Building a healthy
Parramore
A Call to Action to reduce childhood obesity
Table of Contents LETTER FROM THE CHAIRS................... 3
THE CALLS TO ACTION..........................24
EXECUTIVE SUMMARY.......................... 4
CHILDHOOD OBESITY DEFINED............31
INTRODUCTION.................................... 6
CAUSES OF CHILDHOOD OBESITY.......34
PURPOSE............................................... 8
SOCIO ECOLOGICAL FRAMEWORK...37
GOALS.................................................. 9
COMMUNITY PARTNERS.......................42
PARRAMORE........................................10
LOGIC MODEL......................................53
THE PROBLEM.......................................13
ACKNOWLEDGEMENTS........................54
DATA ON CHILDHOOD OBESITY ........14
WORK GROUPS.....................................56
BELIEFS AND BEHAVIORS.....................19
REFERNCES............................................57
MEASURING SUCEESS..........................23
NOTES....................................................58
Orlando Health Teen XPress Program
Page 2 PARRAMORE A CALL TO ACTION
and outcomes. ltchare delivery ort to improve hea supp am gr pro d an cattion Providing research, edu
ore Community,
To our Friends in the Parram
Parramore, The Health ood overweight and obesity in ldh chi of e rat g win gro the s addres Blue Cross and In an effort to collaboratively l to Action Plan. Funded by the Cal this ped elo dev has rs, munity partne efforts already Council along with many com igned to build upon the many des is n pla ion Act to l Cal tion, the Parramore Blue Shield of Florida Founda The goal is to eliminate the active lifestyles for children. and lthy hea te mo pro to nity under way within the commu risks for childhood obesity. ond of risk factors that go well bey resulting from a broad range on diti con lth hea ed cet ltifa Childhood obesity is a mu ld lives plays a very big role the environment in which a chi t tha wn sho has ch ear Res genetics and medical history. prehensive strategies to sidered when developing com con be st mu ons diti con ic nom Call to Action Team in their health. Social and eco ognizing these barriers, the Rec en. ldr chi in tus sta t igh d to overwe ces reduce the risks that can lea needed education and resour en implemented, will provide wh t, tha ies ivit act and s gie the identified specific strate s will be required to reverse across all community sector ly tive ora lab col g rkin Wo . to support healthy lifestyles childhood obesity trend. s: Hebni Nutrition many community organization of rts effo the d age eng y plan has alread ment, The Parramore Call to Action Orange County Health Depart vention, Get Active Orlando, Pre and ss llne We al ltur ticu Consultants, Center for Mul goes out to the broad a few. The Call to Action now e nam to t jus lth, Hea o and and Orl Parramore Kidz Zone (PKZ), munity where children ke Parramore a healthy com ma to er eth tog rk wo and er e togeth Parramore community, to com ive living. and can safely engage in act have access to healthy foods
Ken Peach Executive Director
Elaine Cauthen Assistant Director
Page 3 PARRAMORE A CALL TO ACTION
EXECUTIVE SUMMARY
In 2009 the Health Council of East Central Florida received a grant from the Blue Cross and Blue Shield of Florida Foundation and in-kind support from Nemours to support the development of a consortium to address childhood obesity. ROCK (Reduce Obesity in Central Florida Kids) consortium partners work to ensure that children living in East Central Florida have healthy lifestyles that eliminate their risk for childhood obesity. Through collaborative community action ROCK fosters the necessary social change in the East Central Florida Region that will prevent childhood obesity. The Health Council of East Central Florida, the Center for Multicultural Wellness and Prevention, and Hebni Nutrition Consultants collaborated to develop this action plan. The process began in May 2009 and was completed in June 2011. To gain an understanding of the needs for Parramore residents to be healthier, the group conducted stakeholder interviews and focus group research and hosted work group meetings. A planning team was formed to begin the process of organizing community members to address childhood obesity. This small team identified the appropriate partners to include in the Call to Action development process. Members provided critical insight into how Parramore functions as a community, the importance of addressing populations individually, and the role of the faith-based organizations within the larger community. Stakeholder interviews were held at the beginning of the development process. The information collected provided an understanding of the community. These interviews also uncovered major issues and long-term problems within the community. Next, focus group research was conducted with many different community members to learn about the perceptions, opinions, beliefs, and attitudes they have about childhood obesity. The information gathered from the residents provided in-depth knowledge of the barriers that limit the opportunities for engaging in healthy lifestyle behaviors. Work Groups were developed to address four community sectors: Early Learning, Schools, Community and Faith-Based, and Health Care. Work Group meetings were held to discuss the information that was collected from the stakeholder interviews and focus group research. Three goals were established for each meeting. They are as follows: • • •
Learn of other initiatives currently under way in the community Discuss the most constructive ways to address the areas of need Build the advocacy and support needed to implement the Call to Action plan
Page 4 PARRAMORE A CALL TO ACTION
EXECUTIVE SUMMARY CONTINUED
The prevalence rate of overweight and obesity is more than two out of five for Florida children.
Members developed strategies that could be implemented to address the barriers preventing healthy lifestyle choices in Parramore. The Health Council assembled all the supportive data for the Call to Action. This included a demographic profile of Parramore residents; survey data on healthy eating behaviors and knowledge; childhood overweight/ obesity status at the national, state, county, and local levels; the definition of obesity as used by the Centers for Disease Control and Prevention; the health implications associated with childhood obesity; a social timeline that explains changes in eating and exercise habits in America; an explanation of the socioeconomic framework; the definition of a healthy community; and one formula for a healthy lifestyle.
The Call to Action plan is the result of a broad community engagement process that brings together the data, community perceptions and knowledge, defined actions and identified strategies. Promoting collaborative efforts that build upon Parramore assets, including Hebni Nutrition Consultants, Center for Multicultural Wellness and Prevention, Get Active Orlando, Teen Xpress, Nemours, Orlando Health, Orange County Health Department, Bridge to Independence, Orange County Healthy Start Coalition, Jackson Community Center, Callahan Neighborhood Center and the City of Orlando, will enable the community to effectively address the barriers preventing the adoption of healthy lifestyle behaviors.
Page 5 PARRAMORE A CALL TO ACTION
ccording to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years. Data show significant disparities exist among race, ethnicity and income. Sandra G. Hassink, MD, MPH, FAAP, in her address to the U.S. Senate Committee on Health, Education, Labor and Pensions, stated that there is no single one factor responsible for childhood obesity. Recent research indicates that any approach to address obesity should be multi-faceted; including not only the individual, but also the environments (social, structural and environmental) in which they live. Creating a healthy living environment should be an essential component of addressing childhood obesity. Developing a comprehensive community-based strategy that promotes and supports healthy lifestyle behaviors has the potential to eliminate the risks for childhood obesity. Prolonged and sustained social change will prevent this medical issue for future generations.
The Health Council of East Central Florida received a grant from the Blue Cross and Blue Shield of Florida Foundation to address the disproportionately high rates of childhood obesity in Parramore, a vulnerable neighborhood in downtown Orlando, Florida. The Building a Healthy Parramore Call to Action plan was
Page 6 PARRAMORE A CALL TO ACTION
INTRODUCTION CONTINUED developed through a broad community engagement process designed to produce a multi-faceted and comprehensive approach to address childhood obesity. Using the model developed by the Healthy Jacksonville Childhood Obesity Prevention Coalition, this plan identifies strategies that can be implemented to address the barriers currently limiting the adoption of healthy lifestyle behaviors. The ultimate goal is to eliminate the risks of childhood overweight and obesity in the Parramore community.
Expert knowledge, stakeholder interviews and focus group research provided the framework to begin creating a plan for a healthier Parramore community. Building on existing initiatives, resources, collaborations and partnerships, the Call to Action Work Groups developed culturally-sensitive community sector strategies to address the barriers for healthy eating and physical activity. It is envisioned that the implementation of these strategies will build the community systems to support healthy lifestyle behaviors for all community members. The adoption of these behaviors will eliminate the risks for childhood overweight and obesity and, over time, prevent childhood obesity!
