Meiler_Final_Paper

Running Head: OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO

Overweight and Obese Children in Harrison School District Two

and El Paso County, A Needs Assessment

Christa Hyson Meiler

MPH Candidate

PHC 6601 Public Health Seminar

University of Florida

9 February 2015

OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 2

ABSTRACT

Background: Childhood obesity is considered one of the major epidemics of the 21st century. It

is believed that for the first time, in a long time, the life expectancy of Americans will decrease

due to the occurrence of obesity and obesity-related chronic conditions (Olshansky et al., 2005).

Current research is starting to examine the physical and social environment. Factors like the

influence of parents, amount of physical activity, socioeconomic status, and culture play a large

role in a child’s health status (Patrick & Nicklas, 2008). A focus was placed on the children of

Harrison School District Two in El Paso County, located in Colorado Springs, Colorado to

examine childhood obesity.

Specific Aims: The specific aims of this needs assessment are to gain a general understanding of

the health status of the children in El Paso County. Find out how many of these children are

overweight or obese and identify disparities that prevent them from being a healthy weight.

Assess the opportunities for physical activity available to children living in Harrison School

District Two with a focus on the Meadows Park Community and assess the availability of

healthy food choices for children living in the Meadows Park Community.

Methods: In order to examine the reasons that prevent children from achieving a healthy weight

status, in Harrison School District Two, multiple methods were used. The methods that were

used were interviews, a sidewalk audit, the System for Observing Play and Recreation in

Communities (SOPARC), and secondary data. Interviews were conducted with key stakeholders

in Harrison School District Two. These stakeholders were chosen because of their involvement

or proximity to the children of Harrison School District. Individuals from El Paso County Public

Health, Harrison School District Two administration, Meadows Park Community Center, and

parents were among the interviewed. A sidewalk audit and SOPARC examination were

conducted to assess the quality and use of the physical environment in the area of Meadows

Park. This park has a community center and is located in the heart of the Harrison school district.

Secondary data was used to supplement the project. Data came from sources like the CDC,

USDA, the US Census, and state health departments.

Results: Results from the interviews were very significant. Each interviewee spoke about the

lack of financial resources, a lack of knowledge, limited physical activity, and food insecurity as

reasons why obesity is prevalent in the community. The sidewalk audit and the SOPARC tool

revealed that the Meadows Park community has a great, accessible park at their disposal.

However, this park is not used as frequently as it should be. The environment of the community

could benefit from clean up efforts and outdoor lights installed.

Conclusions: Implications for research are mostly positive. Childhood obesity is at times, a

difficult topic to discuss. Recognizing trends, habits, and behaviors that contribute to obesity is

an effective way to identify disparities and issues that are worsening this epidemic. Identifying

these disparities will help providers, parents, and public health professionals make informed

decisions about the health of their patient, child, or population. Outcomes from this needs

assessment can propose additional bus routes, farmers markets in new locations, physical and

nutrition education classes offered on a more regular basis, neighborhood fixes such as outdoor

lights or other environmental and safety changes.


I. INTRODUCTION

Childhood Obesity is in epidemic proportions in the United States (Kaiser Permanente,

2006). Obesity creates not only a difficult life for an individual, but also from a population

standpoint. From increasing healthcare costs to an increased number of deaths due to diabetes,

obesity has created unhealthy generations and established poor habits that have unfortunately

become acceptable. In order to stop the cycle of obesity a healthy diet and physical activity

habits in children must be established early on in life. The following needs assessment explores

the role of obesity and factors in a community that create challenges and disparities that prevent

children from achieving a healthy weight status. It also identifies areas and systems that could be

changed to help improve the outcome.

II. BACKGROUND

Overweight & Obesity in the United States

In the United States overweight and obesity are defined and described as an abnormal or

excessive fat accumulation that presents a risk to health (World Health Organization, 2014).

Being overweight or obese is a health condition not caused by one item like environment,

personal choices, or genetic predisposition. It is caused by a multitude of reasons and a

combination of choices, actions, and genetics. Weight is not a reliable measure of being

categorized as overweight or obese. Weight and a person’s height are necessary to determine

their weight status. Body mass index or BMI is a number that is derived from a person’s weight

and height. Weight (lb) / [height (in)]2 x 703 is the formula to calculate BMI (Centers for Disease

Control and Prevention, 2011). For the most part, BMI is a reliable measure of body fatness, but

does not work in certain cases of larger athletes or certain body types.

For adults, BMI is defined using a number. For example, if a BMI is between 18.5-24.9 the

weight status for that individual is in the normal range. For children, BMI is organized in

percentiles. For example, a healthy weight for a child is in the 5th

percentile to less than the 85th

percentile. Critical literature and the Centers for Disease Control and Prevention (CDC) both

shows data that states more than one-third of adults in the United States are obese (2014). This

means that 34.9% of US adults have a BMI of 30 or higher (Centers for Disease Control and

Prevention, 2014). Obesity-related chronic conditions range from heart disease to cancer, with

some conditions being completely preventable. With over 30% of the adult US population being

obese, this has placed a significant burden on individuals paying for medical care. According to

the CDC in 2008, the estimated annual cost of obesity was $147 billion and the medical costs of

people who are obese were on average $1,429 higher than individuals that are normal weight

(2014).

Critical Literature on Childhood Obesity

There are countless journal articles and research authored by businesses and hospitals to

universities across the globe on obesity and obesity related studies. There is even a new journal

entitled the International Journal of Pediatric Obesity. It is peer-reviewed and released on a

quarterly basis. A few pieces of literature chosen for this paper examined behavioral

interventions, social determinants, and life expectancy in overweight and obese children. A


review authored by Kamath et al. (2008) argued that there were no significant changes in BMI

when compared with weight control when it comes to behavioral interventions. Different

behavioral interventions were reviewed to measure effectiveness and a random-effects

metaanalyses was used to evaluate collected data. It was argued that long-term interventions with

longer measurement timeframes are needed to create more positive results when combating

obesity (Kamath et al. 2008).

Patrick and Nicklas (2008) took a unique perspective on childhood obesity by examining

social determinants on a child’s diet. Their research explores the environment, physical and

social, which surround a child’s eating patterns. These physical and social environments include

socioeconomic status, cultural factors, attitudes towards food and parental behaviors and feelings

toward eating. They explore the importance of parents modeling healthy food acceptance and

dietary behaviors. It was especially helpful that they discussed the structure of meals, including

the rise in recent history of eating out and portion sizes and “the super-sizing of America”

(Patrick & Nicklas, 2008).

Olshansky et al. (2005) provided detailed accounts that obesity is one of the reasons that

explain the decline of life expectancy in the 21st Century. This research suggests that the severity

of obesity will worsen, especially among children, due to higher BMIs and higher death rates due

to diabetes in the past 20 years (Olshansky et al., 2005).

