Child physical activity report

Priority: Child Physical Activity

National Performance Measure: (#8) Percent of children ages 6 through 11 years who are physically active at least 60 minutes per day

Interpretation of national performance measure data:

The percent of children ages 6 – 11 years who were physically active at least 60 minutes per day decreased from 32.8% to 30.7%, when comparing 2017/18 data to 2018/19 data. This decrease should be interpreted with caution due to the small sample size of the National Survey of Children’s Health in Oregon.

Strategies:

Strategy #1: Support physical activity in childcare settings through policy, training, and workforce development.

• Activities – State Level:
  • Complete updated scan of current landscape for physical activity standards in state systems identified in CDC ECE State Indicator Report.

 

• Draft Oregon companion to the CDC ECE State Indicator Report. Align with Raise Up Oregon Early Learning Plan and Early Learning Division (ELD) priorities - quality child care, equity, academic readiness, and provider support.

 

• Convene local Title V partners for cross-grantee sharing of information, support and technical assistance in core physical activity strategy areas. Provide or facilitate access to technical assistance as needed.

 

• ESM: 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)

 

• Progress on ESMs: During the reporting period, 1 of the 9 ECE Spectrum of Opportunities systems was specifically addressed through efforts and activities conducted with Title V funding.

 

• Accomplishments:
  • Provided 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.

 

• Participated in Oregon State Health Improvement Plan Obesity Priority Workgroup to promote collaboration, life course perspective awareness and consistent, shared communications across public health initiatives.

 

• Participated in Oregon Safe Kids Advisory Committee, providing technical support and data interpretation for child injury areas, which include injury hospitalizations and deaths related to physical activity - including falls, pedestrian and cycle, and other conveyances, for children birth to 5.

 

• Challenges/emerging issues: The COVID-19 pandemic and other pressing priorities in the early care and education sphere made it difficult to advance this area of work. Staff across the MCH Section were deployed to the state’s COVID-19 response, leaving the remaining staff to backfill and cover other staff duties. The pandemic diluted the capacity available to focus on Title V activities.

 

Strategy #2: Support physical activity before, during and after school.

• Activities – State Level:
  • Continue to co-facilitate the Oregon Healthy Weight CoIIN team in partnership with Department of Education, Safe Routes to School National Partnership, and the Multnomah Educational Service District.

 

• Participate in Oregon Healthy Schools Advisory Committee. Attend bimonthly meetings.

 

• Participate in monthly Wellness in School Environment (WISE) meetings.

 

• Convene and advance multisector conversations related to teacher training and technical assistance to support students experiencing dysregulation due to trauma, adversity, and mental health issues in equitable access to physical education and activity.

 

• Convene local Title V partners for cross-grantee sharing of information, support, and technical assistance in core physical activity strategy areas. Provide or facilitate access to technical assistance as needed.

 

• Five local Title V grantees (Confederated Tribes of the Umatilla Indian Reservation, the Coquille Tribe, Jefferson County, Marion County and Wheeler County) will conduct activities related to physical activity before, during and after school.

 

• ESM:
  • 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.

 

• 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.

 

• Progress on ESMs:
  • ESM 8.1.3:  All 5 grantees were provided support and technical assistance related to their individual needs for plan implementation.

 

• ESM 8.1.7: Three school districts participated in focus groups to explore challenges and opportunities to implement physical activity before, during and after school.

 

• Accomplishments:
  • Co-facilitated the Oregon Healthy Weight CoIIN team in partnership with Department of Education, Safe Routes to School National Partnership, and the Multnomah Educational Service District; leveraged the CoIIN experience and partnerships to successfully apply for the ASPHN Nutrition Capacity Grant.

 

• Contributed to coordination and collaboration opportunities through active participation in:
  • Oregon Department of Education led Oregon Healthy Schools (CDC 1801 Grant) Advisory Committee. Attended bimonthly meetings.
  • Monthly Wellness in School Environment (WISE) meetings.

 

• Convened local Title V partners for cross-grantee sharing of information, support, and technical assistance in core physical activity strategy areas. Provided and facilitated access to technical assistance as needed.

 

• 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.

 

• Was interviewed for article about Title V children’s physical activity work for the NW Public Health Bulletin.

 

• Participated on Blue Ribbon Panel for annual School Wellness Award through Department of Education. The Panel solicits, reviews, and selects schools to receive wellness awards based on commitments and investments in student and staff health. Award monies are used to improve the physical environment of the schools for health and wellness.

