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Final Deliverables

Prepared by: The New School Practicum Team

Kristina Capron, Ellen Davidson,

Talar Khatchadourian, Mina Nabizada,

Thea Rome, Brian Stern and Eda Tekeoglu

Advisor: Stacey Flanagan

Submitted to: The Department of Health and Mental Hygiene

May 27th

, 2011

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Table of Contents

Deliverable I: Comparative Analysis of Physical Activity Programs…..…………4-13

Deliverable II: Walking Group Feasibility Case Study………………..…………14-21

Deliverable III: Shape-Up Feasibility Study………………………………………22-27

Deliverable IV: Nonprofit Assessment of Physical Activity Programming

and Partnership……………………………………………………………………..28-33

Deliverable V: Business Wellness Survey……………………………...…………..34-36

Deliverable VI: Grant Proposal to Fund Pilot Program………………...……..…37-49

Executive Summary………………….…………………...…………………….......…..37

Statement of Need…………………………………...……………………..…………...38

Organization Mission Statement………………………..……………..………………39

Project Description………………………………………….……………………….…39

Short term outputs…………………………………………..……………………39

Long-term outputs………………………………….………………………….…40

Methodology……………………………………………………………..………40

Sessions…………………………………………………………………......……41

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Incentives…………………………………………………………………...……41

Personnel……………………………………………………………………...…41

Potential Partnerships with Non-Profits……………………………………...…42

Table 1: Non-Profits……………………………………………….…………42-43

Project Duration…………………………………………………………...……………44

Table 2: Timeline…………………………………………………...……………44

Timeline Narrative……………………………………………………………….44

Budget…………………………………………………………………………………...45

Table 3: Scenario A……………………………………………………………...46

Table 4: Scenario B………………………………………………………….…..46

Evaluation Method……………………………………………………………..………47

Table 6: BMI indicator……………………………………………......................47

Table 5: Knowledge and Participation Indicator………………………………..47

Evaluation Method Narrative ……………………………………………......48-49

References………………………………………………………………………..…50-53

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Deliverable I: Comparative Analysis of Physical Activity Programs

Paris

France current total population – 62 million i

In 2002, the National Institute of Statistics and Economic Studies (INSEE) conducted a

study to calculate the rate of overweight and obesity levels in France. Surveys were

conducted via telephone with over 25,770 participants ages 15> from a total population

of nearly 50 million. The study showed that of the total population in 2002, 5.3 million

adults were obese, while 14.4 million people were considered overweight.ii The method

used to collect this data however has some limitations; there may be sampling errors,

measurement error, and reporting bias where people over- or under-report during self-

reporting questionnaires.

Obesity prevalence

Although the rate of obesity in France is still much lower than that of many developed

countries, such as the US and Britain where over 50% are overweight,iii

the prevalence

has slowly increased from 8% in 1997 to 11% in 2003.iv

In comparing the annual rate

between this time period, the percentage of overweight and obese adults increased from

37%-42%: a projected annual increase of 5%.v

Obesity as a Risk Factor

Obesity is one of the most important risk factors leading to diabetes, hypertension,

arterial disease, and high cholesterol. Studies show that 43% of people who are

overweight or obese have a greater risk of experiencing the multiple symptoms

mentioned above, whereas 19% of people who are considered normal-weight experience

only one symptom.vi

Obesity Rates by Age and Gender

Studies show that obesity rates are rising for both men and women. Table 1 illustrates the

rise in obesity by age group and gender. In comparing obesity rates between that of men

and women, we see a greater prevalence for women between the ages of 15-45. However,

this trend begins to reverse quite drastically when comparing men and women between

the ages of 45-65, where the prevalence for males increases by 4% in comparison to

females.vii

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Figure 1. Prevalence of obesity by age and sex

Source: "ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17

June 2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>.

pg2

Link Between Obesity and Poverty:

Obesity in France has shown to largely affect lower socio-economic and professional

groups.viii

This may be due to the fact that far more people are beginning to purchase

cheap processed and frozen foods from large supermarkets, rather than healthier choices

from their local markets due to their affordability and convenience. This cultural shift has

created an economic burden, not only on the small family-run specialty food stores, but

also on government health expenditures.

Reported Physical Activity

Over the last 30 years, there has been a major rise in fast food consumption along with a

decline in physical activity. Reports show that only half of the population meets the 30-

minute recommended amount of physical activity per day.ix

Assumptions have been

made that there is a direct link between the amount of physical activity a person engages

in, and their weight. Those who categorize themselves as normal-weight, will engage in

149 minutes of physical activity per day, while those who see themselves as too thin, or

too fat, engage in 130 minutes of physical activity per day.x

Physical Activity in the Workplace

For some, physical activity in the workplace is where they meet their daily-required

amount of motion. A study was conducted to evaluate where the most common forms of

physical activity take place (activity in the work place, leisure, commuting) for people of:

normal-weight, overweight, and obese. Table 2 illustrates that people in the obese and

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overweight categories engage in more physical activity while in the workplace (54.3, and

50.0) and less on their own time, than those who are normal-weight.xi

There is not a

significant difference in the percentage of physical activity people engage in due to

commuting.

Figure 2. Percentage of people engaging in physical activity based on weight category

and location: workplace, commuting, and leisure

Source: "Barometre Sante Nutrition 2008." Barometres Sante. INPES. Web. 29 Mar.

2011. <http://www.inpes.sante.fr/barometre-sante-nutrition-2008/pdf/activite-

physique.pdf>

Economic Expenses:

The rising rates of obesity have led to an increase in medical treatments for a number of

other diseases. The direct cost of obesity is estimated to be between 1% and 2% of the

total healthcare expenditure.xii

In 2008, 11.2% of France‟s GDP was spent on healthcare

costs. Table 3 places France second in line to the US who spends 16% of its GDP on

healthcare.xiii

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Figure 3. Percent of GDP spent on health care expenditure by country in 2008

Source: "Eco-Sante OCDE 2010 Comment La France Se Positionne." OCDE. Web. 28

Mar. 2011. <http://www.oecd.org/dataoecd/45/20/38980771.pdf>. pg 1

Government Response

In 2004, parliament enacted a wide-range of legislation to combat obesity and promote a

public health campaign. Laws have now been passed which prohibit the use of

snack/soda vending machines in schools, replacing them with healthier choices and

nutrition tutorials. A law has also been passed to control advertisements and food

companies through a 1.5% tax if they do not promote healthy habits. However, the latar

has yet to be implemented.xiv

National Programme for Nutrition and Health (PNNS)

Before 2001, and the establishment of the PNNS, there were no public nutrition policies

in France. The first phase of the PNNS was established to measure the progress of public

health issues such as eating habits and physical activity in the country, which ended in

2005. The second phase of the program was approved by the Minister of Health and was

launched between 2006-2009. The program focused on (1) promoting environmental

changes to motivate people to engage in physical activity, (2) targeting disadvantaged

groups, based on socio-economic status, and (3) lower obesity in children and adults. xv

EPODE Programme – Together Lets Prevent Childhood Obesity

France launched its first EPODE program in 2003, which aims at changing the

environment and peoples unhealthy behaviors, (particularly that of school children) by

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working with schools to promote physical activity programs after school, and access to

healthier cafeteria foods. The program now affects 1.8 million French citizens in over

167 cities.xvi

The methods they use to measure the rates of success are large field

mobilization and BMI evaluations of children in the pilot cities.xvii

Physical Elements of the Program

This fall, the National Institute for Prevention and Health Education (INPES) launched its

first national and local physical activity campaign: “Bouger”; “move 30 minutes a day;

its that easy!” The campaign uses signs throughout pedestrian walkways and in bicycle

lanes to promote physical activity rather than the use of public transportation (Figure 4).

The aim of the campaign is to get people moving and to show citizens that getting their

daily-required amount of physical activity does not necessarily need to include strenuous

exercise, nor does it have to be expensive (Figure 5).

Figure 4. Walking signs

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Figure 5. Advertisements

Source: "Bouger 30 Min Par Jour, C‟est Facile - Campagnes." Ministère Du Travail, De

L'Emploi Et De La Santé (Secteur Santé). Web. 30 Mar. 2011.

<http://www.sante.gouv.fr/bouger-30-min-par-jour-c-est-facile.html>.

Program Elements

The programs affect both urban and rural areas alike. They encourage cities to be more

pedestrian and bike friendly to promote activity. A proposal has been made which would

provide subsidies for active modes of transportation while accommodating people who

ride their bikes to work with free/safe bike parking access. The Ministry of Health has

also proposed developing leisure sports centers in parks. They encourage schools to

establish walking buses to teach kids at a young age the importance of physical

activity.xviii

Recommendations

The physical elements of the “Bouger” campaign in France is well suited for the French

culture and scenic views of the major cities. In downtown NYC, there are signs posted

for tourists to use as location references, however, they only mention the physical

location, and not the amount of time or steps it takes to arrive at their desired location.

Although these signs do seem useful for tourists, it does not seem suitable for our target

high-needs neighborhoods. Posters and advertisements promoting physical activity can

encourage people to put their bodies in motion. If however the posters do not properly

consider the demographics (target audience, language, etc), the advertisements will be

ineffective.

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Taiwan

Prevalence of Obesity in Taiwan

There is a great need for physical activity programs within Taiwan with growing rates of

obesity, both in children and adults, among its 23 million residents. According to a

survey conducted in 2001 by the International Association for the Study of Obesity

(IASO), 18.6% of boys were overweight and 8.2% were obese. For girls, 13% were

overweight and 3.6% were obese. The survey was conducted among children aged 6 to

18 years, with a sample size of 24,586. Weight, height, systolic and diastolic blood

pressures, and fitness tests were all measured during the survey (IASO, 2011). The IASO

does not have a survey available on Taiwan‟s adult obesity population. However, an

article in Obesity Reviews, Prevalence of obesity in Taiwan, states that from 2000-2001,

28.9% of men were overweight and 15.9% were obese. For women, 18.7% were

overweight and 10.7% were obese. The adults in the study group were aged 20 and older.

The survey was conducted using Taiwan‟s Department of Health‟s criteria of overweight

as BMI > 24 and obese as BMI > 27 (Chu, 2005).

