Washington Parish (County) Wide Program

to Improve Health of Children

A model for other Parishes (Counties)

BHS

Goal:
To assess the health problems of children in Washington Parish (approximately N = 7000 at elementary school age) and develop programs that can improve the health of children in a Parish-wide area as a Model for other parishes in Louisiana, and counties elsewhere.

Outcome:
     1. To develop programs to Improve children’s health throughout Washington Parish
     2. Internalize programs to be ongoing and sustainable throughout the Parish
     3. To provide a Model that can be adapted by other Parishes

Medical and Social Issues to be Addressed:
     · Control and prevention of obesity
     · Improve asthma-bronchitis treatment and follow-up
     · Complete vaccination programs
     · Address drug and alcohol abuse, and tobacco use
     · Address Social Issues:
          - Sexually transmitted diseases
          - Teenage pregnancies
          - Violent behavior
          - Suicides

General Background:
The Bogalusa Heart Study, encompassing Ward 4, has documented medical and social issues that involve the health of children. Many of these are preventable and they have a detrimental effect not only on the health of growing children but also on the economy of the community. Improving health of children and individuals throughout the Parish can be accomplished by planning and implementing already available programs. Although the Bogalusa Heart Study focused primarily on cardiovascular diseases, it became obvious that general health of children and young adults followed over the past 30 years have developed preventable medical problems, not only heart disease but other medical, dental and social problems. These disabilities can be prevented by helping young individuals achieve healthy lifestyles, not only through nutrition and physical activity but by understanding the damaging effect of unhealthy lifestyles such as use of excessive alcohol, tobacco use, inactivity and poor diets leading to obesity and increasing diabetes. Morbidity studies of 60-75% of participants in the Bogalusa Heart Study show abnormal cardiovascular risk factors. These are abnormal cholesterol and lipoprotein levels, high blood pressure, and morbid obesity leading to increase in Type II diabetes in young individuals. Although still rather young a number have already developed heart disease leading to bypass surgery and a number have sudden deaths. Smoking and alcohol use occur in 30% of young students. (Read more under Lessons Learned from the Bogalusa Heart Study)

We have an opportunity based on these findings to write a new chapter on the health of children which could be modeled across Louisiana and, in fact, the United States. The observations that have been made in Bogalusa are comparable to those in the Southeast and in the United States.

A $3.5 million award from NIH provided funds to develop cardiovascular prevention programs for families at high risk and a more important general public health school model directed to all children. The program to be outlined for Washington Parish is primarily directed toward health issues for all children. This includes 7,000 children of elementary school age throughout the Parish. (See also STICH – Supporting Timely Improvement in Children’s Health - Washington Parish Health Program for Elementary School Children, Health Ahead/ Heart Smart)

Implementation of the Program:
Funds have been awarded by the Washington Parish Council and materials by the Louisiana Office of Public Health to implement this program. Continuation funds need to be obtained for continuity of the program. The program requires a large amount of volunteer help throughout the Parish and within the small communities to see activities implemented. A number of committees or task forces can be formed to help implement various activities. The purpose of each is briefly outlined:

Public Relations - This involves news media, paper, radio, television reporting activities to get the word out beyond Washington Parish, of what is being accomplished.
Medical, Dental and Nursing - Following major medical or other health problems of each child within the schools and refer or try to make available needed health care by doctors and Parish wide facilities.
Business - The need to see how such a program can be financed and how fund raising through grant writing, seeking federal and state funds, can be accomplished.

