1. Statewide Health Improvement Program Community Health Indicators: Roseau County Prepared by: Garth Kruger, Ph.D. Dmitri Poltavski, Ph.D. EvaluationGroup, LLC

2. Introduction EvaluationGroup,LLC Dmitri Poltavski, Ph.D. Garth Kruger Ph.D. Jacque Gray, Ph.D. OUR SERVICES INCLUDE PROGRAM EVALUATION DESIGN WRITING LOGIC MODELS NEEDS ASSESSMENTS SURVEY CONSTRUCTION DATA ANALYSIS POLICY ANALYSIS WEB PAGE DESIGN

3. Purpose of Presentation To review county and state health risk indicators Select interventions that provide maximum impact.

5. What are the results? Adults in Roseau County and the NW MN Region are overweight/obese. Increase physical activity and improve nutrition. Roseau County youth need tobacco prevention/intervention Use tobacco products significantly more often. Most likely to smoke cigarettes Smokeless tobacco use is twice the state average. Physical activity and nutritional issues important but secondary.

6. The End…

7. Overview Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: Adults (18+) Indexes of Obesity and Tobacco Use for High School Students (grade 12) Overweight and Obesity Exercise and Physical Activity Fruit and Vegetable Consumption Tobacco Use, Access, Smoking Policy Interviews with County Residents Review of Interventions and Recommendations

8. Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: Adults (18+)

9. Risk Statistics (Adults) Data Used Behavioral Risk Factor Surveillance Survey (BRFSS) databases 2004, 2007 and 2008. There are only synthetic estimates of behavioral adult risk statistics for the 8-county SHIP region.  There are currently no recent BRFSS data available on smokeless tobacco use in Minnesota. Known Age Gender ESTIMATE ? Unknown ?

10. MN Risk Statistics (Adults) General Health and Obesity Over 60% of all Minnesotans are overweight or obese (mean BMI of 27.5 [1] ). [1] 37.5% of all Minnesotans were overweight. 26.5% were classified obese. [1][1] BMI between 25.00 and 29.99 corresponds to the category “overweight”; BMI of 30.00 and above corresponds to the category “obese”.

11. MN Risk Statistics (Adults) 45.5% of Minnesotans met physical activity recommendations. 40.4% reported insufficient levels of physical activity. 12.9% had none at all. 2007 Minnesota Physical Activity (PA) Categories (%).

12. Roseau County Risk Statistics (Adults) Health risk category Roseau County (%) SHIP Counties (%) [1] [1] MN State (%) Overweight (not obese) 36.4 37.5 Obese 26.225.926.5 Current smokers 16.415.615.7 No Exercise 16.617.812.9 Fair or Poor Overall Health 11.412.514.2 [1] [1] Aggregate data for Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake & Roseau Counties.

13. MN Risk Statistics (Adults) Fruit and Vegetable Consumption 21.3% of Minnesotans reported consuming 5 or more servings of fruits and vegetables per day.

14. MN Risk Statistics (Adults) Tobacco Use and Smoking Policy 15.7% of Minnesotans in 2008 reported currently smoking at least on some days. 11.1% percent were regular smokers (smoke every day).  53% of smokers reported trying to quit at least once in the past 12 months.

15. Summary Data suggest Over half the adult population is overweight or obese. Only slightly more than 20% of adults eat the recommended guidelines of fruits and vegetables. Roseau county adults are much less physically active (no exercise) than other adults statewide.

16. Behavioral Risk Statistics Indexes of Obesity and Tobacco Use: High School Students (grade 12)

17. Risk Statistics (High School Students) Datasets Used Minnesota Student Survey 2007 Information used for only students in grade 12. Good proxy for needs given SHIP parameters. They show the greatest prevalence of health risk behaviors compared to grades 6 and 9. 80.8% response rate 72% response rate for SHIP region

18. Datasets Used MN Student survey administrators provided raw data sets in order for us to make statistical comparisons. Confidence intervals used to assess statistical differences. Risk Statistics (High School Students) 14.0% 9.9% 19.3% 95% Confidence Interval

19. Risk Statistics (High School Students) Overweight and Obesity –See Table 2, pg. 7 14.0 % of 12th-graders in Roseau County were classified ‘at risk’ for becoming overweight 29.1% of Roseau county students thought they were overweight. 8.8% of 12th-graders in Roseau County were considered overweight. Adult population at 60%

