Combating Obesity among Adolescents in Houston’s 3rd Ward

1. Combating Obesity among Adolescents in Houston’s 3rd Ward A Community Based Program to Educate Adolescents about the Relationship between Poor Food Choices and Their Health Group G: Crystal Cao, Susan Lampa, and Doc Tran HS 3073: Health Promotion Program Planning TWU Spring 2006 April 30, 2006

2. Health Issue/Target Population • Health issue: overweight/obesity among Mexican American adolescents in the Third Ward, Houston, Texas. • 23% of Mexican American adolescents are overweight. (Centers for Disease Control and Prevention,, 2005). • Health consequences for overweight adolescents as well as adults include type 2 diabetes, cardiovascular disease, high blood pressure, sleep apnea, increased LDL cholesterol and risk of liver and gall bladder diseases. (Center for Health and Health Care in Schools, 2006). • Overweight adolescents have a 70% chance of becoming overweight/obese adults (U.S. Department of Health and Human Services, 2001).

3. Cultural Factors Contributing to Overweight • 2000 U.S. Census data shows that 43.5% of the population of the Third Ward are Hispanics. • Cultural factors contribute substantially to excess weight in minority populations. Food choices and preparation, frequency of meals and attitudes about body image. • Many Mexican American adults view an overweight child as a sign of a healthy child. • Hispanic adolescents perceive themselves as being of normal weight even when they are overweight. (Center for Health and Health Care in Schools, 2006).

4. Social Factors Contributing to Overweight • Social factors also contribute to poor nutrition and increased risk for overweight/obesity: • Low income adolescents living 130% below the poverty level are twice as likely to be overweight compared with those above the poverty level. (U.S. Department of Health and Human Services, 2001). • Working poor often have no time for cooking, little money to buy fresh vegetables and few supermarkets with good produce. (Mayo Clinic, 2005) • Poor communities often lack safe places for recreation that promotes physical activity which contributes to the risk for overweight/obesity.

5. Program Mission • The purpose of this program is to promote and increase knowledge in Third Ward adolescents about the relationship between poor food choices and their health and to increase consumption and access to fruits and vegetables.

6. Goals • Reducing overweight/obesity through a nutrition education program that takes participants’ usual eating habits, cultural food preferences, and financial limitations into consideration • Increasing consumption and availability of fruits and vegetables in the Third Ward community through a nutrition education program and a community garden/farmer's market.

7. Key Components Ensuring Program Success • Community Partnership and Volunteers • Based on Health Belief Model Components of Perceived Susceptibility and Severity raising awareness among the community for a need of prevention and health education in obesity and diet. (McKenzie et. al, 2005) • Rewards and Perceived Benefits as reinforcing factors to the success of the program.

8. Program Services – Level I • Communication and Awareness • Brochures and questionnaires • Personally inform local community gatekeepers and leaders • Population targeted: • Adolescents • Parents of adolescents • Community gatekeepers and leaders

9. Program Services – Level II • Screening and Assessment • Nutritional screening of adolescent population • Population targeted: • Hispanic Adolescents

10. Program Services – Level III • Education and Behavior Modification • During-school-for-elective-credit program open to all students • After school program open to students and their family members • Population targeted • Adolescents • Family members of adolescents

11. Program Services: Level IV • Environmental Support • Students will have the option of participating in the program during or after school • All materials, equipment and supplies will be provided at no cost to participants • Participants will receive produce from garden • Population targeted: • Adolescents • Family member of adolescents

12. Motivation and Retention Strategies • Social reinforcers • Friendship • Inclusion of family members in the program • Material reinforcers • High school elective credit for those participating in the during-school-for-elective-credit program • Participants will be able to take home the products that are grown in the garden

13. Feb. Mar. April May June July Aug. Sep. Oct. Nov. Dec. Develop goals & objectives Marketing Staff Training After school program Summer program After school program Enrollment in during-school-for-elective-credit class During-school-for-elective-credit class Pre-test Pre-test Post test Time Line Jan.

