Special Thanks to:

1. Special Thanks to: Chicago Community Trust & Washington Square Health Foundation for their support and funding. Helping us get one step closer to our goal.

2. WHY TALK FAT?Origins of the Project • Growing awareness of obesity as a national problem

3. National Concerns • Doubling of obesity rates • Associated increase of Type 2 Diabetes • Anticipated increase of cardiovascular disease, orthopedic problems, and depression

4. Percent of Teens who fall above the 85th or 95th %ile for BMI • NHANES III (’88 to ’91) • 12-17 yo

5. ACHN SBHC vs. NHANES, Percent of Teens >95%ile BMI

6. WHY TALK FAT?Origins of the Project • Growing awareness of obesity as a national problem • Observation in our own clinics of large numbers of overweight youth • Need to address diabetes prevention and diagnosis

7. Where Will Intervention Take Place:School-Based Health Center(SBHC) • Provide ease of access and familiarity to students and families • Students receive comprehensive health care services • Patient population with increased risks for obesity and diabetes (40% of 1st or 2nd degree relatives with diabetes)

8. What is STRIDE?Smart Teens Reducing the Incidence of Type 2 Diabetes, Etc. • SBHC obesity intervention and behavior change program • Context: Enhanced diabetes screening study • Focus: Healthy eating & increase of physical activity • Method: Adult and teen focus groups drawn from 3 urban high schools with SBHC

9. Teens Talk FatMinority Students & their Families Discuss Experiences and Ideas for Healthy Eating and Physical Activity From the Cook County ACHN N. Fritz, S. Corbin, C.Stahl, N. Mourikes, M. Driscoll

10. Focus Groups • PURPOSE: Use adult and teen opinions to guide development of interventional program to reduce diabetes risks

11. Focus Group Recruitment • FOCUS GROUP • Students were recruited via classroom, hallway fliers, patient contact, word of mouth, and referral from providers • Parents were recruited via their children, at report card pick-up and clinic registration, and from pre-existing school based parent groups

12. Focus Group • REVIEW • Groups were held between November 2001-January 2002 • 1 student and 1 parent group from each of 3 schools • Group leader matched by ethnicity • Groups of 7-17 participants • Groups lasted 1-2 hours • Healthy foods served

13. Focus Groups con’t • Focus group questions addressed: • Participants’ experience with diet or exercise change • Knowledge of community resources for eating and physical activity • Participants’ opinions about useful intervention strategies in the SBHCs

14. Focus Group • METHODS: • Discussions were audio recorded • Tapes reviewed by all investigators independently and themes identified • Transcriptions of discussions were also reviewed

15. Analysis: • Particular attention to: • Common themes across groups • Differences between AA and Latino groups • Differences between teens and parents

16. Results: All groups • 71 participants • 19 males, 52 females • 36 teens, 35 parents • 22 Latinos, 49 African-Americans • Most participants were overweight

17. Results: Observations • Many participants expressed a concern for better health and nutrition • All participants were able to list community resources • All participants tried the “healthy” foods that were provided

18. Themes • Feeling unable to sustain healthy choices • “One of my ex-boyfriends got me one of those things you put your feet on, and I sold it . Then he got me an old stationary bike. . And I sold that too..” • “I don’t like walking. I tried sit-ups. I even tried the cha-cha-cha dance….I am just lazy…” • “It’s like when you try…OK, you’re trying..”

19. Themes • Denial there’s a problem • “I don’t want to talk about diabetes – it scares me.” • “My doctor tells me to lose weight; But I’m happy with how I am. I don’t want anyone telling me how I should be . .”

20. Themes • Knowledge deficits • “For a while I tried to stop drinking pop so I switched to juice” • “Regular salt is bad for you – you have to buy sea salt from the health food store, it’s better”

21. Themes • Expediency of junk food: • “If the junk food’s there, you just eat it…” • “If you put healthy food in the machines, don’t SAY it’s healthy. . .or people won’t buy it. . .they’ll be afraid it tastes nasty.”

22. Themes • Community resources identified and concerns about these resources (healthy eating): • “Our neighborhood is ghetto, we don’t sell that stuff. They sell spoiled, rotten meat and stuff.” • “Basically, in our neighborhood, you really can’t buy fresh vegetables from there because they are not fresh . . .”

23. Themes • Suggestions for programmatic supports: • Some sort of group—a support group, cooking group, restaurant field trip group, dance/drama group, etc. • Use of school facilities as a resource • Very few suggestions regarding provider in-put

24. Results: Teen Groups • There were a total of 36 teens (9 male, 27 female) • 22 African-American and 14 Mexican-American teens • 2/3 of the teens were overweight • Most of the teens had family hx of diabetes, as well as, personal experience with dieting and weight loss

25. Results: Teen Groups con’t • Most teens expressed a concern for their health and nutrition • Most teens did not eat meals provided by the schools’ cafeteria • Most teens were eager to make changes, but also wanted the support needed to make these changes

26. Results: Adult Groups • There were a total of 35 adults (10 male, 25 female) • 10 Mexican-American and 25 African-American adults • 2/3 of the adults were overweight • Some of the adults were diabetic, most had family hx of diabetes and had some experience with dieting/weight loss

27. Contrasts: Adults & Teens • Parents were more concerned about safety issues in the community than were teens. • Parents were less likely to try the various healthy snacks provided during the groups.

28. Contrasts: African-Americans & Mexican-Americans • Mexican-American teens expressed more dissatisfaction about their physical appearance than did the African-American teens • Mexican-American parents were more open to changing their eating/cooking habits than the African-American parents • African-American teens but NOT parents were more likely to deny obesity as a problem.

29. Conclusions: Intervention needs to • Address psychological barrier of hopelessness • Build interpersonal support groups • Address school environmental issues: lunch, vending machines, PE classes, after school opportunities • Education is important but insufficient • Support development of change agents among youth, parents, and staff