Prevention Strategies in Taiwan: “Health 2011” weight-loss Campaign

The Taipei Times reported in February 2011 that the Department of Health in Taiwan has

launched a “Health 2011” weight-loss campaign. Between 2001 and 2003, Taipei City

had been successful in getting its residents to lose 100 tons. With this success, the DOH

decided to expand the battle against obesity nationwide. For each district of Taiwan, the

DOH‟s “Health 2011” campaign has set up weight-loss goals. New Taipei city, being the

most populated city with 3.9 million residents has been set with a goal to lose 136 tons.

Other goals have been set for Taipei City (101 tons), Taichung (75.1 tons), Tainan (98

tons), and Kaohsiung (103.8 tons) (Taipei Times, 2011).

The goal of the Health 2011 weight-loss campaign is to encourage healthy eating and

exercise for “the sake of one‟s health”, instead of taking diet pills or having weight-loss

surgery. The director of Taipei City Hospital‟s nutrition department, Chin Hui-min,

stated, “that if people consumed 300 fewer calories and burned 200 more calories per day

than they normally would, they could lose 0.5 kg per week” (Taipei Times, 2011).

Residents between the ages of 6 and 64 who are either obese or overweight can sign up at

local public health centers to take part in the free weight-control program. The program

provides guidance in dieting, nutrition, and exercise. A listing of the public health centers

was not available and results thus far have not been recorded.

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National Walking Day

In 2002, the Bureau of Health Promotion began encouraging residents to walk 10,000

steps a day. In 2006, November 11th

was designated as National Walking Day throughout

Taiwan‟s cities and counties. The date November 11th

was chosen because the numerals

represented a pair of legs. Posters, like the one below, were placed throughout cities to

remind and encourage residents to walk 10,000 steps a day. Residents are encouraged to

take part in either fitness walking or power walking. Both types are suggested to be done

at a speed of 4.8 kilometers per hour to 9.6 kilometer per hour while keeping the body

erect, hands level to the waist, swinging the arms while keeping the shoulders relaxed,

and taking bigger steps than usual (Taiwan Review, 2009).

Junk Food Tax

In December 2009, Taiwan began to plan the world‟s first junk food tax. The Bureau of

Health Promotion began drafting a bill that would place taxes on unhealthy foods such as

sugary drinks, candy, cakes, fast food, and alcohol. The revenue gained from the tax is

planned to go towards those groups that have been promoting health awareness and to

help subsidize Taiwan‟s national health insurance program (AFP, 2009). The tax is to

begin this year, but there have been no reports that it has been passed or what percentage

the tax would be. New York Governor David Paterson was proposing to pass a similar

bill in 2009, but with much public opposition he withdrew the bill. The bill was to add an

18% tax on soft drinks.

Prevention Strategy in China

There is no available public information on Taiwanese elderly exercising in public areas,

but this activity seems to be a popular one in China. China, with a population of over 1

billion people, has a growing obesity population much like Taiwan. According to a 2002

survey conducted by the IASO, 16.7% of Chinese men were overweight and 2.4% were

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obese. For women, 15.4% were overweight and 3.4% were obese. The survey was

conducted among adults aged 18 and older (IASO, 2011). China‟s elderly population, 60

years and older, is over 140 million people. Roughly 54 million of them take part in

physical activity. Many of them gather in public parks across the country to take part in

martial arts like tai chi, dance, and singing (Liang & Hornby, 2009). There is no specific

mention of any costs associated with these park gatherings. Rather, it seems that word of

mouth and motivation to stay fit at an old age is what drives China‟s elderly population to

take part in some form of physical activity.

Additionally, China Daily reported that China has released a set of guidelines for its

National Fitness Program 2011-2015. The program sets the minimum exercise

requirement to at least 30 minutes for at least three times a week for 32% of its

population. The program calls for a raise in the number of gymnasiums and stadiums

throughout the country, from 1 million to 1.2 million. The program is targeted to have

50% of China‟s cities and counties to set up physical training centers, and 50% of its

communities to have sports facilities that are convenient and in functional condition for

the entire population. A budget has not been introduced, but all levels of the government

are to plan their investment on promoting the program. A plan to evaluate the

successfulness of the program will take place in 2014 (Lei & Yue, 2011).

Recommendations for NYC

Programs like the “Health 2011” campaign and National Walking Day would be ideal in

New York City. The city could encourage residents with its own walking day, week,

month, or year; placing posters throughout the city asking residents how many steps they

took today, and/or highlighting routes they can take to reach 10,000 steps a day. Posters

can also encourage them to take the stairs, rather than the escalator or elevator. At present

there are posters depicting the amount of sugar and sodium found in several drinks and

foods. Walking can be viewed as a simple and effective form of exercise that can show

measurable results. The DOH can team up with a company that would be willing to

donate free pedometers for participating New Yorkers. On a nice day, rather than taking

the subway a few blocks, residents can try walking them.

Additionally, Taiwan‟s Health 2011 campaign has set up a hotline that people can call

into to gain advice on diet and exercise. The NYC DOH could set up a similar hotline

where NYC residents can call toll-free to attain information on diet, exercise, local gyms

and their promotions, local YMCAs, local parks, and a listing of healthy

restaurants/markets at affordable prices. The choices are plentiful. To make the concept

even more up-to-date with today‟s technology, a smart-phone application can be set up

that could easily provide this information. Perhaps teaming up with Yelp.com to offer

local listings of such facilities presents an opportunity as well.

Although the “junk food tax” was not a crowd pleaser when the idea was first introduced

to New York, a “no refills” rule can be implemented. When patrons go out to eat, eateries

should no longer place the soda machines in a public area where patrons can fill their

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own cups. Also, restaurants should no longer give free refills. Rather, they should charge

for each glass filled. This could possibly reduce the amount of sugary drinks that New

Yorkers consume, as they would not be willing to pay for several glasses.

Lastly, following the Chinese, New Yorkers can take part in a group exercise routine in

one of NYC‟s numerous parks. Perhaps teaming up with volunteers who would dedicate

their time to teach interested individuals easy dance and exercise routines. After the first

month, for example, participants can carry out the routines on their own and new comers

can follow the guidance of veteran participants. However, if the program requires

funding, a $1 fee can be instilled for each participant. A website or a smart-phone

application can be set up where individuals can view where and when the next group

exercise routine will take place.

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Deliverable II: Walking Group Feasibility Case Study

Introduction

In light of the obesity epidemic in New York City, the private and public sector has to

assume responsibility in increasing access to low-cost physical activity programming.

Data from the Department of Health and Mental Hygiene shows that NYC‟s high-needs

communities experience disproportionate overweight and obesity rates in comparison to

middle-income neighborhoods.

Walking is a well-known form of low-impact physical activity that is safe for all ages. In

addition, organizing walking groups is relativity inexpensive when compared to indoor

activities such as dance. The health benefits of walking are undeniable and the low-cost

component makes walking groups a great form of physical activity that can be health

promoting, educational, and social all at once.

We need to understand what obstacles exist in implementing a walking group initiative in

NYC‟s highest-needs communities. In addition, it is beneficial to analyze existing and

past initiatives in order to learn what components have culminated into successful and

sustainable walking group programs.

Our research on three walking group initiatives in East and Central Harlem has provided

important information that we have used to design a pilot program.

Methodology

Our team reached out to Javier Lopez, the director of the NYC Strategic Alliance for

Health in order to connect with walking groups located in Harlem. He put us in contact

with Lourdes J. Hernández-Cordero, D.PH and Monique Hedmann, MPH, the directors

of the CLIMB project and Walk it Out! Program, respectively. Through email and phone

interviews the team collected information on these two walking group initiatives. In

addition, the team conducted an in-person interview with John Falzon, the center

manager of the Thomas Jefferson Recreation Center. Team members also visited the

recreation center in order to participate in the walking group. Interviewee contact

information is included below:

Javier Lopez

Director, NYC Strategic Alliance for Health

jlopez@health.nyc.gov

(212) 996-8738

Lourdes J. Hernández-Cordero, D.PH

Assistant Professor of Clinical Sociomedical Sciences

SMS Practicum Director

Associate Director Columbia Center for Youth Violence Prevention

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Columbia University Mailman School of Public Health

722 West 168th Street Room 514

New York, NY 10040

Phone: (212) 305-1077

ljh19@mail.cumc.columbia.edu

Monique Hedmann, MPH

Assistant Director, Department of Neurology

Harlem Hospital Center

506 Lenox Avenue, 16th floor

New York, NY 10037

Office (212) 939-4239

Monique.Hedmann@nychhc.org

John Falzon, Center Manager

Thomas Jefferson Park Recreation Center

2180 1st Avenue at East 12th

Street

New York, NY 10128

(212) 860-1371

john.falzon@parks.nyc.gov

Findings

CLIMB Program Background

The City Life is Moving Bodies project (CLIMB) is a partnership between Columbia

University Medical School and community organizations based in Northern Manhattanxix

.

The project‟s mission is to address various social and health issues endemic to the area of

which some are obesity, inactivity, youth violence, and drug abusexx

. CLIMB believes

that increasing access to parks and ensuring that it is safe to enjoy them will help alleviate

some of the problems noted abovexxi

. In order to increase safety and accessibility CLIMB

has created and linked trails within the cliff-like ridges that characterize the terrain of

Northern Manhattan‟s parks. CLIMB aims to create park and neighborhood ownership by

targeting all levels of involvement: individual, family, neighborhood, and cityxxii

.

On June 4, 2011, CLIMB is hosting the seventh annual Hike the Heights eventxxiii

. This

event promotes CLIMB and its community partners‟ initiatives by inviting the

community to enjoy the park trails.

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CLIMB Findings

Through a phone interview with Lourdes J. Hernández-Cordero, the team learned more

about City Life is Moving Bodies (CLIMB) xxiv

. The project was created by the

Community Research Group more than 17 years ago in order to address the issue of safe

parks and neighborhoods. According to Lourdes, the need for safe parks evolved from the

reality that the parks of Northern Manhattan (including Inwood, Washington Heights, and

Harlem) were abandoned and unsafe. The project aims to reinvigorate the area by

making public spaces such as parks accessible for safe and multi-generational use.

