Thesis Presentation

Juana MontalvoClaudia ElizaldeEmily Schumann

EVALUATION OF THE EFFECTIVENESS OF

WELLNESS INTERVENTIONS IN

A SUBURBAN SCHOOL DISTRICT

1

Childhood Obesity

Statistics

Approximately 17% of children and adolescents aged 2-19 years are obese in the United States

This accounts for 12.5 million children

INTRODUCTION

Center for Disease Control(CDC). Data and Statistics. 2011 Available at http://www.cdc.gov/obesity/childhood/data.html. Accessed April 20, 2011.

2

Childhood Obesity

Statistics

NHANES shows that obesity among adolescents’ ages 12-19 has increased over the years. In 1966-1970 data showed 4.6% of this particular age group was considered obese and the recent survey showed an incredible 18.1% of adolescents are considered obese in the United States

INTRODUCTION

Data from the Department of Health and Human Services,

1999-2002, NHANESOgden, Cynthis, Carroll, Margaret. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 through 2007-2008. Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf. Accessed August 28, 2011.3

Childhood Obesity

Statistics

Approximately 26.8% of Hispanic American boys are considered obese

17.4% of Mexican American girls are considered obese

LET’S NARROW IT DOWN AND BRING IT CLOSE TO HOME

Center for Disease Control(CDC). Data and Statistics. 2011 Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed April 20. 4

30 states in the U.S have a percentage at or above 30% of children who are considered obese or overweight

Current data shows that Illinois has 28.2% of its children considered obese

LET’S NARROW IT DOWN AND BRING IT CLOSE TO HOME

Center for Disease Control(CDC). Data and Statistics. 2011 Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed April 20, 2011. 5

According to the 2010 census, there are 308.7 million people in the United States

50.5 million (16%) are Hispanic or of Latino origin

121,506 live in DuPage County

Our studies were conducted in a primarily Hispanic population

LET’S FOCUS ON OUR POPULATION

US Census Bureau. Available at http://2010.census.gov/2010census/ Accessed on October 30, 2011

6

http://2010.census.gov/2010census/

Possible reasons of the link between childhood obesity and the Hispanic culture

LETS FOCUS ON OUR POPULATION

Low socioeconomic status

Lack of health insurance or being under-insured

Poor dietDecrease of physical

activityMother’s perception

of overweightDegree of

acculturationSealy Y. Parents’ Food Choices: Obesity Among Minority Parents and Children. Journal of Community Health Nursing.2010; 27:1–11, Taylor & Francis Group, LLC ISSN: 0737-0016 print/1532-7655 online DOI: 10.1080/07370010903466072

7

Juana Montalvo

PUBLIC MESSAGE CAMPAIGN INTERVENTION: GO, SLOW, WHOA

PROGRAM IMPLEMENTATION IN A CHICAGO-LAND SUBURBAN SCHOOL

DISTRICT

8

Factors that contribute to childhood obesity Dietary Trends Physical Activity Sedentary Behavior

Consequences of childhood obesity Health Economic Emotional

REVIEW OF LITERATURE

Koletzko B, Toschke A. Meal Patterns and Frequencies: Do They Affect Body Weight in Children and Adolescents?. Critical Reviews in Food Science & Nutrition [serial online]. February 2010;50(2):100-105. Available from: Academic Search Premier, Ipswich, MA. Accessed May 5, 2011.Ebbeling C, Pawlak D, Ludwig D. Childhood obesity: public-health crisis, common sense cure. Lancet [serial online]. August 10, 2002; 360 (9331):473. Available from: Academic Search Premier, Ipswich, MA. Accessed May 2, 2011.

9

National public message campaigns

Go, Slow, Whoa Developed to identify foods We Can! Was Launched in

2005 by the National Institutes of Health (NIH)

Focuses on 3 important behaviors:1. Improve food choices2. Increase physical activity3. Reduce screen time

WE CAN! & GO, SLOW, WHOA

National Lung and Blood Institute. Educational campaigns: About We Can! http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/about-wecan/index.htm. Accessed May 23 2011. 10

To compare the knowledge and recognition of a public message campaign intervention in a Chicago-land suburban school district.

