropout-age question was part of the Kentucky Parent Survey, which provided a snapshot of parental views on a number of issues involving health care, school and home life. It surveyed parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky.

The poll was conducted in July and August 2012 by the Center for Survey Research at the University of Virginia.  More than 1,000 parents and guardians of children under 18 from throughout the state were interviewed by telephone, including landlines and cell phones.  The survey's margin of error is plus or minus 3 percentage points. 

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky ranks third among the states in child obesity, a problem that has a broad scope and deep roots (first in a series)

(Photo by Tara Kaprowy for Kentucky Health News)

By Tara Kaprowy
Kentucky Health News

At every Girl Scouts meeting, Christmas concert, soccer field and swimming pool in Kentucky lies a trend that is easy to spot. It doesn't have to do with the Toms on the children's feet or the feathers affixed to their hair. It's the fact that every third child in Kentucky is overweight, and many of them are obese. As they stand in front of the crowd or struggle to swim to the other side, the problem is plain. Its consequences are not so plan, but are far-reaching.

Kentucky has the third-highest childhood obesity rate in the country and the seventh-highest rate in adult obesity, Trust for America's Health's "F as in Fat" report shows. Sixty percent of Kentucky women and 80 percent of men living the state are either overweight or obese.

CHILD OBESITY RATES from Trust for America's Health

Estimates show that one in three children who were born in the year 2000

will develop Type II diabetes at one point in their lives, in large part because of the food choices they make. "We're also seeing lots of heart indicators, like high-blood pressure, high lipids and cardiac changes, in kids that are overweight," said Dr. Christopher Bolling, a pediatrician in Kenton County. "And we're seeing a lot of other issues like liver disease and kids with orthopedic problems."

Obese children can also have breathing problems like sleep apnea and asthma. They struggle with low self-esteem and the depression that can result from it. And they are the first American generation expected to live a shorter life than their parents. "They're taking medicine we used to give to old people," said Duff Holcomb, the schools nurse in Laurel County. "They're 15 and 16, so what are they going to be like when they're 36?"

The issue stems from "a perfect storm" of factors, said Elaine Russell, the state's obesity prevention coordinator. "Our food is high in calories with little nutrients," she said. "A lot of physical education has been taken out of normal daily routines."

And food is everywhere, from billboards to unexpected places like cash registers at T.J. Maxx and Office Depot, Russell said. One study found kids see about 4,000 television commercials advertising food each year. During Saturday morning cartoons, they see a food ad nearly every five minutes, and about 95 percent are pushing food with poor nutritional value. "And it's not just TV," Russell said. "Look at all the billboards, look at the Internet, look at your packaging, with characters that say, 'Come see me and do the Web game.'"

The variety of food is also staggering, Russell pointed out. "Look and see how many Oreos there are. It's not just Oreo or double-stuffed. There's also ones with mint and peanut butter. How many different chips? How many different sodas? Our choices are so unlimited."

Halloween candy displays are already set up
in grocery stores, pharmacies and other stores
across the state. (Photo by Tara Kaprowy)

So, it's easy for children to make the wrong choices. Almost 40 percent of the total calories consumed by 2- to 18-year-olds are in the form of empty calories, meaning solid fat and added sugars. Next to Mississippi, Kentucky youth drink the most soft drinks in the country — up to 89 gallons per person, according to information researchers at the University of Kentucky's Nutrition Education Program compiled from the USDA's Food Environment Atlas. Meanwhile, just 17 percent of Kentucky high school students reported eating fruit and vegetables five times per day over a week's time, the amount recommended by the United States Department of Agriculture.

Children adopt bad eating habits from their parents, who "gatekeepers" of the kitchen, Russell said. "If Mom and Dad are feeding you [junk food] then you tend to eat that because that's what available to you."

Parents blame busy schedules and lack of time — and they are busier, in large part because both parents work in most households. Also, many of today's parents either don't like to cook, or can't.

Debra Cotterill teaches cooking classes for the University of Kentucky's Nutrition Education Program and is often shocked at the decline in cooking skills. "There's people out there who have said to me that they literally did not know how to boil water," she said. "I've also met people who live on candy and packaged chips because they don't know how to cook." Ginger Gray, director of food services in Kenton County Schools, was not surprised, saying many of today's parents "are a generation of microwave users."

