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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.
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 3
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
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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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 5
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.
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 6
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
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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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 8
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:
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 9
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
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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.
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 11
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 12
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.
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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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 14
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 15
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 16
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 17
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 18
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.
Source: SOPARC Park Observation, 2014
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.
Source: SOPARC Park Observation, 2014
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 19
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 20
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.
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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-
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 22
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).
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 23
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 24
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 25
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.
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 26
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.”
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 27
VIII REFERENCES
Active Living Research. (2014). About. Retrieved June 5, 2014, from
http://activelivingresearch.org/about
Active Living Research. (2014). Active Neighborhood Checklist Home. Retrieved June 3, 2014,
from http://activelivingresearch.org/active-neighborhood-checklist
Active Living Research. (2014). SOPARC: System for Observing Play and Recreation in
Communities. Home. Retrieved June 1, 2014, from
http://activelivingresearch.org/node/10654
Centers for Disease Control and Prevention. (2014, March 28). Adult obesity facts. Retrieved
May 21, 2014, from http://www.cdc.gov/obesity/data/adult.html
Centers for Disease Control and Prevention. (2014, March 28). Childhood Obesity Facts.
Retrieved May 22, 2014, from http://www.cdc.gov/obesity/data/childhood.html
Centers for Disease Control and Prevention. (2011, September 13). BMI for Adults. Retrieved
May 21, 2014, from
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
Center for Health Leadership & Practice. (2013). Colorado community center collaborative,
colorado springs, co (cohort 2 - 2013). Retrieved from
http://www.healthleadership.org/content/colorado-community-center-collaborative-
colorado-springs-co-cohort-2-2013
Cleveland Clinic. (2013). High cholesterol in children. Retrieved June 20, 2014 from
http://my.clevelandclinic.org/healthy_living/childrens_health/hic_high_cholesterol_in_ch
ildren.aspx
Drewnowski, A. (2010) The Cost Of US Foods As Related To Their Nutritive Value. American
Journal of Clinical Nutrition, 1181-1188. Retrieved May 26, 2014. doi: 10.3945
El Paso County Public Health. (2014, June 23). Community health improvement plan. Retrieved
from http://www.elpasocountyhealth.org/sites/default/files/imce/CHP 6-23-2014.pdf
El Paso County Public Health. (2013) Annual Report. Retrieved May 14, 2014, from
http://tinyurl.com/oqyyxxe
El Paso County Public Health. (2013, March). Healthy community collaborative. Retrieved from
http://www.elpasocountyhealth.org/service/healthy-community-collaborative
Glaser, B. G. (2008). The constant comparative method of qualitative analysis. Grounded Theory
Review, 7(3), Retrieved from http://groundedtheoryreview.com/2008/11/29/the-constant-
comparative-method-of-qualitative-analysis-1/
Harrison School District 2. (2014). Department: Nutrition. Retrieved May 20, 2014, from
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 28
http://www.hsd2.org/departments/support-services/nutrition
Hoehner, C. M., Ivy, A., Ramirez, L. K., Handy, S., & Brownson, R. C. (2007). Active
neighborhood checklist: A user-friendly and reliable tool for assessing activity
friendliness. American Journal of Health Promotion, 21(6), 534-537. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17674642
Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and Policy.
Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences.
Washington (DC): National Academies Press (US); 2001. 3, Behavioral Risk Factors.
