Tippecanoe County Assessment and Best Practices April 2007

1. Tippecanoe County Assessment and Best Practices April 2007 Tippecanoe County Health Department Pauline Shen, MPH Introduce yourself I work for the county health department collecting data and producing reportsIntroduce yourself I work for the county health department collecting data and producing reports

2. Why create a Benchmark? Self reported data is not accurate with adults or teenagers in dealing with weight or height Are we better or worse than the national and state self reported data? How can we improve if we don�t recognize the problem? How can limited resources be prioritized? Benchmark data is available for metrics. Are the programs we offer making a difference? How much of a difference? Statistics in Ind grossly underestimate the number of children that are at risk or overweight. Most estimate aer based on self reported data. Self reported data is not a good idea with teenagers. Idea came from Dr. W. Riggs, former health officer w/ ?40 yrs of pediatric experiences. Kids are fatter, but where and whom. Go forth. You always think that your community is exempt from the national statistics My experience in weighing close to 3,000 students is that very few teenagers have an idea of how tall they are or how much they weigh. Made no difference whether they were overweight or not. Girls are more concerned with privacy issues, but did not know how tall they were. Boys always wanted to be 6 foot. If they were 5�10� they would tell me they were 6� and I would have to re ask them, �well that�s how tall I want to be.� Can you imagine if you ask them on the phone and there is no follow up and you can�t visually see them? The only students that were accurate were the wrestlers, by the lb.Statistics in Ind grossly underestimate the number of children that are at risk or overweight. Most estimate aer based on self reported data. Self reported data is not a good idea with teenagers. Idea came from Dr. W. Riggs, former health officer w/ ?40 yrs of pediatric experiences. Kids are fatter, but where and whom. Go forth. You always think that your community is exempt from the national statistics My experience in weighing close to 3,000 students is that very few teenagers have an idea of how tall they are or how much they weigh. Made no difference whether they were overweight or not. Girls are more concerned with privacy issues, but did not know how tall they were. Boys always wanted to be 6 foot. If they were 5�10� they would tell me they were 6� and I would have to re ask them, �well that�s how tall I want to be.� Can you imagine if you ask them on the phone and there is no follow up and you can�t visually see them? The only students that were accurate were the wrestlers, by the lb.

3. Background Information Are the children fat? How fat? Who is fat? Important point is the historical nature of this slide. In every age group over time the trend is the same. These are national statistics. We have only collected data for 6-11 year olds and 12-19 year olds. Important point is the historical nature of this slide. In every age group over time the trend is the same. These are national statistics. We have only collected data for 6-11 year olds and 12-19 year olds.

4. Tippecanoe County Statistics Fifth largest county in Indiana with 166,000 residents Two cities, Lafayette and West Lafayette Three public school corporations, Tippecanoe (county), Lafayette, West Lafayette Independent schools (private, parochial) 22,000 students in K-12 grades Socio economic diversity, including international population � home of Purdue University One of the largest growing Hispanic population in Indiana Quick snapshot of our county. Many counties have only 1 school corporation, but we have three. We have one of the highest percentage of Asians in the state because of the university. PU gives us international diversity. (USC is higher, but they are a private university) Tippecanoe has a high proportion of Hispanics also.Quick snapshot of our county. Many counties have only 1 school corporation, but we have three. We have one of the highest percentage of Asians in the state because of the university. PU gives us international diversity. (USC is higher, but they are a private university) Tippecanoe has a high proportion of Hispanics also.

5. Classifications of weight for children Confusion and controversy with BMI. How did the CDC come up with these guidelines? The categories are formed by percentile. A child is considered overweight if for their age they are below the 5th percentile in weight and height. A child is considered overweight if they are >95th percentile if they are heavier than 95% of other children in the that age range. Using 2000 standard CDC reference. US has their own charts. If we used the WHO charts more American children would be overweight. �At Risk� = Overweight in adults terms �Overweight� = Obese. But children grow, which can help even it out. Confusion and controversy with BMI. How did the CDC come up with these guidelines? The categories are formed by percentile. A child is considered overweight if for their age they are below the 5th percentile in weight and height. A child is considered overweight if they are >95th percentile if they are heavier than 95% of other children in the that age range. Using 2000 standard CDC reference. US has their own charts. If we used the WHO charts more American children would be overweight. �At Risk� = Overweight in adults terms �Overweight� = Obese. But children grow, which can help even it out.

