Statewide Health Improvement Program Community Health Indicators: Mahnomen County

1. Statewide Health Improvement ProgramCommunity Health Indicators: Mahnomen County Prepared by: Garth Kruger, Ph.D. Dmitri Poltavski, Ph.D. EvaluationGroup, LLC

2. Introduction • EvaluationGroup,LLC • Dmitri Poltavski, Ph.D. • Garth Kruger Ph.D. • Jacque Gray, Ph.D. • OUR SERVICES INCLUDE • PROGRAM EVALUATION DESIGN • WRITING LOGIC MODELS • NEEDS ASSESSMENTS • SURVEY CONSTRUCTION • DATA ANALYSIS • POLICY ANALYSIS • WEB PAGE DESIGN

4. What are the results? • Adults in Mahnomen County and the NW MN Region are overweight/obese. • Increase physical activity and improve nutrition. • Children need better nutrition • Followed by increased physical activity

5. The End…

6. Overview • Behavioral Risk Statistics • Indexes of Obesity and Tobacco Use: Adults (18+) • Indexes of Obesity and Tobacco Use for High School Students (grade 12) • Overweight and Obesity • Exercise and Physical Activity • Fruit and Vegetable Consumption • Tobacco Use, Access, Smoking Policy • Interviews with County Residents • Review of Interventions and Recommendations

7. Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: Adults (18+)

8. ESTIMATE ? Unknown ? Known Age Gender Risk Statistics (Adults) Data Used • Behavioral Risk Factor Surveillance Survey (BRFSS) databases 2004, 2007 and 2008. • There are only synthetic estimates of behavioral adult risk statistics for the 8-county SHIP region. • There are currently no recent BRFSS data available on smokeless tobacco use in Minnesota.

9. MN Risk Statistics (Adults) General Health and Obesity • Over 60% of all Minnesotans are overweight or obese (mean BMI of 27.5 [1] ). • 37.5% of all Minnesotans were overweight. • 26.5% were classified obese. [1] BMI between 25.00 and 29.99 corresponds to the category “overweight”; BMI of 30.00 and above corresponds to the category “obese”.

10. MN Risk Statistics (Adults) 2007 Minnesota Physical Activity (PA) Categories (%). • 45.5% of Minnesotans met physical activity recommendations. • 40.4% reported insufficient levels of physical activity. • 12.9% had none at all.

11. Mahnomen County Risk Statistics (Adults) [1] Aggregate data for Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake & Roseau Counties.

12. MN Risk Statistics (Adults) Fruit and Vegetable Consumption • 21.3% of Minnesotans reported consuming 5 or more servings of fruits and vegetables per day.

13. MN Risk Statistics (Adults) Tobacco Use and Smoking Policy • 15.7% of Minnesotans in 2008 reported currently smoking at least on some days. • 11.1% percent were regular smokers (smoke every day). • 53% of smokers reported trying to quit at least once in the past 12 months.

14. Summary • Data suggest • Over half the adult population is overweight or obese. • Only slightly more than 20% of adults eat the recommended guidelines of fruits and vegetables. • Mahnomen county adults are much less physically active (no exercise) than other adults statewide.

15. Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: High School Students (grade 12)

16. Risk Statistics (High School Students) Datasets Used • Minnesota Student Survey 2007 • Information used for only students in grade 12. • Good proxy for needs given SHIP parameters. • They show the greatest prevalence of health risk behaviors compared to grades 6 and 9. • 55.6% response rate • 72% response rate for SHIP region

17. Risk Statistics (High School Students) Datasets Used • MN Student survey administrators provided raw data sets in order for us to make statistical comparisons. • Confidence intervals used to assess statistical differences. 18.4% 9.6% 95% Confidence Interval 32.2%

18. Risk Statistics (High School Students) Overweight and Obesity –See Table 2, pg. 7 • 18.4 % of 12th-graders in Mahnomen County were classified ‘at risk’ for becoming overweight • 12.2% of 12th-graders in Mahnomen County were considered overweight. • Adult population at 60% • 28.0% of Mahnomen county students thoughtthey were overweight.

19. Risk Statistics (High School Students) • 75.6% of students met recommendations for regular weekly physical activity. • Higher than MN (68.7%). Exercise and Physical Activity • 13.3% of students reported insufficient physical activity. • 11.1% reported no weekly physical activity.

20. Risk Statistics (High School Students) Fruit and Vegetable Consumption • Only 8.0% of students reported adequate daily intake of fruits and vegetables. • Far fewer than MN (16.1%).