Olshansky et al. (2005) makes two profound statements that exemplify the importance of

this article: Unless effective population-level interventions to reduce obesity are

developed, the steady rise in life expectancy observed in the modern era may soon come

to an end and the youth of today may, on average, live less healthy and possibly even

shorter lives than their parents. The health and life expectancy of minority populations

may be hit hardest by obesity, because within these subgroups, access to health care is

limited and childhood and adult obesity has increased the fastest. (p. 1143)

In fact, if the negative effect of obesity on life expectancy continues to worsen, and

current trends in prevalence suggest it will, then gains in health and longevity that have

taken decades to achieve may be quickly reversed. The optimism of scientists and of

policymaking bodies about the future course of life expectancy should be tempered by a

realistic acknowledgment that major threats to the health and longevity of younger

generations today are already visible. (p. 1143)

Prevalence of Childhood Obesity

While it is difficult to determine the exact number of overweight and obese children in

the United States, Ogden, Carroll, Kit, and Flegal (2012) present that there was “a significant

increase in obesity prevalence between 1999-2000 and 2009-2010 in males aged 2 through 19

years” (p.483). According to the CDC, currently 17% or 12.5 million children (ages 2-19) are

obese (2014). This number does not include the number of overweight children. In the state of

Colorado one in four children are overweight or obese (LiveWell Colorado, 2013). Colorado has

the reputation of being an active state full of healthy individuals. This reputation does not remain

present when reviewing data. 31.9% of children 2-14 years old of El Paso County, Colorado

were reported by their parents as being overweight or obese according to the 2013 annual report


from El Paso County Public Health, (2013).

Rationale For Needs Assessment

Obesity is now considered a disease in epidemic proportions. Obesity has been compared

to threats of bio-terrorism and smallpox because of the dangers and costs it places on society.

Former U.S. Surgeon General, Richard Carmona, MD, calls childhood obesity, “the fastest-

growing, most threatening disease in America today” (Kaiser Permanente, 2006). Medical costs,

an abundance of chronic health conditions, and an unhealthy future generation are a few of the

major issues caused by obesity. One of the most crucial realizations during the obesity epidemic

is the prediction that children today may shorter lives than their parents (Olshansky et al., 2005).

Obesity is a problem that is not simply fixed. Colorado has a reputation of being a

healthy place, however data describes a different picture when it comes to the weight status of

Colorado’s children. With this needs assessment the goal is to identify the disparities that prevent

children in Harrison School District Two from being a healthy weight. Harrison School District

Two is arguably one of the poorest districts in El Paso County. According to United States

Census Bureau Harrison School District Two have 34.7% of its families living in poverty, while

in the surrounding school districts the next highest rate of poverty is 26.6% (2012).

Harrison School District two includes 13 elementary schools, one K-8 school, three

middle schools, one high school preparatory, two high schools, four charter schools and a home

school program (Harrison School District 2, 2014). Harrison also has 6,953 students participate

in the National School Lunch Program (NSLP) and 2,970 students participate in the School

Breakfast Program (SBP) on a daily basis (Harrison School District 2, 2014). A startling statistic

is that individuals in Colorado making $25,000 or less a year have a 24% obesity rate and the

number of children in Colorado living in poverty soared over 70% between 2000 and 2006

(LiveWell Colorado, 2013).

There is an undeniable link between poverty and obesity, especially among children. One

goal of this needs assessment is to identify these links within Harrison School District Two.

Another goal of this assessment is to identify areas within the school district that lack access to

healthy food or places for safe, out door physical activity. Located within El Paso County and

Harrison School District Two is Meadows Park Community Center (MPCC). I am currently

serving as an intern for MPCC. MPCC is a safe place for children in the area to go afterschool.

Children are offered snacks, a safe place to play, a quiet area for homework, and an all-day camp

during the summer.

Specific Aims of Needs Assessment

The following list consists of the specific aims of the needs assessment:

1. Through interviews and secondary data gain a general understanding of the health

status of the children in El Paso County.

2. Find out how many children in El Paso County/ Harrison School District Two are

overweight or obese.


3. Through interviews, identify disparities that prevent children in the Meadows Park

Community from being a healthy weight.

4. Assess the opportunities for physical activity available to children living in Harrison

School District Two with a focus on the Meadows Park Community.

5. Assess the availability of healthy food choices for children living in the Meadows

Park Community.

III. METHODS

Identification of Methods

Interviews

Interviews were conducted with key stakeholders in the Harrison School District Two.

These stakeholders were identified based on their proximity and involvement with Harrison

School District Two and El Paso County. They are community health educators, nutritionists,

and program directors, along with community members. There were five interviewees: one from

El Paso County Public Health, two from Harrison School District Two administration, one from

Meadows Park Community Center, and one parent with children in the Harrison School District

Two. Interviews were conducted in person. Each interview focuses on the health status of

children in the Harrison School District Two and identifying if there are disparities in nutrition

and physical activity. An open-ended and unstructured interview instrument was chosen to allow

for free-flowing answers without constraints. Interview transcripts and recordings were kept on a

secure server in a password-protected folder. The interview questions and informed consent that

were used are in Appendix A and B, respectively.

Sidewalk Audit

Using the Active Neighborhood Checklist a sidewalk audit was conducted. This method

was chosen because of the advocacy, action, and analytic research opportunities (Active Living

Research, 2014). For example, the results of this checklist can provide community members with

advocacy initiatives to create safe places for children to play. This checklist could also inspire

what actions need to be taken to improve a community or can be used to identify and analyze the

elements in a community that may help or hinder physical activity. Active Living Research

designed the Active Neighborhood Checklist, which is a national program of the Robert Wood

Johnson Foundation. It assesses the physical environment that could help or hinder physical

activity in a neighborhood (Active Living Research, 2014). It was especially designed for

community stakeholder use. The checklist focused on the following areas: land use, public

transportation, street characteristics, environmental quality, walkability, and bike accessibility.

The data that resulted from the sidewalk audit showed the characteristics and areas in need of

improvement in the Meadows Park neighborhood. Prior to conducting this audit, I reviewed the

Active Living Research training that consisted of identifying important features of the

environment. When conducting this audit I walked the length of South El Paso Avenue located in

Colorado Springs, 80905. This street was chosen because it is surrounded by Meadows Park and

Meadows Park Community Center and is the heart of the Harrison School District Two

community. While walking I answered questions of the sidewalk audit and included the


important environmental features, as instructed by training. To see a copy of the checklist and

results, please see Appendix C and to see a map of the route walked please see Appendix D.

SOPARC: System for Observing Play and Recreation in Communities

The SOPARC system is a detailed assessment guide that requires direct observation. A

systematic sampling technique is used to capture data. Periodic visual scans from left to right

looking at target areas such as a basketball court, baseball field, or grassy area. As the visual

scans occur each individual is categorized as sedentary, walking, or very active. (Hoehner, Ivy,

Ramirez, Handy, and Brownson, 2007). Different visual scans were made to record genders,

ages, and race/ethnicity. I visited the defined community recreational area at different times in

the day over the course of three weeks. This assessment utilized the SOPARC online application

that summarizes data input into useful results. The results are formed by direct observation and

recording a series of characteristics of a specific park or recreational area. The SOPARC

assessment guide helps researchers gather objective data on participants, physical activity,

environmental characteristics, equipment use, and supervision if applicable (Active Living

Research, 2014). In this study, Meadows Park (located within El Paso County and Harrison

School District Two) was the selected park. Meadows Park was chosen because of its proximity

to Harrison District schools and it is the site of my internship, Meadows Park Community

Center.

