revised 8/99

GOAL 3: A HEALTHY, WELL-NOURISHED POPULATION

Program 6: Physical Activity and Health Habits

Statement of Issue
In 1996, the United States Surgeon General issued a report regarding the physical activity and health habits of citizens in the United States. From that report we learned that during the past decade the number of children in the US who are overweight has more than doubled. It is now estimated that approximately 11% of American children are overweight and an additional 14% have a body mass index between the 85th and 95th percentiles, which puts them at increased risk for becoming overweight. Further, 60% of high school females and 24% of high school males are trying to lose or control their weight. In North Dakota, 51% of 7th and 8th grade females and 47% of 9th through 12th grade females are dieting to maintain their current weight or lose weight. Of these students, 12% use laxatives or vomit to control their weight. And, 50% of adult females and 25% of adult males are trying to lose or control their weight.

With regard to physical activity, nearly 50% 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% of 7th graders, 59% of 10th graders, and 27% of 12th graders attend physical education class at least once a week. That these patterns track to adulthood is supported by the current estimate that approximately one-fourth of the adult US population fails to engage in physical activity during their leisure time while only 15% regularly engage in vigorous physical activity during leisure.

It is estimated that inactivity and poor diet cause at least 300,000 deaths a year in the United States. Only smoking and the use of tobacco products causes more preventable deaths.

Performance Goal
Increase awareness of and participation in appropriate physical activity and adherence to healthy methods of maintaining, gaining or losing weight among North Dakota children and youth.

Output Indicators
Researchers in the Department of Health, Physical Education and Recreation at NDSU have used new technologies (heart rate monitors and motion sensors) and developed new educational materials (fitness education pyramids and caloric expenditure target) which have been used in various research projects involving public school children and youth in and around the Fargo-Moorhead area.

Outcome Indicators
This research will result in increased knowledge regarding appropriate physical activity and caloric expenditure, increased participation in physical activity among children and youth, and a healthier population.

Key Program Components
Research projects will focus on: assessment of caloric expenditure and heart rate intensity of children and youth engaged in physical education/health activities, comparisons of various teaching styles and models relative to caloric expenditure and heart rate intensity, and the effects of calorie education and heart rate education on caloric expenditure and heart rate intensity during physical education/health.

Internal and External Linkages
Partnerships will continue between the Department of Health, Physical Education and Recreation and the Fargo Public Schools, specifically Agassiz Middle School and Fargo South High School.

Target Audiences
We will focus on public school physical education/health teachers in the state of North Dakota and in Minnesota schools close to the Fargo-Moorhead area. Demonstrations and publications related to this research will educate teachers relative to research findings and in the use of technologies such as heart rate monitors and motion sensors and educational materials such as the fitness education pyramids and the caloric expenditure target.

Program Duration
This program will continue for the five years of this plan.

Allocated Resources ($ x 1,000)	FY
		00	01	02	03	04
1862 Extension ($)	Smith-Lever	23	23	23	23	23
	State	31	31	31	31	31
	FTE	0.6	0.6	0.6	0.6	0.6

1862 Research ($)	Hatch	0	0	0	0	0
	State	0	0	0	0	0
	FTE	0	0	0	0	0

Education and Outreach Programs
The extension program is supported by research at NDSU and other institutions.

Program 7: Nutrition and Health

Statement of Issue
Many of the chronic diseases such as heart disease, cancer and diabetes have direct correlations to diet and physical activity. Despite the evidence supporting consumption of a varied diet with less than 30 percent of total calories from fat and regular, moderate physical activity, Americans in general and North Dakotans in particular are not meeting all the national Healthy People 2000 goals.

Among the draft Healthy People 2010 objectives for prevention and control of chronic diseases are the following: to increase to at least 75 percent the proportion of people aged 2 and older who meet the Dietary Guidelines' minimum average daily goal of at least five servings of vegetables and fruits; to increase to at least 75 percent the proportion of people aged 2 and older who meet the Dietary Guidelines' average daily goal of no more than 30 percent of calories from fat; to increase to at least 75 percent of people aged 2 and older who meet the Dietary Guidelines' goal of less than 10 percent of calories from saturated fat; to increase to at least 60 percent of the population the prevalence of healthy weight (BMI 19 to 25) among all people aged 20 and older; and to increase to 30 percent of people aged 18 and older who engage in regular, preferably daily, sustained physical activity for at least 30 minutes per day.

