state of the problem: cleveland community

State of the Problem:State of the Problem:Cleveland CommunityCleveland Community

Natalie Colabianchi, Ph.D.Natalie Colabianchi, Ph.D.Department of Epidemiology and Department of Epidemiology and

BiostatisticsBiostatisticsCase Western Reserve UniversityCase Western Reserve University

Obesity Trends* Among U.S. Adults BRFSS,Obesity Trends* Among U.S. Adults BRFSS, 19941994

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

No Data <10% 10%–14% 15%–19%

Source: Behavioral Risk Factor Surveillance System, CDC

Source: Behavioral Risk Factor Surveillance System, CDC

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. Adults BRFSS,Obesity Trends* Among U.S. Adults BRFSS, 20022002

Percentage of U.S. Children and Percentage of U.S. Children and Adolescents Who Were Overweight*Adolescents Who Were Overweight*

02468

1012141618

1963-70* *

1971-74 1976-80 1988-94 1999-2000

Ages 12-19

Ages 6-1154

* >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts**Data are from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of ageSource: National Center for Health Statistics

02468

1012141618

1963-70* *

1971-74 1976-80 1988-94 1999-2000

Ages 12-19

Ages 6-1154

16

15

* >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts**Data are from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of ageSource: National Center for Health Statistics

Percentage of U.S. Children and Percentage of U.S. Children and Adolescents Who Were Overweight*Adolescents Who Were Overweight*

The Local PictureThe Local Picture

Adolescent Data SourceAdolescent Data Source

Adolescent data comes from the Center for Adolescent data comes from the Center for Adolescent Health (CAH)Adolescent Health (CAH)

The survey instrument used was the Youth Risk The survey instrument used was the Youth Risk Behavior Survey (YRBS) developed by the CDCBehavior Survey (YRBS) developed by the CDC

Data was collected in 2002 from the inner-ring high Data was collected in 2002 from the inner-ring high schoolsschools

Data from the CMSD is being collected this month Data from the CMSD is being collected this month Outer-ring data was collected but it is not Outer-ring data was collected but it is not

representativerepresentative Comparison data: 1999 State-wide YRBS data & Comparison data: 1999 State-wide YRBS data &

2001 National YRBS data2001 National YRBS data

Adolescent SampleAdolescent Sample

Eleven of the fifteen inner-ring high schools Eleven of the fifteen inner-ring high schools participated participated (73.3% school response rate)(73.3% school response rate)

3428 students participated3428 students participated (78.6% response rate)(78.6% response rate)

Data were weighted to be representative of Data were weighted to be representative of adolescents in the inner-ring schoolsadolescents in the inner-ring schools

Sample CharacteristicsSample Characteristics

Format of SlidesFormat of Slides

Body Mass Index Body Mass Index in the 85th Percentilein the 85th Percentile

Body Mass Index Body Mass Index in the 95th Percentilein the 95th Percentile

No Physical Activity in Past WeekNo Physical Activity in Past Week

Attend Physical Education Class in Attend Physical Education Class in an Average Weekan Average Week

Two Hours or Less of TV Viewing Two Hours or Less of TV Viewing on School Dayson School Days

Ate Three or More Servings of Ate Three or More Servings of Vegetables Per DayVegetables Per Day

Ate Two or More Servings of Fruit Ate Two or More Servings of Fruit Per DayPer Day

Adult DataAdult Data

Adult Data SourceAdult Data Source

Adult data comes from the Center for Health Adult data comes from the Center for Health Promotion Research (CHPR) and the Promotion Research (CHPR) and the Cuyahoga County Board of HealthCuyahoga County Board of Health

The survey instrument used was the The survey instrument used was the Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System (BRFSS) developed by the CDC(BRFSS) developed by the CDC

Data was collected in 2003 from Cleveland Data was collected in 2003 from Cleveland and Cuyahoga Countyand Cuyahoga County

Comparison data: 2002 BRFSSComparison data: 2002 BRFSS

Adult SampleAdult Sample

1,144 people participated 1,144 people participated 43.4% response rate (CASRO)43.4% response rate (CASRO) Weighted to be representative of Cuyahoga Weighted to be representative of Cuyahoga

CountyCounty

Adult Sample CharacteristicsAdult Sample Characteristics

MalesFemales

WhiteAAOther

0

5

10

15

20

25

30

35

18-34 35-49 50-64 65+

18-3435-4950-6465+

Obese (BMI of 30 or more)Obese (BMI of 30 or more)

