Hunger & Homelessness. Operation CHOICES: Promoting Healthy Food & Fitness for Families in Emergency Housing

Transcription

1 Hunger & Homelessness Operation CHOICES: Promoting Healthy Food & Fitness for Families in Emergency Housing Karen Hudson, MSW, LSW Melissa Berrios, MSW Melissa Bennett, MD Beth Rezet, MD The Children s Hospital of Philadelphia Homeless Health Initiative

2 Objectives Increase understanding of the connection between hunger, homelessness, and obesity within families in shelter Learn how food insecurity and trauma impact hunger and homelessness Integrate knowledge into a workable plan for your community

3 The Problem 17% (12.5 million) children & adolescents (2-19 years) are obese Obesity prevalence among children & adolescents has almost tripled since of 7 low-income, preschool-aged child (2-4 years) is overweight or obese Nearly 1.25 million 541,000 obese National Health and Nutrition Examination Survey (NHANES) Available at: Lumeng, J.C., Forrest, P., Appugliese, D.P., Niko Kaciroti, Corwyn, R.F., & Bradley, R.H. (2010). Weight status as a predictor of being bullied in third through sixth grades. Pediatrics (125), 6, e1301-e1307. Available at:

4 Problem: The Cost of Obesity Annual hospital costs related to obesity among children and adolescents increased from $35 million (1979) to $127 million (1999) In 2006, individuals that experience obesity spent $1,400 more on medical care costs In 2007, approximately 300,000 deaths per year may have been attributable to obesity In 2008, annual healthcare cost of obesity in the US was estimated to be as high as $147 billion Finkelstein, EA, Trogdon, JG, Cohen, JW, and Dietz, W. Annual medical spending attributable to obesity: Payer- and servicespecific estimates. Health Affairs 2009; 28(5): w822-w831. Available at: Office of the Surgeon General. (2007). Overweight and Obesity: What You Can Do. Available at: CDC National Center for Chronic Disease Prevention and Health Promotion. (2009). Halting the epidemic by making

5 Homeless Health Initiative Goals: To provide comprehensive medical services to children in emergency housing. To assist families in accessing important services including health insurance, primary care, and specialty care. To enhance healthcare providers knowledge of, and exposure to, homelessness and its impact on children s lives and their health. To provide education and advocacy. Collaboration, Partnerships & Replication

6 HHI Services Developmental Screenings Operation CHOICES Acute Care Women s Health Health Education Lactation Consultation HHI Autism Screening Donations Staff Training Special Events Health Insurance Advocacy Projects Parenting Skills

7 2009 State Prevalence Among Low-Income Children Aged 2 to 4 Years CDC US Obesity Trends by State Available at:

8 Prevalence of Obesity U.S. children and adolescents aged % 15% 10% 5% 0% Age in years CDC. Prevalence of Obesity Among Children and Adolescents: United States, Trends Through Available at:

9 Prevalence of Obesity Among US Adolescents (12-19 years) Boys Girls 30% 30% 25% 25% 20% 20% 15% 10% 5% 0% White Black Mexican American 15% 10% 5% 0% White Black Mexican American CDC. Prevalence of Obesity Among Children and Adolescents: United States, Trends Through Available at:

10 Consequences of Childhood Obesity Children experiencing obesity are more likely to have: High blood pressure and high cholesterol Risk factors for cardiovascular disease Increased risk of type 2 diabetes Breathing problems Sleep apnea Asthma Joint problems and musculoskeletal discomfort Greater risk of social and psychological problems (e.g., discrimination, poor self-esteem) Fatty liver disease Gallstones Heartburn Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007;150(1):12 17.e2.; Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics. 2005;116(1):e ; Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. May ;375(9727): ; Sutherland ER. Obesity and asthma. Immunol Allergy Clin North Am. 2008;28(3): , ix; Taylor ED, Theim KR, Mirch MC, et al. Orthopedic complications of overweight in children and adolescents. Pediatrics. Jun 2006;117(6): ; Dietz W. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics 1998;101:518

