Community Needs Assessment: (Delaware State University)
Community Nutrition Fall 2011
The prevalence of obesity is on the rise nationwide. The latest findings from the Centers for Disease Control National Health and Nutrition Examination Survey (NHANES) report an adult obesity rate of 33.8% nationally (CDC, 2008). According to Boyle and Holben, obesity is a significant public health issue that affects the entire population through the increased cost of health care and increases in mortality and morbidity among citizens. A statement from Dr. William Dietz of the Centers for Disease control and Prevention is quoted to have said:
"Given the size of the population that we are trying to reach, we obviously cannot rely solely upon individual interventions that target one person at a time. Instead, the prevention of obesity will require coordinated policy and environmental changes that affect large populations simultaneously." (Holben & Boyle, 2010)
In a recent interview, Marianne Carter of the Delaware Center for Health Promotion at Delaware State University stated that the decision for individuals to live a healthier lifestyle isn't always solely up to them. Rather, there is also a need to address other areas such as environmental and policy issues. (Carter, 2011) In our group's approach to the Community Needs Assessment, the problem of obesity was considered to be a powerfully relevant choice which could be readily adjusted through environmental and policy changes. According to the course text: "Many of the policy initiatives [regarding the obesity epidemic] address children rather than adults, for a number of reasons. First, because obesity is so intractable [...] The rates of overweight are increasing in children as well as in adults [...] Food habits are still malleable for children [and] Finally it is easy to reach children because the majority of children attend schools..." (Holben & Boyle, 2010) In terms of narrowing the population for analysis, the group determined that high school students would be a valuable target considering the distinct developmental stages that occur during the teen years. High school students are in the formative years of developmental maturity through a transitional balance teetering between childhood and adulthood. Teens, unlike young children, have developed the ability to think about and understand abstract ideas such as long term consequences of behavior. They have the ability to understand the complex issues related to the relationships between lifestyle and long term health. Teens are in a social developmental stage in which they are seeking opportunities for self-growth and fulfillment, while remaining relatively impressionable and easily accessible given the academic setting. (WebMD, 2010)
According to the 2010 County Health Rankings study released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson foundation ranked Kent County as the worst among Delaware counties in terms of both study measures of Health Outcomes and Health Factors. (University of Wisconsin and Robert Wood Johnson Foundation, 2011)
Location of Interest
Kent County, Delaware
High school students grades 9-12
Examine the extent that overweight and obesity exists amongst Kent County high school students and the characteristics of the population and community which may influence this prevalence.
Kent County Delaware high school students (grades 9-12) in the following school districts: Capital, Caesar Rodney, Lake Forest & Polytech.
Goals and Objectives of the Needs Assessment
Goal 1: Compare the prevalence of overweight and obesity among Kent County high school students to similar groups at state and national levels.
- Objective A: Assess the rate of overweight and obesity among high school students.
- Objective B: Compare Kent County rates to other counties within Delaware.
- Objective C: Compare Kent County rates to that of the national averages.
Goal 2: Assess the school lunch program within Kent County with regards to health standards, food availability and costs.
- Objective A: Identify the level of participation in high school lunch programs among student population. (Including statistics on free and reduced lunch participation)
- Objective B: Assess the school lunch program guidelines, and outline requirements and mandates. (Including source of mandates and enforcement)
- Objective C: Identify the source of foods provided and funding/subsidization provided.
Goal 3: Assess the amount and quality of Nutrition Education and Wellness programs available within Kent County High Schools.
- Objective A: Determine the guidelines for Nutrition Education for High School students (Number of hours, courses, etc. and frequency ie. per semester, per school year etc.)
- Objective B: Assess the method of administration of Nutrition education; in classroom, by assembly, etc.
- Objective C: Determine faculty requirements for Nutrition Education (who provides coursework, level/type of degree, etc) **If available.
- Objective D: Assess the presence of Wellness Centers within County Schools and determine functions and programs.
Goal 4: Assess community and environmental factors related to overweight and obesity among High School students in Kent Co.
- Objective A: Collect statistical information related to the following factors:
- Household Income
- Household composition
- Education level (within household)
- Sports Participation
- Parks and Recreation
- Video game sales
- Dietary Environment of community (proximity of fast food restaurants, etc)
- Objective B: Determine the impact of this data with regards to overweight and obesity in Kent Co.