 

• Five local Title V grantees (Confederated Tribes of the Umatilla Indian Reservation, the Coquille Tribe, Jefferson County, Marion County and Wheeler County) worked in this area:
  • Marion County staff provided training, consultation, and support for the promotion of physical activity before, during and after school. Provided leadership and support for active transportation and expansion of Safe Routes to School in neighborhoods. Provided outreach and consultation to school districts in support of physical activity.

 

• Jefferson County partnered with the Confederated Tribes of Warm Springs to convene the Child Health Task Force, develop outreach and engagement opportunities for families in the community, participated in transportation meetings and conducted youth engagement opportunities to understand barriers among youth to active transportation choices. In addition, Jefferson County adopted a wellness policy to support nutrition and physical activity among staff.

 

• Confederated Tribes of the Umatilla Indian Reservation focused on improving places and access for physical activity, and on providing intentional physical activity opportunities for the community including youth. These included in -person structured classes pre- COVID-19, and “PE at home” videos available on YouTube for families to use during COVID-19 restrictions. In addition, the Tribe’s Indigenous Project LAUNCH team developed a partnership with the Department of Child and Family Services to support foster families with supplies, games and safety equipment to participate in physical activity together.

 

• Wheeler County expanded a yoga program started in rural schools, provided information about physical activity to providers and families at annual Health Fair.

 

• The Coquille Indian Tribe completed 8 safe routes walking maps for tribal and non-tribal members, young and old alike to enjoy.

 

• Challenges/emerging issues: The COVID-19 pandemic made it difficult to advance this area of work. Staff across the MCH Section were deployed to the state’s COVID-19 response, leaving the remaining staff to backfill and cover other staff duties. This diluted the capacity available to focus on Title V activities. Schools across Oregon were closed at the onset of the pandemic in March/April, and focus shifted to standing up online learning, concerns about food security for families, family safety, and educational deficits caused by the pandemic. Local public health agencies and tribal health agencies caught on the front line of the COVID-19 public health emergency experienced severe capacity and community impacts, impacting the extent to which plans could be implemented.

 

Smoking Report (children)

Priority: Smoking (Children)

National Performance Measure: Percent of children who live in households where someone smokes.

Interpretation of national performance measure data:

The percent of children who live in a household where someone smokes increased from 12.1% to 13.5%, when comparing data from 2017-18 to data from 2018-19. This increase should be interpreted with caution due to the small sample size of the National Survey of Children’s Health in Oregon.

Strategies:

Strategy #1: Develop a policy agenda that decreases youth exposure to tobacco products and decreases likelihood for initiation and use.

• Activities – State Level:
  • Act as MCH Section liaison to the Alcohol and other Drug Prevention Services Unit of the Center for Prevention and Health Promotion.

 

• Liaison with Tobacco Prevention and Education Program within the Chronic Disease Section of the Public Health Division

 

• Participate in the work of the state health division’s State Health Improvement Plan - Behavioral Health.

 

• Partner with the adolescent health unit to identify and develop opportunities for tobacco prevention for adolescents.

 

• Promote the linkage between ACEs prevention and tobacco prevention in state agency work groups and policy settings.

 

• Explore partnerships to expand protections for children from second and third hand smoke exposure in home childcare settings.

 

• ESM: ESM 14.2.5: Number of external partners engaged in developing a policy agenda to decrease youth exposure to tobacco.

 

• Progress on ESMs: We were able to engage 5 partners to develop a policy agenda to decrease youth exposure to tobacco and other substances during the grant year, including: Health Promotion and Chronic Disease Prevention, Injury and Violence Prevention, OHA Health Systems Division, Adolescent & School Health Unit, Alcohol and Drug Policy Commission

 

• Accomplishments:
  • A new state staff person was hired in November 2019 to be the lead for Smoking Cessation priority area activities. The current Title V coordinator oriented the new staff member to this work throughout fall 2019.

 

• The staff member initiated monthly meetings with staff from the Health Promotion and Chronic Disease Prevention Program and Maternal and Child Health (MCH) Section, including those working on smoking cessation, nutrition, and physical activity. Those meetings unfortunately had to be put on hold when the COVID-19 emergency was declared in March 2020 and staff were reassigned to the state COVID-19 response.

 

• Another cross-division group was formed during the grant year to coordinate Public Health Division work related to substance use disorders. Two staff from MCH regularly attend this Alcohol and Other Drug Coordinating Team. These two staff participated in the development of a collaborative framework and action plan for Division-wide AOD prevention work. MCH staff contributed a health equity and trauma-informed lens to the planning and discussion to emphasize the upstream factors (e.g., chronic stress, trauma) that may contribute to tobacco and substance misuse.

