September 2023


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NCCOR Releases a New Factsheet as Part of Early Childhood Focus during National Childhood Obesity Awareness Month

NCCOR, September 2023

Infants and toddlers will take center stage during National Childhood Obesity Awareness Month as NCCOR publishes a new factsheet about the Healthy Eating Index (HEI). For the first time, the recently released HEI highlights the unique dietary needs of young children.

Created by the National Cancer Institute and the U.S. Department of Agriculture, the HEI measures how closely foods adhere to the Dietary Guidelines for Americans’ (DGA) recommendations. The updated HEI includes two scoring systems: HEI-2020 for children and adults aged 2 years and older and HEI-Toddlers-2020. The new versions address a need identified by the 2020 DGA Committee to have a scoring system for infants and toddlers. Until now, HEI-scoring was only possible for those aged 2 years and older.

NCCOR collaborated with the HEI’s authors to develop a summary factsheet describing the latest changes and the need for a separate toddler version. Both systems address 13 measures of dietary quality, but young children have smaller calorie constraints appropriate for their age group. As a result, the 2020-2025 DGAs introduced a new USDA Dietary Pattern for toddlers aged 12 through 23 months, spurring the need for a new HEI system.

Other notable differences in the HEI-Toddlers-2020 include:

  • A recommendation that children in this age group avoid all added sugars
  • No recommendation to limit saturated fats to less than 10% of energy intake
  • Recommendations for complementary foods and beverages for children who no longer receive human milk or infant formula. If toddlers are still receiving these foods, the HEI-Toddlers-2020 score should be calculated without energy or nutrient contributions from these foods.

The 2020-2025 DGA did not include a USDA Dietary Pattern for infants under 12 months, so no HEI was developed for this age group.

NCCOR’s new HEI factsheet is part of our special focus on the needs of young children during National Childhood Obesity Awareness Month. Follow us on social media, as we will showcase how NCCOR can help conduct research for this population. For additional tools and resources visit:

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Publications & Tools

NCCOR Toolbox: Evaluating the Effectiveness of Childhood Healthy Weight Programs

NCCOR created A Toolkit for Evaluating Childhood Healthy Weight Programs to help program administrators, public health professionals, and researchers design and implement effective program evaluations. It details evaluation readiness, process measures, outcome measures, contextual factors, program sustainability, and remote evaluation of CHWPs. In addition, the toolkit features a resource library with links to guides, databases, research articles, and other evaluation toolkits. Download a PDF copy or read it on the NCCOR website.

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USDA Releases Menu Planner for School Meals

August 24, 2023, U.S. Department of Agriculture

The Menu Planner for School Meals is a technical resource to help school nutrition professionals plan, prepare, provide, and market great tasting, nutritious, and safe meals that meet the nutrition standards in the National School Lunch and School Breakfast Programs as well as the Child Nutrition Programs: Transitional Standards for Milk, Whole Grains, and Sodium Final Rule that was published in February 2022. The content covers information on the following topics: nutrition, food safety, Farm to School, USDA Foods, seasonal foods, marketing, and administrative review. The resource consists of seven chapters designed to stand independently in addition to the introduction, quiz answer key, glossary, and appendixes sections. This resource is available for schools and state agencies participating in or administering school meals programs. All are welcome to download these materials and make copies.


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More Back-to-School Resources from USDA

September 2023, NCCOR

In addition to the new Menu Planner, USDA recently updated their school meal resources. Their USDA Support for Schools page outlines how the Agency works with states and school nutrition professionals to ensure that challenges like rising food costs or supply chain issues don’t disrupt their mission of feeding kids. Their Back to School page contains a library of free promotional resources to help communities strengthen, energize, and renew their school meal programs.

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Find Evidence-Based Childhood Obesity Treatment Programs

September 2023, NCCOR

National Childhood Obesity Month highlights the importance of compassionate and effective treatment options for pediatric populations. The American Academy of Pediatrics recently endorsed intensive health behavior and lifestyle interventions for pediatric obesity but recognized that effective programs may be difficult to find. The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity maintains a list of recognized family healthy weight programs to help health care payers and systems, clinical or community practitioners, and others seeking more information. All CDC-recognized programs are based on evidence, appropriate for childhood obesity treatment, and available for immediate use. They include various options for ages, implementation settings, and course content.