Currently, the CLIMB project is part of the Columbia Center for Youth Violence

Prevention. According to Lourdes, obtaining funding is more feasible when the target is

children and adolescence. In addition, targeting youth has been an effective avenue for

reaching other generations. For example, the annual Hike the Heights event promotes

multi-generational activities in a safe outdoor setting.

While the Hike the Heights event is only held once a year in June, the project promotes

the event and its initiatives year round. Lourdes aims to “bring a diversity of users to the

park” because it “increases use around the clock and makes the parks safer. And it‟s a

way to have folks more physically active, but also provides an opportunity to be more

civically active and socially active”xxv

.

The CLIMB Project‟s institutional review board (IRB) evaluates its efforts by designing

questionnaires that asks participants how they found out about the event and the parks.

These questionnaires are helpful because it allows the project to design its initiative

around the needs of the community.

CLIMB partners with many community-based organizations in Northern Manhattan. One

of their biggest collaborators is the Northern Manhattan Community Voices Asthma

Basics for Children initiative. ABC holds its annual asthma awareness walk on the day of

the Hike the Heights event and the walk culminates at the event. The collaboration

enables a large range of participants to become aware of the accessibility of Northern

Manhattans parks.

One of CLIMB‟s main initiatives is to promote physical activity in NYC‟s parks.

According to Lourdes, walking is a great form of exercise that is appropriate for all ages.

However, in order to motivate people to walk together, you must add an additional

component. For example, as part of the youth violence prevention initiative, CLIMB

organizes youths into teams that go out into Northern Manhattan‟s parks to clean up the

area. In addition, CLIMB organizes educational walking tours. These tours are designed

to educate participants about the rich social and ecological history of Northern

Manhattan.

According to Lourdes, there are challenges in organizing walking groups, especially for

elders. She argues, “walking groups for seniors are difficult because promoting health

benefits [only] is not effective.”xxvi

Lourdes recommends that seniors will more likely be

interested in participating in a walking group if it is socially engaging.

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Walk it Out! Program Background

The Walk it Out! Program is a Harlem Hospital Center initiative that aims to promote

physical activity among senior citizens residing in Harlem. In addition to emphasizing

health benefits for senior citizens, Walk it Out! promotes multi-generational activities and

peer bondingxxvii

. The Harlem Hospital Center held The Walk it Out! Family Walk and

Run event last year on August 1, 2010 at the Riverbank State Park. This event promoted

the program‟s goals while bringing the community together in a healthy setting filled

with physical activities and healthy foods.

The Walk it Out! program was created in February of 2010 and is sponsored by the

Healthy Heart Program of the New York State Department of Health and other

donorsxxviii

.

Walk it Out! Findings

Through a phone interview with Monique Hedmann, the team learned about the Walk it

Out! initiative of the Harlem Hospital Centerxxix

. According to Monique, since its

inception in [February] 2010, the program has had its ups and downs, but boasts overall

success in supporting a culture of wellness among Harlem seniors”xxx

.

One of the main reported obstacles is obtaining funding. The program receives a small

grant from the Healthy Heart Program of the New York State Department of Health,

which covers personnel costs. An additional $1,500 is provided by AARP, a nonprofit

organization committed to helping persons aged 50 and older. The Friends of Harlem

Hospital Center support efforts to help their patients by providing grants; so far, they

have awarded the Walk it Out! program $5,000. Monique Hedmann, as director of this

initiative has had to be innovative in cutting costs because donor funding, while

generous, is not enough to sustain the program.

Through partnerships with academic institutions and community organizations, the

program has effectively lowered overall costs. For example, Walk it Out! currently

partners with the Joseph L. Mailman School of Public Health of Columbia University.

The graduate program provides Walk it Out! with graduate student volunteers. These

students are trained by the program to lead walking groups and receive a volunteer

training manual. Currently, the student volunteers do not receive certification, but

according to Monique, this is something that they may explore. In regards to liability

issues, all participants sign an acknowledgement of risk and must be cleared by a doctor

before engaging in any physical activity organized by the program.

Monique Hedmann argues that one of the benefits of having student walking instructors

is that elders enjoy interacting with youth. Participants have expressed their appreciation

for multi-generational interaction and some have told Monique directly that they continue

to participate because the walks are led by young and energetic students.

While student volunteers are an effective way to lower program costs, Monique has cited

some obstacles in this partnership. On several occasions, students have failed to show up

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for their delegated walking group and this has had a negative impact on the programs

reputation. The credibility of the program depends on the professionalism of the walking

instructors and not showing up to lead a walk will deter future participation. Monique

suggested that there should be a form of accountability for unexcused absences from

students. Monique feels that if volunteering for leading walks could be incorporated into

a for credit class, this might eliminate the issue at hand.

In addition to utilizing student volunteers as walking instructors, the Walk it Out!

program trains senior citizens to be walking guides. Having a peer leader (alongside the

student volunteer) promotes individual ownership of the program. Monique Hedmann

believes that the combination of a peer leader and a student volunteer walking instructor

has been a factor in the programs popularity. When Walk it Out! promotes the program,

they find that emphasizing the multi-generational component as well as the opportunity

for peer bonding is highly effective in motivating senior citizens to engage in physical

activity.

Walk it Out! effectively targets senior citizens by collaborating with senior centers.

Currently, Walk it Out! partners with 10 senior centers located in Central Harlem. The

program provides the student volunteer instructors, training for peer instructors,

incentives for participations, and the overall framework so that the program can run at all

10 senior centers simultaneously.

The majority of the partner senior centers hold walking groups three times a week from

9:00 - 10:00 a.m. since senior centers usually serve lunch around 11:30 a.m. Also, as

Monique points out, most adults, regardless of age, prefer to exercise during the early to

mid-morning.

Monique Hedmann would like to engage senior citizens residing in East Harlem;

however, the current budget does not allow for this expansion. With that said, Walk it

Out! has recently expanded its programming beyond senior centers and is collaborating

with the SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender

Elders), an organization that aims to support the needs of LGBT older adultsxxxi

.

Another partnership offers a solution for inclement weather or cold winters. The Walk it

Out! program has partnered with the 369th

Regiment Armory, located in Central Harlem.

Through this partnership, the walking groups have an indoor space to engage in physical

activities when walking outdoors is not possible.

Not only does Walk it Out! lower program costs through its partnerships, it ensures that

the program‟s initiative is reaching senior citizens beyond the senior centers. One of the

obstacles in promoting the program is reaching seniors that do not belong to senior

centers. In response, Walk it Out! partners with the NORC (Naturally Occurring

Retirement Community) program. Monique attempted to advertise the program to seniors

living in NYCHA (New York City Housing Authority) housing developments; however,

she did not receive approval. Additional strategies include advertising with flyers in

churches, hospitals, and promoting the initiative at community board meetings.

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With a tight budget, the Walk it Out! program allocates a portion of funding to cover

incentives for participation. Monique Hedmann argues that offering incentives is a very

important motivator. The provision of incentives is carefully allocated by providing

participants with a “loyalty card” which is stamped by the instructor at every walking

group they attend.

On the first day, the participants receive a Walk it Out! t-shirt and they are encouraged to

wear it whenever they walk for fitness. Monique Hedmann argues that senior citizens

who wear the t-shirts are a great form of advertisement for the program. For example,

several elders who were not participants of a senior center have shown up to participate

because they saw their peers wearing the t-shirts.

After the first day, incentives are given as participants accumulate stamps; some of the

incentives given out: pedometers, drawstring bags, water bottles and gift certificates.

The health benefits of walking are undeniable. However, the Walk it Out! program does

not monitor important health indicators such as BMI and blood pressure. Again, budget

and time constraints do not allow for a comprehensive evaluation. However, as requested

by the New York State Department of Health, the program tracks the amount of time

participants engage in physical activity. The participants fill out a questionnaire that asks

them how many minutes they engage in physical activity per week. The NYS Department

of Health recommends that people of all ages engage in at least 150 minutes of physical

activity weekly.

As the program moves forward, Monique aims to address the fact that the participants are

almost exclusively female. Males belong to senior centers; however, they do not

participate in the walking groups led by the Walk it Out! program. She claims, “There are

mostly females at the walking groups. There are more senior women anyway, but across

all ages women participate more in group physical activities”xxxii

.

According to Monique, elderly males argue that they prefer to run instead of walking.

While running is another low-cost form of physical activity, there are liability issues in

leading a running group. Overall, Monique emphasizes, “You have to make walking fun

in order to motivate people”xxxiii

.

Walk NYC Program Background

Walk NYC is a walking for fitness partnership between the New York City Department

of Parks and Recreation and Empire Blue Cross Blue Shield. The program is held at

recreation centers citywide and is open to all ages. Empire BCBC provides funding to

Parks and Recreation in order to finance certified walking instructorsxxxiv

. In addition to

hiring and training instructors, Parks and Recreation provides the space (recreation

centers) for participants to meet and promotes the program. Walk NYC is in its second

year after launching in June of 2010xxxv

and is currently operating in all five boroughs,

including all of the five high-needs communities.

May 27th

2011 Page 20 of 53

Walk NYC Findings

While participating in a Shape-Up class at the Thomas Jefferson Recreation Center, team

members noticed a sign advertising the Walk NYC program. Through an interview with

John Falzon, the center manager of the Thomas Jefferson Recreation Center, the team

gathered additional information about the Walk NYC programxxxvi

. According to Falzon,

Empire BCBC approached Parks and Recreation about starting a walking for fitness

program because they want to target blood pressure and promote fitness, particularly

among senior citizens. Falzon believes that Empire BCBS thinks that walking groups will

attract their target audience, senior citizens, because it is low impact and a social activity.

Empire sponsors the program by providing funds so that Parks and Recreation can recruit

and hire certified instructors. Parks and Recreation also provides the space and

advertisement throughout all five boroughs.

The Walk NYC program began citywide the week of April 18, 2011 and concludes in

December. At the Thomas Jefferson Recreation Center, located in East Harlem, the

walking group meets outside of the center three times a week on Mondays, Wednesdays,

and Fridays from 10:00 a.m.- 11:00 a.m. According to Falzon, the group will start their

walk by circling the tracks at the center and then they will walk down the East River

Walkway. If there is inclement weather, Falzon forecasts that the group will engage in

indoor activities at the Recreation Center.

