1. Overweight & Obese Children
in Harrison School District Two
and El Paso County,
a Needs Assessment
Christa Hyson Meiler
2014 MPH Candidate
University of Florida
2. Introduction
Internship Site
Meadows Park Community Center (MPCC)
• Located in Colorado Springs, Colorado
• In El Paso County, Harrison School District Two
• Utilized by southeast Colorado Springs
• 71% of participants in summer camp programs received a reduced
rate
• MPCC is a result of available space in the community and a group
of concerned citizens about gangs and teenagers in the early 1980s
Source: Meadows Park Community Center 2014
3. Order of Presentation
Meadows Park Community Center Profile
Background
Methods
Results
Discussion
Implications
Conclusion
4. Meadows Park Community Center Profile
Focus on
•Early Childhood, Youth and
Teens
•Health and Wellness
•Food Insecurity
•Medical Services
•Public Safety
•Technology
•Community Building
Services offered
•Golden Circle Nutrition Program
•After School Program
•Before School Breakfast
•Summer Camp
•Grant-Funded Services
5. Background
• Childhood obesity is considered one of the major epidemics of the 21st
century
• Decrease in life expectancy
• Examine the physical and social environment
• Connection between low socioeconomic status (SES) and obesity
Obesity and public health values
• Right to healthcare
• Health Education
• Improve & Protect Life
9. About El Paso County
Population El Paso County Colorado
Population, 2012 estimate 645,439 5,189,458
Persons under 5 years, percent,
2012
7.0% 6.5%
Persons under 18 years, percent,
2012
25.3% 23.7%
Persons 65 years and over,
percent, 2012
10.7% 11.8%
Female persons, percent, 2012 49.9% 49.8%
Population of El Paso County and Colorado by age in 2012
Source: U.S. Census Bureau: State and County QuickFacts, 2014
10. Educational Attainment
Estimate Male Female
Population Over 25 393,192 190,547 202,645
Less than 9th
grade 2.2% 2.3% 2.1%
9th
-12th
grade, no
diploma
4.4% 4.2% 4.6%
High school graduate
(includes
equivalency)
21.9% 21.0% 22.8%
Some college, no
degree
26.0% 25.8% 26.1%
Associate’s degree 10.3% 9.6% 10.8%
Bachelor’s degree 21.7% 21.3% 22.1%
Graduate or
professional degree
13.6% 15.9% 11.4%
In El Paso County, ages 25 and over
Source: U.S. Census Bureau: American Community Survey, 2012
11. Small Area Income & Poverty Estimates
Source: United States Census Bureau: Small Area Income and Poverty Estimates, 2013
State of Colorado in 2012, Percent in Poverty, Ages 5-17 in Families
12. Percent of Children Engaging in Selected Eating &
Recreational Behaviors, Colorado 2009 to 2010
A
Five or more servings per day.
B
Food is paid for at a counter or drive thru, before being eaten.
C
60 minutes of physical activity per day.
D
Unrelated to school
n/a: Measure unavailable for age group Source: El Paso County Public Health
13. Unhealthy Weight in El Paso County
The percent of population with an unhealthy weight
in El Paso County and Colorado from 2008 to 2010
Source: El Paso County Public Health, 2014
14. Research Question & Specific Aims
Research Question
• Is there a causal relationship present between low
socioeconomic status (SES) and obesity in children?
Specific Aims
• Through interviews and secondary data gain a general
understanding of the health status of the children in El
Paso County.
• Find out how many children in El Paso County/ Harrison
School District Two are overweight or obese.
15. Specific Aims
• Through interviews, identify disparities that prevent
children in the Meadows Park Community from being a
healthy weight.
• Assess the opportunities for physical activity available to
children living in Harrison School District Two with a
focus on the Meadows Park Community.
• Assess the availability of healthy food choices for
children living in the Meadows Park Community.
16. Methods
• Interviews
• Active Neighborhood Checklist- Sidewalk Audit
• SOPARC: System for Observing Play and Recreation In
Communities
• Secondary Data
17. Methods- Interviews
• Community Center Director
• El Paso County Public Health, Community Health Educator
• Single Parent with Four Children in Harrison Schools
• Harrison School District Administrators
Why these individuals?