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Childhood Obesity Research & News

Penn Medicine researchers identify the link between memory and appetite in the human brain to explain obesity

August 30, 2023, EurekAlert!

Disrupted connections between memory and appetite regulating brain circuits are directly proportional to body mass index (BMI), notably in patients who suffer from disordered or overeating that can lead to obesity, such as binge eating disorder (BED), according to new research from the Perelman School of Medicine at the University of Pennsylvania. Published today in Naturethe research notes that individuals who are obese have impaired connections between the dorsolateral hippocampus (dlHPC) and the lateral hypothalamus (LH), which may impact their ability to control or regulate emotional responses when anticipating rewarding meals or treats.

“These findings underscore that some individual’s brains can be fundamentally different in regions that increase the risk for obesity,” senior author, Casey Halpern, MD, an associate professor of Neurosurgery and Chief of Stereotactic and Functional Neurosurgery at Penn Medicine and the Corporal Michael J. Crescenz Veterans Affairs Medical Center. “Conditions like disordered eating and obesity are a lot more complicated than simply managing self-control and eating healthier. What these individuals need is not more willpower, but the therapeutic equivalent of an electrician that can make right these connections inside their brain.”

The dlHPC is located in the region of the brain that processes memory, and the LH is in the region of the brain that is responsible for keeping the body in a stable state, called homeostasis. Previous research has found an association with loss of function in the human hippocampus in individuals with obesity and related disordered eating, like BED. However, outside of imaging techniques such as magnetic resonance imaging (MRI), the role of the hippocampus has been difficult to study in humans with obesity and related eating disorders.

In this study, researchers were able to evaluate patients whose brains were already being monitored electrically in the Epilepsy Monitoring Unit. Researchers monitored brain activity as patients anticipated and then received a sweet treat (a chocolate milkshake). They found that both the dlHPC and the LH activated simultaneously when participants anticipated receiving the rewarding meal. These researchers confirmed using stimulation techniques pioneered by coauthors, Kai Miller, MD, PhD, and Dora Hermes Miller, PhD, from Mayo Clinic, that this specific zone of the hippocampus, the dlHPC, and LH exhibited extremely strong connectivity, as well.

In individuals with obesity, researchers found that the impairment of this hypothalamus-hippocampus circuit was directly proportional to their BMI. That is, in participants with a high BMI, the connection was even more disturbed.

To further validate the connection, Halpern’s team used a technique called “brain clearing,” to analyze brain tissue. The technique revealed melanin-concentrating hormone, a hormone known to regulate feeding behavior that is produced in the LH. They found the presence of MCH in the dlHPC, and nowhere else, confirming a link between the two regions.

“The hippocampus has never been targeted to treat obesity, or the disordered eating that can sometimes cause obesity,” said Halpern. “We hope to be able to use this research to both identify which individuals who are likely to develop obesity later in life, and to develop novel therapies – both invasive and not – to help improve function of this critical circuit that seems to go awry in patients who are obese.”

This research was funded by the Foundation for OCD Research, the National Institute of Health (R01 MH124760, K23 MH106794, R01 NS095985), the Natural Sciences and Engineering Research Council of Canada (#40306) and the Canadian Institutes of Health Research (#41916).


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Boys who smoke in their early teens risk passing on harmful epigenetic traits to future children

August 30, 2023, EurekAlert!

Boys who smoke in their early teens risk passing on harmful epigenetic traits to future children

  • People whose fathers smoked in their early teens had epigenetic markers associated with asthma, obesity, and low lung function
  • Biomarkers associated with paternal preconception smoking were different from those associated with maternal or personal smoking
  • ‘We must act now to stop teenage vaping’ say scientists

A new study suggests boys who smoke in their early teens risk damaging the genes of their future children, increasing their chances of developing asthma, obesity and low lung function.

Research published today [31st August 2023] in Clinical Epigenetics is the first human study to reveal the biological mechanism behind the impact of fathers’ early teenage smoking on their children.

Researchers from the University of Southampton and the University of Bergen in Norway investigated the epigenetic profiles of 875 people, aged 7 to 50, and the smoking behaviours of their fathers.

