1. Statewide Health Improvement Program Community Health Indicators: Polk 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. 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

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

5. 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.

6. MN Risk Statistics (Adults) General Health and Obesity Over 60% of all Minnesotans are overweight or obese. 37.5% of all Minnesotans were overweight. 26.5% were classified obese (mean BMI of 27.5 [1] ). [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”.

7. 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 (%).

8. Polk County Risk Statistics (Adults) Health risk category Polk County (%) SHIP Counties (%) [1] [1] MN State (%) Overweight (not obese) 35.836.437.5 Obese 25.525.926.5 Current smokers 15.815.615.7 No Exercise 17.8 12.9 Fair or Poor Overall Health 12.112.514.2 [1] [1] Aggregate data for Kittson, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake & Roseau Counties.

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

10. 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. Polk county adults are much less physically active (no exercise) than other adults statewide.

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

12. 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. 59.4% response rate 72% response rate for SHIP region MN Student survey administrators provided raw data sets in order for us to make statistical comparisons. Confidence intervals used to assess statistical differences.

13. Risk Statistics (High School Students) Overweight and Obesity –See Table 2, pg. 6 9.7 % of 12th-graders in Polk County were classified ‘at risk’ for becoming overweight. 14.4% of 12th-graders in Polk County were considered overweight. 29.2% of Polk county students thought they were overweight –Sig. higher than state average. 5.8% of students reported using cigarettes in the past 12 months to help them lose or control their weight. 50% of students reported using exercise and 48.8% reported using healthier diet to help them lose or control their weight (see Figure 2 and Table 2).

14. Risk Statistics (High School Students) Exercise and Physical Activity 61.8% of students met recommendations for regular weekly physical activity. Significantly less than for MN (68.7%). 21.8% of students reported insufficient physical activity. 16.4% reported no weekly physical activity. Significantly more than the corresponding proportion of sedentary students in MN (10.4%;).

15. Risk Statistics (High School Students) Fruit and Vegetable Consumption Only 10.4% of students reported adequate daily intake of fruits and vegetables. Significantly fewer than MN (16.1%).

16. Risk Statistics (High School Students) Tobacco Use and Access 32.5% of the 12th-grade students in Polk County reported using tobacco products in the 30 days preceding the survey. Cigarette smoking was the most frequent form of tobacco use reported by 26.6% of students. Smokeless tobacco use was reported by 13.5% of the 12th graders. 75% of tobacco users purchased them at a gas station or a convenience store. Significantly more than MN average of 63.1%.

17. Summary of Findings Compared to the statewide averages of MN youth, Polk County youth… Meet PA guidelines significantly less often. Are more likely to get no physical activity at all. Eat significantly less fruits/vegetables per day. Use tobacco products more often. Are more likely to buy tobacco at a gas station or convenience store. Perceive themselves to be overweight more often. These perceptions are much higher than their actual reported degree of overweight.

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

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

20. Interviews Extent of Problem: Unhealthy Eating/Physical Activity Participants reported difficulty quantifying the extent of the problem. Confluence of factors negatively impacting healthy eating and physical activity in Polk 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

21. Interviews Extent of Problem: Tobacco Viewed as potentially related to low socioeconomic and/or educational status. Tobacco use viewed in part as stemming from parents acting as poor examples (i.e. smoking). Also a lack of parental involvement in deterring their children from tobacco use. A number of interviewees already were implementing tobacco use policies.

22. Interviews Comments from interviewers…

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

24. Recommendations Findings suggest that lack of exercise for adult populations within Polk County may be a significant issue. COMMUNITY/WORKSITE SETTING INTERVENTIONS Policies and practices that create active communities by increasing opportunities for non-motorized transportation (walking and biking) and access to community recreation facilities. Implement signage prompting use of stairs in community buildings. A comprehensive employee wellness initiative that provides health assessment with follow-up coaching, ongoing health education, and policy and environment support 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.

25. Recommendations Findings suggest that unhealthy dietary practices and lack of physical activity for youth within Polk County may be a significant issue. SCHOOL SETTING INTERVENTIONS Comprehensive nutrition policies including: breakfast promotion; healthy lunch and snacks; school gardens; and farm-to-school initiatives. Policies and practices that create more active schools by:  Supporting quality school-based physical activity  Increasing opportunities for non-motorized transportation  Increased access to school recreation facilities. COMMUNITY SETTING INTERVENTIONS Policies, practices and environmental changes that improve access to nutritious foods (e.g. fruits, vegetables) such as: 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.

26. Recommendations Findings suggest that the use of tobacco products, including smokeless tobacco by youth within Polk County may be a significant issue. 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).

27. Recommendations Conduct BRFSS locally within each of the eight counties to obtain a more accurate accounting of the adult population risk factors within northwest Minnesota.

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