estilos de vida en jóvenes de la ciudad de toluca y metepec · “aliviánate, sacude tu vida”:...

“Aliviánate, Sacude

tu

vida”:

promoting positive attitudes toward physical activity

and drinking water among youth aged 14‐ 18 in the State of Mexico.”

Pilot project for overweight and obesity prevention

among adolescents in Mexico (2010).

Pamela FauraCountry DirectorPopulation Services International MéxicoEmail: [email protected]

Overweight and Obesity in Mexico::

Mexico ranks 1st worldwide for adult and childhood obesity (OECD)

::

30% of Mexican adults are obese and 70% are overweight

::

Being

overweight/obese

has

strongly

increased

the

risk

of

Mexicans

to

develop chronic diseases such as diabetes, hypertension, etc.

:: The evolution of lifestyles in Mexico such as decreased physical

activity,

increased

availability

of

affordable

food

items

with

high

sugar

and

fat

content,

changes

in

food

consumption

patterns

(more

solitary,

more

frequent, larger quantities)

has made obesity a complex health issue

Why work with teens?::

The

Mexican

government

has

developed

different

strategies

to address this new epidemic:•

Legislation

•

National and State level prevention plans for chronic diseases

•

Publicity campaigns (national and state levels)

::

Initiatives designed directed at younger children and adults

::

Little

or

no

strategies

developed

for

adolescents

(they

do

not

have a clue how to reach them)

::

Adolescents

are

a

national

priority.

PSI’s

focus

on

teens

was

welcomed

Project Objective

Objective

of

the

pilot:

Design

and

implement

a

campaign

aimed

at

preventing

overweight

and

obesity

in

adolescents

14

to

18

years

old

in

Toluca,

State

of

Mexico,

by

promoting

active life styles and healthy dietary choices, specifically:

::

Increased physical activity

::

Increased water intake

Project Phases

Designing the intervention

Implementingthe intervention

Understanding the audience

Monitoring &Evaluation

• Literature review

• PEER & In-depth interviews

• Analysis of select teen advertisements

• FoQus w/ programmers

• conceptual frameworks w/ Dr. Tilly Gurman

• DELTA w/ programmers

“Aliviante,

sacude tu vida”Registration data

Prospective case- control (Quasi- experimental) study

1. Understanding the Audience: PEER Findings

:: Water takes away the thirst and makes you feel healthier

:: It helps you lose weight

:: It is easier to drink water than to do physical activity

Water

Physical Activity

:: Doing physical activity is a way to socialize

:: Sometimes it’s fun to do physical activity

:: It makes you more attractive and helps your self-esteem

Water

Physical Activity

:: Water makes you go to the bathroom and has no flavor

:: Friends and family prefer soft (sugary) drinks

:: There is limited access to potable water

:: There are no places to exercise nor a variety of activities to do

:: Going to the gym is expensive

:: Friends and family do not exercise

:: They make fun of you when you do physical activity

:: Doing physical activity hurts and makes you sweaty

1. Understanding the Audience: PEER Findings

:: Water takes away the thirst

:: It refreshes you after doing physical activity

Water

Physical Activity

:: Physical activity lets you compete with other youth and makes you feel like a “big shit”

:: It lets you socialize with other youth

:: It makes you feel healthier

:: It’s fun and makes you more attractive (to the opposite sex)

Physical Activity

:: Water has no flavor

:: Friends and family prefer soft (sugary) drinks

:: There is limited access to potable water

:: There are limited spaces to do physical activity

:: When you do physical activity they make fun of you and your body hurts

:: There aren’t a variety of activities to do and there’s no time to do them

1. Understanding the Audience: Analysis of Ads

MARKET RESEARCH AGENCY analyzed 5 Ads that target teens: Coca Cola, Sprite, Converse, Saba (sanitary napkins) and Asepxia (medicated make-up):

• Do not dream about revolutions or conspiracies; nor do they feel the need to rebel against adults

• Theirs is a digital world that permits experimentation, control, freedom and helps their self-esteem

• They want to look and feel good about themselves• Psychological needs: express themselves,

individuality, freedom and acceptance• They show a capacity to get ahead in spite of

adversities• Their relationship to brands is more emotional

than functional; they seek personalization and a spirit of co-creation and have a desire to define their own style

2. Designing the Intervention: Conceptual Framework: Physical ActivityContextual

Factors

• Stigmatization of obesity• Influence of the mass media•Commercialization of food• Urbanization• Public politics against obesity • Socioeconomic inequality • Social norms around gender • Smoking and alcohol consumption by adolescents• Obesogenicenvironment