11 Consequences of Childhood Obesity Later in life More likely to experience obesity as adults Obesity in adulthood is likely to be more severe Adult obesity is associated with: Heart disease Diabetes Some cancers Decreased quality/length of life Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr. May 2010;91(5):1499S 1505S.; Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;37(13): ; Serdula MK, Ivery D, Coates RJ, Freedman DS. Williamson DF. Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22: ; National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: the Evidence Report. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 1998; Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood overweight to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 2001;108:

12 Obesity & Homelessness The New York Children s Health Project, a program of The Children s Health Fund, assessed obesity rates among a sample of 520 children experiencing homeless in NYC Childhood Obesity Rates (2004) 40% 30% 20% 10% General Population (CDC) Homeless (NY) 0% Grant, R., et al. (2007). The health of homeless children revisited. Advances in Pediatrics, 54, Available at:

13 Obesity & Homelessness Researchers from Johns Hopkins University found a high prevalence of obesity and overweight in homeless Baltimore caregivers (77%) and their children (23%) Schwartz, Kathleen B., & et al. (2007). High prevalence of overweight and obesity in homeless Baltimore children and their caregivers: a pilot study. Medscape General Medicine, 9. Available at:

14 Obesity in Adults in the U.S. 34.2% overweight 33.8% obese* 5.7% extremely obese Minority and low-income populations have a disproportionate burden of cardiovascular disease Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics Available at: CDC Office of Minority Health & Health Disparities. (2012). Eliminate Disparities in Cardiovascular Disease Factsheet. Available at: *35.7% ( )

15 Obesity Trends Among U.S. Adults BRFSS, 1985 No Data <10% 10% 14% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

16 Obesity Trends Among U.S. Adults BRFSS, 1986 No Data <10% 10% 14% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

17 Obesity Trends Among U.S. Adults BRFSS, 1987 No Data <10% 10% 14% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

18 Obesity Trends Among U.S. Adults BRFSS, 1988 No Data <10% 10% 14% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

19 Obesity Trends Among U.S. Adults BRFSS, 1989 No Data <10% 10% 14% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

20 Obesity Trends Among U.S. Adults BRFSS, 1992 No Data <10% 10% 14% 15% 19% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

21 Obesity Trends Among U.S. Adults BRFSS, 1993 No Data <10% 10% 14% 15% 19% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

22 Obesity Trends Among U.S. Adults BRFSS, 1994 No Data <10% 10% 14% 15% 19% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

23 Obesity Trends Among U.S. Adults BRFSS, 1995 No Data <10% 10% 14% 15% 19% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

24 Obesity Trends Among U.S. Adults BRFSS, 1996 No Data <10% 10% 14% 15% 19% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

25 Obesity Trends Among U.S. Adults BRFSS, 1997 No Data <10% 10% 14% 15% 19% 20% 24% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

26 Obesity Trends Among U.S. Adults BRFSS, 1998 No Data <10% 10% 14% 15% 19% 20% 24% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

27 Obesity Trends Among U.S. Adults BRFSS, 1999 No Data <10% 10% 14% 15% 19% 20% 24% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

28 Obesity Trends Among U.S. Adults BRFSS, 2000 No Data <10% 10% 14% 15% 19% 20% 24% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

29 Obesity Trends Among U.S. Adults BRFSS, 2001 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

30 Obesity Trends Among U.S. Adults BRFSS, 2002 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

31 Obesity Trends Among U.S. Adults BRFSS, 2003 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

32 Obesity Trends Among U.S. Adults BRFSS, 2004 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

33 Obesity Trends Among U.S. Adults BRFSS, 2005 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

34 Obesity Trends Among U.S. Adults BRFSS, 2006 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

35 Obesity Trends Among U.S. Adults BRFSS, 2007 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

36 Obesity Trends Among U.S. Adults BRFSS, 2008 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

37 Obesity Trends Among U.S. Adults BRFSS, 2009 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Centers for Disease Control (2011). CDC US Obesity Trends by State Retrieved from

38 The Operation CHOICES Plan Conduct needs assessments & focus groups: Mothers, Children, Staff Readiness to Change Environmental Context Emergency Housing Facility Neighborhood Create intervention based on above findings

39 Focus Group Findings: Children Consume high fat, calorie dense foods, especially at school Don t enjoy many meals at the shelter Parents make decisions about the food they eat, but children know how to influence parents Some familiarity/introduction to nutrition & fitness concepts Want to learn more about nutrition & physical fitness with their moms Our brain is smarter than our stomach. The brain makes the decision to eat healthy food.