Performance Goals
As a result of participation in Extension Food and Nutrition programs, participants will show:

Increased knowledge and awareness of the importance of variety in the diet coupled with reduced fat consumption in reducing the risk of chronic diseases.
Increased knowledge and awareness of the importance of moderate physical activity in reducing the risk of chronic diseases.
Behavioral changes regarding consumption of a varied diet and moderate physical activity on a regular basis.
Increased knowledge and awareness of the symptoms, treatment and long-term effects of diabetes.
Output Indicators
- 5 Plus 5 Coalitions of NDSU Extension personnel, North Dakota Department of Health Nutritionists, hospital/wellness center staff, commodity group representatives, Parks and Recreation staff, school representatives, and community members will promote variety in the diet (particularly 5 A Day), decreased fat consumption and regular moderate physical activity in a variety of settings including grocery stores and worksites. The community plans will be established at the local level and will use/adapt materials (lesson plans, handouts, press releases, etc.) developed by NDSU Extension Specialist(s) and North Dakota Department of Health staff and other members of the North Dakota Healthy Heart Council.
- In-services and printed summaries of recent research in physical activity and human nutrition will be provided to extension agents and other collaborators. Information releases, public service announcements and other tools to support the 5 Plus 5 program will be developed/adapted.
- Diabetes educational materials (Part 2) will be distributed for use with Family and Community Educator organizations and others throughout North Dakota.
Outcome Indicators

Pre/post surveys to determine change in knowledge and awareness of the importance of a varied diet and moderate physical activity will be administered in multi-session classes.

Records of self-reported fruit and vegetable consumption and physical activity will be evaluated and summarized to determine changes in behavior. Participant comments/success stories also will be summarized.

Pre/post survey to determine change in knowledge and awareness of diabetes.

Key Program Components

Lesson plans, handouts, public service announcements and information releases will be developed based on research conducted on herbs and other dietary supplements; fad diets/size acceptance; evaluation of Internet resources; and current recommendations regarding nutrition throughout the life cycle (particularly children and the elderly) will be developed/adapted.
Lesson plans, handouts, public service announcements and information releases will be developed based on current issues in nutrition and food selection and purchasing.

Internal and External Linkages

North Dakota Dietetic Association
% Sandy Walen, NDDA Executive Secretary
2603 Olive St
Grand Forks, ND 58201

North Dakota Nutrition Council
%Marie Williams (Membership Chair)
Lake Region WIC
Ramsey County Courthouse
Devil's lake, ND 58301

Fargo-Moorhead Dietetic Association
P.O. Box 1477
Fargo, ND 58107

Dairy Council of Upper Midwest
Bismarck, ND 58501

Fargo Cass Public Health
401 3rd Ave N
Fargo, ND 58102

Grand Forks Public Health
112 S 5th St.
Grand Forks, ND 58201

ND State Department of Health
State Capitol
600 E Boulevard Ave
Bismarck, ND 58505

Cardiovascular Disease Prevention Program
ND Department Health
600 E Blvd Ave
Bismarck, ND 58505

WIC
2400 Broadway
Bismarck, ND 58501

Public School Systems

Community Wellness Centers

Meals on Wheels and Congregate Meal Sites

Lutheran Social Services of North Dakota
1325 11 St. South
Fargo, ND 58103

Child Nutrition Programs
600 E Boulevard Ave
State Capitol
Bismarck, ND 58505

Richland County Health Department
413 3rd Ave N
Wahpeton, ND 58075

Public Health Nutrition
IHS Diabetes Program
Box 400
New Town, ND 58763

Diabetes Control Project
ND State Dept Health
600 E Boulevard
Bismarck, ND 58515

ND Beef Commission
4023 State Street
Bismarck, ND 58501

American Diabetes Association,
North Dakota Affiliate
Box 5234, 101 North Third Street
Grand Forks ND 58206-5234

Indian Health Services
Parklawn Building, Rm 6-05
5600 Fishers Lane
Rockville MD 20857

United Tribes Technical College
3315 University Drive
Bismarck ND 58504

Standing Rock Sioux Reservation
Tribal Council
PO Box D
Fort Yates ND 58538

Kellogg Foundation Visions for Change
One Michigan Avenue East
Battle Creek, MI 49017-4058

Targeted Audience
Individuals and families residing in North Dakota. The diabetes work will focus on North Dakota's Indian population.

