Tulsa Health Department It s All About Kids Program

Tulsa Health Department It s All About Kids Program Preliminary Report 2012-2013 Prepared by: Evie M. Muilenburg-Trevino, PhD, and Jeanne Gillert, MHR June 2013 Technical Report No.: ARC-03-06-13

Table of Contents Executive Summary... 6 Program Overview... 6 CATCH Nutrition Program... 6 BMI and BP Study... 6 Oral Health Program... 7 Nutrition Detectives... 7 Study Overview... 9 Purpose of Study... 9 Methodology... 9 CATCH Nutrition Program... 11 Purpose of Study... 11 Methodology... 11 Results... 11 Graph 1: CATCH Participants by School... 12 Graph 2: CATCH Pre- and Post-Test Results... 13 Discussion... 14 Body Mass Index and Blood Pressure Study... 16 Purpose of Study... 16 Methodology... 16 Table 1: BMI Category and Percentile Ranking... 17 Table 2: Systolic and Diastolic BP Category and Percentile Ranking... 17 Results... 17 BMI Results... 18 Graph 3: BMI Participants by School for Spring 2012-2013... 19 Graph 4: BMI Participants by Grade for Spring 2012-2013... 20 Graph 5: BMI Participants by Gender for Spring 2012-2013... 21 Graph 6: BMI Changes Overall Spring 2012-2013... 22 Table 3: BMI Rates of Change Overall... 22 2

Graph 7: BMI Changes Clinton Spring 2012-2013... 23 Table 4: BMI Rates of Change at Clinton Elementary... 23 Graph 8: BMI Changes Hawthorne Spring 2012-2013... 24 Table 5: BMI Rates of Change at Hawthorne Elementary... 24 Graph 9: BMI Changes Penn Spring 2012-2013... 25 Table 6: BMI Rates of Change at Penn Elementary... 25 Graph 10: BMI Changes for First Graders Spring 2012-2013... 26 Table 7: BMI Rates of Change for First Graders... 26 Graph 11: BMI Changes for Second Graders Spring 2012-2013... 27 Table 8: BMI Rates of Change for Second Graders... 27 Graph 12: BMI Changes for Third Graders Spring 2012-2013... 28 Table 9: BMI Rates of Change for Third Graders... 28 Graph 13: BMI Changes for Fourth Graders Spring 2012-2013... 29 Table 10: BMI Rates of Change for Fourth Graders... 29 Graph 14: BMI Changes for Fifth Graders 2012-2013... 30 Table 11: BMI Rates of Change for Spring 2012-2013... 30 Blood Pressure Results... 31 Graph 15: Overall Systolic Changes for Spring 2012-2013... 32 Table 12: Systolic Percentages Overall... 32 Graph 16: Overall Diastolic Changes for Spring 2012-2013... 33 Table 13: Diastolic Percentages Overall... 33 Graph 17: Clinton Systolic Changes for Spring 2012-2013... 34 Table 14: Systolic Percentages for Clinton Elementary... 34 Graph 18: Clinton Diastolic Changes for Spring 2012-2013... 35 Table 15: Diastolic Percentages for Clinton Elementary... 35 Graph 19: Hawthorne Systolic Changes for Spring 2012-2013... 36 Table 16: Systolic Percentages for Hawthorne Elementary... 36 Graph 20: Hawthorne Diastolic Changes for Spring 2012-2013... 37 Table 17: Diastolic Percentages for Hawthorne Elementary... 37 Graph 21: Penn Systolic Changes for Spring 2012-2013... 38 3

Table 18: Systolic Percentages for Penn Elementary... 38 Graph 22: Penn Diastolic Changes for Spring 2012-2013... 39 Table 19: Diastolic Percentages for Penn Elementary... 39 Graph 23: Systolic Changes for First Graders Spring 2012-2013... 40 Table 20: Systolic Percentages for First Graders... 40 Graph 24: Diastolic Changes for First Graders Spring 2012-2013... 41 Table 21: Diastolic Percentages for First Graders... 41 Graph 25: Systolic Changes for Second Graders Spring 2012-2013... 42 Table 22: Systolic Percentages for Second Graders... 42 Graph 26: Diastolic Changes for Second Graders Spring 2012-2013... 43 Table 23: Diastolic Percentages for Second Graders... 43 Graph 27: Systolic Changes for Third Graders Spring 2012-2013... 44 Table 24: Systolic Percentages for Third Graders... 44 Graph 28: Diastolic Changes for Third Graders Spring 2012-2013... 45 Table 25: Diastolic Percentages for Third Graders... 45 Graph 29: Systolic Changes for Fourth Graders Spring 2012-2013... 46 Table 26: Systolic Percentages for Fourth Graders... 46 Graph 30: Diastolic Changes for Fourth Graders Spring 2012-2013... 47 Table 27: Diastolic Percentages for Fourth Graders... 47 Graph 31: Systolic Changes for Fifth Graders Spring 2012-2013... 48 Table 28: Systolic Percentages for Fifth Graders... 48 Graph 32: Diastolic Changes for Fifth Graders Spring 2012-2013... 49 Table 29: Diastolic Percentages for Fifth Graders... 49 BMI and BP Comparisons... 50 Graph 33: Overall Spring 2012 BMI and Systolic Blood Pressure Data... 51 Graph 34: Overall Spring 2012 BMI and Diastolic Blood Pressure Data... 52 Graph 35: Overall Spring 2013 BMI and Systolic Blood Pressure Data... 53 Graph 36: Overall 2013 BMI and Diastolic Blood Pressure Data... 54 References... 55 Oral Health Program... 57 4

Purpose of Study... 57 Methodology... 57 Results... 57 Graph 37: Oral Health Program Participants by School... 58 Graph 38: Oral Health Program Pre- and Post-Test Results... 59 Discussion... 60 Nutrition Detectives... 62 Purpose of Study... 62 Methodology... 62 Results... 62 Graph 39: Nutrition Detective Program Participants by Grade... 63 Graph 40: Nutrition Detective Program Pre- and Post-Test Results... 64 Graph 41: Nutrition Detective Program Pre- and Post-Test Results by School... 65 Graph 42: Nutrition Detective Program Pre- and Post-Test Results by Grade... 66 Discussion... 67 Appendix A... 68 List of Schools... 68 Appendix B... 70 Center for Disease Control BMI Charts... 70 Appendix C... 73 Blood Pressure Levels by Age and Height Percentile... 73 Appendix D... 78 Guide to Blood Pressure Measurement in Children... 78 Appendix E... 83 CATCH Nutrition Test... 83 Appendix F... 99 Oral Health Program Test... 99 Appendix G... 101 Nutrition Detectives Test... 101 5

Program Overview It s All About Kids Executive Summary Tulsa City-County Health Department (TCCHD) implemented the It s All About Kids program in order to improve health outcomes for first through fifth grade students. It s All About Kids is a prevention program that encourages kids to make healthy choices and habits for a brighter future. The program has four goals: 1) improve healthy lifestyles, 2) reduce obesity, 3) improve school performance, and 4) build decision making. TCCHD implemented a health and nutrition program including the CATCH nutrition program including pre- and post-test analysis, body mass index (BMI) measurements, and blood pressure (BP) measurement. Data was collected in the spring and fall of 2012 and the spring of 2013, and then analyzed to determine the effects of the programs on student knowledge retention of the nutrition program, BMI score changes, BP scores changes, fitness measurements, and a summary of community events and presentations. The purpose of this report is to provide the results for the It s All About Kids program for 2012-2013 school year. CATCH Nutrition Program The CATCH Nutrition program is a coordinated school health program that unites parents, teachers, children, and community partners in teaching children and their families about healthy practices. As a classroom health program, it teaches children healthy eating and physical activity habits. The CATCH Nutrition program was pre and post-tested in 7 schools with 146 participants. Results indicate significant differences between Section A, C and I scores examined. These findings suggest improvement in regards to student choices and perceptions. There were no statistically significant findings for Checklist scores. BMI and BP Study Body mass index (BMI) scores were collected in spring 2012 (451) and spring 2013 (198) from three schools. Scores were then characterized as underweight, normal, overweight, or obese based on percentiles defined by the Center for Disease Control (Center for Disease Control and Prevention, 2007 b). Matched BMI data were collected in the spring from 72 students attending three elementary schools. Blood pressure (BP) scores were collected in spring 2012 (451) and spring 2013 (198) semesters. Scores were then characterized as normal, prehypertension ( Pre-HTN ), Stage 1: hypertension ( Stage 1: HTN ), or Stage 2: hypertension ( Stage 2: HTN ) based on percentiles defined by the US Department of Health and Human Services (US Department of Health and Human Services, 2007). 6