40 Focus Group Findings: Mothers Do not believe the food being served in shelter is nutritious & balanced Not accustomed to food served Sneak food into shelter When families eat outside the shelter, they usually eat fast food Toddlers are served same food/quantity as adults Force children to eat or go to bed hungry Want to give their children 100% juice Want to learn more about nutrition & fitness We don t make any decisions now.

41 Focus Group Findings: Mothers Barriers: No choice No fresh options Little to no money No access to kitchen Shelter rules When children are sick, moms can't even go out and get some ginger ale and crackers.

42 Shelter Staff Concerns Fresh options Healthier culture Empower families Creative meals Change menus

43 Shelter Environment Strengths Garden Children s cooking classes Community food pantry DVAEYC trained education coordinator On-site nurse

44 Shelter Environment Challenges Policies Menu restrictions Stress Trauma Neighborhood

45 Ecological Perspective Mothers & Children Shelter Family & Friends Neighborhood Society

46 Development of Operation CHOICES Created a leadership team Recruited volunteers Created/piloted nutrition lessons Created/piloted fitness lessons Advocated on City level

47 Pilot Project, Shelter 4 weekly nutrition sessions (moms & children) 2 volunteers 20 participants 5 weekly fitness sessions (moms & children) 4 volunteers 52 participants

48 Nutrition for Moms Six week series (1 hour sessions each week) FUN, INTERACTIVE! Lessons: Basic Food Groups Nutrition Labels & Serving Sizes Vitamins & Minerals Go, Slow, Whoa Foods Health Consequences of Obesity (Hypertension, Diabetes, Cardiovascular Disease) Grocery Shopping

49 Nutrition for Children Six week series (1 hour sessions each week) FUN, INTERACTIVE! Pre-school Lessons: Being Healthy Fruits Vegetables Milk Builds Strong Bones Healthy Food & Not-so-Healthy Food Making Healthy Meals School Age Nutrition Lessons Being Healthy Go, Slow, Whoa Foods Food Pyramid Read it before you eat it Sugar Restaurant

50 Fitness FUN! Moms & children, together Lessons: Flexibility Strengthening Endurance Balance, Coordination & Agility DANCE! Yoga

51 Impact 1 st Year 2 nd Year 3 rd Year 1 shelter 3 shelters 3 shelters 6 volunteers 42 volunteers 106 volunteers 4 nutrition sessions 18 nutrition sessions 36 nutrition sessions 20 participants 82 participants 238 participants 5 fitness sessions 20 fitness sessions 74 fitness sessions 52 participants 120 participants 786 participants

52 Advocacy Families Shelter Kitchen Staff Health Promotion Council Public Health Management Corporation Office of Supportive Housing Child & Adult Care Food Program

53 Challenges Volunteers Consistent Participation Coordination with shelter staff Program Evaluation Navigating Systems

54 Increasing CHOICES Families Increasing physical activity Making & buying healthy snacks Shelter Food tastings Food committee Healthy snacks at meetings City Menu planning: offering options, more culturally appropriate, more child-friendly Empowering kitchen staff

55 Everyone wants and deserves CHOICES!

56 Questions

57 What created the Success? Building relationships Being consistent Developing cross system collaboration Empowering ALL stakeholders

58 Hunger & Homelessness Reflection Questions How does homelessness contribute to obesity in families experiencing homelessness? How does food insecurity intersect with obesity? What is the connection between trauma and obesity? Where can you make an impact in addressing the issue of hunger & homelessness?

59 Developing Your Plan Share where your communities are struggling with the issue of hunger & homelessness? Identify the level at which you might make an impact * families * shelter * neighborhood * society

60 Contact Karen Melissa Berrios