14. Evaluation Methods • Process Objectives: 1) By April 6, 2006, 1000 brochures and questionnaires will be distributed to the Third Ward community by April 1 to inform and assess their thoughts on beginning a community garden/food cooperative program. Evaluation Measure: Counting and keeping track of distribution can effectively measure this process. 2) By April 1, 2006, 25% of the Third Ward adolescents who attended the Third Ward Health Fair will have registered for the nutrition health education program. Evaluation Measure: Attendance records of all Third Ward adolescents who participated in the Health Fair will be kept. Those who have registered for the nutrition education program will also be noted and the successful evaluation in which the objective was met is dependent on comparing the two sources of data.

15. Evaluation cont. • Impact Objectives: 1).By the end of the health education program, participating Third Ward 75% adolescents will be able to recall the 2005 dietary guidelines for Americans as outlined by the USDA. Evaluation Measure: A brief, 15 question/answer and true/false, quiz will be given at the completion of the health education program. Successful outcome will be achieved if 75% of adolescents are able to pass the quiz by answering 12 of 15 questions correctly. 2. By the end of the health education program, knowledge among participating Third Ward adolescents about USDA dietary guidelines and the relationship between health and poor food choices will have increased by 50% over pre-program numbers. Evaluation Measure: Similar to the precious impact objective, the quiz will be utilized to evaluate the success that the objective has been met. The data collected from the quiz will be compared to that of a pretest given prior to the start of the program. The comparison of the two pre/post tests will be the evaluation measure for this objective.

16. Evaluation cont. • Outcome Objective: By the next Selected Metropolitan/Micropolitan Area Risk Trends (SMART) Behavioral Risk Factor Surveillance System (BRFSS) survey performed by the National Center for Chronic Disease Prevention and Health Promotion, 60% of program participants will show an increase in their consumption of fruits and vegetables as measured by the SMART BRFSS survey as compared to county wide numbers. Evaluation measure: Since data from the CDC BRFSS is conducted annually by county, a comparison of pre assessment numbers of program participants who regularly consume fruits and vegetables versus those who do not will be utilized. These numbers will be compared to that of the county statistics and its percentages to measure the success of the objective.

17. Costs and Income Sources • Total Start Up and Operating Costs for the health education program to combat obesity among adolescents in Houston’s Third Ward (5/06-5/07) are $429,579.00. • Total Income = $430,000.00 • Sources of Income: • The United States Department of Agriculture Community Food Projects Competitive Grant Program - $300,000 grant. • The Aetna Regional Community Health Grants Program for the Southwest Region - $50,000 grant. • The Dell Foundation’s Healthy Communities Grant Program – $5,000 grant.

18. Income Sources • U.S. Department of Health & Human Services Community Food and Nutrition Discretionary Grant Program –$75,000 grant. • Fiskars Garden Tools Project Orange - $1,000.00 in Fiskars garden tools and an additional $800.00 in gardening-related materials (plants, seeds, mulch). • Gardner’s Supply Company Donation and Awards Programs – $1,000.00 in garden-related materials (soil, mulch, plants, and seeds). • Additional funding and donations will also be received from several third party payers such as Houston area civic or service groups, as well as other external resources of funding and in-kind support totaling $5,000.00.

19. Perceived Barriers to the Program • Attitude of adolescents may affect participation and volunteer rates • Time constraints and schedules of community members may affect volunteers • Community inability to recognize perceived susceptibility and severity of health issue

20. References • The center for health and health care in schools (2006). Childhood Overweight: What the Resarch Tells us. Retrieved on April 2006 from http://www.healthinschools.org/sh/obfs2.asp • Centers for Disease Control and Prevention (2005). National Center for Health Statistics. Retrieved on February 10, 2006 from http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm • McKenzie, J. F., Neiger, B. L., Smeltzer, J. L. (2005). Planning, implementing and evaluating health promotion programs. (4th ed.). Benjamin Cummings. • Mayo Clinic (2005). Childhood Obesity: What Parents can do. Retrieved on February 16, 2006 from http://www.mayoclinic.com/health/childhood-obesity/FL00058 • United States Department of Health & Human Services (2001). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Retrieved on February 10, 2006 from www.surgeongeneral.gov/topics/obesity/ • U. S. Census Bureau (2000). Census 2000. Retrieved on February 10, 2006 from http://quickfacts.census.gov/qfd.index.html