Transcript Document

State of the Problem:
Cleveland Community
Natalie Colabianchi, Ph.D.
Department of Epidemiology and
Biostatistics
Case Western Reserve University
Obesity Trends* Among U.S. Adults BRFSS,
1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS,
2002
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
Source: Behavioral Risk Factor Surveillance System, CDC
≥25%
Percentage of U.S. Children and
Adolescents Who Were Overweight*
18
16
14
12
10
8
6
4
2
0
Ages 12-19
5
4
196370**
Ages 6-11
1971-74
1976-80
1988-94
19992000
* >95th 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
Percentage of U.S. Children and
Adolescents Who Were Overweight*
18
16
14
12
10
8
6
4
2
0
16
15
Ages 12-19
5
4
196370**
Ages 6-11
1971-74
1976-80
1988-94
19992000
* >95th 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
The Local Picture
Adolescent Data Source
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

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
Adolescent Sample

Eleven of the fifteen inner-ring high schools
participated


3428 students participated


(73.3% school response rate)
(78.6% response rate)
Data were weighted to be representative of
adolescents in the inner-ring schools
Sample Characteristics
Format of Slides
Body Mass Index
in the 85th Percentile
Body Mass Index
in the 95th Percentile
No Physical Activity in Past Week
Attend Physical Education Class in
an Average Week
Two Hours or Less of TV Viewing
on School Days
Ate Three or More Servings of
Vegetables Per Day
Ate Two or More Servings of Fruit
Per Day
Adult Data
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
Adult Sample



