Statewide Health Improvement ProgramCommunity Health Indicators: Mahnomen County Prepared by: Garth Kruger, Ph.D. Dmitri Poltavski, Ph.D. EvaluationGroup, LLC
Introduction • EvaluationGroup,LLC • Dmitri Poltavski, Ph.D. • Garth Kruger Ph.D. • Jacque Gray, Ph.D. • OUR SERVICES INCLUDE • PROGRAM EVALUATION DESIGN • WRITING LOGIC MODELS • NEEDS ASSESSMENTS • SURVEY CONSTRUCTION • DATA ANALYSIS • POLICY ANALYSIS • WEB PAGE DESIGN
What are the results? • Adults in Mahnomen County and the NW MN Region are overweight/obese. • Increase physical activity and improve nutrition. • Children need better nutrition • Followed by increased physical activity
Overview • Behavioral Risk Statistics • Indexes of Obesity and Tobacco Use: Adults (18+) • Indexes of Obesity and Tobacco Use for High School Students (grade 12) • Overweight and Obesity • Exercise and Physical Activity • Fruit and Vegetable Consumption • Tobacco Use, Access, Smoking Policy • Interviews with County Residents • Review of Interventions and Recommendations
Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: Adults (18+)
ESTIMATE ? Unknown ? Known Age Gender Risk Statistics (Adults) Data Used • Behavioral Risk Factor Surveillance Survey (BRFSS) databases 2004, 2007 and 2008. • There are only synthetic estimates of behavioral adult risk statistics for the 8-county SHIP region. • There are currently no recent BRFSS data available on smokeless tobacco use in Minnesota.
MN Risk Statistics (Adults) General Health and Obesity • Over 60% of all Minnesotans are overweight or obese (mean BMI of 27.5  ). • 37.5% of all Minnesotans were overweight. • 26.5% were classified obese.  BMI between 25.00 and 29.99 corresponds to the category “overweight”; BMI of 30.00 and above corresponds to the category “obese”.
MN Risk Statistics (Adults) 2007 Minnesota Physical Activity (PA) Categories (%). • 45.5% of Minnesotans met physical activity recommendations. • 40.4% reported insufficient levels of physical activity. • 12.9% had none at all.
Mahnomen County Risk Statistics (Adults)  Aggregate data for Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake & Roseau Counties.
MN Risk Statistics (Adults) Fruit and Vegetable Consumption • 21.3% of Minnesotans reported consuming 5 or more servings of fruits and vegetables per day.
MN Risk Statistics (Adults) Tobacco Use and Smoking Policy • 15.7% of Minnesotans in 2008 reported currently smoking at least on some days. • 11.1% percent were regular smokers (smoke every day). • 53% of smokers reported trying to quit at least once in the past 12 months.
Summary • Data suggest • Over half the adult population is overweight or obese. • Only slightly more than 20% of adults eat the recommended guidelines of fruits and vegetables. • Mahnomen county adults are much less physically active (no exercise) than other adults statewide.
Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: High School Students (grade 12)
Risk Statistics (High School Students) Datasets Used • Minnesota Student Survey 2007 • Information used for only students in grade 12. • Good proxy for needs given SHIP parameters. • They show the greatest prevalence of health risk behaviors compared to grades 6 and 9. • 55.6% response rate • 72% response rate for SHIP region
Risk Statistics (High School Students) Datasets Used • MN Student survey administrators provided raw data sets in order for us to make statistical comparisons. • Confidence intervals used to assess statistical differences. 18.4% 9.6% 95% Confidence Interval 32.2%
Risk Statistics (High School Students) Overweight and Obesity –See Table 2, pg. 7 • 18.4 % of 12th-graders in Mahnomen County were classified ‘at risk’ for becoming overweight • 12.2% of 12th-graders in Mahnomen County were considered overweight. • Adult population at 60% • 28.0% of Mahnomen county students thoughtthey were overweight.
Risk Statistics (High School Students) • 75.6% of students met recommendations for regular weekly physical activity. • Higher than MN (68.7%). Exercise and Physical Activity • 13.3% of students reported insufficient physical activity. • 11.1% reported no weekly physical activity.
Risk Statistics (High School Students) Fruit and Vegetable Consumption • Only 8.0% of students reported adequate daily intake of fruits and vegetables. • Far fewer than MN (16.1%).
