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State of the Problem:State of the Problem:Cleveland CommunityCleveland Community
Natalie Colabianchi, Ph.D.Natalie Colabianchi, Ph.D.Department of Epidemiology and Department of Epidemiology and
BiostatisticsBiostatisticsCase Western Reserve UniversityCase Western Reserve University
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Obesity Trends* Among U.S. Adults BRFSS,Obesity Trends* Among U.S. Adults BRFSS, 19941994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC
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Source: Behavioral Risk Factor Surveillance System, CDC
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Obesity Trends* Among U.S. Adults BRFSS,Obesity Trends* Among U.S. Adults BRFSS, 20022002
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Percentage of U.S. Children and Percentage of U.S. Children and Adolescents Who Were Overweight*Adolescents Who Were Overweight*
02468
1012141618
1963-70* *
1971-74 1976-80 1988-94 1999-2000
Ages 12-19
Ages 6-1154
* >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 ageSource: National Center for Health Statistics
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02468
1012141618
1963-70* *
1971-74 1976-80 1988-94 1999-2000
Ages 12-19
Ages 6-1154
16
15
* >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 ageSource: National Center for Health Statistics
Percentage of U.S. Children and Percentage of U.S. Children and Adolescents Who Were Overweight*Adolescents Who Were Overweight*
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The Local PictureThe Local Picture
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Adolescent Data SourceAdolescent Data Source
Adolescent data comes from the Center for Adolescent data comes from the Center for Adolescent Health (CAH)Adolescent Health (CAH)
The survey instrument used was the Youth Risk The survey instrument used was the Youth Risk Behavior Survey (YRBS) developed by the CDCBehavior Survey (YRBS) developed by the CDC
Data was collected in 2002 from the inner-ring high Data was collected in 2002 from the inner-ring high schoolsschools
Data from the CMSD is being collected this month Data from the CMSD is being collected this month Outer-ring data was collected but it is not Outer-ring data was collected but it is not
representativerepresentative Comparison data: 1999 State-wide YRBS data & Comparison data: 1999 State-wide YRBS data &
2001 National YRBS data2001 National YRBS data
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Adolescent SampleAdolescent Sample
Eleven of the fifteen inner-ring high schools Eleven of the fifteen inner-ring high schools participated participated (73.3% school response rate)(73.3% school response rate)
3428 students participated3428 students participated (78.6% response rate)(78.6% response rate)
Data were weighted to be representative of Data were weighted to be representative of adolescents in the inner-ring schoolsadolescents in the inner-ring schools
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Sample CharacteristicsSample Characteristics
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Format of SlidesFormat of Slides
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Body Mass Index Body Mass Index in the 85th Percentilein the 85th Percentile
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Body Mass Index Body Mass Index in the 95th Percentilein the 95th Percentile
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No Physical Activity in Past WeekNo Physical Activity in Past Week
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Attend Physical Education Class in Attend Physical Education Class in an Average Weekan Average Week
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Two Hours or Less of TV Viewing Two Hours or Less of TV Viewing on School Dayson School Days
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Ate Three or More Servings of Ate Three or More Servings of Vegetables Per DayVegetables Per Day