Goal 5: Assess the access to foods provided through sources other than School Lunch program foods within High Schools of Kent County.
- Objective A: Assess the availability of a la carte menu items including item, nutrition information and relative cost compared to healthy options.
- Objective B: Assess the availability of vending and soft drink machines on campus and determine if access is restricted.
- Objective C: Assess access to other food items from concessions, school stores, and other food sources on campus.
- Objective D: Determine prevalence of food advertisements on school campus.
Goal 6: Assess the Physical Education Programs and access to campus recreation within Kent County High Schools.
- Objective A: Determine number of hours and interval of physical education required for students.
- Objective B: Assess access to additional physical activities after hours (ie open gym, weight rooms, etc.)
- Objective C: Determine graduation requirements related to physical education.
- Objective D: Assess student athletic programs and availability (number and types of sports offered per school.)
Issue 1: The overweight and/or obesity level among high school students in Kent County.
- The obesity rate in Kent County among adults as of 2011 is 32% (CDC, 2008)
- 33.2% of children between the ages of 10 - 17 are classified as overweight or obese. (University of Wisconsin and Robert Wood Johnson Foundation, 2011)
- Kent County is ranked third in overall health outcomes and health factors in Delaware by County Health Rankings (University of Wisconsin and Robert Wood Johnson Foundation, 2011)
Issue 2: The number of high school student eligible for free or reduced lunches
- At Caesar Rodney High School 19% of the students are eligible for free lunches and 5% are eligible for reduced lunches.
- At Dover High School 31% of the students are eligible for free lunches and 6% are eligible for reduced lunches.
- At Lake Forest High School 26% of the students are eligible for free lunches and 6% are eligible for reduced lunches.
- At Polytech High School 12% of the students are eligible for free lunches and 5% are eligible for reduced lunches.
(Public School Review, 2010)
Characteristic 1: The rate of overweight or obesity among 10-17 year olds is different among ethnic groups.
The breakdown among the ethnic groups are:
- Black (Non-Hispanic) 42.7%
- White (Non-Hispanic) 27.9%
(Child Health Data, 2007)
Characteristic 2: The high schools in the county each have a wellness center.
Bay Health provides a wellness center in the following high schools
They provide the following services to students and their families at no cost.
- Physical health - routine physical exams, sports or employment physicals, treatment of minor illnesses or injuries, immunizations, prescriptions for routine medications, family physician follow-up, diagnosis and treatment of sexually transmitted diseases and identification and referral for treatment of high-risk conditions.
- Mental health - drug and alcohol counseling, self-esteem enhancement, stress and anxiety intervention, suicide prevention, individual and family counseling and referral services.
- Nutrition - information on healthy eating, special diets, weight management and sports nutrition.
- Laboratory tests - simple blood tests, throat cultures and pregnancy testing.
- Education - programs to promote a healthy and safe lifestyle, including smoking prevention/cessation, individual and group health education, HIV and AIDS education, responsible decision making, healthy lifestyle habits and health promotion.
Christiana Care provides a wellness center to Polytech High School.
They provide the following services to the students.
- Physical examinations, including routine exams, sports physicals and pre-employment physicals.
- Health screenings, including those for communicable infections.
- Women's health care.
- Treatment for minor illnesses and injuries.
- Nutrition and weight management.
- Individual, family and group counseling.
- Crisis intervention and suicide prevention.
- Tobacco cessation counseling.
- Drug and alcohol abuse counseling and referral.
- Outreach to at-risk youth.
- Health and nutrition education.
- Doctor referrals.
- Follow-up as requested by the student's family health care provider.
(Adolescent Health Services, 2011)
Characteristic 1: Fast Food Restaurants
- There are a total of 84 fast food restaurants in Kent County as of 2008.
(Find the Best, 2008)
Characteristic 2: Parks and recreation centers
There are 29 parks in Kent County (Info Sports, 2011)
- 27 of those parks are located in the Dover area and 2 of the parks have recreation center at them.
- John W. Pitts Recreation Center
- Dover Park Recreation Center
(City of Dover, 2011)
Characteristic 1: Household education levels
The breakdown of the education level for households in Kent County. (US Census Bureau, 2009)
- 84.6% are high school graduates
- 19.4% have a bachelor's degree
Characteristic 2: Household income
The breakdown of the annual income for households in Kent County. (Best Places, 2011)
- 10.67% income below $15,000
- 11.06% income between $15,000 and $25,000
- 10.89% income between $25,000 and $35,000
- 16.54% income between $35,000 and $50,000
- 22.43% income between $50,000 and $75,000
49.16% of the households in Kent County make below $50,000 annually.
