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Editor's Notes

• #2: Introduce yourself Why your opinion as a MCAH Director is important: Provide a background on why systems and environmental change is important to the audience you are addressing Prior to presentation: email or use Survey Monkey to see what the targeted audience’s topics of greatest concern/need are Focus on these areas before adding more information
• #3: Photo: Lactation Room Sign at the California Department of Public Health
• #4: Use the question(s) to generate thought and get audience connected with the answers they need to know.
• #5: Physical environment – the physical and social conditions that surround a person Food environment – the factors, such as store/restaurant proximity, food prices, etc. that influences food choices and diet quality Biking or walking to school can provide children (and even their parents) with daily physical activity Image credit: http://icsw.nhtsa.gov/nhtsa/ImageLibrary/index.cfm
• #6: *A sample data graph is included in the following slide Use data related to what you want to highlight.
• #7: In 1969, 48% of children ages 5-15 walked or biked to school, as compared to 13% of children in 2009. In 1969, only 12% of children were driven to school. In 2009, 44% of children are driven to school. This decline in walking and bicycling to school may be due to several barriers, such as: Distance to school – beginning in the 1970s, schools were being built on the edge of communities where land costs were cheaper and more available. This required students to travel farther to get to school, making it more difficult or even impossible to walk or bike. Traffic-related danger – communities often accommodate increased motor vehicle traffic volumes, which convinces parents that walking to school is unsafe for their kids. This can be due to motor vehicle crashes or unfit or non-existent sidewalks. Crime danger – both real and perceived crime affects how many children are allowed to walk and bike to school. All of these barriers and their solutions can be considered part of the built environment, or environmental change! Look at this article to learn more: http://guide.saferoutesinfo.org/introduction/the_decline_of_walking_and_bicycling.cfm We will discuss how to address these issues in a later Safe Routes to School slide.
• #8: GIF credit: Microsoft Office Clip Art Food access – what kinds of foods do people have access to? Are they nutritious, affordable, and available? Walkability – a measure of how friendly an area is to walking. This can include the presence/absence of sidewalks or pedestrian right-of-ways, traffic and road conditions, safety, accessibility, and land use. Breastfeeding accommodations – are there services that protect, promote, and support breastfeeding? For example, are there lactation rooms and refrigerators for milk storage in worksites? Mixed land use – in development, when jobs, housing and commercial activities are located close together. This can increase transportation options and promote walking or biking to commute to work, school, etc. This is opposed to single-use zoning, where different uses in different places are set by legislative mandate. Safety – from street lights and abandoned lots to traffic volume and speed limits, the built environment contributes to the community’s perceptions of safety. This can affect whether or not people chose to walk or bike to their destinations, or if parents will allow their kids to play outside or walk/bike to school.
• #9: This editorial can be found at: http://www.nejm.org/doi/full/10.1056/NEJMe1204710 We need to make it easier for people to make healthy choices; for example, being physically active, eating healthy foods, and breastfeeding. This means we need to change the environment in which we live because it influences the food and physical activities we have access to.
• #10: Maternal, Child, and Adolescent Health programs have a unique role in addressing environmental system changes. Their work with various local and governmental organizations and the vast population they cover allow for many collaborations and partnerships to be built and expertise to be shared. Focusing on nutrition, physical activity, and breastfeeding in relation to the environment can lead to sustainable and cost effective methods of promoting the well-being of the MCAH population as a whole. A useful brief on MCH and their role on addressing the built environment: http://webmedia.unmc.edu/Community/CityMatch/HealthBrief/whbrief_isssue3.pdf Photo credit: Microsoft Office clip art
• #11: It is recommended that you replace these images with images from your own communities. If you cannot find a particular image, take your own picture or use these suggested image libraries. Be sure to follow the rules on permission and usage. http://designforhealth.net/resources/image-resources/ http://www.pedbikeimages.org
• #12: Image credit: http://www.pedbikeimages.org/ This is a great website to find free images of walking or bicycling. Broken sidewalks, unsafe crosswalks, or badly lit areas can all contribute to the walkability of a place. The less walkable it is, the less likely people are to walk or bike to their destinations, which means less physical activity for all.
• #13: Left photo: Sidewalk path in Sacramento Right Image credit: http://www.pedbikeimages.org/ This is a great website to find free images of walking or bicycling. Sidewalks that are complete paths that are destination-oriented, creative, and/or inviting are much more likely to encourage daily physical activity.
• #14: Parents are less likely to allow their kids to go to the park or playground if they feel that it is an unsafe environment. This can reduce the child’s opportunities to be physically active. Also, if many playgrounds, school yards or recreational facilities such as basketball courts or tennis courts are locked up after-hours, children (and adults) will not have access and cannot engage in physical activity.
• #15: Photo: Fremont Park in Midtown Sacramento Opening up school yards and gyms as well as maintaining public parks and other recreational areas encourages children and their families to play and be physically active.
• #16: Photo: convenience store in Sacramento It’s one thing to educate people about nutritious foods, but it is another thing to make sure that they have access to these foods. For some people, just hearing about the benefits of a healthy diet can persuade them to change their eating habits but for others, healthy foods may not be readily available, affordable, or accessible in their communities. Especially for inner-city residents, many corner grocery stores in their neighborhoods feature alcohol, cigarette, and convenience foods rather than produce, meat and dairy.
• #17: Photo: Weekly Tuesday Farmers’ market at Fremont Park, Midtown Sacramento By changing the food landscape of our communities, we can make it easier and cheaper for people to eat healthier.
