HLTH 4200 Worksite Paper

By Justin Cude, Cami Lee, Maria Hartung, Constantine Unanka, and Trey Pennington

Section I

On an international scale, childhood obesity is considered to be one of the most serious

public health challenges of the 21st century [2]. Steadily on the rise as of 2013, obesity among

children below the age of five is estimated to be as high as 42 million globally, majority of them

(31 million) said to be living in developing countries [2]. According to the Harvard School of

Public Health, obesity can harm nearly every system within a child's physiology, including the

heart and lungs, muscles and bones, kidneys and digestive tract along with the hormones that

control blood sugar and puberty. Also associated with obesity among the childhood population

includes, unfortunately, the heavy social and emotional stresses added by one’s peers and/or self.

What makes the problem of childhood obesity even worse is the fact that youth who are

overweight or obese have substantially higher risks of remaining overweight or obese leading

into adulthood [1]. In a 2012 published study, one which focused in on and collected data from

numerous studies held between 1999 and 2011, authors Sameera Karnik and Amar Kanekar go

into great detail explaining multiple factors which influence childhood obesity and more

importantly what can be done to combat this epidemic. According to this pair of authors,

“childhood obesity is due to the imbalance between caloric intake of the child and the calories

utilized for growth, development, metabolism, and physical activities. Normally the amount of

calories a child consumes through food or beverages, if not used for energy activities, leads to

obesity.” They go on further to explain that, “Factors causing childhood obesity are genetic,

behavioral, and environmental,” and “that obesity can be multifactorial in children.” However

the authors concluded by stating that childhood obesity can be tackled at the population level by

education, prevention and sustainable interventions related to healthy nutrition practices and

physical activity promotion[6].

Childhood obesity is becoming more prominent in America. According to NCCP

(National Center for Children in Poverty), childhood obesity was found to be most prevalent in

the Southeastern region of the United States with eight of the ten states recording the highest

rates of childhood obesity among the rest of the nation[10]. Nationally, more than one-third of

children and youth are overweight and more than 17 percent are obese [4]. Overall 33.5% of

children ages 10-17 years old are considered overweight or obese within the state of North

Carolina. In fact, North Carolina is ranked fifth worst nationally in regards to childhood obesity

shown by the graph below [5].

States with Highest Rates of Obese 10-17 year olds

Ranking States Percentages of Obese 10-17yr olds

1 D.C 22.8%

2 West Virginia 20.9%

3 Kentucky 20.6%

4 Tennessee 20.0%

5 North Carolina 19.3%

6 Texas 19.1%

7 South Carolina 18.9%

8 Mississippi 17.8%

9 Louisiana 17.2%

10 New Mexico 16.8%

In 2008, among N.C. children ages 10-17, 17.6 percent were overweight, and 15.2

percent were obese (a combined 32.8 percent were overweight or obese), compared to 61.3

percent who were at a healthy weight [4]. These results are shown in the graph below.

*BMI category based on percentile (underweight = below 5th percentile, healthy weight = 5th percentile to less than the 85th percentile, overweight = equal to or greater than the 85th percentile but less than the 95th percentile, obese = equal to or greater than the 95th percentile) for age. Data source: North Carolina Child Health Assessment and Monitoring Program (CHAMP) Survey Data (2008): State Center for Health Statistics, Raleigh NC.

In 2010, males had a higher rate of obesity than their counterpart females except for

African Americans. Percentages were collected for races of the following: Hispanic, Mexican

American, White, and African American. Hispanic males had an obesity rate of 25.5% while the

females stood at 17.5%. Mexican American males had an obesity rate of 26.7% compared to the

females at 17.4%. White American males had an obesity rate of 16.7% while the females were at

14.5%. Finally, African American males had an obesity rate of 19.8% compared to 29.2% of the

females [10]. More specifically, Pitt County, located in Greenville, North Carolina, is home to

168,148 citizens. Of those citizens, half of them are overweight or obese [3]. More than 1 in 3 kids

are obese or overweight, and 72% of adults are affected as well [8]. Obesity is often the product of

factors such as sedentary lifestyles, fatty foods, and family history. Research shows that families

ate more meals prepared away from home than in the past, resulting in consumption of more

total calories per sitting. In 2007, 49.9% of children were found to watch more than two hours of

television per day adding to the less than 44% of North Carolina’s high school students that were

physically active. In fact, around 20 percent of children did not meet the 60 minutes per day

recommendation for physical activity [7]. Below is a graph that includes percentages of children

ages 6-17 who met the 60 minute recommendation of physical activity.

