Abstract
Obesity is a serious public health issue in the United States. The prevalence and incidence of childhood and adolescent obesity have been explored in abundance. This paper is a continuation of the health campaign plan developed specifically to reduce obesity among school children in Delaware. The paper provides and evaluates available statistical information on adolescent obesity at state and national levels. Differences in community and institutional leadership are discussed. The role of social marketing in public muscle strengthening programs is evaluated.
Introduction
Obesity is one of the most serious national health problems. Adolescents and adults are equally susceptible to the risks of developing overweight and obesity complications. Negative consequences of adolescent obesity continue to persist through adulthood. This is why more programs are being developed to target and reduce obesity among children and adolescents. This paper is a continuation of the health campaign plan developed specifically to reduce obesity among school children in Delaware. The paper includes detailed statistics on adolescent obesity at the state and national levels, as well as a discussion of the economic and social marketing considerations affecting the implementation of the health promotion campaign.
Summary
Obesity in the United States has already become an epidemic. As a result, communities are faced with a multitude of diverse health, economic, and social challenges. One of the Healthy People 2020 objectives is to “promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights” (Healthy People, 2010). Physical activity as a measure of reducing obesity is the main goal of the discussed health campaign. Federal agencies involved in addressing and managing obesity include Centers for Disease Control and Prevention, the Department of Health and Human Services, as well as the American Academy of Pediatrics. State departments of health and local agencies play a role in how obesity prevention campaigns are implemented. Key models used to measure obesity incidence among different population groups are National Health and Nutrition Examination Survey (NHANES), the Body Mass Index (BMI), and the data from hospital registries. Target population for the proposed muscle strengthening activity campaign includes female and male Delaware students of various racial and tribal backgrounds, fifth to tenth grades. The main epidemiologic survey designs and models for monitoring obesity prevalence among students are the Behavioral Risk Factor Surveillance System (BRFSS) and the NHANES system. Disease incidence and prevalence are the two principal epidemiology tools to be used in addressing childhood and adolescent obesity in Delaware.
Incidence, Prevalence, and Mortality: State and National Statistics
Incidence and prevalence of obesity at state and national levels have been explored in abundance. According to the Centers of Disease Control and Prevention (2011), about one-third of American adults suffer from obesity. The past 20 years witnessed a dramatic increase in obesity rates at the federal level (CDC, 2011). In 2010, no state had obesity prevalence less than 20% (CDC, 2011). Obesity prevalence in thirty-six states exceeded 25% in 2010 (CDC, 2011). Compared to the national rates, Delaware shows a promising 28% obesity prevalence (CDC, 2011). Nonetheless, even with 28% of obesity prevalence at the state level, Delaware obviously needs to organize its efforts in dealing with issue of overweight and obesity.
The situation with childhood and adolescent obesity in the United States and Delaware is very serious. In the past thirty years, prevalence and incidence of obesity in the United States has nearly tripled (CDC, 2011). Obesity prevalence among children 6-11 years old increased from 6.5% to 19.6% (CDC, 2010). Between 1980 and 2008, the prevalence of obesity in adolescents 12-19 years of age increased from 5% to more than 18% (CDC, 2010). CDC (2010) claims that obese children and adolescents face high risks of cardiovascular complications: 70% of obese adolescents have at least one risk factor for developing a cardiovascular disease. Bone, joint, and sleep apnea problems, as well as psychological disorders are among the most frequent co-morbidities of adolescent obesity (CDC, 2010). The prevalence of obesity among Delaware students exceeds national prevalence indicators. At least 33% of Delaware children have overweight or obesity (National Conference of State Legislatures, 2010). Compared to 35.5% in 2005, the number of obese and overweight children in Delaware gradually decreases (NCSL, 2010). Nonetheless, the incidence and prevalence of obesity in Delaware remain very high. The situation is further complicated by the fact that only 14.7% of obese adolescents cease to be obese in adulthood (Gordon-Larsen et al, 2004). Moreover, as children and adolescents are getting older, their engagement in physical activity dramatically declines (Kimm et al, 2002). In light of these difficulties, a state campaign for increased muscle strengthening activity holds a promise to improve public health in Delaware.
