ClicktoeditMaster/tlestyleAreWeMakingProgressinChildObesityinTexas?Resultsfromthe2015-2016SPANStudy

DeannaM.Hoelscher,PhD,RD,LD,CNS,FISBNPATheUniversityofTexasHealthScienceCenteratHouston

(UTHealth)SchoolofPublicHealthinAusSnMichael&SusanDellCenterforHealthyLiving

WHATISLIVESMARTTEXAS?

LiveSmartTexas(LST)isacoalitionoforganizationsandindividualswhoworktogethertoaddressthestate’sobesityepidemic,especiallyinchildren.Foundedin2007withtheidea

thatittakesmorethanonevoicetoenactchange,LSTmembersrepresentinterdisciplinarysectorsincluding:policy/

advocacy,education,government,academia/research,professionalassociations,andlocalcommunitygroups.

LSTTexasHealthServiceRegions

MembersofLSTworkcollaborativelyto:

   ConnectandbuildrelationshipswithotherswhoshareacommonvisiontoreduceobesityratesinTexas

   Accessopportunitiestoengageincollaborativeresearchandcommunitypartnerships

   Sharebestpracticeswithandlearnfromtheexperienceofothercoalitionmembers

   Createaunitedobesitypreventionpolicyagenda

   ShareandbringresourcestoaddressconcernsthataffecteveryregionofTexas

LSThasregionalrepresentativesfromalleightTexasHealthServiceRegions(seemap)andisledbyDrs.DianeDowdyandHodaSana.

ClicktoeditMaster/tlestyleToday’sPresenta/on

•  SPANBackground•  Measures•  Preliminaryresults

– Obesity– Dietarybehaviors– Physicalac/vitybehaviors– Otherbehaviors

•  Conclusions/Implica/ons

ClicktoeditMaster/tlestyleq  Comple/onoftheSchoolPhysicalAc/vityandNutri/on(SPAN)reportwas

supportedbytheHealthResourcesandServicesAdministra/on(HRSA)oftheU.S.DepartmentofHealthandHumanServices(HHS)underGrantNumberB04MC2937,TexasTitleVMaternalandChildHealthServices.Addi/onalfundingwasprovidedbytheMichael&SusanDellFounda/onthroughtheMichael&SusanDellCenterforHealthyLiving.

q  Otheracknowledgements:DSHSOfficeofBorderHealth;UTSPHcampuses;DSHSRegion4/5CommunityOutreachDivision;DSHSRegional9/10;AreaHealthEduca/onCenters(AHEC):DesertMountainAHEC,GreaterHoustonAHEC,LowerRioGrandeAHEC,PanhandleAHEC,WestTexasAHEC;CityofElPasoDepartmentofPublicHealth;UTHealthSchoolofNursing;UTHealthScienceCenterRegionalCampus,Laredo;UTTylerNursing

q  Thankyoutotheschooldistricts,schools,children,andparentswhopar/cipatedinthestudy!

Acknowledgements

ClicktoeditMaster/tlestyle•  UTHealthSPH

–  Inves/gators:•  DeannaHoelscher,PhD,RD,PI•  NaliniRanjit,PhD,Co-PI•  AdrianaPerez,PhD

–  ProjectDirector:•  CarolynSmith

–  ResearchCoordinators:•  AlisonMassie,DrPH•  BlancheGreene-Cramer,DrPH

–  DoctoralStudents:•  EunMeCha•  LeighAnnGanzar•  AmandaReat

•  DSHSStaff:–  RamahLeith–  JeremyTriplef–  DebraSaxton–  NatalieArcher

•  UTHealthSPHStaff:–  ShadyAl-Sayyed–  GregChidoAmajuoyi–  MarlonArmstrong–  AidaCerda-Prazak–  JamesCuster–  KynaFarmer–  JohannahFrelier–  TiaraJackson–  Chris/neJovanovic–  RajaMalkani–  ClaireNiday–  DinaSanchez–  KeithWinters

SPANResearchTeam

ClicktoeditMaster/tlestyleq  SchoolPhysicalAc/vityandNutri/on(SPAN)Project.q  SPANisasurveillancesystemthatmonitorstheprevalenceofand

seculartrendsinoverweightandobesityinschoolchildreninTexas.

q  SPANiden/fiesotherobesity-relatedfactorsinTexasstudents.q  Informa/onfromSPANwillassistinthedevelopmentoftargeted

programsandpoliciestoaddressoverweightandobesityamongTexasyouth.

q  SPAN2015–2016isthefourth/methestate-wideprojecthasbeenconducted.