21. Risk Statistics (High School Students) Tobacco Use and Access • 38.8% of the 12th-grade students in Mahnomen County reported using tobacco products in the 30 days preceding the survey. (15.7% of adult Minnesotans smoke) • Cigarette smoking was the most frequent form of tobacco use reported by 24.5% of students. • 16.3% of 12th graders had used smokeless tobacco or smoked cigars before the age of 13 compared to state average of 5.0%.

22. Risk Statistics (High School Students) • 73.7% of tobacco users purchased them at a gas station or a convenience store. • Higher than MN average of 63.1% (but not stat sig).

23. Summary of Findings Compared to the statewide averages of MN youth, Mahnomen County youth… • Meet PA guidelines significantly less often. • Are more likely to get no physical activity at all. • Eat less fruits/vegetables per day. • Use tobacco products more often. • May be more likely to buy tobacco at a gas station or convenience store. • Perceive themselves to be overweight more often. • These perceptions are much higher than their actual reported degree of overweight.

24. What are the results again? • Adults in Mahnomen County and the NW MN Region are overweight/obese. • Increase physical activity and improve nutrition. • Children need better nutrition • Followed by increased physical activity

25. County Resident Interviews Most Pressing Issues and Extent of Problems

26. Interviews • Primary and pressing healthcare issues facing their community • Obesity • Tobacco use both by adults and students

27. Interviews • Extent of Problem: Unhealthy Eating/Physical Activity • Participants rated obesity as a 7-8 and • Tobacco use at a 5-6. • A number of participants indicated that community member groups at risk included students and kids uninvolved in sports activities. • One participant indicated that the area is highly unbalanced when thinking of socio-economic status, they stated “If you are not living in a trailer you’re living in a half million dollar place on the lake.”

28. Interviews • Confluence of factors negatively impacting healthy eating and physical activity in Mahnomen County: • Food costs • cheap, fast, unhealthy food is what people want • Food vendors offer poor choices • Culture of inactivity • Lack of supports for those seeking to become healthier • Lack of parent time/interest in children’s’ weight and activity

29. Interviews • One convenience store clerk respondent stated “I feel bad when people come into the store and say, I need my fruit for the day” when buying Starburst candy.

30. Interviews • Extent of Problem: Tobacco • A number of interviewees already were implementing tobacco use policies or seeing their results. • “It seems like everywhere you go you see groups of 10-11 people smoking.” • “Why should I quit?”

31. Interviews • Comments from interviewers…

32. Recommendations Best Options for Addressing Overweight, Physical Activity and Tobacco Use in Adults and Youth

33. Intervention Settings Community Worksites Schools Tobacco Use and Obesity Healthcare

34. Recommendation: Increase Adult Physical Activity COMMUNITY/WORKSITE SETTING INTERVENTIONS • Policies and practices that create active communities • Increase opportunities for non-motorized transportation (walking and biking) • Increase access to community recreation facilities. • Implement signage prompting use of stairs in community buildings. • A comprehensive employee wellness initiative • Provide health assessment with follow-up coaching, • Provide ongoing health education, • Provide policy and environmental supports that promotes healthy weight and behaviors. • HEALTHCARE SETTING INTERVENTIONS • Develop relationships among health care providers and community leaders to facilitate active referral of patients to resources that increase access to nutritious foods, physical activity, and tobacco use cessation.

35. Recommendation: Nutrition & Physical Activities for Youth • SCHOOL SETTING INTERVENTIONS • Comprehensive nutrition policies: • Breakfast promotion; • Healthy lunch and snacks; • School gardens; • Farm-to-school initiatives. • Creating more active schools through: • Supporting quality school-based physical activity • Increasing opportunities for non-motorized transportation • Increased access to school recreation facilities. • COMMUNITY SETTING INTERVENTIONS • Improving access to nutritious foods (e.g. fruits, vegetables) through: • Increased availability and affordability of nutritious foods in grocery stores, corner stores, concession facilities, and other food vendors. • License and facilitate the development of new farmer’s markets and promote their use.

36. Recommendation: Decrease Tobacco use by Youth • COMMUNITY SETTING INTERVENTIONS • Tobacco-free policies for parks, playgrounds, beaches, zoos, fairs, and other recreational settings. • Policies that restrict youth access to tobacco such as sales laws directed at tobacco retailers to reduce illegal sales to minors. • HEALTH CARE SETTING INTERVENTIONS • Better connect people with existing effective cessation services (such as the 5 A’s and fax referral).

37. Recommendation: Collect Better Data • Conduct BRFSS locally within each of the eight counties to obtain a more accurate accounting of the adult population risk factors within northwest Minnesota.

38. If you have further questions you can contact us at… www.evaluationgroupllc.com 29337 310th ave NW Warren, MN 56762 Ph:218-201-0375 Fax: 218-437-8435