Physical Activity for Children 2019 Report
National Performance Measure (#8)
Percent of children ages 6 through 11 years who are physically active at least 60 minutes per day.
The percent of children ages 6 through 11 who are physically active for at least 60 minutes per day has increased slightly, when comparing data from 2016 to combined years of data from 2016 and 2017 (29.7% vs. 30.9%). 2017 data cannot be compared independently within Oregon due to small sample size. In 2016, Oregon’s outcome for this performance measure was not statistically significantly different to the national average.
Strategy #1: Support physical activity in childcare settings through policy, training, and workforce development.
ESM (8.1.6): Number of state early care and education systems addressed or influenced by Title V physical activity efforts during the grant year (CDC ECE Spectrum of Opportunities).
Accomplishments
- Continued to provide technical assistance, policy review and support as needed related to state childcare health and safety rules and their alignment with national standards and evidence-based practices.
- Continued to participate in Oregon State Health Improvement Plan Obesity priority workgroup to promote collaboration, life course perspective awareness and consistent, shared communications.
Challenges/emerging issues
Challenges related to advancing physical activity in childcare settings are primarily state level capacity limitations and difficulties influencing change in the early learning and education sectors. The early learning and education sectors are very focused on their own priorities, such as childcare quality, addressing sleep related deaths in care, academic readiness of children, issues of equity and supporting childcare providers in the field. Among the many other competing priorities, it is difficult to see improvement in healthy weight practices in childcare settings.
Progress on ESMs: 3 of 9
During this funding cycle, Oregon Title V has primarily focused on 3 of the 9 components of the Spectrum of Opportunities: improving licensing standards, increasing participation and retention in the Child and Adult Care Food Program, and supporting the development and availability of obesity prevention trainings in professional development systems. Title V has been an invested stakeholder and participant in efforts to update standards in Oregon’s Quality Rating Improvement System, with little effect.
Strategy #2: Support physical activity before, during and after school.
ESM (8.1.7): Number of school districts who have participated in focus groups to explore challenges and opportunities to implement physical activity before, during and after school.
Accomplishments
State-Level
- Continued to co-lead Children’s Healthy Weight CoIIN through the Association of State Public Health Nutritionists (ASPHN) in partnership with the Oregon Department of Education, Safe Routes to School National Partnership, and the Multnomah Education Service District. The team meets monthly to advance project components focused on understanding and addressing the challenges to meeting the state’s physical education and activity law (Senate Bill 4). As part of this project, Title V staff helped craft a presentation abstract submitted to the Annual Oregon Conference of School Administrators, and developed a poster presented at the Association of State Public Health Nutritionists Annual Conference in June 2019 describing our efforts to date. In addition, Title V staff participated in planning the Oregon Healthy Schools Pro-Bowl training in July 2019 where school administrators, physical education teachers and nutrition directors joined for a day of intensive training and learning together.
- Participated in monthly Wellness in School Environments (WISE) coalition meetings.
- Provided technical assistance and support to local Title V partners to strengthen and improve school and district wellness policies.
- Participated with other PHD colleagues (1305 funded staff, Title V, WIC) in monthly meetings and coordinated efforts of State Health Improvement Plan Obesity team.
- Engaged in exploratory conversations with researchers and academics in Oregon and across the US to address CoIIN-identified gaps related to behavioral health and inclusive physical education and physical activity for children
- Participated in discussions with researchers from Oregon State University to support their use of BMI data available through the Oregon SMILE survey to look at the impacts of the 4-day school week model and explore the impacts of state level physical education policies on children’s development.
Local-Level
- Klamath County participated in community outreach events, participated with Blue Zones Partnership, supported schools and districts in adopting physical activity policies, and supported growth of walking school buses and other Safe Routes activities.
- Marion County developed and supported expansion of Safe Routes to School in neighborhoods, presentations and outreach to schools and districts.
- Polk County collaborated with community wide 5-2-1-0 campaign, partnered in outreach events at a local university and free clinic for physical activity promotion, promoted via social media.
- Jefferson County partnered with Warm Springs Tribe to convene Child Health Task Force, develop outreach and engagement opportunities for families in the community, participated in transportation meetings and conducted youth engagement to understand barriers among youth to active transportation choices.
