Goal 3: A Healthy, Well-Nourished Population

With regard to physical activity, nearly 50 percent of American youth are not vigorously active on a regular basis and one-fourth of American young people ages 12-21 report no vigorous physical activity. Participation in all types of physical activity declines as age and grade in school increases. In North Dakota, 89 percent of seventh graders, 59 percent of 10^th graders and 27 percent of 12^th graders attend physical education class at least once a week. That these patterns tract to adulthood is supported by the current estimate that about a fourth of the adult U.S. population fails to engage in physical activity during their leisure time while only 15 percent regularly engage in vigorous physical activity during leisure.

North Dakotans face all of these problems and has some unique health- and nutrition-related concerns including an increased risk of diabetes and heart disease.

NDSU has developed a range of programs that target the problems outlined above.

The NDSU Extension Service has helped form 5 Plus 5 coalitions across the state. These coalitions bring together local experts to work toward the goals of the 5 Plus 5 program. In 1999-2000, nine coalitions developed community-wide educational plans and were designated as "5 Plus 5 Communities." To achieve this recognition, they established a partnership including a 5 A Day nutritionist, physical activity expert, and influential leader. Other less formalized 5 Plus 5 programs have occurred throughout the state.

The in-school Kids Calcium project increased knowledge as measured by pre/post testing and a 50 percent increase in calcium intake during school hours. About 41 percent of the students surveyed indicated they drank more milk as a result of this intervention. About 83 percent noticed the cow faces/captions, 67 percent watched the weekly video on the school channel, 50 percent read the calcium facts in the speech bubbles.

Nutrition knowledge scores of the 185 second graders that participated in the Pyramid Players program increased significantly from pre to post-test. In one of the cities, follow-up testing showed that 95 percent of the children brought the educational newsletters from the lessons home; 86 percent of the children reported trying new foods, 48 percent reported being more physically active and 42 percent reported eating more fruits and vegetables as a result of the five-week program. In the second city, 36 percent reported being physically active more often, 32 percent reported eating more fruits and vegetables, 60 percent reported trying new foods and 39 percent reported their families had tried at least one of the healthy recipes at home.

An extensive survey of 323 Tribal College students was conducted and will be used to develop and implement diabetes education programs for Native Americans. Nearly 40 percent of those surveyed had an immediate family member with diabetes, and 85 percent reported an extended family member had been diagnosed with diabetes.

Key Theme - Human Health: The 5 Plus 5 Program

Cardiovascular disease is the leading cause of death in North Dakota. Nationally, 40 percent of the deaths in the U.S. are due to heart disease and stroke, with a national annual health care cost of $260 million. Proper nutrition and regular physical activity are two ways to reduce the risk of cardiovascular disease and other illnesses. A North Dakota Department of Health survey found that only 18 percent of North Dakota adults eat five servings of fruits and vegetables per day and 34 percent of North Dakotans are completely physically inactive outside of work.

The North Dakota 5 Plus 5 program is an educational campaign designed to encourage participants to eat at least five servings of fruits and vegetables per day and to engage in 30 minutes of moderate physical activity at least five days per week as recommended by health and nutrition experts. The program is led by the North Dakota State University Extension Service, the North Dakota Department of Health and the Healthy Heart Council which includes representatives from the American Heart Association, the Dairy Council of the Upper Midwest, the North Dakota Beef Commission and healthcare centers, parks and recreation departments, registered dietitians and other agencies across North Dakota.

As an example of local participation, Fort Berthold, a reservation site, hosted 40 people (83 percent Native American) who completed a 5 Plus 5 program with linkages to the commodity foods program. The program includes cooking classes, lectures, displays and individual instruction. Elsewhere, a community coalition in Emmons, Kidder, Logan and McIntosh counties had 65 participants. The intervention included classes, educational displays, and the participants kept track of their daily fruit/vegetable intake and physical activity.