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Ate Two or More Servings of Fruit Ate Two or More Servings of Fruit Per DayPer Day
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Adult DataAdult Data
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Adult Data SourceAdult Data Source
Adult data comes from the Center for Health Adult data comes from the Center for Health Promotion Research (CHPR) and the Promotion Research (CHPR) and the Cuyahoga County Board of HealthCuyahoga County Board of Health
The survey instrument used was the The survey instrument used was the Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System (BRFSS) developed by the CDC(BRFSS) developed by the CDC
Data was collected in 2003 from Cleveland Data was collected in 2003 from Cleveland and Cuyahoga Countyand Cuyahoga County
Comparison data: 2002 BRFSSComparison data: 2002 BRFSS
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Adult SampleAdult Sample
1,144 people participated 1,144 people participated 43.4% response rate (CASRO)43.4% response rate (CASRO) Weighted to be representative of Cuyahoga Weighted to be representative of Cuyahoga
CountyCounty
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Adult Sample CharacteristicsAdult Sample Characteristics
MalesFemales
WhiteAAOther
0
5
10
15
20
25
30
35
18-34 35-49 50-64 65+
18-3435-4950-6465+
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Obese (BMI of 30 or more)Obese (BMI of 30 or more)
22.1 23 22.1 20.7 23.4
37
16.720.7 20.9
27.4 22.3
0102030405060708090
100
Cuyahoga County Ohio National male female AA white 18-34 35-49 50-64 65+
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Overweight (BMI>=25 and <30)Overweight (BMI>=25 and <30)
34.8 35.8 3740.9
29.335.9
30.5 27.5
40.3 37.4 36
0102030405060708090
100
Cuyahoga County Ohio National male female AA white 18-34 35-49 50-64 65+
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Overweight or ObeseOverweight or Obese
56.9 58.8 59.2 61.652.7
67.6
52.5 48.1
61.1 64.958.2
0102030405060708090
100
Cuyahoga County Ohio National male female AA white 18-34 35-49 50-64 65+
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SolonParma
Strongsvil le Brecksville
Euclid
Westlake
North Royalton
BereaOlmsted T.
Broadview Hts.
Gates Mills
North Olmsted
BedfordBrook Park
Independence
Garfield Hts.
Pepper Pike
Walton Hills
Cleveland Hts.
Lakewood
Shaker Hts.
Middleburg Hts.
Moreland HillsOrange
Riverside
Brooklyn
Valley View
Hunting Valley
Maple Hts.
Mayfield
Beachwood
Old Brooklyn
Lyndhurst
Seven Hills
Bay Village
Rocky River
Highland Hts.
South Euclid
Parma Hts.
Oakwood
Bedford Hts.
Fairview Park
Mayfield Hts.
Tremont
Central
Hough
Lee-Miles
Jefferson
Olmsted Falls
Richmond Hts.
Glenville
Downtown
Glenwillow
Kamms Corners Warrensville Hts.
Bentleyville
CorlettSouth Broadway
Cuyahoga Hts.
East Cleveland
Kinsman
Fairfax
Puritas-Longmead
Cudell
North Collinwood
Chagrin Falls
University
Mt. Pleasant
Highland Hills
South Collinwood
Brooklyn Hts.
Forest Hills
Stockyards
University Hts.
Detroit Shoreway
Union-Miles Park
North Broadway
Euclid Green
Brooklyn Centre
Industrial ValleyEdgewater
St. Clair-Superior
Woodland Hills
Goodrich/Kirtland Park
North Randall
Chagrin Falls T.Woodmere
Linndale
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SolonParma
Strongsvil le Brecksville
Euclid
Westlake
North Royalton
BereaOlmsted T.
Broadview Hts.
Gates Mills
North Olmsted
BedfordBrook Park
Independence
Garfield Hts.
Pepper Pike
Walton Hills
Cleveland Hts.
Lakewood
Shaker Hts.
Middleburg Hts.
Moreland HillsOrange
Riverside
Brooklyn
Valley View
Hunting Valley
Maple Hts.
Mayfield
Beachwood
Old Brooklyn
Lyndhurst
Seven Hills
Bay Village
Rocky River
Highland Hts.
South Euclid
Parma Hts.
Oakwood
Bedford Hts.
Fairview Park
Mayfield Hts.
Tremont
Central
Hough
Lee-Miles
Jefferson
Olmsted Falls
Richmond Hts.
Glenville
Downtown
Glenwillow
Kamms Corners Warrensville Hts.
Bentleyville
CorlettSouth Broadway
Cuyahoga Hts.
East Cleveland
Kinsman
Fairfax
Puritas-Longmead
Cudell
North Collinwood
Chagrin Falls
University
Mt. Pleasant
Highland Hills
South Collinwood
Brooklyn Hts.
