Progress in Preventing Childhood Obesity How Do We Measure Up? (2007) / Chapter Skim
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3 Diverse Populations
3 Diverse Populations
Pages 74-108
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From page 74... ...
, epidemiologic evidence shows that African-American, Hispanic/ Latino, American Indian/Alaska Native, and Pacific Islander populations and children experiencing poverty are more likely to live in environments with inadequate support for health-promoting behaviors. Assessing the impact of these different environments presents an enormous challenge for tracking progress against obesity in diverse populations.
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From page 75... ...
emphasized the need for prominent government leadership and community collaboration to develop and promote programs and policies that will collectively encourage healthful eating patterns and physical activity behaviors, particularly for young populations at the highest risk for obesity and related chronic diseases. Helping at-risk children and youth balance their energy intakes and their energy expenditures requires an understanding of the complex and interacting influences of the social, economic, and built environments and the adverse environmental conditions that low-income and racially/ethnically diverse populations encounter as they regularly attempt to obtain affordable foods, beverages, and meals that contribute to a healthful diet and find opportunities to engage in recreational play and physical activity (Day, 2006; Glanz et al., 2005; Goodman, 2003; Gordon-Larsen et al., 2006; IOM, 2005; Jetter and Cassady, 2005; Powell et al., 2004)
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From page 76... ...
. By tracking obesity prevalence rates in subpopulations and evaluating the progress achieved by obesity prevention interventions, it may be pos
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. Although no geographic predominance was apparent, the number of states reporting obesity prevalence rates of more than 10 percent increased from 11 in 1989 to 28 in 2000.
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From page 78... ...
However, the obesity prevalence rate among a sample of low-income preschool children in Hawaii was 8.7 percent in 1997, whereas the national mean that year was 10.3 percent. However, the rate caught up to the national mean in 2002, with prevalence rates of 13.1 percent in Hawaii and 13.5 percent nationally (Baruffi et al., 2004)
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. American Indians/Alaska Natives have the highest rates of type 2 diabetes of any racial/ethnic group in the United States (National Diabetes Information Clearinghouse, 2005)
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reported that they were American Indians/Alaska Natives (2.4 million or 1 percent reported only American Indian/Alaska Native as their race) , of which 35.9 percent live in American Indian areas (which include reservations)
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. The implications of social determinants of health for assessing and evaluating progress in obesity prevention are discussed at the end of this chapter and in Chapter 6.
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. Racial/ethnic minority children and youth face a number of barriers to receiving timely, appropriate, and high-quality health care services (NCHS, 2005; NRC, 2006a)
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. Mexican-American children and youth living along the U.S.-Mexico border ex perience higher levels of economic disadvantages and special challenges in ac cessing foods that contribute to a healthful diet, regular physical activity, and health care services (Abarca and Ramachandran, 2005; Ruiz-Beltran and Kamau, 2001)
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From page 84... ...
. Although the obesity prevalence did not differ by SES or family poverty status for teens through age 14 years, a widening disparity was observed for 15- to 17-year-olds, especially boys, girls, non-Hispanic whites, and non-Hispanic African Americans.
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From page 85... ...
. Because of the complexity of identifying, measuring, and monitoring health status and health determinants, it is challenging to reach a consensus about the dimensions of health disparities.
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. Adverse childhood experiences are an example of a set of life contexts which are experienced early in life, yet have profound effects on health and obesity risks into adulthood, independent of SES, race, and ethnicity.
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As important as the issue of obesity prevention may be, many of these communities are facing problems that have immediate consequences (e.g., unemployment, poor schools, and violence) leaving fewer resources available for obesity prevention.
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An ecologic and culturally competent5 paradigm is urgently needed to address the spectrum of barriers that racial/ethnic groups and low-income children and youth face to identify the most promising practices that will reduce the prevalence of obesity and promote healthy lifestyles. Issues Related to Progress Despite the multiple challenges that diverse communities experience, resources and assets exist that should be used to design, implement, and evaluate childhood obesity prevention interventions.