Exacerbating the problem is a lack of exercise. Gone are the days of students heading to the change room to get ready for gym class. In Kentucky, elementary schools must offer some type of physical activity for 30 minutes each day, but that can include unsupervised recess. There are no physical education requirements in middle schools, and high-school students just need to take one half-credit of phys-ed to graduate. The decline in phys-ed is coupled with the fact that kids lead an increasingly sedentary lifestyle. In Kentucky, nearly one in three high school students watch three or more hours of TV each day and more than 60 percent of kids have a TV in their bedroom.

A lack of play time after school is another culprit, in large part because "There's a lot of media that say it's not safe to go outside and play," Russell said. In fact, just over 100 children are kidnapped in a stereotypical way each year in the U.S., according to the National Center for Missing & Exploited Children, and the number of violent crimes was lower last year than it has been in 40 years. Yet, fear of the unknown is embedded in parents, Gray said, who sees parents waiting in their running cars for their children to be dropped off at bus stops. "What a huge impact changing that attitude would make," she said.

(Photo by Tara Kaprowy, Kentucky Health News)

While the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" estimates 33 percent of Kentucky children are already overweight or obese, there is no way of knowing how those numbers vary county to county, because there is no systematic collection of them. Body-mass index, a rough measure of fat to weight, is measured statewide only for children aged 2 to 4 in the Women, Infants and Children nutrition program. "Some individual school districts and counties are collecting more information, but it is spotty," said Sarah Walsh, senior program officer at the Foundation for a Healthy Kentucky.

Starting this school year, the state board of education started requiring that there be a place on the state health exam form that includes a student's BMI, though physicians are not required to fill it in. The exams are required when a student enters school in Kentucky, generally in kindergarten, and again when a student is about to enter the sixth grade. "I would say it's a start but this is not a mandate on students or parents or physicians or schools. This is an option," said Lisa Gross, spokeswoman for the Kentucky Department of Education. Still, the BMI information could be shared at the aggregate level if the Department of Public Health asked for it as part of an analysis, Gross said.

But regardless of what data is collected, there is a problem "showing us basically whatever age group you look at, you've got too high of a proportion of children who are overweight and obese," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. Some data show obesity rates are higher in children living in the Appalachian part of the state. Many studies also correlate children from low-income families with higher obesity rates. Giving counties an idea of where they stand is essential to getting a handle on the fight. "There is an old adage that 'what gets measured gets done,' and it couldn't be more true in this case," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "Local communities need to know where they stand on this important health issue so they can track progress and really make changes with childhood obesity."

NEXT: What is being done in nationwide, in Kentucky, and in individual communities to address the problem.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

What is being done to fight child obesity in Kentucky, which ranks third nationally in the problem? (second in a series)

Students in Kenton County Schools sample kale chips
as part of an effort to incorporate more fruit and
vegetables into their diets. (School district photo)

By Tara Kaprowy
Kentucky Health News

Now that all schools are back in session, cafeterias in every corner of Kentucky are bustling with students sweeping through lunch lines, sitting down with their best friends and sampling their meal.

It's in these loud, boisterous rooms that the fight against childhood obesity, which is higher in Kentucky than in all but a few states, is beginning to take shape.

Many children eat more than half their calories at school, but schools are just one of the battlegrounds. Across the country and the state, there are initiatives that are gaining traction to take a bite out of the problem.

When school started this year, the 556,000 Kentucky kids who get their lunch from school cafeterias may have noticed a more apples and oranges on their plates. With the goal of creating a healthier school environment, the United States Department of Agriculture has revamped school lunch regulations for the first time in 15 years. Many of the changes involve what some see as the saviors of kids caught in the obesity epidemic: fruit and vegetables.

In order for lunches to qualify for School Lunch Program funding, students now must have at least one serving of fruit or vegetables on their plate by the time they reach the cash register. And "vegetable" no longer just means French fries. And at least once each week, schools must serve a green, leafy vegetable like broccoli or spinach, plus an orange or red vegetable like carrots, and a legume like lentils or chickpeas, which are a good blend of protein and carbohydrates with very little fat.

Food service directors are optimistic elementary students
will adjust to school lunch changes, but high schoolers
are a different story. (Kenton County Schools photo)

Will students actually eat those foods? Julia Bauscher, food service director at Jefferson County Public Schools, is optimistic about elementary school students. So is Ginger Gray, director of food services in Kenton County, who has been serving such vegetable dishes as broccoli parmesan and kale chips for several years.

"Kids are more open to trying new things than adults realize." Gray said, but "It takes persistence. You can't just say I tried it once and kids didn't eat it so you don't try it again." 