Data Source: North Carolina Child Health Assessment and Monitoring Program (CHAMP) Survey Data (2007): State Center for Health Statistics, Raleigh NC.

In Pitt County alone, 25% of adults eat fast food 4+ times a week, 16.8% adults meet the

fruit and vegetable requirements, 42% meet exercise requirements, and 20.5% claim to have

been sedentary for the past month [3]. Pitt County was the #1 city with most fast food restaurants

in 2006, and currently has 100 fast food restaurants (not sit-down service) surrounding the area.

Obesity is a problem because it is affecting not only adults, but children as well since the parents

are setting examples for them.

Pitt Fit is a program that promotes health education as well as health promotion to

overweight and obese adolescents between the ages of 12-17 years old. By creating a safe, fun

environment for adolescents to exercise, Pitt Fit also hopes to target and change the lifestyles as

well. Project Mentor, a program based at East Carolina University that focuses on overweight

and obese adolescents, has had positive outcomes from the program throughout the years [7]. By

facilitating physical activity and fun, we hope to influence adolescents and educate them about

lifestyle changes. With a hands-on program that works one-on-one with kids, valuable benefits

such as self-esteem, self-confidence, and education can make a world of difference. Funding this

program can help with that. We truly believe Pitt Fit will be successful as well since it holds the

same values and ideals as Project Mentor.

Bibliography

[1] "Child Obesity: Too Many Kids Are Too Heavy, Too Young." Obesity Prevention Source.

Harvard School of Public Health, n.d. Web. 12 Nov. 2014.

<http://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/global-obesity-

trends-in-children/>.

[2] "Childhood Overweight and Obesity." WHO. World Health Organization, 2014. Web. 12 Nov.

2014. <http://www.who.int/dietphysicalactivity/childhood/en/>.

[3] "Community Profile: Pitt County, North Carolina." Centers for Disease Control and

Prevention. Centers for Disease Control and Prevention, 25 Oct. 2013. Web. 8 Oct. 2014.

<http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/

communities/profiles/obesity-nc_pitt-county.htm>.

[4] “Data Resource Center for Child and Adolescent Health.” National Survey of Children’s

Health. Child and Adolescent Health Measurement Initiative Data Resource Center. 2007.

Web. 6 Nov. 2014. <http://www.childhealthdata.org/>

[5] “F as in Fat: How Obesity Policies Are Failing in America.” Trust for America’s Health.

National Survey of Children’s Health. 2009. Web. 15 Oct 2014.

<www.healthyamericans.org>

[6] Karnik, Sameera, and Amar Kanekar. "Abstract." National Center for Biotechnology

Information. U.S. National Library of Medicine, 2 July 2005. Web. 14 Nov. 2014.

<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278864/>.

[7] Muse, Kathy. "MINDSET MENTORS: ECU Students Learn While Training Teens to Embrace

Healthy Lifestyles." ECU Project Mentor. ECU News Services, 13 Oct. 2014. Web. 20

Oct. 2014. <http://www.ecu.edu/news/projectmentor.cfm>.

[8] “North Carolina State Center for Health Statistics”. Child Health Assessment and Monitoring

Program. North Carolina Department of Health and Human Services, 13 Nov. 2013. Web.

14 Oct. 2014. <http://www.schs.state.nc.us/units/stat/champ/>

[9] Oughton, Hali. "Pitt County Is 'Fit Community' with Obesity Problem." Pirate News Network

RSS. N.p., 11 June 2012. Web. 08 Oct. 2014.

<http://www.piratenewsnetwork.net/2012/06/11/fit-pitt/>.

[10] Wile Schwarz, Susan. "Adolescent Obesity in the United States." NCCP. Facts for

Policymakers, n.d., November 2010. Web. 16 Oct. 2014.

< http://www.nccp.org/publications/pub_977 >

Section II

As an assessment mechanism, existing records would be most appropriate for Pitt Fit.