• Proximity to Population
• Knowledge of Population
• Involved Community Members
18. Analysis of Methods
Four stages of the constant comparative method:
Categorize data
Place data into proper homes or properties
Define possible theories
Write the theory
19. Analysis of Methods
Categories to assess the results of the Sidewalk Audit/SOPARC:
Land use/ Public transportation/ Street characteristics/ Environmental
quality/ Walkability/ Bike accessibility/ Park Conditions/ Activities/
Age/ Gender/ Ethnicity
21. Results- Sidewalk Audit
• Premier use of land is mostly residential
• Homes or apartments in the area had on street parking or a small
lot or 1-car garage
• Large green space and playground present in the middle of the
community
• Street characteristics are lacking
• No pedestrian scale lighting present or benches outside of the bus
stop
22. Results- SOPARC
Source: SOPARC Park Observation, 2014
This is the average park use from June 10-July 10 2014, items are separated
by target area, activity, and gender.
23. Conditions of Meadows Park
This chart shows the percentage of target areas observed.
Source: SOPARC Park Observation, 2014
25. Average Number of Park Users by Age
Children 0-12
Teens 13-17
Adults 18-55
Seniors 55+ Source: SOPARC Park Observation, 2014
26. Results- Interview
Food Insecurity Limited Physical
Activity
Lack of Financial
Resources
Lack of Knowledge
Cost Video Games Personal
Transportation
Scratch Cooking
Convenience School Regulations WIC Diet Habits
Time Park Safety Competing
Priorities
Picky Eaters
Distance Neighborhood
Safety
Single Parent School Curriculum
Food Desert Time Need vs. Want Stigma
The table shows the most frequently mentioned observations on why
childhood obesity occurs in the community, as perceived by the interviewees.
29. Relationship to Research Question & Aims
Research Question: Is a causal relationship present between low socioeconomic
status (SES) and obesity in children?
•Interview statements and secondary data
•2008, 13.9% of children were obese in El Paso County In 2010, this percentage was
21.0%
•2008 59% of students received free/ reduced lunches, in 2012, 70% of students
received free/ reduced lunches.
Specific Aims: Through interviews and secondary data gain a general
understanding of the health status of the children in El Paso County.
•Varied
•Divide of wealth
•Transient area/ military
•Increase in medication
Source: El Paso County Public Health, 2013 & Harrison School District Two, 2014
30. Relationship to Research Question & Aims
Through interviews, identify disparities that prevent children in the Meadows
Park Community from being a healthy weight.
Food Insecurity Limited Physical
Activity
Lack of Financial
Resources
Lack of Knowledge
Cost Video Games Personal
Transportation
Scratch Cooking
Convenience School Regulations WIC Diet Habits
Time Park Safety Competing Priorities Picky Eaters
Distance Neighborhood
Safety
Single Parent School Curriculum
Food Desert Time Need vs. Want Stigma
31. Relationship to Research Question & Aims
Find out how many children in El Paso County/ Harrison School District Two are
overweight or obese.
•Harrison SD2, not tracked
•El Paso County Public Health 2013 Annual Report stated that 31.9% of children in
2010-2012 were overweight or obese
Assess the availability of healthy food choices for children living in the
Meadows Park Community.
Store Walk (one way) Bus Ride (one way) Distance from
Meadows Park
Albertsons 43 minutes 33 minutes 2.2 miles
Wal-Mart 57 minutes 35 minutes 2.8 miles
Safeway 20 minutes 18 minutes 1 mile
32. Relationship to Research Question & Aims
Assess the opportunities for physical activity available to children living in
Harrison School District Two with a focus on the Meadows Park Community.