PURPOSE OF STUDY

11

Cross-sectional studyAdministered survey at one point in time from a sample selected to represent a larger population

Variables Independent= School, Grade, Ethnicity, Gender, Fruit and vegetable intake yesterday

Dependent=Student’s recognition and knowledge of public message campaigns

STUDY DESIGN

12

Instrumentation tools Continuation of 2009 survey as a base (see attached)

Revised to improve the scope of the questions asked 14 dietetic interns placed in every school in the district

Training was conducted

Data collection & coding Randomized oral survey Convenience sample SPSS Chi-Squared testing for independence

Recognition Knowledge

METHODS: ALL SCHOOL WELLNESS WALK

13

ALL SCHOOL WELLNESS WALK FUN!!

14

Gender for entire data n=843

DESCRIPTIVE STATISTICS: GENDER

Malesn=37

0 44%

Fe-malesn=46

2 56%

Total Students by Gender

Gender for per school n=843

School 1 School 2 School 3 School 4 School 5 School 6 School 70.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

51.1%

37.9%

50.0%46.5%

37.8%42.1%

39.8%

48.9%

57.8%

49.2%

53.0%

60.4%

55.3%

60.2%

0%4.3%

0.8% 0.5% 1.8% 2.6%0%

Gender

Male Female No Data

15

Grade for entire data n=843

DESCRIPTIVE STATISTICS: GRADE

n=135 16% n=38

5%

n=168 20%

n=16319%

n=11814%

n=88 11%

n= 113 14%

Total Students by Grade

First Second Third Fourth Fifth Sixth Seventh/Eight

16

DESCRIPTIVE STATISTICS: GRADE

Grade per school n=843


15.00%

30.00%

45.00%

60.00%

75.00%

90.00%

10.9%

37.9%

16.7%16.7%

20.70%

2.6% 0.00%

15.2%0.8%

8.3%

0%

6.3% 7.9%9.8%

0%

17.5%

35.3% 36.9%

27.6%30.4%

16.40%

19.2% 19.5%

14.40%

46.1%

29.3%

19.8%

31.7%

9.3%6.3% 3.9%

0%

19.8%

5.0%17.7%

12.6%

9.2%

0% 0% 0% 0% 0% 0%

100.00%

4.3% 5.2% 1.7%1.4%

2.7%2.6%

Grade

1st 2nd 3rd 4th 5th 6th 7th/8th No Data

17

Ethnicity for entire data n=843

DESCRIPTIVE STATISTICS: ETHNICITY

n=189 23%

n=56670%

n=405%

n=18 2%

Total Students by EthnicityWhite Hispanic African American Other

18

DESCRIPTIVE STATISTICS: ETHNICITY


10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

7.6% 6.0%

50.8%

10.7%

27.0%31.6% 32.7%

80.4% 81.0%

38.3%

80.0%

64.9%

55.3% 58.4%

6.5%

38.3%

7.5% 5.6%2.7%

0%4.4%

2.2%0% 0.8% 0.5%

5.4%9.2%

0.9%3.3%

8.6%2.5% 3.3%

0%3.9% 3.5%

Ethnicity

White Hispanic African American Other No Data

Ethnicity per school n=843

19

Ho1a= School Ho1b= GradeHo1c=

EthnicityHo1d= Gender

HO1: THERE IS NO ASSOCIATION BETWEEN RECOGNITION OF GO, SLOW, WHOA FOODS

(HAVE YOU HEARD OF GO, SLOW, WHOA FOODS) OF STUDENTS BY:

Results

P Value

School .007

Grade .146

Ethnicity .193

Gender .540

There is an association between recognition of Go, Slow, Whoa and

school


10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Heard of Go, Slow, Whoa

YesNoNo data

20



HO2: THERE IS NO ASSOCIATION BETWEEN KNOWLEDGE OF GO, SLOW, WHOA FOODS

(CAN YOU NAME A GO, SLOW, WHOA FOOD?) OF STUDENTS BY:

Results

P Value

School .002

Grade .693

Ethnicity .931

Gender .664

There is an association between knowledge of Go,

Slow, Whoa Foods and School.


10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Name a Go, Slow, Whoa Food?