Anonymous student identifiers, which are used to protect the privacy of students, were used to track individual changes over time. Thus, comparisons can be made from spring 2013 to spring 2013 on an individual level basis with regards to BMI and BP scores. Because of the small sample size in the spring, mean scores were reported by grade and overall school results presented in graphs for the spring data. Chi-square analyses were computed to examine BMI rates of change by grade; these analyses are presented in table format. On the whole, findings are mixed with some improvements observed and some negative changes observed. Overall, there was statistically significant change for BMI scores with both positive change and negative change (see Graph 6). Overall, there was statistically significant change for systolic or diastolic blood pressure (see Graphs 15-16). Oral Health Program According to TCCHD, the Oral Health program provides instruction about caring for teeth to fourth grade students. The goals are to provide an understanding of the causes and prevention of tooth decay and gum disease, and instruct on proper tooth brushing and dental flossing. The two-session course was implemented in 11 schools. The Oral Health program was designed to track differences in pre- and post-test scores. T-test results indicate a significant difference between the pre- and post-test. These findings suggest an increase in students knowledge of oral health. Nutrition Detectives According to TCCHD, Nutrition Detectives was developed by David Katz, MD, MPH, FACPM, FACP, Director of the Yale Prevention Research Center and Catherine Katz, PhD. The program teaches students 5 clues to healthy eating and making healthy choices. Students learn how to read food labels and how to choose foods that are more nutritious. By the end of the program students have become Nutrition Detectives and earn their badge. The objectives of the program are to: 1) teach students to make healthful choices and detect marketing deceptions 2) give students the opportunity to practice what they have learned 3) empower students to share their detective skills with other family members. The two-session course was implemented in 4 schools with 307 students. A t-test analysis was used to examine differences in pre- and post-tests. The findings suggest that students knowledge of nutrition increased from the pre- to the post-test. 7

It s All About Kids Study Overview 8

It s All About Kids Study Overview Purpose of Study The It s All About Kids (IAK) program is a school health program provided by Tulsa City County Health Department (TCCHD). Based upon the Center for Disease Control s Coordinated School Health Program model, the program is comprised of eight areas of focus including physical education, nutrition and healthy eating, community health services, social services, health education, parent/community involvement, health promotion for school personnel, and ancillary services such as dental education and outreach. The goal of the program is to provide a prevention model for elementary school-aged youth to improve healthy lifestyles, reduce obesity, improve school performance and enhance decision making and negotiation skills. The program is offered to low-performing schools in Northeast Oklahoma, including schools with poor attendance rates, schools lacking a physical education instructor, schools with poor parental involvement, and schools with limited access to healthcare services. A list of participating schools is available in Appendix A. The purpose of the current report is to provide TCCHD with the fall 2012, spring 2012 and spring 2013 final results of the program evaluation for the It s All About Kids program. Methodology The purpose of this study was to analyze data collected from TCCHD to determine the effectiveness of the It s All About Kids program. The University of Oklahoma, Center of Applied Research for Nonprofit Organizations, analyzed data collected by TCCHD. Data includes nutrition scores from the CATCH nutrition test, BMI and BP data, Oral Health, and Nutrition Detectives. Because the study involves analysis of multiple program components, methodology, results and discussion sections are presented under individual headings. 9

It s All About Kids CATCH Nutrition Program 10

It s All About Kids CATCH Nutrition Program Purpose of Study The CATCH Nutrition program is a coordinated school health program that unites parents, teachers, children and community partners in teaching children and their families about healthy lifestyle practices. As a classroom health program, children learn healthy eating and physical activity habits. Methodology The CATCH Nutrition program pre- and post-test was administered to 146 fourth grade students in 7 schools. TCCHD used a pre- and post-test model to measure knowledge retention. The test consisted of four sections: Pre and Post Section A, Pre and Post Section C, Pre and Post Section I, and Pre and Post Checklist. In the Section A portion, students are asked 13 questions in regard to food choices; for each item, two food choices are provided. Higher scores indicate healthier food choices. The Section C is comprised of 14 items and questions students knowledge of healthy food in a 2-point multiple choice format (example: Which of these foods is better for your health? ). Higher scores indicate more knowledge of healthy foods. The Section I is comprised of 15 items which deal with students belief in their ability to make healthy choices (examples: I can eat fruit every day. I can play hard during most of recess. ). Questions are presented in a 3-point Likert type response format (1 Not Sure; 2 A Little Sure; 3 Very Sure). Higher scores indicate a decrease in negative self-perceptions in regard to the ability to make healthy choices. The Checklist section is a food checklist comprised of 34 items with a yes or no response format. Students are asked, Yesterday, did you eat or drink any of these foods? Higher scores indicate healthier food choices. A series of t-tests were computed to examine differences in mean scores on the pre- and post-test measures. Results The following graphs depict the results of the CATCH Nutrition program scores. 11

Graph 1: CATCH Participants by School CATCH Nutrition Program Number of Participants by School Briarglen 24 Clinton 27 McAuliffe 20 Marshall 11 Rosa Parks Roy Clark 18 18 Penn 28 0 5 10 15 20 25 30 n=146, TCCHD It s All About Kids Program Report 2012-2013 The graph above depicts the number of participating students in each school for the CATCH nutrition program. A total of 146 fourth grade students, representing 7 schools, participated in the program. 12

Graph 2: CATCH Pre- and Post-Test Results CATCH Nutrition Program Mean Scores for CATCH Tests Post-Test Pre-Test Section A*** Section C*** 8.59 7.91 10.3 9.25 Section I** 34.43 32.48 Checklist 12.87 13.42 0 5 10 15 20 25 30 35 40 Level of Significance: *** p <.001, ** P <.05 n=146, TCCHD It's All About Kids Program Report T-tests were used to assess differences in mean scores for all 7 school sites (N = 146). As the preceding graph illustrates, there are statistically significant differences between the Section A, Section C and Section I pre- and post-tests indicating improvement. Section A scores [t (146) = -2.446; p <.001] significantly increased indicating students chose healthier foods. Section C [t (146) = -4.099; p <.001] scores show significantly increased knowledge of healthy foods. Section I scores [t (146) = -2.807; p <.05] were also significantly different suggesting a decrease in negative self-perceptions in regards to their ability to make healthy choices. Checklist scores [t (146) = 1.696; p >.001] were NOT statistically significant. 13

Discussion The CATCH Nutrition program was designed to track differences in pre- and post-test scores which consisted of four segments. Results indicate statistically significant differences between Section A, Section C and Section I scores examined in 7 schools with 146 participants. These findings suggest improvement in regards to student choices and perceptions. The CATCH Nutrition test is available in Appendix E. 14

It s All About Kids Body Mass Index and Blood Pressure Study 15

It s All About Kids Body Mass Index and Blood Pressure Study Purpose of Study TCCHD collected student body mass index (BMI) scores and blood pressure (BP) from elementary school students who participated in the It s All About Kids program. The following analyses and results are from spring 2012 and 2013. Methodology TCCHD collected BMI and BP scores from 451 students during spring 2012 and 198 students during spring 2013. Participating students were enrolled in grades first through sixth. Each time BMI and BP scores were collected, a TCCHD official recorded participants school, teachers name, student code, age, grade level, height, weight, systolic BP, and diastolic BP. TCCHD officials then calculated and recorded BMI scores based on the Center for Disease Control s (CDC) BMI calculation formula (Center for Disease Control and Prevention, 2007a): BMI = (weight in pounds x 703) (kg/m 2 ) height in inches 2 TCCHD provided the BMI information to the Center of Applied Research For Non-Profit Organizations for analysis. Student names were not identified with student scores; instead, TCCHD officials used codes in place of names for student tracking. OU researchers were given only codes to track student BMI scores. These procedures are followed to protect the privacy of participants. Because children s height and weight change as they mature, childhood BMI scores can be plotted onto the CDC s gender specific BMI-for-age Growth Charts (Center for Disease Control and Prevention, 2007c) to determine a percentile ranking. BMI raw scores were transformed into percentiles using the CDC s BMI percentile formula, which corresponds to the BMI-for-age Growth Charts; the formula is based on BMI, date of birth, gender, height, and age in months at time of assessment. Formulas are used rather than the growth charts to ensure greater accuracy. CDC s gender specific Growth Charts (Center for Disease Control and Prevention, 2007c) are located in Appendix B. The percentile ranking represents the child s BMI score among other children of the same age and gender. The BMI categories and the corresponding percentile are presented in Table 1 (Center for Disease Control and Prevention, 2007 b): 16

Table 1: BMI Category and Percentile Ranking BMI Category Underweight Healthy Weight Overweight Obese Percentile Ranking <5th percentile 5th percentile to < 85th percentile 85th percentile to < 95th percentile 95th percentile In addition, TCCHD provided BP scores to researchers at the Center of Applied Research For Non-Profit Organizations for analysis. Student codes rather than names were used to track students. BP raw scores were transformed into percentiles based on systolic BP, diastolic BP, date of birth, gender, height, and age in months at time of assessment. The charts for blood pressure levels by age and height percentile are presented in Appendix C (National Heart Lung and Blood Institute, 2008). BP scores were then characterized as normal, prehypertension ( Pre-HTN ), Stage 1: hypertension ( Stage 1: HTN ), or Stage 2: hypertension ( Stage 2: HTN ) based on percentiles defined by the US Department of Health and Human Services (2007; See Appendix D). Table 2: Systolic and Diastolic BP Category and Percentile Ranking BP Category Percentile Ranking Normal < 90th percentile Prehypertension 90th percentile to < 95th percentile Stage 1: Hypertension 95th percentile to 99th percentile Stage 2: Hypertension 99th percentile Note: The purpose of the present data is not to diagnose students with a given BP category. Further, doing so would be inaccurate since multiple measures of BP are required before a diagnosis can be made. Rather the purpose of this study is to obtain a general understanding of student BP categories. Participant demographics and BMI/BP categories from spring 2012 to spring 2013 semesters were analyzed to determine individual level changes of BMI categories between semesters. Results For the spring 2013 and 2013 semesters, 72 matched records were obtained from three schools. Frequency analyses were used to determine participant demographic characteristics. Graphs 3-5 depict demographic characteristics for the entire sample of unmatched participants (N = 450, spring 2012; N = 198, spring 2012). Because of small number of matches, BMI category changes were examined by grade level only (Note: 2012 spring grade level was used). Graphs 6-11 illustrate BMI changes and chi-square tests for matched data. Graphs 12-24 illustrate blood pressure changes and chi-square tests for matched data. Finally, overall BMI categories and BP categories were examined for spring 2012 and 2013 (Graphs 25-28). 17