Community-Based Response
That 33% of Delawarean children and adolescents are obese confirms the validity of the community campaign to strengthen muscle activity among fifth to tenth grade students. High incidence of obesity in Delaware justifies the need for such intervention. As of today, local and state agencies run a number of programs to address the issue of obesity and promote healthy lifestyles. Delaware Partners to Promote Healthy Eating and Active Living have launched a 2010-2014 Physical Activity, Nutrition & Obesity Prevention program, whose main goal is to address obesity and overweight by changing individual attitudes and beliefs about physical activity. In its current state, the program exemplifies the most promising community-based response to obesity. The proposed muscle strengthening activity program will add weight to the existing and future community-based interventions against childhood and adolescent obesity. The main goal of the proposed community-based intervention is to ensure that all students of fifth-tenth grades engage in at least three hours of physical activity on a weekly basis. The related objective is to develop and implement a school-based policy, providing students with a variety of physical activity opportunities that strengthen their muscles. The latter include the development of built-in sports facilities, especially in high-minority Delawarean schools, since inequality and unavailability of muscle strengthening opportunities contribute to increased overweight and obesity among adolescents (Gordon-Larsen et al, 2006).
The Role of Institutional and Community Leadership
Both institutional and community leaders play a huge role in how muscle strengthening activities are implemented. While “communities are an essential forum for obesity prevention, state health departments are uniquely positioned to support and enhance these efforts” (Cousins et al, 2011). Apparently, communities initiate and justify the need for health promotion campaigns, whereas state health departments exemplify an essential ingredient of institutional leadership and possess a unique authority to support and implement these programs. The role of institutional leadership in muscle strengthening activity programs cannot be overstated. At the very basic level, institutional leaders can leverage financial and ideological support required to implement these projects (Cousins et al, 2011). Institutional leadership is needed to create and enhance the local capacity for achieving program objectives (Cousins et al, 2011).
Leaders of state health departments take strategic funding decisions, whereas communities can provide information regarding previous experiences with implementing similar programs (Cousins et al, 2011). Community and institutional leaders collaborate and develop partnerships, to avoid previous mistakes and work collectively toward the main health promotion goals. Institutional leaders evaluate community leaders’ capacity to implement the project (Cousins et al, 2011). At the community level, leaders provide information and create networks to share and disseminate the data concerning the program, its implementation, its goals and results. Community leaders possess resources and opportunities to solve local problems and celebrate program achievements; in the meantime, institutional leaders provide technical assistance and facilitate community data collection (Cousins et al, 2011).
Notwithstanding the differences between institutional and community leadership roles, implementing a muscle strengthening activity program is impossible without constant collaboration among institutional and community leaders. It would be fair to assume that institution-community cooperation is an important predictor of the future program success. More often than not, community leaders lack capacity to implement and govern budgeting and funding processes (Cousins et al, 2011). Therefore, it is in the institutional leaders’ interests and abilities to prepare and secure effective funding mechanisms to support the entire course of program implementation.
Economic Factors and Funding Interventions to Achieve the Health Objective
The role of economic factors in achieving increased physical activity among fifth-tenth grade students in Delaware is two-fold. On the one hand, community and institutional leaders need a better understanding of the economic incentives to increase physical activity in the target population (Pratt et al, 2004). On the other hand, both community and institutional leaders must evaluate the funding options available in the proposed health campaign. In terms of the former, the SLOTH model has the potential to provide economic incentives and implement muscle strengthening activity among fifth-tenth grade students. The Sleep-Leisure-Occupation-Transportation-Home (SLOTH) model is an effective approach to designing health promotion campaigns (Pratt et al, 2004). Muscle strengthening relates to the leisure component of the SLOTH model, and the economic factors involved in the health campaign will be addressed via sports and technological advances.
Sport and exercise activities to encourage muscle strengthening activity among students will involve price discounts on pedometers (Pratt et al, 2004). In the meantime, local authorities and businessmen will be encouraged to invest in new and existing school-based sport facilities (Pratt et al, 2004). Local programs for low-income students will involve the use of the so-called “sport stamps”, which are similar to food stamps and provide access to sports facilities and equipment (Pratt et al, 2004). Schools can enter in agreements with recreational facilities and local authorities, to make their sports facilities available for use by students outside of school hours (Pratt et al, 2004). Computers and television can be used to spread the message of muscle strengthening activities and their role in reducing the risks of obesity and overweight.
In terms of funding, three options are possible. First, coordination of funds from multiple programs will help local and institutional leaders to increase the program’s budget (The Finance Project, 2004). Second, public-private partnerships will become a relevant response to the funding issues involved in the implementation of the health campaign (The Finance Project, 2004). Third, statewide networks can grant support to state health departments and local leaders in the development of obesity prevention interventions (The Finance Project, 2004). To make this happen, state and local leaders must work collaboratively to estimate the costs of program implementation.
