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Community Education Intervention Project:

Drink Up Philly Campaign Kick-Off













The Food Trust & The Partnership for a Healthier America
May 11, 2014
Heather Pavlik
Aramark Dietetic Internship

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OVERVIEW
In the next year, The Food Trust will partner with the City of Philadelphia
Department of Public Healths Get Healthy Philly initiative, the Philadelphia Water
Department, and other local partners to promote the national Drink Up campaign. The
Drink Up Philly campaign will aim to increase the availability and marketing of water in
Philadelphia corner stores, schools, farmers markets, and Night Market events. The
objective of the campaign will be to reach more than half a million Philadelphia residents
with the message that water is a healthy choice. This far-reaching campaign will work to
increase consumption of water and educate children and families on the importance of
drinking water every day.
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A nutritional education table was set up at the Drink Up Philly
launch event to educate participants at the event on the importance of drinking water
daily.
Every bodily system depends on water, which makes up about 60% of a persons
body weight, according to the Mayo Clinic.
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Water is a calorie-free option for youth and
families to substitute for sugar-filled beverages and is largely inexpensive and available
practically everywhere. Yet, despite recent trends showing a rise in water consumption
and declines in the amount of soda people drink, the Drink Up campaign is still needed.
Obesity rates are also rising in the United States.
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Health advocates have blamed the
corn syrups and other sugars in soda for obesity, but the Drink Up campaign will not
force anti-sugary drink messages on consumers. Instead, the campaign will opt to have
a positive tone associated with water from start to finish.


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NUTRITION ASSESSMENT
The Nutrition Care Process is a standardized model and systematic approach
intended to guide Registered Dietitians and Dietetic Technicians, Registered in
providing high quality nutrition care.
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Food/Nutrition-Related History
1. FH-1.2.1.1: Fluid/Beverage Intake Oral Fluid Intake
A study analyzing the drinking habits of 3,397 adults who participated in
the National Cancer Institute's Food Attitudes and Behaviors Survey was
published in 2013 by the CDC's journal, Preventing Chronic Disease. According
to this study, 43% of American adults drink less than 4 cups of water a day. This
includes 36% who drink 1 to 3 cups per day, and 7% who drink none.
Additionally, about 25% of kids under the age of 19 drink no plain water at all on
any given day, according to government statistics. Thankfully, 35% of Americans
drink 4 to 7 cups a day, while 22% drink 8 or more.
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2. FH-6.3.1: Safe Water Availability Availability of Potable Water, access to
functioning well or treated public water supply
The Philadelphia Water Department (PWD) uses proven treatment
practices in innovative research to provide drinking water that consistently
exceeds standards. Philadelphias drinking water sources are the Delaware and
Schuylkill Rivers. PWD embraces a watershed protection approach that monitors
and evaluates events and practices that may impact water quality in Philadelphia.
Watershed businesses and residents also play a role in the health of Philadelphia
waterways. Proper disposal of hazardous wastes, household chemicals, and
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unused prescriptions are essential to protecting drinking water.
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Client History
1. CH-1.1: Personal Data
The degree of water intake by Americans varies greatly depending on the
demographics and health habits of persons living in the United States. In the
Food Attitudes and Behaviors study, the likelihood of drinking less than 4 cups of
water daily was significantly higher among participants aged 55 years or older
than among those aged 18 to 34. The likelihood of drinking less water was also
greater among residents of the Northeast than among residents of the South and
among participants who consumed 1 cup or less of fruits or vegetables per day
than among those who consumed 4.5 cups or more.
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Participants who exercised
150 minutes or more per week consumed more water than participants who did
not exercise. There was also a noticeable distinction between participants who
were neither trying to gain nor lose weight and those trying to lose weight;
participants aiming for weight loss seemed to consume more water daily.
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Understanding the associations between culture, demographics, and ethnicity
and water consumption helps to identify populations that may benefit from water-
promoting interventions.