High school students are a harder sell. Sylvia Moore, child nutrition and food service director at Mercer County Schools, said lunch participation rates have dropped by about 5 percent since the beginning of the school year. "Just this week I was up at the high school to stand at the garbage can. I was just there a minute when a girl came and tossed her totally-untouched orange in front of me," she said. "We are already making healthier garbage cans," not healthier students, she added.

The media angle

Another nationwide effort involves what children see on TV, which could have a big impact. A 2009 study found they average more than 32 hours a week. Excessive TV viewing is linked to a sedentary lifestyle, and American children see about $1.6 billion a year worth of food and beverage marketing. "It's a double-whammy," said Josh Golin, associate director for the Campaign for Commercial-Free Childhood. "It's the combination of not moving, and being urged to consume unhealthy food."

(Kentucky  Health News photo)

By 2015, that will change on channels of the Walt Disney Co., which will no longer put ads for products like Capri Sun and Kraft Lunchables (left), as well as a variety of candy, sugared cereal and fast food.

The television show iCarly, popular on Nickelodeon, is approaching the issue differently, encouraging viewers to create their own wacky veggie dish and submit the recipe for the "iCarly iCook with BirdsEye" intiative. Spots on the channel show the kinds of dishes the contest wants, like a "veggie sundae," which consists of a scoop of carrots, cauliflower and broccoli in a banana split dish.

A 2006 study showed 88 percent of the food ads on Nickeldeon promoted unhealthy food. A year later the channel announced its characters like Dora the Explorer and SpongeBob SquarePants would be licensed to sell only healthy foods; that's why Dora appears on packages of frozen edamame -- green soybeans, often in their pods.

Teaching the basics, and behaviors

Statewide programs are also infiltrating directly into communities. One involves cooking classes, with teachers from the University of Kentucky's Nutrition Education Program setting up demonstrations everywhere from public housing to women's crisis centers to church basements.

For 10 weeks, the teachers educate low-income adults about the basics of cooking with the hope they will change the way they feed their families. "We talk to them about how to use coupons, how to use dried beans instead of canned beans, how to use those leftovers and how to stretch their food dollars so they can provide good-tasting and nutritious food," said Debra Cotterill, the program's director.

The 43-year-old program was created to teach people how to use government commodities, like big blocks of cheese, that they received in the 1970s. Since obesity has become so prevalent, Cotterill said the emphasis has changed and interest in classes is up dramatically. In fact, Cotterill said the extension program's whole mission has expanded.

"It is not enough to share information, we also have a responsibility to help change behaviors," she said. "Now, all agents do some type of nutrition education in their work somewhere or other, even the ag agents, because it's become such a problem in our counties."

State regulations lack some specificity

Since many children entering kindergarten are already overweight, state government is examining preschools and daycare centers to see what policies they have in place when it comes to nutrition and physical activity. Though there are state regulations for licensed child care centers, "the language is not specific," explained Elaine Russell, the state's obesity prevention coordinator. For example,  regulations say bread should be served with meals, but don't specify the type of bread, such as whole grain or whole wheat, and don't prohibit high-fat snacks or sugar-sweetened beverages.

As part of a pilot program, state workers went to nine facilities each in Northern Kentucky, the lower Green River region and the Barren River region to assess their policies, teach directors and staff about obesity in Kentucky and discuss goals with directors and staff about their goals.

They also taught them the program 5-2-1-0, a catchy way of reminding students they should have five servings of vegetables each day, no more than two hours of screen time, at least one hour of physical activity and drink zero sugary beverages. The program is being pushed by pediatricians and at offices where poor mothers sign up for the Women, Infants and Children nutrition program. "Our goal is to make sure our parents hear this from more than one spot," Russell said. "We can change these policies but unless parents understand why we're making them, they probably won't stick."

Many facilities in the pilot program didn't have wellness policies before the process, but all did afterward. However, Russell would also like to see child-care centers adopt the standards for nutrition and physical activity as suggested in Caring for Our Children: National Health and Safety Performance Standards, which have stronger guidelines that promote active play every day and follow minimum standards as recommended by the USDA's Child and Adult Care Food Program. "Some states require at least two hours of physical activity a day, she said. "Physical activity is encouraged in Kentucky, but it's not specified. Kentucky rules do limit screen time, but kids are still allowed to watch two hours a day."

An early start

Some programs focus on even younger children, including infants, and pregnant women. "A lot of times when we talk about childhood obesity, we kind of default into talking about school-age kids," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. "But if we're going to take a really multi-faceted approach, what we now know is it actually starts with the mother's nutrition while she's pregnant."

