With the completion of the 2017-2018 school year, the IHLP is now integrated into every Worcester County Public School, first through eighth grade. The results for the 2017-2018 school year demonstrate the positive impact of the program.

In grade seven, the average health literacy scores increased from pre-test to post-test. Both 7^th and 8^th grade showed increasing scores when asked mathematical questions regarding health facts and nutrition labels. Other findings:

• 7^th graders’ average health literacy score significantly increased from pre-test to post-test.
• There was a statistically significant increase in the percentage of 7^th grade students who moved from lower health literacy to higher health literacy from pre- to post-test.
• At post-test, 72.1 percent of 7^th grade students reported being extremely confident to say “no” when a friend is pressuring them to drink alcohol or smoke cigarettes. This represents a significant increase in confidence from the pre-test.
• Eighth grade had demonstrated improvement in their self-confidence for making healthy decisions. At post-test, 64.3 percent of the students answered the following question correctly: “if you could only eat 60 grams of carbohydrates per day, what is the maximum amount of ice cream per day you could eat?” This is an increase of nearly 10 percentage points over pre-test scores.
• 8^th graders showed a significant increase in talking about safety on the Internet with family and friends from pre- to post-test.

The next steps for the program include a senior health literacy survey for all 12th grade students of Worcester County Public Schools. The survey is in development with our IHLP partners, UMD Herschel S. Horowitz Center for Health Literacy and WCPS. The purpose of the survey is to determine the long-term effectiveness of the IHLP. Improving health literacy for the next generation will address the health needs in the community by reducing their risk of poor health outcomes, decreasing unnecessary visits to the emergency room and increasing their ability to access appropriate care.

The Integrated Health Literacy Program (IHLP) is now serving grades 1-6 county-wide and pilots in grades 7 and 8 at Stephen Decatur Middle School are now taking place. The program is currently serving approximately 3,500 students.

The Integrated Health Literacy Program (IHLP) welcomes Ms. Candy Edwards, from the Maryland Governor's Office for Children, to help present to first grade students "Lessons in a Lunchbox."

As of the 2015-2016 school year, the IHLP serves more than 2,400 students (roughly one third of the entire Worcester County school district) in grades one through five. The program is being piloted in grade six at one local middle school as well.

After a spring term pilot implementation of the IHLP lessons into the curriculum for second through fifth grades students are post-tested on the topics covered during those lessons and measurements of health literacy. These lessons are integrated into their science, social studies, reading language arts, and math classes. In the post-testing, the University of Maryland Herschel S. Horowitz Center for Health Literacy (UM) found:

• Second grade students' awareness of food labels increased from 55.5% at pre-test to 88% after receiving the curriculum.
• 57% of second grade students stated they had poor health literacy at pre-testing. This dropped to 31% during the post-test evaluation.
• Third graders considered to have a high health literacy increased from 36% pre-test to 78% post-test. Other grades improved by 11% to 28%.
• The percentage of fourth-graders with low health literacy dropped from 14.6% at pre-testing to 4.5% post-test.
• Fifth grade students who reported being "sort of healthy" increased from 38% pre-test to 52% post-test.

Pre-testing for second, third, fourth and fifth graders throughout the county takes place. The roll-out is new to Showell, Buckingham, Snow Hill, and Pocomoke Elementary and Snow Hill and Pocomoke Middle schools this year. First grade does not receive testing due to the broad range in development at this grade level, but they are being introduced to integrated health literacy curriculum.

Dawn Rogers, principal of Ocean City Elementary School and the school’s second grade teachers are recognized by the Worcester County Council and Maryland State Senator Jim Mathias for their efforts in a health literacy curriculum integration collaborative with Atlantic General Hospital and the University of Maryland’s School of Public Health.

Second graders at Ocean City Elementary receive a second assessment to identify any changes in understanding of basic health concepts. The improvement in health literacy is significant:

• 63% increase in the number of students able to recognize the term “heart healthy”
• 41% increase in the number of students that knew how to take their heart rate
• 100% of students were able to identify “My Plate,” a 20% increase
• 58% increase in the number of students reporting they know how to talk to doctors or nurses about their health
• 76.5% of students believed that advertisements can change the way kids think about food

Based upon these results, the health literacy partners decide to roll out lesson plans to all second grade classes at Worcester County public schools in the 2014-2015 school year. Integrated curriculum will also be developed and piloted in grades 1, 3, 4, 5 at select schools in the county. Teachers undergo training during the summer. The position of Health Literacy Liaison is created at Atlantic General Hospital to coordinate efforts between the hospital and school system. The goal is for the health literacy standards to be adopted by the state and, eventually, the nation. These standards are the first to be developed in the U.S.

Through the hard work and dedication of Atlantic General’s Community Education Department, the University of Maryland, the Worcester County Board of Education and the second grade teachers at Ocean City Elementary, launch a pilot project that integrates the proposed health literacy standards into daily curriculum.

The goal: to avoid adding another layer of education to their lesson plans. For example, the teachers will be incorporating a lesson on healthy eating from a story that they have been using in their language art programs for several years.

Students are assessed before the new lessons begin to establish a baseline of their understanding of basic health concepts. A second assessment will be conducted at the end of the school year to measure improvement.

“The teachers’ knowledge and skill in incorporating these standards into their existing lesson plans has been crucial to the success of this program,” states Michael Franklin, AGH president and CEO, “These teachers are truly laying the groundwork for a successful, sustainable program. They are making history happen for the benefit of our children and our community.”

The program is expected to expand to the second grade classes in all Worcester County elementary schools next school year; the integration of health literacy standards will also be introduced in all Worcester County elementary and middle schools in varying grade levels. The data collected from the expanded pilot will then be used to present the model for adoption into the Maryland state curriculum changes in 2015.

Atlantic General Hospital receives a $40,000 grant from the Arthur W. Perdue Foundation to further its efforts to improve the health literacy of Worcester County’s youth. The Foundation is the charitable giving arm of Perdue Farms.

“At Perdue, we salute the commitment of these health care and education partners in their efforts to enhance the health and quality of life for children in Worcester County. This curriculum will engage children in their formative years and provide valuable lessons for creating a foundation for healthy living,” states Bill Hetherington, executive director of the Arthur W. Perdue Foundation. “We’re proud to invest in their future through this funding from the Foundation.”