Page 7 PARRAMORE A CALL TO ACTION
The Call To Action Purpose T
he Building a Healthy Parramore Call to Action plan is designed to foster the
community advocacy needed to begin the social transformation that will eliminate the risks for childhood obesity in this vulnerable urban neighborhood. This communitybased approach is a successful engagement process that will educate, encourage and ultimately build community capacity to address the systemic causes of childhood obesity. Implementing culturally-sensitive strategies that leverage precious resources across various community sectors will support and reinforce healthy lifestyle behaviors, leading to a sustained initiative with a measureable impact. The Call to Action research and documentation was made possible by a grant from the Blue Cross and Blue Shield of Florida Foundation Embrace a Healthy Florida childhood obesity initiative. Greater Orlando is one of five communities chosen by the Blue Cross and Blue Shield of Florida Foundation to participate in this initiative that aims to reduce childhood obesity through the funding of promising practices, applied research and community engagement.
Mission
Vision
To attain social transformation
To develop advocacy and collaboration
that will eliminate the risks for
across all community sectors that
childhood obesity in Parramore.
will address the systemic causes of childhood obesity in Parramore.
Page 8 PARRAMORE A CALL TO ACTION
Goals - To educate the Parramore community about childhood obesity - To identify the actions needed to build a healthy Parramore - To build synergy in the Parramore community through the Reduce Obesity in Central Florida’s Kids (ROCK) Consortium
Objectives - Develop childhood obesity educational programs that address the needs of the African-American and Haitian populations in Parramore - Promote collaboration and advocacy among Parramore residents to advance healthy eating and physical activity initiatives throughout the community - Complete the U.S. Department of Agriculture (USDA) recommended elements of the Community Food Assessment to effectively address access barriers to healthy food options Page 9 PARRAMORE A CALL TO ACTION
PARRAMORE
P
arramore is the historical hub of Orlando’s
African-American community. This vulnerable neighborhood is located on the west side of downtown Orlando, Florida. Parramore is comprised of four communities: Lake Dot, Callahan, Parramore and Holden Heights. A disproportionate share of the city’s crime is reported here. All of the shelters for the city’s homeless are located in this 1.4-square-mile neighborhood. Parks are frequented by vagrants and drug dealers. The 22 convenience stores located throughout the community offer an abundance of snacks and ready-to-eat foods but fresh fruits and vegetables are difficult to find. There is not one full-service grocery store located in Parramore.
According to the U.S. Census American Community Survey (2005-2009), 7,012 people reside in Parramore. Demographically, 68.7 percent of community members are Black, 25.8 percent are White, and less than 3 percent reported belonging to other races. Twenty-two percent of the population is less than 20 years of age. More than half of all children 0-19 years of age are below the age of 10. Educational attainment is low, with only 33.9 percent of residents over the age of 25 earning a twoor four-year college degree. Black residents were almost six times more likely than their White counterparts to leave high school before graduating. In 2009, the median family income in Parramore ranged from $17, 544 to $25,238, far Page 10 PARRAMORE A CALL TO ACTION
PARRAMORE CONTINUED
below that for families in Orange County at $57, 738. More than half of the residents reported an income within the past 12 months that was below the poverty level. Female households with no husband presently make up 57.9 percent of all family households in Parramore. They are 28 times more likely to live in poverty than their married counterparts. Eighty-three percent of Parramore children between the ages of 0-17 years live below 200 percent of poverty. Sadly, 86 percent of Parramore students who attend Orange County Public Schools receive free/reduced price lunch, a prime indicator of poverty and food insecurity. Although Parramore has traditionally been an African-American community, there is anecdotal evidence of an emerging Haitian population. It is estimated that 8.6 percent of the total Parramore population is of Haitian nationality. Focus group research revealed that target strategies designed to meet the unique needs of both populations will be required to effectively address the systemic causes of childhood obesity in Parramore.
Page 11 PARRAMORE A CALL TO ACTION
Parramore Food & Nutrition Assessment Lake Dot, Callahan and Holden/Parramore Neighborhoods RE RE
ST AU
RA
CO N VE N IE N CE
NT
01
06
RE
11
ST AU
RA
ST AU
RE RA
13
NT
ST AU
NT
ST AU
RA
CO N VE N IE N CE NT
12 CO N VE N IE N CE
RE RA
RA
NT
15
01 RE
ST AU
CO N VE N IE N CE
NT
14
16
02
RE
ST AU
RA
06
NT
17
07
Lake Dot
4
04
CO N VE N IE N CE
01
09
SCH OO L
02 RE
RE
AMWAY ARENA ST AU
ST AU
RA
NT
19 RA
NT
20 RE
ST AU
RE RA
NT
ST AU
RA
06
01 24
03
ORLANDO CENTROPLEX
21
Callahan
ARTS
NT
18
07 CO N VE N IE N CE
01 RE
ST AU
RA
15
10
02
02
05
SCH OO L
GRO
NT
02
CER
Y
02
02
03 SCH OF OO LAWL
08 03
08
05
19
SCH OO L
RE
04 ST AU
RA
NT
08 07 04 17
RE
ST AU
RA
SCH OO L
16
09 18
NT
20
23
06
07 RE
RE
ST AU
RA
ST AU
RA
RA
NT
05
NT
Holden/Parramore
06 RE
ST AU
RE NT
05
ST AU
RA
RE
CO N VE N IE N CE
ST AU
23
NT
RE
09
NT
RE
15 RA
14
GRO
ST AU
RA
RA
NT
22
Y
11
04
ST AU
NT
21 CER
03
04 CO N VE N IE N CE
11
CO N VE N IE N CE
07
10 22
09
10
07
12
CO N VE N IE N CE
12
08 CO N VE N IE N CE
13
14
05 03 SCH OO L
05
408 RE
ST AU
RA
CO N VE N IE N CE
NT
13
03 06 CO N VE N IE N CE
RE
ST AU
RA
CO N VE N IE N CE
08
16
NT
02
CO N VE N IE N CE
CO N VE N IE N CE
03
4
04
SCH OO L
01 GRO
01
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03
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NT
01
09
CO NV EN IEN CE
Presented to the City of Orlando Page 12
RES
Produced by the Florida Hospital Center for Health Futures for Hebni Nutrition Consultants, Inc.
RAN
PLACES OF WORSHIP
R E S TA U R A N T
G O V E R N M E N T, P O L I C E , F I R E & P O S TA L S E R V I C E S
CLINICS
01. Faith Healing
01. Wendy’s
01. Collaborative Function
01. Orange Co. School Board
02. Tony’s Southern Butcher
02. Church of Christ
02. McDonald’s
02. Health Care Center
02. Fire Department
03. 7-Eleven
03. Greater Faith
03. Halal Gyro’s Place
04. People’s Food & Gas
04. Emmanuel United
04. Church’s Chicken
05. Citgo/Quick Mart 06. 7-Eleven
05. Goff’s Drive In
Methodist 05. Christ Open Door
07. Arena’s Foodstore
Community Church
08. Big B Food Store
06. First Church of the
09. Tony’s Food Center
PARRAMORE A CALL TO ACTION
TAU
T
CONVENIENCE
01. Al’s Food Store
Loving God
and Biscuits
07. Outreach Ministries
09. Cafe Express
08. St. Matthews House
10. China Grille
14. CR Food Store 15. P&D Food Center 16. Fruit Stand
of Prayer 09. International House of Faith 10. Church of Power and Deliverence 11. Free Will Deliverance Praise Ministries Inc.
