Lake County Assessment and Community Focused Interventions for Obesity Among 7th-9th Grade Children

1. Lake County Assessment and Community Focused Interventions for Obesity Among 7th-9th Grade Children Team C Presentation Stephanie Daus, Kelly DeRop, Emily Dutmers, Cassandra Kotlarczyk, MiSuk Robinson, & Landon Smith

2. Assessment & Analysis of the Lake County Community •Poverty Level: –Lake County 19.4% –State of Michigan 10.5% Almost twice as many residents experience poverty in the County when compared to the rest of the state. (Citydata, 2012)

3. Assessment & Analysis of the Lake County Community •Unemployment In Lake County 11.3% of residents are unemployed, or just over one out of every ten (State of Michigan, 2012)

4. Assessment & Analysis of the Lake County Community

5. Analysis of Assessment Findings Percentage of children with risk factors by grade for Mason and Lake County

6. Analysis of Assessment Findings

7. Analysis of Assessment Findings

8. Analysis of Assessment Findings

9. Analysis of Assessment Findings

10. Analysis of Assessment Findings

11. Analysis of Assessment Findings Pender’s Health Promotion Model is helpful in explaining the cause of disparity in the population of Lake County 7th – 9th graders. Pender states that “prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health promoting behavior.” (Pender, Murdaugh & Parsons, 2010)

12. Analysis of Assessment Findings Based on the data current culture or belief systems being passed on to children do not effectively encourage healthy behaviors. This could be for a number of reasons including actual and perceived barriers such a lack of accessibility to whole foods to knowledge deficits regarding nutrition and exercise. (Pender, Murdaugh & Parsons, 2010)

13. Nursing Diagnosis Risk of Obesity among 7th-9th graders of Lake County, Michigan.

14. Related To • Educational Background • Socioeconomic Level • Family Lifestyle • Recreational Resources

15. As Evidenced By • Unhealthy Eating Habits • Obesity in one or both parents • Lack of sleep • Lack of parental support • Decreased knowledge • Low income households • Inactivity • No access to a gym • No access to parks • Age • Gender • Genetics

16. Changeable Indicators • Unhealthy Eating Habits • Obesity in one or both parents • Lack of sleep • Lack of parental support • Decreased knowledge • Low income households • Inactivity • No access to a gym • No access to parks

17. Direct Causes • Age • Gender • Genetics These causes cannot be changed. However, they can be supported by healthy lifestyles.

18. Indirect Causes • Unhealthy Eating Habits • Obesity in one or both parents • Lack of sleep • Lack of parental support • Decreased knowledge • Low income households • Inactivity • No access to a gym • No access to parks Each of these factors can change to support a healthy lifestyle.

19. Healthy Diet According to the American Heart Association the dietary recommendation for children age 9-13 are: Female: Calories 1600/day Male: Calories 1800/day Fat: 25-35% Milk/Dairy: 3 cups Lean Meat/Beans: 5 oz Fruits: 1.5 Cups Vegetables: 2-2.5 cups Grains: 5-6 oz

20. Goals • Increase activity levels in Children • Increase knowledge base about health and nutrition • Decrease calorie intake • Provide assistance to low income households • Promote family support • Decreased BMI

21. SMART Objectives The number of obese children grades 7-9 in Lake County will be reduced by 10% in 2013. The activity level of child grades 7-9 in Lake County will increase by 30% in 2013. 85% of Lake County students grades 7-9 will successfully pass a nutrition course. 70% of Lake County students grades 7-9 will successfully pass the FIT test.

22. Primary community prevention is essential when it comes to tackling childhood obesity. Screening of those who are most at risk and educating children and parents plays a key role in the prevention process. Evidenced based practice indicates healthcare professionals should focus their counseling on: · Decreasing sweetened beverages such as soda or juice · Increasing daily physical activity to 30-60 minutes daily · Making healthier food choices such as increasing fruits, vegetables and whole grains; limiting consumption of energy-dense foods such as high fat or sugar laden snacks · Decreasing screen time and other sedentary behaviors · Limiting portion sizes and amount of times per week eating out at fast food restaurants · Eating meals together as a family and making healthy changes together (Rausch, Rothbaum Perito & Hametz, 2011) Primary Community Interventions

23. Secondary Community Intervention Secondary prevention is more specific and focuses on the issues within a targeted population. There are a multitude of programs and studies that have been utilized for children from preschool to high school level. The next few slides will highlight the most successful evidenced based practice (EBP) based programs for 7th-9th graders. These interventions may be compounded with what already exists in Lake County, Michigan to improve childhood obesity statistics. The three EBP programs include the following: · The Dutch Obesity Intervention in Teenagers or DOiT · Health in Motion · Intervention Centered on Adolescents' Physical Activity and Sedentary Behavior (ICAPS)

24. Analysis of Evidenced Based Practice Programs/Interventions The Dutch Obesity Intervention in Teenagers: · Students aged 12-14 years. Purpose was to increase awareness of the energy input and energy output equation. · Behavioral interventions: • surveying consumption of high sugar snacks and beverages, physical activity level and screen time . ·Educational interventions: • Educational courses in biology and physical education, altering cafeteria food options, additional choices for physical activity classes ·Results: • A decrease in skinfold thickness measurements, with greater success for girls than boys. Overall reduction in the amount of high sugar beverages consumed by both sexes (Singh, Chin A Paw, Brug, & Van Mechelen, 2009).