- Confederated Tribes of the Umatilla Indian Reservation focused on improving places and access for physical activity, as well as conducting a broad tribal multi-sector community engagement event to learn from community members about visions for healthy spaces for youth.
- Wheeler County expanded yoga program started in rural schools, provided information about physical activity to providers and families at annual Health Fair.
Challenges/emerging issues
Despite Oregon’s investment in physical education and activity for children, demonstrated by passage of legislation in 2017 that sets intermediate benchmarks to ramp up PE minutes to 150 minutes for K-5 grade students and 225 minutes for middle school students, as well as updated academic content standards, there are real and perceived barriers to increasing physical activity before, during and after school. Many of these are structural barriers, such as physical space, scheduling challenges, difficulty integrating more physical activity into an already short instructional day, lack of prepared teachers, and more.
Through the Healthy Weight CoIIN project, our team has identified a potential gap in the research, teacher preparation, and training related to students with behavioral issues and dysregulation due to trauma, adversity and mental health issues being equitably served with physical education and activity. These children and youth may be unable to participate in physical education and activity due to their own traumatic experiences and can disrupt learning and participation for other students. Teachers need training and support to engage these students in appropriate and responsive ways that do not retraumatize, nor sideline students, but instead support equitable access. The team began formative work to identify an expert in inclusive physical activity/education and behavioral health who could provide training, technical assistance and consultation in Oregon. We attempted to craft a Title V Technical Assistance request for consultation and training to improve inclusive practices, but have not successfully found the right trainer/consultant, nor been able to adapt the need to the parameters of TA requests.
Progress on ESMs: 3 school districts – large urban, rural, and suburban
Strategy #3: Improve the physical environment for physical activity.
Accomplishments
State-Level
- Partnered with Jefferson County to support their efforts to create and convene listening sessions for youth engagement related to active transportation, built environment and physical activity; engaged Oregon Dairy and Nutrition Council and other state experts in participatory research to contribute their perspectives and suggestions to Jefferson County staff.
- Co-authored poster for Safe Kids PrevCon describing rates of child injuries and fatalities in Oregon over time, including pedestrian, bicycle, other wheeled conveyances, and sports-related injuries, which are impacted by the physical and built environment.
- Annual participation as member of Oregon School Wellness Awards Blue Ribbon Panel which solicits, reviews and selects schools to receive wellness awards based on commitments and investments in student and staff health. Award money is typically used to improve the physical environments of the schools for physical activity and wellness.
Local-Level
- Marion County continues to be a leader in active transportation promotion and built environment improvements to support health. During the reporting year, they engaged with local partners to continue long term planning for traffic calming and bike/pedestrian infrastructure, as well as supporting local schools and districts in applying for funding for infrastructure projects.
Challenges/emerging issues
Nothing to report.
Strategy #4: Increase safe and active transportation options.
Accomplishments
- Marion County continues to be a leader in active transportation promotion and built environment improvements to support health. During the reporting year, they engaged with local partners to continue long term planning for traffic calming and bike/pedestrian infrastructure, as well as supporting local schools and districts in applying for funding for infrastructure projects.
- Jefferson County actively participated in local transportation and planning meetings, used data to identify hazardous zones where pedestrians and cyclists were exposed to vehicles moving at excess speeds, surveyed youth to better understand the culture around physical activity and active transportation in their community, and performed walkability assessments.
Challenges/emerging issues
Nothing to report.
Strategy #5: Provide technical assistance to local health agencies working on strategies to promote physical activity.
ESM (8.1.3): Percent of local grantees supported/provided with technical assistance to work on developing school wellness policies or safe routes to school, among those that selected the child physical activity priority area.
Accomplishments
- 100% of grantees were offered and received training and support related to school wellness policies, collaboration opportunities with school districts, and safe routes to schools during a webinar training held in March 2019.
Challenges/emerging issues
Nothing to report.
Progress on ESMs: 100%
Oral Health (Children) 2019 Report
National Performance Measure (#13)
Percent of children ages 1 to 17 years who had a preventive dental visit in the last year.
There has been a small increase in the percent of Oregon children ages 1 to 17 years who had a preventive dental visit in the last year, when comparing the 2016 rate of 80.1% to the combined 2016 and 2017 rate of 81.8%. 2017 data cannot be examined independently in Oregon due to small sample size. In 2016, the outcome of this performance measure was slightly better in Oregon than nationally, with a national average of 78.7%.