Analysis and Interpretation of Data
The focus of this community needs assessment was finalized as a review of the factors related to Obesity among the High School student population of Kent County, Delaware. Environmental factors, policies, demographics, and socioeconomic statistics were among the elements of review for this analysis. The information has been outlined by the target population and supporting data within the key areas of background conditions, community, socioeconomic and environmental characteristics. Additionally, the data will be analyzed and interpreted by answering the following five questions in marked sections:
Did your perception of the targeted community change? If yes, what was the basis for the change?
What were the five leading health and nutritional problems that emerged from your community study? Present the incidence and/or prevalence of these problems.
How would you prioritize these health and nutritional problems?
Were you able to obtain all types of data shown in Tables 2-2, 2-3 and 2-4? If not, why not? What does this suggest to you?
How can you apply your knowledge of the community and any background conditions to addressing the health issues that you have identified? List and describe three (3) action steps that you could take
Section 1: Did your perception of the targeted community change? If yes, what was the basis for the change?
It was initially expected that obesity rates for the targeted population of Kent County would be aligned with that of the national average for similar subjects and lower than other counties within Delaware. This expectation was based upon several assumptions related to the community of Kent County, the first being population size. Kent County has fewer inhabitants than both New Castle and Sussex counties. Given the smaller population, it was assumed that Kent County would therefore contribute less than other counties to the obesity statistics for the state of Delaware as a whole. It was discovered early in this project, however that this is not in fact the case. According to the Childhood Obesity Action Network profile for the state of Delaware, the prevalence of overweight and/or obesity among high school students is 33.2%. (NICHQ, 2007) This is nearly 2% higher than the national average of 31.6% outlined by the CDC from the latest NHANES data (CDC, 2008). Data was not available regarding the prevalence of obesity among the target population of Kent County High School students specifically. However according to the Centers for Disease Control county level assessments for Delaware, Kent County is at the top of the list with the highest rate of adult obesity at 32.4%, Sussex and New Castle counties rank second and third in the state with figures of 28.9% and 27.2% respectively. Considering the data available, the following inferences were made: If rates among high school students in Delaware are higher than the national average and rates amongst adults in Kent County are higher than other counties within the state- then rates among high school students within Kent County must also be higher than other counties. The previously cited NICHQ fact sheet lists that regarding 'Obesity related school standards' the state of Delaware as one of only 21 states in the nation to collects body mass index information. This type of data for Kent County students specifically, was not published in any publicly available forum. It is therefore unclear if and how body mass index information is being collected and to whom it is reported.
A second assumption that changed regarding the target population was related to the topic of physical activity. The community of Kent County exists on a diverse spectrum ranging between rural farmland and urban living. In such a complex landscape it was expected that a variety of opportunities for physical activity would be utilized- through labor intensive farm work in rural areas and the use of sidewalks and public park space in developed regions. It was discovered early on, however, that young people in this region do not regularly engage in physical activity. When surveyed for the 2009 Delaware Youth Risk Behavior Surveillance System (YRBSS) 20% of high school students reported that they did not participate in at least 60 minutes of physical activity on any day during the 7 days before the survey. Furthermore, teens who did report physical activity were not consistently active on a daily basis. Among teens that were physically active at least 60 minutes per day, 76% were active on less than 7 days during the week before the survey. When questioned regarding other activities, 38% of high school students watched television 3 or more hours per day on an average school day and 27% used computers 3 or more hours per day on an average school day to play video or computer games or use a computer for something that was not related to school work. With a cumulative screen time of 6 hours for some students, it's easy to see how little time remains in the day for physical activity. (CDC YRBSS, 2009)
Finally, there was a great change in the initial impression of the socioeconomic status of the target population. At first glance, Kent County appears to be populated by middle class families with a countywide median household income of $50,884 and a prevalence of families below the poverty line at 13.6% according to the Census bureau (US Census Bureau, 2009). However, upon further investigation it was determined that the number of high school students in low income families is larger than expected with the Delaware Department of Education reporting a rate of 48.8% for 2010-2011. (Delaware Department of Education, 2010-2011 ) The rate of free and reduced lunch participation is another indicator of the socioeconomic climate for this population, with rates of participation for Dover High school at 37%, Lake Forest High at 32%, Polytech at 17% and Caesar Rodney at 24% participation (Public School Review, 2010-2011). These figures illustrate that the median income and poverty statistics of the countywide population may not accurately represent a significant portion of the target population. Socioeconomic factors and financial instability may be significant factors relating to the problem of obesity amongst Kent County high school students.