BMI Results Spring 2013 Spring 2013 18

Graph 3: BMI Participants by School for Spring 2012-2013 Body Mass Index Study Number of Participants 2013 2012 Clinton 8.59 131 Hawthorne 62 165 Marshall 0 102 Penn 24 53 0 20 40 60 80 100 120 140 160 180 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report The graph above depicts the number of participants for each school for spring 2012 and spring 2013. Four schools were involved. The percent of students participating by school in spring 2012 is as follows: Penn (12%), Marshall (23%), Hawthorne (37%), and Clinton (22%). The percent of students participating by school in spring 2013 is as follows: Clinton (57%), Hawthorne (12%), and Penn (12%). Matched scores were obtained from three schools. 19

Graph 4: BMI Participants by Grade for Spring 2012-2013 Body Mass Index Study Number of Participants 2013 2012 First 53 86 Second 33 79 Third 29 122 Fourth 36 68 Fifth 13 25 0 20 40 60 80 100 120 140 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the number of participants by grade for spring 2012 and spring 2013. In regard to grade level for spring 2012, 86 (19%) participants were from the first grade, 79 (18%) participants were from the second grade, 122 (27%) participants were from the third grade, 70 (16%) participants were from the fourth grade, 68 (15%) were from the fifth grade, and 25 (6%) were from sixth grade. In regard to grade level for spring 2013, 53 (27%) participants were from the first grade, 33 (17%) participants were from the second grade, 29 (15%) participants were from the third grade, 34 (17%) participants were from the fourth grade, 36 (18%) participants were from fifth grade and 13 (7%) were from sixth grade. 20

Graph 5: BMI Participants by Gender for Spring 2012-2013 Body Mass Index Study Number of Participants 2013 2012 Female 108 272 Male 90 179 0 50 100 150 200 250 300 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report According to TCCHD BMI records, Graph 5 indicates that in spring 2012, 40% (n=179) of the students were male and 60% (n=272) of the students were female. In the spring of 2013, 45% (n = 90) of students were male and 55% (n = 108) of students were female. 21

Spring 2012 BMI Graph 6: BMI Changes Overall Spring 2012-2013 Body Mass Index Study Overall BMI Changes Obese Overweight Healthy Underweight Spring 2012 1 20 25 53 Spring 2013 2.4 19 26 52 0 10 20 30 40 50 60 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report As Graph 6 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters. For the spring 2012 semester, 11 (2.4%) of all students were in the underweight category, 236 (52%) were in the healthy category, 86 (19%) were in the overweight category, and 118 (26%) were in the obese category. For spring 2013, 2(1%) were in the underweight category, 106 (53%) of all students were in the healthy category, 40 (20%) were in the overweight, and 50 (25%) were in the obese category. Table 3: BMI Rates of Change Overall Underweight (n=3) Healthy (n=37) Overweight (n=13) Obese (n=19) Spring 2013 BMI Underweight Healthy Overweight Obese 2 (66.7%) 1 (33.3%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 30 (81.1%) 7 (18.9%) 0 (0.0%) 0 (0.0%) 4(30.8%) 6 (46.2%) 3 (23.1%) 0 (0.0%) 1 (5.3%) 1(5.3%) 17 (89.5%) Table 3 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (9) = 106.456; p <.001]. In the spring 2012, of the 3 students in the underweight category, 1 (33.3%) moved to the healthy category. Of the 37 students that were in the healthy category, 7 (18.9%) moved to overweight category in spring 2013. In spring 2012 of the 13 students in the overweight category, 4 (30.8%) moved to the healthy category and 3 (23.1%) moved to the obese category in spring of 2013. In spring 2012, of the 19 students in the obese category, 1 (5.3%) moved to the healthy category and 1 (5.3%) moved to the overweight category. 22

Spring 2012 BMI Graph 7: BMI Changes Clinton Spring 2012-2013 Body Mass Index Study Clinton BMI Changes Obese Overweight Healthy Underweight Spring 2012 3.8 17.6 26 52.7 Spring 2013 4.9 19.5 34.1 41.5 0 10 20 30 40 50 60 n=131, Spring 2012; n=41, Spring 2013 TCCHD It's All About Kids Program Report As Graph 7 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters for Clinton Elementary. For the spring 2012 semester, 5 (3.8%) of all students were in the underweight category, 69 (52.7%) were in the healthy category, 23 (17.6%) were in the overweight category, and 34 (26%) were in the obese category. For spring 2013, 2(4.9%) were in the underweight category, 17 (41.5%) of all students were in the healthy category, 8 (19.5%) were in the overweight, and 14 (34.1%) were in the obese category. Table 4: BMI Rates of Change at Clinton Elementary Underweight (n=3) Healthy (n=17) Overweight (n=8) Obese (n=13) Spring 2013 BMI Underweight Healthy Overweight Obese 2 (66.7%) 1 (33.3%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 14 (82.4%) 3 (17.6%) 0 (0.0%) 0 (0.0%) 1(12.5%) 4 (50.0%) 3 (37.5%) 0 (0.0%) 1 (7.7%) 1(7.7%) 11 (84.6%) Table 4 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (9) = 59.341; p <.001]. In the spring 2012, of the 3 students in the underweight category, 1 (33.3%) moved to the healthy category. Of the 17 students who were in the healthy category, 3 (17.6%) moved to overweight category in spring 2013. In spring 2012 of the 8 students in the overweight category, 1 (12.5%) moved to the healthy category and 3 (37.5%) moved to the obese category in spring of 2013. In spring 2012, of the 13 students in the obese category, 1 (7.7%) moved to the healthy category and 1 (7.7%) moved to the overweight category. 23

Spring 2012 BMI Graph 8: BMI Changes Hawthorne Spring 2012-2013 Body Mass Index Study Hawthorne BMI Changes Obese Overweight Healthy Underweight Spring 2012 0.6 21.2 23 55.5 Spring 2013 0 18.5 18.5 63 0 10 20 30 40 50 60 70 n=165, Spring 2012; n=27, Spring 2013 TCCHD It's All About Kids Program Report As Graph 8 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters for Hawthorne Elementary. For the spring 2012 semester, 1 (.6%) of all students was in the underweight category, 91 (55.2%) were in the healthy category, 38 (23%) were in the overweight category, and 35 (21.2%) were in the obese category. For spring 2013, 0 (0.0%) were in the underweight category, 17 (63%) of all students were in the healthy category, 5 (18.5%) were in the overweight, and 5 (18.5%) were in the obese category. Table 5: BMI Rates of Change at Hawthorne Elementary Spring 2013 BMI Healthy Overweight Obese Healthy (n=18) 15 (83.3%) 3 (16.7%) 0 (0.0%) Overweight (n=4) 2(50.0%) 2 (50.0%) 0 (0.0%) Obese (n=5) 0 (0.0%) 0 (0.0%) 5 (100%) Table 5 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (4) = 29.541; p <.001]. In the spring 2012, of the 18 students who were in the healthy category, 3 (16.7%) moved to overweight category in spring 2013. In spring 2012 of the 4 students in the overweight category, 2 (50.0%) moved to the healthy category in spring of 2013. In spring 2012, of the 5 students in the obese category, all 5 (100%) remained in the obese category. 24

Spring 2012 BMI Graph 9: BMI Changes Penn Spring 2012-2013 Body Mass Index Study Penn BMI Changes Obese Overweight Healthy Underweight Spring 2012 7.5 18.9 28.3 45.3 Spring 2013 0 18.5 25 50 0 10 20 30 40 50 60 n=53, Spring 2012; n=4, Spring 2013 TCCHD It's All About Kids Program Report As Graph 9 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters for Penn Elementary. For the spring 2012 semester, 4 (7.5%) of all students were in the underweight category, 24 (45.3%) were in the healthy category, 10 (18.9%) were in the overweight category, and 15 (28.3%) were in the obese category. For spring 2013, 0 (0.0%) were in the underweight category, 2 (50%) of all students were in the healthy category, 1 (25%) was in the overweight, and 1 (25%) was in the obese category. Table 6: BMI Rates of Change at Penn Elementary Spring 2013 BMI Healthy Overweight Obese Healthy (n=2) 1 (50.0%) 1 (50.0%) 0 (0%) Overweight (n=1) 1 (100%) 0 (0.0%) 0 (0.0%) Obese (n=1) 0 (0.0%) 0 (0.0%) 1 (100%) Table 6 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 5.000; p >.05]. In the spring 2012, of the 2 students in the healthy category, 1 (50%) moved to overweight category in spring 2013. In spring 2012 of the 1 student in the overweight category, 1 (100%) moved to the healthy category in spring of 2013. In spring 2012, of the 1 student in the obese category, that student (100%) remained in the obese category. 25

