How Garfield, N.J.

, Got Its Kids Moving More and Eating Better

A Case Study - 2008
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How Garfield, NJ Got Its Kids Moving And Eating Better

arfield is a small city in Bergen County, New Jersey that has made big steps towards creating an active, healthy community. A collaboration of Garfields local government, schools, the local Y, the parks and recreation department and area higher education institutionsall coordinated by the Garfield health departmenthas been working since 2005 to create opportunities for Garfields children and families to be more physically active and eat more healthily. This is the story of how Garfield has done it.

arfields campaign to create an active, healthy community began when Mayor Calandriello, City Manager Thomas J. Duch and Darleen Reveille, R.N., public health nurse for Garfield, attended a meeting of the New Jersey Mayors Wellness Campaign in early spring 2005. The Mayors Wellness Campaign aims to equip New Jerseys mayors and other key leaders with the tools to develop and implement active-living initiatives in their communities with the ultimate goal of improving health and reducing the health care costs that come with the obesity problem in New Jersey. In late spring 2005, in light of what the mayor and the city manager had learned at the meeting, the City Council requested Reveille to pull together the Childhood Obesity Intervention Task Force, which she did, along with colleague Kathleen M. Burke, Ph. D., assistant dean in charge of nursing at nearby Ramapo College of New Jersey. The two brought together a broad coalition of health, education and community development professionals from public and private sector organizations from throughout Bergen County, including: Garfield school system Garfield YMCA Garfield park and recreation department Garfield Boys and Girls Club Ramapo College of New Jersey Hackensack Medical Center William Paterson University North Hudson Community Action Corporation

Photo above: Fifth graders from PS#7 demonstrate where a bike rack should be placed -- on a very visible space in front of the school.

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Photos by Mark Plotz, NCBW

Concern for Childrens Health Inspires the City Council to Act

The task forces first action was to ask a team of nursing students from Ramapo College to conduct a community health assessment of Garfield. The nursing students conducted the assessment as part of their work for a community health course. Burke supervised the students. As part of their assessment, the nursing students measured the body-mass index (a measure of body fat) of all Garfields fifth and sixth grade students, with the permission of the school system and parents. The nursing students discovered that the group of Garfield students they measured was more obese on average than children in other New Jersey communities. (The nursing students also identified three other priority health concerns during their assessment: The need for Spanish interpreters in city facilities. Limited access to health care. Increasing rates of domestic violence.)

Garfield: A small city with a diverse population and some unusual assets. With some 30,000 residents, an area of only 2.2 square miles and a long history (it was originally a settlement of the Leni Lenape, a Native American people), Garfield is a densely populated, traditionally-built New Jersey city. That is to say, the entire city consists of mixed used neighborhoods where residents can easily walk to schools, places of worship, shops and other frequent destinations. Almost no street is wider than two lanes, reducing the amount of high speed traffic and making streets amenable to crosswalks. Garfield also represents demographically the face of New Jerseyone of the nations most ethnically diverse states. Children in the schools come from families speaking some 66 languages, according to Frank Calandriello, Mayor of Garfield. Among these languages are Spanish, Polish, Italian, Russian, Macedonian, Korean, Hindi, Croatian and Arabic. Many of Garfields residents are working class who have recently immigrated or arrived in earlier generations to work in the towns textile and paper mills. Most of those mills have closed, including the recycling company Garden State Paper, leaving some 100 various enterprises. Average per capita income in Garfield, according to the 2000 census, was $19,530, contrasting with the statewide average of $40,455. Garfield is both an Abbott and Urban Aid school district, meaning that the schools receive extra funding from the state to help improve school facilities and educate the many students from low-income families. Despite economic challenges, Garfield is in many ways fortunate, according to Joanne Wendolowski, R.N., B.C., M.S., Public Health Nurse Supervisor at Hackensack Medical Center, one of Garfields main health care providers. She noted the strong sense of community in Garfield and the habit that local organizations already have of working together. The public health department is well-respected, she said, giving their efforts weight and credibility. But most important, said Wendolowski, is that the public health department takes a broad, activist view of its role in the community. The public health department really understands that their role is to make sure their community is a place where people can be healthy. Also, for a city its size, Garfield is unusually rich in open spacemost families can walk to one of Garfields nine parks within five or 10 minutes. The city has several local organizations that can provide opportunities to be physically active including a YMCA, a community recreation center and a Boys and Girls Club.

The city council invited the nursing students to present their findings during the councils May 2005 meeting. The fact that the whole council listened to the students presentation on the health assessment at one of their regular meetings says something about the involvement of Garfields leadership right from the start, observed Burke. The outcome of the presentation was that Garfield signed on to the Mayors Wellness Campaign, making an official commitment to create a more active, healthier community, especially for children.