34. Discussion
Kamath et al. (2008) - Argued that the efficacy of lifestyle interventions is
unclear
• Children were very receptive to the messages of 5210 programming and
could answer questions
Patrick & Nicklas (2008)- Examined physical and social environments
• Positive role models and examples are essential early on in life
Olshansky et al. (2005)- Continuing the status quo
• The profound effect that environment has on eating/ activity habits, it is
imperative to fund programs that set healthy examples and keep places
like Meadows Park Community Center running
35. Strengths
• Qualitative Data
• Unique perspective and data from interviews
• Community relationships
• Able to understand situation in a local context
• Easy to replicate
• Attention to detail
• Good listener
36. Limitations
• Lack of quantitative data
• Amount of qualitative data
• Short period of time
• Bias during interview
• Personal accounts are not as easy to be generalized
• Data analysis (constant comparative method) is very time
consuming
• Results reflect my personal biases when categorizing data
37. Generalization
• Needs assessment was designed to be easily replicated
• Interview questions could be asked to any community member,
community health educator, or school administrator in any state or
community
• Identified themes: lack of financial resources, lack of knowledge,
food insecurity, and limited physical activity are all things that
communities across the nation understand and experience
• The sidewalk audit and SOPARC system are both evidence based
assessment tools that have over time provided reliable results
38. Implications
• Special project became the internship
• Childhood obesity will continue to be a problem without
intervention and change
• Disparities to healthcare/ chronic condition care
• SES & Obesity
• Health education, health administration, and observing the
environment were the largest parts of this project
39. MPH Core Competencies
Develop policies and plans that support individual and community
health efforts - Policy implementation for the 5210 Let’s Go program
Link people to needed personal health services and assure the
provision of health care when otherwise unavailable – Peak Vista
Mobile Clinic
Conduct research for new insights and innovative solutions to health
problems - SOPARC (System for Observing Play and Recreation in
Communities) and Active Neighborhood Checklist, a sidewalk audit
40. MPH Core Competencies
Diagnose and investigate health problems and health hazards in the community
using an ecological framework – Identifying barriers and problem solving
Monitor health status to identify and solve community health problems &
Conduct research for new insights and innovative solutions to health problems –
Food accessibility and bus routes
Inform, educate, and empower people about health issues - Nutrition education
Mobilize community partnerships and action to identify and solve health
problems - Work with the Healthy Communities Collaboration and the Colorado
Community Center Collaborative
41. Concentration Competencies
Demonstrate knowledge and skills needed to design and implement a public
health information campaign - 5210 Let’s Go program implementation
Understand and apply the principles of community participation in public
health interventions- Community and trust
Apply social and behavioral science theories and concepts to public health
problems- Understanding the community
Specify approaches for assessing, preventing, and controlling environmental
hazards that pose risks to human health and the environment – Sidewalk
audit
42. Concentration Competencies
Describe genetic, physiological and psychosocial factors that affect
susceptibility to adverse health outcomes following exposure to
environmental hazards- Asthma in Colorado
Monitor and evaluate programs for their effectiveness and quality – Summer
Camp evaluations at MPCC
Identify, retrieve, summarize, manage and communicate public health
information- Sharing findings from methods of this needs assessment
Demonstrate communication skills key to public health workforce
participation and advocacy – 5210 Let’s Go programming advocacy
43. Lessons Learned
• Childhood obesity is not a huge issue to some community members
• More concern that their children are safe and fed, not their weight
status
• Without community centers many senior citizens may not have a
meal everyday if not for the nutrition program offered by the
community center
• Community center provides a snack and a safe place to go
afterschool for children of all ages after school
• Trust must be earned in a community situation
44. Recommendations for Future Projects
• Geographic information system or GIS mapping of grocery stores/
shopping Markets, WIC offices, primary care/ treatment facilities,
and hospitals
• Change bus routes to meet the needs of the community
• Longitudinal study that focuses on tracking the effects of
community centers on health, safety, and education
45. Conclusions
• Building the trust of the community
• Mission of organizations will continue to change as the health status of
children change
“It [Parks & Recreation] used to be about quality of life and leisure
and fun experiences. Now it is very much public health. It is about food,
clothing and shelter, if it’s an exercise class it’s as much about reducing your
medications and BMI as it is having something enjoyable, maybe a
distraction in life. Years ago this wasn’t even close to something we felt we
had to take on. That’s what doctors do. Now it has come to a community
center. Until you have the health of your community squared away
you don’t have the luxury to take on leisure.”