22.1 23 22.1 20.7 23.4

37

16.720.7 20.9

27.4 22.3

0102030405060708090

100

Cuyahoga County Ohio National male female AA white 18-34 35-49 50-64 65+

Overweight (BMI>=25 and <30)Overweight (BMI>=25 and <30)

34.8 35.8 3740.9

29.335.9

30.5 27.5

40.3 37.4 36

0102030405060708090

100


Overweight or ObeseOverweight or Obese

56.9 58.8 59.2 61.652.7

67.6

52.5 48.1

61.1 64.958.2

0102030405060708090

100


SolonParma

Strongsvil le Brecksville

Euclid

Westlake

North Royalton

BereaOlmsted T.

Broadview Hts.

Gates Mills

North Olmsted

BedfordBrook Park

Independence

Garfield Hts.

Pepper Pike

Walton Hills

Cleveland Hts.

Lakewood

Shaker Hts.

Middleburg Hts.

Moreland HillsOrange

Riverside

Brooklyn

Valley View

Hunting Valley

Maple Hts.

Mayfield

Beachwood

Old Brooklyn

Lyndhurst

Seven Hills

Bay Village

Rocky River

Highland Hts.

South Euclid

Parma Hts.

Oakwood

Bedford Hts.

Fairview Park

Mayfield Hts.

Tremont

Central

Hough

Lee-Miles

Jefferson

Olmsted Falls

Richmond Hts.

Glenville

Downtown

Glenwillow

Kamms Corners Warrensville Hts.

Bentleyville

CorlettSouth Broadway

Cuyahoga Hts.

East Cleveland

Kinsman

Fairfax

Puritas-Longmead

Cudell

North Collinwood

Chagrin Falls

University

Mt. Pleasant

Highland Hills

South Collinwood

Brooklyn Hts.

Forest Hills

Stockyards

University Hts.

Detroit Shoreway

Union-Miles Park

North Broadway

Euclid Green

Brooklyn Centre

Industrial ValleyEdgewater

St. Clair-Superior

Woodland Hills

Goodrich/Kirtland Park

North Randall

Chagrin Falls T.Woodmere

Linndale

No Leisure Time Physical ActivityNo Leisure Time Physical Activity

18.825.4 24.4

16.321

28.2

15.6 13.5 17.5 18.2

28.6

0102030405060708090

100


SolonParma


Euclid

Westlake

North Royalton

BereaOlmsted T.

Broadview Hts.

Gates Mills

North Olmsted

BedfordBrook Park

Independence

Garfield Hts.

Pepper Pike

Walton Hills

Cleveland Hts.

Lakewood

Shaker Hts.

Middleburg Hts.


Riverside

Brooklyn

Valley View

Hunting Valley

Maple Hts.

Mayfield

Beachwood

Old Brooklyn

Lyndhurst

Seven Hills

Bay Village

Rocky River

Highland Hts.

South Euclid

Parma Hts.

Oakwood

Bedford Hts.

Fairview Park

Mayfield Hts.

Tremont

Central

Hough

Lee-Miles

Jefferson

Olmsted Falls

Richmond Hts.

Glenville

Downtown

Glenwillow


Bentleyville


Cuyahoga Hts.

East Cleveland

Kinsman

Fairfax

Puritas-Longmead

Cudell

North Collinwood

Chagrin Falls

University

Mt. Pleasant

Highland Hills

South Collinwood

Brooklyn Hts.

Forest Hills

Stockyards

University Hts.

Detroit Shoreway

Union-Miles Park

North Broadway

Euclid Green

Brooklyn Centre


St. Clair-Superior

Woodland Hills


North Randall


Linndale

2114.5

25.2 18.8 22.515.2 16.2

21.230.9

0102030405060708090

100


* *

This information was not reported by the state of Ohio

This information was not reported in the National report**

Ate Two or More Servings of Fruit Ate Two or More Servings of Fruit Per DayPer Day

SolonParma


Euclid

Westlake

North Royalton

BereaOlmsted T.

Broadview Hts.

Gates Mills

North Olmsted

BedfordBrook Park

Independence

Garfield Hts.

Pepper Pike

Walton Hills

Cleveland Hts.

Lakewood

Shaker Hts.

Middleburg Hts.