1,144 people participated
43.4% response rate (CASRO)
Weighted to be representative of Cuyahoga
County
Adult Sample Characteristics
35
Males
Females
30
25
18-34
35-49
50-64
65+
20
15
10
White
AA
Other
5
0
18-34 35-49 50-64 65+
Obese (BMI of 30 or more)
100
90
80
70
60
50
40
30
20
10
0
37
22.1 23 22.1
Cuyahoga County
Ohio
National
20.7 23.4
male
female
16.7
AA
white
20.7 20.9
18-34
27.4
35-49
22.3
50-64
65+
Overweight (BMI>=25 and <30)
100
90
80
70
60
50
40
30
20
10
0
34.8 35.8 37
Cuyahoga County
Ohio
National
40.9
40.3 37.4 36
35.9
29.3
male
female
30.5
AA
white
27.5
18-34
35-49
50-64
65+
Overweight or Obese
100
90
80
70
60
50
40
30
20
10
0
67.6
56.9 58.8 59.2
Cuyahoga County
Ohio
National
61.6
61.1
52.7
male
female
52.5
AA
white
64.9
58.2
48.1
18-34
35-49
50-64
65+
Euc l id
N orth C o llin wo od
Bay Vi llag e
W e s tl ak e
N orth O lm s ted
R ic hm o nd H ts .
H igh lan d H ts .
Sou th C olli nw oo d
M ay field
Euc l id Gr ee n
Fo re st H ill s
Gle nv ill e
Gate s M i lls
Eas t C lev e lan d
Sou th Eu cl id
St. C la ir- Su per ior
Ly ndh urs t M ay field H ts .
Goo dr ic h/Ki rtlan d Pa rkH oug h
C lev el and H ts .
D ow ntow n
U niv er s ity
Fa irfa x
U niv er s ity H ts .
C entra l
Edg ew ate r
W o odl and H ills
In
dus
tri
al
Va
lle
y
Lak e w ood
H untin g Va lley
D etroi t S hor ew ay
Pep pe r Pik e
Kin s m an
R oc k y R i v er
C ude ll
Sha
k
er
H
ts
.
Bea
c
hw
oo
d
Tr em o nt N orth B roa dw ay
M t. Ple as a nt
W o odm ere
Stoc k y ard s
Je ffers o n
Sou th Bro ad w ay
H igh lan d H ills
C hag rin F a lls T .
Bro ok ly n C e ntre
C orle tt
Linn da le
M ore lan d H ills
Fa irv ie w Par k
U nio n-M il es Pa rk Lee -M ile s N orth R a nda ll
Ora ng e
Bro ok ly n
Kam m s C o rne rs
W a rre ns v ill e H ts .
C hag rin F a lls
Old B ro ok ly n C uy aho ga H ts .
Pur itas -L ong m ea d
Gar field H ts .
Bro ok ly n H ts .
R iv ers i de
Ben tley v ille
M apl e H ts .
Bro ok Pa rk
Bed ford Bed ford H ts .
Par m a H ts .
Olm s te d T .
Ber ea
Par m a
M idd lebu rg H ts .
W a lton H il ls
Olm s te d F alls
Stron gs v il le
Sol on
In dep en den c e
Sev e n H ill s
Val ley Vie w
N orth R o ya lton
Bro adv i ew H ts . Bre c k s vi lle
Oak w o od Gle nw ill ow
Euc l id
N orth C o llin wo od
Bay Vi llag e
W e s tl ak e
N orth O lm s ted
R ic hm o nd H ts .
H igh lan d H ts .
Sou th C olli nw oo d
M ay field
Euc l id Gr ee n
Fo re st H ill s
Gle nv ill e
Gate s M i lls
Eas t C lev e lan d
Sou th Eu cl id
St. C la ir- Su per ior
Ly ndh urs t M ay field H ts .
Goo dr ic h/Ki rtlan d Pa rkH oug h
C lev el and H ts .
D ow ntow n
U niv er s ity
Fa irfa x
U niv er s ity H ts .
C entra l
Edg ew ate r
W o odl and H ills
Lak e w ood
H untin g Va lley
D etroi t S hor ew ay In dus tri al Va lle y
Pep pe r Pik e
Kin s m an
R oc k y R i v er
C ude ll
Sha k er H ts .
Bea c hw oo d
Tr em o nt N orth B roa dw ay
M t. Ple as a nt
W o odm ere
Stoc k y ard s
Je ffers o n
Sou
th
Bro
ad
w
ay
H igh lan d H ills
C hag rin F a lls T .
Bro ok ly n C e ntre
C orle tt
Linn da le
M ore lan d H ills
Fa irv ie w Par k
U nio n-M il es Pa rk Lee -M ile s N orth R a nda ll
Ora ng e
Bro ok ly n
Kam m s C o rne rs
W a rre ns v ill e H ts .
C hag rin F a lls
Old B ro ok ly n C uy aho ga H ts .
Pur itas -L ong m ea d
Gar field H ts .
Bro ok ly n H ts .
R iv ers i de
Ben tley v ille
M apl e H ts .
Bro ok Pa rk
Bed ford Bed ford H ts .
Par m a H ts .
Olm s te d T .
Ber ea
Par m a
M idd lebu rg H ts .
W a lton H il ls
Olm s te d F alls
Stron gs v il le
Sol on
In dep en den c e
Sev e n H ill s
Val ley Vie w
N orth R o ya lton
Bro adv i ew H ts . Bre c k s vi lle
Oak w o od Gle nw ill ow
No Leisure Time Physical Activity
100
90
80
70
60
50
40
30
20
10
0
28.2
18.8
Cuyahoga County
25.4 24.4
Ohio
National
16.3
male
21
28.6
15.6
female
AA
white
13.5
17.5 18.2
18-34
35-49
50-64
65+
Euc l id
N orth C o llin wo od
Bay Vi llag e
W e s tl ak e
N orth O lm s ted
R ic hm o nd H ts .
H igh lan d H ts .
Sou th C olli nw oo d
M ay field
Euc l id Gr ee n
Fo re st H ill s
Gle nv ill e
Gate s M i lls
Eas t C lev e lan d
Sou th Eu cl id
St. C la ir- Su per ior
Ly ndh urs t M ay field H ts .
Goo dr ic h/Ki rtlan d Pa rkH oug h