WhatisSPAN?

ClicktoeditMaster/tlestyleOverviewofSPANSurveys&Data

Survey Grades HSR’s Other

SPAN2000-2002 4,8,11 1,3,5,7,11,2,4,6,8,9/10

SPAN2004-2005 4,8,11 1,2/3,4/5N,6/5S,7,8,9/10,11

9coun/es

SPAN2009-2011 4,8,11,4thparents 1,2/3,4/5N,6/5S,7,8,9/10,11,border/non-border

Schoolhealthpolicysurvey,CIP

SPAN2015-2016 2,4,8,11 1-9/10,2/3,4/5N,6/5S,7,8-11,border/non-borderforgrades4,8,11

Schoolhealthpolicysurvey,CIP,vendingmachineaudits,signageobserva/on

ClicktoeditMaster/tlestyleq Objec/velymeasuredheightandweightforstudentsfrom2nd,4th,8th,

and11thgrades

q  Aself-reportques/onnaireadministeredtostudentsof4th,8th,and11thgradesq  Demographics,diet,andphysicalac/vityprac/cesandknowledge

q  Atakehomesurveyforparentsof2ndgradestudentsq  Informa/ononthechild’sdietandac/vity,aswellasparentalprac/cesandrules

rela/ngtodietandphysicalac/vity

DataCollectedDuringSPAN

ClicktoeditMaster/tlestyleq Mul/stage,probability-basedsurvey.

q  SPANisdesignedtoyieldrepresenta/vedataattheTexasstatelevel,healthserviceregion(HSR),andattheTexas-Mexicoborderandnon-borderareas.

q  Samplingweightsareavailableforeachlevelofrepresenta/on.

q  Coun/esdesignatedasborderornon-borderaccordingtoAr/cle4oftheLaPazAgreementof1983,whichdefinesacountyasabordercountyifthatcountyiswithin100KilometersoftheU.S./Mexicoborder.q  32coun/esmeetthiscriterioninTexas.

SamplingDesign

ClicktoeditMaster/tlestyleq  StrataweredesignatedbyHealthServiceRegionsurban/ruralareas

q  HealthServiceRegions:1-9/10,2/3,4/5N,6/5S,7,8/11q  Defini/onsfor“rural”and“urban”followDSHSdefini/ons

q  Thesamplingframeincluded:q  ListofeligibleschooldistrictsinTexasforfirststageofsampling

q  Listofschoolswithineachdistrictforthesecondstageq  Classroomswithineachschoolasthirdstage

q  PPSsampling,controllingforeconomicdisadvantageateachgradelevel,isusedforthefirsttwostages,andafixednumberofstudentsatthelaststage.

SamplingDesign

ClicktoeditMaster/tlestyleStatewidePar/cipa/on

q  HealthServiceRegions:1-9/10,2/3,4/5N,6/5S,7,8/11q  NumberofDistrictsSurveyed:70

q  NumberofSchoolsSurveyed:280

Students/ParentsParScipaSng

2015–2016PopulaSonRepresentaSon

2ndGradeParents 2,317 320,8004thGrade 6,180 315,2288thGrade 5,421 347,62011thGrade 3,635 311,668Total 17,553 1,295,316

ClicktoeditMaster/tlestyle

51.4 51.3 51.4 50.648.6 48.7 48.6 49.4

0

10

20

30

40

50

60

2 4 8 11

Boys Girls

GenderDistribu/onPe

rcen

tofstude

nts

Grade

ClicktoeditMaster/tlestyle

11.9 12.2 12.5 12.5

55.6 55.451.7 50.0

32.4 32.535.8 37.4

0

10

20

30

40

50

60

2 4 8 11

African-American Hispanic White/Other*

EthnicDistribu/onPe

rcen

tofstude

nts

Grade

*White/Otherincludesmul/-racialstudents.