Empire BCBS has a target attendance of 25 participants per class; however, John Falzon

predicts that participants may complain that it‟s “too hot or too cold outside”xxxvii

, which

will affect attendance during NYC‟s hot summers and cold winters. If the “Walk NYC”

program does not meet their goal of 25 people per class, it will be cancelled at the low

turn-out locations. In addition, Falzon worries that, “when something is free, people

don‟t take advantage because it‟s not exciting.”

According to Falzon, Adrian Benepe, the Commissioner of the Department of Parks &

Recreation, is aware of budget cuts and is searching for alternative resources for funding.

The “Walk NYC” program is a perfect example of a partnership that offers the

community a free program while not affecting NYC‟s budget.

The team decided that the Walk NYC program was an interesting walking group to

observe since it is a private/public partnership that reduces city spending on physical

activity programs. We returned to the Thomas Jefferson Recreation Center on

Wednesday April 27th

hoping to participate in the walking group and collect feedback

from participants and the instructor. However, after a half hour, neither the instructor nor

any participants had arrived. We spoke with a security guard and she told us that that the

walking instructor had only showed up on the first day, April 18th

, and had not returned

since. On the previous Wednesday, two participants arrived but left after the walking

instructor did not show up. We decided to try again on Friday April 29th

, but no one

showed.

The advertising for the Walk NYC program is a flyer with the text, “free fitness walks led

by experienced instructors,” and has the following slogan: “Get out to the park and walk

May 27th

2011 Page 21 of 53

the City!” Our research indicates that this may not be enough to motivate people to

engage in this program.

Top Key Recommendations

In order to lower overall costs, we recommend that the piloted walking program in East

Harlem utilize student volunteers in place of hiring certified walking instructors. The

program should partner with academic institutions that offer Public Health programs or

other health related majors because these students will most likely understand the benefits

physical activity has on overall health. Lessons learned from the Walk it Out! program

show that accountability is necessary for program credibility. Therefore, student

volunteers must be enrolled in a for-credit class that deducts points for unexcused

absences and no-shows.

The program should partner with a nonprofit organization that is willing to offer indoor

space as an alternative to outdoor activities during inclement weather. It is important that

the walking program continue to run regardless of weather and climate changes. This will

ensure that participants are not turned-off when the program is cancelled due to weather.

There is evidence that offering incentives to participants is an effective motivator for

participating in a walking group. A low-cost option would be to partner with a private

sector corporation that can fund or offer healthy lifestyle incentives such as water bottles,

pedometers, and jump ropes.

We recommend that the program offer multi-generational activities and promote peer

bonding. In addition to student volunteer walking instructors, a peer walking instructor

should lead the week alongside the student. This allows for group ownership and

promotes peer bonding.

The program should be multi-dimensional and include educational, social and “walking

with a purpose” components. Evidence from the Walk NYC program shows that

promoting a program as walking solely for fitness may not be enough to motivate

participants to engage in walking groups.

An additional study of walking groups in NYC‟s other high-needs neighborhoods may be

helpful in fully understanding how to motivate people to engage in group and individual

physical activity. It will also offer additional insight on strategies for running a low-cost

walking group program.

May 27th

2011 Page 22 of 53

Deliverable III: Shape-Up Feasibility Study

Introduction

Gaining an understanding of Shape Up NYC and its participants is a critical component

to finding best practices as relates to executing a free-to-low-cost physical activity

program for high-needs New York City neighborhoods.

Conducting surveys of Shape Up NYC is designed to answer several questions, all of

which will feed into our proposal for a pilot program.

Quantitatively, we need to understand who attends Shape Up NYC classes; which classes

they attend; how many, if any, would be open to paying to participate in a physical

activity program; how many have and would potentially participate in walking groups;

and, to determine multi-generational participation, how many have children present in the

household.

Qualitatively, we need to understand how well Shape Up NYC meets their physical

activity interests and needs; if a substitute program carried out by a nonprofit with a

requirement to pay would meet their needs similar to Shape Up; and how having children

present impacts their time to participant and if a program that brings together parent and

child would empower parents to participant more often.

Our surveys across several Shape Up classes spanning the three high-needs

neighborhoods specified by the DOHMH have answered these questions and have

provided us with the necessary information to craft a credible proposal for a pilot

program.

Methodology

Surveys were designed using Survey Monkey and take into account age, gender, location

of class, and queries that would satisfy the quantitative and qualitative requirements

discussed in the preceding section.

Participants across the three boroughs of highest need were approached prior to

commencing their Shape Up class, with the consultant taking the participant through the

survey asking the participant the designed questions. The consultant manually entered all

participant answers into Survey Monkey for analysis.

May 27th

2011 Page 23 of 53

High-Level Findings

The consulting team spoke to fifty-three participants, all female. As the chart below

shows, an aggregate of 87% of all Shape Up respondents are between the ages of 35-64.

Participants by Age

25%

32%

30%8% 6%

25-34 35-44 45-54 55-64 65+

A similar percentage of respondents said they have an interest in participating in a

walking group. Additionally, of those in the 45-54 age group, 100% said they would be

interested in leading a walking group.

May 27th

2011 Page 24 of 53

Interest in Walking Group by Age

5%5%28%

36%

26%

25-34 35-44 45-54 55-64 65+

The below chart illustrates that the majority of respondents, 53%, said they are not

willing to pay a fee to participant in a physical activity program, while slightly more than

one third, 38%, said they would be willing to pay between one and five dollars. Only 9%

said they would be willing to pay more than five dollars.

53%38%

9%0%

10%

20%

30%

40%

50%

60%

Will Not Pay Under $5 Over $5

% Willing to Pay

May 27th

2011 Page 25 of 53

Survey results indicate areas for program growth, most specifically as relates to the types

of classes to offer. Our findings show that more than half, 53%, would like to see more

dance classes, dance being an umbrella term that includes belly, salsa, zumba, and

meringue dance forms as an aggregate. Both aerobics and yoga were also mentioned as

classes respondents were interested in but could not find in their local areas.

53%

18% 18%

0%

10%

20%

30%

40%

50%

60%

Dance

Classes

Aerobics Yoga

% Requesting More Classes

Answers regarding multi-generational activity were revealing. Eighty-seven percent

reported that they have children present in the household. Of those, 33% said caring for

their children‟s needs limits their access to physical activity to some degree. Of those,

100% said they would bring their children to a physical activity program provided that

the program brings together the parent and the child. This does not necessarily mean the

parent and the child must be taking part in the same activity together, but that the parent

and the child are in the same venue with easy access to each other in case a need arises.

High-Level Borough by Borough Findings

The following is a breakdown of the more salient findings by borough.

In all cases, the 35-64 age range dominates:

May 27th

2011 Page 26 of 53

Age Group by Borough

East Harlem 25-34 7.4%

35-44 33.3%

45-54 37.0%

55-64 18.5%

65+ 3.7%

Brooklyn

25-34 6.7%

35-44 26.7%

45-54 13.3%

55-64 46.7%

65+ 6.7%

Bronx

35-44 42.9%

45-54 57.1%

East Harlem shows demand for innovative programming, both in terms of walking

groups and dance classes:

Walking Group Participation by Borough

East Harlem 61%

Brooklyn 35%

Bronx 4%

In most cases, participants say they are not willing to pay for a physical activity program;

if asked to pay, the cost must remain under $5 to achieve a turnout:

Willing to Pay by Borough

East Harlem

No 48.1%

Under $5 33.3%

Over $5 18.5%

Brooklyn

No 46.6%

Under $5 53.3%

Over $5

Bronx

No 85.7%

Under $5 14.2%

Over $5

May 27th

2011 Page 27 of 53

There are opportunities to grow programs to meet interests:

Request for More Programs by Borough

East Harlem

Dance 35.7%

Aerobics 28.5%

Yoga 14.2%

Brooklyn

Dance 60%

Aerobics 20%

Yoga

Bronx

Dance 33.3%

Aerobics 66.6%

Yoga

Multi-generational activity represents an opportunity for program innovation:

Children Present by Borough

East Harlem 41.5%

Brooklyn 24.5%

Bronx 13.2%

Top Key Recommendations

Program messaging and initiatives should target a female constituency between the ages

of 35-64, with an emphasis on women in the 45-54 age group.

There is a clear demand for dance classes; sourcing dance instructors with diverse

experience in offering different forms of dance as physical activity will meet the interests

of the core constituency and generate greater turnout.

Keeping cost-to-participant low is critical; creating a self-sustaining model can be done

through proper, in-demand programming, such as offering a variety of dance; careful

targeting of the core constituency; and requiring a modest fee not to exceed five dollars.

Additional study may be helpful to determine if a pay-as-you-go pricing model would be

best, or if a one-time fee for a set number of weeks would be an option. Furthermore,

determining price elasticity of demand would also prove beneficial to find the

intersection between the right price and where maximum weekly participation occurs.

May 27th

2011 Page 28 of 53

Deliverable IV: Nonprofit Assessment of Physical Activity

Programming and Partnership

Introduction

In light of forecasted budget-cuts, the New York City Department of Health and Mental

Hygiene must investigate alternative strategies that can sustain physical activity

programming. Addressing obesity and inactivity is a necessary step towards overall city

health, particularly in NYC‟s high-needs communities. So far, NYC‟s Shape-Up program

has effectively provided group fitness classes for people in all boroughs. However,

funding is limited and these programs are at risk of being cancelled.

The chronic diseases associated with obesity (i.e., heart disease, hypertension, and type 2

diabetes) disproportionately affect the residents in these five targeted communities.

Considering the health benefits of being active, physical activity programming cannot be

cut from vulnerable high-needs communities.

We need to investigate if nonprofits that are already conducting physical activity

programming are willing to collaborate with the city in its efforts in combating obesity.

Additionally, we must expand partnerships beyond nonprofits that already provide

similar programming and seek out nonprofits that we can learn from.

The goal is to create a physical activity program that will be free to participants and low-

cost to the program organizers.

Methodology

We designed a nonprofit assessment questionnaire on Survey Monkey and Javier Lopez,

director of the Strategic Alliance for Health, and Stacey Flanagan, director of

Neighborhood WIC at Public Health Solutions distributed it via their listservs. The 16-

question survey sought to investigate if NYC based nonprofit organizations would be

interested in partnering with the Department of Health and Mental Hygiene in its physical

activity initiatives. We asked nonprofits who are engaged in physical activity programs to

specify which activities they offer (walking groups, group fitness classes, recreational

sports, etc.).