(University of Louisville Hospital photo)

That idea is behind the Kangaroo Care Initiative, which promotes skin-to-skin contact with new mothers and their babies in order to promote breastfeeding and bonding. Among other benefits, breastfeeding can help reduce the risk of obesity. One study showed children who were breastfed were 22 percent less likely to be overweight by age 14, said Marlene Goodlett, Kentucky's breastfeeding coordinator.

The effort started in 2007 with the University of Louisville's Hospital Center for Women and Infants. This year, U of L partnered with the WIC program to train all 51 birthing hospitals in the state. Now, 84 percent of them have implemented Kangaroo Care. One of the first hospitals on board was Flaget Memorial Hospital in Bardstown, where breastfeeding rates increased to 61 percent from 49 percent.

Community lessons

From a walking trail mowed on land owned by the community hospital in Winchester, to the Hopkinsville farmers' market accepting food stamps, there are local efforts to combat obesity in place that, inch by inch, are causing change.

(Photo by Steve Patton, UK College of Agriculture)

These success stories are detailed in the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity," funded in part by the state health department, which illustrates ways Kentucky communities are making policy, environmental and systems changes.

One of these is the Better Bites program in Lexington, a revamp of how food is sold at swimming-pool concession stands in Lexington. "We learned you could exercise at the pool for two hours, go to the concession and get a standard hamburger, fries and soft drink combo and you would actually take in more calories that you're burning. That was a shocking statistic for us and really propelled us along," said Brian Rogers, deputy director of enterprise at Lexington Parks and Recreation. Organizers introduced menu items like yogurt and fresh fruit, replaced hot dogs with turkey dogs, standard popcorn with low-fat popcorn and sold only baked chips at two public swimming pools in the city starting last year. This summer, candy sales went down 20 percent. and the Better Bites menu items constituted 15 to 20 percent of all sales, up from 10 percent last summer, Rogers said.

Berea is concentrating its efforts on environmental change with its Complete Streets project, which is aimed at making the city's streets more accessible to walking and biking. Two major projects — a bridge project that includes sidewalks and bike lanes and a three-mile trail that connects downtown with the Indian Fort Theatre — are opening up much more territory to pedestrians. The city has coupled these efforts with simple changes like making walkways more visible, installing bike racks around town, and changing the timing on lights to give pedestrians more time to cross the road.

Mayor Steve Connelly said the effort is about culture change. "I do think that we have perhaps by accident created these barriers to walk and bike largely since the 1950s when America really fell in love with the Interstate, franchise restaurants, the suburbs and the automobile," he said. "Really, we need to get back to walking as second nature." With each installation of more sidewalks and trails, though, that is exactly what is happening, Connelly said. "It's the classic when you build it, they're out there using them," he said.

Still a way to go

While progress is being made, experts say the nation is just beginning to round the corner on the problem. Though some studies show childhood obesity and overweight rates may be leveling off, many kids are simply graduating from the overweight to the even more unhealthy obese category, said Dr. Christopher Bolling, a Kenton County pediatrician.

After a visit this fall to school cafeterias to document changes that are happening there, perhaps reporter Lenny Bernstein said it best in The Washington Post: "If we don't yet know how well we're doing in this battle, we are at least figuring out how to develop our weapons."

NEXT: Why the obesity epidemic is such a difficult problem to solve.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Cafeteria workers wear fruit costumes to promote healthy eating

Wanna get kids to eat more fruit and vegetables at lunch time? Dress up in a banana suit. That's what cafeteria workers do at an elementary school in Hallandale Beach, Fla. (MCT photo by Mike Stocker)

"They love it," said intern Ericka Floyd while wearing the yellow costume. "Some kids want to bite me."

Floyd and other workers have put on the costume, as well as others depicting corn, grapes, carrot and watermelon, to encourage kids to eat more healthy, reports Robert Nolin for the Fort Lauderdale Sun Sentinel. "We're trying to attract attention to the concept that fruits and vegetables are good for you. They're good to eat, they're fun," said Darlene Moppert, a nutritionist who helps feed about 140,000 students each day.

Moppert said kids need to be prodded to eat healthily because "their consumption of fruits and vegetables is not where it needs to be." In addition to the costumes, Moppert hosts focus groups to see what students like to eat; do "plate waste" studies; and buy fresh produce from Florida farmers. She also working with popular menu items like pizza, burgers and chicken nuggets to make them more healthy. "We're taking what kids like and are familiar with and making it in a form that's a little healthier," she said. (Read more)

Sodas losing fizz in schools, but exclusive deals remain

New research from the Robert Wood Johnson Foundation shows more than half of middle and high schools have purged the pop since the 2006-2007 school year. That year, 53.6 percent of high schools and 27.4 percent of middle schools gave students access to soda. In the 2010-2011 those numbers dropped to 25.3 in high schools and 12.5 percent in middle schools, reports Sarah Kliff for The Washington Post.