Secondary Data Collection

Additional pre-existing data was gathered from the US census, Harrison School District

Two, City of Colorado Springs Parks and Recreation Department and other governmental and

nongovernmental agencies. Information that was collected ranged from recess time, physical

education, other activities offered during school hours, and demographics. This data will be used

to complement and further explain the qualitative data provided from the interviews.

Research Question

The research question in this needs assessment asks if there is a causal relationship

present between low socioeconomic status (SES) and obesity in children? In recent studies, those

with lower SES are more likely to lead sedentary lives (Institute of Medicine 2001; Putnam

2000) SES indicators such as education level, food security, built environment, and community

also contribute to an individual’s health status (Institute of Medicine, 2001). A theory to be

examined is that the surrounding community a child lives in has an effect on his or her health and

weight status. This theory has been research thoroughly by Robert D. Putnam, author of, Bowling

Alone, a book that tells the detailed story of the breakdown of the American community. He

examines many factors that have led to the downfall of community, but he discovered that there

is a present connection between social capital and obesity and social networks help maintain

health (Putnam, 2000, p. 331).

One of the most important identified factors in the relationship between SES and obesity

in children is the cost of healthy, nutritious food. In a study published by The American Journal

of Clinical Nutrition stated that grains and sugars were cheaper than fruit and vegetables per


serving, this is one reason why cheap, energy-dense foods have lower nutritious value and are

connected with lower income individuals (Drewnowski, 2010).

Justification of Methods

Intentions of the previous methods explained are to use the data collected to be presented

in an easy to understand and valuable manner. Interviewing key stakeholders for the assessment

was a necessary part to gather the most accurate data possible. Interviews are an effective way to

establish rapport with a community and identify community needs that are not present through

secondary data. Qualitative research provides a unique and detailed perspective on the issue of

childhood obesity. Childhood obesity is a touchy subject that is not simply black and white; this

is why I chose to incorporate qualitative date consisting of individual experience and in-depth

explanations. Another benefit of qualitative research is that it can be used in conjunction with

collected secondary data to help better define and understand outcomes.

The tools and measures provided by Active Living Research, a national program of the

Robert Wood Johnson Foundation, are evidence-based evaluation and assessment tools that have

proven over time to successfully identify the needs and shortcomings of a community (Active

Living Research, 2014). A study published by Hoehner et al. (2007) found that the Active

Neighborhood Checklist was proved to be a highly reliable and useful tool for assessing

environmental structures that support physical activity. “The Checklist was designed as a refined

version of existing audit tools, with emphasis on capturing the community physical environment

domain of the ecological framework” (Hoehner et al., 2007).

The Active Neighborhood Checklist and SOPARC system are both a part of these

assessment tools. They were chosen because of the focus Active Living Research has on

childhood obesity. Active Living Research (2014) provides time-tested results that address the

root causes of obesity in children and reasons for physical inactivity. Active Living Research

promotes an active lifestyle along with focusing on physical activity within communities,

schools, and parks and recreational settings. The use of secondary data sources is essential for a

needs assessment. The use of existing data collected by reputable sources saves time and money.

With the ease and sophistication of computer programs data can easily be accessed and analyzed.

In this specific case secondary data has allowed for the collection of useful data in a timely

manner to effectively be used to provide evidence for claims and create a clear picture of obesity

in El Paso County and Harrison School District Two.

Analysis of Methods

In order to attempt to answer the research question, the constant comparative method was

used to evaluate the interviews. Using qualitative data requires defined categories and

established patterns to present data in an organized manner. The constant comparative method

aids in defining categories, problems, or interviewee statements (Glaser, 2008). Glaser (2008)

presented the four stages of the constant comparative method:


1. Categorize data

2. Place data into proper homes or properties

3. Define possible theories

4. Write the theory

To better categorize data I have also chosen to follow the defined strategies of Patton

(1990). A stratified purposeful sample is a small group that does not have statistical significance,

but was chosen for a specific reason. The interviewees I chosen, were chosen because of their

proximity and knowledge of the health condition of children in El Paso County. The topics of the

questions asked are listed below.

In order to evaluate this qualitative data I followed a methodical process that consisted of

creating transcripts of each interview, reviewing transcripts for key words or phrases then

categorizing each key element into a specific category. This continued until the last line of the

transcripts were complete. If a new key word or element was present, I created a new category.

In the end I ended up with many categories that fit into four major themes. Using these themes, I

am able to create a theory based on the interviews.

Analysis of the Active Neighborhood Checklist provides data that could be used to

improve communities to allow for increased physical activity. The analysis is determined by

categorizing items by land use characteristics, sidewalks, street shoulders, bike lanes, quality of

environment, and street characteristics. A total of 102 total characteristics are measured and the

available responses are dichotomous, categorical, or ordinal (Hoehner et al., 2007). Results will

provide further information under each of the following categories.

Childhood Obesity

Health Status

Barriers to

Physical Activity

Health Education

Health/ Nutrition Behaviors

Workplace Priorities

Food Insecurity

Barriers to good

nutrition


The categories to assess the results of the sidewalk audit are:

1. Land use

2. Public transportation

3. Street characteristics

4. Environmental quality

5. Walkability

6. Bike accessibility

Another way data is analyzed is by using SOPARC: System for Observing Play and

Recreation in Communities. After answering questions on accessibility, resources, and

supervision of each aspect of a specific park, activity levels are measured by being categorized

into sedentary, walking, or vigorous activity levels. Race, ethnicity, gender, and age are also

observed. While this is a challenging method to capture data, because of the number of

individuals to observe at one time, the SOPARC web application provides constant analysis of

data, as it is being input. Data can be extracted to show activities levels by gender, race, and age,

along with target areas, and time of day activity is occurring. The validity of the activity

categories (sedentary, walking, vigorous) has been defined through heart rate monitoring. This

way energy expenditure rates for defined areas can be estimated.

Stakeholder Involvement

Stakeholder involvement is a crucial part of any research project. Multiple stakeholders

are involved in this needs assessment. The main involvement of stakeholders is through the

interviews that were conducted. The information they provided was invaluable to the needs

assessment and identified factors that could not have been found without their input.

IV. RESULTS

Description and Interpretation of Findings

The Sidewalk Audit gives a clear picture of what improvements need to be performed in

a community. The Side Walk Audit uncovered that the premier use of land in Meadows Park is

for mostly residential use. The only non-residential use present was the community center. Most

homes or apartments in the area had on street parking or a small lot or 1-car garage. Meadows

Park community is blessed to have a park with a large green space and playground present in the

middle of the community. There is one bus stop on both sides of Corona Street public

transportation. Many frequent this bus stop each day. The street characteristics are lacking in

some areas like posted speed limits, stoplights, speed zones, bike lanes or lane markers. There is

no pedestrian scale lighting present or benches outside of the bus stop. The sidewalks are in

decent condition with not too many cracks or areas of disrepair.

