Session1b Vargas FINAL POST 11 7 16 › documents › ClemenciaVargas.pdf11/22/16 4 *...
Transcript of Session1b Vargas FINAL POST 11 7 16 › documents › ClemenciaVargas.pdf11/22/16 4 *...
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Health Equity Issues Related to Childhood Obesity
Session I: Overview of the Science Clemencia M. Vargas, D.D.S., Ph.D.
Co-‐authors: Elsie M. Stines, D.N.P., C.R.N.P. Herta S. Granado, B.S.
November 3, 2016 Washington, DC
Disclosure and Presentation Support
The author and co-‐authors have no financial or other conflicts of interest to disclose This presentation was supported by a grant from the Robert Wood Johnson Foundation
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To answer the question:
What are the health-‐equity issues that relate to disparities in childhood (under age 12) obesity?
Purpose of this Review
* Definition of Equity: Attainment of the highest level of health for all people * Therefore, attaining equity requires: Eliminating health disparities by improving the health of disadvantaged groups.
Health Equity
Graphic Concept: Froehle C. Graphic Source: King County, WA http://kingcounty.gov/elected/executive/constantine/priorities/building-‐equity.aspx
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Prevalence of Obesity in Children by Age and Race, NHANES 2011-‐2012
30%
25%
20%
15% 10%
2-‐5 years
6-‐11 years
12-‐19 years
2-‐19 years
5%
0% All Non-‐Hispanic Non-‐Hispanic Non-‐Hispanic Hispanic
white black Asian
Source: Ogden, Carroll, Kit , Flegal. Prevalence of childhood and adult obesity in the United States, 2011-‐2012. JAMA 2014;311(8):806-‐814
Social Determinants of Obesity Inequalities
Adapted from Friel S, Chopra M, Satcher D. Unequal weight oriented policy responses to the global obesity epidemic. BMJ 2007;335:1241-‐1243
Macrosocial Context Sociopolitical, Sociocultural, Socioeconomic, and Socioenvironmental Context
Inequalities in Obesity Rates
Individual Level Factors Food Nutrient intake Energy expenditure Psychological factors Biological factors Health literacy
Social Stratification Income Education Occupation Sex Ethnicity
Food Environment Natural and Build Environment Social Environment Trade agreements Urban design Financial capacity/ Distribution School environment Poverty Production Land use Living conditions Processing Transportation mode Transport access Advertising Public facilities Remoteness Price Market access Social support Food deserts Social cohesion Food insecurity Working practices School food Eating habits
Social norms Time
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* Addresses broader topics than a systematic review * Includes different types of study designs * Studies would not be comparable
* Does not include analysis of quality of the studies * Identifies gaps in the literature
Scoping Study or Review
Source: Arksey H, O’Malley L. 2005. Scoping studies: toward a methodological framework. International Journal of Social Research Methodology 8(1):19-‐32
Stage 1: Discussing and refining the research question Stage 2: Literature search
* Preliminary searches to define comprehensiveness of the study * Inclusion/exclusion: US, <12 yr olds, English, published 2005+ Preference given to systematic reviews * Key words: Obesity or overweight, children with words for each factor * Used RefWorks and searched Medline, PubMed, and Web of Science
Stage 3: Review and selection of references Stage 4: Chart to extract information. Added snow ball search and
excluded redundant references Stage 5: Summary and qualitative thematic analysis (content analysis)
Scoping Review Process
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References Selection Process
Final Number of References = 39
Food environment 16 Natural built environment 11 Social environment 12
Redundant References Removed = 10
Food environment 4 Natural built environment 2 Social environment 4
Snow Ball Technique = 13
Food environment 4 Natural built environment 4 Social environment 5
After Reviewing the Articles = 36
Food environment 16 Natural built environment 9 Social environment 11
Initial Selection Based on Abstracts = 351 Food environment 152 Natural built environment 144 Social environment 55
Food Advertisement * Affects food preferences and selection * Discordance between health recommendations
and marketing Price * Healthy food is more expensive Access to Healthy Food * No association between food desert and obesity Food Insecurity * No association with obesity (role of SNAP) School Food * Breakfast=low BMI * Food served=obesity * Competitive food=obesity Trade Agreements * Strong influence on diet, obesity in the other
countries
Results: Food Environment
What is a Food Desert?
• No grocery stores • No farmers market • Surrounded by fast food, junk food, or food high in sugars and fats
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Food accessibility * Vehicle ownership, public transit, walkability, neighborhood safety
Physical activity * Access to recreational facilities, walkability, safe
neighborhoods=more physical youth * Limited options for outdoor activities = Higher screen time * Ethnic minorities higher screen time (50% more than whites)=obesity
Results: Natural and Built Environment
Poverty * Poor=obesity * “parents try to stretch their dollar” Social Cohesion * Similar background= low obesity Social Norms * Ideal weight à stigma Time to Prepare Meals * Insufficient time for working mothers to cook=higher obesity Living Conditions * Having cooking supplies
Results: Social Environment
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* Strong association among macrosocial context and environments with childhood obesity. * The increase in obesity over the past 25 years cannot be explained by genetic or biological changes given the short period of time. "an obesogenic environment that promotes inactivity and overeating”+
* This strong social aspect of obesity must be considered when seeking for solutions to address the problem.
Discussion
+Source: Johnson. The nation’s childhood obesity epidemic: Health disparities in the making. CYF News, 7(2). 2012.
* The only food environment elements that were not consistently associated with obesity were food insecurity and food deserts. * Safety is paramount to the built/natural environment. * Critical to have transportation to buy groceries in other places and to access recreation sites. * Methodological limitations: definitions, statistical techniques, study design, confounding variables.
Discussion
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* Factors that could affect food insecurity such as social support and living conditions * Housing conditions such as functional kitchen, water supply, sharing kitchen area and cooking utensils * Parents’ time available for cooking, grocery shopping, and exercise * Healthy food requires more resources: price, processing, preservation * Physical activity in public schools
Gaps in the Literature
Oral Health Professionals * Support policy that will
reduce health disparities Community * Community gardens or
farmers markets * Snacks and food available at
healthcare facilities * Work with local business to
replace unhealthy rewards * Walking routes to schools * Repurpose of space for
physical activity, walkability
Decreasing the Effect of Disparities
Schools * Health curriculum * School food * School gardens Oral Health Practices and Clinics * Obtain and discuss BMI with
families * Start a conversation about
healthy food and exercise
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Parents * Participate in policy making work * Improve family members financial
skills to reduce food insecurity * Encourage healthy habits with
healthy rewards * Participation in school activities * Limit children’s screen time – but
need alternatives * Limit weight related stigma:
emphasize what the body can do rather than how it looks
Decreasing the Effect of Disparities
Objective: To eliminate disparities Regulations -‐ Policies * Hurdles * Lack of support * Financial limitations * Legal * Chances * Stakeholders participation * Political buy-‐in / political will
Addressing Obesity Equity Issues
Source: Hayne CL, Moran PA, Ford MM. 2004. Regulating environments to reduce obesity. Journal of Public Health Policy 25(3/4):391-‐407.
Graphic Concept: Froehle C. medium.com/@CRA1G/the-‐evolution-‐of-‐an-‐accidental-‐meme ddc4e139e0e4#.judgmo98z
Equality Equity No Barriers
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* Most food environment elements were associated with obesity, except food insecurity and food deserts * Unfavorable built/natural and social environments are associated with obesity * Oral health professionals have a role in community, schools, and their practices to reduce effect of disparities * Reducing macro-‐contextual disparities is required to address childhood obesity equity issues * Most equity issues could be addressed with policies
Conclusions
Questions?
Thank You!