why schools should promote physical activity and healthy eating and prevent tobacco use
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Centers for Disease Control and Prevention Division of Adolescent and School Health. Why Schools Should Promote Physical Activity and Healthy Eating and Prevent Tobacco Use. Making the Case:. Howell Wechsler, Ed.D., MPH Health Scientist. (Part 1). Overview of The Case. - PowerPoint PPT PresentationTRANSCRIPT
Why Schools Should Promote Physical Activity and Healthy Eating
and Prevent Tobacco Use
Centers for Disease Control and PreventionDivision of Adolescent and School Health
Making the Case:
Howell Wechsler, Ed.D., MPHHealth Scientist(Part 1)
Overview of The Case
(1) Promoting physical activity, healthy eating, and tobacco use prevention for youth is a critical public health priority
(2) Prevalence of physical inactivity, poor eating behaviors, and tobacco use among youth is high, with unfavorable trends
Overview of The Case
(3) Promoting physical activity, healthy eating, and tobacco use prevention for youth is an important educational priority
Educational benefits
Benefits for society
Desired by families
premature mortality in general
death from heart disease
diabetes
colon cancer
hypertension
Regular Physical Activity Reduces Risk Of:
Dietary factors are associated with:
coronary heart disease stroke
type 2 diabetes osteoporosis breast cancer colon cancer
prostate cancer
heart disease
stroke
cancer of the lung, larynx, esophagus, pharynx, mouth, bladder
chronic lung disease
Cigarette smoking contributes to:
cancer of the pancreas, kidney, cervix
Cigarette smoking causes:
Causes of All Deaths in the U.S., 1997
CardiovascularDisease
39%
Cancer23%
COPD5%
Diabetes3%
Other Causes30%
Source: CDC, National Vital Statistics Reports 2000: 47(19)
Actual Causes of Death in the United States, 1990
Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.
400,000
300,000
100,000 90,000
30,000 20,000
0
100,000
200,000
300,000
400,000
500,000
Tobacco Diet/Activity Alcohol Microbialagents
Sexualbehavior
Illicit use ofdrugs
Estimated Annual Direct and Indirect Costs of CVD, Cancer, and Diabetes in the U.S. (in $ billions)
$98$107
$286
0
50
100
150
200
250
300
350
CVD1 Cancer2 Diabetes3
$ in
bil
lio
ns
1 - Health care and lost productivity costs (American Heart Association); 2 - Health care, lost productivity, and mortality costs (National Cancer Institute); 3 - Medical care costs and lost wages (American Diabetes Association)
Estimated Annual Costs Attributable to Obesity and Cigarette Smoking in the U.S.
Obesity1
Direct health care costs: $39 - $52 billion
4.0% - 5.7% of all health care costs
Indirect costs: $47 billion
Sources: (1) Wolf AM, Colditz GA. Ob Res 1998;6:97-106; Allison DB et al. AJPH 1999; 88:1194-9 (2) Miller VP et al. Soc Sci Med 1999;48:375-91
Cigarette Smoking2
Direct medical care costs: $53 billion
6.5% of all health care costs
Consequences of Osteoporosis
Contributes to 90% of hip fractures in women, 80% in men
Virtually all hip fracture patients are hospitalized; 2/3 don’t return to prior level of function
Estimated 1995 health care expenditures for hip fractures:
$8.7 billion
Source: U.S. DHHS. Healthy People 2010 (Conference Edition), 2000
80% of adult
smokers
started
smoking before
they finished
high school
Source: U.S. DHHS. Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994
Why Target Youth?
Why Target Youth?
The younger people are when they start using tobacco, the more likely they are to become dependent on nicotine
25% of high school students smoked a whole cigarette before age 13*
Physical activity and dietary patterns may be established during childhood and adolescence
*CDC, National Youth Risk Behavior Survey, 1997
Why Target Youth?
Risk factors for heart disease and diabetes develop early in life
Triglycerides
LDC-Cholesterol
HDL-Cholesterol (low)
Insulin
Blood Pressure
Why Target Youth?
Risk factor trends are going in the wrong direction
Atherosclerosis is present in late adolescence
Why Target Youth?
% of children, aged 5-10, with 2 or more adverse CVD risk factor levels:
Source: Freedman DS et al. Pediatrics 1999;103:1175-82
27.1%
6.9%
% of children, aged 5-10, with 1 or more adverse CVD risk factor levels:
Trends in Coronary Risk Factors in Children
StudySite
Years (n) Ages SignificantIncreases In:
Louisiana1 19811991
(417)(235)
16-17Weight, bodymass, triglycerides
Ohio2 1973-51989-90
(299)(1456)
7-13
Weight, bodymass, total choles-terol, triglycerides,blood pressure
Minnesota3 19861996
(4239)(5223)
10-14Weight, bodymass, systolicblood pressure
Sources: (1) Gidding SS et al. J Pediatr 1995;127:868-74 (2) Morrison JA et al. Am J Public Health 1999;89:1708-14 (3) Luepker RV et al. J Pediatr 1999;134:668-74
Why Target Youth?