6. Results Used community instead of county so no confusion with county school corporation. 2 year sample n=10,053. county, Laf, W. Laf, Independent K-12 Used community instead of county so no confusion with county school corporation. 2 year sample n=10,053. county, Laf, W. Laf, Independent K-12

7. National State and County Comparisons Body Mass Screenings started in 2004 Established a county wide benchmark This is a summary slide of all the schools. Even though people believe that Tippecanoe is more highly educated and the problem is not as prevalent this slide shows that it is indeed troubling. Interestingly self report is a real issue with height and weight of children and adults. The figures here show a true sample for USA and ARK and Tippecanoe county. The best the state could come up with was an estimate with self report data. I said they were way off and in Tippecanoe I could show the real value. At this time we have weighed 10,000 of the 22,000 K-12 age children in the county. ARK passed a mandatory law that all schools had to report the BMI. Notice the difference between at risk and overweight. In the southern states that are further along the obesity trend the overweight and at risk are close. In those states that have not gotten that far there will be more at risk and less overweight. This is a summary slide of all the schools. Even though people believe that Tippecanoe is more highly educated and the problem is not as prevalent this slide shows that it is indeed troubling. Interestingly self report is a real issue with height and weight of children and adults. The figures here show a true sample for USA and ARK and Tippecanoe county. The best the state could come up with was an estimate with self report data. I said they were way off and in Tippecanoe I could show the real value. At this time we have weighed 10,000 of the 22,000 K-12 age children in the county. ARK passed a mandatory law that all schools had to report the BMI. Notice the difference between at risk and overweight. In the southern states that are further along the obesity trend the overweight and at risk are close. In those states that have not gotten that far there will be more at risk and less overweight.

8. 2004-2006 Male and Female Data By Gender, some difference, but both of them are serious. Female 33% Total, Male 37%. Boys are further along. More of them are overweight. When you look at these figures for a long time you being to see some patterns. Over time the overweight gets larger than the At Risk. In the final report there are further breakdowns by ethnicity and by age.By Gender, some difference, but both of them are serious. Female 33% Total, Male 37%. Boys are further along. More of them are overweight. When you look at these figures for a long time you being to see some patterns. Over time the overweight gets larger than the At Risk. In the final report there are further breakdowns by ethnicity and by age.

9. Comparison by School Corporation No corporation is exempt. Socio economic or not. County 35%, Laf 43%, W Laf 24%, Indep 31% Reduce the proportion of children and adolescents who are overweight or obese to 5% Take a moment to talk about Healthy People 2010. Nationwide goals the CDC has recommended. Not very realistic Increase the proportion of children and adolescents whose intake of meal and snacks at school contributes to good overall dietary quality No corporation is exempt. Socio economic or not. County 35%, Laf 43%, W Laf 24%, Indep 31% Reduce the proportion of children and adolescents who are overweight or obese to 5% Take a moment to talk about Healthy People 2010. Nationwide goals the CDC has recommended. Not very realistic Increase the proportion of children and adolescents whose intake of meal and snacks at school contributes to good overall dietary quality

10. Benton County Middle School Benton is 37%Benton is 37%

11. Survey Statistics Obesity in children is often linked to socio economic status. This is the same slide as before, but I wanted you to see the subsidy of the school corporation. You can see that while there is a relationship it is not totally correlated. Obesity in children is often linked to socio economic status. This is the same slide as before, but I wanted you to see the subsidy of the school corporation. You can see that while there is a relationship it is not totally correlated.

