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Application of the PRECEDE model to obesity preventionSally Black, RN, PhD & Cayley Warner, RD

Saint Joseph’s University

In the United States, childhood obesity is becoming the greatest challenge of this century. A goal of Healthy People 2010 is to reduce the proportion of children and adolescents who are overweight or obese to 5% (Baseline=11%). In Pennsylvania, an estimated 18.2% of eighth grade students are overweight. 1 In 2003, the overall incidence of obesity was 24% with Hispanic (31%) and Black (23%) at highest risk compared to White children (16%) in New York City. 2 Frequencies of overweight and obese may be higher in inner city, minority youth. The purpose of this study was to plan and pilot a program to reduce childhood obesity in Philadelphia. Researchers and practitioners from Saint Joseph’s University investigated childhood obesity at environmental, educational, and policy levels and planned interventions. Major components of the project were a science based nutrition education program, critical media awareness, working with food manufacturers to influence marketing practices, and building a community playground to provide safe play opportunities for children.

1PA Department of Health, (2002). “Pennsylvania Assessment of Overweight Children and Youth.” 2Thorpe, L.E., List, D.G., Marx, T., May, L., Helgerson, S. D., and Frieden, T.R. (Sep 2004). Childhood Obesity in New York City Elementary School Students, Am J Public Health, 94: 1496 – 15003Green, Kreuter, Deeds, & Partridge (1980). Health Education Planning: A Diagnostic Approach. Mountain View, CA: Mayfield.

INTRODUCTION

FIGURE: The PRECEDE-PROCEED model3 applied to childhood obesity

PRECEDE

PROCEED

Quality of LifePhysical and mental health and well being

Health Problem27% Overweight or at risk

Heart diseaseHypertensionType 2 diabetes CancerAsthmaAltered glucose metabolismIncreased lipid levels Low self-esteemDepressionSocial discriminationPremature sexual developmentHip and joint problems

Literature review (Swartz)

BehaviorsFood choicesActivity levelsNeeds Assessment to identify current behaviors (Logio)

EnvironmentAccess to healthy foodsAccess to safe play areasMedia influenceFamily influenceCultural influenceGIS Mapping to geographically identify areas of higher obesity (Jambulingam)

Predisposing FactorsBody image (size = power)Perceived riskPerceived susceptibilitySeries of health fairs (Black)

Phase 4: Educational and Organizational Diagnosis Phase 3: Behavioral and Environmental Diagnosis

Phase 2: Epidemiological Diagnosis

Phase 1: Social Diagnosis

Reinforcing Factors Advice from health care providersCommunity Media is taking a more positive roleInvestigation of food advertising aimed at children (Lord)

Enabling Factors Access SkillsKnowledgeCommunity playground (Brady & Black)

Health Promotion

Phase 5: Administrative And Policy Diagnosis

EducationalProvide nutrition education (Cifelli & Reynolds)Provide critical media awareness (Lazar)

Policy Regulation OrganizationConsumer reactions to obesity information (Simmers) Investor reactions to obesity information influences stock prices (Ghani)Evaluation of current marketing practices to inform policy regulation (Childs)

Phase 6: Implementation Phase 7: Process Evaluation Phase 8: Impact Evaluation Phase 9: Outcome Evaluation

Research projects funded by Centers for Disease Control, Chronic Disease Prevention & Promotion Division