We asked respondents if they targeted low-income communities and asked them to

specify their funding sources. Additionally, the survey asked which age groups they

target, how often they run their physical activity programming and in which community

their services targeted.

The survey asked if nonprofits were interested in partnering with the DOHMH. Those

who replied yes were asked what resources they could offer (space, equipment, support

staff, interns and funding assistance). Additionally, we asked respondents to describe

their physical activity programming if they believed it to be innovative.

May 27th

2011 Page 29 of 53

Findings

The team received a limited response to the nonprofit assessment survey. However, we

were able to pick seven nonprofits that we believe are possible candidates for a

partnership with the DOHMH. The chosen organization‟s contact information,

background information, and highlights from their responses are summarized below:

1. Organization: CHALK at New York-Presbyterian Hospital Columbia University

Medical Center

Contact name: Stephanie Pitsirilos-Boquin

Contact Email Address: chalk@nyp.org

Contact Phone Number: 212.305.2771

CHALK at New York-Presbyterian Hospital Columbia University Medical Center is a

nonprofit that focuses on health care (including hospitals, mental health, and medical

research). This nonprofit caters to children up to the age of 12 in low-income

communities. This organization receives funding through government grants. CHALK

focuses on physical activity programming programs focusing on group fitness classes,

recreational sports and family fitness night at the Y. These events take place up to ten

times a month. The organization feels that their program is innovative and they focus on

culturally appropriate sports. CHALK currently partners with the YM and YWHA, J's

Big Gym-Asociacion de Mujeres Progresistas, and Parks Department. CHALK is

interested in partnering with the NYC Department of Health and Mental Hygiene‟s

physical activity initiatives, and would be able to offer funding assistance, interns, and

exercise supplies (jumping ropes, balls, pedometers). CLIMB recently partnered with

SHAPE UP NYC as well.

2. Organization: Northern Manhattan Perinatal Partnership, Inc.

Contact Name: Maria Guevara

Contact Email Address: nmpp_chwp@yahoo.com

Contact Phone Number: 212.289.8800

ZIP: 10035

Northern Manhattan Perinatal Partnership, Inc. is a nonprofit that focuses on human

services in Manhattan. This organization focuses on thirteen year olds and up in low-

income communities. They currently receive funding from government grants. Northern

Manhattan Perinatal Partnership, Inc. currently does not focus on physical activity

programming but is interested in implementing physical activity programming. Northern

Manhattan Perinatal Partnership, Inc. is interested in partnering with the NYC

Department of Health and Mental Hygiene‟s physical activity initiatives, and would be

able to offer space including indoor and outdoor space.

May 27th

2011 Page 30 of 53

3. Organization: Fort Tryon Park Trust

Contact Name: Nancy Bruning

Contact Email Address: nbruning@aol.com

Contact Phone Number: 646.318.8544

ZIP: 10040

Fort Tryon Park Trust is a nonprofit that focuses on recreation and sports, community

improvement, and capacity building in Manhattan. The organization focuses on all age

groups and low-income communities. The organization receives funding through

donations, fundraising, government grants, private grants, and nonprofit grants. Fort

Tryon Park Trust focuses on physical activity programming and focuses on walking

groups and group fitness classes. These activities run between 21 to 30 days a month

when the weather is in good condition, and less physical activity programs are offered in

the winter. Fort Tryon Park Trust believes that their physical activity programming is

innovative because they follow a “Green Exercise” Philosophy. It goes all year round,

and uses only the park's features and furniture; it is led by trained fitness professionals

and has been in operation since 2004.

This program is supported with a printed brochure providing instructions for 10 exercises

in addition to 10 suggested routes through the park which range from easy to moderate to

intense. A 15-minute DVD/video "101 Things to Do on a Park Bench" has just been

released to further support the use of park benches for a range of exercises that are

designed to improve flexibility, strength, and balance. This program is complemented in

the summer with Tai Chi, Yoga, Dance, and Qigong classes led by certified volunteers.

All classes are free and open to all levels.

Fort Tryon Park Trust is interested in partnering with the NYC Department of Health and

Mental Hygiene‟s physical activity initiatives and would like to have help distributing the

15-minute video, "101 Things to Do on a Park Bench", which motivates and inspires

people to use their parks for exercise on their own and in informal groups, without the

need for special, expensive, or inconvenient equipment. The video helps people go

beyond just walking or jogging to do a complete workout including strengthening

exercises, as the government recommends.

Fort Tryon Park Trust partners with CLIMB (City Life is Moving Bodies), PS 187,

Asociacion de Mujeres Progresistas, The YM/YWHA on Nagle Ave, and CHALK in

physical activity initiatives. Fort Tryon Park Trust is interested in partnering with the

NYC Department of Health and Mental Hygiene‟s physical activity initiatives, and would

be able to offer support staff (trainers, instructors) space including indoor and outdoor

space.

May 27th

2011 Page 31 of 53

4. Organization: Randall's Island Sports Foundation

Contact Name: Laurence Vargas

Contact Email Address: laurence.vargas@parks.nyc.gov

Contact Phone Number: 212.860.1899

ZIP: 10023

Randall‟s Island Sports Foundation is a nonprofit that focuses on recreation and sports in

Manhattan, Bronx, and Queens. This organization focuses on physical activity

programming for all ages. Randall‟s Island Sports Foundation receives funding from

donations, fundraising, government grants, income generating activities, private grants,

and nonprofit grants. The physical activity programming focuses on walking groups,

group fitness classes, recreational sports, water sports, and bicycling. These activities

occur during March through November from 21 to 30 days a month.

The organization feels that their physical activity programming is innovative because

they partner with a wide variety of CBOs, schools, and other groups. They also offer

unusual sports like rugby and golf. The nonprofit partners with Department of Education

PSAL and CHAMPS in its physical activity initiatives. Randall‟s Island Sports

Foundation is interested in partnering with the NYC Department of Health and Mental

Hygiene‟s physical activity initiatives, and would be able to offer space, especially the

park, during weekdays before 3pm. They need outreach and funding from the

department of health to assist their physical activity programming.

5. Organization: Mount Sinai SOM/Little Sisters of the Assumption

Contact Name: Perry Sheffield

Contact Email Address: perry.sheffield@mssm.edu

Contact Phone Number: 212-241-2265

ZIP: 10029

Mount Sinai SOM/Little Sisters of the Assumption is a nonprofit that focuses on health

care in Manhattan, Bronx, Brooklyn, and Staten Island. The organization focuses on ages

0 to 19 in low-income communities. The organization earns funding through donations,

government grants, and private grants. Mount Sinai SOM/Little Sisters of the

Assumption focuses on walking groups, recreational sports, and after school activities for

children. The nonprofit runs the physical activity programs from 1 to 10 days a month.

The organization feels that their physical activity programming is innovative because

they combine nutrition, exercise education, and practice for children from low-income,

mostly 1st generation American Latino group. Mount Sinai SOM/Little Sisters of the

Assumption is interested in partnering with the NYC Department of Health and Mental

Hygiene‟s physical activity initiatives, and would be able to offer funding assistance.

May 27th

2011 Page 32 of 53

6. Organization: FC HARLEM

Contact Name: Irvine Smalls, Executive Director

Contact Email Address: irv.smalls@fcharlemlions.org

Contact Phone Number: 917 572 1994

ZIP: 10026

FC HARLEM Assumption is a nonprofit that focuses on recreation and sports in

Manhattan. The nonprofit focuses on 19 and under ages in low-income communities. The

organization earns funding through donations, fundraising, and government grants. FC

HARLEM Assumption focuses on physical activity programming especially recreational

sports 1 to 10 days a week.

The nonprofit feels that their physical activity programming is innovative because they

utilize small spaces to teach the game of soccer similar to how it‟s done in Latin

American and African countries. FC HARLEM Assumption is interested in partnering

with the NYC Department of Health and Mental Hygiene‟s physical activity initiatives,

and would be able to offer funding assistance, space, exercise supplies, support staff, and

interns.

7. Organization: Partnerships for Parks - Catalyst Program

Contact Name: Carlos Martinez

Contact Email Address: Carlos.Martinez@cityparksfoundation.org

Contact Phone Number: 212-788-8067

ZIP: 10007

Partnerships for Parks is a nonprofit organization that focuses on recreation and sports,

youth development, community improvement and capacity building, foundations, and

philanthropy. The organization focuses on Manhattan, Bronx, Queens, Brooklyn, and

Staten Island. The nonprofit focuses on all age groups and low-income communities. The

organization receives funding through donations, fundraising, government grants, private

grants, and nonprofit grants. Partnerships for Parks focuses on physical activity programs

including walking groups, group fitness classes, recreational sports, water sports, and

bicycling 21 to 30 days a month.

They believe their physical activity programs are innovative. Partnerships for Parks and

its Catalyst for Neighborhood Parks is a multi-year initiative, working in historically

under-served neighborhoods that galvanize support for and commitments to: physical

renovations of the parks; sports, arts, and education programming; local parks

stewardship; and collaborative work amongst the partners, including those between the

communities and municipal agencies. Partnerships for Parks are currently working on a

project that the Department of Health and Mental Hygiene physical activity initiative

would be able to assist. For their project, they would need assistance accessing resources

for local groups, physical activity volunteers, and healthy programs for low-income

communities.

May 27th

2011 Page 33 of 53

They are currently partnering with CityParks Foundation in its physical activity

initiatives.

Partnerships for Parks is interested in partnering with the NYC Department of Health and

Mental Hygiene‟s physical activity initiatives, and would be able to offer funding

assistance, space, exercise supplies, support staff, and interns.

Top Key Recommendations

We recommend that the Department of Health and Mental Hygiene consider partnering

with the seven selected nonprofit organizations. Collaborating with nonprofits will allow

the DOHMH to receive support in its physical activity programming in the form of

indoor and outdoor space, funding opportunities, trainers, interns, equipment and other

resources.

In addition, four out of the seven selected nonprofits have already implemented walking

groups in their physical activity programming. We recommended that the DOHMH

analyze their practices and put them at the top priority of future partnerships.

Also, as highlighted in our findings, the DOHMH can apply innovative components of

the selected nonprofits to its own programming.