Education - To help implement health education throughout the Parish. This is to include all elementary school children in the Parish including he small communities. We have tested and evaluated a health education program, Health Ahead/Health Smart, developed through federal funds 15 years ago. It has been updated to meet national standards. The program addresses the entire school environment: nutrition, physical education, personal health programs for teachers and parents. It is important that the program also addresses social problems listed above i.e. smoking, alcohol, drugs, violent behavior. Health education beginning at kindergarten is the major prevention program. That outlined through research in the Health Ahead/Health Smart program is feasible and can be successful. It will require inservice training and possibly some can be done by distant learning from New Orleans to Franklinton and Bogalusa. Importantly this cannot address exercise or smoking alone, but has to address all health problems as listed above. Parental involvement is encouraged.
Public Policy - This would involve out of offices of both mayors, and involve Parish Sheriff as well. Thirty percent or more high school students are smoking and using alcohol on a regular basis under the age of being able to purchase these products. Procedures will have to be developed for security for school grounds in the afternoon, the construction of bicycle paths and areas for exercise for the children. How tobacco and alcohol are purchased has to be addressed. Vending machines to raise money for schools is an issue to be considered.
Evaluation - From past experiences it is important to evaluate the program and know its accomplishments. It is extremely expensive to evaluate in a detailed research manner as we have conducted the Bogalusa Heart Study and the research to develop the Health Ahead/Health Smart program. We are past that need and can implement proven programs. Evaluation could be accomplished by teachers. Process evaluation and success of committees is of interest.

Comment:
Although the main prevention program can be implemented through health education in the two school systems, in the Parish, Washington Parish and Bogalusa, to accomplish lifestyles changes within the Parish involves different elements reflected in categories of committees. Activities have to be reported to the leadership for the overall program. From past experience the most that one can accomplish within a short time is behavioral change and change of lifestyles. One should not expect changes of cholesterol or risk factor levels or even reduced mortality. These only come about after 10-20 years of change of lifestyles. For example, we can follow a well-known program in Finland conducted over the past 30 years. They now have a decrease of cardiovascular disease from the highest in the world earlier.

It is a great opportunity for Washington Parish to take advantage of the research funded by the federal government over the past 30 years as the Bogalusa Heart Study and National Research and Demonstration Center – Arteriosclerosis . The study of children has moved to young adulthood and now has an understanding of the early origin of coronary artery disease, hypertension, diabetes, obesity. The success of the Bogalusa Heart Study can really be attributed to the support that has been given from parents, doctors, school, etc. of Bogalusa and Franklinton. The work really gave an opportunity to apply scientific background to an entire community. Bogalusa has now become one of the world’s premiere epidemiology studies and the only biracial (black-white) rural community studying heart disease beginning in childhood in the world. Since the Bogalusa Heart Study earlier was a natural history study health education was not introduced as a prevention program. Two years ago the Superintendent supported school health by increasing physical activity throughout Bogalusa schools. We now have the opportunity to broaden this aspect Parish-wide and to begin to address other health problems, as outlined. The program can be very successful but will require a great deal of volunteerism and dedication. We have the know-how from the research conducted in the Bogalusa Heart Study and Health Ahead/Heart Smart research and it will be great to have that knowledge implemented.

Lessons Learned from the Bogalusa Heart Study

Obesity
     · Children are 12 lbs. heavier, not taller since 1973
     · Over 30 percent of children are obese. Ten percent are frankly fat. Obesity in
          children predicts cardiac enlargement, insulin resistance, and diabetes in
          adulthood
     · Average TV watching is 2 – 4 hours/day

Asthma
     · Has increased from 7% to 14%

Hypertension
     · High blood pressure levels in childhood predict hypertension in adulthood
     · Increased left ventricular mass is found in children at 90th percentile

Lipids, Lipoproteins
     · HDL-C decreases dramatically at puberty in white males
     · LDL-C rises in adolescent and young adult ages

Risk factors
     · Gender and racial contrasts occur
     · Cluster as a cardiometabolic syndrome
     · Track – predictive of adult levels
     · Tend to explain more hypertension and diabetes in blacks and coronary artery
          disease in white males

Tobacco and Alcohol use
     · Over 30% are regular smokers and persistent alcohol users (below legal age to
         purchase). These habits are documented to begin in the 3rd grade (age 8 years)

Diet
     · 60% exceed recommended cholesterol intake
     · 80% exceed recommended fat intake
     · excess Na+ and inadequate K+ intake

Morbidity and Mortality
     · 54.7% of known information on deaths are unnatural – accidents, violence,
          suicide etc.
     · Average age of heart attacks is 51 years
     · Anatomic changes noted by autopsy relate strongly to risk factors
     · Abnormal C-V structure and function changes relate to risk factors

Social
     · 17% of pregnancy – teenage and unwed
     · 46% do not finish high school

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