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Obesity Surveillance in Colorado Children A project of the COPAN Surveillance and Evaluation Task Fo

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Describe variability in prevalence of obesity ... Prevalence of overweight and obesity in early elementary age children in Colorado is about 25 ... – PowerPoint PPT presentation

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Title: Obesity Surveillance in Colorado Children A project of the COPAN Surveillance and Evaluation Task Fo


1
Obesity Surveillance in Colorado Children A
project of the COPAN Surveillance and Evaluation
Task Force
  • Julie Marshall
  • Rocky Mountain Prevention Research Center, UCD
    CSPH
  • Andrea Poniers
  • Colorado Physical Activity and Nutrition Program,
    CDPHE
  • Jodi Drisko
  • Health Statistics, CDPHE
  • Cathy White
  • Child and Adolescent Health, CDPHE
  • Martha Tenney
  • Center for Human Nutrition, UCD SOM

2
Trends in childhood obesity - U.S.
What is the prevalence in Colorado youth?
BMI ? age and sex-specific 95 percentile revised
2000 growth charts
3
(No Transcript)
4
Why collect height and weight information?
  • To assess
  • The magnitude of the obesity problem
  • Geographic areas subgroups at highest risk
  • Changes over time
  • To inform
  • The need for public health programs
  • Allocation of limited resources
  • Priority areas for prevention research
  • To support
  • Grant applications
  • Program evaluation

5
Formative Research
  • 2004-05
  • Inventory of other states
  • Survey of School Nurses
  • Key informant interviews
  • Pilot collection of heights and weights
  • (convenience sample, 1st and 5th grades)
  • 2005-06
  • Pilot collection of heights and weights
  • (random sample, 1st and 5th grades)
  • 2006-07
  • Partner with Oral Health Program
  • 2007-08
  • Survey of School Nurses (Cathy White Kathy
    Patrick)

6
Objectives
  • Describe prevalence of obesity in Colorado
    children
  • Compare prevalence estimates based on two methods
  • Measurement
  • Caregiver report
  • Describe variability in prevalence of obesity
  • Discuss importance and limitations of state-wide
    prevalence estimates

7
Two Methods Conducted in Colorado
  • Measured height and weight
  • Add-on to CDC Oral Health Surveillance
  • 2006-2007 school year
  • Kindergarten and 3rd grade
  • Caregiver Report
  • Colorado Child Health Survey
  • 2006-2007 calendar year
  • Children 5-9 years old

8
Measured Height and Weight 2006-2007 school year
  • Purpose to assess feasibility of partnering with
    the CDPHE Oral Health Program to recruit schools
    and collect heights and weights in a random
    sample of Colorado schools.
  • Sampling Frame A random sample of schools
    stratified by free/reduced lunch where each
    child had an equal probability of being selected.
  • Sample size 5,648 children in 43 schools (21
    school districts)

9
Measured Height and Weight 2006-2007 school year
  • Height Seca portable stadiometer
  • Weight Tanita BWB-800-S electronic scale with
    digital read out
  • Children removed shoes and heavy clothing before
    measurement

10
Caregiver Report of Height and Weight Colorado
Child Health Survey 2006-2007 calendar years
  • Survey Purpose to fill the health data gap in
    Colorado children 1-14 years of age
  • Sampling Frame
  • Households that participate in the BRFSS
    telephone survey and have a child between the
    ages of 1 and 14 are asked to participate in a
    second interview.
  • One child from each household is sampled.
  • Primary caregiver is interviewed
  • Sample size
  • 2503 completed interviews (2-14 yrs ht wt)
  • 2323 with useable height and weight
  • 760 5-9 yrs old

11
Caregiver Report of Height and Weight 2006-2007
calendar years
  • Procedure
  • Who in the household knows the most about the
    health and health practices of the child?