NUTRITION DIAGNOSIS
PES Statements
1. Inadequate Fluid Intake (NI-3.1) related to food- and nutrition-related knowledge
deficit concerning appropriate fluid intake as evidenced by reports of estimated
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intake of fluid less than requirements (43% of American adults drink less than 4
cups of water a day).
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2. Food- and Nutrition-Related Knowledge Deficit (NB-1.1) related to lack of prior
nutrition-related education as evidenced by observations of verbalizing
inaccurate or incomplete information, indicating the need for nutrition education.

NUTRITION INTERVENTION
Based on the nutrition diagnoses, an educational intervention in the form of a
nutrition session at a campaign kick-off event was developed and provided. The session
provided learners with nutrition information on drinking water, different types of water,
and hydration status.
1. E-1.4: Nutrition Education Content, relationship to health and disease
2. E-2.2: Nutrition Education Application, skill development
Healthy People 2020
Healthy People 2020 is a science-based program that sets an achievable, 10-
year national objectives for the health of the American people aimed at encouraging
individuals to make better, more informed health decisions, measure the impact of
health-based prevention activities and encourage collaboration across communities and
sectors.
! Goal: Increase the quality, availability, and effectiveness of educational and
community-based programs designed to prevent disease and injury, improve
health, and enhance quality of life.
! Objective: ECBP-3.5: Increase the proportion of elementary, middle, and senior
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high schools that have health education goals or objectives which address
practicing health-enhancing behaviors and reducing health risks (skills).
The intervention delivered contributed to addressing the nutrition problem,
knowledge deficit related to the required amount of water recommended daily, and the
larger goal and objective in Healthy People 2020 related to improving educational and
community-based programs. In 2006, 98.9% of elementary, middle, and senior high
schools had health education goals or objectives that addressed practicing health-
enhancing behaviors and reducing health risks (skills) articulated in the National Health
Education Standards. The target for this objective is that 100% of schools address
practicing health-enhancing behaviors and reducing health risks in their standards.
The Healthy People 2020 objective to increase the proportion of elementary,
middle, and senior high schools that have health education goals or objectives which
address practicing health-enhancing behaviors and reducing health risks is written in
SMART criteria and assists in the measurement of success of the educational
intervention. The condition, population and target are very specific. An increase from
98.9% of schools to a target of 100% of schools is measureable. The target is
achievable and realistic compared to the current percentage of schools with health
education, especially over the time-frame of 14 years, 2006 2020.
An emerging trend in dietetics that is addressed by this intervention is the
groundbreaking innovativeness of a campaign that urges Americans to drink more
water. This campaign piggybacks First Lady Michelle Obamas Lets Move effort to
build a healthier youth and healthier families. Supporting organizations made the
following commitments as part of the local campaign in Philadelphia
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:
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! The Food Trust (TFT): To increase marketing and consumption of water in
Philadelphia, The Food Trust pledged to promote water in more than 600
neighborhood corner stores, schools, farmers markets, and Night Market
Philadelphia events, reaching more than half a million residents with the
message that water is a healthy choice that we can all make every day.
! The Philadelphia 76ers: To help increase the consumption of water and raise
awareness of its importance in Philadelphia. The 76ers pledged to provide
suitable drinking water to children participating in all of the community programs
conducted in the region over the summer.
! The Philadelphia Department of Public Health (PDPH): To increase marketing
and consumption of water in Philadelphia, PDPH pledged to increase access to
tap water in schools and afterschool settings and promote healthier beverage
choices through healthy vending policies.
! The Philadelphia Water Department (PWD): To increase marketing and
consumption of water in Philadelphia, PWD pledged to continue to provide high
quality, cost-effective drinking water to the residents and businesses of
Philadelphia and to encourage the consumption of tap water through a variety of
educational tools, such as social media, school outreach, distribution of
promotional materials, and programming at the Fairmount Waterworks
Interpretive Center.


