Application of the PRECEDE model to obesity prevention Sally Black, RN, PhD & Cayley Warner, RD Saint Joseph’s Unive

1. Application of the PRECEDE model to obesity prevention Sally Black, RN, PhD & Cayley Warner, RD Saint Joseph’s University INTRODUCTION In the United States, childhood obesity is becoming the greatest challenge of this century. A goal of Healthy People 2010 is to reduce the proportion of children and adolescents who are overweight or obese to 5% (Baseline=11%). In Pennsylvania, an estimated 18.2% of eighth grade students are overweight. 1 In 2003, the overall incidence of obesity was 24% with Hispanic (31%) and Black (23%) at highest risk compared to White children (16%) in New York City. 2 Frequencies of overweight and obese may be higher in inner city, minority youth. The purpose of this study was to plan and pilot a program to reduce childhood obesity in Philadelphia. Researchers and practitioners from Saint Joseph’s University investigated childhood obesity at environmental, educational, and policy levels and planned interventions. Major components of the project were a science based nutrition education program, critical media awareness, working with food manufacturers to influence marketing practices, and building a community playground to provide safe play opportunities for children. • PRECEDE PROCEED Phase 3: Behavioral and Environmental Diagnosis Phase 2: Epidemiological Diagnosis Phase 4: Educational and Organizational Diagnosis • Phase 5: Administrative And Policy Diagnosis Phase 1: Social Diagnosis • Predisposing Factors • Body image (size = power) • Perceived risk • Perceived susceptibility Series of health fairs (Black) • Health Problem • 27% Overweight or at risk • Heart disease • Hypertension • Type 2 diabetes • Cancer • Asthma • Altered glucose metabolism • Increased lipid levels • Low self-esteem • Depression • Social discrimination • Premature sexual development • Hip and joint problems Literature review (Swartz) • Behaviors • Food choices • Activity levels Needs Assessment to identify current behaviors (Logio) Health Promotion • Educational • Provide nutrition education (Cifelli & Reynolds) • Provide critical media awareness (Lazar) • Reinforcing Factors • Advice from health care providers • Community • Media is taking a more positive role Investigation of food advertising aimed at children (Lord) Quality of Life Physical and mental health and well being • Environment • Access to healthy foods • Access to safe play areas • Media influence • Family influence • Cultural influence GIS Mapping to geographically identify areas of higher obesity (Jambulingam) • Policy Regulation Organization • Consumer reactions to obesity information (Simmers) • Investor reactions to obesity information influences stock prices (Ghani) • Evaluation of current marketing practices to inform policy regulation (Childs) • Enabling Factors • Access • Skills • Knowledge Community playground (Brady & Black) Phase 6: Implementation Phase 9: Outcome Evaluation Phase 8: Impact Evaluation Phase 7: Process Evaluation FIGURE: The PRECEDE-PROCEED model3 applied to childhood obesity 1PA Department of Health, (2002). “Pennsylvania Assessment of Overweight Children and Youth.” 2Thorpe, L.E., List, D.G., Marx, T., May, L., Helgerson, S. D., and Frieden, T.R. (Sep 2004). Childhood Obesity in New York City Elementary School Students, Am J Public Health, 94: 1496 – 1500 3Green, Kreuter, Deeds, & Partridge (1980). Health Education Planning: A Diagnostic Approach. Mountain View, CA: Mayfield. Research projects funded by Centers for Disease Control, Chronic Disease Prevention & Promotion Division