They found epigenetic changes at 19 sites mapped to 14 genes in the children of fathers who smoked before the age of 15. These changes in the way DNA is packaged in cells (methylation) regulate gene expression (switching them on and off) and are associated with asthma, obesity and wheezing.

“Our studies in the large international RHINESSARHINE and ECRHS studies have shown that the health of future generations depends on the actions and decisions made by young people today – long before they are parents – in particular for boys in early puberty and mothers/grandmothers both pre-pregnancy and during pregnancy,” says Professor Cecilie Svanes from the University of Bergen and Research Director of the RHINESSA study. “It is really exciting that we have now been able to identify a mechanism that explains our observations in the cohorts.”

“Changes in epigenetic markers were much more pronounced in children whose fathers started smoking during puberty than those whose fathers had started smoking at any time before conception,” says co-lead author of the paper Dr Negusse Kitaba, Research Fellow at the University of Southampton. “Early puberty may represent a critical window of physiological changes in boys. This is when the stem cells are being established which will make sperm for the rest of their lives.”

The team also compared the paternal preconception smoking profiles with people who smoked themselves and those whose mothers smoked before conception.

“Interestingly, we found that 16 of the 19 markers associated with fathers’ teenage smoking had not previously been linked to maternal or personal smoking,” says Dr Gerd Toril Mørkve Knudsen from the University of Bergen and co-lead author of the study. “This suggests these new methylation biomarkers may be unique to children whose fathers have been exposed to smoking in early puberty.”

The number of young people smoking has fallen in the UK in recent years. But co-author Professor John Holloway, from the University of Southampton and the NIHR Southampton Biomedical Research Centre, is concerned about children taking up vaping.

“Some animal studies suggest that nicotine may be the substance in cigarette smoke that is driving epigenetic changes in offspring,” says Professor Holloway. “So it’s deeply worrying that teenagers today, especially teenage boys, are now being exposed to very high levels of nicotine through vaping.

“The evidence from this study comes from people whose fathers smoked as teenagers in the 60s and 70s, when smoking tobacco was much more common. We can’t definitely be sure vaping will have similar effects across generations, but we shouldn’t wait a couple of generations to prove what impact teenage vaping might have. We need to act now.”

The new findings have significant implications for public health. They suggest a failure to address harmful exposures in young teenagers today could damage the respiratory health of future generations, further entrenching health inequalities for decades to come.

The University of Southampton’s LifeLab programme engages with young people to show how lifestyle choices can impact their health and the health of any children they may have in the future. Dr Kath Woods-Townsend, LifeLab Programme manager says: “Parents, teachers and young people themselves are concerned about the impact of vaping. We’re working with our Youth Panel to understand the role vaping plays in their lives and to cocreate resources that will help inform young people about the risks.”

Fathers’ preconception smoking and offspring DNA methylation is published in Clinical Epigenetics and is available to read online.


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NIH-funded study supports use of ECMO for critically ill patients with obesity

August 28, 2023, National Institutes of Health

A National Institutes of Health-supported study suggests that adults with obesity may benefit from the use of extracorporeal membrane oxygenation (ECMO), an advanced form of breathing support, when in intensive care for respiratory failure. ECMO’s use was previously questioned for patients with obesity due to the belief that it may complicate treatment. However, the current findings, which published in the American Journal of Respiratory and Critical Care Medicine, show that patients with obesity who received ECMO for acute respiratory distress syndrome (ARDS) had lower mortality rates compared to patients with ARDS without obesity who received ECMO.

In this study, researchers retrospectively reviewed data from 790 patients from more than 20 medical centers across 10 countries who received ECMO for ARDS, a critical lung injury. Among these patients, 320 had obesity. They found 24% of patients with obesity died in the intensive care unit compared to 35% of patients without obesity. The authors couldn’t control for all variables among the larger group analysis, including disease severity. However, they conclude the findings support the concept that obesity, a risk factor for ARDS, shouldn’t factor into treatment decisions for ECMO.

“We hope that clinicians will consider the data from this study when making bedside decisions for ARDS patients with obesity instead of preemptively withholding this lifesaving therapy,” said Darya Rudym, M.D., a study author, pulmonologist, and assistant professor of medicine at NYU Langone Health, New York City.

