Youth in Motion: WHF Teen Esteem Program – Health, Wellness and Fitness at Trenton Central High School

Age Range: 15 to 17

The Women’s Heart Foundation (WHF) Teen Esteem program is offered to 156 students at the Trenton Central High School (TCHS) in New Jersey on a daily basis. WHF brought the program to the school in response to health teachers’ requests for an intervention to address teen obesity and other health issues related to an unhealthy lifestyle. WHF has offered the program at the school for the past 3 years as part of its Gender Care Initiative® to promote care models that better serve females. Previous to the intervention, more than 50% of the female students were not partaking in physical activity during co-ed gym class, citing a high level of discomfort exercising in the same room as the boys and being unwilling to be seen in unattractive workout clothes. Seed money for the Teen Esteem program was provided by the state of New Jersey in 2003. WHF and the school worked collaboratively to renovate 1700 square feet of space to include a dance floor, exercise equipment and a kitchen as part of a new wellness environment for the female students to embrace as their own.

WHF hired consultants to assist with the curriculum development, advise on the fitness routine and plan the architectural design of the room. At the same time, WHF collaborated with the Rutgers University–Camden to initiate a research project to measure the effectiveness of the Teen Esteem program. The school decided that the Teen Esteem program would be open to all sophomore girls as a “girls-only” gym-alternative, and on a voluntary basis. Students were invited to join the Teen Esteem program September 2004. Parental and physician consent were required as well as student assent. The Teen Esteem work-out was judged to be on par with a higher level of fitness, requiring a physical examination in order to participate.

Teen Esteem Research Project
The research team from the Rutgers University-Camden utilized CDC subscales for nutrition, physical activity and self esteem. Height, weight, waist and blood pressure were measured. Blood was tested, through means of a finger prick, measuring for glucose, cholesterol and triglycerides. Non-participating 10th grade girls at the TCHS served as the “control group” and completed surveys, but blood work was not permitted to be done on this group, per advisement of the nursing department who felt this to be too invasive a procedure in the high school setting. Allowances were made for the experimental group to have blood work completed. Screenings and surveys were obtained at the beginning and end of the school year.
The school uses the Teen Esteem program booklet that was developed by WHF with advisement from students and its stakeholders. The program’s mission statement is “for heart, for health, for life”. Participants learn about nutrition, exercise, balance, integrity, respect, community resources, and how to manage a fitness center. The Teen Esteem strategy is to incorporate a variety of different activities to encourage each student to feel comfortable in the Teen Esteem environment, to enjoy movement and healthy eating, to connect with one another on a non-competitive level, to enjoy a closer bonding with her physical education teacher and to simply have fun. There are structured activities each day (Monday – Circuit training, alternating with cardio dance every other week; Tuesday – Health; Wednesday – Free Weights; Thursday – Hands-on Nutrition; Friday – Teacher’s Pick). A free breakfast program was started in the Teen Esteem kitchen, serving up healthy meals on a rotational basis, responding to student need.

Special programs
In addition to mandated health classes, expert speakers from the Rutgers University-Camden are engaged to present on a variety of relevant topics including teen depression, cutting, violence in the home, drug abuse, alcoholism in the family, bullying, gangs, HIV and AIDS, managing your money during the college years, and job interview skills. The school nurse is invited to deliver a program on pregnancy prevention and the school counselor speaks to normal teen development and community resources.

A “Parent Night” is held with a free dinner and blood pressure screening. This is to introduce the parents to the Teen Esteem program and encourage the healthy lifestyles behaviors to carry through into the home. Siblings are also invited to attend the festive evening activities and try out the circuit equipment.

Shopping for a Healthy Heart is a field trip to the grocery store that the WHF organizes each year during the month of March – National Nutrition Month. The program is administered in collaboration with the UMDNJ School of Health Professional Dietetic Internship Program. The TCHS students learn ABC of choosing healthier foods right at the grocery store shelf. Moms are invited as chaperones. The health messages are reinforced through a teaching packet that is dispensed and pre and post test with prizes for correct answers. After the event, WHF organizes a delicious heart-healthy luncheon for all to enjoy.

Outcomes
The first year – 2004-05 school year (n=126)

• 11 students had a Body Mass Index (BMI) score of 35 or above at the beginning of the year and 9 students at the end of the year. A BMI score of 35 or above places the child in the 95 percentile for weight;
• Nutrition subscales showed improvement in the number of servings taken in of fruits, vegetables and salads;
• Activity subscales showed improvement.