 

• Finally, the new Smoking Cessation lead served as the chair for the Oregon Health Authority’s State Health Improvement Plan Behavioral Health subcommittee at the beginning of this grant cycle. Goals, strategies, and activities for the SHIP were finalized in fall 2019.

 

• Challenges/emerging issues: The COVID-19 pandemic made completion of our planned activities difficult this grant cycle. Although we were able to complete many activities, we had set out to accomplish this grant cycle, progress was significantly slowed due to OHA agency staff being redirected to the state COVID-19 response.

 

Strategy #2: Provide technical assistance to local health agencies and tribes working on strategies to decrease tobacco use among pregnant women and children’s exposure.

• Activities – State Level:
  • Twice yearly webinars with all counties and tribes that have identified smoking as a priority to share successes, challenges, and to provide a learning collaborative opportunity.

 

• Provide regular email communication updates to all smoking priority counties and tribes which may include research articles, tool kits, policy updates, and other resources.

 

• Participation in the Public Health Division’s State Health Improvement Plan - Behavioral Health.

 

• Provide necessary print, electronic, and training materials to counties and tribes to increase knowledge around tobacco cessation benefits and the Oregon Quitline.

 

• ESM: ESM 14.1.2: Percent of local Title V grantees who have selected smoking as a priority area who have at least two technical assistance contacts.

 

• Progress on ESMs: All local Title V grantees who selected smoking as a priority area received at least two technical assistance contacts with the Smoking Cessation priority lead.

 

• Accomplishments:
  • A new state staff person was hired in November 2019 to be the lead for Smoking Cessation priority area activities. The current Title V coordinator oriented the new staff member to this work throughout fall 2019.

 

• The priority lead contacted all Title V grantees who selected smoking as a priority area for an initial technical assistance call as part of her onboarding. The priority lead also reviewed plans and coordinated technical assistance calls with Title V grantees during spring 2020.

 

• A new Native QuitLine was developed by the Health Promotion and Chronic Disease Prevention program in partnership with Oregon Tribes. The priority lead distributed information about this new program, including materials and promotional items, to Title V grantees. Smoking cessation materials were also distributed to pregnant clients via the Oregon MothersCare program. The Smoking Cessation priority lead worked with the OHA materials distribution center to maintain smoking cessation educational materials for all Oregon MothersCare sites to use.

 

• Challenges/emerging issues: The COVID-19 pandemic made completion of our planned activities very difficult. Many local Title V staff were pulled into their community COVID-19 responses and traditional public health programs were temporarily “paused” or scaled back during the grant year. Local Title V staff lacked the capacity to participate in regular technical assistance opportunities for Title V activities.

 

Oral Health Report (children)

Priority: Oral Health (Children)

National Performance Measure: Percent of children ages 1 to 17 years who had a preventive dental visit in the last year.

Interpretation of national performance measure data:

There has been a decrease in the percent of Oregon children ages 1 to 17 years who had a preventive dental visit in the last year, when comparing the 2016/17 rate of 81.8% to the 2017/18 rate of 80.9%. Single year data cannot be examined independently in Oregon due to small sample size. Another consequence of the small sample size is that the decrease in the rate should be interpreted with caution.

Strategies:

Strategy #1: Increase awareness and engagement within the dental community of oral cancer and HPV.

• ESM: ESM 13.2.3: Number of oral health providers provided training on oral cancer and HPV.

 

• Progress on ESMs: 48 participants attended the oral health specific presentation at the HPV Virtual Summit.

 

• Accomplishments:
  • Collaborated with the state Immunization Program to update the brochure titled, “Oral Cancer and HPV: Protect Your Family” to be more health literate. The brochure is used by dental providers to promote the HPV vaccine with adolescents and parents/caregivers.

 

• Participated on the planning committee for the 2020 Statewide HPV Virtual Summit, sponsored by the American Cancer Society and state Immunization Program, that was held on August 19-20, 2020. We engaged the dental community to attend the event and had the Dean of the Dental School at Oregon Health & Science University (OHSU) present on HPV and the dental community.

 

• Challenges/emerging issues:
  • The COVID-19 pandemic limited progress in this area. Several Oral Health Unit staff members were reassigned to help with the emergency response, limiting the amount of time staff worked on oral health and title V activities.