The Task Force Works to Improve Childrens Healthand Becomes FUN

wo private sector partnersthe managed health care insurers Amerigroup NJ and Horizon New Jersey Healthand the New Jersey Department of Health and Senior Services funded the Childhood Obesity Intervention Task Forces very first initiative, a community health resource guide that was printed and distributed via Garfields schools and city agencies.

Reveille and Burke hoped task force members could work together to create a pilot program to increase physical activity and promote healthier eating for kids in Garfield. They hoped, too, that Garfield could identify some best practices to help fight childhood obesity that might even be shared with other communities in New Jersey. We knew the problem, said Reveille, what we needed was to create interventions.

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Reveille quickly understood that the first thing to do was to name the task forces initiative something that might appeal to and engage all residents of Garfield. We are a very diverse community and everyone needs to see a piece of themselves in our program, said Reveille. So the task force named the initiative Fitness, Unity, Nutrition, or FUN. The word unity is important, said Reveille, because task force members aim to bring the whole community together to create healthier lifestyle habits. Garfields Health Department and Schools Work Together to Create Safe Routes to School

hrough the Mayors Wellness Campaign, Reveille and city manager Duch learned about the federal Safe Routes to School program and decided that enabling more children to walk to school safely was a strategy that meshed well with the aims of FUN. The Safe Routes to School program provides funds to the states to improve the ability of primary and middle school students to walk and bicycle to school safely.

In late 2005, Garfield applied to participate in a three-day City Safe Routes to School workshop that the Active Living Resource Center had designed especially for urban areas. The Active Living Resource Center provides information and resources to help individuals, neighborhood groups and community partnerships create communities that promote physical activity. In part because the community was already mobilizing around childrens health through the F.U.N. task force, the Active Living Resource Center selected Garfields school system for a workshop in May 2006. The workshop brought together teachers, parents, elementary school students and a variety of local leaders to assess conditions for walking to school and to develop local commitment to making conditions better. As a workshop activity, fourth and fifth grade students and teachers from Woodrow Wilson #5 and Roosevelt #7 schools walked the blocks around their schools to identify danger spots and suggest solutions to make the routes safer for walking. Then in 2007, Garfield became one of 29 New Jersey communities to which the New Jersey Photo: School dismissal at PS#7. Department of Transportation awarded a grant under the federal Safe Routes to School program. Garfield received $18,000 to launch Get Up and Go with the Newspaper in Education project of the daily Bergen County newspaper, The Record. Get Up and Go is an eight-part series of activities incorporating math, science, language arts and other subjects that teachers can use in their classrooms to teach students how to safely walk to school. Kids write stories about their walks to school or calculate their carbon footprints, that is, their personal impact on the environment. The series reached many more families than just those in Garfield: each edition went out as an insert in the newspaper to the 30,000 subscribers to The Record. Garfields Safe Routes to School campaign has many facets and has expanded to ten elementary and

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middle schools, explained Reveille. Among the ongoing activities are: Walking clubs at elementary schools #5 and #7 where kids walk during the school day and engage in special projects such as holiday food drives. Walking school buses once a month where parent volunteer walking bus drivers stop at the houses of some 100 kids to pick them up and safely walk them in a group to school. Walking events a couple of times a year that the schools publicize through e-mails home and flyers in students backpacks including International Walk to School Day. In preparation for walking to school each year, students and teachers at elementary school #7 walk around the area near the school. The schools principal, Margarita Pennisi, described how kindergarten students and first graders do an orientation walk around the school building and the older studentssecond through fifth graderswalk the entire perimeter of the school zone. During these walks teachers review safety conceptsbeing aware of dogs, stopping and looking before crossing streetsand encourage the children to travel along more major streets, avoid congested side streets and strictly keep to sidewalks.

Photo: School crosswalk at PS#5.

The school finishes field day at the end of the school year with another perimeter walk to set the students up for walking during the next school year. Principal Pennisi believes the orientation walks help children become more aware of their surroundings. Still, change is happening only slowly. For example, students at #7 school were still not allowed to ride their bikes to school as of fall 2008. Pennisi voiced her continuing concerns about the dangers of letting children ride their bikes on Garfields congested, narrow streets. Pennisi also perceived that although parents were more aware of the walking program, she had not seen a big uptick in numbers of children walking to school. She estimated some 25 to 30 percent continued to do so. For many parents, she said, it was still a matter of family convenience and feeling secure about their childrens whereabouts. (Pennisi did say she thought more children were walking home from school.) Joanne Wendolowski, the public health nurse supervisor from Hackensack Medical Center, identified another source of resistance to the Safe Routes to School program: most parents believe that walking and biking programs get imposed when the school district no longer wants pay for providing buses. But Safe Routes to School champion Reveille has made it clear that walking and biking to school are healthy behaviors for children. For their childrens health, says Reveille, parents must know that we need to promote more walking and biking to school. This new way of looking at community health may be helping to overcome parents resistance to the Safe Routes to School program, said Wendolowski.