Spring 2012 BMI Graph 10: BMI Changes for First Graders Spring 2012-2013 Body Mass Index Study First Graders BMI Changes Obese Overweight Healthy Underweight Spring 2012 3.5 20.9 26.7 48.8 Spring 2013 0 6.7 40 53.3 0 10 20 30 40 50 60 n=86, Spring 2012; n=15, Spring 2013 TCCHD It's All About Kids Program Report As Graph 10 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters. For the spring 2012 semester, 3 (3.5%) of all students were in the underweight category, 42 (48.8%) were in the healthy category, 23 (26.7%) were in the overweight category, and 13 (20.9%) were in the obese category. For spring 2013, 6 (40%) of all students were in the healthy category, 1 (6.7%) was in the overweight, and 8 (53.3%) were in the obese category. Table 7: BMI Rates of Change for First Graders Spring 2013 BMI Healthy Overweight Obese Healthy (n=4) 4 (100%) 0 (0%) 0 (0%) Overweight (n=3) 1 (33.3%) 0 (0.0%) 2 (66.7%) Obese (n=8) 1 (12.5%) 1(12.5%) 6 (75%) Table 7 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 8.958; p >.05]. In the spring 2012, of the 4 students in the healthy category, 100% remained in the healthy category in spring 2013. In spring 2012 of the 3 students in the overweight category, 1 (33.3%) moved to the healthy category in spring of 2013 and 2 (66.7%) moved to the obese category. In spring 2012, of the 8 students in the obese category, 1 (12.5%) moved to the healthy category and 1 (12.5%) moved to the overweight category, and 6 (75%) remained in the obese category by spring 2013. 26

Spring 2012 BMI Graph 11: BMI Changes for Second Graders Spring 2012-2013 Body Mass Index Study Second Graders BMI Changes Obese Overweight Healthy Underweight Spring 2012 1.3 16.5 25.3 57 Spring 2013 0 0 25 75 0 10 20 30 40 50 60 70 80 n=79, Spring 2012; n=12, Spring 2013 TCCHD It's All About Kids Program Report As Graph 11 illustrates, BMI categories were tabulated for spring 2012 and spring 2013 semesters. For the spring 2012 semester, 1 (1.3%) of all students was in the underweight category, 45 (57%) were in the healthy category, 13 (16.5%) were in the overweight category, and 20 (25.3%) were in the obese category. For spring 2013, 9 (75%) of all students were in the healthy category, 3 (25%) were in the overweight, and 0 (0%) were in the obese category. Table 8: BMI Rates of Change for Second Graders Spring 2013 BMI Healthy Overweight Obese Healthy (n=11) 9 (81.8%) 2 (18.2%) 0 (0%) Overweight (n=1) 0 (0.0%) 1 (100%) 0 (0%) Obese (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 8 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (1) = 3.273; p >.05]. In the spring 2012, of the 11 students in the healthy category, 9 (81.8%) remained in the healthy category and 2 (18.2%) moved to the overweight category in spring 2013. In spring 2012, 1 (100%) remained in the overweight category in spring of 2013. In spring 2012, there were no students in the obese category. 27

Spring 2012 BMI Graph 12: BMI Changes for Third Graders Spring 2012-2013 Body Mass Index Study Third Graders BMI Changes Obese Overweight Healthy Underweight Spring 2012 2.5 17.2 25.4 54.9 Spring 2013 4.8 14.3 23.8 57.1 0 10 20 30 40 50 60 n=122, Spring 2012; n=21, Spring 2013 TCCHD It's All About Kids Program Report As the above graphs illustrates, for the spring 2012 semester, 3 (2.5%) of all the students were in the underweight category, 67 (54.9%) were in the healthy category, 21 (17.2%) were in the overweight category, and 31 (25.4%) were in the obese category. For spring 2013, 1 (4.8%) was in the underweight category, 12 (57.1%) were in the healthy category, 5 (23.8%) were in the overweight category, and 3 (14.3%) were in the obese category. Table 9: BMI Rates of Change for Third Graders Spring 2013 BMI Underweight Healthy Overweight Obese Underweight(n=1) 1 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Healthy (n=13) 0 (0.0%) 10 (76.9%) 3 (23.1%) 0 (0.0%) Overweight (n=4) 0 (0.0%) 2 (50%) 2 (50%) 0 (0%) Obese (n=3) 0 (0.0%) 0 (0.0%) 0 (0.0%) 3 (100%) Table 9 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (9) = 43.319; p <.001]. In the spring 2012, 1 (100%) student was in the underweight category and remained in the underweight category, of the 13 students in the healthy category, 10 (76.9%) remained in the healthy category, 3 (23.1%) moved to the overweight category in spring of 2013. Of the 4 students in the overweight category in the spring 2012, 2 (50%) moved to the healthy category and 2 (50%) remained in the overweight category. 28

Spring 2012 BMI Graph 13: BMI Changes for Fourth Graders Spring 2012-2013 Body Mass Index Study Fourth Graders BMI Changes Obese Overweight Healthy Underweight Spring 2012 2.9 21.4 31.4 44.3 Spring 2013 5.6 22.2 27.8 44.4 0 5 10 15 20 25 30 35 40 45 50 n=70, Spring 2012; n=18, Spring 2013 TCCHD It's All About Kids Program Report As graph 13 illustrates, for the spring 2012 semester, 2 (2.9%) of all students were in the underweight category, 31 (44.3%) students were in the healthy category, 15 (21.4%) were in the overweight category and 22 (31.4%) were in the obese category. For spring 2013, 1 (5.6%) of all students was in the underweight category, 5 (27.8%) were in the healthy category, 4 (22.2%) were in the overweight category, and 8 (44.4%) were in the obese category. Table 10: BMI Rates of Change for Fourth Graders Spring 2013 BMI Underweight Healthy Overweight Obese Underweight(n=1) 1 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Healthy (n=6) 0 (0.0%) 4 (66.7%) 2 (33.3%) 0 (0.0%) Overweight (n=4) 0 (0.0%) 1 (25%) 2 (50%) 1 (25%) Obese (n=7) 0 (0.0%) 0 (0.0%) 0 (0.0%) 7(100%) Table 10 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (9) = 34.313; p <.001]. In the spring 2012, the 1 underweight student remained underweight in spring of 2013. Of 6 healthy students in 2012, 4 (66.7%) remained in the healthy category and 2 (33.3%) moved to the overweight category in spring 2013. Of the 4 students in the overweight category in spring 2012, 1 (25%) improved to the healthy category, 2 (50%) remained in the overweight category, and 1 (25%) moved to the obese category in the spring 2013. Of the 7 students in the obese category in spring 2012, 7 (100%) saw no improvement in the spring of 2013. 29

Spring 2012 BMI Graph 14: BMI Changes for Fifth Graders 2012-2013 Body Mass Index Study Fifth Graders BMI Changes Obese Overweight Healthy Underweight Spring 2012 1.5 13.2 29.4 55.9 Spring 2013 0 16.7 16.7 66.7 0 10 20 30 40 50 60 70 80 n=68, Spring 2012; n=6, Spring 2013 TCCHD It's All About Kids Program Report As graph 14 illustrates, for the spring 2012 semester, 1 (1.5%) student was in the underweight category, 38 (55.9%) were in the healthy category, and 9 (13.2%) were in the overweight category and 20 (29.4%) were in the obese category. For spring 2013, 4 (66.7%) of all students were in the healthy category, 1 (16.7%) was in the overweight category and 1 (16.7%) was in the obese category. Table 11: BMI Rates of Change for Spring 2012-2013 Spring 2013 BMI Underweight Healthy Overweight Obese Underweight(n=1) 0 (0.0%) 1 (100%) 0 (0.0%) 0 (0.0%) Healthy (n=3) 0 (0.0%) 3 (100%) 0 (0.0%) 0 (0.0%) Overweight (n=1) 0 (0.0%) 0 (0.0%) 1 (100%) 0 (0.0%) Obese (n=1) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1(100%) Table 11 presents the results of the chi-square test used to track individual level BMI rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (6) = 12.000; p >.05]. In the spring 2012, the 1 underweight student moved to the healthy category; of the 3 healthy students, all 3 (100%) maintained a healthy category in spring 2013. The 1 (100%) student in the overweight category remained in the overweight category and 1 (100%) student in the obese category remained in the obese category in spring 2013. 30

Blood Pressure Results Spring 2012 Spring 2013 31

Spring 2012 Systolic Graph 15: Overall Systolic Changes for Spring 2012-2013 Blood Pressure Study Overall Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 12.9 10.4 76.7 Spring 2013 0 13.6 11.6 74.7 0 10 20 30 40 50 60 70 80 90 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the overall systolic percentages. For the spring 2012 semester, 346 (76.7%) students were in the normal category, 47 (10.4%) were in the Pre-HTN category, 58 (12.9%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 148 (74.7%) of all students were in the normal category, 23 (11.6%) were in the Pre-HTN category, 27 (13.6%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 12: Systolic Percentages Overall Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=52) 43 (82.7%) 3 (5.8%) 6 (11.5%) 0 (0.0%) Pre-HTN (n=11) 10 (90.9%) 1 (9.1%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=9) 2 (22.2%) 3 (33.3%) 4 (44.4%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 12 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (4) = 17.817; p <.001]. In the spring 2012, of the 52 students in the normal category, 3 (5.8%) showed increased systolic pressure to the Pre-HTN category, and 6(11.5%) increased to the Stage 1 HTN category. Of the 11 students in Pre-HTN category in 2012, 10 (90.9%) had improved to the normal category. Of the 9 students in the Stage 1 HTN category, 2 (22.2%) had improved to the normal category and 3 (33.3%) had improved to the Pre-HTN category by spring of 2013. 32