25. Health in Motion: An interactive computer based obesity prevention program developed for high school aged students. Computer messages deliver tailored feedback on progression. Interventions: • 60 minutes of physical activity 5 days per week, 5 servings of fruits/vegetables daily, 2 hours or less of screen time daily. • Individualized plans were based on the Transtheoretical Model of Behavior Change. Results: • According to Mauriello, et al (2010) the program ”initiated behavior change across energy balance behaviors and also helped students who were already doing the behaviors to maintain their healthy behavior” (p. 453). Intervention Centered on Adolescents Physical Activity and Sedentary Behavior or ICAPS Started with younger adolescents (aged 12-16) and lasts four years; focuses on a socioecological model perspective to prevent obesity. Interventions included education on benefits of physical activity, additional in-school opportunities for physical activity and parental support of behavioral changes. Results: • According to Haynos and Donohue (2011) after four years of implementation, “the intervention group demonstrated significantly smaller increases in BMI and lower incidence of overweight than the control groups” (p. 395).

26. Which EBP intervention would best suit the 7-9th graders of Lake County? The DoIT program would be the best because... • it is a lifestyle change not just an intervention. • it really educates the students to think about what they are eating and how they are exercising. --> this is very important because there are 17 fast-food restaurants in Lake County and only three full-service sit-down restaurants. --> there are also only two grocery stores in Lake County and ten convenience stores . • the age groups are closely related • the geopolitical communities are different (Lake County Michigan Obesity, 2008) (Lake County, Michigan, 2012)

27. What Local Resources Are Lacking in Lake County? • No fitness centers • No farmer's markets • Very few parks What Local Resources Does Lake County Have? • Many different campgrounds in the area • Manistee National Forest with many different hiking trails and outdoor activities -bicycling -hiking -water activities -winter sports -horse riding -fishing (Huron-Manistee National Forest Recreation, 2013)

28. Theoretical Support for Community Focused Intervention Successful community focused interventions decreasing obesity in children requires understanding of family systems and the motivation to adopt healthier behaviors. Family-based conceptual models are often utilized for childhood-obesity research. (Sung-Chan, Sung, Zhai, & Brownson, 2012)

29. Theoretical Support for Community Focused Intervention Darling & Steinberg's Integrative Model of Parenting • conceptual framework for understanding family systems • parent-focused interventions for healthy weight development in school-aged children (Ward et al., 2011)

30. Theoretical Support for Community Focused Interventions Darling and Steinberg's Integrative Model of Parenting Parent practices and style is influenced by the integration of parents' goals, values, child behaviors, and character qualities. (Ward et al., 2011)

31. Theoretical Support for Community Focused Interventions Darling and Steinberg's Integrative Model of Parenting Parent variables affect child behaviors: • value • parenting practices: strategies or behaviors used to help child achieve goals and directly affects child outcomes • parenting style: moderates the influence of parenting practices on child behavior (Ward et al., 2011)

32. Theoretical Support for Community Focused Intervention Ryan and Deci's Self-Determination Theory Theory of self-motivation for improving intrinsic motivation to adopt healthy behaviors. (Ward et al., 2011)

33. Theoretical Support for Community Focused Interventions Ryan and Deci's Self-Determination Theory Self-motivation can be reinforced by fulfillment of 3 innate psychological needs: • competence • relatedness • autonomy (Ward et al., 2011)

34. Theoretical Support for Community Focused Interventions Ryan and Deci's Self-Determination Theory Competence can be increased by: • positive feedback • communication • rewards (Ward et al., 2011)

35. Theoretical Support for Community Focused Interventions Ryan and Deci's Self-Determination Theory Relatedness is enhanced by having behaviors modeled or valued by parents, family, friends, and society. Support for healthy drinks and food choices by movie or sports stars encourage similar choices by kids. (Ward et al., 2011) (Ward et al., 2011)

36. Theoretical Support for Community Focused Interventions Ryan and Deci's Self-Determination Theory Autonomy can be enhanced by: • providing choices • acknowledging feelings • opportunities for self-direction (Ward et al., 2011)

37. Theoretical Support for Community Focused Interventions Summary Primary and Secondary Interventions: • Community focused interventions should recognize the importance of parents' role and influence in childhood obesity. • Understanding theories of self-motivation for behavior change must be integrated in EBN interventions within the family unit, school, and community. • Implementation of evidence-based programs to monitor obesity in children and effectiveness of programs in meeting national health goals to reduce childhood obesity.