Strategy #1: Integrate oral health into state Maternal and Child Health (MCH), Health Promotion, and Chronic Disease Prevention Programs.
ESM (13.1.1): Number of materials developed on the common risk factors and associations between chronic diseases and poor oral health such as cavities and periodontal disease.
Accomplishments
- Developed monthly oral health messages that were posted on the MCH and Public Health Division’s Twitter and Facebook accounts.
- Developed and posted bi-weekly oral health messages on Facebook and Twitter to promote Children’s Dental Health Month in February 2019. Topics included oral hygiene techniques, access to dental care, dental sealants, fluoride, mouth guards, etc. A resource table was staffed for the entire month in the lobby of the Public Health Division.
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Hosted a site visit with Tim Ricks, DMD, MPH, Rear Admiral, Assistant Surgeon General on September 23, 2019. Activities included:
- Dr. Ricks met with senior leadership where oral health integration efforts into Oregon’s system of care were highlighted.
- Live streamed a presentation where the public could learn about the upcoming Surgeon General’s Report on Oral Health, and successes and challenges of oral health integration nationally and in Oregon.
- Toured Multnomah County Health Department’s Northeast Dental Clinic as an example of successful oral health integration within a FQHC.
- Participated on the planning committee for the 2019 Statewide HPV Summit, sponsored by the American Cancer Society and state Immunization Program. We engaged the dental community to attend the event and have two presentations specifically on oropharyngeal cancer and HPV.
- The Oral Health Unit presented posters and exhibited at the 2018 Oregon Rural Health Conference in October 2018, Oregon Oral Health Coalition’s (OrOHC) 2018 Fall Conference in November 2018, and the WIC Statewide Meeting in May 2019. The posters utilized described the link between oral health and chronic diseases and how oral health can be integrated into chronic disease systems of care. Oral health educational materials were disseminated at the conferences.
Challenges/emerging issues
The Oral Health Unit intended to collaborate with the Health Promotion and Chronic Disease Prevention Section but did not have enough capacity to establish this relationship. Funding outside of Title V is necessary to support their grantees, and no grant opportunities were available during the grant period.
Progress on ESMs
Two fact sheets, three posters, and three presentations were developed.
Strategy #2: Provide technical assistance to school oral health programs and Title V grantees.
ESM (13.2.1): Number of school oral health programs and Title V local grantees provided with technical assistance to enhance the quality of oral health services and increase oral health visits.
Accomplishments
- Eleven grantees – ten local health agencies and one tribe – were provided with individualized technical assistance throughout the grant year.
- Held the training, “Introduction to Health Literacy, Plan Language and Design”, on March 19, 2019 for Title V MCH grantees and school dental sealant programs. Participants learned how to better communicate with the communities we serve. The examples used during the training were oral health related.
- The Oral Health Unit conducted a clinical training for school dental sealant programs on August 16, 2019 that included sessions on trauma informed practices and cultural humility.
- Site visits were conducted with 21 school dental sealant programs to ensure they were meeting certification requirements. One of the requirements specifies that programs must refer children for further treatment if needed.
- The Oral Health Unit collaborated with the Oregon Oral Health Coalition to promote the First Tooth training program with grantees. First Tooth trains medical providers, such as public health nurses, to deliver oral health preventive services (oral health screenings, fluoride varnish, anticipatory guidance, and referral/case management services) within their existing practice for infants and toddlers.
Challenges/emerging issues
No challenges to report.
Progress on ESMs
Technical assistance was provided to 21 school dental sealant programs.
Strategy #3: Increase oral health surveillance in Oregon.
ESM (13.1.2): Number of data sets in the Oregon Oral Health Surveillance System (OOHSS) that can be analyzed for oral health disparities.
Accomplishments
- Seven data sources were identified within the Oregon Oral Health Surveillance System (OOHSS) can be analyzed by race, ethnicity, language, and disability (REALD).
- The Oral Health Unit piloted a voluntary REALD questionnaire that was included with parent permission forms provided to elementary and middle schools served by the statewide OHA School-based Dental Sealant Program.