GR
12. New Liver Overcoming OC
ER
Y
GROCERY
Holy Church of God 13. Bethel Missionary
01. Family Foods Supermarket 02. Sunlite Grocery 03. Sy’s Supermarket
Baptist Church 14. Harvest Baptist 15. Faith Deliverance Temple 16. Breath of Life International Ministries 17. Tabernacle of God
04. US Govt. Courts 05. Orange County Health Department 06. Police Departmen
08. Popeye’s Chicken
11. Food Store 13. Young’s Store
03. Law Enforcement Dept.
Drug-Free Living
07. Station 441
10. Convenience Store 12. Adam’s Food Store
for the Homeless 03. Center for a
06. Lalo’s Cafeteria
11. Wendy’s 12. Mama’s Cheesesteak 13. Garden Cafe Vegetarian 14. Burger King 15. Italian Beefstro 16. O’Boys Real Smoked Bar BQ 17. District Five 18. Breakfast & Real Pit Barbecue 19. Mr. B’s Hot Food 20. Pat Little’s Bbcue, Soul Food & Cafe 21. Paradise Island Cafe 22. Piatinni Italian 23. Johnson’s Diner
07. Lynx Orange County 08. Orange Blossom
PA R K S A N D R E C R E AT I O N
Post Office 09. Orlando Fleet
01. Orlando Recreational
Management
Complex 02. Parramore Community Garden 03. Dr. J.B. Callahan Neighborhood Center SCHO
04. Parramore Heritage Park
SCHOOLS, UNIVERSITY BUILDINGS & THE ARTS
OL
05. Z.L. Riley Park
01. Happy Times Child Care
06. John H. Jackson
02. Orlando Tech
Community Center
03. Harvest Baptist School
and Pool
04. Orange County
07. New Image Youth Center
Head Start 05. Nap Ford Community School 06. Bob Carr Performing Arts Centre
The Problem Research indicates that the characteristics of the community environment affect the overall health of its residents. Broken sidewalks, unsafe parks, lack of grocery stores, and too many fast-food restaurants make it very difficult for anyone, let alone children, to be physically active and eat healthy foods. When this happens, children can gain more weight than is needed for normal growth and development. This imbalance of energy consumed (food eaten) and energy expended (physical exercise) causes a medical condition known as childhood obesity. According to published research, obesity in children increases their risk for serious health conditions like Type 2 Diabetes, high blood pressure and high cholesterol. When cardiovascular risk factors are present in childhood, it can lead to serious medical problems such as heart disease, heart failure and stroke as children grow into adulthood. Obese children may also be prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Children who are unhappy with their weight may be more likely than average-weight children to: •
Develop unhealthy dieting habits and eating disorders, such as Anorexia Nervosa and Bulimia
•
Be more prone to depression
•
Be at risk for substance abuse
•
Be at risk for developing other medical problems that affect their present and future health and quality of life, including: o
Bone and joint problems
o
Shortness of breath
o
Restless or disordered sleep patterns, such as obstructive sleep apnea
o
Tendency to mature earlier
o
Liver and gall bladder disease Page 13 PARRAMORE A CALL TO ACTION
The Data on the Childhood Obesity Epidemic At The National Level In 1971, only 5 percent of U.S. children were obese, defined as a body mass index (BMI) greater than or equal to sex- and age-specific 95th percentile from the 2000 CDC Growth Charts. Over the past 40 years the overall rate of childhood obesity has grown to 16.9 percent. The chart below shows how the percentage of obese children has increased from 1971 to 2008. This data is gathered by The National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.
Page 14 PARRAMORE A CALL TO ACTION
At The State Level According to the National Initiative for Children’s Healthcare Quality (NICH), Florida ranked 35th (1st is best) in overall prevalence with 33.1 percent of children (ages 10-17 years) considered either overweight or obese. For children ages 2-4 years, the obesity prevalence was estimated at 14.1 percent. Prevalence refers to the number of cases of a disease that are present in a particular population at a given time.
Obesity rates have increased for all children. However, the percentage of overweight/ obesity among low income and minority groups is disproportionately higher when compared to white children of higher economic status. The chart below depicts the disparity of overweight/obese status by socioeconomic and demographic indicators.
Page 15 PARRAMORE A CALL TO ACTION
At The County Level The Florida Youth Risk Behavioral Surveillance System (YRBSS) monitors priority health risk behaviors and the prevalence of overweight and obesity among youth and young adults. Representative samples of students attending Orange County Public Schools complete the 87-question survey every two years. The data collected provides important information regarding adolescent health. The charts below depict the overweight and obesity trends for 2001-2009 for Orange County High School students. The percentage of Orange County high school students reporting height and weight measurements between the 85th and 94th percentiles (defines overweight status) has steadily increased from 14 percent in 2001 to 15.7 percent in 2009. Obesity status for Orange County high school students has remained more constant over the past eight years, increasing from 11.3 percent in 2001 to 11.6 percent in 2009.
Page 16 PARRAMORE A CALL TO ACTION
Looking at the percentage of Orange County overweight/obese students by race reveals the same disparity previously shown at the state level. For Orange County, the percentage of Black students with an overweight status grew from 14.1 percent in 2001 to 19 percent in 2009, while the percentage of White overweight students decreased in the same time period. Obesity status for Black students increased over the past eight years from 12.1 percent in 2001 to 14.9 percent in 2009. The rate of obesity among White students remained relatively unchanged at 10 percent.
Page 17 PARRAMORE A CALL TO ACTION
At The Local Level
I
n 2006, the Health Council of East Central Florida, The Winter Park Health Foundation and Florida Hospital sponsored Professional Research Consultants, Inc., to conduct
the first child and adolescent health survey in the district. The random telephone survey captured responses from 1,600 parents and 263 adolescents living in Brevard, Orange, Osceola and Seminole counties. The sampling structure used for the survey ensures the data is significant at the ZIP code level. Using height and weight measurements provided by surveyed parents and the CDC definition of overweight and obese, the data revealed that 32.3 percent of children living in Parramore (Zip code 32805) are overweight and 37.5 percent are obese. This is higher than the percentage of overweight children in Orange County, Florida, and far above the Healthy People 2020 goal to have no more than 14.6 percent of children overweight or obese. As observed at both the state and county levels, socioeconomic and demographic characteristics influence the overweight status of children. The high rates of childhood obesity in Parramore are reflective of the challenging social environment that exists in this community. There is no single factor to blame, but many factors coming together at one time and in one place. Childhood obesity carries serious but preventable health risks for children. Left untreated, these health risks become even greater as children grow into adults. Creating a healthy Parramore can help reverse childhood obesity and further ensure the health of the community. Page 18
PARRAMORE A CALL TO ACTION
Beliefs and Behaviors In 2009, the Health Council of East Central Florida, The Winter Park Health Foundation, Florida Hospital, and many other community organizations sponsored Professional Research Consultants, Inc., to conduct the third Community Health Assessment. Surveyed respondents were asked about their healthy eating and physical activity knowledge as well as their daily behaviors. This baseline information will be trended using data from future heath assessments to measure the change in community attitudes regarding healthy living. The table below shows the U.S. Department of Health and Human Services daily recommendations for fruits/vegetables, physical activity and the consumption of sugarsweetened beverages along with the reported responses from Orange County residents regarding knowledge and behavior. Broad community education is needed to ensure all residents have the proper information for leading healthy and active lives. Comparison of Daily Consumption Recommendations to Community Needs and Behaviors HHS Daily Recommendations
Community Survey Responses Educational Needs
Reported Behaviors
57.2% of survey respondents did not know the correct number of daily recommended servings for fruits and vegetables
57% of survey respondents reported having 2 or more fruits and vegetables daily
150 minutes of moderately intense physical activity per school week
42% of survey respondents did not know the number of daily recommended minutes of physical activity
29.9% of surveyed respondents reported exercising 5 or more days, for 30 minutes per day
Few or no regular sodas, sports drinks, energy drinks and fruit drinks
47.9% of surveyed respondents did not know the maximum number of weekly recommended sugarsweetened beverages
4-5 ½-cups fruits and vegetables per day
This indicator was not measured by the community health survey
Page 19 PARRAMORE A CALL TO ACTION
Beliefs and Behaviors continued
Adults were also surveyed on the factors contributing to childhood obesity; these included too much screen time, too much junk food, not getting enough exercise, eating for the wrong reasons, and lack of self-control. Respondents were asked whether the factor contributed A lot, Some, A little, or Not at All, to childhood obesity. The majority of adults surveyed believed these factors contributed A lot to the overweight status of children and teens in Orange County. The percentages are summarized below: • 79.7 percent of respondents believed that children and adolescents spend too much time watching television and playing computer and video games was also a big contributor to childhood obesity • 84.1 percent of respondents believed that marketing and easy access of junk food to chindren and teens was a big contributor to childhood obesity • 84.8 percent of respondents believed that children and adolescents not getting enough exercise was also a big factor contributing to childhood obesity • 66.4 percent of respondents believed that children and adolescents eating for the wrong reasons, such as boredom or comfort, contributed to overweight status • 56.1 percent of respondents believed that a lack of self control plays a role in childhood obesity
Page 20
PARRAMORE A CALL TO ACTION
Addressing Childhood Obesity Through The Community Engagement Process The Health Council of East Central Florida,
Stakeholder interviews were held at the
the Center for Multicultural Wellness
beginning of the development process.
and Prevention, and Hebni Nutrition
The information collected provided an
Consultants collaborated to develop this
understanding of the community. These
action plan. The process began in May
interviews also uncovered major issues
2009 and was completed in June 2011. To
and long-term problems within the
gain an understanding of the needs for
community.