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A Week-Long Summer Survival Camp in the Meadowlands Marsh n May 2006, Reveille and task force member Kathy Burke from Ramapo College reached out to another colleague on the task force, Angela Cristini, head of environmental education at Meadowlands Environmental Center. They hoped to develop more opportunities for Garfields kids to stay active during the summer. Their resourcefulness paid off in the creation of the Ramapo and Meadowlands Survival CampRAMS Campthat helps keep Garfields kids moving and intellectually stimulated for one week during the summer. RAMS camp takes place at the environmental center, about a 15-minute bus ride from Garfield. The camps goal, according to the camp brochure, is for students to learn to prepare themselves in the best ways to survive in any environment from the Marsh to School to Home. That means children will learn how to feed themselves nutritious food and condition their bodies for any challenges that may arise. The camp is free and transportation is provided. Grants from the New Jersey Department of Health and Senior Services Leaders Academy program (to support community-based physical activity initiatives) helped partially fund the camp during 2006 and 2007. A grant from Amerigroup Community Care the health care insurer helped support the 2008 session. During the camp session, camp staff Cristini and other counselors, including LaSpisa from the Garfield YMCA divide the campers into teams. At the end of the week, members of the team with the highest number of survival points receive prizes such as gift certificates from local businesses, binoculars and sports equipment. Cristini described some of the kids favorite camp activities: The Whats in Your Food? lab that teaches them how to analyze whether foods contain proteins, fats, carbohydrates and sugar. The campers separate into groups at tables where each table has five samples of mystery food and equipment to analyze the samples. (Camp staffers chose tuna in oil, chicken in water, white grape juice, saltines and vegetable oil.) With the help of an adult at each table, the campers analyze the samples to figure out the composition of the samples. The kids love it, they get gloves and goggles and learn how to measure and interpret data, said Cristini.

Photo: Garfield students enjoy the Ramapo & Meadowlands Survival Camp -- RAMS.

At the end of the lab, the campers write their results on the blackboard. The team that does the best job determining whats in the samples is the winner. Once the campers better understand what foods are made of, Cristini conducts a lab to demonstrate how much fat is in a Big Mac and how much sugar in a Slurpee. That really shocks them, said Cristini. The Botanical Challenge, where the campers roam the Meadowlands boardwalks to find samples of three different types of marshland plants: edible plants, medicinal plants and plants used for building shelters. As campers explore the terrain, taking pictures with digital cameras

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and filling out their answer sheets, they not only learn about the environment of the marsh, but also accumulate steps on their pedometers (a clip-on, watch-sized instrument that counts steps)and those add up to survival points for the end-oftheweek contest, too. The campers also analyze the lunches that they bring from home to camp every day. Each day at lunch time over the course of the week, campers write down what theyve got in their lunch bags, eat, and then rate their plates. That is, they figure out the serving size, number of calories from fat and the amounts of sugar and sodium for all the items in their lunch. Each day, a lunch table team captain makes a tally for his or her team. At the end of the week, the team that wins this contest is the one whose members have collectively brought lunches with the healthiest variety of foods, lowest amounts of sugar and sodium and fewest calories from fat. As the week goes on, the lunches do change, observed Cristini and we see healthier foods like pretzels and yogurt, instead of potato chips and cookies. Campers also participate in relay races, and learn how to canoe and do yoga. Yoga is really their favorite activity, reported Cristini. Cristini at the Meadowlands and other professors from Ramapo College piloted RAMS Camp in 2006. Twenty Garfield school teachers and nurses attended a first week-long session, and then some 18 Garfield middle school students attended a second week-long session. When Cristini and her camp team discovered that teachers were not able to incorporate as many activities as they had hoped into their curricula during the school year, they decided to offer the camp to kids only, and focused on expanding the number of kids who could attend. Cristini also encouraged teachers who attended the original session to come back as counselors. In the summer of 2007 and again in 2008, a total of 80 middle schoolers who were participating in the summer sessions of Garfields recreation center, YMCA and Boys and Girls Club attended the camp. Plans are to hold the camp again in the summer of 2009, although as of January 2009 Reveille reported they had not identified funding.