Challenges/emerging issues
The Oral Health Unit would like to increase its capacity to decrease oral health racial and ethnic disparities in Oregon. In 2018, the Unit applied for a 2018 Dental Trade Alliance (DTA) Foundation grant titled, “Understanding Barriers to Optimal Oral Health in Oregon’s Minority Communities,” but did not receive funding. The grant would have supported conducting a panel survey with Hispanic/Latino, Black/African American, and American Indian/Alaska Native racial and ethnic groups. The findings would have been used to develop a health equity communications plan; test oral health messages with partners in the specific racial and ethnic communities; and develop social media content and materials targeted to each specific racial/ethnic population.
Progress on ESMs
Seven data sets in the OOHSS can be analyzed for oral health disparities.
Strategy #4: (Local) Provide oral health preventive services or education and referral/case management services through Oregon's Home Visiting System.
Accomplishments
- Benton, Linn, and Lincoln Counties provided oral health education and referrals for dental care in their home visiting programs (Babies First! and Maternity Case Management). They also provided First Tooth training for home visiting staff.
- Morrow County provided oral health education and referral case management for their home visiting clients in the CaCoon and NFP programs.
Challenges/emerging issues
Some public health nurses are hesitant to apply fluoride varnish during home visits. Counties intend to provide regular oral health and fluoride varnish training so that staff become more comfortable.
Strategy #5: (Local) Educate pregnant women, parents/caregivers of children, and children 0-17 about oral health and the importance of dental visits.
Accomplishments
- Benton, Linn, and Lincoln Counties provided culturally appropriate oral health education to all clients (e.g. WIC, home visiting, etc.).
- Clackamas County incorporated oral health education and referral services into all programs administered such as WIC, school-based health centers and the federally qualified health center (FQHC).
- Douglas County collaborated with Advantage Dental to provide oral health education and preventive services at two community baby showers, a well-child clinic hosted by a local family practice, and the Douglas County fair.
- Hood River County provided oral health education and referrals to dental care for home visit and WIC clients.
- Klamath County facilitated the Klamath Basin Oral Health Coalition and developed a three-year strategic plan, which included specific strategies for children.
- Cow Creek Band of Umpqua Tribe of Indians sent out dental care kits for children who saw the dentist for the first time. The kits included culturally and age appropriate oral health education.
Challenges/emerging issues
Counties have done a good job in referring clients for dental care, but it is difficult to track whether those clients followed through on the referral. It is challenging to build a system that tracks closed-loop dental referrals.
Strategy #6: (Local) Incorporate oral health preventive services for adolescents into School-based Health Centers (SBHCs) and adolescent well care visits.
Accomplishments
- Wheeler County incorporated oral health into the adolescent well care visit at three Asher Clinic locations. Clinics had to modify their workflow to provide oral health education and referrals to dental care.
Challenges/emerging issues
No challenges to report.
Smoking (Children) 2019 Report
National Performance Measure (#14B)
Percent of children who live in households where someone smokes.
The percent of children who live in households where someone smokes has held fairly steady over the past two years for which we have data, from 14.2% in 2016 to 14.3% in 2017. Oregon is slightly below the national average for this performance measure.
Strategy #1: Develop a policy agenda that decreases youth exposure to tobacco products and decreases likelihood for initiation and use.
ESM (14.2.5): Number of external partners engaged in developing a policy agenda to decrease youth exposure to tobacco
Accomplishments
Oregon Administrative Rules related to inhalant delivery systems packaging attractive to minors were recently revised. These rules are effective as of September 1, 2018, but are only being enforced in cases where a product's packaging is so clearly attractive to minors that there is no room for doubt that it is attractive to minors.
Challenges/emerging issues
Business owners complain that ensuring packaging isn’t attractive to minors is costly for them. Complaints are regularly filed with the State’s Tobacco Prevention and Cessation Program.
The lead for the Smoking priority at the State Maternal & Child Health program retired in spring 2019. Her replacement was not hired until mid-October 2019. Unfortunately, this gap in coverage impacted our ability to complete some of the State level activities we had planned for this grant cycle.
Progress on ESMs
None. Gap in staffing coverage impacted ability to complete planned activities.