"You have policymakers at the state level, and also more local, moving policies into this directions," said researcher Yvonne Terry-McElrath. "You have policymakers at the state level, and also more local, moving policies into this direction. I also think you're seeing movement from parents and individuals who are becoming more aware of what is and isn't healthy."

That is the case in Kentucky. Under a state law passed a few years ago, students can only buy school-day-approved beverages — 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving — during the school day. It may benefit reporters to ask school administrators though if there are vending machines at school that sell soda after the school day is finished, however. 

Though schools are getting rid of soda in high numbers across the country, a lot of them still have relationships with Coke or Pepsi, something reporters can find out by simply asking administrators.

Photo by Paul Robert Lloyd, via Flickr

A 2005 survey found nearly half of elementary schools and about 80 percent of public high schools nationwide had pouring rights contracts with one or the other of the soda companies, which gives them exclusive rights to supply all the beverages in school snack bars, vending machines, school stores and at sports events.

The upside for the schools can include funding for field trips, gym uniforms, SMART boards and other perks, reports blogger Tom Philpott for Mother Jones. Philpott cites one study that shows students living in states with laws that limit junk food sales gained less weight — an average of about 2.25 pounds for a 5-foot child — than those that didn't. A study in California showed students consumed 158 less calories each day in schools where sodas were banned and new nutritional regulations were implemented in cafeterias.

But one study of 20,000 students found no correlation between obesity rates and access to soda at school. "The research is pretty mixed," Terry-McElrath said.

As schools resume and prepare to follow new lunch rules, federal fruit and vegetable snack program is up for debate

Bloomberg photo by Ian Waldie

With students and teachers returning, school food-service directors are working to implement the new federal school lunch regulations that take effect this year. This would be a good story for local news media, since it affects almost every student.

As school resumes, another school food program is up for debate. Congress is deciding whether frozen, canned and dried produce should be included in the Fresh Fruit and Vegetable Program. House Republicans say yes, to save money and make a wider range of options available year round. But the Senate is pushing to keep the program limited to fresh fruit and vegetables only. The argument — or food fight, as Dina ElBoghdady of The Washington Post calls it — has trade and other groups weighing in.

"If the goal is to expand and improve upon childhood nutrition, it doesn't make sense to limit the kinds of fruit and vegetables that schools serve," said Corey Henry, a spokesman for the American Frozen Food Institute. "Let the schools decide." But Sandi Kaur, acting director of nutrition services at the California Department of Education, disagrees, saying "it's the fresh that makes this program unique."

More than 50,000 students in 125 Kentucky elementary schools benefit from the program, run by the U.S. Department of Agriculture. To see which schools participate, click here. The program allows schools to distribute fresh fruit and vegetables as snacks to students and has "raised consumption in participating schools by a quarter-cup per day, or 15 percent," ElBoghdady reports. "The increase did not contribute to weight gain, suggesting that the fruit and vegetables replaced other foods." Last year, USDA spent $150 million to pay for the snacks for 3 million children. (Read more)

Kentucky students will get extra education in nutrition, exercise

Kentucky children will get extra nutrition education at school starting Oct. 1, thanks to a $6 million federal grant intended to instill better eating and physical-activity habits in families eligible for food stamps.

The education will be provided by local health departments. It will encourage students to:
• Fill half their plates with fruits and vegetables; drink fat-free or low-fat milk; and make sure they eat whole grains.
• Increase physical activity and cut down on sedentary behaviors.
• Consume the appropriate amount of calories for their age.

Kentucky students will get more nutrition education
aimed at getting those eligible for the Supplemental
Nutrition Assistance Program to make healthy food
choices. (Photo from The Lane Report)

Details about how many children will benefit from the education and how many minutes of instruction they will receive per week have not yet been ironed out, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.

"Sometimes children can be the best teachers, so our hope is that they will pass on to their parents some of what they have learned at school about the importance of nutrition and physical activity," said Teresa James, acting commissioner of the Department of Community Based Services. "If children ask their parents to serve more fruits and vegetables, or take a walk instead of watching TV and the parents comply, this effort can benefit the entire household — just look at the influence children have had on recycling." (Read more)

Schools have big role to play in battling childhood obesity

Schools can make a powerful impact on battling the childhood obesity epidemic, but only when health and nutrition are seen as a way to improve student learning rather than take away from it.