Finally, five of the selected nonprofit organizations already collaborate with other

organizations. We can learn from these partnerships and they can offer additional

connections and resources for the DOHMH.

May 27th

2011 Page 34 of 53

Deliverable V: Business Wellness Survey

Introduction

Our business wellness deliverable was created in order to develop possible partnerships

between private organizations and the Department of Health and Mental Hygiene.

Fostering these partnerships is crucial for the DOHMH given that its physical activity

programs such as Shape-Up are subject to budget cuts. There must be secured capital for

funding, as well as interested parties to participate.

Stressing the importance of good health and an active lifestyle should start where a large

majority spend most of their day, at work. Implementing an employee wellness program

can lower the overall cost of healthcare and increase the health of employees. Taking

initiatives to improve the health of employees can lower the amount of doctor visits they

make, lowering the cost of healthcare for businesses and lowering the amount of sick

days employees would take from work. Furthermore, when employees are healthy their

productivity is bound to increase and improve. We took the initiative to understand

whether or not businesses throughout the South Bronx, Harlem, and Brooklyn already

take part in a business wellness program or would be interested in partnering with the

DOHMH to establish such a program.

Methodology

The first step in this analysis was to develop a survey to measure the following: how

many companies offer full time employees health insurance, how many businesses are

currently offering wellness incentives to their employees, and finally, how many of these

organizations would be willing to partner with the DOHMH. It is important to determine

the rate of health insurance offered to full time employees as health insurance is the first

step to leading a healthy lifestyle.

Examples of wellness incentives include: offering non-smokers breaks for exercise or to

get fresh air, reimbursement or free gym memberships, and money for quitting smoking..

While few businesses surveyed actually have these incentives in place, a large majority of

the employees said they would participate in the programs if they were offered. The final

step in our survey process was to determine how many private businesses would like to

partner with the DOHMH on future endeavors. This response was about half, many of

these companies already partner with other local businesses, but were not connected to

the NYC health community.

The survey was conducted throughout the South Bronx, East Harlem, and Central

Brooklyn among 27 different businesses. These businesses included fast food franchises

(ie. Taco Bell, Subway, Dominos), other franchises (ie. weight loss centers),

independently owned establishments, and corporate chains.

May 27th

2011 Page 35 of 53

Overall Findings

70% of the 27 surveyed businesses offer their full time employees health insurance.

4% offer wellness incentives to their employees in the form of reimbursements/free gym

memberships, or financial incentives to take the stairs instead of the elevator or escalator.

89% of businesses reported that their employees would take advantage of wellness

incentives if they existed in their establishment.

52% are interested in partnering with the DOHMH to establish a business wellness

program and/or offer incentives.

15% are already partnered with local gyms, restaurants, and other businesses offering

incentives to their employees

Borough-to-Borough Findings

All East Harlem and South Bronx businesses that we surveyed do not already partner

with local businesses to offer incentives to their employees.

4 out of 6 businesses in Central Brooklyn have partnered with local businesses.

3 businesses in East Harlem, 6 in Central Brooklyn, and 5 in the South Bronx, out of the

27 total surveyed businesses, are interested in partnering with the DOHMH to increase

business wellness programs and initiatives.

May 27th

2011 Page 36 of 53

Top Key Recommendations

Develop a generic partnership plan for any interested businesses wanting to team up with

the DOHMH to provide comprehensive business programs and initiatives for their

employees.

Encourage businesses to provide health insurance to all of their employees and provide

an informative database of affordable health insurance options.

Become a liaison for businesses wanting to partner with other local businesses to provide

employees wellness incentives.

May 27th

2011 Page 37 of 53

Deliverable VI: Grant Proposal to Fund Pilot Program

EXECUTIVE SUMMARY

Given the increase in obesity rates in the United States and in New York City

specifically, the New School Practicum Team set out to determine the feasibility of

increasing access to free or low-cost physical activity programs among three low-income

neighborhoods, specifically East and Central Harlem, North and Central Brooklyn, and

the South Bronx. Through national and international comparative analyses, on-the-

ground quantitative/qualitative surveying, research of applicable best practices, and an

assessment of how to effectively operate a self-sustaining program without reliance on

city funds, the team has established several key recommendations on how best to carry

out programming that will increase access for the three low-income neighborhoods noted

previously. Recommending a six-month pilot program in East Harlem, a minimum

participant goal of 1,800 participants has been established for the period, followed by

roll-outs in Central Brooklyn and the South Bronx, subsequent to a period of performance

evaluation. By creating greater accessibility to physical activity programming not subject

to city budget cuts, persons residing in the communities in question will have the

opportunity to participate in activities that will reduce the negative effects of an

unhealthy lifestyle, thereby reducing health care costs over the long term. This grant will

include: the organization mission statement; a thorough project description, both short

and long term goals which will also include methodology, the use of incentives, staffing

procedures, and potential partnerships with non-profit organizations. The grant will also

highlight a budget proposal, timeline and project duration, and evaluation strategy.

May 27th

2011 Page 38 of 53

STATEMENT OF NEED

Data shows that regular physical activity can reduce obesity and obesity related illnesses,

which are endemic in NYC. According to the Department of Health, over 42% of New

Yorkers are overweight, while more than 700,000 have diabetes. Through program

evaluation methods using surveys and assessments, it has been determined that walking

groups are in fact feasible in the high-needs neighborhoods, as long as the program

provides incentives for participants. These programs can allow better health and

increased quality of life for people living in: the South Bronx, East and Central Harlem,

and North and Central Brooklyn. As a result, we are expecting to see: reduced obesity-

related illness within these communities, decreased dependence on medications, and

fewer trips to the hospital. It is also likely that greater physical fitness and awareness will

result in overall lifestyle changes such as improved eating habits and greater mental

wellness. Our conclusions and basis for our project are based on best practices of current

programs such as Walk It Out and Shape-Up. Having surveyed Shape-Up participants in

the formally mentioned neighborhoods, our data indicated that women ages 34-54 are

more willing to participate in walking groups. They are also demanding more physical

activity programs, such as outdoor walking groups and are willing to pay an average of 5

dollars to participate. The women we surveyed throughout the three boroughs mentioned

how effective programs such as Shape-Up are in relation to their fitness goals.

Anecdotally, some also said that they have seen greater results from these classes than

they could ever get from a gym: “I lost 20 pounds since I began the Shape-Up program in

October” said one of the participants. Unfortunately, because of a lack of space, these

classes are unable to meet the demands of the participants. In East Harlem, women stand

in line for over an hour to receive an entry ticket, and some even fight for a spot in line. It

is critical that the DOHMH establish new programs to fit the demands of the public, as

well as continue to provide support for current physical activity programs. Without the

establishment of walking groups or other physical activity programs, the DOHMH‟s goal

of reducing the impact of obesity will fail.

May 27th

2011 Page 39 of 53

ORGANIZATION MISSION STATEMENT

The New York City Department of Health and Mental Hygiene (DOHMH) is one of the

oldest health departments in the nation. The DOHMH stands out among local health

departments in its level of commitment to, and its activities in chronic disease prevention

and control. Recent domestic and internationally progressive initiatives include the

introduction of regulations that ban trans fats and that require calorie labeling in NYC

restaurants.

The DOHMH is also involved in active living through addressing opportunities for daily

physical activity through environmental change. Initiatives include both Take the Stairs

Campaign, as well as Active Design Guidelines, which were launched in January 2010

(www.nyc.gov/adg). Additionally the District Public Health Offices of DOHMH, focus

agency resources in the three poorest communities in New York City, and seek to reduce

the gaps in health between these and other NYC neighborhoods.

PROJECT DESCRIPTION

Goals and Objectives

Short Term Outputs

That the implementation of walking groups and activities will engage/interest

community members. The goal is to maintain an excellent turnout, which will be

measured by a minimum of 25 people per walking group; a total of 75 participants

per week. In the six-month period of the pilot program in East Harlem, we will expect

a minimum of 1,950 participants in a total of 78 classes to consider the program as

successful before rolling it out to the other high-needs neighborhoods: Central

Harlem, East and Central Brooklyn, and the Bronx.

Community members will play an active role in the walking group programs.

Partnering with Universities such as Columbia, NYU, and the New School, will allow

students to lead the walking groups, which will create room for community

leadership, ties, and intergenerational interaction.

May 27th

2011 Page 40 of 53

The financial component to the classes will motivate and interest community

members to take part in the walking groups. We would keep the walking group at no-

cost to the individual, while also providing a loyalty program through the use of

incentives such as: heart rate monitors, pedometers, jump ropes, t-shirts, water bottles

etc., to keep participants engaged and interested.

Long Term Outputs:

The walking group will roll-out into all high-needs neighborhoods

These programs will be self-sustaining, and sustained through private-public

partnerships with nonprofit organizations. Classes and activities will continue to

operate at low-or-no-cost.

The activities will have a high-turnout rate with more individuals in the community

engaging in walking groups; they will reduce BMI and blood pressure levels.

Obesity, and obesity related illnesses will have decreased in the high-needs

neighborhoods by a minimum of 20%.

Methodology

The walking group pilot program will target female participants ages 34-54, and will take

place from April 1st – October 31

st 2012 for a six-month duration. In Year 1, the pilot

program will first commence in East Harlem due to the great demand, turnout and

feedback received from surveyed participants attending Shape-Up classes within this

neighborhood. Evaluation and monitoring will occur throughout the entire pilot program

(April 1st – October 31

st 2012), and will extend for 2 months (November-December 2012)

after the end date in order to ensure that data is collected and analyzed effectively.

Success will be measured by: the number of participants who attend walking groups and

the percentage of those who lower their BMI, and blood pressure. In year 2 (2013), after

determining the program‟s success through thorough evaluation, walking groups will

then be replicated in Central Brooklyn. In year 3 (2014), if the program continues to

show growth and success, walking group programs will be implemented throughout all of

May 27th

2011 Page 41 of 53

NYC‟s high-needs communities, which include Central Harlem, North and Central

Brooklyn and the South Bronx.

Sessions:

Walking group sessions will be held 3 days a week: Monday/Wednesday/Friday from

9:00am – 10:00am. We expect a minimum of 25 participants per walking group. The 60-

minute session will include 10 minutes of stretching prior to 40 minutes of walking, and

another 10 minutes of cooling down and stretching to avoid injury.

