Transcript Enabling the Nation’s Schools to Prevent Heart Disease

Centers for Disease Control and Prevention
Division of Adolescent and School Health
Making the Case:
Why Schools Should Promote
Physical Activity and Healthy Eating
and Prevent Tobacco Use
(Part 1)
Howell Wechsler, Ed.D., MPH
Health Scientist
Overview of The Case
(1) Promoting physical activity, healthy eating, and
tobacco use prevention for youth is a critical
public health priority
(2) Prevalence of physical inactivity, poor eating
behaviors, and tobacco use among youth is
high, with unfavorable trends
Overview of The Case
(3) Promoting physical activity, healthy eating, and
tobacco use prevention for youth is an
important educational priority

Educational benefits

Benefits for society

Desired by families
Regular Physical Activity Reduces Risk Of:
premature mortality in general
death from heart disease
diabetes
colon cancer
hypertension
Dietary factors
are associated with:
coronary heart disease
stroke
type 2 diabetes
osteoporosis
breast cancer
colon cancer
prostate cancer
Cigarette smoking
causes:
heart disease
stroke
cancer of the lung, larynx,
esophagus, pharynx, mouth, bladder
chronic lung disease
Cigarette smoking contributes to:
cancer of the pancreas, kidney, cervix
Causes of All Deaths in the U.S., 1997
Cardiovascular
Disease
39%
Other Causes
30%
Diabetes
3%
COPD
5%
Cancer
23%
Source: CDC, National Vital Statistics Reports 2000: 47(19)
Actual Causes of Death in the United States, 1990
500,000
400,000
400,000
300,000
300,000
200,000
100,000
100,000
90,000
30,000
20,000
Sexual
behavior
Illicit use of
drugs
0
Tobacco
Diet/Activity
Alcohol
Microbial
agents
Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.
Estimated Annual Direct and Indirect Costs of CVD,
Cancer, and Diabetes in the U.S. (in $ billions)
350
$ in billions
300
$286
250
200
150
$107
100
$98
50
0
CVD1
Cancer2
Diabetes3
1 - Health care and lost productivity costs (American Heart Association); 2 - Health care,
lost productivity, and mortality costs (National Cancer Institute); 3 - Medical care costs
and lost wages (American Diabetes Association)
Estimated Annual Costs Attributable to Obesity
and Cigarette Smoking in the U.S.
Obesity1
 Direct health care costs: $39 - $52 billion

4.0% - 5.7% of all health care costs
 Indirect costs: $47 billion
Cigarette Smoking2
 Direct medical care costs: $53 billion

6.5% of all health care costs
Sources: (1) Wolf AM, Colditz GA. Ob Res 1998;6:97-106; Allison DB et al. AJPH 1999;
88:1194-9 (2) Miller VP et al. Soc Sci Med 1999;48:375-91
Consequences of Osteoporosis
 Contributes to 90% of hip fractures in women,
80% in men
 Virtually all hip fracture patients are
hospitalized; 2/3 don’t return to prior level of
function
 Estimated 1995 health care expenditures for hip
fractures:
$8.7 billion
Source: U.S. DHHS. Healthy People 2010 (Conference Edition), 2000
Why Target Youth?
80% of adult
smokers
started
smoking before
they finished
high school
Source: U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among
Young People, 1994
Why Target Youth?
 The younger people are when they start using
tobacco, the more likely they are to become
dependent on nicotine