Findings resulting from the SOPARC were varied. Though this system I was able to track

park and recreational facilities by usage, gender, race, and time of day. For example, both males

and females exert a moderate level of activity when playing in the designated target areas. The

target area that is most utilized by the Meadows Park population is the playground equipment.


The conditions for Meadows Park were mostly positive, such as target areas being accessible,

equipped and usable. It was identified that if it is not daylight, it is difficult to see since there are

no functioning lights present throughout the park.

After using the constant comparative method to analyze the interview data, four themes

emerged from the interviews. The first theme I noticed was food insecurity. Each interviewee

described what food insecurity looked like from their view. This is the first theme that appeared.

Each had a unique perspective due to their relationship between them and the children of

Harrison School District Two and El Paso County. Participants in the study agreed that a lack of

reliable transportation, a lack of grocery stores in the Harrison District area, and there needs to be

additional support for families, especially in single parent homes. The next theme that was

identified is limited physical activity. Interviews identified that physical education or gym time is

only offered twice a week for elementary grades. There is also a concern about the safety of

neighborhoods and the amount of required testing within schools that detracts from a child’s

chance at physical activity.

The third theme observed was a lack of financial resources. Affording fresh, healthy fruit

and vegetables can become expensive, especially out of season items. Many families and

organizations struggle with competing priorities on where and how to spend their funds. Even

well intentioned local farmers would like to be able to take WIC funds, but due to requirements

that are both costly and time consuming, they are unable to sell their produce to WIC users. The

fourth theme observed was a lack of knowledge. This includes an uncertainty of what to do with

fresh produce and how to cook it. This lack of knowledge includes children as well. Some

children at MPCC could not identify certain fruits and vegetables when asked.

I assisted with a survey throughout my internship that focused on the health status,

behaviors, knowledge, and habits of children that attend MPCC’s summer camp. This survey

was completed by parents and showed that 34.5% of parents did not know what BMI was or

measured. The secondary data provided valuable quantitative data to fill in the holes of this

study. I was able to find out poverty rates, educational attainment, and ethnicity information

from this method. While interviews provide great insight and qualitative information, secondary

allows for concrete numbers to back up statements made in the interviews.

Relationship of Findings to Research Question and Specific Aims

The research question in this needs assessment asks if there is a causal relationship

present between low socioeconomic status (SES) and obesity in children. This is no way is meant

to say that all obese children have a low SES, but recent existing research does display some

links between the two. According to Ogden, Lamb, Carroll, and Flegal (2010) low-income

children and teens are more likely to be obese than families that earn a higher income. This is a

general observation, but does not apply across different racial groups.

It was stated in the interviews that as childhood obesity rates have raised in El Paso

County, so has the percentages of free and reduced lunches in Harrison School District Two.

While from a distance these measurements may seem mutually exclusive, however to key

stakeholders in the community say see a link between obesity and low SES. According to the El


Paso County Public Health Annual Report (2013) 13.9% of children in El Paso County were

obese in 2008-2010 and in 2010-12 this number rose to 21.0%. In a survey conducted by El Paso

County 31.9% of children were reported as being overweight or obese by their parents in 2012

(El Paso County Public Health, 2013). According to Harrison School District, in 2008 59% of

students received free/ reduced lunches, while in 2012, 70% of students received free/ reduced

lunches (2014). All interviewees agreed that a lack of financial resources were one main reason

that healthy foods were not accessible. Reasons varied such as cost of healthy food and not

owning a vehicle.

Research has provided answers to each of the specific aims of the needs assessment. Each

specific aim is listed below with an answer provided by the methods previously stated.

Through interviews and secondary data gain a general understanding of the health status of the

children in El Paso County.

After interviewing key stakeholders in the community and reviewing supportive

secondary data, it is determined that the health status of children in El Paso County and Harrison

School District was varied. El Paso County has a unique spread of wealth/poverty and health

status in the area. It is a transient area with two air force bases, one army post, and the Air Force

Academy all in one county. A few of the interviewees stated that they have noticed an increase in

need for medications for children. These included medications for hyperactivity and asthma.

Find out how many children in El Paso County/ Harrison School District Two are overweight or

obese.

According to interviews with Harrison school district the number of overweight and

obese students is not tracked. Competing priorities and limited funding for data collected have

prevented them from providing an exact number or percentage of overweight and obese children.

However, there are plans for the 2014-15 school year to start recording data on overweight and

obese students. According to El Paso County Public Health in their 2013 Annual Report stated

that 31.9 percent of children in El Paso County 2-14 years old were overweight or obese in 2010-

2012, as reported by their parents (2013).

Through interviews, identify disparities that prevent children in the Meadows Park Community

from being a healthy weight.

Through the interviews I was able to determine four themes that emerged. These four

themes that were present through each interview are food insecurity, limited physical activity,

lack of financial resources and a lack of knowledge. One theory that could be retrieved from

these four themes is that childhood obesity is not an individual issue, it is a problem that has

worsened over time due to a lifestyle created on immediate convenience and instant gratification.

Those without the funds or support or the freedom to chose other foods, or live in safe

neighborhoods fall victim to a system that requires immediate needs to be satisfied, like food.

Take for example if a single parent has to work two jobs in order to support a family, there is not

much wiggle room for making meals at home, let alone having the time to prepare and shop for

them. America has no shortage of cheap, fast food. However cheap, fast food along with a lack

of physical activity is creating an unhealthy generation that is not being taught how or why it is

important to cook meals at home.


The table shows the most frequently mentioned observations on why childhood obesity occurs in

the community, as perceived by the interviewees.

Assess the opportunities for physical activity available to children living in Harrison School

District Two with a focus on the Meadows Park Community.

The graphic below shows the boundaries of the Harrison School District Two and the

parks are present in the district. Most are accessible on a daily basis and have some type of

playground equipment available.

Food Insecurity Limited Physical

Activity

Lack of Financial

Resources

Lack of Knowledge

Cost Video Games Personal

Transportation

Scratch Cooking

Convenience School Regulations WIC Diet Habits

Time Park Safety Competing Priorities Picky Eaters

Distance Neighborhood Safety Single Parent School Curriculum

Food Desert Time Need vs. Want Stigma


However the issue of safety arises. Meadows Park is a great place during the day but when the

light disappears, it takes on a new appearance. One interviewed participant said, “I’ve noticed

kids less able to be like kids. They don’t feel like they are in a safe place and are able to act a

little goofy and know that that’s ok. A lot of times they are like prisoners in their own house.

Summoned to stay there and play videogames and put a hot pocket in the microwave if they are

hungry. That’s not really being a kid.” The physical activity levels of children in the area could

increase with well-lit, accessible parks.