Risk Statistics (High School Students) Tobacco Use and Access • 38.8% of the 12th-grade students in Mahnomen County reported using tobacco products in the 30 days preceding the survey. (15.7% of adult Minnesotans smoke) • Cigarette smoking was the most frequent form of tobacco use reported by 24.5% of students. • 16.3% of 12th graders had used smokeless tobacco or smoked cigars before the age of 13 compared to state average of 5.0%.
Risk Statistics (High School Students) • 73.7% of tobacco users purchased them at a gas station or a convenience store. • Higher than MN average of 63.1% (but not stat sig).
Summary of Findings Compared to the statewide averages of MN youth, Mahnomen County youth… • Meet PA guidelines significantly less often. • Are more likely to get no physical activity at all. • Eat less fruits/vegetables per day. • Use tobacco products more often. • May be more likely to buy tobacco at a gas station or convenience store. • Perceive themselves to be overweight more often. • These perceptions are much higher than their actual reported degree of overweight.
What are the results again? • Adults in Mahnomen County and the NW MN Region are overweight/obese. • Increase physical activity and improve nutrition. • Children need better nutrition • Followed by increased physical activity
County Resident Interviews Most Pressing Issues and Extent of Problems
Interviews • Primary and pressing healthcare issues facing their community • Obesity • Tobacco use both by adults and students
Interviews • Extent of Problem: Unhealthy Eating/Physical Activity • Participants rated obesity as a 7-8 and • Tobacco use at a 5-6. • A number of participants indicated that community member groups at risk included students and kids uninvolved in sports activities. • One participant indicated that the area is highly unbalanced when thinking of socio-economic status, they stated “If you are not living in a trailer you’re living in a half million dollar place on the lake.”
Interviews • Confluence of factors negatively impacting healthy eating and physical activity in Mahnomen County: • Food costs • cheap, fast, unhealthy food is what people want • Food vendors offer poor choices • Culture of inactivity • Lack of supports for those seeking to become healthier • Lack of parent time/interest in children’s’ weight and activity
Interviews • One convenience store clerk respondent stated “I feel bad when people come into the store and say, I need my fruit for the day” when buying Starburst candy.
Interviews • Extent of Problem: Tobacco • A number of interviewees already were implementing tobacco use policies or seeing their results. • “It seems like everywhere you go you see groups of 10-11 people smoking.” • “Why should I quit?”
Interviews • Comments from interviewers…
Recommendations Best Options for Addressing Overweight, Physical Activity and Tobacco Use in Adults and Youth
Intervention Settings Community Worksites Schools Tobacco Use and Obesity Healthcare
Recommendation: Increase Adult Physical Activity COMMUNITY/WORKSITE SETTING INTERVENTIONS • Policies and practices that create active communities • Increase opportunities for non-motorized transportation (walking and biking) • Increase access to community recreation facilities. • Implement signage prompting use of stairs in community buildings. • A comprehensive employee wellness initiative • Provide health assessment with follow-up coaching, • Provide ongoing health education, • Provide policy and environmental supports that promotes healthy weight and behaviors. • HEALTHCARE SETTING INTERVENTIONS • Develop relationships among health care providers and community leaders to facilitate active referral of patients to resources that increase access to nutritious foods, physical activity, and tobacco use cessation.
Recommendation: Nutrition & Physical Activities for Youth • SCHOOL SETTING INTERVENTIONS • Comprehensive nutrition policies: • Breakfast promotion; • Healthy lunch and snacks; • School gardens; • Farm-to-school initiatives. • Creating more active schools through: • Supporting quality school-based physical activity • Increasing opportunities for non-motorized transportation • Increased access to school recreation facilities. • COMMUNITY SETTING INTERVENTIONS • Improving access to nutritious foods (e.g. fruits, vegetables) through: • Increased availability and affordability of nutritious foods in grocery stores, corner stores, concession facilities, and other food vendors. • License and facilitate the development of new farmer’s markets and promote their use.
Recommendation: Decrease Tobacco use by Youth • COMMUNITY SETTING INTERVENTIONS • Tobacco-free policies for parks, playgrounds, beaches, zoos, fairs, and other recreational settings. • Policies that restrict youth access to tobacco such as sales laws directed at tobacco retailers to reduce illegal sales to minors. • HEALTH CARE SETTING INTERVENTIONS • Better connect people with existing effective cessation services (such as the 5 A’s and fax referral).
Recommendation: Collect Better Data • Conduct BRFSS locally within each of the eight counties to obtain a more accurate accounting of the adult population risk factors within northwest Minnesota.
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