Other Important CBPR Aspects Recognize & highlight community assets & strengths – View community members as advisers & experts Provide real service to communities by addressing the community's needs Build & maintain respecting, trusting relationships within/across the community. – Develop relationships with opinion leaders in the community Agency for Healthcare Research and Quality, 2003

CBPR IN BROWNSVILLE, TEXAS CULTURAL RESPONSES TO OBESITY (WELLNESS)

Children BORN TODAY HAVE A LOWER LIFE EXPECTANCY THAN THEIR PARENTS 1 in 3 will develop diabetes 3/5 if African American ½ if Hispanic > ½ if Native American

Portrait of an Overweight Child

Toxic Environment Availability & affordability of high fat/high carbohydrate food (fast food, soft drinks) Large portion sizes Marketing to children Fewer family meals TV, computers, video games Safety issue Decrease in physical education Schwartz MB & Brownell KD, 2007

Dollars spent on U.S. food advertising in 2005 Food, beverages, candy $7,313,200,000 Restaurants & fast food $5,061,000,000 Advertising Age, 2006

Mixed messages

Obesity is caused by long-term positive energy balance Fat Stores ~ 600 calories per day

Obesity Interventions Current strategies are not containing the “diabesity” (sedentary) epidemic Need to shift away from clinical view of obesity as personal disorder requiring medical R x Understanding, measuring, & altering the “obesogenic” environment is critical Society has a key role in sharing with individuals the high “costs” of a healthy lifestyle change (maintenance)

A framework for obesity prevention

The Truth About TV (True or False) The average child watches about one hour of TV a day. TRUEorFALSE By the age of eighteen, the average child has seen about two- thousand murders on TV. TRUEorFALSE Children who watch three or more hours of TV a day are more likely to be overweight than children who watch less than two hours a day. TRUEorFALSE Children who have a TV in their bedrooms are more likely to be overweight. TRUEorFALSE

What is Screen-Time? Time spent in front of a screen: – TV (videos or DVDs) – Computer (surfing the Internet, ing, playing games) – Handheld (instant messaging, playing games)

American Academy of Pediatricians Guidelines for Children’s Media Use No TV viewing for children < 2 years old No more 2 hours/day for older children Monitor programming

Over Exposed Average of 5½ hours a day using media Preschoolers (< 6 years old) – Time with screen media – Playing outside The Role of Media in Childhood Obesity, 2004

TV Viewing & Behavior Problems Healthy Steps for Young Children Age 2.5 & 5.5 – 20% watched 2+ hrs – Behavioral problems 41% kids had a TV in their bedroom – Poor sleep Mistry et al., Pediatrics, 2007

TV Advertisements & Kids 40,000 ads a year on TV Elaborate advertising campaigns – Candy – Soda – Snacks Illustration:: Cathy Wilcox The Role of Media in Childhood Obesity, 2004

TV Watching & Over Eating 24 children 3-5 years old – High socioeconomic status > 1.5 hours of TV daily ate more while watching TV Francis & Birch, J Am Diet Assoc, 2006 Credit iStock

What To Do about the TV? Set family goal to reduce screen-time “No eating while watching TV” rule Remove the TV from child’s bedroom Reward family with fun - EXERCISE

Physical Activity Reduces the risk for many diseases Helps control weight Strengthens muscles, bones, & joints Reduces feelings of depression & anxiety

Physical Activity & Academic Achievement Healthier students do better in school Students who do better on achievement tests tend to be more physically fit than peers Exercise alleviates stress & anxiety, improves asthma, boosts self-esteem – FACTORS that influence school attendance & performance Vail, Am School Board J, 2006; Grissom, 2004