Available from: http://www.ncbi.nlm.nih.gov/books/NBK43744/
Kaiser Permanente. (2006, January). Childhood Obesity. Retrieved May 21, 2014, from
http://tinyurl.com/osqv2q9
Kamath, C., Vikers, K., Ehrlich, A., McGovern, L., Johnson, J., Singhal, V., Paulo, R., &
Hettinger, A., et al. (2008). Behavioral interventions to prevent childhood. The Journal
of Clinical Endocrinology & Metabolism, 93(12), 4606–4615. doi: 10.1210/jc.2006-
2411
Let’s Go!. (2012). Let’s go! 5-2-1-0. Retrieved from http://www.letsgo.org/
LiveWell Colorado. (2013). Is Colorado a healthy place to raise your child?. Retrieved May 21,
2014, from http://tinyurl.com/pfre5uu
Meiler, C. (Producer) (2014). 5210 at meadows park community center [Web Video]. Retrieved
from https://www.youtube.com/watch?v=4IDd6aJTyww
Ogden, C., Carroll, M., Kit, B., & Flegal, K. (2012). Prevalence of Obesity and Trends in Body
Mass Index Among US Children and Adolescents, 1999-2010. JAMA: The Journal of the
American Medical Association, 307, 483-490. Retrieved May 19, 2014, from
http://www.ncbi.nlm.nih.gov/pubmed/22253364
Ogden CL, Lamb MM, Carroll MD, Flegal, KM. (2010) Obesity and socioeconomic status in
children: United States 1988–1994 and 2005–2008. NCHS data brief no 51. Hyattsville,
MD: National Center for Health Statistics. 2010. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db51.pdf
Olshansky, S., Passaro, D., Hershow, R., Layden, J., Carnes, B.A., Brody, J., Hayflick, L.,
Butler, R., Allison, D., and Ludwig, D.S. (2005). A Potential Decline In Life Expectancy
In The United States In The 21st Century. New England Journal of Medicine, 352, 1138-
1145. Retrieved May 16, 2014, from
http://www.nejm.org/doi/pdf/10.1056/NEJMsr043743
Patrick, H., & Nicklas, T. (2005). A review of family and social determinants of children’s
eating patterns and diet quality. Journal of the American College of Nutrition, 24(2), 83–
92. Retrieved from http://www.jacn.org/content/24/2/83.full
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 29
Patton, M. (1990). Qualitative evaluation and research methods (pp. 169-186). Beverly Hills,
CA: Sage. Retrieved from http://legacy.oise.utoronto.ca/research/field-
centres/ross/ctl1014/Patton1990.pdf
Peak Vista. (2014). The ronald mcdonald care mobile™. Retrieved from
http://www.peakvista.org/locations/ronald-mcdonald-care-mobile
Putnam, R. D. (2000). Health and Happiness. Bowling alone: the collapse and revival of
American community (327-331). New York: Simon & Schuster.
SOPARC Park Observation. (2014). Soparc park observation beta, web results. Retrieved from
http://soparc.rand.org/
United States Census Bureau. (2012). Small Area Income and Poverty Estimates. Retrieved May
20, 2014, from http://tinyurl.com/opsocpo
United States Census Bureau: American Community Survey. (2012). American factfinder:
Educational attainment. Retrieved from
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_
12_5YR_S1501
United States Census Bureau: Small Area Income and Poverty Estimates. (2013, December 11).
Small area income and poverty estimates: Colorado. Retrieved from
http://tinyurl.com/lpq5f59
United States Census Bureau: State and County QuickFacts. (2014, July 08). State & county
quickfacts. el paso county, colorado.. Retrieved from
http://quickfacts.census.gov/qfd/states/08/08041.html
USDA:ERS. (2014). Food access research atlas. Retrieved from http://www.ers.usda.gov/data-
products/food-access-research-atlas/go-to-the-atlas.aspx
World Health Organization (WHO). (2014). Obesity. Retrieved May 19, 2014, from
http://www.who.int/topics/obesity/en/
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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
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 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?
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Is there anything else you would like to add? Do you have any questions or additional comments
at this time?
INTERVIEW GUIDE
Harrison School District 2 Administration
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 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?
Is there anything else you would like to add? Do you have any questions or additional comments
at this time?
INTERVIEW GUIDES
Parent of Harrison District Students
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. 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?
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 32
Is there anything else you would like to add? Do you have any questions or additional comments
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
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 33
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: _________________
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 34
APPENDIX C
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 35
OVERWEIGHT AND OBESE CHILDREN IN HARRISON SCHOOL DISTRICT TWO 36
APPENDIX D