• #18: Photo: weekly Sunday Farmers’ market in downtown Sacramento , weekly Saturday Farmers’ market in San Francisco
• #19: Photos: Weekly Tuesday farmers’ market at Fremont Park, Midtown Sacramento
• #20: Photo: weekly Thursday farmers’ market by the Capitol Building in Sacramento
• #21: Photo: Lactation rooms at the California Department of Public Health A proper lactation room is NOT a bathroom stall. A lactation room is a place, other than a bathroom, that is shielded from view and free from intrusion from the public to allow an employee to express breast milk. Minimum requirements of California can be found here: http://www.cdph.ca.gov/programs/breastfeeding/Documents/MO-MinRequire.pdf
• #22: Types of projects - Non-infrastructural interventions : Walking school bus – a group of children walking to school with one or more adults. See link for more information: http://www.walkingschoolbus.org/ Remote drop-offs – drivers can drop-off their kids in a set location, and the children can then walk to school with a chaperone or their own parent. This can ease traffic around schools and allows for children in rural communities (where houses are not within a walkable distance to school) to walk to school as a part of their daily physical activity. To learn more about remote drop-offs, here is a case study from Missouri: http://saferoutesinfo.org/data-central/success-stories/columbia-missouri-new-drop-area-creates-excitement-about-walking-school Walk to School and Bike to School Day – schools and communities can use this as the first step to changing community culture about walking and biking to school. http://www.walkbiketoschool.org/ Infrastructural interventions: grants for better crosswalks, signage, lights, and even trees for shade along walking paths. To learn more about Safe Routes to School, visit http://www.saferoutesinfo.org/ Photo credit: Microsoft Office clip art To find SRTS Images, look at “Picturing Safe Routes to Schools”:http://www.saferoutesinfo.org/about-us/news-room/in-the-news
• #23: To find SRTS Images, look at “Picturing Safe Routes to Schools”:http://www.saferoutesinfo.org/about-us/news-room/in-the-news A California study concluded that schools that received infrastructure interventions through Safe Routes to School demonstrated walking and bicycling increases in the range of 20 to 200%. A safety analysis estimated that the safety benefit of the program was up to 49% decrease in the childhood bicycle and pedestrian collision rates.
• #24: Photo credit: Microsoft Office clip art A public, (usually) outdoor market that promotes healthy eating and active living where farmers can sell their produce directly to the community who in turn get fresh food and a place to socialize and gather. Locations: Shopping centers and malls Public parks State and Federal building parking lots for weekend markets Block off street connecting local businesses For an overview on farmers’ markets and how to start one, look at this Powerpoint presentation: http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELDEV3022129
• #25: Improved access to community supermarkets and farmers’ markets is correlated with lower overweight status increased fruit and vegetable consumption among participants Lower prices for fruits and vegetables See article: Rahman T, Cushing RA, Jackson RJ. Contributions of built environment to childhood obesity. Mt Sinai J Med 2011;78(1):49-57.
• #26: Image credit: Microsoft Office clip art Time – break time should coincide with the employee’s break time. The woman needs to express breastmilk about every 2-3 hours, and it takes about 20-40 minutes each time. Space – a room (other than a toilet stall) needs to be made available for lactating employees. This can be a vacant office, a cubicle with a curtain, or a room that can be arranged to be used during specific times of the day. A great presentation on breastfeeding accommodation can be found here: http://www.breastfeedingworks.org/images/stories/BF_Works_Policy_Training.pdf Minimum requirements of California can be found here: http://www.cdph.ca.gov/programs/breastfeeding/Documents/MO-MinRequire.pdf
• #27: Both California and Federal law require employers to provide lactation accommodation. Supporting breastfeeding in worksites, hospitals, and childcare settings is beneficial for babies, mothers, and the community. Reduces the risk of diseases for both mothers and babies Lessens health care costs as well as the environmental impact of using and producing formula. The California Breastfeeding Laws and Regulations can be found here: http://www.californiabreastfeeding.org/laws.html LABOR CODE SECTION 1030-1033 1030. Every employer, including the state and any political subdivision, shall provide a reasonable amount of break time to accommodate an employee desiring to express breast milk for the employee's infant child. The break time shall, if possible, run concurrently with any break time already provided to the employee. Break time for an employee that does not run concurrently with the rest time authorized for the employee by the applicable wage order of the Industrial Welfare Commission shall be unpaid. 1031. The employer shall make reasonable efforts to provide the employee with the use of a room or other location, other than a toilet stall, in close proximity to the employee's work area, for the employee to express milk in private. The room or location may include the place where the employee normally works if it otherwise meets the requirements of this section. 1032. An employer is not required to provide break time under this chapter if to do so would seriously disrupt the operations of the employer. 1033. (a) An employer who violates any provision of this chapter shall be subject to a civil penalty in the amount of one hundred dollars ($100) for each violation. (b) If, upon inspection or investigation, the Labor Commissioner determines that a violation of this chapter has occurred, the Labor Commissioner may issue a citation. The procedures for issuing, contesting, and enforcing judgments for citations or civil penalties issued by the Labor Commissioner for violations of this chapter shall be the same as those set forth in Section 1197.1. (c) Notwithstanding any other provision of this code, violations of this chapter shall not be misdemeanors under this code.
• #29: Ask: Of the information provided, what was new/useful, what questions do they still have and how can the presentation be improved. Can be on paper, Tweeted, Survey Monkey or e-mail.