Parramore residents to be healthier, the group conducted stakeholder interviews
Next, focus group research was conducted
and focus group research and held
with many different community members
community forums.
to learn about the perceptions, opinions, beliefs and attitudes they have about
A planning team was formed to begin
childhood obesity. The information
the process of organizing community
gathered from the residents provided
members to address childhood
in-depth knowledge of the barriers that
obesity. This small team identified the
limit the opportunities for engaging in
appropriate partners to include in the
healthy lifestyle behaviors.
Call to Action development process. Members provided critical insight into
Work Group meetings were held to
how Parramore functions as a community,
discuss the information that was collected
the importance of addressing populations
from the stakeholder interviews and focus
individually and the role of the faith-based
group research.
organizations within the larger community. Page 21 PARRAMORE A CALL TO ACTION
Addressing Childhood Obesity Through The Community Engagement Process Three goals were established for each
childhood overweight/obesity status
meeting. They are:
at the national, state, county, and local
• To learn of other initiatives currently
levels, the definition of obesity as used
underway in the community • To discuss the most constructive ways to address the areas of need • To build the advocacy and support
by the Centers for Disease Control and Prevention, the health implications associated with childhood obesity, a social timeline for changes in eating and
needed to implement the Call to
exercise habits, an explanation of the
Action plan
socioeconomic framework, the definition of a healthy community, and one formula
Members developed strategies that could
for a healthy lifestyle.
be implemented to address the barriers preventing healthy lifestyle choices in Parramore. The following work groups were identified: Early Learning, Schools, Community and Faith-based, and Health Care.
The Call to Action plan is the result of a broad community engagement process that brings together the data, community perceptions and knowledge, defined actions, and identified strategies that will build collaboration across Parramore
The Health Council assembled all the supportive data for the Call to Action. This included a demographic profile of Parramore residents, survey data on healthy eating behaviors and knowledge,
Page 22 PARRAMORE A CALL TO ACTION
to effectively address the barriers preventing the adoption of healthy lifestyle behaviors.
MEASURING SUCCESS
T
he year-long community engagement process has built the advocacy and partnerships needed to implement the strategies identified in the Call to Action
plan. The Health Council, through the leadership of the ROCK Director, will manage the Blue Cross and Blue Shield of Florida Foundation mini-grant process designed to provide seed money to fund initial strategies identified in the Call to Action plan. These oneyear projects will capture outcomes and outputs on the progress being made to create an environment that supports healthy and active lifestyles for Parramore residents.
Page 23 PARRAMORE A CALL TO ACTION
THE CALLS TO ACTION The work of the planning committee and work groups has defined the following Calls to Action to eliminate the risks for childhood obesity in Parramore • Engage EARLY LEARNING providers to implement strategies to promote healthy eating and active living that will eliminate the risks for childhood obesity in Parramore • Engage SCHOOLS to implement strategies to promote healthy eating and active living that will eliminate the risks for childhood obesity in Parramore • Engage COMMUNITY and FAITH-BASED organizations to implement strategies to promote healthy eating and active living that will eliminate the risks for childhood obesity in Parramore • Engage HEALTH CARE providers to implement strategies to promote healthy eating and active living that will eliminate the risks for childhood obesity in Parramore
Page 24 PARRAMORE A CALL TO ACTION
THE CALLS TO ACTION Overarching themes include: •
Need for a healthy eating and active living educational campaign, with consistent messaging and resources, that can be promoted through the coordinated efforts of indivuals, families, institutional and community-based educators, faith-based organizations, health care providers, child care centers, businesses and nonprofit/ grassroots organizations
•
Leverage activities in individual sectors to develop partnerships across the community
•
Implement policy changes to increase access to healthy foods in schools and general community publicly supported programs
•
Partner with the faith-based community to disseminate healthy messages and practices in an effort to increase capacity and align strategies that support healthy living
•
Promote collaborative approaches between health care providers, schools, churches, early childhood, and other community sectors to integrate developmentally informed access on healthy eating and active living
•
Develop an interactive approach to inform policy decisions related to healthy eating and active living including, but not limited to safe and accessible sidewalks, bike paths, parks, recreation facilities, and other aspects of the built environment
•
Develop comprehensive culturally competent and informed strategies that meet the needs of the diverse Parramore community
•
Develop comprehensive strategies that will build the capacity and infrastructure with the Haitian community to provide healthy eating and active living activities that are culturally competent and linguistically appropriate for all age groups
•
Develop concrete strategies that provide resources to support healthy lifestyle behav iors including but not limited to, cooking classes, community gardens, food security, exercise, portion control and advertising awareness
•
Promote ROCK as a venue for community advocates that will build partnership synergy to advance community initiatives that are targeted to promote healthy lifestyle behaviors
Page 25 PARRAMORE A CALL TO ACTION
THE CALLS TO ACTION EARLY LEARNING Encourage
consistent social
messaging regarding healthy lifestyle.
Activities 1. Promote consistent social marketing message 2. Engage providers of pre-, postand inter-conception care (Healthy Families, Healthy Start, Obstetrics/Gynecology medical practices and other health care providers) Policies - Develop and implement proven healthy eating, physical activity, and sleep requirement guidelines for parents and care givers of Voluntary Pre-Kindergarten students
Page 26 PARRAMORE A CALL TO ACTION
Promote
recommendations to
enhance current physical activity
and nutritional guidelines for early learning facilities
Activities 1. Promote the adoption of best practices (Expand availability of existing programs to child care centers and home child care, e.g., Nemours Healthy Habits for Life, the PKZ Baby Institute program, etc.) 2. Support the development and implementation of a Quality Rating Improvement System (QRIS) designed to implement strategies to evaluate the quality of care in the early learning and educational environments to support and improve child development Policies - Require physical activity and nutritional components be incorporated into all newly developed early childhood curricula
THE CALLS TO ACTION SCHOOLS Implement
school policies that
increase access to healthy foods and active living:
Activities 1. Create signage for preferred healthy foods 2. Promote cooking competitions among schools 3. Improve healthy food offerings at school stores 4. Encourage PTSA’s to promote school gardens, recipes swaps Policies 1. Develop guidelines for packing a healthy lunch 2. Promote curriculum that provides a foundation in nutrition and physical educational
Distribution of healthy lifestyle information, including but not limited to: Activities 1. Develop a school forum for parents to share information and resources
regarding healthy lifestyles 2. Develop materials, resources, events and activities for after-school and evening programs 3. Encourage physical education coaches to develop programs for parents to support active living outside of school 4. Encourage consistent social marketing messaging (5-2-1-Almost None) on healthy lifestyle behaviors through various school/community communication portals 5. Develop a referral source for parents of children who receive BMI notifications
Page 27 PARRAMORE A CALL TO ACTION
THE CALLS TO ACTION COMMUNITY AND FAITH-BASED Create
community and faith-based
alliances that support healthy lifestyle behaviors
Activities 1. Develop and conduct workshops to promote wellness, e.g. healthy cooking classes 2. Encourage community gardening 3. Develop mobile food market Policies 1. Assist faith-based organizations in developing wellness policies 2. Mobilize grass roots support for local and regional ordinance/regulation changes that promote health eating and activity level
Conduct
assessments that will build
on existing surveys to increase community capacity and infrastructure
Activities 1. Conduct congregational needs assessment and recommendations regarding development of healthy lifestyle programs 2. Conduct transportation needs assessment to improve access to healthy food options 3. Conduct United States Department of Agriculture (USDA) recommended community surveys to complete the Parramore Food Assessment Study
Page 28 PARRAMORE A CALL TO ACTION
Development
of a culturally
competent childhood obesity
educational campaign that addresses the unique needs of the diverse
Parramore
community
Activities 1. Instruct community on shopping for healthy foods on a budget 2. Conduct parenting classes that support healthy eating at home 3. Promote consistent social marketing message Policies - Develop guidelines for on-hand pantry foods
Encourage collaborations within the Haitian community that support healthy living