20. Risk Statistics (High School Students) 70.4% of students met recommendations for regular weekly physical activity. Higher than MN (68.7%). 45% of MN Adults  15.0% reported no weekly physical activity. 14.6% of students reported insufficient physical activity. Exercise and Physical Activity

21. Risk Statistics (High School Students) Fruit and Vegetable Consumption Only 14.6% of students reported adequate daily intake of fruits and vegetables. Far fewer than MN (16.1%). 21.3% of adults met

22. Risk Statistics (High School Students) Tobacco Use and Access 43.8% of the 12th-grade students in Roseau County reported using tobacco products in the 30 days preceding the survey. (15.7% of adult Minnesotans smoke) Cigarette smoking was the most frequent form of tobacco use reported by 32.1% of students. 20.5% of 12th graders had used smokeless tobacco during the last 30 days compared to state average of 10.4%.

23. Risk Statistics (High School Students) 71.1% of tobacco users purchased them at a gas station or a convenience store. Higher than MN average of 63.1% (but not stat sig).

24. Summary of Findings Compared to the statewide averages of MN youth, Roseau County youth… Use tobacco products significantly more often than the statewide average.. Most likely to smoke cigarettes Smokeless tobacco use is twice the state average. Meet PA guidelines about the same as state average. However, youth are more likely to get no physical activity at all. (Those uninvolved in sports?). Eat slightly less fruits/vegetables per day than state average.

25. What are the results again? Adults in Roseau County and the NW MN Region are overweight/obese. Increase physical activity and improve nutrition. Roseau County youth need tobacco prevention/intervention Use tobacco products significantly more often. Most likely to smoke cigarettes Smokeless tobacco use is twice the state average. Physical activity and nutritional issues important but secondary.

26. County Resident Interviews Most Pressing Issues and Extent of Problems

27. Interviews Primary and pressing healthcare issues facing their community Obesity Tobacco use both by adults and students

28. Interviews Confluence of factors negatively impacting healthy eating and physical activity in Roseau County: Food costs  cheap, fast, unhealthy food is what people want  Food vendors offer poor choices Culture of inactivity Lack of supports for those seeking to become healthier Lack of parent time/interest in children’s’ weight and activity

29. Interviews One convenience store clerk respondent stated “I feel bad when people come into the store and say, I need my fruit for the day” when buying Starburst candy.

30. Recommendations Best Options for Addressing Overweight, Physical Activity and Tobacco Use in Adults and Youth

31. Intervention Settings Community Worksites Schools Healthcare Tobacco Use and Obesity

32. Recommendation: Increase Adult Physical Activity COMMUNITY/WORKSITE SETTING INTERVENTIONS Policies and practices that create active communities Increase opportunities for non-motorized transportation (walking and biking) Increase access to community recreation facilities. Implement signage prompting use of stairs in community buildings. A comprehensive employee wellness initiative Provide health assessment with follow-up coaching, Provide ongoing health education, Provide policy and environmental supports that promotes healthy weight and behaviors. HEALTHCARE SETTING INTERVENTIONS Develop relationships among health care providers and community leaders to facilitate active referral of patients to resources that increase access to nutritious foods, physical activity, and tobacco use cessation.

33. Recommendation: Decrease Tobacco use by Youth COMMUNITY SETTING INTERVENTIONS Tobacco-free policies for parks, playgrounds, beaches, zoos, fairs, and other recreational settings. Policies that restrict youth access to tobacco such as sales laws directed at tobacco retailers to reduce illegal sales to minors. HEALTH CARE SETTING INTERVENTIONS Better connect people with existing effective cessation services (such as the 5 A’s and fax referral).

34. Recommendation: Nutrition & Physical Activities for Youth SCHOOL SETTING INTERVENTIONS Comprehensive nutrition policies: Breakfast promotion; Healthy lunch and snacks; School gardens; Farm-to-school initiatives. Creating more active schools through: Supporting quality school-based physical activity Increasing opportunities for non-motorized transportation Increased access to school recreation facilities. COMMUNITY SETTING INTERVENTIONS Improving access to nutritious foods (e.g. fruits, vegetables) through: Increased availability and affordability of nutritious foods in grocery stores, corner stores, concession facilities, and other food vendors. License and facilitate the development of new farmer’s markets and promote their use.

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