Overweight & Obese Children in Harrison School District Two and El Paso County, a Needs Assessment

Christa Hyson Meiler2014 MPH Candidate

University of Florida

IntroductionInternship Site Meadows Park Community Center (MPCC)• Located in Colorado Springs, Colorado • In El Paso County, Harrison School District Two • Utilized by southeast Colorado Springs • 71% of participants in summer camp programs received a reduced

rate • MPCC is a result of available space in the community and a group

of concerned citizens about gangs and teenagers in the early 1980s

Source: Meadows Park Community Center 2014

Order of PresentationMeadows Park Community Center Profile

Background

Methods

Results

Discussion

Implications

Conclusion

Meadows Park Community Center Profile

Focus on•Early Childhood, Youth and Teens•Health and Wellness•Food Insecurity•Medical Services•Public Safety•Technology•Community Building

Services offered•Golden Circle Nutrition Program•After School Program•Before School Breakfast•Summer Camp•Grant-Funded Services

Background

• Childhood obesity is considered one of the major epidemics of the 21st century

• Decrease in life expectancy• Examine the physical and social environment• Connection between low socioeconomic status (SES) and obesity

Obesity and public health values• Right to healthcare• Health Education • Improve & Protect Life

Review of Critical Literature

Review of Critical Literature

Review of Critical Literature

About El Paso County

Population El Paso County ColoradoPopulation, 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%

Population of El Paso County and Colorado by age in 2012

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

Educational Attainment 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%

In El Paso County, ages 25 and overSource: U.S. Census Bureau: American Community Survey, 2012

Small Area Income & Poverty Estimates

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

State of Colorado in 2012, Percent in Poverty, Ages 5-17 in Families

Percent of Children Engaging in Selected Eating &Recreational Behaviors, Colorado 2009 to 2010

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 schooln/a: Measure unavailable for age group Source: El Paso County Public Health

Unhealthy Weight in El Paso County

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

Research Question & Specific Aims

Research Question• Is there a causal relationship present between low

socioeconomic status (SES) and obesity in children? Specific Aims

• Through interviews and secondary data gain a general understanding of the health status of the children in El Paso County.

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

Specific Aims

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

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

Methods

• Interviews

• Active Neighborhood Checklist- Sidewalk Audit

• SOPARC: System for Observing Play and Recreation In Communities

• Secondary Data

Methods- Interviews

• Community Center Director

• El Paso County Public Health, Community Health Educator

• Single Parent with Four Children in Harrison Schools• Harrison School District Administrators

Why these individuals?• Proximity to Population• Knowledge of Population• Involved Community Members

Analysis of MethodsFour stages of the constant comparative method: Categorize data

Place data into proper homes or properties

Define possible theories

Write the theory

Analysis of Methods

Categories to assess the results of the Sidewalk Audit/SOPARC:Land use/ Public transportation/ Street characteristics/ Environmental quality/ Walkability/ Bike accessibility/ Park Conditions/ Activities/ Age/ Gender/ Ethnicity

Results- Sidewalk Audit

Results- Sidewalk Audit

• Premier use of land is mostly residential • Homes or apartments in the area had on street parking or a small

lot or 1-car garage• Large green space and playground present in the middle of the

community• Street characteristics are lacking • No pedestrian scale lighting present or benches outside of the bus

stop

Results- SOPARC

 

 

Source: SOPARC Park Observation, 2014

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

Conditions of Meadows Park

This chart shows the percentage of target areas observed.

Source: SOPARC Park Observation, 2014

Results- SOPARC

Source: SOPARC Park Observation, 2014

Average Number of Park Users by Age

Children 0-12Teens 13-17Adults 18-55Seniors 55+ Source: SOPARC Park Observation, 2014

Results- Interview

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

The table shows the most frequently mentioned observations on why childhood obesity occurs in the community, as perceived by the interviewees.

Results- Interview

Most Frequented Key Words:• Video Games• Cost (of healthy food)• Personal Transportation• Cooking from Scratch

Significant Quotes

Relationship to Research Question & AimsResearch Question: Is a causal relationship present between low socioeconomic status (SES) and obesity in children? •Interview statements and secondary data •2008, 13.9% of children were obese in El Paso County In 2010, this percentage was 21.0% •2008 59% of students received free/ reduced lunches, in 2012, 70% of students received free/ reduced lunches.

Specific Aims: Through interviews and secondary data gain a general understanding of the health status of the children in El Paso County.

