Obesity Prevention & Control in Underserved Populations: - PowerPoint PPT Presentation

Obesity Prevention & Control in Underserved Populations: asset-based sociocultural environmental change Antronette K. Yancey, MD, MPH, FACPM Associate Professor, Health Services Dept. Co-Director, Center to Eliminate Health Disparities UCLA School of Public Health

Introduction Ain’ Like There’s Hunger Sweet tooth Salt tooth Chocolate tooth Jonesin’ for fries Mickey D’s And Popeye’s But no runnin’ tooth Swimmin’ tooth Stretchin’ tooth Dancin’ tooth Weight liftin’ tooth After all Ain’ like there’s hunger …

Summary Points � Current strategies are not containing the obesity and sedentariness epidemics � Need shift away from clinical view of obesity as personal disorder requiring medical R x � An ecological approach regards obesity as a normal response to an abnormal environment, rather than vice versa � Understanding, measuring, and altering the “obesogenic” environment is critical—society has key role in sharing, with individuals, the high “costs” of healthy lifestyle change/maint.

Adult Obesity : 1988-94 to 1999-2000 Race/Ethnicity 1988-94 Target Total White Female Male Black Female Male Mexican American Female Male 0 10 20 30 40 50 Percent Note: Data are for ages 20 years and over, age adjusted to the 2000 standard population. Obesity is defined as BMI >= 30.0. Black and white exclude persons of Hispanic origin. Persons Obj. 19-2 of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Staying healthy is easier for some than for others… UPPER SES LOWER SES Education College GED or HS Housing Own / Safe Rent / Safe? Physical activity Gyms / Parks, “move Parks?, “move insecure” secure” Neighborhood stores Fruit/ Veg, food secure Drugs/ Alcohol, food insecure Police Helpful Abusive Healthcare Private Doc ER, VA Sick leave Accrued None Leisure priority Exercise Rest Work conditions Safe, hi decis. lat., Hazardous, lo decis. lat., no + flex time no flex time Child care Nanny/ hi-qual facil. Family/ neighbor, lo-qual facil. Elder/ disabled care HHW/ hi-qual facil. Family/ neighbor, lo-qual facil. Criminal just. sys. Little contact Much contact Premature M&M Low High

Years of Potential Life Lost by Ethnicity (per 100,000) 14000 12000 10000 Afr Am 8000 Am I nd AsianPI 6000 Latino 4000 W hite 2000 0 Total

Lesser Effectiveness of Key Environmental I nterventions in Underserved Groups: Example Posting of Signs Promoting Stair Usage (suburban Baltimore mall) � Overall, stair use increased from 4.8% to 6.9%, 7.2%, depending upon which of 2 signs used � Among whites, increased from 5.1% to 7.5%, 7.8% � Among blacks, changed from 4.1% to 3.4%, 5.0% � Among n’l wt, inc from 5.4% to 7.2%, 6.9% � Among overwt, inc from 3.8% to 6.3%, 7.8% Andersen, Franckowiak, Snyder et al., Ann Int Med, 1998;129:363-369.

Excess physical environmental risk in underserved communities: � Pervasive targeted commercial marketing � Distance to private fitness facilities � Few worksite fitness opportunities � Few/poor neighborhood recreation facilities � Lesser neighborhood safety � Poorer public/less reliable private transportation Adapted from Kumanyika S. Obesity in Minority Populations. In Fairburn G & Brownell K, Eating Disorders and Obesity. A Comprehensive Handbook , 2002.

Which billboard(s) is (are) about physical activity?

Excess economic environmental risk in underserved communities: � Limited investment in public parks/recreation facilities � Fitness facility fees � Cost of exercise & sports equipment & fees � Less stable employment patterns � Fewer trained PE instructors � Large PE classes � Poorly equipped facilities � Poorly maintained sidewalks � Fewer traffic calming devices, e.g., speed bumps � Ample car “accommodation,” e.g., parking, high- speed/multi-lane roads = “Move insecurity” 1, 2 1 Jahns & Jones, AJPM 2004;26:186 2 Yancey, AJPM 2003;25(3Si)

Buford Highway in Atlanta: housing populated by low-income recent immigrants to the US Common Uncommon

Excess sociocultural environmental risk in underserved communities: � Cultural attitudes about work, activity, rest � Fears about safety � Prevalent obesity/norms � Female roles � Cultural reverence for cars � Hairstyle-related concerns about sweating � Increased screen time, e.g., TV viewing, movie-going

LA’s ESPN Radio 710 AM Ad “We’re the prime rib on a dial full of tofu” --March 2006

Cultural reverence for SUVs?