Impact - Among the outputs of the program are a 5 Plus 5 manual for establishing local coalitions, two to three new lesson plans annually, handouts and media releases. Joint training was held with public health nutritionists and extension agents. The NDSU Extension Service has helped form 5 Plus 5 coalitions across the state. These coalitions bring together local experts to work toward the goals of the 5 Plus 5 program. In 1999-2000, nine coalitions developed community-wide educational plans and were designated as "5 Plus 5 Communities" . To achieve this recognition, they established a partnership including a 5 A Day nutritionist, physical activity expert, and influential leader. Other less formalized 5 Plus 5 programs have occurred throughout the state.

Pre/post testing at Fort Berthold indicated an increase in knowledge. About 90 percent of participants changed their food choices to include more fruits and vegetables and 30 percent increased their physical level to be more consistent with the Surgeon General's recommendations.

The 65 participants in Emmons, Kidder, Logan and McIntosh increased their knowledge and changed their behavior according to pre/post testing. On the pre-test, about 32 percent reported consuming five or more servings of fruits and vegetables daily, while, on the post-test, about 57 percent reported eating five or more servings of fruits and vegetables daily. The average number of self-reported minutes of physical activity the participants engaged in increased to about 34 minutes daily.

Source of federal funds: Smith-Lever

Scope of Impact: State Specific

Key Theme - Human Nutrition: Pyramid Players

Research shows that few children meet current recommendations for nutrition and exercise, and obesity among children is becoming a topic of increasing concern. Unfortunately, diet and exercise patterns set early in life are among those most difficult to break. The result may be an increased risk of some diseases and other health problems such as diabetes, cancer and heart disease.

Second graders in two North Dakota cities received education in a pilot nutrition, food safety and physical educational program using a new set of five lessons developed by the NDSU Extension Service. Extension agents trained the teacher on the curriculum and the teachers used the materials in their classrooms.

Impact - Educational efforts targeting children in North Dakota led by the NDSU Extension Service have included the development of a curriculum for second graders, the "Pyramid Players," which includes five lessons based on the Food Guide Pyramid, food safety concepts and physical activity information and activities. These lessons were piloted in ten schools in two North Dakota cities before being released statewide in 1999. Other counties and schools have begun using the curriculum in classrooms and in after-school enrichment programs.

Nutrition knowledge scores of the 185 participants increased significantly from pre to post-test. In one of the cities, follow-up testing showed that 95 percent of the children brought the educational newsletters from the lessons home; 86 percent of the children reported trying new foods, 48 percent reported being more physically active and 42 percent reported eating more fruits and vegetables as a result of the five-week program. In the second city, 36 percent reported being physically active more often, 32 percent reported eating more fruits and vegetables, 60 percent reported trying new foods and 39 percent reported their families had tried at least one of the healthy recipes at home.

Source of federal funds: Smith-Lever

Scope of Impact: State Specific

Key Theme - Human Nutrition: Kids Calcium Project

Calcium has emerged as a "super nutrient" as research has shown its roles in reducing risk of osteoporosis, hypertension, stroke, kidney stones, colon cancer and breast cancer. Calcium is one of the nutrients most likely to be missing from the diets of Americans. Calcium is of critical concern in the diets of children because of its role in bone development and growth. Findings from national food intake surveys reveal that milk intake drops off rapidly during the teen years from ages 12-19. This low level of calcium intake constitutes a "calcium crisis" according to nutrition experts. By age 17, 90 percent of adult bone development has taken place. Calcium deficiency is creating a generation at risk of osteoporosis, a "pediatric condition with geriatric consequences."

Impact -This in-school educational intervention held during National Nutrition Month used promotion, education and environmental changes to increase calcium intake among 1200 teenagers at a junior high school. In conducting this intervention, Student Council representatives at the pilot school served as a focus group and provided input in establishing a realistic milk consumption goal, in developing key messages relevant to their peers in the campaign. Unlike many interventions, this project did not involve classroom instruction but consisted of key messages posted in the students' home room areas, videos, interactive library displays and environmental changes to promote milk consumption (milk breaks during school, larger containers/different flavors of milk available during school lunch).

Student outcomes included increased knowledge as measured by pre/post testing and a 50 percent increase in calcium intake during school hours. About 41 percent of the students surveyed indicated they drank more milk as a result of this intervention. About 83 percent noticed the cow faces/captions, 67 percent watched the weekly video on the school channel, 50 percent read the calcium facts in the speech bubbles.