But there can be push-back in making this transition, said John Skretta, a health advocate and superintendent of Norris School District in Firth, Ky. At the Coordinated School Health Symposium in Lexington Monday, he talked about his efforts to introduce tuna salad in the school lunch menu, with food service directors saying students wouldn't eat it. Finally, the district's head of nutrition made some herself using low-fat mayonnaise and pickles and it was a hit with kids.

To get kids more physically active, Skretta said kids in his elementary schools now take two 10-minute walks a day, which have improved test scores and gets children closer to the goal of making long-lasting choices about their health.

To help with the process, school staff are encouraged to model healthy behavior and avoid eating or drinking items that have low nutritional standards in front of students.

"If schools don't take the lead on this, who will?" Skretta asked. (Read more)

New resource guide and school curriculum aimed at expanding farm-to-school programs in Kentucky

A resource guide and school curriculum are the latest efforts to expand farm-to-school programs in Kentucky. With fewer than 30 percent of Kentuckians consuming the recommended amounts of fruits and vegetables every day, farm to school is a “win-win for students, school food service, farmers and local economies,” said Elaine Russell, coordinator for Kentucky Obesity Prevention Program and chairwoman of the Kentucky Farm-to-School Task Force.

The guide includes advice from Kentuckians who have already participated in projects; resources to connect farmers and school food service directors, how to follow procurement rules; recipes; a produce calculator; funding sources; and how to get kids to eat their vegetables.

The curriculum helps students recognize the sources of the food they eat and explains how eating locally-grown food can improve their diet and nutrition.

The undertaking is a joint effort between the Kentucky Department for Public Health the state Department of Agriculture the state Department of Education and the University of Kentucky. The new resources will be presented to school food service personnel June 19 at the Kentucky School Nutrition Association’s conference at the Northern Kentucky Convention Center in Covington. (Read more)

Task force to consider middle-school sports regulation

A task force made up of legislators, educators and athletic officials will examine what guidelines should be in place for sports at the middle school level, which are not regulated in Kentucky.

The task force was created by the 2012 General Assembly to "discuss 'best practice' guidelines for middle school sports and to take into consideration non-profit organizations that oversee some individual teams," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

"It remains to be seen" what the task force could recommend, Rep. Bob Damron, D-Nicholasville, told Spears. But Damron, who sponsored the resolution creating the task force, said "in the long run that's probably a good direction to have one entity standing for middle school athletics."

The Legislative Research Commission will name task force members by Aug. 1. Recommendations to legislative committees are expected by Dec. 7. (Read more)

School nurses in Fayette cut as public-health dollars shrink

Takirah Sleet, 7, and school nurse Michelle Marra assess her
lunch to manage Takirah's diabetes. (H-L photo by Pablo Alcala)

As public health and education dollars shrink, school nurses are caught in the middle. The Lexington-Fayette County Health Department is among those scaling back its school-nurse program due to cuts, even as "more students with greater medical needs are appearing in classrooms," reports Mary Meehan for the Lexington Herald-Leader.

The cuts and the need present a difficult scenario: "In order to be educated, a student has to be healthy. How do you make that happen?" asked Mary Burch, president of the Kentucky School Nurse Association.

Schools nurses are not mandated in Kentucky, and the way school districts address the issue varies widely. Some districts use a nurse consultant to train school staff. The National Association of School Nurses recommends one school nurse for every 750 students. With 40,000 students, Fayette County falls short of meeting that level of care. The Fayette County school board helps to increase funding to keep nurses in place. About $600,000 would need to be reallocated. (Read more)

Poll finds parents overwhelmingly support more nutritious school food; USDA expected to issue new guidelines

Photo by Reuters' Lucy Nicholson

Chocolate bars, Cheetos and cheesy fries may soon be a thing of the past at public schools in America, and that's fine with parents, a new poll has found.

The survey found "most people agreed the chips, soda and candy bars students buy from vending machines or school stores in addition to breakfast and lunch are not nutritious, and they support a national standard for foods sold at schools," reports Susan Heavey for Reuters.

As it did for school lunch earlier this year, the U.S. Department of Agriculture is expected to release new guidelines for vending machines and à la carte sales by June, some experts say.

In Kentucky, schools are already not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive in the morning until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what food or drinks that can be sold in fundraisers.

The poll, conducted by advocacy group Kids' Safe and Healthful Foods Project, found 80 percent of the 1,010 adults surveyed said they would support nutritional standards that limit the calories, fat and sodium in such schools.

Students eat one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese, As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows.