12. What we are doing now Reports distributed to school administrators, nurses, and physical education/health teachers annually Recommendations that are realistic Work with school wellness committees on Coordinated School Health Program Goals and School lunch menus Arnett Health Plan Power Over Pounds Program Nutrition and Physical activity presentation through faith based community directed towards Hispanic community

13. Power over Pounds Arnett Health Systems Power over Pounds is an Arnett sponsored program for children that are at risk and overweight. This 10 week program has been offered twice for families with follow up. It will be offered again in August. There is a waiting list. Power Over Pounds teaches families and children about proper nutrition, exercise, and good choices for healthy living. This program has been a collaborative community effort with a psychologist, dieticians, nurses, pediatricians and an epidemiologist.Power over Pounds is an Arnett sponsored program for children that are at risk and overweight. This 10 week program has been offered twice for families with follow up. It will be offered again in August. There is a waiting list. Power Over Pounds teaches families and children about proper nutrition, exercise, and good choices for healthy living. This program has been a collaborative community effort with a psychologist, dieticians, nurses, pediatricians and an epidemiologist.

14. In Action Pauline Shen weighing in�

15. Future Plans for Student Body Mass Index Less students were weighed in Tippecanoe since a benchmark has been established (n~2500) Seniors to be weighed to give better sampling Focus on schools in surrounding counties to Tippecanoe in District 4 Begin to analyze data with other factors, such as ethnicity and age Continue working with school staff to recommend changes to breakfast and lunch menus; successes Share the movie Super Size Me with Health and Physical Education teachers County schools make up 50% of all the students in the community Small sample sizes in the 3-5 grade level County schools make up 50% of all the students in the community Small sample sizes in the 3-5 grade level

16. School Projects Fast Food Pocket Guide designed for teenagers about local fast food restaurants will be distributed Walk with the Doc Program Wea Ridge Middle Learn from successful examples (ie. Montgomery County, Crawfordsville schools) Fresh Fruit / Vegetable Program Action for Healthy Kids/Blue Cross Blue Shield/Anthem Grant Stacy Eldridge & Chris Zimmerman Funding for Dance Dance Revolution equipment

17. Public health database Available on line at our county web page Our goal with this project was to establish a public health database. The number of calls we field of people asking what is the prevalence of smoking in our county, obesity, diabetesOur goal with this project was to establish a public health database. The number of calls we field of people asking what is the prevalence of smoking in our county, obesity, diabetes

18. Why establish a Benchmark? How do Tippecanoe County residents compare to the rest of Hoosiers? And the nation? For grass roots organizations and funding organizations to assess the success of their programs Health providers to see the big picture What are our strengths and weaknesses? With limited resources how can we prioritize? Is there a trend? Good or Bad? Are their Red flags in our community?

19. Data Sources Used existing data from the Coalition of Living Well at Purdue University n=309 Gathered new data for adult population 25-50 n=436 Purdue University Social Research Institute (SRI) and Computer Aided Telephone Interviewing (CATI) Lab Standard set of validated questions from the BRFSS

20. Logistics Masters students with the IUPUI MPH program trained by sociology graduate students to ask questions and use equipment Questions chosen that coincide with CDC BRFSS Statistical Analysis software SPSS Basic statistical functions, ie. frequency, prevalence, rate, comparison

21. Tippecanoe County Leading Health Indicators of Chronic Diseases High cholesterol 23.4% Hypertension 26.1% Diabetes 8.8% Smoking 19.4% Chronic Heart Disease 6.6% Cancers (Combined) 7.3% Adult Overweight 34% Adult Obese 27% Children at Risk (overweight) 25% Children (Obese) 10% Adults Lacking Health Insurance 13.1% School age children, not preschool or infantsSchool age children, not preschool or infants

