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Vonna Drayton, DrPH
Gregory D. Benjamin, M.P.H.
Hu An, M.S.
Environmental factors associated with reduction in overweight and obesity among Delaware children age 6-17 years
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Acknowledgements
Likun Hou, MS
Robert Colnes, PhD
Michele Lempa, DrPH
NHPS’ Policy, Evaluation, and Research Dept.
This evaluation has been made possible in part by a grant from the Robert Wood Johnson Foundation (RWJF ID: 62078)
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Presentation Objectives
1. Describe Nemours Health & Prevention Services’ (NHPS) multi-sector intervention to reduce overweight in Delaware’s children.
2. Identify factors associated with the reduction in overweight BMI (body mass index greater than the 85th percentile) in DE children, 6-17 years.
3. Explain the development and use of NHPS’ Healthy Eating and Physical Activity (HEPA) Index.
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NHPS’ Strategy
Strategy based on the social ecological model
Prevention-oriented child health system that includes the following components:– Strategies in multiple sectors: Exposure to consistent
healthy messages/environments for behavior change– Strategic partnerships: Greatest potential impact,
authority to make policy and practice changes, ability to leverage resources
– Social marketing: Creating and accelerating social policy and behavior changes
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A Day in the LifeMultiple Sources of Influence in a Child’s Day
12:00 AM
6:00 AM
3:00 PM 9:00 AM
6:00 PM
9:00 PM
Sleep
Time with parent
Child Care/ School
Afterschool
Primar
y Car
e
Comm
unity/
Family
12:00 PM
8:00 AM
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NHPS’ Healthy Eating and Physical Activity (HEPA) Initiative
Policy and practice changes in child-serving organizations– Office of Child Care Licensing and child care
centers– Department of Education and Delaware school
districts– Primary healthcare providers– Youth-serving organizations (YMCA, 4-H) and
after-school programs– Built Environment (e.g., Delaware Greenways,
Delaware Parks & Recreation, DNREC)
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NHPS’ 5-2-1-Almost None Message
5: Five or more fruits and vegetables consumed each day
2: Screen time is limited to less than 2 hours each day
1: Children are physically active for at least 1 hour each day
Almost None: Sugar-sweetened beverages are limited to no more than 2 servings each week
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Award Winning Media
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Increasing Awareness of NHPS’ 5-2-1-Almost None Message
In 2006, 5% of parents heard of and could recall NHPS’ 5-2-1-Almost None campaign.
In 2008, 19% of parents heard of and could recall NHPS’ 5-2-1-Almost None campaign. 15.5 % of respondents talked to someone about
this message. There was approximately a four-fold increase
in awareness and recall between 2006 and 2008.
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2006 DSCH (N=164) & 2008 DSCH (N=528)
HEPA behaviors of children whose parents were aware of NHPS’ 5-2-1-Almost None message: DSCH 2006 vs. 2008
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Data Sources
Population
HEPA Awareness
HEPA Behaviors
BMI
Systems
Policy and Practice (Child Care and Schools)
Delaware Survey of Children’s Health (DSCH),Electronic Medical Record (EMR)
SHPPS, Wellness Policy Review, Provider Surveys, Document Reviews, and Legislation
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DSCH Design and Sampling Random-digit-dialing (RDD) of DE households
containing at least one child less than 18 yrs of age. Statewide sample (n=3055, response rate=57%)
allowed comparisons among: Four specific locations:
City of Wilmington New Castle County, excluding the City of Wilmington Kent County Sussex County
Children of various age and racial groups: Birth through 5 yrs old 6 through 11 yrs old 12 through 17 yrs old African-American versus all other children
Blumberg SJ, Olson L, Frankel MR, Osborn L, Srinath KP, Giambo P. Design and operation of the National Survey of Children’s Health, 2003. National Center for Health Statistics. Vital Health Stat 1(43). 2005.