Previous studies have found similar findings looking at data from patient registries and observational reviews. However, this study is the largest to date to assess ECMO survival outcomes among adults with obesity who have ARDS based on data from prospective studies and clinical trials, which better reflect real world clinical outcomes.

ARDS varies in prevalence but accounts for 10% of intensive care unit admissions worldwide. In this study, pneumonia was the most common factor leading to severe respiratory illness. Survival rates for ARDS vary, with about half to three-fourths of patients surviving. Survival rates for ECMO, a last resort for treatment, are also variable, but have ranged from about 6075%.

Data for this review came from 440 patients who received intensive care for ARDS at hospitals in the United States, France, Australia, and Italy between 2012–2017. An additional 350 patients came from the Ventilation Management of Patients with Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome (LIFEGARDS) study, which took place at 23 intensive care units in 10 countries.

“The results of this research open up new questions about how obesity affects outcomes in critical illness to inform evidence-based treatment approaches,” said James P. Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI), which funded the study.

This research was partially supported by NHLBI and the National Center for Advancing Translational Sciences.


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Researchers at UC Irvine issue a warning that GLP-1RA’s may be dangerous for children

August 28, 2023, EurekAlert!

A team of clinicians, exercise scientists, pharmaceutical scholars, ethicists and behavioral experts at the University of California, Irvine, outlined their concerns that the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) to treat childhood obesity and type 2 diabetes may have unintended and adverse consequences for children’s health.

The commentary, Unintended Consequences of Glucagon-like Peptide-1 Receptor Agonists Medication in Children and Adolescents – A Call to Action, was published as a perspective in the Journal of Clinical and Translational Science. The article was led by Dan M. Cooper, MD, distinguished professor in the Department of Pediatrics at UCI School of Medicine.

In the perspective, the team noted that the GLP-1RA class of medications is transforming the care of obesity and type 2 diabetes in adults and noted recent studies indicating similar powerful effects in children and adolescents. Given the intractable pediatric obesity epidemic and associated rise in type 2 diabetes in youth, made worse by the COVID-19 pandemic related shutdowns and disruptions in opportunities for exercise and play in youth, this new class of medications will certainly benefit children with morbid obesity and type 2 diabetes. Ironically, it is the unprecedented success of these medications that has the team worried. The team believes that their overuse and abuse among youth is inevitable.

“Our major concern is the unbalance and inappropriate reductions in calorie or energy intake associated with these weight loss drugs,” said Cooper, associate director of the UCI Institute for Clinical and Translational Science and interim director of the UCI Institute for Precision Health. “Unlike in adults, children and adolescents need energy and sufficient calories not only for physical activity, but for growth and development.”

The balance of energy intake (diet) and energy expenditure (such as physical play and exercise) influences a child’s growth and health across their lifespan, and any change in the balance of these two factors can adversely impact health much later in life. For example, optimal levels of both diet and exercise increases bone mineralization during childhood, a critical period of growth and development, and this lessens their risk of osteoporosis and bone fractures later in life.

The team also pointed out the likelihood of abuse among patients with diagnosed eating disorders and children and adolescents involved in competitive sports like wrestling, martial arts, gymnastics and ballet.

“The benefit vs. cost (economic and quality of life) relationship of long-term use in youth needs to be carefully studied,” said Jan D. Hirsch, one of the co-authors, dean of the UCI School of Pharmacy and Pharmaceutical Sciences. “With the increase in social media, young people are already exposed to a diet culture and body images which may not be attainable and, ultimately, unhealthy. These drugs administered without proper supervision could cause a minefield of health and emotional problems for children as they age.”

Cooper also noted that conditions like pediatric obesity have become epidemic in large measure because of environments without adequate venues for safe play and exercise for children and adolescents coupled with the availability of popular, inexpensive, high-calorie fast-foods. Not surprisingly, the epidemic of poor physical fitness and obesity has impacted underrepresented minorities disproportionately.

With the growing efficacy and popularity of these medications, drug manufacturers are quickly developing oral forms of the drugs, which researchers believe could limit oversight and cause cases of abuse. Anecdotal clinical experience suggests that there is already widespread knowledge in the pediatric population about the GLP-1RA effectiveness as satiety medications aiding weight loss, not helped by apparent widespread use documented in the popular media.

