Formative Research for Obesity Prevention among Families In Missouri

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Formative Research for Obesity Prevention among
Families In Missouri

• Darcell P. Scharff, Ph.D.
• Susie Nanney, Ph.D., M.P.H., R.D.
• Shanica Alexander, M.P.H.
• Holly Bante, M.P.H.
• Michael Elliot, Ph.D.

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What is Formative Research?And How Do We Use it?

• Assessment and evaluation that occurs prior to
  program development
• Uses a variety of quantitative and qualitative
  methods to understand the community
• Allows for the creation of programs that are
  appropriate for the community and relevant to its
  needs/desires

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Purpose of this Formative Research

• To identify
• barriers to healthy lifestyles among families
• opportunities to create healthy lifestyles
• ideas/suggestions from the community to reduce
  and prevent obesity in families

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Methods
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Community Selection

• Interest
• Geographic representation throughout state
• Supportive policy environment for future
  programming
• Need
• Obesity prevalence
• Diabetes prevalence
• Hypertension prevalence
• Rates of inactivity

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Counties Chosen
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Methods Used to Collect Data
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Conceptual Framework

• Ecological model
• Individual barriers, facilitators, suggestions
• Social barriers, facilitators, suggestions
• School barriers, facilitators, suggestions
• Community barriers, facilitators, suggestions
• Policy
• Media

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Findings
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Demographic Description of Participants
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Yearly Family Income(Survey Participants n405)
Note Only 34 of focus group participants had gt
40,000 yearly income
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Barriers

• to Healthy Eating and Physical Activity

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Eating Patterns (Parent Survey)Scores Range from
1 (infrequent use) to 5 (frequent use)
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Risk Factors for Obesity (Parent Survey)
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Key Informants

• Individual level barriers
• Lack of awareness
• Lack of time
• Convenience
• They found out that when they had the church
  Wednesday get-together that a lot of younger
  people were not coming because they had to bring
  a dish. As soon as they started catering it in,
  all those families came.
• Social barriers
• Lack of parental modeling

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Key Informants (cont.)

• School barriers
• Serving unhealthy foods
• Vending machines as sources of revenue
• When did educators become so tied to the dollars
  that they are willing to throw sugary snacks at
  the kids who wont eat a healthy school lunch? I
  just cant understand that thinking. We might as
  well give them cigarettes.
• Reduced physical education and recess

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Key Informants (cont.)

• Community barriers
• Limited healthy food options
• High cost of healthy foods
• Low income
• We dont have a lot of the, you know tofu is
  next to impossible to find around here, the
  healthier choices that you can make. Fruits and
  vegetables are were in the Midwest, but there
  arent a lot of fresh vegetables in the winter
  time.
• Safety physical environment and crime

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6-10 year olds

• Individual level barriers
• Preferences look, smell, and taste
• Habits, not exposed
• Screen time frequently mentioned
• I think that video games are kind of addictive.
  You play it once and you want to play it again
  and again.

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6-10 year olds (cont.)

• Social barriers
• Parents dont buy healthy foods
• Because also, they cant have time to go to the
  store to buy healthy food because they are
  spending so much time and most of their money
  trying to fill up the tank.
• 32 eat meals alone or on the run
• Sugary drinks and sodas are most frequently
  consumed drinks at home (57) and with friends
  (60)
• School barriers
• Schools serve both healthy and unhealthy foods
• Pizza mentioned frequently (as both healthy and
  unhealthy food)

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11-13 year olds

• Individual level barriers
• Personal preference smell, taste, look
  packaging
• Screen time (35 report doing sedentary alone
  activities at home)
• Lazy
• Worried about not looking good or smelling bad

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11-13 year olds (cont.)

• Social barriers
• Parents dont buy healthy food, buy junk food
  instead
• More likely to eat junk food with friends
• Parents and teachers may not model good eating
  habits
• Well some of our teachers they eat junk food in
  front of us and stuff like that, and the
  cafeteria brings them cake and stuff, and they
  eat it in class.
• Sugary drinks are most frequently consumed drinks
  at home (36) and with friends (52)

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11-13 year olds (cont.)

• School barriers
• Use vending machines (and throw lunch from home
  away)
• Exercise as punishment
• Kids can sit out during PE classes
• Our teachers dont care.
• All the teachers do is drink coffee
• Community barriers
• Country living other kids are not close-by
  parks too far speed of traffic on the country
  roads

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11-13 year olds (cont.)

• Media
• Recognize that there are a lot of ads for
  unhealthy food
• Sometimes they overemphasize stuff thats not
  good for your body, like nachos. Sometimes I
  think they overemphasize that.

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14-18 year olds

• Individual level barriers
• Screen time (24 report at least 2 hours per day,
  seven days per week 32 report at least 2 hours
  per day, 1-2 days per week)
• Lazy
• Dont like the taste of healthy food
• 73 visit fast food restaurants between 1 and 3
  days per week

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14-18 year olds (cont.)

• Social barriers
• Parents dont model physical activity and healthy
  eating
• Parents dont encourage and may even force kids
  to eat healthy foods
• 17 report eating F/V as snacks at home
• 28 drink soda at home
• 11 drink milk at home
• Snacks and drinks are different when with friends
• 50 report chips, candy and cookies are the snack
  of choice with friends
• 58 report soda is the drink of choice with
  friends

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14-18 year olds (cont.)

• School barriers
• Schools serve unhealthy food faster lines have
  the unhealthiest (but tastiest) foods
• 39 consume chips, cookies, candy as snacks
• 36 consume soda or sports drinks
• Little milk is consumed (8)
• 62 report visiting the vending machines at
  school at least once per week
• Coaches dont model healthy behavior
• My coach sits there and talks on his cell phone.
• Well one of my gym teachers, she is really out of
  shape, so she just sits there and tells us to do
  something.