C lev el and H ts .
D ow ntow n
U niv er s ity
Fa irfa x
U niv er s ity H ts .
C entra l
Edg ew ate r
W o odl and H ills
In
dus
tri
al
Va
lle
y
Lak e w ood
H untin g Va lley
D etroi t S hor ew ay
Pep pe r Pik e
Kin s m an
R oc k y R i v er
C ude ll
Sha k er H ts .
Bea c hw oo d
Tr em o nt N orth B roa dw ay
M t. Ple as a nt
W o odm ere
Stoc k y ard s
Je ffers o n
Sou th Bro ad w ay
H igh lan d H ills
C hag rin F a lls T .
Bro ok ly n C e ntre
C orle tt
Linn da le
M ore lan d H ills
Fa irv ie w Par k
U nio n-M il es Pa rk Lee -M ile s N orth R a nda ll
Ora ng e
Bro ok ly n
Kam m s C o rne rs
W a rre ns v ill e H ts .
C hag rin F a lls
Old B ro ok ly n C uy aho ga H ts .
Pur itas -L ong m ea d
Gar field H ts .
Bro ok ly n H ts .
R iv ers i de
Ben tley v ille
M apl e H ts .
Bro ok Pa rk
Bed ford Bed ford H ts .
Par m a H ts .
Olm s te d T .
Ber ea
Par m a
M idd lebu rg H ts .
W a lton H il ls
Olm s te d F alls
Stron gs v il le
Sol on
In dep en den c e
Sev e n H ill s
Val ley Vie w
N orth R o ya lton
Bro adv i ew H ts . Bre c k s vi lle
Oak w o od Gle nw ill ow
Ate Two or More Servings of Fruit
Per Day
100
90
80
70
60
50
40
30
20
10
0
* *
Cuyahoga County
*
*
25.2
21
Ohio
National
14.5
male
female
30.9
18.8 22.5
AA
white
This information was not reported by the state of Ohio
This information was not reported in the National report
15.2 16.2
18-34
21.2
35-50
51-64
65+
Euc l id
N orth C o llin wo od
Bay Vi llag e
W e s tl ak e
N orth O lm s ted
R ic hm o nd H ts .
H igh lan d H ts .
Sou th C olli nw oo d
M ay field
Euc l id Gr ee n
Fo re st H ill s
Gle nv ill e
Gate s M i lls
Eas t C lev e lan d
Sou th Eu cl id
St. C la ir- Su per ior
Ly ndh urs t M ay field H ts .
Goo dr ic h/Ki rtlan d Pa rkH oug h
C lev el and H ts .
D ow ntow n
U niv er s ity
Fa irfa x
U niv er s ity H ts .
C entra l
Edg ew ate r
W o odl and H ills
Lak e w ood
H untin g Va lley
D etroi t S hor ew ay In dus tri al Va lle y
Pep pe r Pik e
Kin s m an
R oc k y R i v er
C ude ll
Sha k er H ts .
Bea c hw oo d
Tr em o nt N orth B roa dw ay
M t. Ple as a nt
W o odm ere
Stoc k y ard s
Je ffers o n
Sou th Bro ad w ay
H igh lan d H ills
C hag rin F a lls T .
Bro ok ly n C e ntre
C orle tt
Linn da le
M ore lan d H ills
Fa irv ie w Par k
U nio n-M il es Pa rk Lee -M ile s N orth R a nda ll
Ora ng e
Bro
ok
ly
n
Kam m s C o rne rs
W a rre ns v ill e H ts .
C hag rin F a lls
Old B ro ok ly n C uy aho ga H ts .
Pur itas -L ong m ea d
Gar field H ts .
Bro ok ly n H ts .
R iv ers i de
Ben tley v ille
M apl e H ts .
Bro ok Pa rk
Bed ford Bed ford H ts .
Par m a H ts .
Olm s te d T .
Ber ea
Par m a
M idd lebu rg H ts .
W a lton H il ls
Olm s te d F alls
Stron gs v il le
Sol on
In dep en den c e
Sev e n H ill s
Val ley Vie w
N orth R o ya lton
Bro adv i ew H ts . Bre c k s vi lle
Oak w o od Gle nw ill ow
Popular Media
Men’s Fitness Rankings for the Top
Fattest Cities in 2004
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Detroit
Houston
Dallas
San Antonio
Chicago
Fort Worth
Philadelphia
Arlington
Cleveland
Columbus
Atlanta
Mesa
Oklahoma City
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Kansas City
Miami
Las Vegas
Indianapolis
Phoenix
Tulsa
Memphis
New York
New Orleans
Baltimore
El Paso
Washington
Men’s Fitness Rankings for
Cleveland
2004
9th
2003
6th
2002
13th
2001
9th
Men’s 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
Cleveland’s 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

Factors Associated
with Obesity
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
 African American
 Hispanic
 Other

25.6%
23.0%
49.5%
2.0%
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

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

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
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
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
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
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
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
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
Thank you!
For electronic copies of the slides go to:
http://epbiwww.cwru.edu/faculty/colabianchi.html