Section 2: What are the five leading health and nutritional problems that emerged from your community study? Present the incidence and/or prevalence of these problems.
The leading health and nutritional problems that emerged from this study include issues relating to policies at the educational level as well as the community environment. At the educational level factors contributing to the issue of obesity were found to be related to school lunch offerings, nutrition education and physical education requirements. At the community level contributing factors include the availability of fresh fruits and vegetables and the prevalence of fast food restaurants in the surrounding environment.
As previously noted, approximately 1 in 3 students in Kent County high schools is participating in the school lunch program through free or reduced lunch offerings. This prompted our group to review the menu selections for each of the schools, which revealed a pattern of energy dense items such as pizza, pasta, grilled cheese, and chicken tenders on regular menu rotation. There are also additional snack items that are available for purchase in schools known as a la carte items. Many of these foods are processed salty snacks and desserts that offer energy density with few nutritional benefits. The findings of the Delaware YRBSS report note that in terms of schools with a la carte lunch menu offerings only 41% of schools do not sell less nutritious foods and beverages anywhere outside the school food service program. (CDC YRBSS, 2009)
For nutrition education, Kent county high school students are required to complete only one semester of health education during a four year program. This health course outlines various subjects related to health with nutrition being only a minute component. (Caesar Rodney High School, 2011) Physical education curriculum consists of two semesters per four year program which allows for approximately 180-270 hours per high school career of physical activity. This activity level is significantly less than the recommendations outlined by the Centers for Disease Control for healthy adolescents of one hour per day. (Centers for Disease Control and Prevention, 2011). The Delaware Youth Behavior Risk Surveillance System found that among students surveyed "75% did not attend PE classes daily when they were in school." Furthermore, student surveys revealed that "60% did not attend physical education classes in an average week when they were in school" (CDC YRBSS, 2009).
How would you prioritize these health and nutritional problems?
The nutrition and health related problems discussed in Section 2 are each of independent importance. Before discussing the rank of priority assigned to each of the contributing factors related to obesity among Kent County high school students, it is important to note the criteria used for determining priority. Upon reviewing each of the five key factors, emphasis was placed on details relating to the change-ability of the elements and the impact that these changes were presumed to have the ability to yield. For instance, the socioeconomic status of the target population was determined to play a role in the problem of obesity, although greater financial stability would create a major change that could have the potential to impact the problem actually creating the environment to impact the financial status of all of those involved would require complex efforts that are beyond the scope of this assessment. In this light, the five key nutrition and health related problems for this community were prioritized as follows:
- School Lunch Program
- Nutrition Education
- Physical activity
- Affordability and affordability of fresh fruits and vegetables
- Availability and affordability of Fast Food meals
The highest priority was placed upon the school lunch program and nutrition education because of the access to students on a regular basis. If nearly one third of Kent County high school students are participating in school lunch programs through free and reduced lunches- even more participate through their own funding. According to the US Department of Education the average number of schools days per year is 180 days. This means 180 opportunities are available each year to promote healthy eating. Over the four year high school career that is a total of 720 meals that can be used to set the example of a healthy lifestyle. The lunch period is the only class that every single member of the student body has the opportunity to participate in each school day, and holds the potential for major changes that could affect the weight management of students involved. Likewise, increases in classroom nutrition education and in-school physical activity programs are both areas where great improvements can be made. The current requirement for health education is only one semester for a four year program and physical education classes are taken for two semesters, or one school year. An evidence summary from the American Dietetic Association Evidence Analysis Library on the effectiveness of school based programs combining nutrition education and physical education interventions to address childhood overweight cites Grade II evidence to support that combined programs may be useful in improving adiposity measures among students (American Dietetic Association, 2009). YRBSS notes that most schools (71%) in Kent County offer all students the ability to participate in intermural and physical activity clubs. However, the associated costs of these programs may be a barrier for low income students and should be considered as a limiting factor which should be accounted for.