Source: CDC/NCHS, NHES and NHANES

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Walking to School from Before-School Care at the YMCA

he F.U.N. initiative created another opportunity for Garfield kids to walk, sparked by the Safe Routes to School project: Sal LaSpisa, the school-aged child care director at the YMCA, decided to see if the children in the Ys beforeschool care could walk to school. The Ys before-school care program covers Garfield elementary schools #4, #5 and #8. Typically, parents dropped their children off at 7:30 a.m. and then, at 8:15 a.m., the kids got on a bus to go to school. When LaSpisa proposed the idea of walking to school and sent out a release form to parents, parents were extremely resistant. Their Number One concern was safety, said LaSpisa, but they were also worried about the distance and the strain of the book bags on their childrens backs. LaSpisa persisted with his efforts, though, and in fall 2007 started the walking program twice per week. Each group of childrenabout 15--walked with two Y counselors, leaving at about 8:00 a.m. and arriving at school about 25 minutes later, in time for the 8:30 bell.

Garfield Middle and High School Students Map Their Community with an Eye to Health Since 2007, in a special initiative also supported by the Safe Routes to School and Leaders Academy funds, local middle and high school students have been assessing and mapping the conditions in their community for walking and living a healthy lifestyle. Working with Wansoo Im, Ph.D., a geographic information systems (GIS) mapping expert from the private firm VERTICES, L.L.C., the students were developing an interactive map of safe and attractive walking routes for Garfield. The city bought laptop computers and digital cameras so that students could walk around town and document conditions for walkingbeginning with Safe Routes to School. Wansoo is also an adjunct professor at Rutgers University the state university of New Jersey and his intern students volunteered to teach the students the GIS mapping application. This map (shown at the top of page 9) is available at the Garfield FUN Web site. Reveille hoped that parents of school-aged children and all Garfield residents would be able to use the map to create safe walking routes tailored to their own itineraries from home to school or other local destinations such as the YMCA. Beginning in winter 2008, Wansoo and his interns were also helping students to create a second map to inventory all places in the community where people could engage in healthy activities including parks and recreation centers. Future healthy places such as planned school and community gardens were also to figure on the map. On December 30, 2008 six Garfield high school students, several local volunteers, Wansoo and his interns walked around the community conducting the first audit of healthy community assets. As measured by the pedometers they were all wearing, group members walked on average 1.86 miles and burned 191 calories. Reveille reported that sites of Garfields Clean Communities Program (a litter abatement and environmental education program) would also be mapped and that the city administration would be able to use the map to identify problem areas.

Photo: Students from PS#7 show the ALRC staff around their school neighborhood.

The children were enthusiastic. LaSpisa reported that the children really value the time they can spend with the counselors along the way to school. These small groups are more intimate. The kids can tell us whats on their mind before the day begins. They can walk, reflect and calm down before they get to school, he explained. The children now walk to school five days per week. Three groups of about 15 kids (from kindergarten kids to sixth graders) walk to their schools. The YMCA has a bus in reserve to take the kids to school in case of bad weather. The kids are disappointed when they cant walk, said LaSpisa. They ask the staff every morning whether its a walking day. Normally, he said, they walk to school from the beginning

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A map from the Garfield F.U.N. web site; see sidebar on pg. 8 for more information

of the school year through October, and begin again by early March until school lets out for the summer. How did LaSpisa succeed in overcoming the parents strong resistance to the walking program? First, he met with Reveille and the YMCAs executive director. They decided to keep the walks. We needed to show people we were dedicated to the idea of healthy behaviors for kids. We could have easily packed it in when parents were knocking down our doors, said LaSpisa. But the Y stuck with it, he said, and now he believes parents are starting to recognize the importance of physical activity for their childrens health. An added benefit, explained LaSpisa, is that walking teaches kids safetytheyre not going to be in a school bus all the time.

Garfield Continues to Support Community Health

upport for Fitness, Unity and Nutrition appears to be embedded in Garfield. Government continued its support: through city manager Duch, in 2006 Garfield applied for and won a $25,000 grant from the New York Giants to build a family fitness path in a local park. The path was completed in 2007 and the recreation center began using it for a fitness challenge during 2008 summer camp. The city was also redeveloping its river front with New Jersey Green Acres funding. Plans included a walking and biking trail along the river. Pilot programs were spreading to other local agencies. For example, the Garfield Boys and Girls Club planned to start a walking school bus in spring 2009 for the children in their before-school care program.

