State of the Problem: Cleveland Community

1. State of the Problem:Cleveland Community Natalie Colabianchi, Ph.D. Department of Epidemiology and Biostatistics Case Western Reserve University

2. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC

3. 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% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC

4. Percentage of U.S. Children and Adolescents Who Were Overweight* Ages 12-19 5 4 Ages 6-11 * >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

5. Percentage of U.S. Children and Adolescents Who Were Overweight* 16 15 Ages 12-19 5 4 Ages 6-11 * >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

6. The Local Picture

7. Adolescent Data Source • 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

8. Adolescent Sample • Eleven of the fifteen inner-ring high schools participated • (73.3% school response rate) • 3428 students participated • (78.6% response rate) • Data were weighted to be representative of adolescents in the inner-ring schools

10. Sample Characteristics

11. Format of Slides

12. Body Mass Index in the 85th Percentile

13. Body Mass Index in the 95th Percentile

14. No Physical Activity in Past Week

15. Attend Physical Education Class in an Average Week

16. Two Hours or Less of TV Viewing on School Days

17. Ate Three or More Servings of Vegetables Per Day

18. Ate Two or More Servings of Fruit Per Day

19. Adult Data

20. 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

21. Adult Sample • 1,144 people participated • 43.4% response rate (CASRO) • Weighted to be representative of Cuyahoga County

22. Adult Sample Characteristics

23. Obese (BMI of 30 or more)

24. Overweight (BMI>=25 and <30)

25. Overweight or Obese

29. No Leisure Time Physical Activity

31. Ate Two or More Servings of Fruit Per Day * This information was not reported by the state of Ohio This information was not reported in the National report *

33. Popular Media

34. Detroit Houston Dallas San Antonio Chicago Fort Worth Philadelphia Arlington Cleveland Columbus Atlanta Mesa Oklahoma City Kansas City Miami Las Vegas Indianapolis Phoenix Tulsa Memphis New York New Orleans Baltimore El Paso Washington Men’s Fitness Rankings for the Top Fattest Cities in 2004

35. Men’s Fitness Rankings for Cleveland 2004 9th 2003 6th 2002 13th 2001 9th

36. 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

37. 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

38. Factors Associated with Obesity

39. 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 25.6% • African American 23.0% • Hispanic 49.5% • Other 2.0%

40. 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 NOTSURE

41. 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

42. 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

43. 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

44. 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

45. Environment • Only 26.1% of adolescents reported that it was very safefor 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

46. 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

47. 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

48. 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

49. Thank you! For electronic copies of the slides go to: http://epbiwww.cwru.edu/faculty/colabianchi.html