Social Marketing and Health Promotion
Social marketing and health promotion are inseparable. A muscle strengthening activity program is no exception, as social marketing can help to stimulate and sustain a community-wide behavioral change (Lefebvre & Flora, 1988). Social marketing approaches and principles are well-suited for the challenging task of translating health promotion and educational messages into products and activities involving large population segments (Lefebvre & Flora, 1988). Brief social marketing interventions will not lead to significant behavioral changes, but their continuous application is an essential condition for improving public health (Lefebvre & Flora, 1988).
Social marketing will help local and state leaders to define the benefits to be provided to students for their participation and efforts (Grier & Bryant, 2005). These may include tangible benefits, like free access to sport facilities and organized leisure events. Social marketing provides the foundation for effective audience segmentation, which facilitates tailoring the program to the specific needs of the target population (Grier & Bryant, 2005). It is through social marketing that local and state health leaders can guarantee that the program and related decisions emanate from the detailed evaluations of students’ needs and wants (Grier & Bryant, 2005). For example, if students are willing to attend school-based muscle strengthening activities rather than hospital-based physical activity interventions, these needs and preferences should be considered. The implementation of the muscle strengthening program necessitates continued revision and monitoring, and social marketing fosters these activities (Grier & Bryant, 2005). However, for the program to be successful, social marketing must be both continuous and iterative, and cover all aspects of the program implementation process, from initial planning to the evaluation of its results (Grier & Bryant, 2005).
Conclusion
Obesity is one of the most serious national health problems. Between 1980 and 2008, the prevalence of obesity in adolescents 12-19 years of age increased from 5% to more than 18% (CDC, 2010). At least 33% of children in Delaware have overweight or obesity (NCSL, 2010). The proposed muscle strengthening activity program will add weight to the existing and future community-based interventions against childhood and adolescent obesity. Both institutional and community leaders play a huge role in how muscle strengthening activities are implemented. The economic factors involved in the health campaign will be addressed via sports and technological advances. Social marketing can help to stimulate and sustain a community-wide behavioral change (Lefebvre & Flora, 1988). All these elements will ensure the success of muscle strengthening activity among fifth-tenth grade students in Delaware.
References
Centers for Disease Control and Prevention. (2010). Childhood obesity. Centers for Disease Control and Prevention. Web.
Centers for Disease Control and Prevention. (2011). U.S. obesity trends. Centers for Disease Control and Intervention. Web.
Cousins, J.M., Langer, S.M., Rhew, L.K. & Thomas, C. (2011). The role of state health departments in supporting community-based obesity prevention. Preventing Chronic Diseases, 8(4), A87-A90.
Delaware Partners to Promote Healthy Eating and Active Living. (2010). Physical activity, nutrition & obesity prevention comprehensive plan. Delaware Health and Social Services. Web.
Gordon-Larsen, P., Adair, L.S., Nelson, M.C. & Popkin, B.M. (2004). Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study in Adolescent Health. American Journal for Clinical Nutrition, 80, 569-575.
Gordon-Larsen, P., Nelson, M.C., Page, P. & Popkin, B.M. (2006). Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics, 117(2), 417-424.
Grier, S. & Bryant, C.A. (2005). Social marketing in public health. Annual Review of Public Health, 26, 319-339.
Healthy People. (2010). Nutrition and weight status. Healthy People. Web.
Kimm, S.Y., Glynn, N.W., Kriska, A.M., Barton, B.A., Kronsberg, S.S., Daniels, S.R., Crawford, P.B., Sabry, Z.I. & Liu, K. (2002). Decline in physical activity in black girls and white girls during adolescence. The New England Journal of Medicine, 347(10), 709-715.
Lefebvre, R.C. & Flora, J.A. (1988). Social marketing and public health intervention. Health Education Quarterly, 15(3), 299-315.
National Conference of State Legislatures. (2010). Childhood overweight and obesity trends. National Conference of State Legislatures. Web.
Pratt, M., Macera, C.A., Sallis, J.F., O’Donnell, M. & Frank, L.D. (2004). Economic incentives to promote physical activity: Application of the SLOTH model. American Journal of Preventive Medicine, 27, 136-145.
The Finance Project. (2004). Financing childhood obesity prevention programs: Federal funding sources and other strategies. The Finance Project.