Community Interventions to Promote Health and Prevent Chronic ...

Community Interventions to Promote Health and Prevent Chronic ...

STATE OF CHILDHOOD OBESITY IN MISSOURI Shumei Yun, MD, PhD Eduardo Simoes, MD, MSc, DLSHTM, MPH Outline of the Presentation Prevalence of obesity among adults, adolescents, and children in Missouri Factors associated with childhood obesity Health and economic impact of obesity Missouris strategies for obesity prevention Prevalence of Obesity among Adults Age 18 or Older BRFSS, CDC & DHSS Prevalence of Obesity among High School Students

YRBS, CDC & DHSS Prevalence of Obesity among High School Students, Missouri, 2003-2013 50 45 40 Prevalence (%) 35 30 25 20 15 12.1 14.3 13.8 15.4 14.9 11.9 10 5 0

2003 2005 2007 YRBS, YTS for 2011 data, DHSS 2009 2011 2013 Prevalence of Obesity/overweight among High School Students by Race/ethnicity, Missouri, 2013 50 45 Obesity Overweight 40 Prevalence (%) 35 30 16.2 25

18.3 14.9 14.5 15.5 15 Overall non-Hispanic White 20 15 10 18.8 15.2 5 0 YRBS, DHSS non-Hispanic Black

Hispanics Prevalence of Obesity Among Middle School Students, Missouri, 2003-2013 50 45 40 Prevalence (%) 35 30 25 20 15 16.5 13.4 13 11.4 10 11.3 8.6 5 0 2003

2005 2007 2009 YTS, DHSS 2011 2013 Prevalence of Obesity/overweight among Middle School Students by Race/ethnicity, Missouri, 2013 50 45 40 Obesity Overweight Prevalence (%) 35 30 25 20 15 8.6 7.9

8.7 9.3 Overall non-Hispanic White 11.4 10 5 10.2 7.4 6.8 non-Hispanic Black Hispanics 0 YTS, DHSS Prevalence of Obesity/overweight among Secondary School Students, by Grades, Missouri, 2013

40 35 Prevalence (%) 30 19.1 25 13.1 16.3 20 15 10 7.3 Obesity Overweight 10.3 8.2 5 10.5

16.8 10.7 10.1 7th 8th 16 17 11th 12th 12.6 4.9 0 6th 9th YRBS & YTS, DHSS 10th

Prevalence of Obesity among Children age 10-17 NSCH Prevalence of Obesity among WIC Children Age 2-4 WIC Obesity among WIC Children Age 2-4, Missouri, 2000-2013 30 Prevalence (%) 25 20 15.2 15 13.2 13.3 15.8 15.6

15.7 15.5 15.9 16.1 16 15.1 14 14.9 14.4 10 5 0 2000 2001 2002 2003

2004 2005 2006 2007 WIC, DHSS 2008 2009 2010 2011 2012 2013 Obesity among WIC Children Age 2-5 by Race/ethnicity, Missouri, 2000-2013 50 45 Prevalence (%)

40 35 30 NH-White NH-Black Hispanic HP 2020 25 20 15 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 WIC, DHSS Prevalence of Obesity among WIC Children Age 2-4, MO, 2012 Social Determinants of Health Education Poverty Environment and policy

Obesity among Children age 2-18 by Head of Households Education, US, 1999-2010 25 21 Prevalence (%) 20 19 15 11 10 9 5 0 Girls Boys CDC, http://www.cdc.gov/obesity/data/childhood.html

Obesity among Children age 2-18 by Head of Households Education, US 25 23 Prevalence (%) 20 17 15

Poverty Level, Missouri, 2007 100 90 80 Prevalence (%) 70 60 50 46.6 40 30 21.5 20 10 0 <100 FPL >400 FPL NSCH Poverty Rate in Missouri, 2008-2013 30.0% 25.0%

20.0% 15.0% 13.4% 14.6% 15.3% 15.8% 16.2% 15.8% 10.0% 5.0% 0.0% 2008 2009 2010 -5.0% US Census Bureaus

2011 2012 2013 Percent of Population in Poverty by County, Missouri, 2013 Soda Sales Tax in Retail Stores, 2014 Missouri 1.23% National Max 7% Average 3.55% Availability and access to grocery stores, farmers markets, Recreation & Fitness Facilities Fast-food restaurants, Maternal and Early Childhood Factors Maternal obesity and diabetes Excessive weight gain during pregnancy Breastfeeding

Maternal Pre-pregnancy Obesity, Missouri, 1990-2013 50 45 40 Prevalence (%) 35 30 25 20 15 10 10.7 12 13.1 13.8 14.6 15.4 16.5 17.4 18.1 19.1 20