Program Duration
These programs will continue for the five-year plan.

Allocated Resources ($ x 1,000)	FY
		00	01	02	03	04
1862 Extension ($)	Smith-Lever	19	19	19	19	19
	State	26	26	26	26	26
	FTE	0.5	0.5	0.5	0.5	0.5

1862 Research ($)	Hatch	0	0	0	0	0
	State	0	0	0	0	0
	FTE	0	0	0	0	0

Education and Outreach Programs
The extension program is based on research at out-state institutions.

Program 8: Nutrition - Children and Adults

Statement of Issue
Most health care dollars are spent on treatment rather than on prevention. In 1996, heart disease accounted for nearly one-third of all deaths in North Dakota, followed by cancer (23 percent of deaths) and stroke (8 percent of deaths) according to data from the North Dakota Department of Health. Cardiovascular disease costs North Dakota over $300 million per year, or about $500 for each person in North Dakota. Cancer results in one in four deaths in the U.S. and costs the nation over $100 billion yearly.

North Dakotans are falling short of the recommendations for a healthy diet consisting of a variety of foods and no more than 30 percent of calories from fat in the total diet. Despite research on the health benefits of fruits and vegetables, particularly for reducing the risk of cancer, less than 20 percent of North Dakota adults consume five or more servings of fruits and vegetables a day.

The incidence of diabetes in North Dakota also presents a public health concern. About 2,000 new cases of diabetes will occur annually in North Dakota based on the national diabetes incidence pattern, according to the North Dakota Department of Health. About 16 percent of North Dakotans have diabetes at the time of death, and about one-third of Native Americans over age 64 on North Dakota reservations develop diabetes. In 1995, about $79 million was spent on direct hospitalization of patients with complications of diabetes. In North Dakota, an estimated $262 million is spent on diabetes care annually. Native Americans develop Type 2 diabetes at a rate of four to five times greater than the rest of the U.S. population.

Overweight status and physical inactivity are among the contributing factors for cardiovascular disease and other chronic illnesses. About one-third of North Dakotans are overweight according to the North Dakota Behavioral Risk Surveillance studies. According to the Surgeon General's 1995 report, all Americans should aim for 30 minutes of moderate physical activity on five or more days each week. Although physical activity has been shown to provide protection from heart disease, diabetes, cancer and other chronic diseases and conditions such as high blood pressure, Americans in general and North Dakotans in particular are predominantly sedentary. About one-third of North Dakotans are inactive during leisure time.

Performance Goals
As a result of participation in Extension Food and Nutrition programs, participants will show:

Increased knowledge and awareness of the importance of variety in the diet coupled with reduced fat consumption in reducing the risk of chronic diseases.
Increased knowledge and awareness of the importance of moderate physical activity in reducing the risk of chronic diseases.
Behavior changes regarding consumption of a varied diet and moderate physical activity on a regular basis.
Increased knowledge and awareness of the symptoms, treatment and long-term effects of diabetes.

Output Indicators

5 Plus 5 Coalitions of NDSU Extension personnel, North Dakota Department of Health Nutritionists, hospital/wellness center staff, commodity group representatives, Parks and Recreation staff, school representatives, and community members will promote variety in the diet (particularly 5 A Day), decreased fat consumption and regular moderate physical activity in a variety of settings including grocery stores and worksites. The community plans will be established at the local level and will use/adapt materials (lesson plans, handouts, press releases, etc.) developed by NDSU Extension Specialist(s) and North Dakota Department of Health staff and other members of the North Dakota Healthy Heart Council.