Assess the availability of healthy food choices for children living in the Meadows Park

Community.

According to the USDA, Harrison School District Two is classified as a low income and

low access area for food and vehicles (2014). Talking with community members I was able to

find out where they shop and what transportation method they used to shop for food. Albertsons

and Wal-Mart are frequented supermarkets by individuals in the Meadows Park community.

They are the most utilized because of the prices. However those without regular transportation

struggled to shop when they could not find a ride with friends. They were stuck with fast food or

convenience store options to feed their families. The chart below shows the most frequented

stores by Meadows Park community members and their methods of transportation.

Store Walk (one way) Bus Ride (one way) Distance from Meadows Park

Albertsons 43 minutes 33 minutes 2.2 miles

Wal-Mart 57 minutes 35 minutes 2.8 miles

Safeway 20 minutes 18 minutes 1 mile

One mile is not a lengthy walk. However, with children and groceries or severe weather this is a

very unpleasant way to get necessary items for a family. Also Safeway has the reputation of

being the most expensive store compared to the other two.

Additional Tables, Charts and Graphics

The following tables, charts or graphics show a snapshot of the individuals that make up

El Paso County. Below is the population of El Paso County and Colorado by age in 2012

according to the U.S. Census.

Population El Paso County Colorado

Population, 2012 estimate 645,439 5,189,458

Persons under 5 years, percent, 2012 7.0% 6.5%

Persons under 18 years, percent, 2012 25.3% 23.7%

Persons 65 years and over, percent, 2012 10.7% 11.8%

Female persons, percent, 2012 49.9% 49.8%

Source: U.S. Census Bureau: State and County QuickFacts, 2014


This table shows the educational attainment of people age 25 and over in El Paso County.

Estimate Male Female

Population Over 25 393,192 190,547 202,645

Less than 9th

grade 2.2% 2.3% 2.1%

9th

-12th

grade, no diploma 4.4% 4.2% 4.6%

High school graduate

(includes equivalency)

21.9% 21.0% 22.8%

Some college, no degree 26.0% 25.8% 26.1%

Associate’s degree 10.3% 9.6% 10.8%

Bachelor’s degree 21.7% 21.3% 22.1%

Graduate or professional degree 13.6% 15.9% 11.4%

Here are poverty levels shown in a different way, divided by areas of El Paso County. This is the

percent of families below Census poverty threshold from 2006 to 2010.

Source: El Paso County Public Health, 2014

Source: U.S. Census Bureau: American Community Survey, 2012


To boil data down a little further, this graphic below shows small area income and poverty

estimates ages 5-17 in families. This is the State of Colorado, divided by school district in 2012.

Source: United States Census Bureau: Small Area Income and Poverty Estimates, 2013

Below is the percent of population with an unhealthy weight in El Paso County and Colorado

from 2008 to 2010.

Source: El Paso County Public Health, 2014

37.1%

11.1%

14.6%

21.2%

7.1%

13.9%

0% 20% 40% 60%

Adults (El Paso County 2009-10)

Adolescents (Colorado 2009)

Children (El Paso County 2008-10

Overweight

Obese


The below information was important to include to give a clear picture of children’s eating habits

and physical activity behaviors in the state of Colorado. Percent of children engaging in selected

eating and recreational behaviors, Colorado 2009 to 2010.

Ages 1-14

years (2010)

Ages 15-19

years (2009)

Consuming less than recommended daily amount of fruit and

vegetables A

81.3% 75.6%

Eating fast food one or more times per week B

63.3% n/a

Engaging in recommended daily physical activity C

38.0%

(ages 5-14)

26.9%

Watching TV or videos two or more hours on average school

day D

34.1%

(ages 5-14)

45.6%

Playing video games or using computer D two or more hours

on average school day

11.0%

(ages 5-14)

35.2%

Source: El Paso County Public Health, 2014 A Five or more servings per day.

B Food is paid for at a counter or drive thru, before being eaten.

C 60 minutes of physical activity per day.

D Unrelated to school

n/a: Measure unavailable for age group

This is average park use from June 10-July 10 2014, items are separated by target area, activity,

and gender.

Source: SOPARC Park Observation, 2014

0 5 10 15 20 25 30 35

Playground Activities

Walking

Basketball (Outdoors)

Baseball

Basketball (Indoors)

Aerobics

Sedentary

Females

Males

Activities


These are the conditions of Meadows Park. This chart shows the percentage of target areas

observed. The target areas included two basketball courts (one indoor, one outdoor) a baseball

field, gymnasium, auditorium, playground, and an open grass field.


Another aspect of the SOPARC application is tracking the level of the activity in the observed

target areas. Using the method of visual scans I was able to classify the activity level of each

participant.


0

10

20

30

40

50

60

70

80

90

100

Accessible Superviesd Equipped Usable Organized Dark Empty

Average Activity Levels Observed in Meadows Park (10 June- 10 July 2014)

Sedentary

Walking

Vigorous


V. DISCUSSION

Relationship of Findings to Literature Cited

During the course of the internship and special project I used and presented the

curriculum of the ‘5210 Lets Go!’ program to the children attending summer camp. While this

program is education based, Kamath et al. (2008) argued that the efficacy of lifestyle

interventions is unclear. The children that were exposed to the 5210 programming were able to

identify what each of the numbers stood for, identified more vegetables and fruits than at the

beginning of the summer and were able to concisely state why too much screen time is a bad

thing.

My findings resonated with the themes identified by Patrick & Nicklas (2008).

Investigating a child’s environment is a huge component of identifying where the issues are

present. The examination of physical and social environments of children explains a majority of

their eating patterns and habits. I was able to see how not owning or car or a single income

family struggled with purchasing healthy foods for their children. The physical environment

plays a huge factor in the amount of physical activity a child receives. The Meadows Park

Community is blessed with a large green space, however it is poorly lit and there are safety

concerns. I even saw bullet holes in the backboard of the basketball hoop during the sidewalk

audit. It was found that the writing of Olshansky et al. (2005) remains very true. Unless there are

changes being made, the status quo will continue. It is heartbreaking to see children as young as

six or seven with poor health habits so early in life. That is why it is essential to fund and

continue programs that set healthy examples and keep places like Meadows Park Community

Center running.

Strengths and Limitations

Although sometimes looked at as a weakness, in this case I believe that qualitative data

gives this project a chance to thoroughly examine the reasons for childhood obesity in a specific

community. I was able to talk to people in the community and see what they truly need and what

would make their lives a bit easier, when it comes to food access and physical activity

opportunities. Qualitative value added strength to study, although completely subjective.

Childhood obesity is a touchy subject. Parents do not want to admit that their child is overweight

or obese. It is a painful realization that what you are able to feed your child is what is making

them unhealthy. The nutritious value is sometimes replaced with what is affordable or accessible.