Physical Activity Levels, % L.A. County Adults, 1999 District Sedentary (< 10 min/wk) County 41 + 1 Compton 45 + 6 South 50 + 9 Inglewood 46 + 6 Long Beach 37 + 5 West 31 + 3

Physical I nactivity Levels: TV viewing/computer use, % L.A. County Adults, 1999 District TV/ Computer Use > 3 hrs/ d (95% CI) County 21.7 20.6-22.9 African Am. 36.5% 32.4-40.5 Am. Ind./Nat. Am. 34.2% 16.1-52.3 Asian/Pacific Isl. 21.1% 17.6-24.6 Latino 15.8% 14.3-17.3 White 24.3% 22.4-26.2

Physical Activity Levels: TV viewing> 2 hrs/d vs. regular PA, % California adolescents, 2001 Group TV Viewing Regular PA > 2 hrs/ d CDC/ ACSM def. African-American 67.5% 79.9% males African-American 62.4% 67.7% females White males 47.9% 81.4% White females 39.2% 71.2%

Prevalence of Obesity among LAC Adults by Ethnicity, 1997-2002 35 30 25 20 1997 1999 15 2002 10 5 0 Afr-Am API Latino W hite

Unfit Children by Assembly District and SPA 1 Service Planning Area Los Angeles County 2001 SPA 2 Percentage of Unfit Children 19.1 - 34.1 34.2 - 37.8 SPA 3 37.9 - 40.9 41.0 - 45.1 SPA 4 SPA 5 45.2 - 54.0 SPA 6 Data source: California Center for Public Health Advocacy, 2001 California Physical Fitness Test N SPA 7 Note: California Assembly Districts became effective in the November 2002 election, based on the 2000 Census. SPA 8 New SPA boundaries (September 2002) Prepared by Los Angeles County DHS, Public Health, 5 0 5 10 Miles Office of Health Assessment and Epidemiology, December 2002

Overweight Children by Assembly District and SPA 1 Service Planning Area Los Angeles County 2001 SPA 2 Percentage of Overweight Children 16.9 - 22.4 SPA 3 22.5 - 24.6 24.7 - 26.5 26.6 - 30.3 SPA 5 SPA 4 30.4 - 36.8 SPA 7 SPA 6 Data source: California Center for Public Health Advocacy, 2001 California Physical Fitness Test N Note: California Assembly Districts became effective in the November 2002 election, based on the 2000 Census. SPA 8 New SPA boundaries (September 2002) Prepared by Los Angeles County DHS, Public Health, 5 0 5 10 Miles Office of Health Assessment and Epidemiology, December 2002

Self-Perceived Overweight by Ethnicity & Gender, % LA County Adults Female Male AA Overwt 67 29 AA Nml wt 20 -- API Overwt 86 46 API Nml wt 28 10 Lat Overwt 80 41 Lat Nml wt 26 9 W Overwt 84 46 W Nml wt 21 4

Influence of Self-Perceived Weight Status on PA, % LA County Adults � Overall, regardless of BMI, those perceiving themselves as overweight more sedentary than those with average wt. self-perception (45% vs. 30%) � Influence most pronounced for males and normal weight individuals � Overwt. self-perception not assoc. with sedentariness among white women , the only one of the 6 ethnic- gender groups included in which BMI< 25 normative � In multivariate analysis, self-perceived overweight, not BMI, predicts sedentary behavior (OR= 1.40, CI 1.19, 1.64) Yancey, Simon et al., Obes Res, In press, 2006. Yancey, Wold et al., Am J Prev Med, 2004;27:146-52 .

SB19 Early Implementation Study: Baseline demographics Ethnicity of middle school th graders) Number Percent students (7 American Indian 2 0.1% Asian 203 12.7% Filipino 90 5.6% Hispanic/Latino 1,116 70.1% African American 89 5.6% Non-Hispanic white 85 5.3% Multiple responses, Other 8 0.5% Free or reduced lunch eligibility Not eligible –pays full fare 490 30.7% Eligible for reduced price lunch 204 12.8% Eligible for free lunch 830 51.9% Other 74 4.6%

Distribution of dieting classification, by BMI-for-age Not try Work to to Sex-specific BMI for Lose Gain stay the control age classification weight weight same weight Total Underweight 0% 76.67% 13.33% 10% 100% 0 23 4 3 30 Desirable weight 28.94% 14.52% 29.25% 27.28% 100% 279 140 282 263 964 At risk of overwt. 73.21% 2.81% 14.80% 9.18% 100% 287 11 58 36 392 Overweight 87.70% 1.57% 6.94% 3.80% 100% 392 7 31 17 447 Total 958 181 375 319 1833

Proportion of 7th graders reporting depressiveness in last year, by dieting status 45% 40% 35% 30% y = -0.0557x + 0.4641 25% 2 = 0.9383 R 20% 15% 10% 5% 0% lose weight gain weight stay the same not try to control weight OR =0.79, 95% CI: .72, .86, p < .0001, controlling for age, gender and subsidized lunch eligibility N = 1,767 7 th graders