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DSCH Sample Distribution
DSCH 2006 DSCH 2008
New Castle County 833 775
City of Wilmington 741 742
Kent County 721 824
Sussex County 760 740
Delaware (total) 3055 3081
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Identify factors associated with the reduction in overweight and obese BMI (body mass index greater than or equal to the 85th percentile) in DE children, 6-17 years.
Presentation Objective #2
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Expert Committee Recommendations, June 6, 2007
Body Mass Index (BMI)
Body Mass Index (BMI) is derived from a child’s weight and height.
BMI categories for children ages 2 and over:– Underweight < 5th percentile– Healthy weight: 5th ≤ BMI <85thpercentile
(Reference Category)– Overweight or obese: ≥ 85th percentile
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Access to Fruits and Vegetables in the Community
20% of respondents indicated that it was very easy to walk or bike to a fast food restaurant
26% of respondents indicated that it was very easy to walk or bike to the place that sells fruits and vegetables.
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Screen Time: Television
53% of children usually watch TV, watch video or play video games for 2 hours or less on an average weekday.
50% of children are allowed to watch TV, watch video or play video games for 2 hours or less on an average weekday.
24% of children are allowed to watch TV, watch video or play video games for 2 hours or less on an average weekend day.
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School Physical Activity
20% of children ages 6-17 participate in physical education or gym classes five days per week.
77% of school offer recess or a break where selected child can be physically active.
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Parent Support of Physical Activity
Parent or another adult engaged in PA with child 3 days per week on average.
69% of respondents always encouraged child to be physically active.– 43% for at least 60 mins/day
48% of respondents always made sure child was physically active.– 39% at least 60 mins/day
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Walkability of Community
67% of respondents reported that their neighborhood was a very pleasant place to walk.
43% of respondents definitely disagreed that traffic makes it dangerous to walk in their neighborhood.
60% of respondents said yes to the presence of sidewalks.
36% of respondents definitely agreed that their neighborhood is safe from crime.
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Primary Healthcare Provider Promotion of HEPA
84% of primary healthcare providers have discussed healthy eating and physical activity with respondent/child.
77% of primary healthcare providers have made recommendations about healthy eating and physical activity to respondent/child.
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Explain the development and use of NHPS’ Healthy Eating and Physical Activity (HEPA) Index.
Presentation Objective #3
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HEPA Index Algorithm
Factor 13:Access to fruits &
vegetables in community
Factor 3:Screen
Time-TV
Factor 6:Parental
Support of Physical Activity
Factor 9:School
Physical Activity
(6-17 yrs)
Factor 10:Community
Support
Factor 11:Access to
PA in Community
Factor 12:Walkability
of Community
Use the dichotomization system to calculate items’ scores and construct factor scores for Ages 2-5 years and 6-17 years
Factor 14:Societal
promotion of HE/PA
Select the DSCH Questions and conduct Exploratory Factor Analyses for the HEPA Index based on the Social Ecological Model
Sum the dichotomized factors’ scores to construct the HEPA Index
Examine the predictive validity of the HEPA Index for BMI ≥ 85th percentile
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HEPA Index Factors
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HEPA Index Range
INDEX SCORE REFERENCE
HEPA
8 Most healthy
7
6
5
4
3
2
1
0 Least healthy
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Distribution of HEPA Index Factor Scores
53% of DE children ages 6-11 scored 6 to 8 on the HI.
41% of DE children ages 12-17 scored 6 to 8 on the HI.
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Strengths and Limitations
Strengths– Large sample size– Representative of
the data for Delaware
– Consistent with other findings from the NSCH
– Contribution to the literature
Limitations– Some survey items did not lend
themselves to factor analyses.– A few factors contained less
than three items.– Some survey items proved not
to be ‘good’ measures of NHPS’ 5-2-1-Almost None behaviors.
– Causal inferences cannot be made between environmental factors and overweight/obesity.
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http://www.growuphealthy.org
For more info, please contact:
Gregory D. Benjamin, M.P.H.
Evaluation Scientist
(p) 302-444-9163 (e) [email protected]