Spring 2012 Diastolic Graph 16: Overall Diastolic Changes for Spring 2012-2013 Blood Pressure Study Overall Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 13.3 11.8 74.9 Spring 2013 0 13.6 11.6 74.7 0 10 20 30 40 50 60 70 80 n=451, Spring 2012; n=198, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the overall diastolic percentages. For the spring 2012 semester, 338 (74.9%) students were in the normal category, 53 (11.8%) students were in the Pre-HTN category, 60 (13.3%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 148 (74.7%) of all students were in the normal category, 23 (11.6%) were in the Pre-HTN category, 27 (13.6%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 13: Diastolic Percentages Overall Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=56) 46 (82.1%) 4 (7.1%) 6 (10.7%) 0 (0.0%) Pre-HTN (n=6) 6 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=10) 4 (40%) 2 (20%) 4 (40%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 13 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (4) = 10.730; p <.05]. In the spring 2012, of the 56 students in the normal category, 10 showed increased diastolic blood pressure by spring of 2013. Four (7.1%) of the ten increased to the Pre-HTN category and 6 (10.7%) increased to the Stage 1 HTN category. Of the 6 students in the Pre-HTN category, 100% improved to the normal category. Of the 10 students in the Stage 1 HTN category, 4 (40%) improved to the normal category and 2 (20%) improved to the Pre-HTN category. 33

Spring 2012 Systolic Graph 17: Clinton Systolic Changes for Spring 2012-2013 Blood Pressure Study Clinton Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 6.1 14.5 79.4 Spring 2013 0 9.8 17.1 73.2 0 10 20 30 40 50 60 70 80 90 n=131, Spring 2012; n=41, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for Clinton Elementary. For the spring 2012 semester, 104 (79.4%) students were in the normal category, 8 (6.1%) were in the Pre-HTN category, 19 (14.5%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 30 (73.2%) of all students were in the normal category, 23 (9.8%) were in the Pre-HTN category, 7 (17.1%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 14: Systolic Percentages for Clinton Elementary Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=32) 26 (81.3%) 2 (6.3%) 4 (12.5%) 0 (0.0%) Pre-HTN (n=3) 3 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=6) 1 (16.7%) 2 (33.3%) 3 (50.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 14 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (4) = 12.027; p <.05]. In the spring 2012, of the 32 students in the normal category, 2 (6.3%) increased systolic pressure to the Pre-HTN category, and 4 (12.5%) increased to the Stage 1 HTN category. Of the 3 students in Pre-HTN category in 2012, 3 (100%) had improved to the normal category. Of the 6 students in the Stage 1 HTN category, 1 (16.7%) had improved to the normal category and 2 (33.3%) had improved to the Pre-HTN category by spring of 2013. 34

Spring 2012 Diastolic Graph 18: Clinton Diastolic Changes for Spring 2012-2013 Blood Pressure Study Clinton Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 11.5 12.2 76.3 Spring 2013 0 7.3 19.5 73.2 0 10 20 30 40 50 60 70 80 90 n=131, Spring 2012; n=41, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for Clinton Elementary. For the spring 2012 semester, 100 (76.3%) students were in the normal category, 16 (12.2%) students were in the Pre-HTN category, 15 (11.5%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 30 (73.2%) of all students were in the normal category, 3 (7.3%) were in the Pre-HTN category, 8 (19.5%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 15: Diastolic Percentages for Clinton Elementary Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=32) 26 (81.3%) 2 (6.3%) 4 (12.5%) 0 (0.0%) Pre-HTN (n=2) 2 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=7) 2 (28.6%) 1 (14.3%) 4 (57.1%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 15 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 9.323; p >.05]. In the spring 2012, of the 32 students in the normal category, 6 showed increased diastolic blood pressure by spring of 2013. Two (6.3%) increased to the Pre-HTN category and 4 (12.5%) increased to the Stage 1 HTN category. Of the 2 students in the Pre-HTN category, 100% improved to the normal category. Of the 7 students in the Stage 1 HTN category, 2 (28.6%) improved to the normal category and 1 (14.3%) improved to the Pre-HTN category. 35

Spring 2012 Systolic Graph 19: Hawthorne Systolic Changes for Spring 2012-2013 Spring 2012 0 10.3 Blood Pressure Study Hawthorne Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 15.8 73.9 Spring 2013 0 7.4 11.1 81.5 0 10 20 30 40 50 60 70 80 90 n=165, Spring 2012; n=27, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for Hawthorne Elementary. For the spring 2012 semester, 122 (73.9%) students were in the normal category, 26 (15.8%) were in the Pre-HTN category, 17 (10.3%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 22 (81.5%) of all students were in the normal category, 3 (11.1%) were in the Pre-HTN category, 7 (7.1%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 16: Systolic Percentages for Hawthorne Elementary Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=17) 15 (88.2%) 1 (5.9%) 1 (5.9%) 0 (0.0%) Pre-HTN (n=7) 6 (85.7%) 1 (14.3%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=3) 1 (33.3%) 1 (33.3%) 1 (33.3%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 16 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 6.073; p >.05]. In the spring 2012, of the 17 students in the normal category, 1 (5.9%) increased systolic pressure to the Pre-HTN category, and 1 (5.9%) increased to the Stage 1 HTN category. Of the 7 students in Pre-HTN category in 2012, 6 (85.7%) had improved to the normal category. Of the 3 students in the Stage 1 HTN category, 1 (33.3%) had improved to the normal category and 1 (33.3%) had improved to the Pre-HTN category by spring of 2013. 36

Spring 2012 Diastolic Graph 20: Hawthorne Diastolic Changes for Spring 2012-2013 Spring 2012 0 13.9 10.3 Blood Pressure Study Hawthorne Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 75.8 Spring 2013 0 3.7 7.4 88.9 0 10 20 30 40 50 60 70 80 90 100 n=165, Spring 2012; n=27, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for Hawthorne Elementary. For the spring 2012 semester, 125 (75.8%) students were in the normal category, 17 (10.3%) students were in the Pre-HTN category, 23 (13.9%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 24 (88.9%) of all students were in the normal category, 2 (7.4%) were in the Pre-HTN category, 1 (3.7%) was in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 17: Diastolic Percentages for Hawthorne Elementary Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=21) 18 (85.7%) 2 (9.5%) 1 (4.8%) 0 (0.0%) Pre-HTN (n=4) 4 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=2) 2 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 17 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) =.964; p >.05]. In the spring 2012, of the 21 students in the normal category, 3 showed increased diastolic blood pressure by spring of 2013. Two (9.5%) increased to the Pre-HTN category and 1 (4.8%) increased to the Stage 1 HTN category. Of the 4 students in the Pre-HTN category, 100% improved to the normal category. Of the 2 students in the Stage 1 HTN category, 2 (100%) improved to the normal category by spring of 2013. 37

Spring 2012 Systolic Graph 21: Penn Systolic Changes for Spring 2012-2013 Blood Pressure Study Penn Systolic Changes Spring 2012 0 5.7 7.5 Stage 2:HTN Stage 1:HTN Pre-HTN Normal 86.8 Spring 2013 0 0 25 75 0 10 20 30 40 50 60 70 80 90 100 n=53, Spring 2012; n=4, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for Penn Elementary. For the spring 2012 semester, 46 (86.8%) students were in the normal category, 4 (7.5%) were in the Pre-HTN category, 3 (5.7%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 3 (75%) of all students were in the normal category, 0 (0.0%) were in the Pre-HTN category, 1 (25%) was in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 18: Systolic Percentages for Penn Elementary Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=3) 2 (66.7%) 0 (0.0%) 1 (33.3%) 0 (0.0%) Pre-HTN (n=1) 1 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 18 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (1) =.444; p >.05]. In the spring 2012, of the 3 students in the normal category, 1 (33.3%) increased systolic pressure to the Stage 1-HTN category by spring of 2013. Of the 1 student in Pre-HTN category in 2012, 1 (100%) had improved to the normal category by spring of 2013. 38

Spring 2012 Diastolic Graph 22: Penn Diastolic Changes for Spring 2012-2013 Blood Pressure Study Penn Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 7.5 13.2 79.2 Spring 2013 0 25 25 50 0 10 20 30 40 50 60 70 80 90 n=53, Spring 2012; n=4, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for Penn Elementary. For the spring 2012 semester, 42 (79.2%) students were in the normal category, 4 (7.5%) students were in the Pre-HTN category, 7 (13.0%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 2 (50%) of all students were in the normal category, 1 (25%) was in the Pre-HTN category, 1 (25%) was in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 19: Diastolic Percentages for Penn Elementary Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=3) 2 (66.7%) 0 (0.0%) 1 (33.3%) 0 (0.0%) Pre-HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=1) 0 (0.0%) 1 (100%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 19 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (2) = 4.000; p >.05]. In the spring 2012, of the 3 students in the normal category, 1 showed increased diastolic blood pressure to the Stage 1 HTN category by spring of 2013. Of the 1 student in the Stage 1 HTN category, 1 (100%) improved to the Pre-HTN category by spring of 2013. 39