22. Diabetes Nationwide Diabetes Prevalence 8% Tippecanoe County 8.8% Number of adults with Diabetes ~ 7500 Red flag In this county we are higher than the nation and certain age groups are higher than the state average. With 85,000 adults in this county 7500 adults have diabetes, about a third of them don�t even know it yet, pre metabolic syndrome. Notice the difference in age groups How many of these people have diabetes that is managed? Do we have the capacity in our health care system to treat and manage 7500 people? How many people use the Regional Diabetes Ctr on a regular basis? How many people come to the ER with severe symptoms of Diabetes and are unmanaged? Red flag In this county we are higher than the nation and certain age groups are higher than the state average. With 85,000 adults in this county 7500 adults have diabetes, about a third of them don�t even know it yet, pre metabolic syndrome. Notice the difference in age groups How many of these people have diabetes that is managed? Do we have the capacity in our health care system to treat and manage 7500 people? How many people use the Regional Diabetes Ctr on a regular basis? How many people come to the ER with severe symptoms of Diabetes and are unmanaged?

23. Smoking No smoking ban Purdue & W. Lafayette IN Smoke attributable health expenditures 1998 1.6 B and $2.3 B productivity losses Hot topic in town. What is Lafayette going to do? Several years ago PU banned smoking inside buildings. City council passed no smoking, but has not taken effect yet. Most of the restaurants are in Lafayette. Some bars have already filed for an exception. In this graph notice several things. The target audience that smokes is younger. Not shown is that younger men at twice the rate of younger women. Prevention program aimed at young male teenagers. Stop smoking campaigns at men. How does Tippecanoe compare to the state, USA, 2010 Health goals. What is 2010? Every decade for the last 3 CDC has looked at health indicators, mortality, chronic, etc. and come up with a goal to aim for. This goal is useful for the state health dept. and should be useful for the county, health organizations, agencies that are trying to advocate against tobacco useHot topic in town. What is Lafayette going to do? Several years ago PU banned smoking inside buildings. City council passed no smoking, but has not taken effect yet. Most of the restaurants are in Lafayette. Some bars have already filed for an exception. In this graph notice several things. The target audience that smokes is younger. Not shown is that younger men at twice the rate of younger women. Prevention program aimed at young male teenagers. Stop smoking campaigns at men. How does Tippecanoe compare to the state, USA, 2010 Health goals. What is 2010? Every decade for the last 3 CDC has looked at health indicators, mortality, chronic, etc. and come up with a goal to aim for. This goal is useful for the state health dept. and should be useful for the county, health organizations, agencies that are trying to advocate against tobacco use

24. Hypertension US prevalence ~ 30% Indiana ~ 27% Tippecanoe County 26.1% Notice the correlation, not necessarily causation, that those with high blood pressure are much more likely to be overweight or obese. Finding linkages between health indicators can drive educational programs. Notice the correlation, not necessarily causation, that those with high blood pressure are much more likely to be overweight or obese. Finding linkages between health indicators can drive educational programs.

25. Limitations Time gap between the adult data gathering, older population (2003) vs. younger population (2005) children 2004-05 data Over representation in sample size by females 66% (Home more often) Telephone Survey eliminates those without a land line Different definitions of chronic diseases, MD diagnosis

26. Future Plans Masters students with the IUPUI MPH program and PU students from new Public Health program will be trained by sociology graduate students to ask questions and use equipment. Questions chosen that coincide with CDC BRFSS and ISDH chosen optional packages Data gathering to begin in May 2007 for eight surrounding counties of District 4 - Benton, Warren, Fountain, Montgomery, Clinton, Carroll, Cass, White

27. Information Tippecanoe County Health Dept Pauline Shen 629 N. 6th Street, Lafayette pshen@tippecanoe.in.gov (765) 420-8481 Chronic Health Indicator report http://www.tippecanoe.in.gov/egov/docs/1167322234_150085.pdf

28. Thanks Tippecanoe County Health Department Public health nurses and staff North Central Health Services (NCHS) Coalition for Living Well at Purdue University CATI Lab at Purdue University School nurses Vision 2020/Step Ahead Partners Student interns from the IUPUI MPH program