“News about GLP-1RA agonists has infiltrated social media outlets, and is being spoken about by celebrities, fashion models and influencers,” said Emma Cooper, MD, a resident physician in the Department of Psychiatry & Human Behavior at UCI School of Medicine. “It’s reasonable to assume that as access becomes easier, more children will engage in unsupervised use of GLP-1RA agonists in order to facilitate reaching societal beauty standards.” Dr. Emma Cooper added, “As the rate of mental health disorders, including eating disorders, continues to rise, healthcare providers should be screening for and intervening on inappropriate use of these medications.”

Researchers believe appropriate pediatric health could also be threatened, not only by the rise of counterfeit drugs that have been well documented, but by illegitimate access through the internet.

As a result of their research and clinical experience with exercise, diet, and obesity prevention, the UCI team outlined a call-to-action. Targeting the National Institutes of Health network of academic centers, like UCI, that are recipients of Clinical and Translational Science Award (CTSA, led by the National Center for Advancing Translational Sciences) hubs across the nation, the call-to-action includes:

  1. Build and support multidisciplinary teams of frontline clinicians, community partners, physiologists and behavioral and pharmaceutical scientists to address the knowledge gap in GLP-1RA effects in children and adolescents.
  2.  Address the translational bioethics research issues that will result from approval of pediatric formulations of the GLP-1RA medications in particular, and in general, that have evolved from the medicalization of health conditions like pediatric obesity.
  3. Engage and improve the quality and accessibility of relevant real-world data such as school based physical fitness testing (SB-PFT), mandated in 16 states covering around 60% of American school children.
  4. Work with the FDA and other agencies to update guidelines for lifestyle interventions in pediatric clinical trials that incorporate state-of-the-art approaches to quantifying, monitoring, and evaluating physical activity, adherence to diet, and accurate measurement of body composition beyond the current reliance on the body mass index (BMI), a suboptimal metric of overweight and obesity in adolescents.
  5. Elevate and enhance training of the clinical trial workforce on state-of-the-art understanding of effective lifestyle interventions. Such training should also target primary care pediatricians whose exposure to exercise and nutritional science is currently quite limited.
  6. Develop, demonstrate, and disseminate learning modules for school personnel (teachers, coaches), parents, school-aged children, and primary care pediatricians and child mental health professionals about the GL1-RA medications, their appropriate uses and possible abuse.

This research and subsequent call-to-action was part of a multi-disciplinary team effort across University of California, Irvine, and included the UCI School of Medicine, UCI School of Pharmacy and Pharmaceutical Science and the UCI Institute for Clinical and Translational Science.


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Neighborhood Public Transportation Access and Adolescent Body Mass Index: Results from the FLASHE Study

August 22, 2023, Childhood Obesity

Background: Prior investigators have examined the relationship between neighborhood public transportation access and physical activity among adolescents, but research is lacking on the association with obesity in this age group. This study examines the association between neighborhood public transportation access and adolescent BMI using a national sample.

Methods: We used cross-sectional data from the Family Life, Activity, Sun, Health, and Eating study, a national survey (2014) that assessed physical activity and diet, among adolescents (aged 12–17 years, N = 1737) and their parents. We ran crude and adjusted linear regression models to test the association between neighborhood-level public transportation access (less prevalent and prevalent) and individual participant-level BMI z-scores.

Results: The analytic sample included 336 adolescents (50% female; 69% had healthy weight; 28% had overweight or obesity). Adjusted models showed a positive relationship between high public transportation access and adolescent z-BMI (b = 0.25, confidence interval [95% CI]: −0.01 to 0.50). In stratified analyses, high public transportation access was associated with higher z-BMI for high school students (b = 0.57, 95% CI: 0.23–0.91), males (b = 0.48, 95% CI: 0.09–0.87), and adolescents in households with an income below $99,999 (0.29, 95% CI: 0.02–0.56).

Conclusion: Neighborhood public transportation access is associated with adolescent BMI, but the direction of this association varies across urban adolescent demographic subgroups. Further research is needed to clarify the relationships between individual and social-environmental factors that impact public transportation access and its association with adolescent BMI.