Incentives:

As a means to keep participants engaged in these activities, we will provide a loyalty

program which will include incentives to attend the walking groups. On an individuals

first time attending a walking group, they will receive a T-shirt, which will also act as

free advertisement. Day 5, they will receive a water bottle, day 10 – a pedometer, day 20

– jump ropes, day 30 – heart rate monitor, day 40 – blood pressure cuffs, etc.

Personnel:

Personnel include the following: monitoring and evaluation coordinators, focus group

leaders, facilitators, and walking group leaders. Through the evaluation of best practices,

we have determined that we can lower our costs by collaborating with NYU, Columbia,

and the New School Universities public health departments for student volunteers and

interns. Student volunteers will be trained and certified in CPR and first aid to become

walking group leaders. Student interns can work as monitoring and evaluation

coordinators, focus group leaders and facilitators for academic credit. Through the use of

student volunteers, we also expand community ties, and intergenerational activity. If

student volunteers are determined to not be feasible due to liability issues, we will then

hire certified trainers at $100 an hour.

May 27th

2011 Page 42 of 53

Potential partnerships with nonprofits:

The following table (Table 1) presents the nonprofit organizations that are currently

interested in partnering with the DOHMH to implement walking groups, and who can

provide support through staff, incentives, venue, data, etc.

Table 1: Possible Partnerships with Non-Profit Organizations

Non-Profit

Organization

Contact Name:

Email:

Phone:

About the Organization Their interest What they can

provide in

partnering with

the DOH CHALK at New

York-

Presbyterian

Hospital

Columbia

University

Medical Center

Stephanie Pitsirilos-Boquin

chalk@nyp.org

212-305-2771

Focuses on health care

including hospitals, mental

health, and medical research

This organization receives

funding through government

grants

CHALK focuses on

physical activity

programs, particularly on

group fitness classes,

recreational sports and

family fitness

Would be able to

offer funding

assistance, interns,

and exercise

supplies (jump

ropes, balls,

pedometers).

Northern

Manhattan

Perinatal

Partnership, Inc.

Maria Guevara

Nmpp_chwp@yahoo.com

212-289-8800

Focuses on human services

in Manhattan. This

organization focuses on

ages thirteen and up, in low-

income communities. They

currently receive funding

from government grants

Currently does not focus

on physical activity

programming but are

interesting in

implementing physical

activity programming.

Would be able to

offer space

including indoor

and outdoor space.

Fort Tryon Park

Trust

Nancy Bruning

nbruning@aol.com

646-318-8544

Fort Tryon Park Trust is a

nonprofit that focuses on

recreation and sports, and

community improvement

and capacity building in

Manhattan. The

organization focuses on all

age groups and low income

communities. The

organization receives

funding through donations,

fundraising, government

grants, private grants, and

non-profit grants.

Focuses on physical

activity programming

and focuses on walking

groups and group fitness

classes

Would like to have

help distributing

the 15-minute

video, "101 Things

to Do on a Park

Bench", and would

also be able to

offer support

staff(trainers,

instructors) space

including indoor

and outdoor space.

May 27th

2011 Page 43 of 53

Randall’s Island

Sports

Foundation

Laurence Vargas

Laurence.vargas@parks.nyc.go

v

212-860-1899

Focuses on recreation and

sports in Manhattan, Bronx,

and Queens. This

organization focuses on

physical activity

programming for all ages.

Randall‟s Island Sports

Foundation receives funding

from donations, fundraising,

government grants, income

generating activities, private

grants, and nonprofit grants

The physical activity

programming focuses on

walking groups, group

fitness classes,

recreational sports, water

sports, and bicycling

Would be able to

offer outdoor space

during the

weekdays before

3pm. They need

outreach and

funding from the

department of

health to assist

their physical

activity

programming.

Mount Sinai

SOM/Little

Sisters of the

Assumption

Perry Sheffield

Perry.sheffield@mssm.edu

212-241-2265

Focuses on health care in

Manhattan, Bronx,

Brooklyn, and Staten Island.

The organization focuses on

ages 0 to 19 in low income

communities. The

organization earns funding

through donations,

government grants, and

private grants

Focuses on walking

groups, recreational

sports, and after school

activities for children.

Would be able to

offer funding

assistance

FC HARLEM Irvine Smalls

Irv.smalls@fcharlemlions.org

917-572-1994

Focuses on recreation and

sports in Manhattan. The

organization earns funding

through donations,

fundraising, and

government grants

Focuses on physical

activity programming

especially recreational

sports 1 to 10 days a

week

Would be able to

offer funding

assistance, space,

exercise supplies,

support staff, and

interns

Partnerships for

Parks-Catalyst

Program

Carlos Martinez

Carlos.Martinez@cityparksfou

ndation.org

212-788-8067

Focuses on recreation and

sports, youth development,

community improvement

and capacity building. The

organization focuses on

Manhattan, Bronx, Queens,

Brooklyn, and Staten Island.

The nonprofit focuses on all

age groups and low income

communities. The

organization receives

funding through donations,

fundraising, government

grants, private grants, and

nonprofit grants.

Focuses on physical

activity programs

including walking

groups, group fitness

classes, recreational

sports, water sports and

bicycling 21 to 30 days a

month.

Would be able to

offer funding

assistance, space,

exercise supplies,

support staff, and

interns.

May 27th

2011 Page 44 of 53

TIMELINE

PROJECT DURATION

Table 2: Timeline for East Harlem Walking Group Pilot Program

Timeline Narrative

Donor prospecting will take place from June – August of 2011. Once a list of funding

candidates is compiled, grant proposals outlining the pilot program will be sent out to

donors from September – December of 2011. Training instructors and personnel as well

as community outreach should run from January through April of 2012. The goal is to

begin the pilot program in East Harlem on April 1st

of 2012 until October 31st of the same

year, totaling 6 months. Evaluation and monitoring will occur throughout the entire pilot

program (April 1st – October 31

st 2012) and will extend for 2 months (November –

December) after the end date in order to ensure that data is collected and analyzed

effectively. If the pilot program is successful, we recommend that the program be

replicated in Central Brooklyn in 2013. In Year 3 (2014), the program will be

implemented in all of NYC‟s high-needs communities, which includes East and Central

Harlem, North and Central Brooklyn, and the South Bronx.

May 27th

2011 Page 45 of 53

BUDGET

We are requesting $1.2 million over a three-year period.

Budget: Walking Group Pilot Program

East Harlem

April - October

Mon/Wed/Fri

9AM - 10AM

Table 3: Budget with Student Volunteers

SCENARIO A

TYPE OF

EXPENSE

QTY AMOUNT REASON FOR EXPENSE

EQUIPMENT $5,860

Safety:

First Aid Kit 1 $60 Volunteer trained instructor will carry a first aid kit while conducting the walking

group should the need arise to provide care to a participant

Incentives:

Water Bottles 200 $800 Best practice shows that an incentive must be offered to drive participation; Start-

up volume purchased will be minimal; Incentives used in the form of a “frequent

buyer or loyalty program”; participation will be tracked with every 5th

visit

awarded with an incentive to continue. Variety of incentives to be widened to

include gift certificates and savings at neighborhood drug stores and

supermarkets

T-Shirts 200 $1,000

Pedometers 200 $4,000

PERSONNEL --

Certified instructor 1 -- In accordance with best practices, all personnel will be providing their services

pro bono M&E coordinators 2 --

Focus group leader 1 --

Creative designer 1 --

TRAVEL $1,560

Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receive reimbursement for

their MTA subway expenditures; Assumes $5 round-trip, 3x/week over 26 weeks M&E RT MTA 2 metro cards $780

FG leader RT MTA 1 metro card $390

MARKETING/

COMM

$20,000

Creative

(logo/messaging)

-- -- Assumes creative will be provided pro bono; Social media (Facebook, Twitter,

YouTube, targeted blogs), will be absorbed by the nonprofit staff or intern; Print

advertising, using the creative, must be carried out to drive awareness of the

walking groups and spur participation Online Social Media -- --

Print Advertising $20,000

TOTAL $27,420

We will ask for $30,000 per borough for the 6 month program

May 27th

2011 Page 46 of 53

Budget: Walking Group Pilot Program

East Harlem

April - October

Mon/Wed/Fri

9AM - 10AM

Table 4: Budget with Paid Staff and Trainers

SCENARIO B

TYPE OF

EXPENSE

QTY AMOUNT REASON FOR EXPENSE

EQUIPMENT $5,860

Safety:

First Aid Kit 1 $60 Volunteer trained instructor will carry a first aid kit while conducting the

walking group should the need arise to provide care to a participant

Incentives:

Water Bottles 200 $800 Best practice shows that an incentive must be offered to drive

participation; Start-up volume purchased will be minimal; Incentives

used in the form of a “frequent buyer or loyalty program”; participation

will be tracked with every 5th

visit awarded with an incentive to continue.

Variety of incentives to be widened to include gift certificates and

savings at neighborhood drug stores and supermarkets

T-Shirts 200 $1,000

Pedometers 200 $4,000

PERSONNEL $7,800

Certified instructor 1 $7,800 In the event a volunteer certified instructor cannot conduct the walking

groups, a certified instructor will require payment; this figure assumes a

high of $100/hour, 3x/week over 26 weeks M&E coordinators 2 --

Focus group leader 1 --

Creative designer 1 --

TRAVEL $1,560

Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receive

reimbursement for their MTA subway expenditures; Assumes $5 round-

trip, 3x/week over 26 weeks M&E RT MTA 2 metro cards $780

FG leader RT MTA 1 metro card $390

MARKETING/COMM $20,000

Creative (logo/messaging) -- -- Assumes creative will be provided pro bono; Social media (Facebook,

Twitter, YouTube, targeted blogs), will be absorbed by the nonprofit

staff or intern; Print advertising, using the creative, must be carried out to

drive awareness of the walking groups and spur participation

Online Social Media -- --

Print Advertising $20,000

TOTAL $35,220

We will ask for $40,000 per borough for the 6 month long program

May 27th

2011 Page 47 of 53

EVALUATION METHOD

Monitoring and evaluation will measure two key performance indicators:

Awareness among the residents of the presence of walking groups and its features

in the immediate neighborhood

The degree to which participating in the walking group is reducing Body Mass

Indices

Table 5: Are marketing tools informing the population and participants about the benefits

of walking groups?