38. Policy Implications • 1/3 of all American children are overweight or obese • obese children 70% more likely to be obese as adults • greater risk for chronic disease: type 2 diabetes, hypertension, heart disease, sleep apnea, and psychosocial disorders • $150 billion spent annually on health care related to childhood obesity (NCSL, 2011)

39. Policy Implications Many factors contribute to childhood obesity. Policies need to address nutrition, physical activity, and monitoring pediatric growth/wellness. Community policies must acknowledge the role of parents' values and behaviors impacting childhood obesity. Communities and states must also address barriers to physical activity through purposeful urban planning. National policies must promote healthy nutrition and access to health care. (Birch, Parker, & Burns, 2011)

40. Policy Implications Nutrition Access to healthy foods at home involves educating parents/families to model healthy food choices, age appropriate portion size, and variety of new food intake. Federal support of food assistance programs is needed to meet the needs of low-income families. • Supplemental Nutrition Assistance Program (SNAP) provides debit cards to buy food: currently does not restrict purchases to healthy food choices • Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides vouchers to purchase nutritious food, nutrition information, and health care referrals • Emergency Food Assistance Program: distribute to local food pantries (Birch et al, 2011)

41. Policy Implications Nutrition Federal funding for school lunch programs should promote school menus meeting USDA food guidelines, restricting vending machine options of high caloric drinks & snacks, and access for low-income children to have nutritional needs met at school. • National School Lunch Program: provides cash subsidies to school districts, free/reduced meals to eligible children, meets USDA nutritional guidelines • Summer Food Service Program: provides nutritious meals to low-income children during the summer when not in school • Healthy Hunger-Free Kids Act: snack and beverage options from school vending machines cannot exceed 200 calories (Birch et al., 2011; USDA, 2013)

42. Policy Implications Physical Activity • educate, support, and encourage physical activities throughout the entire school system • government incentives to improve health and wellness of society affected by obesity • economic incentives to remove barriers to physical activity (NCPPA, 2013)

43. Policy Implications Media and Marketing Policies Watching television, playing video games, and surfing the internet has shown to increase the risk of obesity. Increase screen time contributes to inactivity, snacking, and exposure to advertising that influences food choices. Policies must address marketing standards for advertising of food and beverages to children. Media also has the opportunity to provide healthy nutritional information and promote physical activity. Successful social marketing interventions for health behavior change include smoking cessation, seat belt use, and oral health promotion. (Birch et al., 2011)

44. Policy Implications Media and Marketing Policies • Target parents/families promoting good nutrition: • 1% Or Less Milk Campaign: encourage intake of milk and dairy products with fat content of 1% or less • 3-A-Day of Dairy Campaign: National Dairy Council and American Dietetic Association educate about nutritional value of dairy products (milk, cheese, yogurt) • Promoting physical activity: • VERB: USDA and CDC campaign to increase physical activity among youths age 9-13: increase knowledge, improve attitudes & beliefs, increase parental support of physical activity • NFL Play 60: supported by the NFL encouraging 60 minutes of daily physical activity, sponsors in-school and after-school programs, $200 million donated by the NFL to support youth health and wellness (Birch et al., CDC, 2010; NFL, 2012)

45. Policy Implications National Physical Activity Plan (NPAP): Make the Move • promote physically active lifestyles by implementation and evaluation of policies & programs at the local, state and national level: • engage business and industry to develop and financially support policies • nutrition and health education • health care policies related to obesity, reduce health disparities • mass media utilization to promote healthy societal behavior change • support parks, recreation, and sports programs • public health policies promoting healthy nutrition, increasing physical activity, and decreasing morbidity related to obesity • transportation, land use, and community design to increase physical activity • partner with volunteer and non-profit groups to implement programs (NPAP, 2010)

46. Evaluation Plan What is the goal of the evaluation plan: • To initiate changes that will decrease the obesity rate among 7th-9th graders of Lake County, Michigan over the next 10 years • To provide a guideline of changes, interventions, & education to decrease the obesity rate

47. Evaluation Plan Timeline: • Short term goal (1st year) • Collect BMI • see BMI chart at the end of presentation • Conduct standard fitness test • see standard fitness test guidelines end of presentation • Partner with local physician & dietician • conduct HgbA1C, cholesterol screening, and baseline nutrition screening

48. Evaluation Plan Short term goal continued... d. Introduce interventions and education to decrease obesity rate • Collaborate with staff to lead by example and make the school a healthy environment • Decrease the amount of sugary beverages & unhealthy snacks in vending machines by 50% & replace with non-caffeinated beverages & healthy snacks • Create a nutritional & physical education area for parents & students to participate in during parent-teacher conferences. Encourage them to set health goals together

49. Evaluation Plan Intermediate Goals (2-5 years) • Introduce additional healthy interventions • Discuss/organize having a garden that the students tend to and learn how to grow healthy fruits, vegetable, & herbs • Remove the remaining unhealthy items from vending machines & replace with healthy items • Create a Walk 12 Trails in 12 Months Challenge using the Manistee National Forest • Develop School Health Advisory Council made up of students, parents, a variety of staff & community members. Guide process on implementing healthy eating & physical activity policies/environment using CDC's Make a Difference at Your School: Key Strategies to Prevent Obesity.

50. Evaluation Plan Midway CheckPoint (5 year mark) • Assess & document BMI trends • Reassess standard fitness test • Reassess HgbA1C, cholesterol, and nutritional screenings • Continue to implement healthy changes • Evaluate the need to make changes to the program