  • How tall is now?
  • How sure are you of this? very, somewhat or not
    very
  • How much does weigh now?
  • How sure are you of this? very, somewhat or not
    very
  • If somewhat or not very sure, caregiver is
    asked to measure the child in next few days and
    call survey unit or have survey unit call back

12
Obesity Surveillance Both Methods
  • Body Mass Index (BMI) Percentiles Age and gender
    specific percentiles were calculated using SAS
    code available from the CDC website and based on
    national standard growth curves.
  • Weight categories
  • BMI percentile
  • 5-84th normal weight
  • 85-94th overweight
  • ? 95th obese

13
Distribution of Weight Status Kindergarten and
3rd Grade Children Colorado, 2006-2007
Caregiver Reported
Measured
14
Distribution of Weight Status by Age Colorado,
2006-2007
Caregiver Reported
Measured
15
Distribution of Weight Status by Gender Colorado,
2006-2007
Caregiver Reported
Measured
16
Distribution of Weight Status by
Ethnicity Colorado, 2006-2007
Measured
Percent of children in school that are Hispanic
17
Distribution of Weight Status by Free/Reduced
Lunch Colorado, 2006-2007
Measured
Percent of children in school qualifying for free
or reduced lunch
18
Distribution of Weight Status by
Setting Colorado, 2006-2007
Measured
19
Percent of students classified as overweight or
obese, Arkansas 2006-2007
20
What accounts for variability in obesity
prevalence across schools?
  • Research Question Do school-level
    characteristics predict school mean BMI, after
    controlling for student-level characteristics?
  • Analysis Method Hierarchical linear modeling
    (HLM)

  • (mixed-effects modeling)
  • Response variable
  • Student-level - BMI (z-score)
  • Predictor variables
  • Student-level - Age
  • - Gender
  • School-level - Hispanic or African-American
  • - students qualifying for free/reduced
    lunch - setting (rural/urban)

21
Results
  • There is a significant
  • amount of variation in
  • mean BMI across schools.
  • The of students who qualify
  • for free- or reduced-priced
  • lunches explains the majority
  • of the variation in mean BMI
  • across schools ( 77).
  • The of Hispanic and African American students
    and urban or rural setting were not statistically
    significant predictors after adjusting for
    free/reduced lunch.

22
Results - continued
  • Two statistically significant cross-level
    interaction effects need to be explored further.
  • BMI differences between boys and girls vary as a
    function of the of FRL students in any given
    school.
  • The increase in BMI with age is stronger in
    schools with a high ethnic minority students.

23
Summary
  • Prevalence of overweight and obesity in early
    elementary age children in Colorado is about 25
  • Increases with age
  • Higher in boys than girls
  • Obesity prevalence varies across schools.
  • School level variability is strongly related to
    the percent of students eligible for free/reduced
    lunch.
  • Partnering with the Oral Health Program was a
    successful way to obtain heights and weights on a
    random sample of children statewide (every 3-5
    years)
  • The Child Health Survey caregiver reported
    heights and weights and the Oral Health Program
    sample of measured weights resulted in similar
    obesity prevalence estimates.

24
Lessons Learned (over the years)
  • It is often difficult to achieve a good response
    rate with a state level sample (lack of trusting
    relationships, it is an add-on to other demands).
  • The data is not as useful as it could be for
    schools that participate because they only end up
    with one year of data (unable to look at change
    over time).
  • BMI in isolation is often a sensitive issue and
    difficult for parents/children to address.
  • Schools often need community support to address
    the determinants of obesity

Future Directions
  • Comprehensive child health screening as a
    partnership of local public health, schools,
    community-based organizations and health care
    providers

25
Acknowledgements
  • Theresa Anselmo, CDPHE Oral Health Program
  • Yvette Beavers, CDPHE Oral Health Consultant
  • Mathew Christensen, CDPHE Epi, Policy
    Surveillance
  • Virginia Englert, Poudre Valley Health
  • Joanne Holden, Tri-County Health Department
  • John Guy, MSPH student
  • Kathy Patrick, Colorado Department of Education
  • Jini Puma, Rocky Mountain Prevention Research
    Center
  • Brandy Ringham, MS student
  • Sharon Scarbro, Rocky Mt Prevention Research
    Center
  • Rickey Tolliver, CDPHE Health Statistics
  • Staff and students who participated in school
    measurements

26
  • Contact information
  • Julie Marshall 303-315-7596
  • julie.marshall_at_ucdenver.edu
  • Rocky Mountain Prevention Research Center
  • www.uchsc.edu/rmprc
  • Allison Reeds 303-315-0934
  • 9/15/08 Webcast on obesity surveillance in
    children
  • www.mchb.hrsa.gov/mchirc/dataspeak/events/
  • sept 08/resources.html
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