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EDUCATION INTERVENTION
Lesson Plan
The science and evidence about hydration's importance is well-established.
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70% of our lean body mass is water. Water is in our bloodstream, our cells, and filling
the spaces between our cells. A nutrition education table for the Drink Up Philly
campaign kick-off was prepared the week prior to the event. The table included posters,
interactive games, and informational handouts for an audience of all ages.
The first section of the nutrition table consisted of a two-sided sandwich board
with large posters displayed on either side. The first poster educated learners on the
importance of hydrating with water daily. Proper hydration is key to good health; not
enough water can affect many systems in the body. Fluid in our bodies helps to control
body temperature. When one is dehydrated, the ability to sweat and cool down the body
is reduced, which could raise risk for heat exhaustion or heat stroke in hot weather.
Another common issue associated with dehydration is decreased blood volume, which
can cause stress on the heart and hinder the ability to maintain blood pressure, leading
one to faint. To ensure proper hydration, leaners were educated to pay close attention
to the color of their urine. The goal is to excrete clear urine at least once a day. Dark
yellow urine is sure sign of dehydration. Younger learners were advised to compare
hydrated urine and dehydrated urine using a lemonade and apple juice model. The
opposing side of the poster board presented a poster that enlightened participants on
various ways to jazz up plain old water to make drinking water fun. See Appendix A.
The next section of the nutrition table was nick-named the Carbonation Station.
At this station, partakers were encouraged to participate in an interactive game that
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tested their knowledge on the differences between various carbonated waters. Learners
were then presented with how to carbonate their own water using a Soda Stream and
no added flavors or sweeteners. The process of carbonation was discussed and carbon
dioxide was defined. The final portion of the educational table was a trivia wheel game
with water-related trivia questions. Learners were able to spin the wheel and answer a
question about water. See Appendix A.
Marketing
A marketing strategy is the basic foundation of a marketing plan that involves
strategic analysis of the internal and external factors. Internal environmental factors
include the marketing mix, or the 4 Ps, performance analysis, and strategic constraints.
External environmental factors include customer analysis, competitor analysis, and
target market analysis. A crucial element of a marketing strategy is to keep marketing
and promotion in line with the missions and objectives of all subsidiaries involved; The
Food Trust, The Partnership for a Healthier America, the Philadelphia Department of
Public Health, and the Philadelphia Water Department included.
Internal factors play a major role in the way an operation markets and promotes
its product, or cause in this case. The marketing mix, also known as the 4 Ps, is one of
these internal environmental factors that includes product, place, price, and promotion.
The Drink Up Philly Campaign Kick-Off (product) was a free event (price) held at the
Fairmount Water Works in Philadelphia, PA on Thursday, May 8, 2014 from 10:00 am to
1:00 (place). The event was endorsed (promotion) by the use of news releases,
announcements on the websites of the various organizations involved in the planning of
the event, invitations sent out to local businesses and schools, flyers, and floor mat
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posters placed in offices, supermarkets, and corner stores. Corner store operators, food
truck vendors, youth leaders, and community groups helped to promote the campaign
kick-off by word of mouth and will continue to promote the campaigns commitments in
the future. An Instagram account (@drinkupphl) and a Twitter account (@drinkupphl)
were created to support the campaign and provide live updates throughout the kick-off
event via pictures, tweets, and videos. See Appendix B for examples of promotional
materials. The Drink Up campaign will include a water drop logo that will be featured on
select water bottles and drinking fountains. Public service announcements will also run
on television networks, and several celebrities, including Eva Longoria, have joined the
campaign and will encourage water drinking through social media.
1. Product: Drink Up Philly Campaign
2. Place: Fairmount Water Works in Philadelphia, PA
3. Price: Free
4. Promotion: News releases, Twitter, Instagram, website announcements by
various organizations involved, flyers, word of mouth, TV, water bottles, drinking
fountains, celebrities, PSAs
Resources
All educational materials, equipment, supplies, and paper products required for
the implementation of the nutrition intervention were calculated into The Food Trusts
budget for the Drink Up Philly launch event. Promotional materials for the campaign
launch event were provided by the national campaign and the Partnership for a
Healthier America.
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NUTRITION MONITORING AND EVALUATION
Evaluation of the effectiveness of the educational intervention was achieved by
use of a verbal pre- and post- test. Learners were invited to participate in a verbal pre-
test in the form of various water-related activities, including a SpinQuest trivia game, a
guessing game about carbonated waters, and a demonstration on the process of
carbonating water. After completing the activities, the instructor and the learners
performed a verbal post-test in which the correct answers to the trivia questions were
discussed, the differences between the types of carbonated waters were explained, an
understanding of hydration status was addressed, and learners return demonstrated the
process of carbonation with the Soda Stream.
The Drink Up Philly kick-off event had about 150 attendants that included a wide
array of people, from CEOs of major corporations to fifth grade students to. Almost 75%
of the attendants took the time to stop by the nutrition education table to participate in
the water activities provided. All participants were engaged in the educational session
and asked relevant questions. In terms of the verbal pre- and post-test, almost no one
was able to determine the difference between tonic water, seltzer water, and club soda.
Participants were educated on the differences between these carbonated waters and
were able to return demonstrate comprehension of the concept. Most, about 70% of
learners, were able to correctly answer water-related trivia questions prior to education
on the information. Questions and answers were reviewed with the participants at the
end of the educational session. Hydration status, urine color, the human water cycle,
and numerous ways to jazz up plain water were discussed with the learners. Leaners
were invited to share thoughts, comments, and observations about the material.
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Suggestions for future plans in executing this nutrition intervention include having
the event indoors. The Drink Up launch event was held at the Fairmount Waterworks,
an outdoor venue right on the Schuylkill River in Philadelphia, PA. The posters, games,
and interactive activities set up at the nutrition table were quite difficult to keep in place
with wind and rain as a contributing factor. Another suggestion for the event would be to
make the nutrition education table a more formal session in which learners could be
given written pre- and post-test to truly determine the effectiveness of the intervention.
Overall, the kick-off event was extremely successful. Attendants were able to
meander through the Waterworks to various tables and educational booths. A street
dancing and hip-hop group and the Philadelphia 76ers performed for attendants.
Leaders of local supporting organizations were able to speak to attendants and a water
toast was made to kick-off the Drink Up Philly campaign. Supporters and attendants
were delivered the important message that you are what you drink, and when you drink
water, you drink up!