The availability and affordability of fresh fruits and vegetables for the population is based upon comparative data for the counties in Delaware. The 2010 County Health Rankings study listed Kent County with the least amount of access to healthy foods, including fresh fruits and vegetables as compared to New Castle and Sussex counties. Researchers assessed access to healthy foods based on the measured percentage of zip codes in a county with a healthy food outlet, defined as a grocery store or produce stand/farmers' markets. The measure is based on data from the US Census Bureau's Zip Code Business Patterns. Healthy food outlets include grocery stores and produce/farmers' markets, as defined by their North American Industrial Classification System (NAICS) codes. The program outlines study results which suggest that a positive food environment is linked to consumption of healthy food and overall positive health outcomes. (University of Wisconsin and Robert Wood Johnson Foundation, 2011)
The availability and affordability of fast food for the population is based upon the number of fast food restaurants per 1000 population in Kent County at a rate of 0.54, higher than any other county in the state. Likewise, the number of fast food restaurants increased by 12.55% from 73 to 84 from 2007 to 2008. (Find the Best, 2008) Fast food restaurants are known for quick and inexpensive menu offerings and the increase in prevalence in recent years may be a response to market demands of community members who are experiencing financial hardships. It is understood that a significant portion of the target population of Kent County high school students come from low income families who may be turning to fast food restaurants to put quick and affordable food into the mouths of their hungry teens. Likewise, with most establishments now offering a full menu of items for $1 or less, fast food restaurants are regular resources for independent high school students with limited funds.
To illustrate the difference in affordability of fresh foods verses fast food in Kent county, group members conducted a study of cost comparison between an advertised meal special at Burger King and fresh food purchased at local supermarkets. The results were as follows:
The BK family bundle:
Feed a family of 4 for $9.99 (Burger King, 2011)
Grocery store comparison with healthier choices:
Cost for 1 pound 90/10 or leaner 100% ground beef, 4 whole grain hamburger buns, 1 head of lettuce, 1 tomato, 1 onion, 4 potatoes, 4 fresh apples, and 2 servings of low fat milk. (Freedman, Zoellner, Saamoi, & Murray, 2011)
Difference vs BK Family bundle
*NOTE whole grain buns not available at this location
The findings outlined above clearly illustrate the increased cost for fresh foods purchased at a grocery or discount store compared to prepared foods purchased at a fast food restaurant. With the schedule and financial constraints that many low income families are faced with, it is easy to see why many tend toward the fast food option.
Section 4: Were you able to obtain all types of data shown in Tables 2-2, 2-3, and 2-4? If not, why not? What does this suggest to you?
We were able to collect some of the data similar to tables 2-2, 2-3, and 2-4. The majority of data collected for this analysis related to the community environment of our target population. For the environment category, data was obtained regarding food systems, health systems, recreation, sociocultural data and trends, and socio- economic data and trends. For food systems, data was collected was on the number of fast food restaurants in Kent County. The health systems data was related to the number of free clinics available for low income families in the area. We wanted to see if there was a place they could go to get medical services that would be at a low cost or free for the families of students in the target population. The recreation data collected was related to the number of parks and recreation centers located in Kent County as well as access to high school intermural sports. For socio-economic analysis data was reviewed to determine the average income level and education level of households within the county. This information was helpful in determining how the problem of obesity in the target population may correlate with the prevalence of low income households within the community. Although a great deal of data and statistics is available online through public forums and nationwide agencies, it was a challenge to locate specific information pertaining to the small population of High School students in Kent County. Some of these limitations are to be expected, given that stakeholders may not have the resources or need to obtain and publish records relating to all of the habits of such a small population. However, it was surprising to discover the difficulty of determining prevalence rates for overweight and obesity for the specific target population, particularly when at least one public source (NIHCQ) noted the statewide ability to obtain body mass index information. Data pertaining to children from ages 2-19 was available but very little information about the ages 13-19 was published. This illustrates the need for additional review on the lack of public record for this population in Delaware. More information should be gathered about this age group when it comes to overweight and/or obesity and the related health issues. Knowledge is power and if a factor is not measured or reported then it cannot affect change for the population that it is meant to assist. By recording and publishing the findings of body mass index information for the population of Kent County high school students, key stakeholders can remain informed with regards to the scope of the problem of obesity and overweight among the population. When stakeholders are informed with accurate and up to date information policy changes can be made to manage the problem.
How can you apply your knowledge of the community and the background conditions to address the health issues that you have identified? List and describe 3 action steps that you could take.