1. Develop culturally competent and linguistically appropriate childhood obesity resources 2. Develop partnerships across Haitian organizations to build capacity and infrastructure to support the needs of the community
THE CALLS TO ACTION HEALTH CARE PROVIDERS Leverage
content expertise of health
care providers to develop programs that promote healthy lifestyle behaviors
Activities
1. Promote breast-feeding education through various partnerships
2. Expand the educational component offered through mobile clinics
3. Participate in community/family engagement meetings
4. Foster inter-professional collaborations
among medical, mental health, nutrition, dental and other allied health
professionals to provide community
education on healthy eating and active living
5. Partner with schools, neighborhood centers and youth development
programs to provide healthy eating and active living education
6. Promote consistent social marketing
Policies
- Incorporate nutrition and physical
education in pre-professional training programs
Increase
linkages between medical
health care service providers and providers of community-based referral system
Activities
1. Educate medical and allied health
professional on effective communitybased childhood prevention activities and interventions
2. Educate health care provider
community about available community resources and referral services
3. Develop and implement systems
for facilitated referral and reciprocal
communication between health care and referral service providers
message
7. Encourage healthcare and educational institutions to provide education and training to healthcare providers on
prevention, diagnosis, and management of obesity
Page 29 PARRAMORE A CALL TO ACTION
THE CALLS TO ACTION HAITIAN COMMUNITY To
determine how
of varying ages in
Holden Heights
Haitian residents Parramore/
neighborhoods
desire to receive information
on nutrition, grocery shopping,
preparing meals and physical activity
Activities
1. Develop a survey specific to the Haitian Community to ascertain how they prefer to receive messages and
education, assess the findings and
implement the most promising options
2. Develop short educational Public
Service Announcements for Haitian radio targeting Haitian family food
buying and preparation habits and the need for physical activity presented in English and Creole
To
educate community members on
nutrition, grocery shopping,
preparing meals and physical activity
Activities
1 Engage Haitian restaurateurs and
grocery store and farmers market
representatives and provide them with training on healthy cooking options to include cooking demonstrations
2. Identify Hospitality ministries at Haitian churches in the area and provide group presentation on nutrition and healthy
cooking options as conducted by Haitian
restaurateurs trained in the Action Step above, including cooking demonstrations
3. Identify Health and Fitness ministries at Haitian churches in the area and
conduct group presentations on topics
listed above as conducted by a Haitian entity with the ability to present in English and Creole
4. Identify Haitian community-based organizations and other groups to conduct group presentations on
nutrition, grocery shopping, preparing meals and physical activity facilitated by a Haitian entity with the ability to present in English and Creole
Page 30
PARRAMORE A CALL TO ACTION
How Childhood Obesity is Defined
Y
our child’s doctor can help you figure out if your child’s weight could pose health problems. To do this, your child’s doctor will calculate your child’s body mass
index (BMI). The BMI indicates if your child is overweight for his or her age and height. Using a growth chart, your doctor determines your child’s percentile, meaning how your child compares with other children of the same sex and age. For example, you might be told that your child is in the 80th percentile. This means that compared with other children of the same sex and age, 80 percent have a lower BMI. Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention (CDC), help identify overweight and obese children: • BMI-for-age between 85th and 94th percentiles — overweight • BMI-for-age 95th percentile or above — obesity
Page 31 PARRAMORE A CALL TO ACTION
One Formula for a Healthy Lifestyle Nemours, located in Delaware, New Jersey, Pennsylvania and Florida, is committed to taking a leading role in obesity prevention. To help families understand the best ways to promote healthier habits Nemours developed a formula for a healthy lifestyle. It’s called 5-2-1-Almost None. • • • •
Eating at least five servings of fruits and vegetables a day Limiting screen time to no more than two hours a day Getting at least one hour of physical activity a day Drinking almost no sugary beverages.
FIVE stands for five or more serving of fruits and vegetables per day. Fruits and vegetables are packed with disease-fighting nutrients and give you energy. They are an important part of a growing child’s healthy diet. Most fruits and vegetables are naturally low in calories and fat, making them a healthy choice anytime. They are also full of water and fiber, which makes them filling. TWO stands for no more than two hours per day in front of a screen (television, video games recreational computer time). Screen time can lead to obesity because it often involves mindless eating, exposure to a lot of advertising for unhealthy foods, and long periods of time spent sitting still, not using energy. Whenever possible, encourage children to engage in other activities that strengthen their bodies and minds. ONE means at least one hour of physical activity per day. Physical activity, especially when it gets your heart pumping faster, is important to maintaining a healthy weight and overall good health. Regular physical activity helps us to have strong and healthy hearts, bones, and muscles. Active people may have an increased ability for learning, feel more energetic, and sleep better. ALMOST NONE refers to almost no sugary beverages – no more than two servings per week of soft drinks, sports drinks and fruit drinks that are not 100 percent fruit juice. Sugary drinks usually don’t have the nutrients that children need to grow strong and healthy bodies. Water, milk, and limited amounts of 100 percent juice are the healthiest drinks to offer children. Page 32 PARRAMORE A CALL TO ACTION
What is a Healthy Community?
iv
Our health is a direct result of the conditions in which we live our daily lives. Our social and physical environments are directly connected to our chances for a long, healthy, and productive life. The factors that affect health can be classified into four different types: individual, social, structural and environmental. A healthy community is achieved when all factors provide the elements of healthy living conditions.
Factors
Individual
Social
Structural
Environmental
Elements for a Healthy Community Eat healthy foods Exercise regularly Adequate housing Good educational system Low unemployment Supportive interpersonal relationships Access to full-service grocery stores with fresh produce Access to transportation Adequate public resources Clean soil, air and water Good sanitation Safe sidewalks and playgrounds
Page 33 PARRAMORE A CALL TO ACTION
What Are The Causes of Childhood Obesity? There are many causes of childhood obesity. Overweight in children and adolescents is generally caused by a lack of physical activity, unhealthy eating patterns resulting in excess energy intake, or a combination of the two. Genetics and social factors, socioeconomic status, race/ethnicity, media and marketing, and the physical environment also influence energy consumption and expenditure. Most factors of overweight and obesity do not work in isolation and solely targeting one factor may not make a significant impact on the growing problem. Nutrition and Eating Habits Children and adolescents are eating more food away from home, drinking more sugarsweetened drinks and snacking more frequently. Convenience has become one of the main criteria for Americans’ food choices today, leading more and more people to consume “away-from-home” quick service or restaurant meals, or to buy ready-to-eat, low cost, quickly accessible meals to prepare at home. Physical Inactivity and Sedentary Behaviors Watching television, using the computer and playing video games occupy a large percentage of children’s leisure time, influencing their physical activity levels. It is estimated that children in the United States are spending 25 percent of their waking hours watching television. Statistically, children who watch the most hours of television have the highest incidence of obesity. v,vi This trend is apparent not only because little energy is expended while viewing television but also because children are prone to eating high-calorie snacks while watching television. Page 34 PARRAMORE A CALL TO ACTION
What Are The Causes of Childhood Obesity? Physical Environment In urban and suburban areas, the developed environment can create obstacles to being physically active. In urban areas, space for outdoor recreation can be scarce, preventing children from having a protected place to play. Neighborhood crime, unattended dogs or lack of street lighting may also inhibit children from being able to walk safely outdoors. Busy traffic can prevent children from walking or biking to school as a means of daily exercise. Socioeconomic Status and Race/Ethnicity The prevalence at which obesity has been increasing in children in the recent years has been even more pronounced and rapid among minority children. Between 1986 and 1998, obesity prevalence among African Americans and Hispanics increased 120 percent, as compared to a 50 percent increase among non-Hispanic Whites.vii The relationship among race/ ethnicity, socio-economic status, and childhood obesity may result from a number of underlying causes, including less healthy eating patterns (e.g., eating fewer fruits and vegetables, more saturated fats), less physical activity, more sedentary behavior, and cultural attitudes about body weight. viii Clearly these factors tend to co-occur and are likely to contribute to the increased risk of obesity in children.