In-services and printed summaries of recent research in physical activity and human nutrition will be provided to extension agents and other collaborators. Information releases, public service announcements and other tools to support the 5 Plus 5 program will be developed/adapted.

Diabetes educational materials (Part 2) will be distributed for use with Family and Community Educator organizations and others throughout North Dakota.

Outcome Indicators

Pre/post surveys to determine change in knowledge and awareness of the importance of a varied diet and moderate physical activity will be administered in multi-session classes.

Records of self-reported fruit and vegetable consumption and physical activity will be evaluated and summarized to determine changes in behavior. Participant comments/success stories also will be summarized.

Pre/post survey to determine change in knowledge and awareness of diabetes.

Key Program Components

Lesson plans, handouts, public service announcements and information releases will be developed based on research conducted on herbs and other dietary supplements; fad diets/size acceptance; evaluation of Internet resources; and current recommendations regarding nutrition throughout the life cycle (particularly children and the elderly) will be developed/adapted.
Lesson plans, handouts, public service announcements and information releases will be developed based on current issues in nutrition and food selection and purchasing.

Internal and External Linkages

North Dakota Dietetic Association
% Sandy Walen, NDDA Executive Secretary
2603 Olive St
Grand Forks, ND 58201

Targeted Audience
Individuals and families residing in North Dakota. The diabetes work will focus on our Indian population.

Program Duration
These programs will continue for the five-year plan.

Allocated Resources ($ x 1,000)	FY
		00	01	02	03	04
1862 Extension ($)	Smith-Lever	23	23	23	23	23
	State	31	31	31	31	31
	FTE	0.6	0.6	0.6	0.6	0.6

1862 Research ($)	Hatch	0	0	0	0	0
	State	0	0	0	0	0
	FTE	0	0	0	0	0

Education and Outreach Programs
The extension program is based on ongoing studies written in North Dakota and other states.

Program 9: Food Security Only One Issue for Limited Resource Audiences

Statement of Issue
North Dakota's EFNEP program is offered in seven locations: three urban centers and four Native American reservations. Site selection is based on poverty figures and criteria affected by poverty. The FNP Program is in 43 locations in North Dakota.

The 1995 poverty estimates for North Dakota indicate that 11.8% of the total population live in poverty.

In 1997, the estimated per capita income in the U.S. was $25,298. In North Dakota, the per capita income was $20,213 during the same time period. (U.S. Department of Commerce.) The median family income for Indians on reservations was $13,700. (U.S. Bureau of the Census.)

The number of Native Americans in North Dakota grew from 25,917 in 1990 to 27,313 in 1994. Native Americans make up 4% of the state's population and have a poverty rate twice as high.

There are 640,883 North Dakota residents (1997). Records indicate that in 1990, 29,732 North Dakota children were impoverished.

Welfare Reform has played a significant role in our outreach to the targeted audience. Many welfare recipients have returned to work but do not earn a living wage. For the month of April 1998, North Dakota had 34,793 people that received food stamps. The participation in the food stamp assistance program represents 5.4 percent of the total population.

Performance Goal

The goal of the North Dakota EFNEP is to provide eligible individuals, with young children, who are responsible for food preparation, and youth with the knowledge, skills and attitudes to form nutritionally-sound diets and to contribute to their personal development. The program is driven by the fact that poorly nourished people perform below their inherent ability at home, at school and on the job. Low-income individuals and youth tend to have poorer than average diets. Inadequate dietary practices can be passed from generation to generation because of a lack of sufficient nutrition knowledge, limited skills to prepare healthful meals and a lack of general resources.
The goal of the North Dakota FNP is to provide foodstamp eligible individuals, not in the EFNEP program, with the knowledge, skills and attitudes to form nutritionally-sound diets and to contribute to their personal development.

Output Indicators
- Food stamp eligible individuals doing food preparation for the family's young children will gain knowledge in food security.
- Food stamp eligible individuals doing food preparation for the family's young children will gain new knowledge in nutrition.
- Food stamp eligible individuals doing food preparation for the family's young children will gain new knowledge in food buying.
- Food stamp eligible individuals doing food preparation for the family's young children will gain new knowledge in food safety techniques.
- Food stamp eligible individuals doing food preparation for the family's young children will gain new knowledge and skill in food preparation for improved nutrition.