Hello, my name is Christa Meiler and my special project is entitled “overweight & obese children in Harrison school district two and el paso county, a needs assessment”
My Internship site was Meadows Park Community Center in Colorado Springs, Colorado; families heavily utilize this center. It is a great place that needs a lot more funding than it is receiving. Just a note about the camp prices, those were based on a sliding scale of income and if families were on Medicaid or received free/ reduced lunches during the school year, they received a reduced rate for camp.
Here are the topics that will be discussed.
Meadows Park focuses on these topics and services, however they are primarily involved with food insecurity issues. Recently they had to shut there on site food pantry down due to funding. Colorado Springs shut down all satellite food pantry locations, so residents now have to travel to a main warehouse, which is not centrally located and has created some serious issues.
Childhood Obesity continues to be a problem. It affects every race and ethnicity no matter the financial situation or culture. Unfortunately it effects the vulnerable especially.
Public Health has a responsibility to be involved because of the effect it has on the population.
When researching literature, I found a new journal entitled the International Journal of Pediatric Obesity. I think it says something about the current health of children in the US if a journal like this even exists. It is peer-reviewed and released on a quarterly basis. As for the critical literature I found, the listed articles are some of the most significant pieces that were written about childhood obesity with topics ranging from critiquing behavioral interventions, assessing social and physical environments and examining short life expectancies.
Here are some additional pieces that focus on low socioeconomic status and the impact of obesity on the US population.
There was also valuable literature, along with help from my advisor, Dr. Hart, that aided me in evaluating qualitative data.
The next few slides paint a picture of El Paso County they will show population, health, and poverty level information.
Most of the population in El Paso County, over the age of 25 has some college, but no degree
This is a map of Colorado’s poverty estimates divided by school districts, the highlighted area is Harrison school district and has the highest percentage of poverty compared to the surrounding districts
El Paso County Public Health participated in the COLORADO HEALTH IMPROVEMENT PLAN and helped gather data such as fast food versus vegetable consumption. I thought this was important to include because Colorado has a reputation of being a very healthy state but the numbers paint a very different picture.
This is also data from the COLORADO HEALTH IMPROVEMENT PLAN
The research question I explored in this needs assessment asked if a causal relationship existed between low socioeconomic status (SES) and obesity in children.
the specific aims of this needs assessment focus on health status, weight status, physical activity and healthy food availability.
The interviews received IRB approval. The Active neighborhood checklist and SOPARC are both created by Active Living research, which is a program of the Robert Wood Johnson Foundation. They are evidence based assessment tools that are easy to use. The side walk audit consists of answering a series of questions that evaluate the physical surroundings and the SOPARC application evaluates target areas based on constant visual scans of a target area and recording data such as gender, ethnicity, activity level or time of day. Secondary data is essential in filling in the holes from qualitative data
These are the individuals that I chose to interview. They were chosen because they were key community members and stakeholders that understand health issues in a local context.
To understand the interview responses, I used the constant comparative method. I created transcripts of each interview and line-by-line identified key words and placed each key word into a category or home. If no category existed or applied at that time I created a new one. After I had finished this I saw a few themes emerge from these categories. This chart covers the topics of questions that were asked in the interviews.
For the Side Walk Audit and SOPARC I completed forms that assessed different targets. These target areas are listed. This image is the route I walked and the red A is Meadows Park Community Center and that large grassy area across the street is Meadows Park
I know you probably can’t read this, but I just wanted to show you what the active neighborhood checklist looked like in order to complete the side walk audit.
These are the results of the sidewalk audit. The only non-residential use present was the community center and the Street characteristics missing posted speed limits, stoplights, speed zones, bike lanes or lane markers. Safety concerns are present due to the lack of lighting.
Using the SOPARC web application I was able to track park and recreational facilities by usage, gender, race, and activities by visual scans. These results show average park use and what activities females and males were choosing.
The conditions for Meadows Park were mostly positive, such as target areas being accessible and usable. This chart shows the percentage of target areas observed. The target areas included two basketball courts (one indoor, one outdoor) a baseball field, gymnasium, auditorium, playground, and an open grass field.