20.7 21.3 21.3 23.3 23.9 23.8 24 22.2 22.4 22.6 22.9 24.6 24.9 5 0 1990 1995 2000 Birth records, MICA, DHSS 2005 2010 2015 Pre-pregnancy and Gestational Diabetes among Pregnant Women, Missouri, 20092012 30 Prepregnancy

25 Prevalence (%) Gestational 20 15 10 8.8 7.7 6.9 7.5 7.1 7.6 2.8 2.7 2.2 2.6

5 2.1 0 2007 2.7 2008 2009 2010 2011 PRAMS, DHSS Questions in 2007 & 2008 are slightly different from the other years 2012 Excessive Weight Gain during Pregnancy & Macrosomia In 2012, 54% pregnant women gained more weight than that recommended by IOM 58.2% among

obese women 1.2% babies born in 2013 had a birthweight >=4,500 g Breastfeeding Initiation 100.0 90.0 81.7 80.0 Prevalence (%) 70.0 71.6 73.1 75.4 80.3 76.1 60.0 50.0 40.0 30.0

20.0 10.0 0.0 2007 2008 2009 PRAMS, DHSS 2010 2011 2012 Breastfeeding at Six Months 100 US 90 Missouri 80 HP 2020 Prevalence (%) 70

60.6 60 50 40 34.2 30 20 36.9 31.8 37.6 39.1 32.3 32.2 42.1 42.9 43.5 43.8 38.2

34.7 32.9 33 44.4 47.2 43.1 49 39.3 49.4 42.1 35.1 21.7 10 0 2002 2003 2004 2005

2006 2007 2008 2009 National Immunization Survey, CDC 2010 2011 2012 2013 Behaviors Related to Obesity Risk Behaviors Diet Fruit and vegetable consumption Sugar-added drinks or non-diet soda consumption

Milk consumption Physical activity Meet physical activity recommendations Physical inactivity Screen time Sugar-added Drinks or Non-diet Soda Consumption 1+ Times per Day*, Missouri 20072013 100 90 80 70 Prevalence (%) 60 MS HS 50 40 30 33.4 30.8

26.9 22.8 20 10 0 2007 2009 * In the past 7 days, YRBS, DHSS 2011 2013 Physically Active for 60+ Minutes per Day on 5+ Days of the Past 7 Days, Missouri 20052013 100 90 MS 80 HS 70 Prevalence (%) 60

51.6 48.3 50 40 30 52.3 48.4 43.5 36 30.3 20 53.4 45.4 33.8 * * 10 0 2005 2007

2009 2011 Moderate physical activity for 30+ minutes on 5 or more days of past 7 days YRBS, DHSS 2013 Daily Physical Education among Middle and High School Students, Missouri, 2003-2013 100 90 M S H S Prevalence (%) 80 70 60 50 41 40

30 33.2 25.5 31.1 27.4 33.4 33.1 32.3 29.9 30.9 26.2 24.1 20 10 0 2003 2005 2007 YRBS, DHSS

2009 2011 2013 TV Viewing 3+hours per Day on an Average School Day, Missouri, 2003-2013 100 90 80 MS Prevalence (%) 70 HS 60 50 40 30 43.7 32.4 40.4 33.9

36.9 29.6 33.2 32.4 32.3 29.9 30.9 25.6 20 10 0 2003 2005 2007 YRBS, DHSS 2009 2011 2013 Playing Video or Computer Games or Using Computers for Other

than School Work 3+ Hours per Day in an Average School Day 50 45 Prevalence (%) 40 35 32.7 30 29.8 25.9 25 20 21.5 22.9 27.1 24.8 MS HS 15 10 5

0 2007 2009 2011 YRBS, DHSS 2013 Data Gap Preschool children Elementary school children No data Middle and high school age children

Only WIC data available Data are self-reported Only at state level Adults Self-reported data Health Consequences of Childhood Obesity Immediate health effects High blood pressure Dyslipidemia Pre-diabetes and diabetes Bone and joint problems Sleep apnea & asthma Fatty liver disease & gallstones

Social and psychological problems CDC, http://www.cdc.gov/obesity/childhood/basics.html Health Consequences of Childhood Obesity Long-term Health Effects Increase the risk and severity of obesity as adults Heart disease, type 2 diabetes, stroke, and osteoarthritis Many types of cancer breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, prostate, multiple myeloma, and Hodgkins lymphoma CDC, http://www.cdc.gov/obesity/childhood/basics.html Obesity-related Chronic Disease in Missouri

The prevalence of diabetes, hypertension, and high cholesterol among adult Missourians is higher than national average The prevalence of these chronic conditions has been increasing overtime Age-adjusted osteoarthritis hospitalization rate more than doubled from 1994 to 2012 Obesity is the second leading cause of preventable premature death, only second to tobacco use Economic Impact of Obesity, Missouri Thorpe, 2008, $1.9 billion, 4.8% 2013, $3.4 billion -- projection 2018, $ 8.2 billion -- projection Trogdon, et al, 2009, 3.2 $billion, 7.7% Progress