Page 35 PARRAMORE A CALL TO ACTION
What Are The Causes of Childhood Obesity? Parental Influences Numerous parental influences shape the eating habits of youth. Several studies suggest that breast-feeding offers a small but consistent protective effect against obesity in children. ix • Constraints on parents’ time potentially contribute to children’s weight problems, as working parents probably rely more heavily than non-working parents on prepared, processed and fast-foods, which generally have high calorie, high fat and low nutritional content. • Children left unsupervised after school may make poor nutritional choices and engage in more sedentary activities. • Child care providers may not offer as many opportunities for physical activity and may offer less nutritious food alternatives. The recent social and economic changes in American society have encouraged the consumption of excess energy and have had a detrimental effect on energy expenditure among youth. These changes have impacted the foods available in the homes and the degree of influence parents have when children make food selections, and have led to increases in sedentary behaviors among youth. Conclusion Research shows that there are a number of root causes of obesity in children. Selecting one or two main causes or essential factors is next to impossible because the potential influences on obesity are multiple and intertwined. However, the fundamentals are clear: to stay healthy, children should eat a balanced diet and devote adequate time to physical activity. x
The information in this section was summarized from the U.S. Department of Health and Human Services. For the complete text, please visit: http://aspe.hhs.gov/health/reports/child_obesity/
Page 36 PARRAMORE A CALL TO ACTION
How Did We Get Here? Larger portion sizes started in the 1970s when childhood obesity was estimated at 4 percent. In 1984, 7-Eleven introduced the Super Big Gulp, a 44-ounce drink (38 oz. of soda with 6 oz. of ice) containing 512 calories!xi The development of VCRs and video games followed in the late 1980s. This promoted sedentary playtime as opposed to moderate and vigorous physical activity. By the late 1990s, white potatoes, Iceberg lettuce and canned tomatoes made up half of America’s vegetable servings. By 2008, one-third of American children were overweight. The time line below was taken from a five-part Washington Post series, “Young Lives at Risk: Our Overweight Children.” The complete series can be found at: http://www.washingtonpost.com/wp-srv/health/ childhoodobesity/index.html
SOURCE: | By Tobey - The Washington Post - May 17, 2008
SOCIO ECOLOGICAL FRAMEWORK
T
he Socio Ecological model recognizes the relationship that exists between the individual and their environment. While individuals are responsible for making the
lifestyle changes necessary to reduce risks and improve health, individual behavior is determined to a large extent by social environment. Barriers to healthy behaviors are shared among the community as a whole. As these barriers are lowered or removed, behavior change becomes more
PUBLIC POLICY national, state, local laws
COMMUNITY relationship among organizations
ORGANIZATIONAL organizations, social institutions
INTERPERSONAL family, friends, social networks
INDIVIDUAL knowledge, attitudes, skills
achievable and sustainable. The most effective approach leading to healthy behaviors is a combination of the efforts at all levels individual, interpersonal, organizational, community and public policy. Below are some suggestions for changing health behaviors. Individuals • Eat reasonable food and beverage portion sizes at home and when eating out • Eat 4-5 1/2-cup servings of fruits and vegetables each day, or more! • Walk or bicycle more often to work or school, for errands, to visit friends and just for the fun of it
Graphic and text used with permission. http://www.balancedweightmanagement.com/TheSocio-EcologicalModel.htm
Page 38 PARRAMORE A CALL TO ACTION
SOCIO ECOLOGICAL FRAMEWORK Parents • Breastfeed your infant for at least one year • Work with your children’s schools to develop policies regarding vending machines, use of foods as rewards in classrooms, adequate lunch and recess time, daily physical education, and safe walking and bicycling routes to school • Organize Walk to School Day events in your children’s schools Employers • Offer walk/bike/transit incentives like bicycle parking and transit passes • Post signs near elevators encouraging people to take the stairs • Set standards for foods served at cafeterias, in vending machines and at meetings Community Members • Participate in neighborhood, community and transportation planning groups • Organize a farmers’ market in your neighborhood or community • Join advocacy groups promoting community design supportive of safe and accessible walking and bicycling • Let your community leaders and elected officials know that you support healthy, active communities
Page 39 PARRAMORE A CALL TO ACTION
SOCIO ECOLOGICAL FRAMEWORK Architects, Community and Transportation Planners • Design buildings where stairs are visible, accessible and safe • Design neighborhoods and communities where children and adults can easily and safely travel between home, work, school, retail establishments, parks and recreation facilities on foot and bicycle Community Leaders and Policy Makers • Consider public health impacts in land-use planning decisions, development of mixed-use neighborhoods and location of farms producing fruits and vegetables near urban areas • Consider zoning regulations that allow more farmers markets in neighborhoods • Assure access to full-service grocery stores in all neighborhoods and limit density of fast food restaurants • Prioritize funding for effective public health interventions to increase physical activity, promote healthy eating and reduce obesity and chronic diseases
Page 40 PARRAMORE A CALL TO ACTION
COMMUNITY PARTNERS
Highlights The Call to Action in Parramore builds on numerous assets in the community. The organizations, partnerships and coalitions are team members and have served to inform our process. • Nemours, a non-profit pediatric health system, and its Florida Prevention Initiative addresses childhood obesity prevention by working with child care providers, including Zanders Family Day Care Home, Orlando Day Nursery and Arising Little Angels Preschool Academy, as well as programs at Nap Ford and the Callahan Neighborhood Center to provide training and informational materials around healthy eating and physical activity tailored for children, families, child care providers, educators and youth serving organizations and developed by their medical experts. • Hebni Nutrition Consultants, Inc., is a community-based not-for-profit agency committed to improving consumers’ health by providing comprehensive nutritional information to culturally diverse populations through seminars and community education programs. • The Get Active Orlando partnership, developed in 2003, brings together a multidisciplinary team representing public health agencies, hospitals, bicycle clubs and shops, neighborhood associations, community organizations, a university and City government to build a community focused on active living. • The mission of the Orange County Health Department is to promote, protect and improve the health of all people in Orange County, placing special emphasis on health education, maternal and child health, epidemiology, environmental health, school health, dental care services and a variety of other programs. • Parramore Kidz Zone (PKZ) aims to lower teenage pregnancy, juvenile crime and child abuse rates, and improve school performance among children in this neighborhood. • The Collaborative Obesity Prevention Program (COPP) provides education on obesity prevention to Parramore children ages 8-12 years and their families. • The Center for Multicultural Wellness and Prevention, Inc., strives to enhance the quality of life for diverse and ethnic populations through the provisions of health promotion services by decreasing health disparities in Central Florida. • Teen Xpress, housed in The Howard Phillips Center for Children and Families at Arnold Palmer Hospital for Children, is a safe and private place for teen wellness. Teen Xpress is a mobile health unit that provides free medical and mental health care for at-risk youth in select locations throughout Orange County. A team of specialized health care professionals provides help to uninsured and at-risk adolescents who might otherwise go without treatment.
Page 41 PARRAMORE A CALL TO ACTION
Healthy Habits for Life The Healthy Habits for Life Child Care Resource Kit was developed by Sesame Workshop® and produced in partnership with Nemours® Health & Prevention Services and KidsHealth® to help young children incorporate healthy eating and physical activity into their everyday routines. This 100-page guide, available in both English and Spanish, contains group poems, songs, posters, activities and family newsletters. The familiar Sesame Street characters keep students’ interest and attention as they learn! Several organizations, including the Early Learning Coalitions, Community Coordinated Care for Children, Inc. (4C), and Head Start of Orange County, have been trained by Nemours in the Healthy Habits for Life Train-the-Trainer program for central Florida’s early childhood educators. Through this training of trainers, child care providers learn about best practices for healthy eating and physical activity for preschool children and the Nemours formula for a healthy lifestyle: 5-2-1-Almost None. This prescription and behavior change strategy has an easy core message and encourages children to do the following each day: eat at least five servings of fruits and vegetables; limit screen time to no more than two hours; get at least one hour of physical activity; and drink almost no sugar-sweetened beverages.