Forest Hills
Stockyards
University Hts.
Detroit Shoreway
Union-Miles Park
North Broadway
Euclid Green
Brooklyn Centre
Industrial ValleyEdgewater
St. Clair-Superior
Woodland Hills
Goodrich/Kirtland Park
North Randall
Chagrin Falls T.Woodmere
Linndale
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No Leisure Time Physical ActivityNo Leisure Time Physical Activity
18.825.4 24.4
16.321
28.2
15.6 13.5 17.5 18.2
28.6
0102030405060708090
100
Cuyahoga County Ohio National male female AA white 18-34 35-49 50-64 65+
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SolonParma
Strongsvil le Brecksville
Euclid
Westlake
North Royalton
BereaOlmsted T.
Broadview Hts.
Gates Mills
North Olmsted
BedfordBrook Park
Independence
Garfield Hts.
Pepper Pike
Walton Hills
Cleveland Hts.
Lakewood
Shaker Hts.
Middleburg Hts.
Moreland HillsOrange
Riverside
Brooklyn
Valley View
Hunting Valley
Maple Hts.
Mayfield
Beachwood
Old Brooklyn
Lyndhurst
Seven Hills
Bay Village
Rocky River
Highland Hts.
South Euclid
Parma Hts.
Oakwood
Bedford Hts.
Fairview Park
Mayfield Hts.
Tremont
Central
Hough
Lee-Miles
Jefferson
Olmsted Falls
Richmond Hts.
Glenville
Downtown
Glenwillow
Kamms Corners Warrensville Hts.
Bentleyville
CorlettSouth Broadway
Cuyahoga Hts.
East Cleveland
Kinsman
Fairfax
Puritas-Longmead
Cudell
North Collinwood
Chagrin Falls
University
Mt. Pleasant
Highland Hills
South Collinwood
Brooklyn Hts.
Forest Hills
Stockyards
University Hts.
Detroit Shoreway
Union-Miles Park
North Broadway
Euclid Green
Brooklyn Centre
Industrial ValleyEdgewater
St. Clair-Superior
Woodland Hills
Goodrich/Kirtland Park
North Randall
Chagrin Falls T.Woodmere
Linndale
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2114.5
25.2 18.8 22.515.2 16.2
21.230.9
0102030405060708090
100
Cuyahoga County Ohio National male female AA white 18-34 35-50 51-64 65+
* *
This information was not reported by the state of Ohio
This information was not reported in the National report**
Ate Two or More Servings of Fruit Ate Two or More Servings of Fruit Per DayPer Day
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SolonParma
Strongsvil le Brecksville
Euclid
Westlake
North Royalton
BereaOlmsted T.
Broadview Hts.
Gates Mills
North Olmsted
BedfordBrook Park
Independence
Garfield Hts.
Pepper Pike
Walton Hills
Cleveland Hts.
Lakewood
Shaker Hts.
Middleburg Hts.
Moreland HillsOrange
Riverside
Brooklyn
Valley View
Hunting Valley
Maple Hts.
Mayfield
Beachwood
Old Brooklyn
Lyndhurst
Seven Hills
Bay Village
Rocky River
Highland Hts.
South Euclid
Parma Hts.
Oakwood
Bedford Hts.
Fairview Park
Mayfield Hts.
Tremont
Central
Hough
Lee-Miles
Jefferson
Olmsted Falls
Richmond Hts.
Glenville
Downtown
Glenwillow
Kamms Corners Warrensville Hts.
Bentleyville
CorlettSouth Broadway
Cuyahoga Hts.
East Cleveland
Kinsman
Fairfax
Puritas-Longmead
Cudell
North Collinwood
Chagrin Falls
University
Mt. Pleasant
Highland Hills
South Collinwood
Brooklyn Hts.
Forest Hills
Stockyards
University Hts.