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APPENDIX A. LESSON PLAN

Figure 1. What is Water Lesson Plan



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Figure 2. Educational Poster


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Figure 3. Educational Poster


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Figure 4. Educational Handout



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Figure 5. Interactive Educational Poster


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Figure 6. SpinQuest Water Trivia Wheel

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Figure 7. Soda Stream to Carbonate Water


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APPENDIX B. MEDIA ADVERTISEMENTS

Figure 1. Campaign Promotion The Food Trust Website


Figure 2. News Release The Partnership for a Healthier America Website

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Figure 3. Drink Up Philly Instagram Account

Figure 4. Drink Up Philly Twitter Account




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REFERENCES

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2014.
2. Clinic M. Water: How much should you drink every day? 2014;
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and attitudes associated with low drinking water intake among US adults, Food
Attitudes and Behaviors Survey, 2007. Prev Chronic Dis. 2013;10:E51.
4. Academy of Nutrition and Dietetics. Pocket Guide for International Dietetics &
Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the
Nutrition Care Process. Chicago, IL; 2013.
5. Department PW. Drinking Water Quality. 2014;
http://www.phillywatersheds.org/drinkingwaterquality. Accessed May 9, 2014.
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water or diet beverages for weight loss in adults: main results of the Choose
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7. America TPfaH. Drink Up Comes to Philadelphia. 2014;
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