 

• The pandemic did garner attention in having dentists administer vaccines. House Bill 2220 was signed into law on May 6, 2019 authorizing Oregon dentists to prescribe and administer vaccines beginning January 1, 2020. Dentists have been recruited to administer the flu and COVID-19 vaccine during the pandemic, but we hope to expand this to the HPV vaccine in the future.

 

Strategy #2: Provide technical assistance to school oral health programs and Title V grantees.

• ESM: 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.

 

• Progress on ESMs: Seventeen Title V local grantees were provided with technical assistance to promote dental visits for children and adolescents. Technical assistance was provided to 21 school dental sealant programs.

 

• Accomplishments:
  • Seventeen grantees - fifteen local health agencies and two tribes - were provided with individualized technical assistance throughout the grant year.

 

• From June 2020 through August 2020, the Oral Health Unit convened a workgroup that developed draft guidelines for school oral health programs to safely provide oral health services in school settings during the COVID-19 pandemic. The workgroup included representatives from the Oregon Department of Education (ODE), PHD Adolescent & School Health, and certified school dental sealant programs. Two guidance documents were created that were finalized by Oregon’s emergency response Team in September 2020:
  • OHA Guidance on Resumption of Dental Services in School Settings
  • OHA Guidance for Certified School Dental Sealant Programs

 

• The Oral Health Unit conducted a virtual clinical training for school dental sealant programs on August 7, 11 & 13, 2020 that included infection control practices during the COVID-19 pandemic.

 

• Before schools were closed due to the COVID-19 pandemic in mid-March 2020, site visits were conducted with 19 out of 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.

 

• Challenges/emerging issues:
  • The COVID-19 pandemic limited progress in this area. Several Oral Health Unit staff members were reassigned to help with the emergency response, limiting the amount of time staff worked on oral health and title V activities. Local public health agencies and tribes also reassigned staff to help with the pandemic, limiting the time being spent on Title V activities.

 

• Schools in Oregon were closed to in-person instruction on March 16, 2020 and remained closed for the remainder of the 2019-2020 academic year. School oral health programs were not allowed to operate.

 

Strategy #3: Increase oral health surveillance in Oregon.

Planned Activities:

• ESM 13.1.2: Number of data sets in the Oregon Oral Health Surveillance System (OOHSS) that can be analyzed for oral health disparities.

 

• Progress on ESMs: Seven data sets in the OOHSS 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).

 

• Pulled together a workgroup to look at REALD for the 2022 Oregon Smile & Healthy Growth Survey.

 

• 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 COVID-19 pandemic limited progress in this area. Several Oral Health Unit staff members were reassigned to help with the emergency response, limiting the amount of time staff worked on oral health and title V activities. Since the pandemic has highlighted the need for REALD, we anticipate future policy changes in this area.

 

Strategy #4: Provide oral health preventive services or education and referral/case management services through Oregon's Home Visiting System.

• Accomplishments:
  • Benton, Jefferson, Jackson, Lake, Linn, Malheur, and Morrow Counties provided oral health education and referrals for dental care during home visits.
  • Benton and Jefferson Counties had all home visiting staff take the national, online Smiles for Life training.

 

• Challenges/emerging issues:
  • The COVID-19 pandemic limited progress in this area. Local public health agencies and tribes reassigned staff to help with the pandemic, limiting the time being spent on Title V activities. Beginning in mid-March 2020, in-person nurse home visiting services were discontinued. Those that provided virtual appointments were limited to providing oral health education and referral services.

 

• Dental referrals became even more challenging during the pandemic. Dental clinics were only allowed to provide emergency services from mid-March until May 2020. Many dental clinics closed entirely during this time and were slow to open. It was challenging for a lot of clinics to meet the reopening guidelines due to staffing challenges and PPE shortages.

 

Strategy #5: Educate pregnant women, parents/caregivers of children, and children 0-17 about oral health and the importance of dental visits.

 

• Accomplishments:
  • Clackamas County worked on scheduling and intake processes to increase the number of WIC clients and young children receiving preventive oral health services as part of their Healthy Smiles Program.

 

• Columbia County provided oral health education and referral services to children in their home visiting and WIC programs.

 

• Cow Creek Band of Umpqua Tribe of Indians provided children with oral health education and dental care kits at least twice a year. Cow Creek Health & Wellness primary care and pediatric care staff received training on how to provide oral health screenings to children and adolescents during physicals.

 

• Hood River County collaborated with Advantage Dental to provide monthly oral health screenings and preventive services for children in their WIC program.