The limitations in this study are present due to the lack of quantitative data and the

amount of qualitative data. Although I would have loved to, it is very difficult to prove the

positive effect that a community center has on a child’s health. The work and programming that

is accomplished at Meadows Park Community Center, will without doubt impact children in a

positive way. Measuring that in such a short period of time is almost impossible. Another

limitation is that I am very unfamiliar with performing an analysis of qualitative data, if not for

my advisor Dr. Mark Hart, I would be very lost. He was able to guide me through the data

analysis phase of this project. Another limitation in this assessment is that I knew one of the

individuals prior to interviewing them. This did create some bias, however it allowed me the


opportunity to ask better follow-up questions.

Generalization

Childhood obesity is an issue that affects our entire nation, not just a few select

communities. In order to make this study applicable to a larger population, I came up with

questions that could be asked to any community member, community health educator, or school

administrator in any state. These questions ask about problems that many communities currently

struggle with, such as disparities, barriers, and access to physical activity and healthy food.

Questions were asked to key stakeholders in a community that way the results could be

generalized to any community. To increase the generalizability of this needs assessment it would

have to be replicated in a different community. This needs assessment could be replicated very

easily in any community. The sidewalk audit and SOPARC system were easy to learn. Each

program had specialty training videos online and presentations available for free. I watched the

necessary training videos to make sure I was aware of items to look out for and how to

appropriately complete the necessary paper work. Results of this needs assessment could be

transferred or applied to any other county or community in America. The identified themes, lack

of financial resources, lack of knowledge, food insecurity, and limited physical activity are all

things that communities across the nation understand and experience.

VI. IMPLICATIONS

Implications for Research/Practice

Childhood obesity is at epidemic levels in the United States (Kaiser Permanente, 2006).

The childhood obesity epidemic is not caused by one source. Studying children as a population

to recognize trends, habits, and behaviors that contribute to obesity is an effective way to pin

point disparities and issues that are worsening this epidemic. Identifying these disparities will

help health educators, medical providers, and parents make informed decisions about the health

of their patient or child. In order to change lives, public health professionals must encourage a

permanent and positive change in behavior, diet, and health habits. Further research is essential

to changing the way America feeds and educates its children. Without change, the US will

continue into a downward spiral and 12 year olds with high cholesterol will become the status

quo (Cleveland Clinic, 2013).

Relationship of Project to the Internship Experience

In my situation the project became my internship. I worked for Meadows Park

Community Center (MPCC) in Colorado Springs Colorado, under the guidance of Director Brian

Kates. I honestly had no idea what I was walking into. Employees joke that MPCC’s unofficial

motto is, “working well with what we don’t have!” Whether it is a constant funding shortage or

low pay, MPCC knows how to work with what they do have, instead of complaining about what

they do not have. My project and internship were one combined experience. I was given

complete autonomy and access to resources and people to speak with about childhood obesity

and the impact of community on health. It was impressive to see the day-to-day workings of a

community center and all the politics, funding, and other items against them.


I met with Brian Kates on a daily basis and was informed on meetings with El Paso

County Public Health, Colorado Community Center Collaborative (CCCC), Healthy Community

Collaborative (HCC) and summer camp activities. In the morning I would greet children and

participate in the morning sport (kickball, baseball, or playground activities). Afternoons

consisted of meetings, field trips, or teaching health education sessions on the importance of

physical activity, good nutrition, and limited screen time. Specific responsibilities included

attending meetings with the HCC, CCCC, documenting physical activity, field trips, and

assessing MPCC’s programming with surveys. At times I would have appreciated more

structure, but I was able to be with the children of Meadows Park Summer Camp, conduct

research, attend meetings, and field trips all in one day.

MPH and Concentration Competencies Strengthened by Project

MPH Competencies

Diagnose and investigate health problems and health hazards in the community using an

ecological framework

My project touched on almost every MPH competency. The core competency that I

developed the most was diagnosing and investigating health problems and health hazards in the

community using an ecological framework. To further develop this competency I spoke with

parents, children, and leaders in the school district and the Meadows Park Community. For one

family, I was able to identify barriers to good health. One child in the summer camp became very

attached to me. I noticed she would arrive to camp everyday very unkempt, usually without a

shower and not fed that morning. The child was not a victim of abuse, but of neglect. I

discovered that the child was from a single parent, single income home, and used public

transportation to summer camp. In order for the child to make it on time to summer camp, she

had to take a very early bus with multiple transfers. This way mom was on time for work and the

child was on time for camp. I was able to speak with the mother and show her multiple bus

routes that she could take in order to have more time at home in the morning. This allowed the

child to eat breakfast, shower, and better prepare herself for the day. Being a single parent

family, new to Colorado, on single income with no car it seemed to her that society was against

her. I introduced her other community members that were in similar situations. By signing her

child up to summer camp, the mother made friends, as well as her child. Introducing her to a

network of support will aid both her and her child in living a healthy, fulfilled life.

Monitor health status to identify and solve community health problems &

Conduct research for new insights and innovative solutions to health problems

A large part of my project was a competency as well. Monitoring health status to identify

and solve community health problems was quite an undertaking. The options for families and

individuals in the Meadows Park Community were very limiting for food accessibility. Speaking

with community members, I discovered that the closest grocery store was Safeway. Safeway was

a 0.8-mile walk, but some of that was on busy roads without sidewalks. However, most residents

considered Safeway to be too expensive and preferred the Wal-Mart Super Center. The Wal-


Mart is over 2.5 miles away, or a 30-minute bus ride with transfers. This also allowed me to

develop new insights and innovative solutions to health problems. I have discussed with Brian

Kates about proposing altered bus routes to grocery stores and other shopping areas.

Inform, educate, and empower people about health issues

Another large part of my internship and project was to inform, educate, and empower

individuals about health issues. In the Meadows Park community, accessibility to healthy food is

an issue, especially for those who do not have a vehicle. A community member said to me, “It is

easier for my family to walk to a fast-food joint, than take the bus to the grocery – and it’s

cheaper!” I was able to price items at local stores and present to them how much nutritious food

is – and what the expense really is to their family, if the consumption of fast food continues. I

also spoke daily to the children attending summer camp about physical activity, nutrition, and

reducing time in front of the TV, computer, or electronic tablet.

Mobilize community partnerships and action to identify and solve health problems

Two groups I worked closely with during my project and internship were the CCCC and

HCC. They both share a very similar mission to mobilize community partnerships and action to

identify and solve health problems with increasing healthy habits and increasing physical activity

to combat obesity (Center for Health Leadership & Practice, 2013; El Paso County Public

Health, 2013). Attending meetings and working with both collaborative teams has taught me the

importance of stakeholder collaboration. Not only is it important to have community members

united and involved in community health programs, it is essential to have the collaborations,

companies, and businesses that provide funding for them invested in the goals as well.

Develop policies and plans that support individual and community health efforts

Another competency I was able to use was to develop policies and plans that support

individual and community health efforts. The HCC has chosen to adopt the 5210 program, an

obesity prevention program. This program stands for five fruits and vegetables daily, two hours

of recreational screen time or less, one hour of physical activity or more, and zero sugary drinks

(Let’s Go!, 2012). I assisted the Director of Communications for El Paso County Public Health

with the implementation plan of the 5210 program in local businesses and schools.