A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. As such, changes might be controversial. The new guidelines for school lunch met with resistance from lawmakers, who "locked limits to french fries and counted pizza as a vegetable because it contains tomato sauce," Heavey reports.  There are concerns industry lobbyists and members of Congress could dilute the USDA proposals. (Read more)

New federal rules on vending machines in schools are expected in the next few weeks

With new lunch standards set to kick in by next school year, the Obama administration is looking at its next target in the school food landscape: vending machines. New guidelines are expected to be released in the coming weeks "for foods that children can buy outside the cafeteria," reports Ron Nixon of The New York Times. Kentucky already has some rules in place, may get stronger as a result of the new guidelines. (NYT photo by Kirsten Luce)

Students eat from one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese. As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows. The administration wants to ensure that students eat what is good for them and avoid becoming overweight, Nixon reports, but there is strong pushback from the food and beverage industries.

A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. Schools have a stake in the fight as well, with candy sold in fundraisers often used to help pay for sports, music and arts programs. In Kentucky, the changeover to water, lowfat milk and fruit juices caused a downturn in revenue from the machines, but in most cases it appears to have rebounded to earlier levels.

The forthcoming guidelines are unknown, but officials predict they will be similar to the changes in the school lunch program, which reduced sugar, salt and fat. Those changes were a compromise after a fight between health advocates and the food industry. Nancy Huehnergarth, executive director of the New York State Healthy Eating and Physical Activity Alliance, said she expects another fight. "I think the food and beverage industry is going to fight tooth and nail over these rules," she said.

In Kentucky, schools are not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what foods or drinks that can be sold in fundraisers. (Read more)

National School Breakfast Week to be observed March 5-9

National School Breakfast Week, an observance meant to increase awareness of the availability of the federal School Breakfast Program, will be held from March 5 to 9 this year.

Research has shown students who eat breakfast score better on tests, have fewer health issues and are better behaved, says a press release from the Kentucky Department of Education. In Kentucky, about 190,000 students eat breakfast at school each day, which represents about 30 percent of public school enrollment, said spokeswoman Lisa Gross. The numbers are not broken down by district.

Schools are encouraged to participate in a spirit contest whose winners will be given a certificate of excellence by Kentucky Education Commissioner Terry Holliday. Schools can plan festivities and then share what they've done to celebrate the event. Winners will be recognized April 19. The deadline to enter is March 22. For more information about contest rules, click here.

Michelle Obama announces nationwide contest to fight childhood obesity; $500,000 in prizes

As part of her Let's Move initiative to fight childhood obesity, First Lady Michelle Obama announced a contest today that will give away $500,000 in prizes. The Active Schools Acceleration Project will reward the most "creative, impactful and scalable school-based programs and technological innovations that promote physical activity for children," a press release reads.

"We know there's so much good work going on all across this country to get our kids up and moving every single day," Obama said. "So we want to find the best school programs and technology ideas that increase physical activity for kids — and then help them reach even more children throughout America."

The competition features two categories: school programs and technology innovation. Teachers, schools or entire districts can submit their in-school activity programs, which could include a curriculum, activity, environmental modification, event or other initiative. The technology innovation category can include devices, tracking and measurement systems, software applications, social media, gaming and smart phones that encourage kids to be physically active.

Applications will be accepted through April 2. For more information, click here.

41 Kentucky high schools receive grants for nutrition, exercise, tobacco prevention to be planned by students

More than 40 Kentucky high schools will receive grants to improve student nutrition, increase physical activity or prevent tobacco use. The "Students Taking Charge" program will have students assessing their school environment and coming up with and implementing an action plan to create healthy changes.

"We have to create programs that get our young people involved in the process and on the path to lifelong health and wellness," said Victoria Greenwell, administrator for the state Department of Public Health's Coordinated School Health program and co-chair of Kentucky Action for Healthy Kids. "If we wait until children are grown to introduce them to healthy environments or sensible eating and exercise plans, it's often too late. We have to act now to instill the values of leading a healthy lifestyle."

Just 16.7 percent of Kentucky students reported eating five servings of fruit and vegetables every day and under 40 percent of students said they had been active for an hour on five days during a week, the 2011 Youth Risk Behavior Survey found. The survey also found nearly 1 in 3 students said they'd used a tobacco product in the past 30 days.

To see which schools received a grant and for more information, click here.

USDA issues new school lunch rules; not as broad as first written, but will make meals healthier

The U.S. Department of Agriculture has released new, finalized requirements that will make school lunch a healthier meal for students.

The guidelines will mean:

• Students will be given both fruit and vegetables every school day.

