Special Thanks to: Chicago Community Trust

&

Washington Square Health Foundation

for their support and funding.

Helping us get one step closer to our goal.

WHY TALK FAT?Origins of the Project

1. Growing awareness of obesity as a national problem

National Concerns

• Doubling of obesity rates• Associated increase of Type 2 Diabetes• Anticipated increase of cardiovascular

disease, orthopedic problems, and depression

Percent of Teens who fall above the 85th or 95th %ile

for BMI

• NHANES III (’88 to ’91)

• 12-17 yo

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

AA boys AA girls Mex. Boys Mex girls

85% 95%

ACHN SBHC vs. NHANES, Percent of Teens >95%ile

BMI

0

5

10

15

20

25

30

35

A.A.

boys

A.A.

girls

M.A.

boys

M.A.

girls

NHANES

SBHCs

WHY TALK FAT?Origins of the Project

1. Growing awareness of obesity as a national problem

2. Observation in our own clinics of large numbers of overweight youth

3. Need to address diabetes prevention and diagnosis

Where Will Intervention Take Place:

School-Based Health Center(SBHC)

• Provide ease of access and familiarity to students and families

• Students receive comprehensive health care services

• Patient population with increased risks for obesity and diabetes (40% of 1st or 2nd degree relatives with diabetes)

What is STRIDE?Smart Teens Reducing the

Incidence of Type 2 Diabetes, Etc.

• SBHC obesity intervention and behavior change program

• Context: Enhanced diabetes screening study

• Focus: Healthy eating & increase of physical activity

• Method: Adult and teen focus groups drawn from 3 urban high schools with SBHC

Teens Talk FatMinority Students & their Families

Discuss Experiences and Ideas for Healthy

Eating and Physical Activity

From the Cook County ACHN

N. Fritz, S. Corbin, C.Stahl, N. Mourikes, M. Driscoll

Focus Groups

• PURPOSE: Use adult and teen opinions to guide development of interventional program to reduce diabetes risks

Focus Group Recruitment

• FOCUS GROUPStudents were recruited via classroom, hallway

fliers, patient contact, word of mouth, and referral from providers

Parents were recruited via their children, at report card pick-up and clinic registration, and from pre-existing school based parent groups

Focus Group

• REVIEWGroups were held between November 2001-

January 20021 student and 1 parent group from each of 3

schoolsGroup leader matched by ethnicityGroups of 7-17 participantsGroups lasted 1-2 hoursHealthy foods served

Focus Groups con’t

• Focus group questions addressed: Participants’ experience with diet or exercise

change Knowledge of community resources for eating

and physical activityParticipants’ opinions about useful intervention

strategies in the SBHCs

Focus Group

• METHODS:Discussions were audio recorded Tapes reviewed by all investigators

independently and themes identifiedTranscriptions of discussions were also

reviewed

Analysis:

• Particular attention to:Common themes across groupsDifferences between AA and Latino groupsDifferences between teens and parents

Results: All groups

• 71 participants

• 19 males, 52 females

• 36 teens, 35 parents

• 22 Latinos, 49 African-Americans

• Most participants were overweight

Results: Observations

• Many participants expressed a concern for better health and nutrition

• All participants were able to list community resources

• All participants tried the “healthy” foods that were provided

Themes

1. Feeling unable to sustain healthy choices “One of my ex-boyfriends got me one of

those things you put your feet on, and I sold it . Then he got me an old stationary bike. . And I sold that too..”

“I don’t like walking. I tried sit-ups. I even tried the cha-cha-cha dance….I am just lazy…”

“It’s like when you try…OK, you’re trying..”

Themes

2. Denial there’s a problem “I don’t want to talk about diabetes – it scares

me.” “My doctor tells me to lose weight; But I’m

happy with how I am. I don’t want anyone telling me how I should be . .”

Themes

3. Knowledge deficits “For a while I tried to stop drinking pop so I

switched to juice” “Regular salt is bad for you – you have to buy

sea salt from the health food store, it’s better”

Themes

4. Expediency of junk food: “If the junk food’s there, you just eat it…” “If you put healthy food in the machines,

don’t SAY it’s healthy. . .or people won’t buy it. . .they’ll be afraid it tastes nasty.”

Themes5 Community resources identified and concerns

about these resources (healthy eating): “Our neighborhood is ghetto, we don’t sell that

stuff. They sell spoiled, rotten meat and stuff.” “Basically, in our neighborhood, you really can’t

buy fresh vegetables from there because they are not fresh . . .”

Themes

6. Suggestions for programmatic supports: Some sort of group—a support group,

cooking group, restaurant field trip group, dance/drama group, etc.

Use of school facilities as a resource Very few suggestions regarding provider in-

put

Results: Teen Groups• There were a total of 36 teens (9 male, 27

female)

• 22 African-American and 14 Mexican-American teens

• 2/3 of the teens were overweight

• Most of the teens had family hx of diabetes, as well as, personal experience with dieting and weight loss

Results: Teen Groups con’t • Most teens expressed a concern for their

health and nutrition

• Most teens did not eat meals provided by the schools’ cafeteria

• Most teens were eager to make changes, but also wanted the support needed to make these changes

Results: Adult Groups• There were a total of 35 adults (10 male,

25 female)

• 10 Mexican-American and 25 African-American adults

• 2/3 of the adults were overweight

• Some of the adults were diabetic, most had family hx of diabetes and had some experience with dieting/weight loss

Contrasts: Adults & Teens

• Parents were more concerned about safety issues in the community than were teens.

• Parents were less likely to try the various healthy snacks provided during the groups.

Contrasts: African-Americans & Mexican-Americans

• Mexican-American teens expressed more dissatisfaction about their physical appearance than did the African-American teens

• Mexican-American parents were more open to changing their eating/cooking habits than the African-American parents

• African-American teens but NOT parents were more likely to deny obesity as a problem.

Conclusions: Intervention needs to

• Address psychological barrier of hopelessness

• Build interpersonal support groups

• Address school environmental issues: lunch, vending machines, PE classes, after school opportunities

• Education is important but insufficient

• Support development of change agents among youth, parents, and staff