Doctors with records of overweight and obese patients are able to determine what is best for their

clientele. Recommendations of our program can be made to the parents, and through that, future

one-on-one meetings can be made with the parents to give them more information.

Another assessment mechanism that may prove to be useful for Pitt Fit would be the

delphi technique. Environments such as schools can be used by sending a form full of

information home with the child. If the parents are interested in the program, they can fill out

their information to be contacted with at a later date. If the parents feel uncomfortable about

giving their information, or if they are uninterested in the program, they have the option to

remain anonymous.

Through both existing records and the delphi technique, interest data can be collected.

The delphi technique is used in an array of fields to study program planning, needs assessment,

policy determination and resource utilization specific to a real-world issue [11]. In regards to Pit

Fit there will be a panel of experts who determine how well the program will succeed. Experts

will use opinion and research based data to come to a consensus opinion on the given issue. Pit

Fit will utilize a health fitness specialist, nutritionist, and a pediatrician as panel members. This

technique will address future developments such as what could be or what should be, rather than

what is happening right now in order to determine overall success of the program.

Besides the health specialists in charge of the program, parents are also invited to

determine what is best for the children as far as the program goes. Parents are one of the most

important determining factors in their children’s success since they spend the most time with

them. Therefore, it is encouraged that they be involved. Teachers, especially physical education

teachers, in their schools should also be allowed to give their input since they are also working

with the children every week at school.

The goal of Pitt Fit is to promote healthy lifestyle habits in young teens and adolescents

between the ages of 12-17 years old, and to reduce the amount of obesity in the residents of Pitt

County. Through educating the parents of these adolescents, we hope to establish a good at

home environment that will aid in the prevention of health related risks.

GOAL: TO REDUCE TO AMOUNT OF OBESITY IN THE RESIDENTS OF PITT COUNTY

PROGRAM OBJECTIVES

1) By 2016, we would like to increase aerobic exercise amongst 12-17 year old kids in Pitt

County by 15%.

OUTCOME (what): increase aerobic exercise

TARGET POP (who): 12-17 year old kids

CONDITIONS (when): 2016

CRITERION (how much): 15%

2) Through our year-long aerobic exercise program at Pitt Fit, overweight and obese teens

will be able to reduce their risks of weight-related diseases as well as participate in a

follow-up every year for 2 consecutive years to determine their success and compare it to

their pre-program level of fitness.

OUTCOME (what): reduce risks of weight-related diseases as well as participate in a

follow-up

TARGET POP (who): overweight/obese teens

CONDITIONS (when): 2yrs

CRITERION (how much): duration of program

BEHAVIORAL OBJECTIVES

1) To encourage 30% of kids in Pitt Fit to adhere to continue on in the program until they

age out, and to continue with the lifestyle later on in life. There will be a follow-up with

each individual both 1 year and 2 years after the program's completion.

OUTCOME (what): At least 30% of kids adhere to lifestyle change

TARGET POP (who): Kids in Program

CONDITIONS (when): Until they age out of program

CRITERION (how much): Programs Duration and 1 and 2 year follow-ups

ENVIRONMENTAL OBJECTIVES

1) There will be a parents-child workout day once every month to both educate the parent

on their influential role in their child’s life, and to also get them involved in the activities.

OUTCOME (what): Educate and Involve in program

TARGET POP (who): Parents

CONDITIONS (when): Offered once a month

CRITERION (how much): Every month their kid is a part of the program

ADMINISTRATIVE OBJECTIVES

1) During the next 12 months, 30 adolescents will be participating in Pitt Fitt.

OUTCOME (what): Adolescents participating in work out

TARGET POP (who): 30 adolescents

CONDITIONS (when): Over the next year

CRITERION (how much): 3 days out of the week.

LEARNING OBJECTIVES

1) After participating in Pit Fit, those participating will be able to identify and make better

choices about daily exercise and eating habits.

OUTCOME (what): identify and make better choices about exercise and eating habits

TARGET POP (who): those participating

CONDITIONS (when): after completing the program

CRITERION (how much): daily

2) During one Pit Fit Session, participants will express their views on healthy eating habits

OUTCOME (what): express views on healthy eating habits

TARGET POP (who): those participating

CONDITIONS (when): during a session

CRITERION (how much): all

Section III

The PRECEDE model fits well with Pitt Fit because it focuses on outcomes rather than

input. It covers both the diagnosis as well as the assessment of the program. The social diagnosis

deals with the problems of the community and priorities of the people such as the overweight and

obesity epidemic. Epidemiological diagnosis identifies health goals and problems of the society.