ClicktoeditMaster/tlestyleMedianAgeMed

ianAg

e

Grade

6.8

8.9

13.0

16.0

0

2

4

6

8

10

12

14

16

18

2 4 8 11

ClicktoeditMaster/tlestyleq Weightstatuscategoriesforchildren2-19aredefinedusingBMI(kg/

m2)percen/lecutpointsontheCDCgrowthchartsq Underweightisdefinedas<5thpercen/leBMIq Healthyweightisdefinedas5thto<85thpercen/leBMIq Overweightisdefinedas85thto<95thpercen/leq Moderateobesityisdefinedas100-119%of95thpercen/leBMIq Severeobesityisdefinedas≥120%of95thpercen/leBMI

q  The“severe”obesitycategoryhasbeenrecentlydevelopedtoaccommodatetheinadequacyofpercen/leBMIincapturingriskatveryhighranges

WeightStatusinChildren

Source:Freedmanetal.,Obesity,2017

ClicktoeditMaster/tlestyleq Nutri/onandWeightStatusObjec/ve-10oftheHealthyPeople2020GoalsistoReducethepropor/onofchildrenandadolescentswhohaveobesityby10%.

q Thus,obesityprevalenceinchildrenages6-11shouldbereducedfrom17.4%to15.7%,andobesityprevalenceamongadolescentsage12-19shouldbereducedfrom17.9%to16.1%.

ObesityReduc/onGoals

ClicktoeditMaster/tlestyleWeightStatusbyGrade,SPAN2015-2016

3.1 1.8 2 2.5

60.354.1 57.3 57.8

14.117.9 16.5 19.5

14.1 17.9 15.1 13.58.2 8.8 9 6.7

0%10%20%30%40%50%60%70%80%90%

100%

2 4 8 11

Underweight HealthyWeight Overweight Obese SevereObesity

ClicktoeditMaster/tlestyleObesityTrends(2000-2016)Pe

rcen

tofstude

nts

0

5

10

15

20

25

30

2000-2002 2004-2005 2009-2011 2015-2016

Grade4 Grade8 Grade11

ClicktoeditMaster/tlestyle

24.622.3

19.5

30.1

26.228.9

0

5

10

15

20

25

30

35

4 8 11

Non-border Border

WeightStatusDistribu/onbyBorder/Non-borderCounty

Percen

tofstude

ntsw

hohaveob

esity

Grade

ClicktoeditMaster/tlestyle

Grade8

Grade11

Grade4

2000-2002 2004-2005 2009-2011 2015-2016

Lessthan15%

15–19.9%20–24.9%

25–29.9%

30–34.9%Above35%

PercentObese TexasSPANPercentObesebyHealthServiceRegion:Trendsfrom2000-2016

ClicktoeditMaster/tlestyleWeightStatusCategoriesbyGradeandRace/Ethnicity,SPAN2015-2016

68%

51%

54%

66%

15%

18%

14%

16%

17%

31%

32%

18%

Grade2

Grade4

Grade8

Grade11

AfricanAmerican

Healthy Overweight Obese

55%

50%

53%

55%

16%

18%

20%

23%

29%

32%

27%

23%

Grade2

Grade4

Grade8

Grade11

Hispanic

Healthy Overweight Obese

75%

67%

71%

66%

12%

17%

12%

16%

14%

16%

17%

18%

Grade2

Grade4

Grade8

Grade11

White/Other

Healthy Overweight Obese

ClicktoeditMaster/tlestyle2nd

grade 4th

grade 8th

grade 11th

grade

Percent that ate no vegetables in the previous day

26.8% 31.5% 33.6% 36.5%

Percent that ate no fruit in the previous day

12.7% 17.0% 21.8% 23.1%

Percent that consumed sugary beverages at least once in the previous day

53.4% 60.3% 60.7% 59.6%

Percent that ate sweet or salty snacks at least once in the previous day

87.2% 83.4% 87.4% 84.1%

Source:Michael&SusanDellCenterforHealthyLiving(2017).The2015-2016SchoolPhysicalAc5vityandNutri5on(SPAN)Survey,ReporttotheTexasDepartmentofStateHealthServicesTitleVMaternalandChildHealth.

