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A multi-component, theory-based intervention to address obesity in rural U.S.

A multi-component, theory-based intervention to address obesity in rural U.S. N. Teixeira November 30, 2012. Background: Rural U.S. Different definitions of rural, generally defined in by comparison to urban/metro areas < 2,500 residents (U.S. Census Bureau, 2012)

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A multi-component, theory-based intervention to address obesity in rural U.S.

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  1. A multi-component, theory-based intervention to address obesity in rural U.S. N. Teixeira November 30, 2012

  2. Background: Rural U.S. • Different definitions of rural, generally defined in by comparison to urban/metro areas • < 2,500 residents (U.S. Census Bureau, 2012) • 19.3% of the U.S. population (2010) • Rural communities are not homogenous (NACO, 2008)

  3. Rural U.S. USDA ERS, 2000 http://www.ers.usda.gov/data-products/atlas-of-rural-and-small-town-america/go-to-the-atlas.aspx

  4. Population Size, 2011 http://www.ers.usda.gov/data-products/atlas-of-rural-and-small-town-america/go-to-the-atlas.aspx

  5. Rural Obesity • Youth and adolescents living in rural areas are significantly more likely to be obese than urban children (Davis et al., 2011) • Compared to overweight youth in metro areas, overweight rural youth are more likely to be • living in poverty • uninsured • less physically active • less likely to have received preventive care in the past 12 months (Lutfiyya et al., 2007) • Rateof adult obesity also greater in rural areas compared to urban • Economy and culture shift in recent decades • Unique challenges with rural living (NACO, 2008)

  6. Significance • Childhood obesity is associated with many adverse health outcomes • Children and adolescents who are overweight are more likely to be obese in adulthood and may be more at risk of premature mortality (Reilly et al., 2010)

  7. Barriers and Challenges • Access to healthy foods • Food deserts & food insecurity • Few opportunities for PA • Transportation • Lack of sidewalks • Social norms • Limited resources and capacity • Population density • Access to health care (NACO, 2008; Maley et al., 2010; Hennessy et al., 2010)

  8. Intervention • Theoretical framework: The TTI • Goal • Reverse obesity trends in rural settings • Establish an environment that supports energy balance • Objectives • Increase FV consumption • Increase PA

  9. Intervention Overview

  10. Formative Steps • Participatory approach to assessment • Engage stakeholders • Pretesting concepts and materials

  11. School • Nutrition curriculum • Garden-based nutrition education • Modeled after CA’s Harvest of the Month program • Cooking/food prep lessons • Policy • Wholesome, nutritious lunches • Restrict competitive foods • Mandated PE meeting national recommendations • Training for educators • Encourage activity breaks • Afterschool programming based on youths feedback

  12. Parent/Guardian Support • Newsletters • Encourage healthy eating and promote PA • Consistent with school curriculum and seasonal produce • Classes • Budget shopping • Healthy cooking • Food preservation • Raffles http://www.harvestofthemonth.cdph.ca.gov/download.asp

  13. Community • Improve access to healthy foods • Farmer’s markets • Improving quality & selection of FV at local food outlets or convenience stores (while ensuring affordability) • Improve opportunities for active living • Sidewalks or paths/trails • Partner with HS for shared use of facilities • Quarterly community events • Information re: nutrition, recipes, opportunities for activity • Tasting tables • Demos & raffles • Partner with local health clinic- health screening • Overcome transportation barriers • Facilitate partnerships with public transit services (or w/school districts, churches)

  14. THE THEORY OF TRIADIC INFLUENCE Levels of Causation Ultimate CULTURAL SOCIAL BIOLOGY/ Causes ENVIRONMENT SITUATION PERSONALITY Social/ Personal Nexus Interactions w/ Social Instit’s Distal Influences Expectancies & Evaluations ATTITUDES SOCIAL SELF-EFFICACY Affect and Cognitions TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Proximal 19 20 21 Predictors Decisions 22 Experiences 23 Intervention School, Family, Community Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Enhanced food environment; trails/sidewalks; transportation Biological/Nature Nurture/Cultural P/G Newsletters P/G/Family classes School activities Nutrition Ed. Opportunities for PA 1 2 3 4 5 6 Transportation improvements School/family support Sense of Information/ Interpersonal Others’ Social Self/Control Opportunities Bonding Beh & Atts Competence Skills related to PA/FV Info re: PA & healthy eating Vol. Screening at community event 7 8 9 10 11 12 Classroom activities & media Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies 13 14 15 16 17 18 DECISIONS/INTENTIONS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Obesity Prevention PA FV consumption Energy Balance 16

  15. Summary • A participatory approach • Collaboration with partners and stakeholders • Multiple synergistic strategies with consistent and reinforcing messages • Continuous monitoring and evaluation • Process, outcome, impact evaluation

  16. References Davis, A. M., Bennett, J. K., Befort, C., & Nollen, N. (2011). Obesity and related health behaviors among urban and rural children in the United States: data from the National Health and Nutrition Examination Survey 2003–2004 and 2005–2006. Journal of Pediatric Psychology, 36 (6), 669-676. Hennessy, E., Kraak, V. I., Hyatt, R. R., Bloom, J., Fenton, M., Wagoner, C., et al. (2010). Active living for rural children: Community perspectives using PhotoVOICE. American Journal of Preventive Medicine, 39 (6), 537-545. Lutfiyya, M. N., Lipsky, M. S., Wisdom-Behounek, J., & Inpanbutr-Martinkus, M. (2007). Is rural residency a risk factor for overweight and obesity for U.S. children? Obesity, 15 (9), 2348-2356. Maley, M., Warren, B. S., & Devine, C. M. (2010). Perceptions of the environment for eating nd exercise in a rural community. Journal of Nutrition Education and Behavior, 42 (3), 185-191. National Association of Counties. (2008). Rural obesity: Strategies to support rural counties in building capacity. Washington, DC. Reilly, J. J., Houston-Callaghan, K., Donaghey, Z., & Hammed, S. (2010). Physical health consequences of child and adolescent obesity. In D. Crawford, R. W. Jeffery, K. Ball, & J. Brug.(Eds.),Obesity Epidemiology (2nd ed.). New York: Oxford University Press. U.S. Census Bureau. (2012). 2010 Census urban and rural classification and urban area criteria. Retrieved from http://www.census.gov/geo/www/ua/2010urbanruralclass.html

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