Spring 2012 Systolic Graph 23: Systolic Changes for First Graders Spring 2012-2013 Spring 2012 0 7 11.6 Blood Pressure Study First Graders Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 81.4 Spring 2013 0 6.7 26.7 66.7 0 10 20 30 40 50 60 70 80 90 n=86, Spring 2012; n=15, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for first graders. For the spring 2012 semester, 70 (81.4%) students were in the normal category, 6 (7%) were in the Pre-HTN category, 10 (11.6%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 10 (66.7%) of all students were in the normal category, 1 (6.7%) was in the Pre-HTN category, 4 (26.7%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 Hypertension category. Table 20: Systolic Percentages for First Graders Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=12) 10(83.3%) 1 (8.3%) 1 (8.3%) 0 (0.0%) Pre-HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=3) 0 (0.0%) 0 (0.0%) 3 (100%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 20 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (2) = 10.313; p <.001]. In the spring 2012, of the 12 students in the normal category, 2 showed increased systolic blood pressure, 1 (8.3%) at the Pre-HTN category and 1 (8.3%) at the Stage 1 HTN category. There were no students in the Pre-HTN category in 2012. Of the 3 students in the Stage 1 HTN category in spring of 2012, 100% remained at the Stage 1 HTN category. 40

Spring 2012 Diastolic Graph 24: Diastolic Changes for First Graders Spring 2012-2013 Blood Pressure Study First Graders Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 12.8 22.1 65.1 Spring 2013 0 13.3 33.3 53.3 0 10 20 30 40 50 60 70 n=86, Spring 2012; n=15, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for first graders. For the spring 2012 semester, 58 (65.1%) students were in the normal category, 11 (12.8%) students were in the Pre-HTN category, 19 (22.1%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 21(53.3%) of all students were in the normal category, 2(13.3%) were in the Pre-HTN category, 5 (33.3%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 21: Diastolic Percentages for First Graders Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=11) 8(72.7%) 1 (9.1%) 2 (18.2%) 0 (0.0%) Pre-HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=4) 0 (0.0%) 1 (25%) 3 (75%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 21 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were statistically significant [ 2 (2) = 6.307; p <.05]. In the spring 2012, of the 11 students in the normal category, 3 showed increased diastolic blood pressure, 1 (9.1%) at the Pre-HTN category and 2 (18.2%) at the Stage 1 HTN category. There were no students in the Pre-HTN category in 2012. Of the 4 students in the Stage 1 HTN category in spring of 2012, 1 (25%) improved to the Pre-HTN category, and 3 (75%) remained at the Stage 1 HTN category. 41

Spring 2012 Systolic Graph 25: Systolic Changes for Second Graders Spring 2012-2013 Blood Pressure Study Second Graders Systolic Changes Spring 2012 0 7.6 11.4 Stage 2:HTN Stage 1:HTN Pre-HTN Normal 81 Spring 2013 0 8.3 8.3 83.3 0 10 20 30 40 50 60 70 80 90 n=79, Spring 2012; n=12, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for second graders. For the spring 2012 semester, 64 (81%) students were in the normal category, 6 (7.6%) were in the Pre-HTN category, 9 (11.4%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 Hypertension category. For spring 2013, 10 (83.3%) of all students were in the normal category, 1 (8.3%) was in the pre-hypertension category, 1 (8.3%) was in the Stage 1 Hypertension category, and 0 (0.0%) were in the Stage 2 Hypertension category. Table 22: Systolic Percentages for Second Graders Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=9) 7(77.8%) 1 (11.1%) 1 (11.1%) 0 (0.0%) Pre-HTN (n=3) 3 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 22 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (2) =.800; p >.05]. In the spring 2012, of the 9 students in the normal category, 2 showed increased systolic blood pressure, 1 (11.1%) at the Pre-HTN category and 1 (11.1%) at the Stage 1 HTN category. Of the 3 students in Pre-HTN category in 2012, 3 (100%) had improved to the normal category. There were no students in the Stage 1 HTN category in spring of 2012. 42

Spring 2012 Diastolic Graph 26: Diastolic Changes for Second Graders Spring 2012-2013 Blood Pressure Study Second Graders Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 13.9 19 67.1 Spring 2013 0 8.3 8.3 83.3 0 10 20 30 40 50 60 70 80 90 n=79, Spring 2012; n=12, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for second graders. For the spring 2012 semester, 53 (67.1%) students were in the normal category, 15 (19%) students were in the Pre-HTN category, 11 (13.9%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 10 (83.3%) of all students were in the normal category, 1 (8.3%) was in the Pre-HTN category, 1 (8.3%) was in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 23: Diastolic Percentages for Second Graders Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=7) 6(85.7%) 0 (0.0%) 1 (14.3%) 0 (0.0%) Pre-HTN (n=4) 4 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=1) 1 (100%) 1 (25%) 3 (75%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 23 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (2) =.779; p >.05]. In the spring 2012, of the 7 students in the normal category, 1 (14.3%) showed increased diastolic blood pressure at the Stage 1 HTN category. Of the 4 students at the Pre-HTN category in 2012, all 4 (100%) improved to the normal category. The 1 (100%) student in the Stage 1 HTN category in spring of 2012 improved to the normal category. 43

Spring 2012 Systolic Graph 27: Systolic Changes for Third Graders Spring 2012-2013 Spring 2012 0 9.8 9.8 Blood Pressure Study Third Graders Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 80.3 Spring 2013 0 4.8 14.3 81 0 10 20 30 40 50 60 70 80 90 n=122, Spring 2012; n=21, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for third graders. For the spring 2012 semester, 98 (80.3%) students were in the normal category, 12 (9.8%) were in the Pre-HTN category, 12 (9.8%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 17 (81%) of all students were in the normal category, 1 (4.8%) was in the Pre-HTN category, 3 (14.3%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 24: Systolic Percentages for Third Graders Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=15) 13 (86.7%) 0 (0.0%) 2 (13.3%) 0 (0.0%) Pre-HTN (n=3) 3 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=3) 1 (33.3%) 1 (33.3%) 1 (33.3%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 24 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 8.235; p >.05]. In the spring 2012, of the 15 students in the normal category, 2 (13.3%) showed increased systolic blood pressure, to the Stage 1 HTN category. Of the 3 students in Pre-HTN category in 2012, 3 (100%) had improved to the normal category. Of the 3 students in the Stage 1 HTN category in spring of 2012, 1 (33.3%) improved to the normal category and 1 (33.3%) improved to the Pre-HTN category. 44

Spring 2012 Diastolic Graph 28: Diastolic Changes for Third Graders Spring 2012-2013 Spring 2012 0 6.6 13.9 Blood Pressure Study Third Graders Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 79.5 Spring 2013 0 9.5 9.5 81 0 10 20 30 40 50 60 70 80 90 n=122, Spring 2012; n=21, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for third graders. For the spring 2012 semester, 97 (79.5%) students were in the normal category, 8 (6.6%) students were in the Pre-HTN category, 17 (13.9%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 17 (81%) of all students were in the normal category, 2 (9.5%) were in the Pre-HTN category, 2 (9.5%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 25: Diastolic Percentages for Third Graders Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=15) 13(86.7%) 1 (6.7%) 1 (6.7%) 0 (0.0%) Pre-HTN (n=2) 2 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=4) 2 (50%) 1 (25%) 1 (25%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 25 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) =3.274; p >.05]. In the spring 2012, of the 15 students in the normal category, 2 showed increased diastolic blood pressure, 1 (6.7%) at the Pre-HTN category and 1 (6.7%) at the Stage 1 HTN category. Of the 2 students at the Pre-HTN category in 2012, both (100%) improved to the normal category. Of the 4 students at the Stage 1 HTN category, 2 (50%) improved to the normal category by spring of 2013 and 1 (25%) improved to the Pre-HTN category. 45

Spring 2012 Systolic Graph 29: Systolic Changes for Fourth Graders Spring 2012-2013 Blood Pressure Study Fourth Graders Systolic Changes Spring 2012 0 11.4 Stage 2:HTN Stage 1:HTN Pre-HTN Normal 20 68.6 Spring 2013 0 11.1 22.2 66.7 0 10 20 30 40 50 60 70 80 n=70, Spring 2012; n=18, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for fourth graders. For the spring 2012 semester, 48 (68.6%) students were in the normal category, 8 (11.4%) were in the Pre-HTN category, 14 (20%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 12 (66.7%) of all students were in the normal category, 4 (22.2%) were in the Pre-HTN category, 2 (11.1%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 26: Systolic Percentages for Fourth Graders Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=13) 10 (76.9%) 1 (7.7%) 2 (15.4%) 0 (0.0%) Pre-HTN (n=2) 1 (50.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=3) 1 (33.3%) 2 (66.7%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 26 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (4) = 6.154; p >.05]. In the spring 2012, of the 13 students in the normal category, 1 (7.7%) showed increased systolic blood pressure to the Pre-HTN category and 2 (15.4%) increased to the Stage 1 HTN category. Of the 2 students in Pre-HTN category in 2012, 1 (50%) had improved to the normal category. Of the 3 students in the Stage 1 HTN category in spring of 2012, 1 (33.3%) improved to the normal category and 2 (66.7%) improved to the Pre-HTN category. 46