In completing this community assessment and great deal of information was uncovered regarding the target population. Kent County high school students are living in an environment that is contributing to the growing problem of overweight and obesity among them. The key to taking action that will affect change for these teens is to create an environment that is built to promote healthy behaviors and food choices. In an ideal environment, students would be educated regarding proper nutrition for optimum health and appropriate weight management and the school lunch program would serve as the model for healthy balanced eating. Students should be able to learn in an environment where is it easy to make the healthiest choices and increase physical activity on a daily basis. The creation of this environment can begin with policy changes in education which increase nutrition education and physical activity in school programs. Two key pieces of legislation presently in Congress address these very issues: HR 2795 Fit for Life Act of 2011 and HR 576 Healthy Children Through School Nutrition Education Act. The Fit for Life Act of 2011 includes provisions to expand the offering of free fresh fruits and vegetables in low income communities, it sets forth grant programs to increase physical activity through health and fitness programs in schools, and creates a National Commission on Child Obesity, among other things. The Healthy Children Through School Nutrition Education requires that participating educational agencies include in their school wellness policies the requirement that each student receive 50 hours of nutrition education each school year. The passing of these two pieces of legislation would be the first of three action steps toward increasing the availability of healthy foods, nutrition education and physical activity for Kent County High School students.
As previously discussed, Fast food restaurant accessibility and affordability are believed to be contributing factors to the problem of obesity within the target population. Although policy changes cannot affect the number of fast food restaurants in Kent County, they can affect the affordability of the calorically dense and nutrient poor menu offerings. The second action step of this assessment is to impose a tax on foods purchased at fast-food restaurants and the sale of sugar sweetened beverages such as soda or energy drinks.
Last year ABC news reported on a study which discussed a similar proposal. Researchers at the University of North Carolina at Chapel Hill found that participants consumed significantly fewer calories from soda and pizza when the price of either was increased by 10 percent (Fiore & ABC News, 2010) "Our results provide stronger evidence to support the potential health benefits of taxing selected foods and beverages," they wrote. "Similar taxation policies have proven a successful means of effectively reducing adult and teenage smoking." Funds raised from these imposed taxes could be reallocated to health promoting programs such as increased physical education, public parks, recreation facilities and nutrition education programs. Success has been seen for similar programs such as the tax of alcohol and tobacco products. New York City is amongst the most successful in implementing public health initiatives through the taxing of tobacco. The average cost of a pack of cigarettes in Manhattan in 2010 was $11 compared to the national average of $5.35. As expected an inverse relationship exists between the cost of cigarettes and smoking rates amongst adults and youths. According to Cathy Nona, the Director of Physical Activity and Nutrition Programs for the NYC Department of Health adult smoking in NYC has decreased by 27% since 2002 and youth smoking has decreased by an astonishing 64%! This is an instance where policies have been created- not to take away choice- but to make it more difficult to make choices that will impact health in a negative way. (Nonas, 2011) Likewise, an excise tax on sugar sweetened beverages at a rate of 1 cent per ounce could assist in reducing consumption, encouraging a switch to non-caloric drinks or smaller portions and raise revenues at the state level to be used for additional public health initiatives. Furthermore tax revenues could be allocated to the subsidization of healthier food choices which lack the price elasticity of soft drinks such as fresh fruits and vegetables, low fat dairy, fish and eggs.
The third and final action step related to improving the environment for high school students in Kent County relates to the availability and affordability of fresh fruits and vegetables by promoting and funding of farmers markets within the community. To increase the availability of local, fresh seasonal produce it is proposed that locally funded incentives and subsidies are offered to area farmers for participation in farmers markets and produce stands. Land grants and tax credits should also be made available for the creation and promotion of community gardens. Finally, fruit and vegetable consumption can be increased by insuring that all state level food assistance programs are accepted at farmers markets and produce stands including WIC and SNAP benefits.
It has been deduced that High school students in Kent County are among the heaviest in the state. More can be done in terms of policy and environmental changes to impart transformation for this generation of overweight and obese teens and adolescents. Focusing on the areas of nutrition education, physical activity programs in schools, policies on sugar sweetened beverages and the relative costs of fresh foods verses fast food meals are ways in which seemingly small changes can impact the lives of thousands.