Link people to needed personal health services and assure the provision of health care when

otherwise unavailable

I was able to communicate and send promotional materials to parents about the Peak

Vista mobile clinic. This mobile clinic offers primary care, vaccines, sports physicals, referrals

for specialty care, dental x-rays, and cleanings for anyone under the age of 21. Some services,

like dental cleanings are free but other services are priced based on a sliding scale of an

individual’s income if they do not have Medicaid (Peak Vista, 2014).


The Peak Vista Care Mobile is pictured here:

Conduct research for new insights and innovative solutions to health problems

One part of my project required research into the built environment of the Meadows Park

Community and see what obstructed children from getting enough physical activity. Using the

SOPARC (System for Observing Play and Recreation in Communities) and Active

Neighborhood Checklist, a sidewalk audit, I was able to compile data to present the Director of

Meadows Park Community Center to show to the leadership of the City of Colorado Springs.

This data can be used to propose changes in the physical environment of the Meadows Park

community.

Public Health Practice Competencies

Apply social and behavioral science theories and concepts to public health problems

A majority of my internship and project was spent talking with the children of Meadows

Park and trying to understand what their day-to-day life is all about. After talking with a few

children it was easy to identify numerous disparities to proper nutrition. Some of these children

(as young as 6) stay home alone at night due to a single parent forced to work night hours at their

place of employment. Money puts food on the table. However, some of these kids were left

afraid at night. Trying to understand these situations is difficult and parents mostly have good

intentions.

Understand and apply the principles of community participation in public health interventions.

Under the category of Public Health Practice, this competency was important in this

project. In the Meadows Park community - community is everything. Currently nursing students


at University of Colorado at Colorado Springs have an agreement with the community centers to

monitor health status. Without the support from the community, the nursing students would not

get the hands-on community health experience they need. Meadows Park community members

are familiar with and have built a trust with the nursing students. It is because of this trust that

public health interventions, like an anti-tobacco campaigns, work. If this trust was not present,

the public health message with fall on deaf ears.

Demonstrate knowledge and skills needed to design and implement a public health information

campaign.

This competency is continuing to develop due to the ongoing work of planning the 5210

campaign. The Director of Communications of El Paso County Public Health, three community

health educators and I were chosen to create and promote the 5210 program. The program will

be implemented in schools, local business and the health department. Currently we are working

on defining the target audience and what methods would most effectively reach them.

Demonstrate communication skills key to public health workforce participation and advocacy

In my second week into the internship I created a presentation of how the 5210 program

is incorporated into MPCC to El Paso County Public Health. Being an unknown face advocating

for a program that many have not heard of was a little intimidating. However I was able to

effectively convey my message, goal, and knowledge through the 5210 video I created (Meiler,

2014). I showed MPCC children eating healthy snacks, participating in physical activity, and

how employees encourage reading over the use of portable electronics.

Identify, retrieve, summarize, manage and communicate public health information

As a large part of my project I collected public health information and health status

information from interviews, sidewalk audits, park observations and conversations with

community members. This information was kept in a secure, password-protected file on my

personal computer. The information I collected is shared not only in this paper, but also with the

Meadows Park community by disseminating the information to Brian Kates.

Monitor and evaluate programs for their effectiveness and quality

I assisted in writing, conducting, and evaluating the Summer Camp at MPCC. These

surveys measure knowledge, behavior, and status on nutrition, eating habits, physical activity

habits, and knowledge of health terms. I originally issued this survey in the first week of summer

camp and will issue the same survey to compare results the last week of camp (the week of 21

July 2014). The results of the survey will allow for comparison to see if knowledge or behavior

changed during the course of summer camp regarding nutrition and physical activity habits.

Describe genetic, physiological and psychosocial factors that affect susceptibility to adverse

health outcomes following exposure to environmental hazards

I worked with a few children with severe asthma. At times, Colorado can have extremely


poor air quality due to smoke, forest fires, pollution, and pollen. I made sure to educate these

children and made sure they had their inhalers before every field trip.

Specify approaches for assessing, preventing, and controlling environmental hazards that pose

risks to human health and the environment

One specific approach I used to assess and control environmental hazards was using the

Active Neighborhood Checklist sidewalk audit. The results of this audit identify what changes

need to be taken to improve a community. It can be used to identify and analyze the elements in

a community that may help or hinder physical activity.

Lessons learned from this project

It might be cliché to say I learned a lot from the children while doing this project, but in

this case it’s true. When considered a new face, it can be a little intimidating to start asking

people about their diet and physical activity habits. The children of Meadows Park Community

Center never lacked a hug, a smile, or a story to tell. I learned never to take offense when

speaking to community members. It was always a possibility that they are going through a very

difficult situation; I came across divorce, abuse, and lack of food. I learned to never take my car

for granted. Buses rarely run in the middle of the night and for some families it is their only

option to get to a hospital, because they know ambulances are too expensive. I learned that

community work is truly a labor of love. Compensation for the employees that do this important

work isn’t anywhere near what they deserve. I learned that trust must be earned in a community

situation. It took awhile for people to being to talk to me and judged me based on my clothes and

skin color. I learned that for some life is a constant uphill battle, and help or guidance given to

them may be what they need, but they may also need a listening ear.

I learned that childhood obesity is not a huge issue to some community members. They

are more concerned that their children are safe and fed, not their weight status. I learned that

without community centers many senior citizens may not have a meal everyday if not for the

nutrition program offered by the community center. This also applies to the children that use the

community center. Most would be sitting at home alone after school; the community center

provides a snack and a safe place to go afterschool for children of all ages. I learned to be

extremely thankful for health insurance and that one injury or accident will not bankrupt my

family. I learned that it is possible for people to change. I have witnessed a felon learn to become

a father again. I learned that forgiveness has the ability to go a long way in any situation. The

most important less that I learned is that the power of community can only be noticed when it is

not present. Many people I spoke to about the community center began their statements with, “If

not for Meadows Park…” The impact that Meadows Park Community Center has had on its

residents is immeasurable. It is almost impossible to capture how many children would have

experimented with drugs – if not for the after school program, or how many of them would not

have graduated high school without the tutoring help, or even how many would have joined a

gang or other negative social group if Meadows Park Community Center did not give them a safe

place to socialize together.


At my internship site, Meadows Park Community Center, there was constant threat of the

center being bought out and sold to a private entity like the YMCA. Most of the families that

utilize Meadows Park Community Center could not afford the membership fees at places like the

YMCA. The community center functions with open arms. If someone cannot afford the program

or camp that is being offered and if they receive free and reduced lunches at school they

automatically qualify for reduced rates or free programs if they volunteer time.