Spring 2012 Diastolic Graph 30: Diastolic Changes for Fourth Graders Spring 2012-2013 Blood Pressure Study Fourth Graders Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal Spring 2012 0 11.4 11.4 77.1 Spring 2013 0 11.1 11.1 77.8 0 10 20 30 40 50 60 70 80 90 n=70, Spring 2012; n=18, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for fourth graders. For the spring 2012 semester, 54 (77.1%) students were in the normal category, 8 (11.4%) student were in the Pre-HTN category, 8 (11.4%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 14 (77.8%) of all students were in the normal category, 2 (11.1%) were in the Pre-HTN category, 2 (11.1%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 27: Diastolic Percentages for Fourth Graders Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=17) 13(76.5%) 2 (11.8%) 2 (11.8%) 0 (0.0%) Pre-HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=1) 1 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 27 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; findings were NOT statistically significant [ 2 (2) =.303; p >.05]. In the spring 2012, of the 17 students in the normal category, 4 showed increased diastolic blood pressure, 2 (11.8%) at the Pre-HTN category and 2 (11.8%) at the Stage 1 HTN category. There were no students at the Pre-HTN category in 2012. The 1 student at the Stage 1 HTN category in 2012, improved to the normal category (100%) by spring of 2013. 47

Spring 2012 Systolic Graph 31: Systolic Changes for Fifth Graders Spring 2012-2013 Spring 2012 0 13.2 17.6 Blood Pressure Study Fifth Graders Systolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 69.1 Spring 2013 0 0 0 100 0 20 40 60 80 100 120 n=68, Spring 2012; n=6, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the systolic percentages for fifth graders. For the spring 2012 semester, 47 (69.1%) students were in the normal category, 12 (17.6%) were in the Pre-HTN category, 9 (13.2%) were in Stage 1 HTN category and 0 (0.0%) were in the Stage 2 HTN category. For spring 2013, 6 (100%) of all students were in the normal category, 0 (0.0%) were in the Pre-HTN category, 0 (0.0%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 28: Systolic Percentages for Fifth Graders Spring 2013 Systolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=3) 3(100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Pre-HTN (n=3) 3(100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 28 presents the results of the chi-square test used to track individual level systolic rates of change from spring 2012 to spring 2013; findings were NOT able to be computed. In the spring 2012, of the 3 students in the normal category, 100% remained in the normal category. Of the 3 students in Pre-HTN category in 2012, 3 (100%) had improved to the normal category. There were no students in the Stage 1 HTN category or Stage 2 HTN category in spring of 2012. 48

Spring 2012 Diastolic Graph 32: Diastolic Changes for Fifth Graders Spring 2012-2013 Spring 2012 0 5.9 13.2 Blood Pressure Study Fifth Graders Diastolic Changes Stage 2:HTN Stage 1:HTN Pre-HTN Normal 80.9 Spring 2013 0 0 0 100 0 20 40 60 80 100 120 n=68, Spring 2012; n=6, Spring 2013 TCCHD It's All About Kids Program Report The above graph illustrates the diastolic percentages for fifth graders. For the spring 2012 semester, 55 (80.9%) students were in the normal category, 9 (13.2%) students were in the Pre-HTN category, 4 (5.9%) were in the Stage 1 HTN category, and 0 (0.0%) students were in the Stage 2 HTN category. For spring 2013, 6 (100%) of all students were in the normal category, 0 (0.0%) were in the Pre-HTN category, 0 (0.0%) were in the Stage 1 HTN category, and 0 (0.0%) were in the Stage 2 HTN category. Table 29: Diastolic Percentages for Fifth Graders Spring 2013 Diastolic Normal Pre-HTN Stage 1 HTN Stage 2 HTN Normal (n=6) 6 (100%) 2 (11.8%) 2 (11.8%) 0 (0.0%) Pre-HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 1 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Stage 2 HTN (n=0) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Table 29 presents the results of the chi-square test used to track individual level diastolic rates of change from spring 2012 to spring 2013; the chi score was not able to be computed. In the spring 2012, of the 6 students in the normal category, 100% remained in the Normal category. There were no students in the Pre-HTN, Stage 1 HTN or Stage 2 HTN categories for spring of 2012. 49

BMI and BP Comparisons Spring 2012 Spring 2013 50

Graph 33: Overall Spring 2012 BMI and Systolic Blood Pressure Data Body Mass Index Study Overall Spring 2012 BMI and Systolic Blood Pressure Normal Pre-HTN Stage 1 HTN Stage 2 HTN Obese 67.8 13.6 18.6 Overweight 74.4 11.6 14 Healthy 81.4 8.9 9.7 Underweight 90.9 9.1 0 20 40 60 80 100 n=451, Spring 2012 Data TCCHD It's All About Kids Program Report Graph 25 illustrates the BMI and systolic blood pressure of all students for spring 2012. Findings were NOT statistically significant [ 2 (6) = 10.192; p >.05]. Of those who had underweight BMI scores, 10 (90.9%) fell in the normal BP category and 1 (9.1%) fell into the Stage 1 HTN category. Of those who had healthy BMI scores, 192 (81.4%) fell into the normal BP category, 21 (8.9%) fell in the category for Pre-HTN BP, and 23 (9.7%) fell in the Stage 1HTN category. In regard to overweight participants, 64 (74.4%) fell into the normal BP category, 10 (11.6%) fell in the category for Pre-HTN BP, and 12 (14%) fell into the Stage 1 HTN category. Of the obese BMI scores, 80 (67.8%) fell into the normal BP category, 16 (13.6%) fell in the Pre-HTN BP category, and 22 (18.6%) fell into the Stage 1 HTN category. There were no individuals who fell in the Stage 2 HTN category. 51

Graph 34: Overall Spring 2012 BMI and Diastolic Blood Pressure Data Body Mass Index Study Overall Spring 2012 BMI and Diastolic Blood Pressure Normal Pre-HTN Stage 1 HTN Stage 2 HTN Obese 77.1 7.6 15.3 Overweight 68.6 16.3 15.1 Healthy 75 12.7 12.3 Underweight 100 0 20 40 60 80 100 n=451, Spring 2012 Data TCCHD It's All About Kids Program Report The above graph illustrates the BMI and diastolic blood pressure of all students for Spring 2012. Findings were NOT statistically significant [ 2 (6) = 8.339; p >.05]. Of those who had underweight BMI scores, 11 (100%) were in the normal BP category. Of those who had healthy BMI scores, 177 (75%) were in the normal BP category, 30 (12.7%) fell into the Pre-HTN BP category, and 29 (12.3%) fell into the Stage 1 HTN category. In regard to overweight participants, 59 (68.6%) fell into the normal BP category, 14 (16.3%) fell into the Pre-HTN BP category, and 13 (15.1%) fell into the Stage 1 HTN category. Of the obese BMI scores, 91 (77.1%) fell into the normal BP category, 9 (7.6%) fell into the Pre-HTN BP category, and 18 (15.3%) fell into the Stage 1 HTN category. There were no individuals who fell into the category of Stage 2 HTN. 52

Graph 35: Overall Spring 2013 BMI and Systolic Blood Pressure Data Body Mass Index Study Overall Spring 2013 BMI and Systolic Blood Pressure Normal Pre-HTN Stage 1 HTN Stage 2 HTN Obese 68 12 20 Overweight 75 12.5 12.5 Healthy 78.3 11.3 10.4 Underweight 50 50 0 20 40 60 80 100 n=198, Spring 2013 Data TCCHD It's All About Kids Program Report The above graph illustrates the BMI and systolic blood pressure of all students in spring 2013. Findings were NOT statistically significant [χ2 (6) = 5.209; p >.05]. Of those who had underweight BMI scores, 1 (50%) fell into the normal BP range and 1 (50%) fell into Stage 1 HTN categories. Of the healthy BMI scores, 83 (78.3%) fell in the category of a normal BP, 12 (11.3%) fell in the category of Pre-HTN BP and 11 (10.4%) fell in the category of Stage 1 HTN. In regard to overweight participants, 30 (75%) had a normal BP, 5 (12.5%) fell in the Pre-HTN BP category, and 5 (12.5%) fell in the range for Stage 1 HTN. Of the obese BMI scores, 34 (68%) fell into the range for a normal BP, 6 (12%) fell in the Pre-HTN BP, and 10 (20%) fell in the Stage 1 HTN category. There were no individuals who fell in the Stage 2 HTN category. 53

Graph 36: Overall 2013 BMI and Diastolic Blood Pressure Data Body Mass Index Study Overall Spring 2013 BMI and Diastolic Blood Pressure Normal Pre-HTN Stage 1 HTN Stage 2 HTN Obese 68 12 20 Overweight 72.5 12.5 15 Healthy 78.3 10.4 11.3 Underweight 100 0 20 40 60 80 100 n=198, Spring 2013 Data TCCHD It's All About Kids Program Report Graph 36 illustrates the BMI and diastolic blood pressure of all students for spring 2013. Findings were NOT statistically significant [χ2 (6) = 3.174; p >.05]. Of those who had underweight BMI scores, 2 (100%) fell into the normal BP category. Of the healthy BMI scores, 83 (78.3%) fell into the normal BP category, 11 (10.4%) were in the Pre-HTN category and 12 (11.3%) fell into the Stage 1 HTN category. In regard to overweight participants, 29 (72.5%) fell into the normal BP category, 5 (12.5%) fell in the category for Pre-HTN BP, and 6 (15%) fell into the Stage 1 HTN category. Of the obese BMI scores, 34 (68%) fell into the normal BP category, 6 (12%) fell in the Pre-HTN BP category, and 10 (20%) fell into the Stage 1 HTN category. There were no individuals who fell in the Stage 2 HTN category. 54