Offer of physical activities

in the schools

Importance of social networks

Importance of family

Spaces to do physical activity

Subjective Norms

Knowledge about physical activity

Self-perception ofbody image

Concern for physical

appearance

Expectations for results

Perception of available time

Time spent w/ media world

Perception of physical activities

available

Attitudes toward physical activity

Self-efficacyIntention

Physical activity

2. Designing the Intervention: Conceptual Framework: Water Intake

Knowledge about beverages

Regulation of drink and food in the schools

Availability of potable water

Importance of social networks

Importance of family

Subjective norms

Self-perception of body image

Concern for physical

appearance

Expectations for results

Attitudes toward drinking water

Self-efficacyIntention

Contextual Factors

• Stigmatization of obesity• Influence of the mass media•Commercialization of food• Urbanization• Public politics against obesity • Socioeconomic inequality • Social norms around gender • Smoking and alcohol consumption by adolescents• Obesogenicenvironment

Replacement of sugary drinks with water

2. Designing the Intervention: DELTA Category MapBEHAVIOR: PHYSICAL ACTIVITY AND DRINKING (NON-SUGARY) WATER

ARCHETYPES María Fernanda Diego

POSITIONING STATEMENT

For Maria Fernanda, participating in the Aliviánate program will allow her to experiment different physical activities to help take care of her body. Doing these activities she will have fun and socialize with other youth. Taking part in the program will allow her to break her daily routine. For Maria Fernanda, participating in the Aliviánate program offers her the opportunity to satisfy her thirst and feel good, without the guilt of drinking sugary drinks.

For Diego, participating in the Aliviánate program will allow him to try different physical activities to keep in shape. Doing these activities he will have fun, compete and socialize with other youth. Taking part in the program will allow him to break his daily routine. For Diego, participating in the Aliviánate program offers him the opportunity to satisfy his thirst and refresh himself, as well as learn about the benefits of water over sugary drinks.

FRAME OF REFERENCE Other methods to prevent obesity

POINT OF PARITY FUNCTIONAL Active behaviors of youth

POINT OF DIFFERENTIA-

TION

FUNCTIONAL Water satisfies the thirst and replaces sugary drinks

EMOTIONAL The varied and fun physical activities that are offered in the program makes socializing with other youth easier and takes into account their preferences

PERSONALITY

Natural, part of their reality, like them; free expression, not imposing, says what’s on their mind; inclusive, everyone fits in and is invited; dynamic, not single-minded, seeking new things

2. Designing the Intervention: DELTA – 4 P’sPRODUCT PRICE PLACE PROMOTION

- Define brand, image and personality

- Define activities

- Define contest dynamicsincluding criteria forparticipation and winning

- Highlight Alivianateattributes making them respond to youthful characteristics

- Hire Ad firm to design brand and image

- Transmit non-monetary cost of not participating in the Alivianate program(will not have fun, will not meet other youth their age, will be bored at home following their same routine)

- Reduce barriers that could cost participating in Aliviánate, i.e.:

1. Monetary2. Time3. Effort4. Psychological factors

- Define “push” strategy to advertise to youth at schools, places ofsocialization, local PSI Office and via web page)

- Define attention-getting “push” strategy using GIOsto attract youth to register,using GIOs (attractiveyouth hired to interact withthe youth to promote theevent and key messages), and peer promoters to visit to schools and placeswhere youth socialize and via web page

- Ad agency design positioning strategy of promotional campaign

- Promotional strategy based on the concept of “experimentation”. Communicate about trying different physical activities, having fun and meeting other youth

2. Designing the Intervention: Strategy

•

Based

on

what

was

discovered

we

designed

a

pilot

project

where

youth

could

discover

that

doing

physical

activity

can

be

fun and diverse. Where they would have the opportunity to be

creative, express their ideas and meet other youth.

•

WE would offer youth the opportunity to explore doing different

types

of

physical

activities

under

one

roof

and

provide

information

on

the

importance

of

drinking

water

and

doing

physical activity as part of their daily lives.