Proposed Indicator

Target

Definition

Recommended level

Participant knowledge of the

benefits physical activity such as

walking groups can provide in

terms of improving overall

health, and reducing obesity

Women ages 34-54

Percentage of people

who know about

walking groups and

can identify at least 1

benefit

Minimum: 75%

Calculation

Numerator Number of survey respondents who are aware of walking groups and can identify

at least one benefit – multiplied by 100

Denominator Total number of respondents (Goal is minimum of 1,800 over six-month period)

May 27th

2011 Page 48 of 53

Table 6: Is the program effectively lowering participants Body Mass Index

Proposed Indicator

Target

Definition

Recommended level

Lower self-reported BMI as a result

of adherence and participation in

walking groups

Women ages 34-54

Proportion of

participants who have

self-reported BMI of

25 or below

Minimum:

20% of participants

seeing results and

lower BMI

Calculation

Numerator Total number of participants on April 1st 2012 – multiplied by 100

Denominator Total number of participants on October 31st 2012

Evaluation Method Narrative

Measuring awareness of the walking group will provide the non-profit organization, with

insight into how effectively they are targeting the core constituency, and how much reach

they are achieving within the target constituency. Additionally, this indicator will

evaluate the clarity of messaging and the appropriateness of the branding, both of which

will play a crucial role in driving participation. Finally, an awareness indicator will

provide insight into how well the overall value proposition is being messaged to and

interpreted by the target constituency. For example, the incentive package, the physical

benefits of participation, and the psychological benefits of participation must all be taken

into account to determine what is driving attendance or lack thereof.

May 27th

2011 Page 49 of 53

Measuring self-reported BMI will provide insight into how beneficial the walking groups

are to achieving a loss in weight. By providing participants with a pre/post report of their

BMI, participation in the walking groups could grow through word-of-mouth referrals,

while demonstrating to attendees that regular physical activity in a walking group,

coupled with their commitment to a balanced diet, provides them with a credible weight

loss and disease-reducing solution.

The timeline for the pilot program indicates a six-month pilot, with monitoring activities

taking place simultaneously. The timeline takes into account a two-month post-evaluation

period, where number of attendees (unique and returning), awareness of programming,

and resulting BMI‟s will be analyzed. Should the metrics indicate a success, roll-out for

Central Brooklyn will follow in January 2013 with a similar cycle of monitoring and

evaluation. Roll-out for the South Bronx would follow in 2014 provided the metrics from

East Harlem and Central Brooklyn indicate strong performance.

May 27th

2011 Page 50 of 53

REFERENCES

I: Comparative Analysis of Physical Activity Programs References

i "WHO Global Infobase: Country Profiles." Web. 30 Mar. 2011.

<https://apps.who.int/infobase/CountryProfiles.aspx>.

ii "ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June

2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1

iii

Rosenthal, Elisabeth. "Even the French Are Fighting Obesity." The New York Times. 4

May 2005. Web. <http://www.nytimes.com/2005/05/03/world/europe/03iht-obese.html>.

iv

"ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June

2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1

v "ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June

2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1

vi

"ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June

2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 2

vii

"ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June

2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>.

viii

Rosenthal, Elisabeth. "Even the French Are Fighting Obesity." The New York Times. 4

May 2005. Web. <http://www.nytimes.com/2005/05/03/world/europe/03iht-obese.html>.

ix

Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Options

for Responding to the Growing Challenge from Obesity in France: Findings from the

PorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing Service

Selection Page. 2007. Web. 26 Mar. 2011.

<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-

92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 1

x Bouges Tes Fesses." Prete Moi Paris. Web.

<http://pretemoiparis.com/2010/12/07/bouges-tes-fesses/>.

xi

"Barometre Sante Nutrition 2008." Barometres Sante. INPES. Web. 29 Mar. 2011.

<http://www.inpes.sante.fr/barometre-sante-nutrition-2008/pdf/activite-physique.pdf>

xii

Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Options

for Responding to the Growing Challenge from Obesity in France: Findings from the

PorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing Service

Selection Page. 2007. Web. 26 Mar. 2011.

May 27th

2011 Page 51 of 53

<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-

92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 1

xiii

"Eco-Sante OCDE 2010 Comment La France Se Positionne." OCDE. Web. 28 Mar.

2011. <http://www.oecd.org/dataoecd/45/20/38980771.pdf>. pg 1

xiv

Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Options

for Responding to the Growing Challenge from Obesity in France: Findings from the

PorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing Service

Selection Page. 2007. Web. 26 Mar. 2011.

<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-

92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 2

xv

Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Options

for Responding to the Growing Challenge from Obesity in France: Findings from the

PorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing Service

Selection Page. 2007. Web. 26 Mar. 2011.

<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-

92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 2

xvi

"EPODE - Together Let's Prevent Childhood Obesity." European Public Health

Alliance. Web. 26 Mar. 2011. <http://www.epha.org/a/3149>.

xvii

"EPODE - Together Let's Prevent Childhood Obesity." European Public Health

Alliance. Web. 26 Mar. 2011. <http://www.epha.org/a/3149>.

xviii

"Consultation Ouverte Pour Preparer Ensemble Le PNNS." Société Française De

Santé Publique. Web. 28 Mar. 2011.

<http://www.sante.gouv.fr/IMG/pdf/Consultation_ouverte_sur_le_site_de_la_Societe_Fr

ancaise_de_Sante_Publique_SFSP_pour_preparer_ensemble_le_PNNS-

_Restitution_des_propositions_et_actions_-_Automne_2010.pdf>.

Google Translate. Web. 30 Mar. 2011.

<http://translate.google.com/translate?hl=en&sl=fr&tl=en&u=http://www.mangerbouger.

fr/bouger-plus/espace-vitalite/bouger-c-est-facile.html>. pg 10

AFP. (2009, December 21). Taiwan „considering world‟s first junk food tax‟. Retrieved

From<http://www.google.com/hostednews/afp/article/ALeqM5hDETMvo0Cr0qUIGrWii

X4hz3OPIw>

Chu, N.F. (2005). Prevalence of obesity in Taiwan. Obesity Reviews, 6, 271-274.

International Association for the Study of Obesity. (2011). Obesity prevalence

worldwide. Retrieved from http://www.iaso.org/

May 27th

2011 Page 52 of 53

Lei, L. & Yue, T. (2011, February 25). Population urged to exercise more. China Daily.

Retrieved from http://www.chinadaily.com.cn/china/2011-02/25/content_

12075220.htm

Liang, G. & Hornby, L. (2009, October 22). China‟s elderly find life and joy in exercise.

Reuters. Retrieved from http://www.reuters.com/article/2009/10/22/us-china-

elderly-idUSTRE59L0R620091022

Taipei Times. (2011, February 8). DOH launches campaign to trim nation‟s waistline.

Retrieved from http://www.taipeitimes.com/News/taiwan/archives/2011/02/08/

2003495365/1

Taiwan Review. (2009, January 3). The Walk of Life. Retrieved from

http://taiwanreview.nat.gov.tw/site/tr/ct.asp?xItem=48269&CtNode=1337&mp=1

II: Walking Group Feasibility Case Study References

xix

The Earth Institute, Columbia University, Urban Design Lab. C.L.I.M.B (City Life is

Moving Bodies), 155 Street. Web.

<http://www.urbandesignlab.columbia.edu/?pid=climb>

xx

Metropolitan Waterfront Alliance. City Life is Moving Bodies.

CLIMB<http://www.waterfrontalliance.org/partners/city-life-moving-bodies-climb>

xxi

The Earth Institute, Columbia University, Urban Design Lab. C.L.I.M.B (City Life is

Moving Bodies), 155 Street.

Web.<http://www.urbandesignlab.columbia.edu/?pid=climb>

xxii

CLIMB Handout. Web.

<http://stnicholaspark.files.wordpress.com/2009/05/climb-handout-update-3-31-08.pdf>

xxiii

IOBY New York City. Hike the Heights 2011. Web.

https://ioby.org/project/hike-heights-2011

xxiv

Lourdes J. Hernández-Cordero, interview held over the phone, New York, New York,

May 3, 2011

xxv

Carla Zanoni, DNA.info, Annual Hike the Heights‟ Provides a Breath of Fresh Air for

Northern Manhattan Residents, 7 June 2010

< http://ec2-174-129-17-40.compute-1.amazonaws.com/20100607/manhattan/annual-

hike-heights-provides-breath-of-fresh-air-for-northern-manhattan-residents>

May 27th

2011 Page 53 of 53

xxvi

Lourdes J. Hernández-Cordero, interview held over the phone, New York, New York,

3 May 2011

xxvii

NYC.gov. Harlem Hospital Center, Press Release, 21 July 2010

<http://www.nyc.gov/html/hhc/harlem/html/news/press-hiphop-education.shtml>

xxviii

NYC.gov. Harlem Hospital Center, Press Release, 21 July 2010

<http://www.nyc.gov/html/hhc/harlem/html/news/press-hiphop-education.shtml>

xxix

Monique Hedmann, interview held over the phone, New York, New York, 5 May

2011

xxx

Monique Hedmann, interview held over the phone, New York, New York, 5 May

2011

xxxi

SAGE. Mission Statement. Web.

<http://www.sageusa.org/about/index.cfm>

xxxii

Monique Hedmann, interview held over the phone, New York, New York, May 5,

2011

xxxiii

Monique Hedmann, interview held over the phone, New York, New York, May 5,

2011

xxxiv

New York City Department of Parks and Recreation, Walk NYC<

http://www.nycgovparks.org/sub_things_to_do/programs/walk_nyc.html>

xxxv

New York City Department of Parks and Recreation. The Daily Plant. Volume XXV,

Number 5233, 7 July, 2010. Web.

<http://www.nycgovparks.org/sub_newsroom/daily_plants/daily_plant_main.php?id=222

12>

xxxvi

John Falzon, interview held at the Thomas Jefferson Park Recreation Center, New

York, New York, 16 April 2011

xxxvii

John Falzon, interview held at the Thomas Jefferson Park Recreation Center, New

York, New York, 16 April 2011