Detroit Shoreway
Union-Miles Park
North Broadway
Euclid Green
Brooklyn Centre
Industrial ValleyEdgewater
St. Clair-Superior
Woodland Hills
Goodrich/Kirtland Park
North Randall
Chagrin Falls T.Woodmere
Linndale
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Popular MediaPopular Media
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Men’s Fitness Rankings for the Top Men’s Fitness Rankings for the Top Fattest Cities in 2004Fattest Cities in 2004
1.1. DetroitDetroit2.2. HoustonHouston3.3. DallasDallas4.4. San AntonioSan Antonio5.5. ChicagoChicago6.6. Fort WorthFort Worth7.7. PhiladelphiaPhiladelphia8.8. ArlingtonArlington9.9. ClevelandCleveland10.10. ColumbusColumbus11.11. AtlantaAtlanta12.12. MesaMesa13.13. Oklahoma CityOklahoma City
14.14. Kansas CityKansas City15.15. MiamiMiami16.16. Las VegasLas Vegas17.17. IndianapolisIndianapolis18.18. PhoenixPhoenix19.19. TulsaTulsa20.20. MemphisMemphis21.21. New YorkNew York22.22. New OrleansNew Orleans23.23. BaltimoreBaltimore24.24. El PasoEl Paso25.25. WashingtonWashington
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Men’s Fitness Rankings for Men’s Fitness Rankings for ClevelandCleveland
20042004 9th 9th
20032003 6 6thth
20022002 13 13thth
20012001 9th 9th
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Men’s Fitness Ranking CriteriaMen’s Fitness Ranking Criteria
50 largest U.S. cities selected50 largest U.S. cities selected Assessed in 14 equally weighted categories: Assessed in 14 equally weighted categories:
gyms/sporting goods, nutrition, exercise, junk food, alcohol, gyms/sporting goods, nutrition, exercise, junk food, alcohol, TV, air quality, climate, overweight/sedentary, geography, TV, air quality, climate, overweight/sedentary, geography, commute, parks, recreational facilities, and health carecommute, parks, recreational facilities, and health care
Cities were ranked first to last and assigned Cities were ranked first to last and assigned numerical grades on a relative curve numerical grades on a relative curve
The scores were translated into letter grades The scores were translated into letter grades
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Cleveland’s Failing gradesCleveland’s Failing grades
We received a We received a ‘F’ ‘F’ on:on: Junk FoodJunk Food ClimateClimate Exercise/sports participationExercise/sports participation
We received a We received a ‘D’ ‘D’ on:on: Overweight/sedentaryOverweight/sedentary Air qualityAir quality GeographyGeography Parks and open spacesParks and open spaces
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Factors Associated Factors Associated with Obesitywith Obesity
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Adolescent DataAdolescent Data
665 students enrolled in the 7th grade 665 students enrolled in the 7th grade (ages 11-15)(ages 11-15)
Data from the CHPRData from the CHPR Three middle schools in ClevelandThree middle schools in Cleveland Race/ethnicity composition of the sample:Race/ethnicity composition of the sample:
WhiteWhite 25.6%25.6% African AmericanAfrican American 23.0%23.0% HispanicHispanic 49.5%49.5% OtherOther 2.0% 2.0%
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KnowledgeKnowledge
Restaurants typically serve two to three times Restaurants typically serve two to three times the normal portion sizethe normal portion size 32%32% said this was said this was TRUETRUE 15.6%15.6% said this was said this was FALSEFALSE 52.4%52.4% said they were said they were NOTNOT SURESURE
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MarketingMarketing
Eating 5-a-day means 1 meat, 1 milk, 1 grain, Eating 5-a-day means 1 meat, 1 milk, 1 grain, 1 fruit, and 1 vegetable1 fruit, and 1 vegetable 37.8%37.8% said this was said this was FALSEFALSE 33.5%33.5% said this was said this was TRUETRUE 28.7%28.7% said they were said they were NOT SURENOT SURE
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Social SupportSocial Support
57.8%57.8% of adolescents reported that, in the past 3 of adolescents reported that, in the past 3 months, their months, their friendsfriends RARELY or NEVER RARELY or NEVER encouraged them to shut off the TV or computer in encouraged them to shut off the TV or computer in order to do something physically activeorder to do something physically active
30.9%30.9% of adolescents reported that, in the past 3 of adolescents reported that, in the past 3 months, their months, their parentsparents RARELY or NEVER RARELY or NEVER encouraged them to shut off the TV or computer in encouraged them to shut off the TV or computer in order to do something physically activeorder to do something physically active