According to the 2010 County Health Rankings study released by the University of Wisconsin Population Health Institute and the Robert Wood Johnson foundation ranked Kent County as the worst among Delaware counties in terms of both study measures of Health Outcomes and Health Factors. (University of Wisconsin and Robert Wood Johnson Foundation, 2011) According to the Childhood Obesity Action Network profile for the state of Delaware, the prevalence of overweight and/or obesity among high school students is 33.2%. (NICHQ, 2007) This is nearly 2% higher than the national average of 31.6% outlined by the CDC from the latest NHANES data (CDC, 2008). Data was not available regarding the prevalence of obesity among the target population of Kent County High School students specifically. However according to the Centers for Disease Control county level assessments for Delaware, Kent County is at the top of the list with the highest rate of adult obesity at 32.4%, Sussex and New Castle counties rank second and third in the state with figures of 28.9% and 27.2% respectively. Considering the data available, the following inferences were made: If rates among high school students in Delaware are higher than the national average and rates amongst adults in Kent County are higher than other counties within the state- then rates among high school students within Kent County must also be higher than other counties. The previously cited NICHQ fact sheet lists that regarding 'Obesity related school standards' the state of Delaware as one of only 21 states in the nation to collects body mass index information. This type of data for Kent County students specifically, was not published in any publicly available forum. It is therefore unclear if and how body mass index information is being collected and to whom it is reported.
Major findings include:
- Kent county is home to a disproportionate number of fast food restaurants compared to more populated New Castle and Sussex counties with 84 out of 221 fast food restaurants (Find the Best, 2008)
- Kent county high school students are required to complete only one semester of health education during a four year program. This health course outlines various subjects related to health with nutrition being only a minute component. (Caesar Rodney High School, 2011)
- Physical education curriculum consists of two semesters per four year program which allows for approximately 180-270 hours per high school career of physical activity. This activity level is significantly less than the recommendations outlined by the Centers for Disease Control for healthy adolescents of one hour per day. (Centers for Disease Control and Prevention, 2011)
- According to the NYC Department of Health and Mental Hygiene, consuming one can of soda per day can result in a ten pound weight gain at the end of one year. (NYC Department of Health and Mental Hygiene, 2009) The Youth Risk Behavioral Surveillance System of Delaware found that 29% of students surveyed reported consumption of a can, bottle or glass of soda at least one time per day during the seven days before the survey (CDC YRBSS, 2009)
In order to address the problems related to the major findings above, it is proposed that Nutrition and Physical Education requirements are amended in accordance with HR 2795 Fit for Life Act of 2011 and HR 576 Healthy Children Through School Nutrition Education Act. Additionally, fast food and sugar sweetened beverage consumption can be curbed through the imposition of tax laws related to these products. It is proposed that a 10% increase in cost through a tax for fast food meals, in accordance with the research findings of the University of South Carolina Chapel Hill, would significantly impact the consumption of these energy dense foods. Likewise, a tax of one cent per ounce for sugar sweetened beverages would assist in decreasing consumption and increase revenue for other health promoting programs such as the subsidization of fresh fruits and vegetables or funding for the nutrition education and physical education curriculum adjustments discussed above.
Marianne Carter of the Delaware Center for Health Promotion at Delaware State University stated that the decision for individuals to live a healthier lifestyle isn't always solely up to them. Rather, there is also a need to address other areas such as environmental and policy issues. (Carter, 2011)
The Centers for Disease Control and Prevention Delaware Youth Risk Behavior Survey summary answered the question "What are the solutions?" regarding the Obesity Epidemic and Delaware Students as the following:
"Better health education [,] More PE and physical activity programs [, and] Healthier school environments." (CDC YRBSS, 2009)