% of children, aged 5-10, with 1 or more adverse CVD risk factor levels:
% of children, aged 5-10, with 2 or more adverse CVD risk factor levels:
Source: Freedman DS et al. Pediatrics 1999;103:1175-82
27.1%
6.9%
60.6%
26.5%
overweight
overweight
Relation of Overweight to Adverse CVD Risk Factors in Children Ages 5-17
Factor Odds Ratio*Cholesterol >200 mg/dl 2.4Triglycerides >130 mg/dl 7.1LDL-C >130 mg/dl 3.0HDL-C < 35 mg/dl 3.4Elevated SBP 4.5 Elevated DBP 2.4Elevated insulin 12.6
*Prevalence for overweight children (> 95th percentile for Quetelet Index) versus prevalence for children who are not overweight or at risk of overweight (< 85th percentile)Source: Freedman DS et al. Pediatrics 1999;103:1175-82
Percentage of U.S. Adolescents, Ages 12-17, Who Were Overweight*, by Sex
* >95th percentile for BMI by age and sex based on NHANES I reference dataSource: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
0
2
4
6
8
10
12
1963-70 1971-74 1976-80 1988-94
Percent 11.4
9.9
Males
Females
4.6
4.5
Percentage of U.S. Children, Ages 6-11, Who Were Overweight*, by Sex
0
2
4
6
8
10
12
1963-70 1971-74 1976-80 1988-94
Percent
* >95th percentile for BMI by age and sex based on NHANES I reference dataSource: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
Males
Females
11.4
9.9
4.3
3.9
Percentage of U.S. Children, Age 6 to 11,Who Were Overweight*, by Race and Sex
02468
1012141618
1963-70 1971-74 1976-80 1988-94
Percent
* >95th percentile for BMI by age and sex based on NHANES I reference dataSource: Troiano RP, Flegal KM. Pediatrics 1998;101:497-504
White females
Black females
Black malesWhite males
Emergence of Type 2 Diabetes Among Youth
1979: First clinical reports in Pima Indians in Arizona
1990-94: First clinical reports in populations other than American Indians
Increased Incidence (New Cases) of Type 2 Diabetes Among Adolescents
in Greater Cincinnati, OH
Incidence in 1982: 0.7 / 100,000 per year
Incidence in 1994:
Source: Pinhas-Hamiel O et al. J Pediatr 1996;128:608-15
7.2 / 100,000 per year
Type 2 Diabetes in Youth
A public health problem for American Indians (estimated prevalence: 2 to 50 per 1000)
Becoming a public health problem for popula-tions other than American Indians (estimated prevalence: <4 per 1000 in general population)
Source: CDC, Division of Diabetes Translation
approximately 30,000 adolescents aged 12-19 in 1988-94
8 to 46% of all new cases of diabetes in pediatric clinics
Health Conditions Associated with Adult Obesity
Hyperlipidemia
Diabetes mellitus
Hypertension
Respiratory
Cardiac
Polycystic ovary disease
Gall bladder disease
Osteoarthritis
Cancer
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1985
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1986
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1987
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1988
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1989
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1990
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1991
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1992
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1993
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1994
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1995
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Prevalence of Obesity* Among U.S. AdultsBRFSS, 1996
(*Approximately 30 pounds overweight)
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.
<10% 10% to 15% >15%
Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%–19% ≥20
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%–19% ≥20
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%–19% ≥20
Obesity Trends* Among U.S. AdultsBRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Source: Behavioral Risk Factor Surveillance System, CDC
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
Healthy People 2010: Leading Health Indicators
Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care
Tobacco use
Physical activity Overweight and obesity
Objectives to be Measured to Assess Progress in Leading Health Indicators
Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.
Reduce the proportion of children and adolescents who are overweight or obese.
Reduce cigarette smoking by adolescents.
Sound Bytes
“No [health] problem needs our attention more than the growing epidemic of obesity in America. In sheer numbers and its toll in death and disability, obesity has reached crisis proportions in the United States.”
- Dr. C. Everett Koop, former United States Surgeon General
Sound Bytes
“Smoking is the chief, single avoidable cause of death in our society and the most important public health issue of our time.”
- Dr. C. Everett Koop, former United States Surgeon General
Sound Bytes
“I am alarmed by the steady trend we have seen over the last two decades toward decreasing physical education requirements in schools... We need to create environments where healthy lifestyles are as easy to adopt as unhealthy ones…Our schools have a responsibility to educate both minds and bodies.”
- Dr. David Satcher, U.S. Surgeon General
Sound Bytes
“Smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murder, suicides, and fires combined.”
- Centers for Disease Control and Prevention, Office on Smoking and Health