Page 42 PARRAMORE A CALL TO ACTION
Healthy Habits for Life Zanders Family Day Care Home in Parramore was one of the providers that received training on Healthy Habits for Life in February 2010. Connie Zanders, owner and director, shared some of the anecdotes relayed by the parents at the post-training follow-up. Ms. Zanders writes: The children, parents, and I rate the Healthy Habits for Life program #10! The children can’t stop singing, talking and moving to the beat about it! One mom shared her story about taking her daughter to McDonald’s. When she asked her what kind of Happy Meal® she wanted, the daughter looked up at her mom and said, “Mommy that’s a sometimes food. I want a salad.” The mom informed her daughter that the salad does not come with a toy. The daughter was okay with no toy and suggested her mom have the salad as well. The cashier was so surprised to hear a 4-year old turn down a Happy Meal for a salad that she rewarded the little girl with a toy for her healthy choice. Both mother and daughter are making healthier food choices when eating out and at home. One of the dads said that when he goes out shopping with his 2-year old daughter, she is able to name the fruits and vegetables in the produce aisle. She likes to sing the BIG Tomato! We had a blast and Nemours made learning fun!
Bulletin Board of the Healthy Habits for Life activities at Zander’s Family Day Care Home.
Page 43 PARRAMORE A CALL TO ACTION
Hebni Nutrition Consultants, Inc., (HNC) is a community-based nonprofit organization committed to improving consumers’ health by providing comprehensive nutrition information. Our major goals are to foster dietary compliance in existing diseases and to facilitate the prevention of nutrition-related disease through appropriate nutrition intervention. HNC targets culturally diverse populations that are at risk for obesity, heart disease, diabetes, cancer, hypertension and other diet-related diseases. It is well-founded that individuals who understand the consequences of and apply good dietary habits live longer. Food pyramids have been developed by the government and other organizations to guide individuals on the consumption of food. HNC has determined, through contacting health care providers and targeted groups, that the standard food pyramid used today is not useful for changing the habits of some groups within the population, particularly African-Americans. To address this need, a food pyramid must take into account the ethnic background of the targeted group. HNC has developed a Soul Food Pyramid to make teaching methods easier for health care providers when disseminating information to minorities.
Page 44 PARRAMORE A CALL TO ACTION
Page 45 PARRAMORE A CALL TO ACTION
active Partnership Developed in the fall of 2003, Get Active Orlando is a community partnership of more than 30 diverse organizations with broad expertise and the ability to influence active living. The partnership provides a unique opportunity to take a comprehensive look at the range of factors that affect health and the relationship between environment and activity levels, as well as land use planning, transportation and economic development. active Programs Get Active Orlando launches new programs promoting physical activity. Get Active Orlando inspires residents to become more physically active through bicycle recycling, senior walking, jump roping, biking, gardening and dance programs. To better understand what people and communities need to be healthy and active, Get Active Orlando monitors the programs to measure their impact. Program data confirms programs effectively increase physical activity. active Projects Get Active Orlando creates and promotes environments that make it safe and convenient for people to be more physically active. Get Active Orlando works to change policy in the City of Orlando, and has successfully integrated active living principles into practice. active Promotions Awareness of active living issues has evolved from a peripheral issue to a regional concern. Get Active Orlando changes attitudes and behaviors by working with its partners to enhance and coordinate messages that encourage active living. active Policy Get Active Orlando influences public policies that support active living in the City of Orlando. The establishment of the Mayor’s Advisory Council on Active Living is testament to the heightened significance of active living in the city.
Each year the Orange County Health Department sponsors an annual 5k Walk and Health Fair in Washington Shores at Hankins Park in Orlando. It’s a day of fun and fitness for all ages and fitness levels. This year’s event featured health screenings, cooking demonstrations, fitness assessments, rock climbing wall, zumba, yoga and even a hula hoop contest!
Page 47 PARRAMORE A CALL TO ACTION
Parramore Kidz Zone aims to reduce juvenile crime, teen pregnancy, and high school drop-out rates in Orlando’s highest poverty, highest crime neighborhood. Strategy •
Identify a community challenged by high levels of crime and poverty, where children disproportionately drop out of school and enter the juvenile justice system.
•
Deploy a full-time outreach team to the zone, build strong relationships with neighborhood youth and families and mobilize them to take back their community.
•
Pursue an “all hands on deck” approach by engaging faith, education, nonprofit, neighborhood, corporate and governmental organizations in a coalition united to transform the neighborhood on behalf of its children.
•
Make targeted investments that enhance the neighborhood’s pre-k, mentoring, educational, health care, afterschool, economic, youth development, and other positive youth infrastructure and systematically connect “a critical mass” of the neighborhood’s children to these opportunities.
•
Leverage funding from all sectors, and meticulously evaluate and disseminate results.
Accomplishments •
Broad range of new programs launched including: free tutoring sites; enhanced access to high quality pre-kindergarten programs; teen facilities; youth employment program; college access program; comprehensive athletics program; and enhanced access to out-of-school time care for children of all ages.
•
FY 2009-10: 466 Parramore children participated in PKZ after school tutoring programs, 126 in pre-kindergarten programs, 129 in health and fitness programs, and 333 in youth development programs, such as community service projects, youth employment, positive peer group meetings, college access programs, and field trips to educational and cultural sites.
•
Since PKZ started in 2006, data show: • Improvements in Florida Comprehensive Assessment Test (FCAT) math and reading scores for Parramore’s elementary and high school students. • A 21 percent reduction in the neighborhood’s teen birth rate. • An 81.3 percent decline in juvenile arrest rate in Parramore.
Page 48 PARRAMORE A CALL TO ACTION
Move the Needle
“Parramore Kidz Zone is connecting children to programs that will positively impact their lives, while also developing a model of cradle to career prevention that can be replicated in other City neighborhoods.” -Orlando Mayor Buddy Dyer
Page 49 PARRAMORE A CALL TO ACTION
I
n the Zone or ItZ, is a partnership between the pediatric residency at Arnold Palmer Hospital for Children and PKZ affiliated agencies. The service-learning program
launched in March 2009 provides residents with innovative educational experiences in community settings, preparing them to assume roles as active community collaborators and enhancing their ability to promote health in the context of family and community needs. Residents spend two weeks in their second year of training participating in nonclinical activities.
T
he Collaborative Obesity Prevention program (COPP) is one offshoot of ItZ. The program is funded by a grant from the American Academy of Pediatrics and provides education on
obesity prevention to Parramore children ages 8-12 years and their families.
Page 50 PARRAMORE A CALL TO ACTION
COMMUNITY HIGHLIGHTS Parramore Food Study To address the issues around food access and availability for Parramore residents, Hebni Nutrition Consultants conducted the Parramore Food Study with funding from the Blue Cross and Blue Shield of Florida Foundation and research by the Center for Health Futures at Florida Hospital. Direct observation and focus group research were used to systematically examine community food issues and assets. The data collected was used to construct a profile of community food resources. Types of Food Stores and Eating Establishments Mapped in Parramore Type of food Place
Number/Percent
Grocery store/corner store/convenience store with or without gas
22 (54%)
Fast food restaurant/carryout
14 (34%)
Full service restaurant
3 (7%)
Supermarket
0 (0%)
Bar/Tavern
2 (5%)
Key findings: • No full-service supermarkets were available in Parramore at the time of the survey • The most common places to buy food in Parramore are carryout/fast-food restaurants and convenience/corner stores, where prices are typically high and the availability of fresh produce is extremely limited • Foods needed to support a healthy diet are not easily accessible in the community • There is a concern with the food quality and freshness • Lack of cleanliness, questionable pricing methods, concerns of personal safety and food freshness and presentation were identified as secondary challenges to accessing and pur chasing healthy food items The study revealed challenging barriers for accessing healthy food choices within Parramore. Additional assessments, such as household food security, resource accessibility and food affordability, will provide a more complete picture of the food issues for Parramore residents. Community-level approaches as well as policy changes will be needed to support healthy eating behaviors in Parramore.