 

• Jefferson County Public Health provided oral health education, fluoride varnish and dental care referrals for children through WIC follow-up appointments.

 

• Josephine County collaborated with Siskiyou Dental to provide oral health education and fluoride varnish to low-income children participating in their WIC and public health programs.

 

• Klamath County collaborated with the Klamath Basin Oral Health Coalition and Cascade Health Alliance CCO to develop oral health education materials for adolescents and parents/caregivers around HPV and oral cancer.

 

• Lake County collaborated with Advantage Dental to provide oral health assessments, education, and fluoride varnish to children in their WIC program.

 

• Morrow County collaborated with Advantage Dental to provide oral health education and screenings in the schools and assisted with getting parent permission for needed follow-up dental care.

 

• Polk County partnered with Capitol Dental Community Outreach to provide onsite dental services for children and families at Polk County Health Services.

 

• Wheeler County distributed the Bright Futures Oral Health pocket guide to parents/caregivers who came to the clinic for WIC services.

 

• Challenges/emerging issues:
  • The COVID-19 pandemic limited progress in this area. Local public health agencies and tribes reassigned staff to help with the pandemic, limiting the time being spent on Title V activities. Beginning in mid-March 2020, in-person programs such as WIC and nurse home visiting were discontinued. Those programs that provided virtual appointments were limited to providing oral health education and referral services.

 

• Dental referrals became even more challenging during the pandemic. Dental clinics were only allowed to provide emergency services from mid-March until May 2020. Many dental clinics closed entirely during this time and were slow to open. It was challenging for a lot of clinics to meet the reopening guidelines due to staffing challenges and PPE shortages.

 

Other Title V Work in this Domain

Title V’s work in child health focused on increasing community and caregiver capacity to promote the foundations of health: stable responsive relationships, safe supportive environments, and nutrition and healthy behaviors. A major focus is integration of child health into programs and policies across state and local agencies, including the early learning and education systems.

 

In addition to priority specific activities, state Title V staff provided leadership, technical and analytic expertise for multiple programs, surveillance systems and initiatives for improved child health in the following areas:

• Leadership and analytic expertise to support the development and implementation of the ECHO (3-year follow back survey to PRAMS);
• Leadership and analytic expertise to support the day to day programmatic activities of the EHDI (early hearing detection and intervention) program, including capacity to apply for CARES Act funding to support telehealth and anti-racism approaches to support EHDI systems;
• Leadership and analytic expertise to support data collection, analysis, and capacity to apply for future federal funding to support Oregon’s Birth Anomalies Surveillance System (BASS);
• Technical expertise for analysis of legislative bills impacting children and youth in Oregon;
• Leadership and subject matter expertise in Oregon’s State Child Fatality Review Team and in providing technical assistance to county child fatality teams;
• Leadership representing public health for Oregon’s Initiative for Inclusive Child Care for Children with Special Health Needs, led by the Oregon Department of Education;
• Leadership and subject matter expertise in reviewing Oregon Coordinated Care Organization’s Community Health Assessments and Health Improvement Plans for maternal and child health content and alignment;
• Leadership and representation on Oregon’s State Interagency Coordinating Council (SICC), convened by the Oregon Department of Education;
• Subject matter expertise and participation in Oregon’s Climate Health Action Planning work;
• Participation in the Children’s Healthy Weight Collaborative Improvement & Innovation Network (CHW-CoIIN) Physical Activity and Nutrition Integration workstreams, coordinated by ASPHN and designed to promote healthy weight among all children, including those with special health care needs (see Supporting Document #3 for infographics).
  • For the Physical Activity workstream, a two-pronged approach was used to increase physical activity among children – 1. conducting focus groups to examine the opportunities and barriers to implementing physical activity and education in school districts; 2. creating a Supplemental Instructional Materials Alignment Tool that organizations can use to align with Oregon state physical education content standards. An infographic describing  this work is available at: https://asphn.org/wp-content/uploads/2021/06/2020-oregon-chw-coiin-pa-final.pdf
  • For the Nutrition Integration workstream, public health programs and agency work across the life course was assessed using the I +PSE framework. An infographic describing this work is available at: https://asphn.org/wp-content/uploads/2021/06/2020-oregon-chw-coiin-in-FINAL.pdf

 

 

Other local Title V grantee work in child health included a focus on car seat safety by the Confederated Tribes of Warm Springs Title V program They have been purchasing, distributing, and installing car seats to Tribal families with newborns, holding car seat clinics, and providing training for staff to be certified car seat educators and installers.