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Social SupportSocial Support
51.1%51.1% of adolescents reported that, in the past of adolescents reported that, in the past 3 months, their 3 months, their friendsfriends RARELY or NEVER RARELY or NEVER exercised with them or offered to exercise with exercised with them or offered to exercise with themthem
47.3%47.3% of adolescents reported that, in the past of adolescents reported that, in the past 3 months, their 3 months, their parentsparents RARELY or NEVER RARELY or NEVER exercised with them or offered to exercise with exercised with them or offered to exercise with themthem
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Social NormsSocial Norms
Over half of the adolescents (56.9%) believed Over half of the adolescents (56.9%) believed that the majority of students (i.e., 61% - 100%) that the majority of students (i.e., 61% - 100%) in their grade ate out at a fast food restaurant in their grade ate out at a fast food restaurant more than 2x a weekmore than 2x a week
In reality, 15% of adolescents ate out at a fast In reality, 15% of adolescents ate out at a fast food restaurant more than 2x a weekfood restaurant more than 2x a week
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EnvironmentEnvironment
Only Only 26.1%26.1% of adolescents reported that it was of adolescents reported that it was very safevery safe for them to play outdoors in their for them to play outdoors in their neighborhood with their friends without an neighborhood with their friends without an adult aroundadult around
46.7%46.7% felt it was felt it was somewhat safesomewhat safe 16.9%16.9% felt it was felt it was not very safenot very safe 10.2%10.2% felt it was felt it was not at all safenot at all safe
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SummarySummary
Current levels of overweight and obesity are a Current levels of overweight and obesity are a national crisis national crisis
Cuyahoga County is experiencing this crisis in Cuyahoga County is experiencing this crisis in both adult and adolescent populationsboth adult and adolescent populations
Most measures of overweight and obesity, Most measures of overweight and obesity, including physical activity are comparable to including physical activity are comparable to national and state estimatesnational and state estimates
Important sub-group differences existed across Important sub-group differences existed across these measures within the Countythese measures within the County
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SummarySummary
There are geographical differences in the adult There are geographical differences in the adult outcomes, which we might expect to see in outcomes, which we might expect to see in adolescents as well if the data were availableadolescents as well if the data were available
Attendance in physical education programs Attendance in physical education programs was low in Cuyahoga County and in the State was low in Cuyahoga County and in the State compared to National levelscompared to National levels
Some evidence that the built environment in Some evidence that the built environment in Cuyahoga County is conducive to being Cuyahoga County is conducive to being overweight or obeseoverweight or obese
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ConclusionConclusion
As we develop our community plan to combat this As we develop our community plan to combat this epidemic, we must address the social norms in our epidemic, we must address the social norms in our communitycommunity
Furthermore, we must consider the context in which Furthermore, we must consider the context in which this epidemic is occurring:this epidemic is occurring: The built environment (food availability, places to recreate, The built environment (food availability, places to recreate,
safety)safety) The neighborhood and school environment including peers The neighborhood and school environment including peers
(marketing, social norms and knowledge)(marketing, social norms and knowledge) The family environment (social support)The family environment (social support)
Lastly, we must capitalize on the progress we have Lastly, we must capitalize on the progress we have made to datemade to date
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Thank you!Thank you!
For electronic copies of the slides go to:For electronic copies of the slides go to:
http://epbiwww.cwru.edu/faculty/colabianchi.htmlhttp://epbiwww.cwru.edu/faculty/colabianchi.html