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This research approach allows stakeholders to identify the key problems to be studied, formulate research questions in culturally sensitive ways, and use study results to support relevant program and policy development or social change. Every obesity prevention initiative does not require using participatory research methods.
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Policy makers can reinforce current programs to foster food security and equity by adding a specific childhood obesity prevention component to the Head Start Program and the USDA-administered federal nutrition programs including the Food Stamp Program (FSP) , the WIC program, and the school nutrition programs (Kumanyika and Grier, 2006)
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From page 91... ...
® by the International Life Sciences Institute (ILSI) Center for Health Promotion have demonstrated the feasibility and utility of this approach for regu larly engaging students and teachers in physical activity at a moderate to vigorous intensity range for 10 minutes and found that it can count toward the minimum 30 minutes of moderate to vigorous physical activity per day in schools recommend ed by the Centers for Disease Control and Prevention.
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® conducted by researchers at the Univer sity of Kansas demonstrated that by the beginning of the third year of implementa tion, more than 70 percent of elementary school non-PE teachers had been con ducting 10-minute physical activity breaks in 14 low-income intervention schools across 3 cities in which an estimated 75 percent of students qualified for free or reduced-cost lunches (ILSI Center for Health Promotion, 2005)
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From page 93... ...
. The Latino Childhood Obesity Prevention Initiative, administered through the nonprofit organization Latino Health Access, is a multiyear demonstration project that involves parents, students, teachers, principals, and other stakeholders in making changes relevant to increasing physical activity and improving nutrition in four schools in Orange County, California.
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From page 94... ...
provide school-based physical activity programs. In addition, a number of programs used SDPI funds to provide fitness classes for children and youth, build or improve playgrounds, initiate walking clubs, and provide aerobics classes (IHS National Diabetes Program, 2004)
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One of its main components is an obesity and diabetes risk-reduction project located at the Cherokee Elementary School. The initiative uses American Indian mentors, who provide healthful eating and physical activity interventions.
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Applying a paradigm that acknowledges the differences in how people from various backgrounds experience life and view the world will assist and enrich the evaluation of obesity prevention initiatives across and within SES groups and ethnically and culturally diverse populations (Brach and Fraserirector, 2000; Hopson, 2003)
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From page 97... ...
. Important considerations for the design, implementation, monitoring, and evaluation of culturally competent obesity prevention interventions in diverse populations include the following: • Build on cultural assets (e.g., the salience of dance as a common form of physical activity among African Americans and Hispanics/ Latinos)
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From page 98... ...
However, methodological limitations to the identification and documentation of health disparities must be addressed. The public health infrastructure has the capacity to monitor aggregate racial/ethnic groups (e.g., categories defined by the U.S.
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Yet, effective programs and services will depend on the ability to measure and evaluate these indicators and integrate an understanding of the indicators into interventions. The ability to measure an array of indicators, both qualitative and quantitative, for a variety of diverse populations and outcomes is central to the elimination of health disparities and the prevention of childhood obesity in high-risk communities.
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From page 100... ...
Recommendation 2: Policy makers, program planners, program imple menters, and other interested stakeholders -- within and across relevant sectors -- should evaluate all childhood obesity prevention efforts, strengthen the evaluation capacity, and develop quality interventions that take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts. Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations.
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From page 101... ...
2006. Active living and social justice: Planning for physical activity in low-income, black, and Latino communities.
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From page 102... ...
. Physical Activity Across the Curriculum/Take 10!
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From page 103... ...
2006. Inequality in the built environment underlies key health disparities in physical activity and obesity.
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From page 104... ...
2005. Preventing Childhood Obesity: Health in the Balance.
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2005. A pilot study of teachers' acceptance of a classroom based physical activity curriculum tool: Take 10!
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2004. The relationship between community physical activity settings and race, ethnicity and socioeconomic status.
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2006. The role of built environments in physical activity, eating, and obesity in childhood.
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2004. Leading by example: A local health department-community collaboration to incorporate physical activity into organizational practice.
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