Riverside

Brooklyn

Valley View

Hunting Valley

Maple Hts.

Mayfield

Beachwood

Old Brooklyn

Lyndhurst

Seven Hills

Bay Village

Rocky River

Highland Hts.

South Euclid

Parma Hts.

Oakwood

Bedford Hts.

Fairview Park

Mayfield Hts.

Tremont

Central

Hough

Lee-Miles

Jefferson

Olmsted Falls

Richmond Hts.

Glenville

Downtown

Glenwillow


Bentleyville


Cuyahoga Hts.

East Cleveland

Kinsman

Fairfax

Puritas-Longmead

Cudell

North Collinwood

Chagrin Falls

University

Mt. Pleasant

Highland Hills

South Collinwood

Brooklyn Hts.

Forest Hills

Stockyards

University Hts.

Detroit Shoreway

Union-Miles Park

North Broadway

Euclid Green

Brooklyn Centre


St. Clair-Superior

Woodland Hills


North Randall


Linndale

Popular MediaPopular Media

Men’s Fitness Rankings for the Top Men’s Fitness Rankings for the Top Fattest Cities in 2004Fattest Cities in 2004

1.1. DetroitDetroit2.2. HoustonHouston3.3. DallasDallas4.4. San AntonioSan Antonio5.5. ChicagoChicago6.6. Fort WorthFort Worth7.7. PhiladelphiaPhiladelphia8.8. ArlingtonArlington9.9. ClevelandCleveland10.10. ColumbusColumbus11.11. AtlantaAtlanta12.12. MesaMesa13.13. Oklahoma CityOklahoma City

14.14. Kansas CityKansas City15.15. MiamiMiami16.16. Las VegasLas Vegas17.17. IndianapolisIndianapolis18.18. PhoenixPhoenix19.19. TulsaTulsa20.20. MemphisMemphis21.21. New YorkNew York22.22. New OrleansNew Orleans23.23. BaltimoreBaltimore24.24. El PasoEl Paso25.25. WashingtonWashington

Men’s Fitness Rankings for Men’s Fitness Rankings for ClevelandCleveland

20042004 9th 9th

20032003 6 6thth

20022002 13 13thth

20012001 9th 9th

Men’s Fitness Ranking CriteriaMen’s Fitness Ranking Criteria

50 largest U.S. cities selected50 largest U.S. cities selected Assessed in 14 equally weighted categories: Assessed in 14 equally weighted categories:

gyms/sporting goods, nutrition, exercise, junk food, alcohol, gyms/sporting goods, nutrition, exercise, junk food, alcohol, TV, air quality, climate, overweight/sedentary, geography, TV, air quality, climate, overweight/sedentary, geography, commute, parks, recreational facilities, and health carecommute, parks, recreational facilities, and health care

Cities were ranked first to last and assigned Cities were ranked first to last and assigned numerical grades on a relative curve numerical grades on a relative curve

The scores were translated into letter grades The scores were translated into letter grades

Cleveland’s Failing gradesCleveland’s Failing grades

We received a We received a ‘F’ ‘F’ on:on: Junk FoodJunk Food ClimateClimate Exercise/sports participationExercise/sports participation

We received a We received a ‘D’ ‘D’ on:on: Overweight/sedentaryOverweight/sedentary Air qualityAir quality GeographyGeography Parks and open spacesParks and open spaces

Factors Associated Factors Associated with Obesitywith Obesity

Adolescent DataAdolescent Data

665 students enrolled in the 7th grade 665 students enrolled in the 7th grade (ages 11-15)(ages 11-15)

Data from the CHPRData from the CHPR Three middle schools in ClevelandThree middle schools in Cleveland Race/ethnicity composition of the sample:Race/ethnicity composition of the sample:

WhiteWhite 25.6%25.6% African AmericanAfrican American 23.0%23.0% HispanicHispanic 49.5%49.5% OtherOther 2.0% 2.0%

KnowledgeKnowledge

Restaurants typically serve two to three times Restaurants typically serve two to three times the normal portion sizethe normal portion size 32%32% said this was said this was TRUETRUE 15.6%15.6% said this was said this was FALSEFALSE 52.4%52.4% said they were said they were NOTNOT SURESURE

