1. Drumming to A Healthy Beat: An Innovative Health Management Program Kimberlee Wyche-Etheridge, MD, MPH Lateesa Posey-Edwards, APRN, BC CityMatCH 2007

2. Objectives To give an overview of why programs like this are beneficial To demonstrate a fun and innovative way to address obesity To point out successes and limitations To outline how lessons learned will be used to move the program forward

3. The Epidemic “This generation of youth will be the first in history that has the potential of living fewer years than their parents” »Federal government

4. The Epidemic Since 1960 the prevalence of obesity in the US ages 12-19 has tripled In 2003 Nashville ranked 43 rd in the Nation for overall health According to the 2003 Youth Risk Behavior Survey: –13% of Nashville youth admit to being obese –16% at risk for overweight –21% of Nashville’s AA youth are overweight and 18% are obese vs. 13% and 10% of Caucasian youth –68% of AA youth indicated watching over 3 hours of TV/day Vs. 34% of Caucasian youth According to Local elementary school data: –28% of elementary students are overweight, and 20% are at risk for overweight. This is up from 22% and 16% 3 years ago. We are super sizing our youth

5. 1995 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) 2005 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

6. The Epidemic CDC notes: –An unhealthy diet and lack of physical activity can be contributing factors in many chronic diseases and conditions, including type 2 diabetes, stroke, hypertension, heart disease, breast cancer, colon cancer, gall bladder disease, depression, and arthritis..

7. The Epidemic Health and Education are linked: –Health goes hand in hand with educational attainment. Therefore, a student who is not healthy, is less likely to excel in school –Children who are overweight in Kindergarten tend to score lower on math and reading tests

8. The Epidemic African Americans (AA) suffer from conditions related to obesity at a higher rate than Caucasians In order to decrease this disparity, it is important to reduce the number of obese and overweight AA people, while improving the quality of life for the general population

9. Barriers Strong interconnection between AA lifestyle and culture Not a strong relationship between cultural identity and health consciousness

10. The Response Target AA female youth who are overweight, and at risk of becoming obese Provide daily physical exercise in the form of structured cultural dance Provide nutrition education through weekly interactive activities focusing on the psychosocial aspects that lead to poor dietary choices Participate in self esteem building through the use of drama and Rights of Passage program

11. Drumming to a Healthy Beat Partners: –Village Cultural Arts Center –Metro Public Health Department –Family Empowerment Services –Community Medical Providers –TN State University Food Stamp Nutrition Education Program

12. Drumming to a Healthy Beat Program Design –Identify and recruit a cohort of AA girls ages 10-13 who attend school in 3 target zip code areas identified as “high risk”

13. Drumming to a Healthy Beat: Goals Goal 1:To decrease the age appropriate Body Mass index of each participant to a healthy level –Objective 1: Increase physical activity of program participants to meet daily recommendations –Objective 2: Monitor key health indicators monthly to include wt, bp, BMI

14. Drumming to a Healthy Beat: Goals Goal 2: To improve the self-esteem and academic performance of young girls through empowerment –Objective 1: Facilitate group sessions to address some of the major psycho-social issues affecting unhealthy diets and other behaviors –Objective 2: Provide monitored homework time to strengthen academic performance –Objective 3: Engage participant’s parents in a series of sessions around adolescent development, health and nutrition

15. Drumming to a Healthy Beat: Goals Goal 3: To guide youth toward making smarter food choices for a healthier future –Objective 1: Engage participants in topic related sessions around healthy eating and activity

16. Drumming to a Healthy Beat: Planned Activities ‘Tween girls with BMI’s >95 th % identified by school nurse Each girl receives a physical exam, and monthly wt and bp checks Girls are transported to the Village after school each day Guided homework and healthy snack time while preparing for exercise 60 minute African dance or Afrocize class each day 60 minute weekly “Rights of Passage class” 60 minute 2X weekly interactive nutrition classes using the Power of Choice curriculum Monthly parents’ meeting Quarterly report card submission

17. Drumming to a Healthy Beat: Reality Activities ‘ Tween girls with BMI’s >95 th % identified by school nurse * avg BMI at start was 32, a lot higher than anticipated Girls are transported to the Village after school each day * there was interest at too many schools to pick up with limited van space Guided homework and healthy snack time while preparing for exercise * girls could buy unhealthy snacks at school and would sneak them during the program 60 minute African dance or Afrocize class each day * several girls complained to their mothers about having to exercise, and they were allowed to drop out of the program Monthly parents’ meeting * parental commitment was lacking making it difficult to reinforce lessons at home

18. Drumming to a Healthy Beat: Results Drumming to a Healthy Beat: Results Education –Avg GA changed from a 2.0 to a 2.8 Self Esteem –At beginning girls were self conscious and didn’t participate in school activities. Now they are trying out for plays and dance programs –Improved attitude and respectfulness towards each other and school –By the end of the program girls were performing at village functions Nutrition –Girls were knowledgeable about the new food pyramid and portion control/size (however they did not practice this at home)

19. Drumming to a Healthy Beat: Results  BMI –Average BMI 31.9 at start. At end, average BMI 33.3 4% increase –Girls noted that clothing fit better, and they could wear more “cute” styles

20. Drumming to a Healthy Beat: Conclusions BMI measures may not be the best measure of success for obesity programs Parental involvement is essential Creating a comfortable environment is important

21. Drumming to a Healthy Beat: Next Steps Identify additional sources of funding to continue program Target students from only a few schools Make parental involvement mandatory Maybe work to get PE credit for school