Outcome Indicators

Food stamp eligible individuals doing food preparation for the family's young children will have an adequate supply of food for the entire month.

Food stamp eligible individuals doing food preparation for the family's young children will increase the amount of fruits and vegetables in their daily diet as evidenced by pre and post food calls.

Food stamp eligible individuals doing food preparation for the family's young children will show evidence of improved food buying skills by stretching their food resources (money, food stamps, etc.) to last to the end of the month.

Food stamp eligible individuals doing food preparation for the family's young children will wash their hands before and during food preparation.

Food stamp eligible individuals doing food preparation for the family's young children will adopt new food preparation techniques to reduce the fat and sugar in their diet.

Key Program Components

Effective internal and external collaboration combined with solid curriculum, staff training and flexible program delivery will continue to be key components of the North Dakota EFNEP and FNP. Effectiveness will be measured through on-going evaluation of skills learned and behaviors modified. In addition to the standard reporting process, a panel of external reviewers--EFNEP leaders from neighboring states--have been invited to conduct in-depth reviews of two North Dakota EFNEP sites. The Cass County program was reviewed in December 1997, and the Sioux County program is scheduled for review. Internal reviews of the other five sites are yet to be scheduled.
The base of foods and nutrition expertise from which the EFNEP and FNP may draw will increase soon with the addition of a new Extension specialist and faculty member at North Dakota State University. Additionally, the food safety/HACCP curriculum has grown substantially making available a variety of program-appropriate materials.
Exciting, new youth nutrition education materials focusing on diabetes prevention will be developed at North Dakota State University during 1998-00. They will prove highly valuable especially to our Native American clientele whose level of diabetes has reached epidemic proportions. According to the North Dakota Diabetes Association, North Dakota has the highest reported incidence per capita of diabetes in the nation. Native Americans in North Dakota develop Type 2 diabetes at a rate four to five times greater than the rest of the United States population.

Internal and External Linkages

The EFNEP and FNP staff will continue to work with county, area and state staff to provide information to adults and youth in the areas of human nutritional needs; food selection, preparation and preservation with emphasis on food safety; food resource management; food production/gardening; and other, program-related areas, as appropriate.
As identified in an external program review of the Cass County site, the statewide EFNEP will become a more integral part of their respective county program by working more closely with extension agents to expand information and educational opportunities, and program delivery options.
Linkage with other agencies and organizations is key to the success of the EFNEP and FNP. WIC offices and Food Stamp offices are the primary collaborators in an agency category, with 10 out of 11 WIC offices served and 9 of 10 Food Stamp offices served during FY97. Future collaborative efforts will be given more emphasis and will include, but not be limited to, Social Services, Job service, Commodity Food Program, FDPIR, Community Action Agency, county and state health departments, homeless shelters, YWCA, Indian Health Service, Bureau of Indian Affairs, tribal employment offices, Child Care Food Program, parks and recreation departments, Headstart, community housing centers, libraries, Air Force Base Family Support Programs, public schools, single parents' classes at community centers and tribal colleges.

Target Audiences

The target audience for the EFNEP include 1) low-income individuals/households (80%) living in either rural or urban areas who are responsible for planning and preparing the family's food (emphasis is on households with young children), and 2) low-income youth (20%) who live in rural or urban areas and who meet the state's definition of 4-H age, which, in North Dakota, is 8 to 18 years.
The target audience for FNP includes all foodstamp eligible audiences not in the EFNEP program.

Program Duration
5 Years

Allocated Resources ($ x 1,000)	FY
		00	01	02	03	04
1862 Extension ($)	Smith-Lever 3d & FNP Funds	2100	2100	2100	2100	2100
	State	0	0	0	0	0
	FTE	50	50	50	50	50

1862 Research ($)	Hatch	0	0	0	0	0
	State	0	0	0	0	0
	FTE	0	0	0	0	0

Education and Outreach Programs
This extension program is based on national programs, models and research information.