25% of high school students smoked a whole
cigarette before age 13*
 Physical activity and dietary patterns may be
established during childhood and adolescence
*CDC, National Youth Risk Behavior Survey, 1997
Why Target Youth?
 Risk factors for heart disease and diabetes
develop early in life
Triglycerides
LDC-Cholesterol
HDL-Cholesterol (low)
Insulin
Blood Pressure
Why Target Youth?
 Risk factor trends are going in the wrong
direction
 Atherosclerosis is present in late adolescence
Why Target Youth?
% of children, aged 5-10, with 1 or
more adverse CVD risk factor levels:
27.1%
% of children, aged 5-10, with 2 or
more adverse CVD risk factor levels:
6.9%
Source: Freedman DS et al. Pediatrics 1999;103:1175-82
Trends in Coronary Risk Factors in Children
Study
Site
Years
Louisiana1
1981
1991
2
Ohio
3
Minnesota
(n)
Ages
(417)
(235)
16-17
1973-5
1989-90
(299)
(1456)
1986
1996
(4239)
(5223)
Significant
Increases In:
Weight, body
mass, triglycerides
Weight, body
mass, total choles7-13
terol, triglycerides,
blood pressure
Weight, body
10-14 mass, systolic
blood pressure
Sources: (1) Gidding SS et al. J Pediatr 1995;127:868-74 (2) Morrison JA et al. Am J
Public Health 1999;89:1708-14 (3) Luepker RV et al. J Pediatr 1999;134:668-74
Why Target Youth?
% of overweight children, aged 5-10,
with 1 or more adverse CVD risk
factor levels:
27.1% 60.6%
% of overweight children, aged 5-
10, with 2 or more adverse CVD risk
factor levels:
6.9%
26.5%
Source: Freedman DS et al. Pediatrics 1999;103:1175-82
Relation of Overweight to Adverse CVD
Risk Factors in Children Ages 5-17
Factor
Cholesterol >200 mg/dl
Triglycerides >130 mg/dl
LDL-C >130 mg/dl
HDL-C < 35 mg/dl
Elevated SBP
Elevated DBP
Elevated insulin
Odds Ratio*
2.4
7.1
3.0
3.4
4.5
2.4
12.6
*Prevalence for overweight children (> 95th percentile for Quetelet Index) versus
prevalence for children who are not overweight or at risk of overweight (< 85th percentile)
Source: Freedman DS et al. Pediatrics 1999;103:1175-82
Percentage of U.S. Adolescents, Ages 12-17,
Who Were Overweight*, by Sex
Percent
12
11.4
10
9.9
8
6
4
Females
4.5
Males
4.6
2
0
1963-70
1971-74
1976-80
* >95th percentile for BMI by age and sex based on NHANES I reference data
Source: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
1988-94
Percentage of U.S. Children, Ages 6-11,
Who Were Overweight*, by Sex
Percent
12
11.4
10
9.9
8
6
Males
4.3
Females
4
2
3.9
0
1963-70
1971-74
1976-80
* >95th percentile for BMI by age and sex based on NHANES I reference data
Source: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
1988-94
Percentage of U.S. Children, Age 6 to 11,
Who Were Overweight*, by Race and Sex
Percent
18
16
14
12
10
8
6
4
2
0
Black females
Black males
White males
White females
1963-70
1971-74
1976-80
1988-94
* >95th percentile for BMI by age and sex based on NHANES I reference data
Source: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
Emergence of Type 2 Diabetes Among Youth
 1979: First clinical reports in Pima Indians
in Arizona
 1990-94: First clinical reports in populations
other than American Indians
Increased Incidence (New Cases) of
Type 2 Diabetes Among Adolescents
in Greater Cincinnati, OH
 Incidence in 1982: 0.7 / 100,000 per year
 Incidence in 1994: 7.2 / 100,000 per year
Source: Pinhas-Hamiel O et al. J Pediatr 1996;128:608-15
Type 2 Diabetes in Youth
 A public health problem for American Indians
(estimated prevalence: 2 to 50 per 1000)
 Becoming a public health problem for popula-
tions other than American Indians (estimated
prevalence: <4 per 1000 in general population)

approximately 30,000 adolescents aged
12-19 in 1988-94

8 to 46% of all new cases of diabetes in
pediatric clinics
Source: CDC, Division of Diabetes Translation
Health Conditions Associated with
Adult Obesity
 Hyperlipidemia
 Polycystic ovary
disease
 Diabetes mellitus
 Hypertension
 Respiratory
 Cardiac
 Gall bladder disease
 Osteoarthritis
 Cancer
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1985
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1986
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1987
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1988
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1989
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1990
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1991
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1992
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1993
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1994
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1995
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Preva lence of Obesity* Among U.S. Adults
BRFSS, 1996
(*Approximately 30 pounds overweight)
< 10%
10% to 15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
> 15%
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI(*BMI
≥30,
oror~
30lbs
lbs
overweight
5’ 4” woman)
30,
~ 30
overweight
for 5’4” for
person)
No Data
<10%
10%–14%
15%–19%
20%–24%
Source: Behavioral Risk Factor Surveillance System, CDC
≥25%
Healthy People 2010: Leading Health Indicators
 Physical activity
 Overweight and obesity
 Tobacco use
 Substance abuse
 Responsible sexual behavior
 Mental health
 Injury and violence
 Environmental quality
 Immunization
 Access to health care
Objectives to be Measured to Assess
Progress in Leading Health Indicators
 Increase the proportion of adolescents who
engage in vigorous physical activity that
promotes cardiorespiratory fitness 3 or more
days per week for 20 or more minutes per
occasion.
 Reduce the proportion of children and
adolescents who are overweight or obese.
 Reduce cigarette smoking by adolescents.
Sound Bytes
“No [health] problem needs our attention more
than the growing epidemic of obesity in America.
In sheer numbers and its toll in death and
disability, obesity has reached crisis proportions
in the United States.”
- Dr. C. Everett Koop, former United States
Surgeon General
Sound Bytes
“Smoking is the chief, single avoidable cause of
death in our society and the most important public
health issue of our time.”
- Dr. C. Everett Koop, former United States
Surgeon General
Sound Bytes
“I am alarmed by the steady trend we have seen
over the last two decades toward decreasing
physical education requirements in schools...
We need to create environments where healthy
lifestyles are as easy to adopt as unhealthy
ones…Our schools have a responsibility to
educate both minds and bodies.”
- Dr. David Satcher, U.S. Surgeon General
Sound Bytes
“Smoking kills more people than AIDS, alcohol,
drug abuse, car crashes, murder, suicides, and
fires combined.”
- Centers for Disease Control and Prevention,
Office on Smoking and Health