References Center for Disease Control and Prevention. (2007a). About BMI for children and teens. Retrieved January 16, 2012 from http://www.cdc.gov/nccdphp/dnpa/ bmi/childrens_bmi/childrens_bmi_formula.htm. Center for Disease Control and Prevention. (2007b). Standard formulas. Retrieved January 16, 2012 from http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_bmi/ about_childrens_bmi.htm Center for Disease Control and Prevention. (2007c). Clinical growth charts. Retrieved August 26, 2013 from http://www.cdc.gov/growthcharts/clinical_charts.htm#set1. National Heart Lung and Blood Institute. (2008). Blood pressure levels for boys and girls by age and height percentile. US Department of Health and Human Services. (2007). A pocket guide to blood pressure measurement in children. National Institutes of Health. 55

It s All About Kids Oral Health Program 56

It s All About Kids Oral Health Program Purpose of Study According to TCCHD, the Oral Health program provides instruction about caring for teeth to fourth grade students. The goals are to provide an understanding of the causes and prevention of tooth decay and gum disease, and instruct on proper tooth brushing and dental flossing. The two-session course was implemented in 25 schools. Methodology The Oral Health program measure included a pre- and post-assessment that was developed by TCCHD personnel. The survey consisted of 6 questions in a multiple choice-type response format. Questions dealt with brushing one s teeth, dental plaque, cavities, toothbrushes, fluoride, and dental floss. Measurements were obtained by TCCHD personnel. A total of 702 students participated in the program Descriptive statistics are reported for the number of participants by school. In addition, a t-test analysis was used to examine differences in pre- and post-tests. Results The following graphs depict the results of the Oral Health program scores. 57

Graph 37: Oral Health Program Participants by School Oral Health Program Number of Participants by School Wolf Creek William Penn Roy Clark Peace Academy Oakcrest Moore Mills McAuliffe Limestone Liberty Mounds Jefferson Jarman Indian Springs Highland Park Garfield Darnaby Cedar Ridge Bixby North Intermediate Bixby North Bailey Arrowhead Anderson 10 21 26 23 17 23 24 22 15 21 26 24 21 18 27 18 23 27 23 43 83 93 0 10 20 30 40 50 60 70 80 90 100 n=702 TCCHD It's All About Kids Program Report The graph above depicts the number of participating students in each school for the Oral Health program. A total of 702 students participated from 25 schools. 58

Graph 38: Oral Health Program Pre- and Post-Test Results Oral Health Program Mean Scores for Oral Health Program Test Post-test 5.1 Pre-test 4 0 1 2 3 4 5 6 n=702, Level of Significance: p <.001 TCCHD It's All About Kids Program Report A t-test analysis was computed to examine differences in mean scores. As the above graph illustrates, there is a statistically significant difference in pre- and post-test scores. Oral health scores increased from 4.0 to 5.1 [t (700) = -29.612; p <.001]. These findings suggest that students knowledge of oral health increased from the pre- to the post-test. 59

Discussion The Oral Health program was designed to track differences in pre- and post-test scores. T-test results indicate a significant difference between the pre- and post-test. These findings suggest an increase in students knowledge of oral health. The Oral Health program test is available in Appendix F. 60

It s All About Kids Nutrition Detectives 61

It s All About Kids Nutrition Detectives Purpose of Study According to TCCHD, Nutrition Detectives was developed by David Katz, MD, MPH, FACPM, FACP, Director of the Yale Prevention Research Center and Catherine Katz, PhD. The program teaches students 5 clues to healthy eating and making healthy choices. Students learn how to read food labels and how to choose foods that are more nutritious. By the end of the program students have become Nutrition Detectives and earn their badge. The objectives of the program are to: 1) teach students to make healthful choices and detect marketing deceptions 2) give students the opportunity to practice what they have learned 3) empower students to share their detective skills with other family members. The two-session course was implemented in four schools. Methodology The Nutrition Detectives program measure included a pre- and post-assessment that was developed by TCCHD personnel. The survey consisted of 10 questions comparing nutrition labels, asking the student to choose the healthier label. Measurements were obtained by TCCHD personnel. A total of 307 students participated in the program from four schools. Descriptive statistics are reported for the number of participants by school. In addition, a t-test analysis was used to examine differences in pre- and post-tests. Results The following graphs depict the results of the Nutrition Detective program scores. 62

Graph 39: Nutrition Detective Program Participants by Grade Nutrition Detectives Number of Participants by School Northwoods 79 Limestone 73 Hawthorne 91 Garfield 63 0 10 20 30 40 50 60 70 80 90 100 n=306 TCCHD It's All About Kids Program Report The graph above depicts the number of participating students in each school for the Nutrition program. A total of 306 students participated. 63

Graph 40: Nutrition Detective Program Pre- and Post-Test Results Nutrition Detectives Mean Scores for Nutrition Detective Test Post-test 7.1 Pre-test 4.6 0 1 2 3 4 5 6 7 8 n=306, Level of Significance: p <.001 TCCHD It's All About Kids Program Report A t-test analysis was computed to examine differences in mean scores. As the above graph illustrates, there is a statistically significant difference in pre- and post-test scores. Nutrition scores increased from 4.6 to 7.1 [t (305) = -17.617; p <.001]. These findings suggest that students knowledge of nutrition increased from the pre- to the post-test. 64

Graph 41: Nutrition Detective Program Pre- and Post-Test Results by School Nutrition Detectives Pre- and Post-Test Results by School Post-Test, 5.38 Northwoods Pre-Test, 3.32 Post-Test, 7.12 Limestone Hawthorne Garfield Pre-Test, 4.86 Pre-Test, 5.09 Pre-Test, 5.19 Post-Test, 7.51 Post-Test, 8.27 0 1 2 3 4 5 6 7 8 9 n=302, Level of Significance: p <.001 TCCHD It's All About Kids Program Report A t-test analysis was computed to examine differences in mean scores. As the above graph illustrates, there is a statistically significant difference in pre- and post-test scores. Nutrition scores increased from 5.2 to 7.1 [t (62) = -7.087; p <.001] for Garfield Elementary. The scores also increased for Hawthorne Elementary from 5.1 to 8.3 [t (90) = -13.508; p <.001]. In addition, test scores increased for Limestone and Northwoods. Limestone s results moved from 4.9 to 7.1 [t (72) = -9.492; p <.001] and Northwoods changed from 3.3 to 5.4 [t (78) = -6.409; p <.001]. These findings suggest that students knowledge of nutrition increased from the pre- to the post-test at each of the schools. 65

Graph 42: Nutrition Detective Program Pre- and Post-Test Results by Grade Nutrition Detectives Pre- and Post-Test Results by Grade Post-Test, 8.27 Missing Grade Pre-Test, 5.08 Post-Test, 5.8 2nd Grade Pre-Test, 3.69 Post-Test, 7.5 4th Grade Pre-Test, 5.19 0 1 2 3 4 5 6 7 8 9 n=302, Level of Significance: p <.001 TCCHD It's All About Kids Program Report A t-test analysis was computed to examine differences in mean scores. As the above graph illustrates, there is a statistically significant difference in pre- and post-test scores. The missing grade Nutrition scores increased from 5.0 to 8.3 [t (90) = -13.508; p <.001]. The 2nd grade Nutrition test scores increased from 3.7 to 5.8 [t (114) = -8.503; p <.001]. The 4th grade Nutrition test scores also increased from 5.2 to 7.5 [t (99) = -9.842; p <.001]. Differences in test scores for all three grades were statistically significant. 66

Discussion The Nutrition Detective program was designed to track differences in pre- and post-test scores. T-test results indicate a significant difference between the pre- and post-test. These findings suggest an increase in students knowledge of nutrition. The Nutrition Detective program test is available in Appendix G. 67

Appendix A It s All About Kids List of Schools 68

It s All About Kids Schools Bixby Broken Arrow Liberty Mounds Owasso Peace Academy Sand Springs Tulsa Comprehensive Sites Bixby Central Intermediate Bixby North Intermediate Arrowhead Country Lane Highland Park Indian Springs Liberty Oak Crest Leisure Park Wolf Creek Liberty Mounds Bailey Mills Northeast Owasso Peace Academy Garfield Limestone Technology Academy Northwoods Fine Arts Academy Celia Clinton Hawthorne Marshall Sequoyah William Penn Andersen Boevers Briarglen Darnaby Jarman Jefferson Christa McAuliffe Moore Roy Clark Rosa Parks 69

Appendix B It s All About Kids Center for Disease Control BMI Charts 70

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Appendix C It s All About Kids Blood Pressure Levels by Age and Height Percentile 73

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Appendix D It s All About Kids Guide to Blood Pressure Measurement in Children 78

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Appendix E It s All About Kids CATCH Nutrition Test 83

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Appendix F It s All About Kids Oral Health Program Test 99

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Appendix G It s All About Kids Nutrition Detectives Test 101

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