Page 51 PARRAMORE A CALL TO ACTION
COMMUNITY HIGHLIGHTS Parramore Commu nity Garden Receives Top Award
T
he Parramore Commun ity Garden was chosen as 2011’s Comm unity Garden of the Year by the Keep Orlando Beautiful Board. Nine gardens participated in the contest and were judge d on criteria such as clean pathways, ga rdener participation and aesthetic tou ches. The Parramore Community Garden rec eived the highest score and was award ed a sign and a gift ce rtificate to Palmers Feed Store. With the growing conc ern regarding obesity and chronic disease an unhealthy diets, comm d the link to unity gardens, once a thing of the past, are no as a way of not only fig w resurging hting disease but also as a form of physical ac way to cut back on ex tiv ity and a penses during these tou gh ec on om ic times. After conducting two focus groups wit h community residents in June 2008 to determi a Parramore Commun ne interest, ity Garden Council wa s formed. To aid in the the garden and to en sta rt-up of sure its continuing suc cess, the following entiti with the project: Get Ac es are partners tive Orlando, Orlando Police Department, Cit – Neighborhood Service y of Or lando s, Leu Gardens, Orange County Health Departm University of Florida Ext ent and ension Office. The garden is located at 654 W. Robinson Str eet. Each gardener pa yearly fee of $20 and ys a nominal is responsible for water ing , maintaining and harve plot. Priority is given to sting their residents of the Parramo re community. Children assist their parents in ten and teens ding their gardens and admit that they are no and enjoying vegetab w eating les some of which the y ne ve r tas ted be fore, like broccoli, cauliflower, pole bean s, cabbage and colla rd greens. Additionally, has become a source the garden of personal and comm unity pride and a cond bors to get to know ea uit for neighch other. Appropriate ly, the ga rde ns’ tagline is “Pride Grows Here.”
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Feet 1,000
LOGIC MODEL Building a Healthy Parramore Logic Model Inputs
To develop a multi-faceted approach to address childhood obesity in Parramore
To attain the social transformation that will eliminate the risks for childhood obesity in Parramore
•ROCK •Call to Action Planning team •Orange County Government •Orange TV •Churches •Health Clinics •OCHD •City Centers •Nutrition Consultants •Healthy Choice Clinic •Teen Xpress •Nap Ford •Bridge to Independence •PKZ •Local Hospitals •Early Learning facilities •Schools •Preconception and postpartum support service organizations
Outputs Activities
•Build central Repository of Central Florida Health Care Resources •Develop educational Programs on obesity, healthy eating, physical activity •Promote community gardening •Foster interprofessional collaborations among all health professionals to provide education •Engage early learning and schools to promote social messaging
Participation
•Kids •Parents •Grandparents •Caregivers •Healthcare Providers •Health Ministries •School Wellness Coordinators •School Food Service managers •School Principals
Assumptions
Outcomes-Impact Short Term
•Increased awareness, knowledge, and importance of healthy eating and physical activity •Begin building advocacy to support the broader community •Begin to address the individual, social, structural, and environmental barriers to healthy lifestyles •Policy development to address systemic causes of obesity
Medium Term
•Community members are taking action to changes behaviors •Increased availability and access to health foods •Increased access to health information •Safe options for physical activities •Increased community capacity
Long Term
Creation of a healthy Parramore where the individual is supported through social, structural, and environmental community systems that promote healthy lifestyle behaviors
External Factors
Evaluation Focus - Collect Data - Analyze and Interpret - Report
Page 54 PARRAMORE A CALL TO ACTION
ACKNOWLEDGEMENTS The Advisory Team Audrey Alexander Elaine Cauthen Therry Feroldi Marie-Jose Francois, MD Shawna Kelsch Brenda March Roniece Weaver, MS, RD, LD Key Stakeholder Interviews Audrey Alexander Tracey M. Conner Lisa Early Shaleana Eubanks-Worlds Gabriella Gscheidle April Johnson Brenda March Penny R. Smith Dawn Stewart Linda Sutherland Focus Group Researchers Angela Allen Jean Garcon Pascale Vincent Jeanette White
Page 55 PARRAMORE A CALL TO ACTION
Planning Comittee Angela Allen Jennifer Battle Oneka Burnett Balthazar Orine Boyd Odett Stanley-Brown, MD Elaine Cauthen Kelly Chevalier Veenod L. Chulani, MD Tracey Conner Rob Cruz, MPH Mae Davis Jon Decker, PhD, ARNP Eva Desrosiers, MD Therry Feroldi Marie-Jose Francois, MD Jean Garcon Kimberly Hicks, PharmD Nicole Phillips Hollis Shawna Kelsch Sandra King Andre Minott Brenda March Bridgette Monroe Lee O’Donnell Glen R. Providence Rita Soza PhD Shaunte Barton Stubbs Roniece Weaver, MS, RD, LD Lloyd N. Werk, MD, MPH, FAAP Jeanette White Nina White EdD Shaleana Eubanks Worlds
ACKNOWLEDGEMENTS CONTINUED
Graphic Designer Glen R. Providence Resource Maps Walter Hawkins, City of Orlando Michael Mills, City of Orlando
Partners Center for Multicultural Wellness and Prevention City of Orlando Get Active Orlando Partnership Hebni Nutrition Consultants, Inc. MicheLee Puppets Nemours Orange County Early Learning Coalition Orange County Health Department Orange County Healthy Start Coalition Orlando Health/Teen Xpress University of Central Florida
A special “thank you” to Roniece Weaver, Executive Director, Hebni Nutrition Consultants for hosting our planning/work group meetings and providing delicious smoothies!
Page 56 PARRAMORE A CALL TO ACTION
WORK GROUPS Member
Audrey Alexander Angela Allen Jennifer Battle Oneka Burnett Bithazar Odett Stanley-Brown, MD Elaine Cauthen Kelly Chevalier Veenod L. Chulani, MD Tracey Conner Cristina Cruz Rob Cruz Mae Davis Jon Decker, Ph.D. Eva Desrosiers, MD Therry Feroldi Marie-Jose Francois, MD Jean Garcon Kimberly Hicks, PharmD Nicole Phillips Hollis Shawna Kelsch Brenda March Bridget Monroe Glen Providence Rita Soza Shaunte Barton Stubbs Roniece Lloyd N.Weaver Werk, MD, MPH, FAAP Jeanette White Nina White Shaleana Eubanks Worlds
Parramore Call To Action Work Groups Organization
Advisory
Orange County Health Department CMWP
X
Early Health Learning Care
X X X
Callahan Center
X
Jackson Center Orlando Health HCECF
Schools Faith-Based and Community
X X X
Nemours
X
Arnold Palmer Hospital
X
MicheLee Puppets City of Orlando Teen Xpress/Orlando Health Callahan Center
X X X
UCF College of Nursing Orlando Health HCECF
Center for Multicultural Wellness and Prevention
X X X
X X
CMWP Pharmacist Bridge to Independence School HCECF City of Orlando
X X X
X
X
X X
Center for Change Hebni Nutrition Consultants, Inc. Teen Xpress/Orlando Health
X X
New Image Youth Center Hebni Nutrition Consultants, Inc. Nemours
X X
X X X
CMWP
Orange County Early Learning Coalition
X
Orange County Healthy Start Coalition
X
Page 57 PARRAMORE A CALL TO ACTION
REFERENCES i
Kids Health from Nemours. Overweight and Obesity. http://kidshealth.org/parent/general/body/overweight_obesity.html#
ii
Mayo Clinic. Childhood Obesity-Symptoms. http://www.mayoclinic.com/health/childhood-obesity/DS00698/ DSECTION=symptoms iii
Nemours Health and Prevention Services. http://www.nemours.org/service/preventive/nhps/521an.html iv
Christine Robinson. Community Engagement Tools to Support Florida’s Communities in Addressing Childhood Obesity. 2010. v
Robinson, T. N. (2001). Television viewing and childhood obesity. Pediatric clinics of North America, 48(4), 1017-1025. vi
Torgan, Op.cit
vii
Strauss (2001) op. cit.
viii
Strauss, R.S. & Knight, J. (1999). Influence of the home environment on the development of obesity in children. Pediatrics, 101 (6). ix
Arenz S, Rucker R, and von Kries R. “Breast feeding and childhood obesity—a systematic review.” International Journal of Obesity 2004; 28: 1247-1256. x
See US Dietary Guidelines at: http://www.health.gov/dietaryguidelines/dga2005/ document/pdf/dga2005.pdf xi
www.sugarstack.com
Page 58 PARRAMORE A CALL TO ACTION
Notes
Page 59 PARRAMORE A CALL TO ACTION
Building a healthy
Parramore
A Call to Action to reduce childhood obesity
Copyright 2011