Another aspect of the SOPARC application is tracking the level of the activity in the observed target areas. Using the method of visual scans I was able to classify the activity level of each participant.
Lastly, these are the average number or park users in june and july by age.
After using the constant comparative method to analyze the interview data, four themes emerged from the interviews. These themes are in the dark gray bar the top of this table. One theory that could be projected from these four themes is that childhood obesity is not an individual issue, it is a community issue, it is a problem that has worsened over time due to a lifestyle created on immediate convenience and instant gratification. Those without the funds or support or the freedom to chose other foods, or live in safe neighborhoods fall victim to a system that requires immediate needs to be satisfied, like food.
These keywords came up in every interview. A few participants went into great detail about the struggles that exist when being told to eat healthy food. One participants said, “Yes, I know I should eat healthy- but honestly, I do not own a set of knives to even cut up the vegetables to cook.”
These were 2 quotes that I think are particularly significant to make note of when studying children’s eating behaviors. I will give you a moment to read them.
Most people I interviewed noticed children getting larger and larger in Harrison SD and at the same time more and more students were qualifying for the free and reduced lunches at school . You can take note of these shifting percentages reflecting that statement. And Due to the Colorado springs having a mostly transient population due to the military, health data that track changes is especially difficult to keep record of. I was told during an interview that the use of medications, especially for hyperactivity and asthma has gone up in recent years.
Again, Here’s the themes that emerged from the interviews. I think they identify the disparities and issues that prevent children from being a healthy weight in the community.
It was surprising, but due to limited funds obesity is not tracked in HSD.
Talking with community members I was able to find out where people shopped. Most said walmart or Albertsons. Safeway is the closest store to the Meadows Park community, but was described as being the most expensive, so it is not really feasible for people to shop there
This is a map of Harrison school district, the yellow star is meadows park and All those turquoise color dots are parks. Parks are plentiful and well maintained for the most part; the biggest concern I read from interviews was the safety of the parks. I personally saw bullet holes in the backboard of basketball hoops at the outdoor court in Meadows Park.
A lot of my findings could be used to encourage policy development like lighting has to be maintained in certain areas of parks. This is a photo of some of our older camp participants. We took them to city hall, for a city hall meeting where the future of community centers was being discussed
Relating my findings back to critical literature, I found quite the opposite, Children that attended the summer were very receptive to the 5210 lets go program. They could easily tell me the components and identify the characteristics of 5-2-1-0. Meadows Park is so important because it give kids that safe environment and positive examples they need early on in life, if they don’t see these necessary examples at home.
The amount of qualitative data can be perceived as a weakness but in this case I think it added to the study, the data I was able to get I couldn’t get unless I was speaking with someone one on one. I developed relationships and by the end of my internship community members were opening up to me.
As for limitations, I did have some personal bias during the interviews because I knew one of the interviewees before hand, however, this allowed me to ask better follow up questions
The themes that emerged from my interviews could be applied to any community or state in the US. Obesity is a universal issue and The other methods I used are evidence based that provided easy to read data.
Obesity will continue if efforts to prevent it don’t continue. And yes, there is a lot of literature that says interventions have LESS THAN effects, but I had a child that could not identify vegetables at the beginning of camp, and by the end he was telling me all about the celery in his lunch.
These are the competencies I developed the most. I developed these through working with community collaboratives, with the health department and working with the promotion of the 5210 lets go program.
I also provided lots of nutrition education during the summer camp
And gained the trust of the community
I also practiced how to share results to propose changes in the community
I learned a lot from Meadows Park. Community centers are SO important to people that utilize them. It is not just a social or recreational function. For some, it’s a way they eat on a daily basis through programs like golden circle nutrition or summer camp meals.
These are some possibilities for future projects, I especially think any project that could provide quantitative data that legitimizes the mission of community center would be invaluable. A study like this could capture graduation rates or track obesity or fitness levels of children who did and did not utilize community center programs.
I concluded that the most important and hardest part of community work is gaining the trust of that community. I will leave you with a final quote from my interviews. It’s long but the last sentence says it all -