YesNoNo data

21



HO3: THERE IS NO ASSOCIATION BETWEEN KNOWLEDGE OF FRUIT OF

THE MONTH AND STUDENTS BY:

There is an association between knowledge of Fruit of the month

and students by school and grade

Results

P Value

School .000

Grade .000

Ethnicity .173

Gender .627

22

HO3: THERE IS NO ASSOCIATION BETWEEN KNOWLEDGE OF FRUIT OF THE MONTH AND STUDENTS BY:


10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

Aprils Fruit of the Month & School

CorrectIncorrectDon't KnowNo data

First Second Third Fourth Fifth Sixth Sevent/Eight

No data0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%

Aprils Fruit of the Month & Grade


23

Ho4a= School Ho4b= GradeHo4c= EthnicityHo4d= Gender

HO4: THERE IS NO ASSOCIATION BETWEEN KNOWLEDGE OF VEGETABLE

OF THE MONTH AND STUDENTS BY:

There is an association between knowledge of vegetable of the month and students by School, Grade, and Ethnicity

Results

P Value

School .000

Grade .000

Ethnicity .020

Gender .438 School 1 School 2 School 3 School 4 School 5 School 6 School 7-5.00%

5.00%

15.00%

25.00%

35.00%

45.00%

55.00%

65.00%

75.00%

85.00%

95.00%

April's Veg. of the Month & School


24

HO4: THERE IS NO ASSOCIATION BETWEEN KNOWLEDGE OF

VEGETABLE OF THE MONTH AND STUDENTS BY:

First Second Third Fourth Fifth Sixth Seventh/Eight

No data0%

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

100%

Aprils Veg. of the Month & Grade


White Hispanic African American Other No data0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

Aprils Veg. of the Month & Ethnicity


25

Ho5a= Number of FRUIT intake yesterdayHo5b= Number of VEGETABLE intake

yesterday

HO5: THERE IS NO ASSOCIATION BETWEEN GO, SLOW, WHOA FOODS RECOGNITION OF STUDENTS BY:

There is no association between Go, Slow Whoa Foods recognition and # of Fruit & Veg. intake

Results

P Value

# of Fruit Intake Yesterday

.146

# of Vegetables Intake Yesterday

.500

26

Ho6a= Number of FRUIT intake yesterdayHo6b= Number of VEGETABLE intake

yesterday

HO6: THERE IS NO ASSOCIATION BETWEEN GO, SLOW, WHOA FOODS

KNOWLEDGE OF STUDENTS BY:

There is no association between Go, Slow, Whoa foods knowledge & # of Fruit or Vegetable intake yesterday

Results

P Value

# of Fruit Eaten Yesterday

.393

# of Vegetables Eaten Yesterday

.150

27

There is an association between recognition (93.1%) as well as knowledge (60%) of Go, Slow, Whoa Foods and students by SchoolStudents NOT aware of public message campaign

There is an association between knowledge of Fruit of the month and students bySchool Grade

INTERESTING FINDINGS

28

There is an association between knowledge of vegetable of the month and students by School Grade Ethnicity

Recognition and knowledge of Go, Slow, Whoa foods does not eff ect the number of fruit or vegetable intake the student ate yesterday.

INTERESTING FINDINGS CONTINUED…

29

More 1st graders have heard of Go, Slow, Whoa

OTHER INTERESTING FINDINGS

1st 2nd 3rd 4th 5th 6th 7th/8th

0.00%20.00%40.00%60.00%80.00%

100.00%120.00%

Grade- Go, Slow, Whoa

YesNoNo data

Male Female No Data0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Gender- Go, Slow, Whoa

YesNoNo data

More males have heard of Go, Slow, Whoa

30

Of those who knew a Go, Slow, Whoa food, most of them got the answer correct

YET MORE INTERESTING FINDINGS….