This targets the unhealthy diet and lack of exercise of the community, as well as lack of

willpower to change their lifestyle. Educational and organizational diagnosis deals with three

factors: the predisposing factors, reinforcing factors, and enabling factors. The predisposing

factors include society’s beliefs, knowledge, attitude, and life experiences. The goal is to

determine why society has allowed itself to live an unhealthy lifestyle full of health risks, and

what can be done to change that. Reinforcing factors include social support, motivation, and

influence. Through support of their family, health education of specialists, and health promotion

of Pit Fitt, goals can be met by the mentees, motivating them to continue with the program.

Enabling factors deal more with the physical and mental ability to take part in the program. It

also takes into consideration the available resources, accessibility to the resources, and

affordability for the resources. Next is the administrative and policy diagnosis which does the

assessment and development of the program before implementing it. We obviously want to

perfect the program as much as possible before introducing it.

At the end of the program, process evaluation, impact evaluation, and outcome evaluation

take place. Process evaluation assesses the equipment, facilities, supplies, and personnel to

determine their impact on the program. Impact evaluation assesses the beliefs, knowledge,

attitude, intentions, and values of the participants to see whether or not there were any changes in

behavior. Pitt Fit hopes to influence the participants’ knowledge about various exercises and

health education, as well as transition their attitude to a positive outlook healthy living. Lastly,

the outcome evaluation assesses the productivity, health care cost, absenteeism, and behaviors.

This summary will help determine what can be done more efficiently, what aspects needs to be

improved, and how this program can be the best it can be.

Section IV

Program development:

What are you going to do to target the identified theoretical constructs? The PRECEDE model

focuses on predisposing factors such as the beliefs, knowledge, attitude, and life experiences of

the community. The goal of limiting the predisposing factors is to determine the causes for

unhealthy lifestyle leading to potential health risks, and create preventative outcomes. In order to

target the predisposing factors identified in section III, activities such as running, walking,

weight-lifting, sports, and machines would be incorporated into the program. Not only does it

include activities that the community has participated in before, but it also encourages new

activities for the community to engage in to increase their knowledge.

Technology:

- Myfitplan

- Music (to listen to with exercise)

- Fitbit and pedometer

Facilities needed:

- Gym

- Wellness center

- Field

Services offered:

- 1-on-1 with mentor

- Education on various health factors

- Group Activities

Contracts needed:

- Doctor notes

- Permission from parents

Marketing of programs:

- Facebook

- Doctor’s offices

- Schools

Timelines:

- 1yr program

- 2yr follow-up

Activities:

- Indoor activities

- Weights

- Machines

- Track for running/walking

- Outdoor activities:

- Sports

- Field activities

- Outdoor games

- Moderate & Intense activities

- Depends on risk classification

- Communication:

- Positive reinforcement

- Increase knowledge/awareness

- Incentives and disincentives:

- Look good/feel good

- Don’t like to sweat/feel gross

- Tired/sore

- Commitment need

Section V

Evaluation Plan

Independent Variables:

- Interventions

Dependent variables:

- Body Mass Index (BMI)

- Skinfolds

- Weight via scale

- Absenteeism

Confounding variables:

- Weather

- Schedules

- Absenteeism

Simple:

- VO2max

- Blood pressure

Complex:

- Absenteeism

- Productivity

Objective:

- Bruce maximal treadmill test

- DEXA

- Pedometers/Fitbit

Subjective:

- Absenteeism (lack of effort/motivation)

- Enjoyment

- Potential Outcomes

Participation:

- Regularity of Participation

- Absenteeism

- Adherence

Measuring program success can benefit Pitt Fit by giving insight about what needs to be

changed, removed, and what needs to be developed more. Measurements such as participation in

physical activity, knowledge and increased awareness of health, overall reduced health risks, and

recruitment/retention would show a success in the program. By inviting friends to join Pitt Fit,

the youth can encourage others to be active. Those who grow out of the program but still want to

be involved, could become a “mentor” for others, encouraging them to make lifestyle changes

while also keeping track of their own lifestyles.