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

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)

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.

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

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

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)

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

Award Winning Media

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.

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

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

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.

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

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

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

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.

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.

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.

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

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.

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.

Explain the development and use of NHPS’ Healthy Eating and Physical Activity (HEPA) Index.

Presentation Objective #3

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

HEPA Index Factors

HEPA Index Range

INDEX SCORE REFERENCE

HEPA

8 Most healthy

7

6

5

4

3

2

1

0 Least healthy

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.

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.

http://www.growuphealthy.org

For more info, please contact:

Gregory D. Benjamin, M.P.H.

Evaluation Scientist

(p) 302-444-9163 (e) gbenjami@nemours.org