School 1

School 2

School 3

School 4

School 5

School 6

School 7

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Food Correct- Go, Slow, Whoa

YesNoNo data

The majority would name a “Go” food

School 1

School 2

School 3

School 4

School 5

School 6

School 7

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Type- Go, Slow, Whoa Food

GoSlowWhoaNo data

31

Limitations Environment of data

collection Data collection was

limited to one day No measure of exposure

to intervention

STRENGTHS/LIMITATIONS

Strengths Administered to entire

district Large sample size

(n=843) Sample accounts for

ethnicity, gender, & current grade

32

Strong need for an increase in public message campaign intervention or examination of methods used to enhance message awareness

Study shows an imbalance between program recognition and schools

Curriculum change has to take place Implement lesson plans for all grades in the district to

increase recognition and knowledge of Go, Slow, Whoa

CONCLUSIONS & APPLICATIONS

33

Claudia Elizalde & Emily Schumann

EFFECTS OF AN AFTER-SCHOOL

NUTRITION INTERVENTION ON

MIDDLE-SCHOOL AGE CHILDREN

34

According to the Journal of Adolescent Health, current policy targets schools as key settings in which to address child obesity. Because of the following…

Easier access to promote healthy eating

Can establish nutritional guidelines for foods served and sold in school

Ability to promote physical activity: In Physical education

classes In Extra curricular

activities

ATTITUDES, BEHAVIORS, AND EFFECTIVE WAYS TO TARGET MIDDLE SCHOOL CHILDREN

Laura M. Bogart et al., Preliminary Healthy Eating Outcomes of SNaX, a Pilot Community-Based Intervention for Adolescents. June 9, 2010. DOI: 10.1016/j.jadohealth.2010.06.004 35

The purpose of this study was to… 1. Investigate a population of children enrolled in an after-school program for a middle school in a suburban area of Illinois

2. Examine the association between nutrition intervention and Heart Healthy Eating Knowledge Overweight/Obesity Knowledge Heart Healthy Eating Attitude Social Views of Healthy Eating

STUDY RATIONALE

36

Cross-sectional study Compared Hearts N’ Parks survey results from pre to

post school yearsStudent interns did instructing at least

1x/month2-4 sessions/month focused on fruits,

vegetables, and physical activityVariables

Dependent: adolescents’ knowledge, behavior, and attitude based on questionnaire

Independent: gender, age, after-school nutrition intervention

STUDY DESIGN

37

Inclusion Criteria & RecruitmentThose involved in after-school program at the middle school

Convenience samplingValidity and Reliability

Social pressuresVariability in instructors/observersTesting threatSelection of subjectsSpanish as primary language

MIDDLE SCHOOL SUBJECTS

38

Whole Group: 94 diff erent subjects


Pre 09 Post 10 Pre 10 Post 11N 46 20 17 29Male 24 14 9 23Female 22 6 8 612 or 13 33 12 15 2014 or 15 13 7 2 816 or 17 0 1 0 018 or over 0 0 0 1

12 or 13 (n=20)69%

14 or 15 (n=8)28%

18 or over (n=1)3%

Age: Post 11

Male (n=24)52%

Female(n=22) 48%

Gender: Pre 09

Pre 09 Post 10 Pre 10 Post 110

1020304050

46

20 1729

N for Each Data Period

39

Matched Group: 12 individuals from Pre 2009/Post 2010


Pre 09 Age 12 or 13 7 Post 10 Age 12 or 13 6

14 or 15 5 14 or 15 5

16 or 17 0 16 or 17 1

18 or over 018 or over 0

Gender Male 7

Gender Male 7

Female 5 Female 5

12 or 13 (n=6)50%14 or 15 (n=5)

42%

16 or 17 (n=1)8%

Age: Post 2010

Male (n=7)58%

Female (n=5)42%

Gender

12 or 13 (n=7)58%

14 or 15 (n=5)42%

Age: Pre 2009

40

Reliability and Validity Same questionnaire pre to post Developed and analyzed by NHLBI and National

Recreation and Park Association Specifically adolescent Pilot in 1999, used in 11 states with 50 Magnet Center

sites Focus on heart-healthy eating and physical activity Knowledge, attitudes, behavior, and intention Broken down into 7 categories

HEARTS N’ PARKS

National Institute of Health: National Heart Lung and Blood Institute. Hearts N’ Parks. Available at: http://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n_pk/index.htm. Accessed April 9, 2011 41