Adolescent Health Services. (2011). Retrieved November 2011, from School based health centers: www.christianacare.org/highschoolwellnesscenters
American Dietetic Association. (2009). Eatright.org. Retrieved 2011, from ADA Evidence Analysis Library: http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251527&highlight=nutrition%20education&home=1
Bayhealth. (2011). High School Wellness Centers. Retrieved November 2011, from Services in Delaware: www.bayhealth.org/high-school-wellness-centers
Best Places. (2011). Economy in Kent County. Retrieved October 2011, from http://www.bestplaces.net/economy/county/delaware/kent
Burger King. (2011, October). BK.com. Retrieved 2011, from BK Family Bundle: http://www.bk.com/en/us/menu-nutrition/full-menu.html
Caesar Rodney High School. (2011). Programs and Departments. Retrieved November 2011, from Physical Education/Health/Drivers Education: http://www.crhs.cr.k12.de.us/departments/physed.html
Carter, M. (2011, November). Director- Delaware Center for Health Promotion, Delaware State University. (A. Saamoi, Interviewer)
CDC. (2008). Centers for Disease Control and Prevention. Retrieved 2011, from National Health and Nutrition Examination Survey: http://www.cdc.gov/nchs/nhanes.htm
CDC YRBSS. (2009). Centers for Disease Control and Prevention. Retrieved 2011, from Youth Behavior Risk Surveillance System: http://cdc.gov/healthyyouth/yrbs/index.htm
Centers for Disease Control and Prevention. (2011, September 15). Adolescent and School Health. Retrieved November 2011, from Youth Physical Activity Guidelines Toolkit: http://www.cdc.gov/HealthyYouth/physicalactivity/guidelines.htm
Child Health Data. (2007). Delaware NSCH Disparities Snapshot. Retrieved October 2011, from Race/Ethnicity: http://www.childhealthdata.org/browse/snapshots/nsch-profiles/race-ethnicity?geo=9&ind=651
City of Dover. (2011). City of Dover. Retrieved November 2011, from Parks: http://www.cityofdover.com/Parks-3907/
Delaware Department of Education. (2010-2011 ). Retrieved 2011, from Student Demographic Date 2010-2011 School year: http://profiles.doe.k12.de.us/schoolprofiles
Find the Best. (2008). Find the Best. Retrieved 2011, from Kent County Delaware Obesity Rates and Fast Food Consumption: http://county-food.findthebest.com/l/314/Kent
Fiore, K., & ABC News. (2010). Junk Food Tax Could Improve Health. ABC News.
Freedman, M. D., Zoellner, A., Saamoi, A., & Murray, J. (2011). Grocery store cost comparison. Dover, DE.
Holben, D. H., & Boyle, M. A. (2010). Community Nutrition in Action. In D. H. Holben, & M. A. Boyle, Community Nutrition in Action- An Entrepreneurial Approach (Fifth Edition ed., pp. 252-253). Belmont, CA: Wadsworth.
Info Sports. (2011). Delaware. Retrieved November 2011, from Kent County Parks: http://www.infosports.com/p.cgi?t=all&c=Kent&s=DE
NICHQ. (2007). National Institute for Children's Healthcare Quality. Retrieved 2011, from Childhood Obesity Action Network- Delaware State Fact Sheet: http://www.nichq.org/pdf/Delaware.pdf
Nonas, C. (2011). Director of Physical Activity and Nutrition Programs- NYC Department of Health. The Role of Public Health in Weight Management. Minneapolis, MN: Commission on Dietetic Registration Training for Adult Weight Management.
NYC Department of Health and Mental Hygiene. (2009, August 31). Pouring on the Pounds. Retrieved November 2011, from http://www.nyc.gov/html/doh/html/pr2009/pr057-09.shtml
Public School Review. (2010). Kent County High Schools. Retrieved October 2011, from School lunch program: www.publicschoolreview.com/school/kent
Public School Review. (2010-2011). Kent County Delaware. Retrieved 2011, from Free and Reduced Lunch Participation: www.publicschoolreview.com/school/kent
University of Wisconsin and Robert Wood Johnson Foundation. (2011). County Health Rankings- Mobilizing Action Toward Community Health. Retrieved 2011, from 2011 Delaware: http://www.countyhealthrankings.org/delaware/overall-rankings
US Census Bureau. (2009). United States Census Bureau. Retrieved October 2011, from Kent County Delaware Quickfacts: http://quickfacts.census.gov/qfd/states/10/10001.html
US Census Bureau. (2009). US Census Bureau- State and County Quick Facts. Retrieved 2011, from Kent County, Delaware Census Facts: http://quickfacts.census.gov/qfd/states/10/10001.html
WebMD. (2010, April 27). Children's Health: Growth and Development Ages 15-18 years . Retrieved 2011, from WebMD: http://children.webmd.com/tc/growth-and-development-ages-15-to-18-years-topic-overview
Meal Project: (Rutgers University)
The group had to develop a menu, modify the ingredient amounts, and change the serving size to accommodate about 100 students at Rutgers University. We worked with the chef to order the food needed to prepare the dishes. We planned two appetizers, a salad and three main dishes, one being vegetarian.