Purpose: :: Increase frequency of physical activity reported the week prior to the

survey:: Increase the amount of water intake reported the week

prior to the survey:: Decrease the amount of soft drink intake reported the week prior

to the

survey

Results:::

Increase positive attitudes toward water intake and physical activity

::

Increase knowledge about the importance of drinking water instead of any

other beverage

::

Decrease myths about physical activity

::

Increase

intention

to

do

more

physical

activity

and

drink

more

water

instead of soft drinks

2. Designing the Intervention: Logical Framework Indicators

3. Implementation: The Campaign

3. Implementation: The Event

4. Monitoring & EvaluationProspective case‐control study: Face to face survey

Intervention group (youth who

attended Alivianate event)

Control group (youth in select

public schools who did not

attend Aliviante event)

Base line data collection

At event registration (Sept 2010) n= 209 At schools (Sept 2010)n=509

Data collection post‐exposureOct 2010 n= 168 Oct2010 n= 235

* p=0.002

Intervention Comparison

16.3

19.5

10.3

17.5

Drank more than 3 litter of soft drinks last week. . Percentages among Comparison and Intervention Groups Before and After Alivianate Event.

Youth Aged 14‐18 years. Toluca‐Estado de Mexico (2010)

Pre‐Intervention Post‐intervention

*

n.s.

4. Monitoring & Evaluation

Item measure on 1-4 scaled where: 1 is strongly disagree; 2 is disagree; 3 is agree; 4 is totally agree * p=0.000

Intervention Group Comparison Group

3.223.18

3.49

3.23

It is not difficult for me to do phyisical activity. Means among Comparison and Intervention group Before and After Alivianate Event.

Youth Aged 14‐18 years. Toluca‐Estado de Mexico (2010)


*n.s.


* p=0.002

3.19

3.39

3.333.28


I DO like to drink water . Means among Comparison and Intervention group Before and After Alivianate Event. Youth Aged 14‐18 years.

Toluca‐Estado de Mexico (2010)


*

n.s.



3.34

3.47

3.21 3.21


I’d like to have more time a week to do physical activity . Means among Comparison and Intervention Groups Before and After

Alivianate Event. Youth Aged 14‐18 years. Toluca‐Estado de Mexico (2010)


*

n.s.



* p=0.002

* p=0.005

50.0

63.0

47.056.0


Drinking bottled juices increases my chance of being overweighted. Percentages among Comparison and Intervention Groups Before and After Alivianate Event. Youth Aged 14‐18 years. Toluca‐Estado de

Mexico (2010)


*n.s.


47.9

67.3

49.950.2


For being healthy I DO NOT need to do more than one hour of physical activity everyday. Percentages among Comparison and Intervention Groups Before and After Alivianate Event. Youth Aged 14‐18 years.

Toluca‐Estado de Mexico (2010)


*n.s.

* p=0.00


48.0

60.6

47.252.8


A person with lots of duties NOT necessarily is an active person. Percentages among Comparison and Intervention Groups Before and After Alivianate Event. Youth Aged 14‐18 years. Toluca‐Estado de

Mexico (2010)


* n.s.

* p=0.004


Conclusions

Comparing

Participants

vs.

Non‐participants

in

time

t0–t1,

we

can

conclude that after attending the event, youth:

1.

Increased

their

positive

attitudes

toward

water

intake

and

physical

activity. Specifically, they report more agreement with the phrases:

‐

It is not difficult for me to do physical activity

‐

I’d like to have more time every week to do physical activity

‐

I like to drink water

2.

Increased

their

knowledge

about

the

negative

effects

of

drinking

bottled juices and about what being physical active means

3.

Reported a decrease in soft drink consumption

Lessons Learned

Research and Evaluation::

Active

effort

is

needed

to

recruit

overweight

youth

in

order

to

ensure

their

points

of

view and interests are adequately reflected::

Conducting the baseline during registration at the Event could bias answers::

Having

a

small

sample

size

reduces

the

opportunity

To

show

significant

differences

in

key indicators::

It

is

possible

that

youth

respond

per

their

social

norms,

creating

a

bias

in

the

results;

designing a tool that overcomes this factor to improve the quality of data is a challenge

Implementation:: Do not underestimate the need for or time required to obtain high level authorizations :: Do not adapt the intervention strategy to the research design; in the end we could only

measure change in knowledge, attitude and intention, not behavior:: Invest money and time in a BTL, attention‐getting promotion campaign; do not rely on

social networks alone::

Due

to

the

complex

nature

of

the

issue

with

teens,

a

comprehensive

program

would

ideally involve peer counseling, nutrition and psychological support over time

estilos de vida en jóvenes de la ciudad de toluca y metepec · “aliviánate, sacude tu vida”:...

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