• More foods will be made with whole grains.

• Students will be offered only fat-free or low-fat milk.

• Calories will be limited by portion size, based on the age of children being served.

• There will be less saturated fat and trans-fats in the food served.

• The amount of sodium will decrease gradually over the next 10 years.

Though the changes represent the first school-lunch overhaul in 15 years, they are not as comprehensive as the Obama administration initially wanted them to be. A bill passed late last year "would require the department to allow tomato paste on pizzas to be counted as a vegetable, as it is now," reports Mary Clare Jalonick of The Associated Press. "The initial draft of the department's guidelines, released a year ago, would have prevented that." Congress also kept USDA from limiting potatoes to two servings a week. Potato farmers and frozen-pizza companies lobbied hard against those proposals, some conservatives said the government shouldn't be telling children what to eat, and some school districts said the changes were too broad and too expensive.

Some of the changes will be incorporated by September, and others will be phased in. The changes affect lunches that are subsidized by the federal government in the National School Lunch Program, which serves 32 million children. Participation rates are very high in Kentucky. The Covington and Owsley County school districts have the highest percentage of students — 88 percent — eligible for free or reduced-price lunch. Magoffin County has the second highest with 86 percent followed by Newport (85 percent); Bell County (83 percent); and West Point Independent in Hardin County (81 percent). (Read more)

The changes are aimed in part at curbing childhood obesity. That has also been the target of measure to limit junk food in schools, which have been called into question. A recent study of almost 20,000 students found no link between junk food at school and weight gain in children. "The researchers examined the children's weight and found that in the eighth grade, 35.5 percent of kids in schools with junk food were overweight while 34.8 percent of those in schools without it were overweight — a statistically insignificant increase," reports Benjamin Radford of Discovery News. (Read more)

Rockcastle County school board nixes ban on smoking at schools

While more than 30 Kentucky communities have banned smoking in enclosed public places, and about as many school districts have imposed a total ban, many districts remain resistant to the idea. This month the Rockcastle County Board of Education turned down a smoking ban that would have allowed designated smoking areas at athletic events but no smoke breaks for employees.

"Four of the five board members expressed opposition to the ban, including Mike Burdette, who said he didn't feel it was right to tell an adult they cannot use a legal product on grounds their taxes pay for," reported  the Mount Vernon Signal. Other board members said they didn't like the fact that the proposal from the administration did not include smoke breaks since employees "can't leave school during the day except for designated reasons."

The Signal reported that Superintendent Larry Hammond "put forth the argument that research has shown that second- and even third-hand smoke can be harmful to students," but only Board Chairman Martin Vanzant supported the proposal. To a member who suggested that the ban be delayed for two or three years, he said that would be "postponing the inevitable." (Read more)

In Kentucky, "All 174 school systems have restrictions of some sort on the use of tobacco products on their campuses, and any that allow staff smoking have designated areas," Brad Hughes of the Kentucky School Boards Association told Kentucky health News. "About 30 have a total ban."

Generals in Kentucky, the national leader in young-adult obesity, say the 'too fat to fight' trend is endangering national security

Recent commanders of the Kentucky National Guard say the country could be at risk because America's youth is too fat to fight, and they urge Congress to take action. A study recently showed more than half of adults 18 to 24 in Kentucky are overweight or obese — the highest share of any state. Nationally, one in four young adults are too overweight to enlist.

"What can we do to combat child obesity and help expand the pool of young adults qualified for military service?" former Adjutant Gens. Donald Storm (right), Michael Davidson and D. Allen Youngman write in an op-ed piece for Kentucky newspapers. "School is a good place to start. Many children consume nearly half of their daily calories at school, and more than half of kids eat at least one meal served in school every day."

The Healthy, Hunger-Free Kids Act, which updates school nutrition standards for the first time in decades and provides more funding for each meal served in school cafeterias, is a step in the right direction, they say, "but more is needed to prevent our childhood obesity crisis from becoming a national security crisis."

Updating school equipment and personnel seem necessary. A recent survey of 13 southeastern Kentucky school districts found that nine use deep fryers and only five use salad bars. The survey also found that the vast majority of districts do not have the funds necessary to update or repair equipment that will be needed to comply with the new nutrition standards. Also, 11 of the 13 school food-service directors said their cafeteria workers need more training in order to be prepared for new standards.

"We are urging members of Congress to help schools meet the standards of the new child-nutrition law and provide additional support for kitchen equipment and training," they write. "These funds will help ensure that all of our children can lead healthy lives and that those who wish to serve their country are fit enough to do so." (Read more)