Ho1 There is no association between the after-school nutrition intervention in middle-school aged children and knowledge, attitudes, and behavior. Ho1a: Heart Healthy Eating Knowledge Ho1b: Overweight/Obesity Knowledge Ho1c: Heart Healthy Eating Attitude Ho1d: Overweight/Obesity Attitude Ho1e: Heart Healthy Eating Behavior Ho1f: Heart Healthy Eating Intention Ho1g: Physical Activity Level

Ho2 There is no association between the after school nutrition intervention and social views. Ho2a: Social Views of Healthy Eating Ho2b: View of people who are meant to be fat

HYPOTHESES

42

Ho3 There is no association between middle school children’s knowledge and behavior and attitude. Ho3a: Heart Healthy Eating Knowledge vs. Heart Healthy Eating

Attitude Ho3b: Overweight/Obesity Knowledge vs. Overweight/Obesity

Attitude Ho3c: Heart Healthy Eating Knowledge vs. Heart Healthy Eating

Behavior Ho3d: Overweight/Obesity Knowledge vs. Heart Healthy Eating

Behavior Ho3e: Heart Healthy Eating Knowledge vs. Physical Activity Level

Ho4 There is no association between middle school children’s attitude and behavior. Ho4a: Heart Healthy Eating Attitude vs. Heart Healthy Eating

Behavior Ho4b: Overweight/Obesity Attitude vs. Heart Healthy Eating Behavior Ho4c: Heart Healthy Eating Attitude vs. Physical Activity Level Ho4d: Overweight/Obesity Attitude vs. Physical Activity Level

HYPOTHESES

43

Ho1: There is no association between the after school nutrition intervention and:

RESULTS: HYPOTHESES 1 & 2

Heart Healthy Categories pHeart Healthy Eating Knowledge 0.778Overweight/Obesity Knowledge 0.317Heart Healthy Eating Attitude 0.337Overweight/Obesity Attitude 0.873

Heart Healthy Eating Behavior 0.642Heart Healthy Eating Intention 0.065

Physical Activity Level 0.687

Ho2: There is no association between the after school nutrition intervention and social views.Social View Questions p

If I eat healthy everyday- My friends will like me 0.167

My family will be proud of me 0.082My friends will want to eat over at my

house 0.277My friends will start eating a healthy

diet too 0.724b. View of People Who Are Meant to Be

Fat 0.845

44

Ho3: There is no association between middle school children’s knowledge and behavior and attitude.

Ho4: There is no association between middle school children’s attitude and behavior.

RESULTS: HYPOTHESIS 3 & 4

Correlation Coefficient (p

value)Heart Healthy Eating KNOWLEDGE vs. Heart Healthy Eating

ATTITUDE 0.322 (0.307)Overweight/Obesity KNOWLEDGE vs. Overweight Obesity

ATTITUDE 0.367 (0.241)Heart Healthy Eating KNOWLEDGE vs. Heart Healthy Eating

BEHAVIOR - 0.018 (0.955)Overweight/Obesity KNOWLEDGE vs. Heart Healthy Eating

BEHAVIOR - 0.609 (0.036)***Heart Healthy Eating KNOWLEDGE vs. Physical ACTIVITY

Level - 0.388 (0.213)

Correlation Coefficient (p

value)Heart Healthy Eating ATTITUDE vs. Heart Healthy Eating

BEHAVIOR 0.595 (0.041)***Overweight/Obesity ATTITUDE vs. Heart Healthy Eating

BEHAVIOR 0.012 (0.969)Heart Healthy Eating ATTITUDE vs. Physical ACTIVITY Level 0.244 (0.445)Overweight/Obesity ATTITUDE vs. Physical ACTIVITY Level - 0.157 (0.625)

45

RESULTS FROM ENTIRE SAMPLE

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Knowledge Pre 2009 vs.

Post 20102009 Pre2010 Post

% c

orr

ect

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Knowledge Pre 2010

vs. Post 20112010 Pre2011 Post

% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Overweight/Obesity Knowledge Pre 2009 vs

Post 20102009 Pre2010 Post

% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Overweight/Obesity Knowledge Pre 2010 vs

Post 2011 2010 Pre2011 Post

% c

orr

ect

46


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Attitude Pre 2009 vs.

Post 2010Pre 2009Post 2010

% c

orr

ect

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Attitude Pre 2010 vs.


% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Overweight/Obesity Attitude Pre 2009 vs.

Post 2010 Pre 2009Post 2010

i% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Overweight/Obesity At-titude Pre 2010 vs. Post

2011Pre 2010Post 2011

% c

orr

ect

47


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Behavior Pre 2009 vs.


i% c

orr

ect

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Heart Healthy Eating Behavior Pre 2010 vs.


% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Heart Healthy Eating In-tention Pre 2009 vs. Post

2010Pre 2009Post 2010

% c

orr

ect

0.00%20.00%40.00%60.00%80.00%

100.00%

Heart Healthy Eating Intention Pre 2010 vs.


% c

orr

ect

48


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Physical Activity Level Pre 2009 vs. Post 2010

Pre 2009Post 2010

% c

orr

ect

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

Physical Activity Level Pre 2010 vs. Post 2011

Pre 2010Post 2011

% c

orr

ect

49

Limitations Small sample for matched group, but similar numbers

compared to Hearts N’ Parks magnet centers Sampling not random Other ethnicities not well represented and one middle

school used for sampling

Strengths Targeted a predominately low-income, Hispanic

population Used same pre and post questionnaire

LIMITATIONS/STRENGTHS

50

No significant results for the categories and social view questions, but interesting descriptive patterns for entire group

The results suggest that attention to attitude and behavior in addition to knowledge is warranted when studying middle school populations

CONCLUSIONS

51

For this specific after-school program: Established curriculum Continuous monitoring (pre, mid, and post

questionnaires) Bilingual Questionnaires

For after-school programs in general: Consider focusing on attitudes along with knowledge

in adolescents Involve parents and address modeling

APPLICATIONS FOR AFTER-SCHOOL PROGRAMS

52

The effect of attitudes in adolescents and strategies to change them

The effect of modeling on children’s eating behaviors and attitudes

Continue research on effectiveness, length of time, and strategy for after-school nutrition interventions

Continue research on minority populations to explore contributing factors and uniqueness of their experiences

FUTURE RESEARCH

53

Nutrition interventions are greatly needed in this Chicago-land school district

Further research and changes will strengthen initiatives and improve efforts

Childhood obesity is a worldwide epidemic Battle can be won by targeting

schools Public messaging campaigns and

after-school programs are great resources!

CONCLUSION

54

Center for Disease Control(CDC). Data and Statistics. 2011 Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed Apri l 20, 2011.

Cynthis Ogden, PhD., Margaret Carrol l , M.S, P.H. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 through 2007-2008. Located at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf

US Census Bureau. Available at http://2010.census.gov/2010census / Accessed on October 30, 2011

Sealy Y. Parents’ Food Choices: Obesity Among Minority Parents and Children. Journal of Community Health Nursing 27:1–11, 2010 Taylor & Francis Group, LLC ISSN: 0737-0016 print/1532-7655 online DOI: 10.1080/07370010903466072

Laura M. Bogart et al. , Prel iminary Healthy Eating Outcomes of SNaX, a Pi lot Community-Based Intervention for Adolescents. June 9, 2010. DOI: 10.1016/j. jadohealth.2010.06.004

National Institute of Health: National Heart Lung and Blood Institute. Hearts N’ Parks. Available at: http://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n_pk/index.htm. Accessed Apri l 9, 2011

REFERENCES

55

http://2010.census.gov/2010census/

Koletzko B, Toschke A. Meal Patterns and Frequencies: Do They Aff ect Body Weight in Children and Adolescents?. Critical Reviews in Food Science & Nutrition [serial online]. February 2010;50(2):100-105. Available from: Academic Search Premier, Ipswich, MA. Accessed May 5, 2011.

Ebbeling C, Pawlak D, Ludwig D. Childhood obesity: public-health crisis, common sense cure. Lancet [serial online]. August 10, 2002; 360 (9331):473. Available from: Academic Search Premier, Ipswich, MA. Accessed May 2, 2011.

National Lung and Blood Institute. Educational campaigns: About We Can! http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/about-wecan/index.htm. Accessed May 23 2011.

REFERENCES CONTINUED…

56

QUESTIONS?

57

Documents

Thesis Presentation