DietaryPrac/cesofTexasSchoolChildren,byGrade,SPAN2015-2016

ClicktoeditMaster/tlestyleMeanNumberofTimesSpecificFoodGroupswereConsumedonPreviousDay,byGrade

ClicktoeditMaster/tlestyle2nd

grade 4th

grade 8th

grade 11th

grade

Mean days / week of at least 60 minutes PA

3.9 2.6 4.3 4.0

Percent that engaged in 60 minutes PA <= 1 day a week

26% 49% 14% 16%

Number of sports teams 0.7 1.2 1.5 1.2

Percent that are in any organized sports activity

47% 77% 73% 66%

Source:Michael&SusanDellCenterforHealthyLiving(2017).The2015-2016SchoolPhysicalAc5vityandNutri5on(SPAN)Survey,ReporttotheTexasDepartmentofStateHealthServicesTitleVMaternalandChildHealth.

PhysicalAc/vityPrac/cesofTexasSchoolChildren,byGrade,SPAN2015-2016

ClicktoeditMaster/tlestyleTimeSpentonTVandElectronicDevices,byGrade,SPAN2015-2016

ClicktoeditMaster/tlestyleDoYouHaveaTVintheRoomWhereYouSleep?Pe

rcen

tofstude

nts

Grade

47.0

35.629.7 28.7

52.9

64.470.3 71.3

0

10

20

30

40

50

60

70

80

2 4 8 11

No Yes

ClicktoeditMaster/tlestyleDoyouhaveacomputer,iPad®,tablet,phone,orgamingconsoleintheroomwhereyousleep?

Percen

tofstude

nts

Grade

63.5

31.2

20.8 21.5

36.0

68.8

79.2 78.5

0102030405060708090

2 4 8 11

No Yes

ClicktoeditMaster/tlestyle2015-2016SPANFactSheets

h`p://go.uth.edu/SPANSheets

ClicktoeditMaster/tlestyleConclusions

•  SchoolchildreninTexashavehighratesofobesity,andratesmightbeincreasing– Needtoincreaseourfocusonchildobesity

•  Therearedispari/esintheprevalenceofobesity,bysub-group,border/non-border,andHSR– Requiresmoreconcentratedefforts&resourcessuchasevidence-basedprograms&policy,systems,environmentalchanges

•  Increasesseemtoacceleratebetween2ndand4thgrades

ClicktoeditMaster/tlestyleConclusions•  DataattheHSRandborderregionareusefulforhelpingusiden/fytrendsandareasofgreaterneedtopriori/zeeffortsandresources

•  Asignificantnumberofchildrendonotconsumefruitsandvegetables(about1/3)onadailybasis

•  AsignificantnumberofchildrenhaveTVsorotherelectronics(phones,computers)intheirbedrooms

•  ….andthisisonlythebeginning…

ClicktoeditMaster/tlestyleContactInforma/on

DeannaM.Hoelscher,PhD,RD,LDDirector,Michael&SusanDellCenterforHealthyLivingUniversityofTexasHealthScienceCenteratHouston(UTHealth)SchoolofPublicHealth-Aus/nCampusDeanna.M.Hoelscher@uth.tmc.edu|512.391.2510www.msdcenter.org@deannahoelscher@msdcenter

ClicktoeditMaster/tlestyle

ClicktoeditMaster/tlestylePercentofChildrenwhohaveObesity,byGradeandHSR

Percen

tofchildrenwho

haveob

esity

0%

5%

10%

15%

20%

25%

30%

35%

1and9/10 2/3 4/5N 6/5S 7 8and11

2ndgrade 4thgrade 8thgrade 11thgrade