The project was supported in part by a grant from the Midwest Dairy Council ($3000)

Source of federal funds: Smith-Lever

Scope of Impact: Statewide

Key Theme - Human Health: Diabetes

Diabetes is a serious and costly disease affecting Native Americans and is increasing at an alarming rate. A leading cause of death for many tribes in the northern plains, diabetes also is a major cause of amputations, kidney failure and blindness. The prevalence of diabetes among American Indians in the Aberdeen Indian Health Service Area, which includes North Dakota, ranks fourth among the 12 Indian Health Service units in the country.

Impact - A USDA-funded extensive survey of 323 Tribal College students was conducted and will be used to develop and implement diabetes education programs for Native Americans. Nearly 40 percent of those surveyed had an immediate family member with diabetes, and 85 percent reported an extended family member had been diagnosed with diabetes. About half of those surveyed reported eating 1 to 3 servings of fruit per week and 38 percent reported consuming 1 to 3 servings of vegetables per week. About one-third of the respondents reported eating fast food meals three or more times weekly, and 81 percent preferred "regular" soda pop over "diet." Only 18 percent have participated in classes on nutrition and health, but 62 percent indicated they would participate in nutrition-related education outside of school. An intervention and educational materials are in development.

Source of federal fund: Smith-Lever

Scope of Impact: Multi-state Extension will influence programs across the country.

Key Theme - Human Nutrition: Family Nutrition Program

Impact - Follow-up evaluation has shown that the participants have increased their knowledge and changed their behavior regarding food spending and food choices. Low income families are at particular risk for poor nutrition and malnutrition. They often lack the skills and education to plan nutritionally balanced meals, shop wisely, and prepare meals in a wholesome and safe manner.

Source of federal funds: Smith-Lever

Scope of Impact: Multi-state Extension. The FNP is a national program.

Key Theme - Human Nutrition: Food Resource Management

The overall goal of the food resource management program of the Family Nutrition Program is to help clients maximize the use of their limited food resources. Utilizing the food resource management components from the Building a Healthy Diet curriculum developed by Iowa State University, nutrition education assistants/agents for the Family Nutrition Program are delivering programs targeted for limited resource audiences across the state of North Dakota. Classes are often held at variety of cooperating agencies such as County Social Services, Tribal organizations, WIC or Head Start.

Impact - 1,328 North Dakota residents attended food resource management programming. Participants defined a variety of means to help them effectively manage their limited resources. Surveys show:

• 39 percent use a spending plan more often than before their participation in FNP.
• 49 percent use a menu planning process.
• 54 percent shop from a list more often since participating in FNP.
• 53 percent use comparison shopping techniques such as reading labels, unit pricing, and reading nutrition fact labels

Source of federal funds: USDA Food Stamp Nutrition Education.

Key Theme - Human Nutrition: Food Security

The goal of food security is to help food stamp recipients have an adequate supply of food throughout the month. Food security issues were incorporated into a variety of educational topics presented by Nutrition Education Agents/Assistants (NEAs) at their nutrition education classes. Emphasized themes included increasing knowledge and/or use of food assistance programs provided in their community. Classes were offered at a variety of locations including the tribal commodity warehouses, food pantries, Headstart, County Social Services, or transitional living facilities.

Source of federal funds: USDA Food Stamp Nutrition Education.

Scope of Impact: State Specific

Key Theme - Human Nutrition - Children and Adults

Research has shown that children who help make food are more apt to try that food, and healthy habits learned young often extend into adulthood. A bread-making fair was conducted in Williams County for 10 to 11 year olds. The students participated in a class on the Food Guide Pyramid and made "bread in a bag."

Impact - Pre/post testing of the 238 participants (53 percent male) showed improved knowledge scores. The average pre-test score was 63 percent correct, and the average post-test score was 85 percent correct. About 88 percent planned to make bread again. About 77 percent of the children planned to share their bread with their families and 16 percent planned to share it with friends.

Source of federal funds: Smith-Lever

Scope of impact: State-specific