Strategy #2: 5As Intervention and Quit Line Referral (or other customized Evidence-Informed Program) within MCH Programs including Home Visiting, Oregon MothersCare, Family Planning, and WIC (if applicable).
ESM (14.1.1): Percent of local Title V grantees who have selected smoking as a priority area who are implementing the 5A’s with their clients.
Accomplishments
Local Level
- In Columbia County, 84% of home visiting clients who smoke received a 5As intervention and 84% also received a referral to the Quit Line, provider, or local tobacco cessation specialist. This process was made easier by incorporating smoking cessation resources into home visiting handouts.
- The Confederated Tribes of the Umatilla Indian Reservation provided 5As intervention during visits at the Yellowhawk clinic for 20% of women ages 13-44 who smoke tobacco.
- The Coquille Indian Tribe worked with multiple partners to improve the tribal clinic’s policies and procedures related to commercial tobacco screening and intervention. Updates were made to the clinic’s EHR to enable providers to document tobacco use, intervention and follow-up at each visit.
- Harney County worked to develop a policy agenda to decrease youth exposure to tobacco products and decrease the likelihood of initiation and use. As part of this effort, staff provided presentations at local schools, reaching over 380 youth. Staff also continued work to make all county properties tobacco free, including the county fairgrounds.
- In Lane County, 53% of home visiting clients who smoke received a 5As intervention and 100% received education on tobacco cessation benefits. Oregon MothersCare (OMC) clients also received information on tobacco cessation benefits. The local Quit Tobacco In Pregnancy (QTIP) program provides support and incentives to quit tobacco.
- Tillamook County’s home visiting program worked to use 5As screening, education and referral for pregnant clients who smoke, referred clients to the Quit Line, and enrolled pregnant people in the tobacco cessation incentive program with Columbia Pacific Coordinated Care Organization. As a result of the incentive program, 10 client quit tobacco completely and 5 cut down on their tobacco use during pregnancy.
- Yamhill County implemented the Healthy Futures smoking cessation program in partnership with a Behaviorist at Valley Women’s Health prenatal care practice. Thirty percent of pregnant clients continued to be tobacco free at their 3-month postpartum visit.
Challenges/emerging issues
Local Level
- The MCH Program has a focus on home visiting and is therefore not able to serve all pregnant smokers. The result is that not all clients receive referrals to providers and may miss getting interventions. Grantees have reported challenges getting pregnant clients to accept referrals either because they are resistant or because they have already received a referral from their primary care provider. Training in motivational interviewing and trauma-informed practices may support grantees to provide these services to pregnant clients.
- Several local grantees also reported challenges with staff turnover, which hindered implementation of smoking cessation efforts.
State Level
The lead for the Smoking priority at the State Maternal & Child Health program retired in spring 2019. Her replacement was not hired until mid-October 2019. Unfortunately, this gap in coverage impacted our ability to complete some of the State level activities we had planned for this grant cycle.
Five out of seven (71%) Title V grantees who selected smoking as a priority implemented 5As with their clients.
All Title V grantees who selected smoking as a priority area (100%) received at least two technical assistance contacts with the State Title V program.
Strategy #3: Collaborate with CCO’s, DCO’s, medical and early childhood/education providers to build screening and intervention processes into their work practices, including workforce training.
ESMs
- (14.2.1) Number of local and state regulatory agencies worked with, contacted, or engaged in smoke free childcare project.
- (14.2.3) Number of proposed smoking related licensing rule changes submitted to the Department of Education/Early Learning Division/Office of Child Care.
Accomplishments
State Level
- The MCH Program promoted and monitored use of the on-line training. Home visiting and PH nurses and dental professionals received information about the training and how to access it. The program also monitored availability and provided information to the Transformation Office when issues arose making the training inaccessible.
Challenges/emerging issues
State Level
While the MCH Program collaborated with the Health Transformation Office in the development of the on-line training, there was difficulty in obtaining CEUs for MCH professionals
The lead for the Smoking priority at the State Maternal & Child Health program retired in spring 2019. Her replacement was not hired until mid-October 2019. Unfortunately, this gap in coverage impacted our ability to complete some of the State level activities we had planned for this grant cycle.
Progress on ESMs
No progress was made on these ESMs during this grant cycle due to staff transitions and shifting state priorities.
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