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Parents

• Individual level barriers
• Time, busy
• Convenience
• Cost of healthy foods and joining
  facilities/sports
• Social barriers
• Poor parental modeling
• Little supervision (3-5 pm a problem time)
• School barriers
• Unhealthy food choices, vending machines
• Coaches kids with the right name play
• Costs associated with school sports (gender
  differences)

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Parents (cont.)

• Community barriers
• Availability of fast food restaurants
• Safety concerns
• Societal
• Making ends meets (two or more jobs per family)
• Kids in activities
• Reduced parental limits

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Facilitators

• for Healthy Eating and Physical Activity

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Key Informants

• Individual level facilitators
• Various programs that increase awareness
• Social facilitators
• Some programs that use social support
• School facilitators
• Recognizing that reduced PE classes and increased
  vending machines at schools are contributing to
  obesity
• Community facilitators
• Collaboration and multiple methods are key

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6-10 year olds

• Individual level facilitators
• Kids are knowledgeable and wise
• PA in groups most frequently reported activity at
  home (37), school (47) and with friends (35)
• Social facilitators
• Some parents offer choices and encourage kids to
  eat healthily
• 53 report eating with family
• F/V most frequently consumed snack at home (43)
  and with friends (27)

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6-10 year olds (cont.)

• Social facilitators (cont.)
• Some parents encourage and model physical
  activity, and play with kids
• Every time we go outside, we play ball with our
  dad, he always has to run along, and I just love
  it,
• School facilitators
• Some schools provide healthy food and offer
  choices

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11-13 year olds

• Social facilitators
• Some parents model and encourage physical
  activities
• School facilitators
• Some schools seem to be making small changes
• Well, they just started they just stopped the
  program, like pizza and nachos and stuff. Now
  we only have pizza every Friday.
• 67 of adolescents report being active with a
  group at school

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14-18 year olds

• Social facilitators
• Some parents model healthy behaviors
• 70 report eating at least one meal per week with
  their family
• Only 19 have a TV in their room
• School facilitators
• Some schools offer fruit and vegetables
• Some schools have a variety of sports to choose
  from

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Parents

• Individual level facilitators (parent survey)
• 62 place limits on the amount of TV their kids
  watch
• 63 allow 2 hours or less per day
• 55 make keeping a healthy weight a high priority
• 51 make physical activity a high priority
• 52 make eating F/V a high priority
• Social facilitators
• Recognize the importance of modeling healthy
  behaviors

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Parents (cont.)

• School facilitators
• Parents report that some schools are beginning or
  trying to change menus
• Community facilitators
• Parents indicate that some communities have
  community facilities, such as track or parks

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Addressing the Problem

• What the Communities Suggested

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Key Informants

• Individual level interventions/programs
• Increase awareness, among kids especially
• Social interventions/programs
• Utilize and support family approaches
• School interventions/programs
• Incorporate physical activity throughout the day
• Increase number of PE and health classes
• Community interventions/programs
• Multi-level and method approaches
• Collaborate, collaborate, collaborate!!!

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6-10 year olds

• Individual level interventions/programs
• Play outside more
• Eat more fruits and vegetables
• Social interventions/programs
• Play with siblings
• Parents can buy healthier foods
• Parents can encourage, model and support kids
  being active

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6-10 year olds (cont.)

• School interventions/programs
• Frequent physical activity breaks during the day
• More recess
• Physical activity field trips
• Nutrition classes
• Encourage no sharing of food
• Encourage gym teachers to be more involved

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11-13 year olds

• Individual level interventions/programs
• Exercise
• Participate in sports
• Eat more fruits and vegetables
• Drink more water
• Social interventions/programs
• Encourage friends to exercise
• Exercise with friends
• Parents can buy and serve healthy foods
• Introduce new things like, all these things like,
  fresh fruit and vegetables.
• I think instead of going to fast food
  restaurants, they should have like a picnic or
  something out in the park.

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11-13 year olds (cont.)

• Social interventions/programs (cont.)
• Parents can turn the TV off
• Parents can encourage kids to be physically
  active and be active with them
• Just a few days ago, we went to a Pizza Hut, that
  AIDS fundraiser and right after we ate we took
  a walk.
• School interventions/programs
• Remove vending machines
• Replace desserts with fruit
• Teachers can reprimand kids for teasing
  overweight kids

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14-18 year olds

• Individual level interventions/programs
• Eat right (reduce junk food, portion control)
• Be physically active
• Social interventions/programs
• Parents can encourage
• Parents can model healthy behavior
• Parents can exercise with kids
• Parents can offer choices
• Limit TV

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14-18 year olds (cont.)

• School interventions/programs
• Make PE for everyones ability level (and fun)
• Coaches can motivate and encourage (athletes and
  non-athletes)
• Coaches can model health behaviors
• Create healthy eating challenges
• Incorporate health into more classes or create
  new classes (health and fitness in school and
  after school)

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Parents

• Individual level interventions/programs
• Increase awareness about how to eat, cook and
  shop for healthy foods
• Social interventions/programs
• Parents can model healthy behaviors (but need to
  be taught and shown how to do it)
• Community interventions/programs
• Increased low cost, healthy, convenience foods
• Increased low cost activities/facilities
• There should be a unified effort.

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In Summary

• Kids are aware of healthy lifestyles.
• Education is necessary, but not enough earlier
  is better make it cool to be physically
  active.
• Parents need to learn to connect with kids.
• Kids really want that!
• Multilevel approaches
• Awareness, family approaches, school and
  community involvement
• Collaboration a must!

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Thank You!!!

• ???Questions???
• !!!Comments!!!