Prevalence of obesity among WIC and middle school children started to decrease Prevalence of breastfeeding initiation and at six months increased. More middle school students participating in daily physical education More students meeting physical activity recommendations Fewer students drinking sugar sweetened beverages one or more times per day Challenges Lack of data and local level data High poverty Obesogenic fetal environment Obesogenic physical environment CDC Framework for Preventing Obesity (adapted from IOM 2005)

Social Norms and Values Home and Family Food and Beverage Industry School Agriculture Sectors of Influence Community Work Site Education Media Healthcare Government Behavioral Settings Public Health Systems

Healthcare Industry Genetics Psychosocial Individual Factors Other Personal Factors Food and Beverage Intake Business and Workers Physical Activity Energy Intake Energy Expenditure Energy Balance Draft last revised, March 24, 2005 Prevention of Overweight and Obesity

Among Children, Adolescents, and Adults Land Use and Transportation Leisure and Recreation Missouris Strategies Adoption of food service guidelines Increase access to healthier foods through small retail venues Promote supportive nutrition environments and comprehensive school physical activity programs Increase physical activity in early care settings Enhance access to PA and outreach within communitiesMO Livable Streets Workplace breastfeeding support

Key Partners University of Missouri Extension Missouri Council for Activity and Nutrition Local Public Health Agencies & Center for Local Public Health Department of Elementary and Secondary Education Missouri Convergence Partnership State Alliance of YMCAs MO Association of Health, Physical Education, Recreation and Dance And more! Acknowledgements

Noaman Kayani Arthur Pashi Jiaqing Li Dave McBride Supriya Nelluri Mary Jo Mosley Venkata Garikapaty Pat Simmons Janet Wilson Sherri Homan Becca Mickels David Kelly

Recently Viewed Presentations

  • Algerian War of Independence

    Algerian War of Independence

    BELLWORK: 10/29. Our first case study of 20th century warfare is guerrilla war & the Algerian War of Independence. As an introduction to guerrilla war tactics/strategies, read pgs. 18-19 and answer the following:
  • Part IV: Execution - Professor Mark J. Grossman | Suffolk ...

    Part IV: Execution - Professor Mark J. Grossman | Suffolk ...

    To discuss the reasons that the public relations professional must be the best writer in the organization. To explore the fundamentals of writing, from draftingto style to ensuring worthwhile content.
  • SPA - Ruđer Bošković Institute

    SPA - Ruđer Bošković Institute

    Ako se korijen stavi u element polja s indeksom 1 i elementi se slažu po razinama, tada će čvor hrpe na poziciji i imati lijevo dijete na 2i poziciji, a desno na 2i+1 Algoritam punjenja hrpe: ulazni podaci su hrpa...
  • Government Systems in Latin America

    Government Systems in Latin America

    BellRinger: 1) Spend the first 3 minutes reviewing your political maps. * Location, Climate, and Natural Resources of Italy and Germany Unit 2 Notes Italy's Location Long, boot-shaped peninsula surrounded on 3 sides by the Mediterranean Sea Alps form the...
  • Spring 2013 Writing SOL Training - Staunton City Schools

    Spring 2013 Writing SOL Training - Staunton City Schools

    Spring 2015Non-Writing SOL Training. ... students with disabilities and LEP students may receive the read-aloud or audio accommodation on the EOC Reading test even though the students have not been determined as eligible by the school division according to the...
  • Chapter 28 Human Geography of East Asia Shared Cultural ...

    Chapter 28 Human Geography of East Asia Shared Cultural ...

    Arial MS Pゴシック Trebuchet MS Georgia Wingdings 2 Calibri Urban 1_Urban 2_Urban 3_Urban Chapter 28 Human Geography of East Asia Shared Cultural Traditions Chapter 28 Section 1 China China's Early History China Opens Up the World Rural & Industrial Economies...
  • Source: The Yacht Report (November 2010)  Issue 118,

    Source: The Yacht Report (November 2010) Issue 118,

    Source: The Yacht Report (November 2010) - Issue 118, pp 68. Introduction to the Commercial Yacht Code 2010 By Ing. Karl Briffa Presentation Outline Introduction Revision Changes Commercial Yacht Code 2010 Surveys and Certifications Conclusion World's Yacht Fleet by Flag...
  • Global Desk - Hinds County School District

    Global Desk - Hinds County School District

    Foundation brakes are . ... 1998 are required to have a lamp on the left side. 5-4. On newer vehicles, the malfunction lamp comes on at start-up for a bulb check, and then goes out quickly. ... it may be...