State of the Problem: Cleveland Community

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State of the ProblemCleveland Community

• Natalie Colabianchi, Ph.D.
• Department of Epidemiology and Biostatistics
• Case Western Reserve University

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Obesity Trends Among U.S. Adults BRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4 woman)
Source Behavioral Risk Factor Surveillance
System, CDC
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Obesity Trends Among U.S. Adults BRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data lt10 1014
1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
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Percentage of U.S. Children and Adolescents Who
Were Overweight
Ages 12-19
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Ages 6-11
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gt95th 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
age Source National Center for Health
Statistics
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Percentage of U.S. Children and Adolescents Who
Were Overweight
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Ages 12-19
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Ages 6-11
4
gt95th 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
age Source National Center for Health
Statistics
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The Local Picture
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Adolescent Data Source

• Adolescent data comes from the Center for
  Adolescent Health (CAH)
• The survey instrument used was the Youth Risk
  Behavior Survey (YRBS) developed by the CDC
• Data was collected in 2002 from the inner-ring
  high schools
• Data from the CMSD is being collected this month
• Outer-ring data was collected but it is not
  representative
• Comparison data 1999 State-wide YRBS data 2001
  National YRBS data

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Adolescent Sample

• Eleven of the fifteen inner-ring high schools
  participated
• (73.3 school response rate)
• 3428 students participated
• (78.6 response rate)
• Data were weighted to be representative of
  adolescents in the inner-ring schools

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Sample Characteristics
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Format of Slides
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Body Mass Index in the 85th Percentile
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Body Mass Index in the 95th Percentile
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No Physical Activity in Past Week
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Attend Physical Education Class in an Average Week
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Two Hours or Less of TV Viewing on School Days
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Ate Three or More Servings of Vegetables Per Day
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Ate Two or More Servings of Fruit Per Day
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Adult Data
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Adult Data Source

• Adult data comes from the Center for Health
  Promotion Research (CHPR) and the Cuyahoga County
  Board of Health
• The survey instrument used was the Behavioral
  Risk Factor Surveillance System (BRFSS) developed
  by the CDC
• Data was collected in 2003 from Cleveland and
  Cuyahoga County
• Comparison data 2002 BRFSS

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Adult Sample

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

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Adult Sample Characteristics
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Obese (BMI of 30 or more)
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Overweight (BMIgt25 and lt30)
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Overweight or Obese
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No Leisure Time Physical Activity
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Ate Two or More Servings of Fruit Per Day

This information was not reported by the state of
Ohio This information was not reported in the
National report

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Popular Media
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Mens Fitness Rankings for the Top Fattest Cities
in 2004

• Detroit
• Houston
• Dallas
• San Antonio
• Chicago
• Fort Worth
• Philadelphia
• Arlington
• Cleveland
• Columbus
• Atlanta
• Mesa
• Oklahoma City

• Kansas City
• Miami
• Las Vegas
• Indianapolis
• Phoenix
• Tulsa
• Memphis
• New York
• New Orleans
• Baltimore
• El Paso
• Washington

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Mens Fitness Rankings for Cleveland

• 2004 9th
• 2003 6th
• 2002 13th
• 2001 9th

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Mens Fitness Ranking Criteria

• 50 largest U.S. cities selected
• Assessed in 14 equally weighted categories
  gyms/sporting goods, nutrition, exercise, junk
  food, alcohol, TV, air quality, climate,
  overweight/sedentary, geography, commute, parks,
  recreational facilities, and health care
• Cities were ranked first to last and assigned
  numerical grades on a relative curve
• The scores were translated into letter grades

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Clevelands Failing grades

• We received a F on
• Junk Food
• Climate
• Exercise/sports participation
• We received a D on
• Overweight/sedentary
• Air quality
• Geography
• Parks and open spaces

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Factors Associated with Obesity
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Adolescent Data

• 665 students enrolled in the 7th grade
• (ages 11-15)
• Data from the CHPR
• Three middle schools in Cleveland
• Race/ethnicity composition of the sample
• White 25.6
• African American 23.0
• Hispanic 49.5
• Other 2.0

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Knowledge

• Restaurants typically serve two to three times
  the normal portion size
• 32 said this was TRUE
• 15.6 said this was FALSE
• 52.4 said they were NOT SURE

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Marketing

• Eating 5-a-day means 1 meat, 1 milk, 1 grain, 1
  fruit, and 1 vegetable
• 37.8 said this was FALSE
• 33.5 said this was TRUE
• 28.7 said they were NOT SURE

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Social Support

• 57.8 of adolescents reported that, in the past 3
  months, their friends RARELY or NEVER encouraged
  them to shut off the TV or computer in order to
  do something physically active
• 30.9 of adolescents reported that, in the past 3
  months, their parents RARELY or NEVER encouraged
  them to shut off the TV or computer in order to
  do something physically active

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Social Support

• 51.1 of adolescents reported that, in the past 3
  months, their friends RARELY or NEVER exercised
  with them or offered to exercise with them
• 47.3 of adolescents reported that, in the past 3
  months, their parents RARELY or NEVER exercised
  with them or offered to exercise with them

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Social Norms

• Over half of the adolescents (56.9) believed
  that the majority of students (i.e., 61 - 100)
  in their grade ate out at a fast food restaurant
  more than 2x a week
• In reality, 15 of adolescents ate out at a fast
  food restaurant more than 2x a week

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Environment

• Only 26.1 of adolescents reported that it was
  very safe for them to play outdoors in their
  neighborhood with their friends without an adult
  around
• 46.7 felt it was somewhat safe
• 16.9 felt it was not very safe
• 10.2 felt it was not at all safe

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Summary

• Current levels of overweight and obesity are a
  national crisis
• Cuyahoga County is experiencing this crisis in
  both adult and adolescent populations
• Most measures of overweight and obesity,
  including physical activity are comparable to
  national and state estimates
• Important sub-group differences existed across
  these measures within the County

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Summary

• There are geographical differences in the adult
  outcomes, which we might expect to see in
  adolescents as well if the data were available
• Attendance in physical education programs was low
  in Cuyahoga County and in the State compared to
  National levels
• Some evidence that the built environment in
  Cuyahoga County is conducive to being overweight
  or obese

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Conclusion

• As we develop our community plan to combat this
  epidemic, we must address the social norms in our
  community
• Furthermore, we must consider the context in
  which this epidemic is occurring
• The built environment (food availability, places
  to recreate, safety)
• The neighborhood and school environment including
  peers (marketing, social norms and knowledge)
• The family environment (social support)
• Lastly, we must capitalize on the progress we
  have made to date

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Thank you!

• For electronic copies of the slides go to
• http//epbiwww.cwru.edu/faculty/colabianchi.html