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USDA Invests Nearly $30 Million to Boost School Nutrition in 264 Small & Rural Communities through Partnership with Action for Healthy Kids]

August 7, 2023, U.S. Department of Agriculture

As part of a cooperative agreement to develop and implement the U.S. Department of Agriculture’s Healthy Meals Incentives Initiative, Action for Healthy Kids today announced that it is awarding nearly $30 million in subgrants to 264 school districts across 44 states and the District of Columbia, reaching students in some of our nation’s highest need schools. These funds are being provided by USDA’s Food and Nutrition Service.

“Students in every community deserve access to healthy and nutritious meals,” said USDA Deputy Secretary Xochitl Torres Small. “Today’s announcement demonstrates the Biden-Harris Administration’s commitment to creating healthier, brighter futures for our children. With these funds, small and rural school districts will be able to modernize their operations and provide more nutritious meals, helping students succeed in the classroom and beyond.”

Each small and/or rural school district will receive up to $150,000 to support them in improving the nutritional quality of their meals and modernizing their operations, through efforts which could include:

  • Innovative staff training programs;
  • Kitchen updates and renovations;
  • Redesigning food preparation and service spaces;
  • Other school-district led efforts to support school meals and school nutrition professionals.

“When we strengthen school meal quality, we strengthen child health,” said USDA Deputy Under Secretary for Food, Nutrition, and Consumer Services Stacy Dean. “These grants are the largest targeted investment USDA has ever made for school meal programs in small and rural communities. We want to ensure every child in America has the opportunity to attend a school with high quality, nutritious meals, and this support is a step in that direction.”

An online map features the selected school districts and their grant amounts. The map will be updated on a rolling basis as schools formalize their grant agreements.

“Offering healthier school meals is key to helping our nation’s kids get the nutrients they need today and for their long-term development,” said Action for Healthy Kids CEO Rob Bisceglie. “Through this historic investment in school nutrition, we will help school districts across the country overcome challenges and develop solutions to provide nutritious foods for the children they serve.”

USDA and Action for Healthy Kids also recently opened applications for the Healthy Meals Incentives Recognition Awards, which celebrate school districts that have made significant improvements to the nutritional quality of their school meals. All school districts in the United States, the District of Columbia, Puerto Rico, Guam, and the United States Virgin Islands are invited to apply. Applications will be reviewed on a rolling basis through June 30, 2025.

School districts that meet Recognition Award criteria will receive benefits such as national and local recognition; travel stipends to attend a national Healthy Meals Summit; access to diverse best practices, training activities; and more.

Action for Healthy Kids will manage the grants to school districts, Recognition Awards, and Healthy Meals Summits with the support of The Chef Ann Foundation and Rocky Mountain Center for Health Promotion and Education.

USDA’s Healthy Meals Incentives Initiative also includes the School Food System Transformation Challenge Grants, which aim to support innovation in the school meals market by increasing collaboration between schools, food producers and suppliers, and other partners. Applications for the Challenge Grants are expected to open in late 2023 or early 2024.

To learn more about other resources USDA provides to strengthen school meal programs, visit the USDA Support for School Meals webpage.

FNS works to end hunger and improve food and nutrition security through a suite of 16 nutrition assistance programs, such as the National School Breakfast and National School Lunch Programs, the Special Supplemental Program for Women, Infants, and Children and the Supplemental Nutrition Assistance Program. Together, these programs serve 1 in 4 Americans over the course of a year, promoting consistent and equitable access to healthy, safe, and affordable food essential to optimal health and well-being. FNS also provides science-based nutrition recommendations through the co-development of the Dietary Guidelines for Americans. FNS’s report, “Leveraging the White House Conference to Promote and Elevate Nutrition Security: The Role of the USDA Food and Nutrition Service,” released in conjunction with the historic White House Conference on Hunger, Nutrition, and Health in September 2022, highlights ways the agency will support the Biden-Harris Administration’s National Strategy. To learn more about FNS, visit and follow @USDANutrition.

Action for Healthy Kids is dedicated to improving children’s health and well-being by bringing together and mobilizing educators, families, and other key stakeholders to help children lead healthy lives. Through its core programming and family-school partnerships, AFHK has impacted more than 20 million children in 55,000 schools nationwide to address systemic challenges in underserved communities. To learn more about its growing network of volunteers and champions, visit


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