The second year – 2005-06 school year (n=125 sophomores, and 30 juniors as “peer leaders”)

• 15 students had a BMI score of 35 or above. Of those, 7 successfully lowered their scores;
• Low density lipoprotein (LDL) levels – the “bad” cholesterol – decreased by 2 points (WHF was able to fund the blood work with complete lipid panel for just this one year, through finger-prick sample);
• 23 students were found to have low High density lipoprotein (HDL) – below 40mg/dL.This number remained unchanged at the beginning and end of the school year. Other studies have shown that low HDL levels in children may be attributed to poor eating habits. An HDL level of 60 mg/dL is considered cardio-protective in an adult female, according to the NHLBI /National Institutes of Health Heart Truth campaign;
• 8 students had three or more indicators for metabolic syndrome (pre-diabetes). Of these, three had a BMI score at or below 29 (within normal weight guidelines). The presence of at least three of the following indicates metabolic syndrome:
  • High blood sugar >110 mg/dL after fasting
  • High triglycerides – at least 150 mg/dL
  • Low HDL (<50 mg/dL in women)
  • Blood pressure of 130/85 or higher
  • Waist >35 inches.
• Attendance records demonstrate 90% of the students participating on any given day, as compared to regular gym class whereby only 50% of the students participate;
• Of the Teen Esteem enrolled students, not one student dropped out of school.
• Student satisfaction surveys were obtained mid year, with an overwhelmingly positive response.

The third year – 2006-07 school year (n=120 sophomores; and 30 juniors and 6 seniors as “peer leaders”)

• CDC surveys and subscales were modified to encourage the students to complete the forms

This is the final year for the research study. The second set of data will be collected April 2007

Lessons Learned

• WHF serves at the pleasure of the school, the principal and the board of education and is a vendor within the school environment. Respecting this symbiotic relationship is at the crux for a successful partnership and collaboration to take place. Patience was tried when the school applied for and received a grant to assist with the purchase of tables and chairs for the Teen Esteem students. It took an entire school year to obtain these items. WHF and the school liaison to the Teen Esteem program came to an agreement that all future funding for the program will be administered solely by the WHF.
• Teen Esteem must be self-sufficient in maintaining its wellness space. Cleaning crews within the school system are not familiar with the special cleaning products required for the program flooring, and it is essential that these products be used, and nothing else.
• Schools are anxious to do a better job at caring for our children. WHF is a facilitator and plays and intermediary role to make schools work better for girls’ fitness and wellness. Perseverance is key. By maintaining a positive, self-assured attitude and following up on tasks, this superb renovation took place. It is now a wellness and fitness center students at Trenton Central High School to enjoy for many years to come.
• A Healthy lifestyles program such as this should start at a younger age.
• It is difficult to interpret BMI scores in children. There is inadequate research. Use caution when discussing this topic area and care when following up
• WHF started a free breakfast program with healthy selections and only 7-10 girls use the program with any regularity. Other obstacles to healthy eating need to be explored.
• Eight normal-weight or near-normal weight students were identified with metabolic syndrome indicators. All eight were Latino. We must not use weight as the main criteria for health.
• High blood pressure was almost non-existent in this population, and this was an unexpected surprise.
• There is much resistance to changing the nutrition department and the school lunch program. The perception of what is healthy food to serve our children is far from the reality. WHF asked for the school nutrition department to provide healthier meals with more fresh salads, high-quality grilled vegetables, whole grains, olive oil – and met with stonewalling or hurt feelings. Directives are only accepted when they came from the board of education.

Implementation Guide

• Network with school principals and health teachers at prospective Teen Esteem program sites
• Make orientation program available to prospective schools. Train program staff; Secure an accessible facility
• Develop age-appropriate class activities, modifying curriculum as needed
• Promote Teen Esteem in schools, at PTA meetings, and at other events in order to establish a connection with parents and students
• Communicate commitment and expectations to school systems through phone calls and weekly mailings

Strengths

• Uses a comprehensive approach to weight management and healthy living
• Keeps girls in school
• Prevents sabotaging of teen girl health through separation of the sexes for fitness to take place, recognizing health and wellness must be gender –specific in its approach
• Involves the entire family – through family night and through a field trip to the grocery store with healthy luncheon post-event
• A comfortable, friendly environment encourages success
• Identifies youth with BMI score in 95%. WHF has a system it implemented to track this and alert the parent, child and school nurse
• Institutionalizes teen girl health… they finally have a place to just “Be” – have ‘girl talk’, sing, listen to favorite music, hang out, dance, laugh and grow.
• Collaborative collection of data assists the school nurses in identifying those at potential risk

Innovative Ideas

• Uses a comprehensive approach to teen health and wellness
• Focuses on improved health and well being rather than improved weight. “Be happy with who you are, no matter what your size. Beauty is on the inside.” Promotes self-esteem, compassion, understanding and respect.
• Open the center after school hours as a low-cost/no-cost fitness and wellness center to moms and school staff.
• Develop a database for schools so that they can begin to gather the necessary data to monitor this global epidemic of teen obesity and track health changes

Resources
www.womensheart.org
Contact: Bonnie Arkus, Exec Director
Women’s Heart Foundation
PO Box 7827
West Trenton, NJ 08628
Phone: (609) 771-9600