Recommendations for Future Projects

Future research or projects in the Harrison School District Two area would be beneficial

to its residents, especially if they involved food access, food deserts, and public transportation

routes. A geographic information system or GIS map could identify grocery stores/ shopping

markets that coincide with bus routes would help city planners identify a need that is present in

the community. In the Colorado Springs area and especially in the Meadows Park Community

transportation is not only difficult to food but also to WIC offices, primary care/ treatment

facilities, and hospitals. Another project that could provide beneficial data is a longitudinal study

that focused on tracking the effects of community centers on health, safety, and education. This

study could provide quantitative data that legitimizes the mission of community centers. A study

like this could capture graduation rates or track obesity or fitness levels of children who did and

did not utilize community center programs.

VII. CONCLUSION

Childhood Obesity will continue to be a problem if preventative measures are not taken.

My hope is that more efficient measures other than BMI will be used in the future to more

accurately describe the number of overweight and obese children in the US. The mission of

organizations will continue to change as the health status of children change. I would like to end

this needs assessment with a quote from one of the interviews. It truly exemplifies why changes

must take place, “It [Parks & Recreation] used to be about quality of life and leisure and fun

experiences. Now it is very much public health. It is about food, clothing and shelter, if it’s an

exercise class it’s as much about reducing your medications and BMI as it is having something

enjoyable, maybe a distraction in life. Years ago this wasn’t even close to something we felt we

had to take on. That’s what doctors do. Now it has come to a community center. Until you have

the health of your community squared away you don’t have the luxury to take on leisure.”


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VIIII. Tables, Figures &Appendices

APPENDIX A

INTERVIEW GUIDE

Interview with El Paso County Public Health

I have several questions here to help guide the discussion, however, I would like you to

elaborate. If you feel there is an aspect to this topic that is not being covered, feel free to expand

your answers to cover all of your related experiences.

1. How would you describe the overall health of children located in El Paso County and

Harrison School District 2? *Trying to gage overall knowledge

2. What do you think the major differences between the two groups? Knowledge

3. Are there barriers to proper nutrition that you have witnessed in the Harrison district

community? Knowledge of health department/ Behavior of citizens

4. Is there adequate access to healthy food in El Paso County? Harrison School District 2?

Knowledge

5. Have you felt that the prevalence of childhood obesity has changed priorities in the health

department? Behavior/ Status

6. If you could change one thing in El Paso County that would help decrease the prevalence

of obesity among your children, what would it be?

Is there anything else you would like to add? Do you have any questions or additional comments

at this time?

INTERVIEW GUIDE

Interview with Meadows Park Community Center




1. How would you describe the overall health of children that utilize Meadows Park

Community Center? Knowledge

2. Over the past 15 years how have you seen the behaviors of children change? Knowledge/

Behavior

3. Are there barriers to proper nutrition that you have witnessed in the Meadows Park

community? Knowledge

4. Could you tell me a little about food insecurity among the Meadows Park community?

Knowledge

5. Have you felt that the occurrence of childhood obesity has changed priorities in the your

work as a community center? Behavior/ Status

6. If you could change one thing at MPCC that would help decrease the prevalence of

obesity among your children, what would it be?



at this time?

INTERVIEW GUIDE

Harrison School District 2 Administration




1. How would you describe the overall health of children located in Harrison School

District 2? Knowledge

2. What are some barriers to proper nutrition that you have witnessed in the Harrison district

community? And what has the school district done about food insecurity? Behavior/

Status

3. Have you felt that the occurrence of childhood obesity has changed priorities in your

district? Behavior/ Status

4. What changes, if any, have you made to school lunches? Behavior

5. Does Harrison incorporate physical, health, and nutrition education in its school? If it

does not, does it plan to in the future? Behavior/Status

6. If you could change one thing in Harrison that would help decrease the prevalence of

obesity among our children, what would it be?


at this time?

INTERVIEW GUIDES

Parent of Harrison District Students



your answers to cover all of your related experiences. It would be helpful to provide ages and

how many children you have.

1. How would you describe the overall health of your child?

(Height/ Weight/ BMI? Eating habits?)

2. Are there barriers to proper nutrition that you have had to overcome? Behavior/ Status

3. How far away is the closest grocery store to you? Status

4. Does your child eat lunch that the school provides or do you pack a lunch? What do you

think about the nutritional quality of school lunches? Behavior

5. Do you think your child gets enough physical activity during the school day and at home?

Knowledge

6. If you could change one thing in your community that would help decrease the

prevalence of obesity among children, what would it be?



at this time? * Note: Correlation to Omaha Rating System in Italics

APPENDIX B

Informed Consent

Protocol Title: Overweight and Obese Children in Harrison School District 2 and El Paso County, a Needs Assessment

Please read this consent document carefully before you decide to participate in this needs assessment.

Purpose of the needs assessment: The purpose of this needs assessment is to identify the disparities and challenges for children achieving and maintaining a healthy weight in El Paso County, Colorado. According to the CDC, in the United States childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. In the state of Colorado one in four children are overweight or obese. According to the 2013 annual report for El Paso County, Colorado 31.9% of children 2-14 years old were reported as being overweight or obese. Multiple government agencies, nutrition journals, and studies have shown a relationship between the prevalence of obesity and poverty. I have chosen to focus on Harrison School District 2. Census Data from 2012 reports Harrison School District Two as having 34.7% of its families living in poverty.

What you will be asked to do in the needs assessment: You will be asked a few questions surrounding the health status, health habits and healthy food access, physical activity opportunities.

Time required: 30 Minutes to 1 hour

Risks and Benefits There are no direct benefits or risks to you for participating in the study.

Compensation: You will not be paid compensation for participating in this research.

Confidentiality: Your identity will be kept confidential to the extent provided by law. Your name will not be used in any report. All tapes, transcripts, emails and files will exclude names and only be stored on researcher’s personal computer that can be accessed by only the researcher. Recordings or emails will be stored in password-protected documents and folder, placed on a SSL server. Once research is complete the recordings/emails will be


deleted. Participants can be given access to verbatim transcripts/emails of the interview and can be given the opportunity to have any responses excluded from the research, if requested. The researcher will also provide opportunities to examine the analysis and results prior to the end of the study.

Voluntary participation: Your participation in this needs assessment is completely voluntary. There is no penalty for not participating.

Right to withdraw from the study: You have the right to withdraw from the needs assessment at anytime without consequence.

Whom to contact if you have questions about the study: Christa Meiler, Graduate Student, College of Public Health and Health Professions, [email protected] or 513-368-9683, faculty supervisor is Dr. Mark Hart. He can be reached at [email protected] or 352-273-8545.

Whom to contact about your rights as a research participant in the study: IRB02 Office, Box 112250, University of Florida, Gainesville, FL 32611-2250; phone 392-0433.

Agreement: I have read the procedure described above. I voluntarily agree to participate in the needs assessment and I have received a copy of this description.

Participant: ______________________________________ Date: _________________

Principal Investigator: ______________________________ Date: _________________

mailto:[email protected]

mailto:[email protected]


APPENDIX C


APPENDIX D

Meiler_Final_Paper

Documents

Transcript of Meiler_Final_Paper