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Although F.U.N. has yet to create formal benchmarks with which to evaluate its progress, Joanne Wendolowski of Hackensack Medical Center said she detected a difference in peoples behavior coming from Garfields efforts. From my windshield survey, she said, I can see that Garfield is a more active place. Theyve taken all their open space and made it usable for families. People are in the parks, people are out there walkingthe healthy values are being integrated into the recreation programming, you can see people out there using the facilities Whats Next for Garfield? eveille and Burke noted that the FUN Task Force is one sustainable result of Garfields efforts. That means a group of committed community leaders can continue to brainstorm ideas, seek new partners and reach out for funding and support for health-promoting initiatives. As of January 2009, FUN was developing partners in a new area--school gardens-- filled with possibilities to promote better nutrition and physical activity. Reveille saw an opportunity in the new Thomas Jefferson Middle School. According to Reveille, this new facility, built with Abbott funds, had a beautiful, new greenhouse, but no person to staff it. So Reveille reached out to middle school principal Marilyn Martorano to discuss how to build healthy programming around the greenhouse. With a master gardener from the 4-H Club extension program at Rutgers University, FUN and the schools developed a six-week garden curriculum that will be integrated into the middle school science curriculum. The curriculum will teach middle-school students such topics as how to grow food, how to store food safely and nutritiously through canning and freezing and the components of good nutrition. The course will culminate in a Cook Off (like the Food Networks Iron Chef, said Reveille) in the schools new life skills classroom. A nutritionist from Hackensack Medical Center will judge the competition. The gardening course was scheduled to begin on January 20, 2009. At the request of Principal Martorano, a horticultural therapist from Rutgers will also create programming for special needs kids including a work force component to help them prepare for jobs in agriculture.

Photo: Third graders from #5 school participate in a walking audit of their school neighborhood with ALRC staff.

With typical resourcefulness, Reveille made the case to the New Jersey Clean Communities program that the garden program incorporates environmental education by teaching youth about healthy soil and good conditions for plants. Clean Communities funding is helping support the consultants who will present the garden curriculum to the science classes. Whats more, the Garfield Clean Communities coordinator is now part of the F.U.N. task force. Still, Reveille reflected that finding funding to support programming is a constant and ongoing challenge. But she does not plan to give up. I am passionate about this work she reflected,

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because I spent most of my 30-year career in nursing in the field of Critical CareI have witnessed a lot of human suffering from chronic disease. We need to promote programs that can help prevent chronic disease, like Safe Routes to School and FUN. Lessons Learned from the F.U.N. campaign 1. One committed persona championcan catalyze community change, engage the necessary partners and resources and sustain a vision for change. 2. A broad-based community coalition is necessary to bring in talent and resources over the long run and to enable the implementation of broad-based community change. Such a coalition can also help sustain change. 3. Support of a communitys political leadership is necessary to institutionalize change and find permanent sources of staffing and funding. 4. Communities can seldom directly change the behavior of community members: by changing community environmentsphysical and culturalthey can encourage desired behavior change and make it easier for more people. 5. Communities must experiment with programming to identify what works for the members of their communities.
Photo: This map depicting some of the good and bad aspects of life in Garfield was produced during an ALRC City-SRTS workshop.

Sources of Grant Funding for Garfields FUN Initiative Leaders Academy, from the New Jersey Depart2006: $ 2,500.00 ment of Health & Senior Services through the New 2007: $10,000.00
Jersey Council of Physical Fitness & Sports National Football League Charities through the New York Giants Football Team

2006: $25,000.00

New Jersey Safe Routes to School Program, from 2007: $18,000.00 the Federal SRTS program through the New Jersey Department of Transportation Amerigroup Community Care provided support for the Ramapo and Meadowlands Survival Camp RAMS Camp

2008: $5,000.00

Horizon NJ Health provided support for community 2006: $5,000 health projects Mayors Wellness Campaign provided seed money to help Garfield launch a comprehensive wellness program for the City.

2005: $500.00

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Fifth grade school students from Garfield, New Jersey, are helping to make healthy decisions about their community and their lives.

The Active Living Resource Center (ALRC) is a program managed by the National Center for Bicycling and Walking (NCBW) and funded by The Robert Wood Johnson Foundation. The program provides technical resources and outreach programs to community activists and grass roots groups seeking to increase walking and bicycling with a special emphasis on creating opportunities for children in disadvantaged communities across the United States. See our web site at: www.activelivingresources.org

www.activelivingresources.org National Center for Bicycling & Walking 1612 K Street NW, Suite 802 Washington, DC 20006 Phone: 202.223.3621 e-mail: info@bikewalk.org