•Varied•Divide of wealth•Transient area/ military •Increase in medication

Source: El Paso County Public Health, 2013 & Harrison School District Two, 2014

Relationship to Research Question & Aims

Through interviews, identify disparities that prevent children in the Meadows Park Community from being a healthy weight.

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

Relationship to Research Question & Aims

Find out how many children in El Paso County/ Harrison School District Two are overweight or obese.•Harrison SD2, not tracked

•El Paso County Public Health 2013 Annual Report stated that 31.9% of children in 2010-2012 were overweight or obese

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

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

Relationship to Research Question & AimsAssess the opportunities for physical activity available to children living in Harrison School District Two with a focus on the Meadows Park Community.

Interpretation of Findings• Policy development • Proposed bus routes changes• More than obesity• Effect of community

Discussion

Kamath et al. (2008) - Argued that the efficacy of lifestyle interventions is unclear

• Children were very receptive to the messages of 5210 programming and could answer questions

Patrick & Nicklas (2008)- Examined physical and social environments • Positive role models and examples are essential early on in life

Olshansky et al. (2005)- Continuing the status quo• The profound effect that environment has on eating/ activity habits, it is

imperative to fund programs that set healthy examples and keep places like Meadows Park Community Center running

Strengths

• Qualitative Data• Unique perspective and data from interviews • Community relationships• Able to understand situation in a local context • Easy to replicate• Attention to detail• Good listener

Limitations

• Lack of quantitative data • Amount of qualitative data• Short period of time • Bias during interview• Personal accounts are not as easy to be generalized• Data analysis (constant comparative method) is very time

consuming• Results reflect my personal biases when categorizing data

Generalization

• Needs assessment was designed to be easily replicated • Interview questions could be asked to any community member,

community health educator, or school administrator in any state or community

• 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

• The sidewalk audit and SOPARC system are both evidence based assessment tools that have over time provided reliable results

Implications

• Special project became the internship • Childhood obesity will continue to be a problem without

intervention and change • Disparities to healthcare/ chronic condition care• SES & Obesity • Health education, health administration, and observing the

environment were the largest parts of this project

MPH Core Competencies

Develop policies and plans that support individual and community health efforts - Policy implementation for the 5210 Let’s Go program

Link people to needed personal health services and assure the provision of health care when otherwise unavailable – Peak Vista Mobile Clinic

Conduct research for new insights and innovative solutions to health problems - SOPARC (System for Observing Play and Recreation in Communities) and Active Neighborhood Checklist, a sidewalk audit

MPH Core Competencies

Diagnose and investigate health problems and health hazards in the community using an ecological framework – Identifying barriers and problem solving

Monitor health status to identify and solve community health problems & Conduct research for new insights and innovative solutions to health problems – Food accessibility and bus routes

Inform, educate, and empower people about health issues - Nutrition education

Mobilize community partnerships and action to identify and solve health problems - Work with the Healthy Communities Collaboration and the Colorado Community Center Collaborative

Concentration Competencies

Demonstrate knowledge and skills needed to design and implement a public health information campaign - 5210 Let’s Go program implementation

Understand and apply the principles of community participation in public health interventions- Community and trust

Apply social and behavioral science theories and concepts to public health problems- Understanding the community

Specify approaches for assessing, preventing, and controlling environmental hazards that pose risks to human health and the environment – Sidewalk audit

Concentration Competencies

Describe genetic, physiological and psychosocial factors that affect susceptibility to adverse health outcomes following exposure to environmental hazards- Asthma in Colorado

Monitor and evaluate programs for their effectiveness and quality – Summer Camp evaluations at MPCC

Identify, retrieve, summarize, manage and communicate public health information- Sharing findings from methods of this needs assessment

Demonstrate communication skills key to public health workforce participation and advocacy – 5210 Let’s Go programming advocacy

Lessons Learned

• Childhood obesity is not a huge issue to some community members

• More concern that their children are safe and fed, not their weight status

• Without community centers many senior citizens may not have a meal everyday if not for the nutrition program offered by the community center

• Community center provides a snack and a safe place to go afterschool for children of all ages after school

• Trust must be earned in a community situation

Recommendations for Future Projects

• Geographic information system or GIS mapping of grocery stores/ shopping Markets, WIC offices, primary care/ treatment facilities, and hospitals

• Change bus routes to meet the needs of the community

• Longitudinal study that focuses on tracking the effects of community centers on health, safety, and education

Conclusions

• Building the trust of the community • Mission of organizations will continue to change as the health status of

children change

“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.”

Thank you for listening!

Questions or Comments?