MarketingMarketing

Eating 5-a-day means 1 meat, 1 milk, 1 grain, Eating 5-a-day means 1 meat, 1 milk, 1 grain, 1 fruit, and 1 vegetable1 fruit, and 1 vegetable 37.8%37.8% said this was said this was FALSEFALSE 33.5%33.5% said this was said this was TRUETRUE 28.7%28.7% said they were said they were NOT SURENOT SURE

Social SupportSocial Support

57.8%57.8% of adolescents reported that, in the past 3 of adolescents reported that, in the past 3 months, their months, their friendsfriends RARELY or NEVER RARELY or NEVER encouraged them to shut off the TV or computer in encouraged them to shut off the TV or computer in order to do something physically activeorder to do something physically active

30.9%30.9% of adolescents reported that, in the past 3 of adolescents reported that, in the past 3 months, their months, their parentsparents RARELY or NEVER RARELY or NEVER encouraged them to shut off the TV or computer in encouraged them to shut off the TV or computer in order to do something physically activeorder to do something physically active

Social SupportSocial Support

51.1%51.1% of adolescents reported that, in the past of adolescents reported that, in the past 3 months, their 3 months, their friendsfriends RARELY or NEVER RARELY or NEVER exercised with them or offered to exercise with exercised with them or offered to exercise with themthem

47.3%47.3% of adolescents reported that, in the past of adolescents reported that, in the past 3 months, their 3 months, their parentsparents RARELY or NEVER RARELY or NEVER exercised with them or offered to exercise with exercised with them or offered to exercise with themthem

Social NormsSocial Norms

Over half of the adolescents (56.9%) believed Over half of the adolescents (56.9%) believed that the majority of students (i.e., 61% - 100%) that the majority of students (i.e., 61% - 100%) in their grade ate out at a fast food restaurant in their grade ate out at a fast food restaurant more than 2x a weekmore than 2x a week

In reality, 15% of adolescents ate out at a fast In reality, 15% of adolescents ate out at a fast food restaurant more than 2x a weekfood restaurant more than 2x a week

EnvironmentEnvironment

Only Only 26.1%26.1% of adolescents reported that it was of adolescents reported that it was very safevery safe for them to play outdoors in their for them to play outdoors in their neighborhood with their friends without an neighborhood with their friends without an adult aroundadult around

46.7%46.7% felt it was felt it was somewhat safesomewhat safe 16.9%16.9% felt it was felt it was not very safenot very safe 10.2%10.2% felt it was felt it was not at all safenot at all safe

SummarySummary

Current levels of overweight and obesity are a Current levels of overweight and obesity are a national crisis national crisis

Cuyahoga County is experiencing this crisis in Cuyahoga County is experiencing this crisis in both adult and adolescent populationsboth adult and adolescent populations

Most measures of overweight and obesity, Most measures of overweight and obesity, including physical activity are comparable to including physical activity are comparable to national and state estimatesnational and state estimates

Important sub-group differences existed across Important sub-group differences existed across these measures within the Countythese measures within the County

SummarySummary

There are geographical differences in the adult There are geographical differences in the adult outcomes, which we might expect to see in outcomes, which we might expect to see in adolescents as well if the data were availableadolescents as well if the data were available

Attendance in physical education programs Attendance in physical education programs was low in Cuyahoga County and in the State was low in Cuyahoga County and in the State compared to National levelscompared to National levels

Some evidence that the built environment in Some evidence that the built environment in Cuyahoga County is conducive to being Cuyahoga County is conducive to being overweight or obeseoverweight or obese

ConclusionConclusion

As we develop our community plan to combat this As we develop our community plan to combat this epidemic, we must address the social norms in our epidemic, we must address the social norms in our communitycommunity

Furthermore, we must consider the context in which Furthermore, we must consider the context in which this epidemic is occurring:this epidemic is occurring: The built environment (food availability, places to recreate, The built environment (food availability, places to recreate,

safety)safety) The neighborhood and school environment including peers The neighborhood and school environment including peers

(marketing, social norms and knowledge)(marketing, social norms and knowledge) The family environment (social support)The family environment (social support)

Lastly, we must capitalize on the progress we have Lastly, we must capitalize on the progress we have made to datemade to date

Thank you!Thank you!

For electronic copies of the slides go to:For electronic copies of the slides go to:

http://epbiwww.cwru.edu/faculty/colabianchi.htmlhttp://epbiwww.cwru.edu/faculty/colabianchi.html

state of the problem: cleveland community

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