Collaborating Partners –Edward R. Roybal Comprehensive Health Center (East Los Angeles) –Hubert H. Humphrey Comprehensive Health Center (South Los Angeles) Childrens Hospital Los Angeles –Division of Endocrinology –Health Services and Community Health Research Program USC Keck School of Medicine USC Clinical Diabetes Program Los Angeles County Department of Health Services Funded by the W.M. Keck Foundation

Phase I funding will provide support for formative research and planning to lead to a large-scale, multi-year diabetes prevention intervention The Initiative aims to: 1) Identify the factors that contribute to diet, physical activity, and healthcare utilization within the targeted communities; 2) Develop strategies to prevent diabetes and promote healthy lifestyle choices that are appropriate for the populations served; and 3) Engage and mobilize experts, government officials, community leaders, and local residents in these efforts.

Prevalence of Overweight Among Public School Children 2002 California Physical Fitness Testing Program -Overweight is a body mass index (calculated from height and weight) at or above the 95th percentile, based on growth charts from the Centers for Disease Control and Prevention. -At risk for overweight is defined as a BMI at or above the 85th percentile and less than the 95th percentile. -Of 359,911 Los Angeles County students with results reported in 2001, body mass index or gender were not reported for 60,219 (16.7%) students. Only schools reporting results on >30 students were included. -Prepared by the Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services, (213)

Profile of East Los Angeles Indicators of Poverty in Targeted Service Areas Source: US Census 2000 N Median Household Income Zip Code Boundary <100% of FPL ($0 - 17,761) >100% but <130% FPL ($17, ,089) >130% but <185% FPL ($23, ,857) >185% but <200% FPL ($32, ,522) >200% but <300% FPL ($35, ,283) >300% FPL ($53, ,001) Freeway Nearly all residents in the zip code live under 185% of Federal Poverty Line.

Profile of South Los Angeles Indicators of Poverty in Targeted Service Areas Source: US Census 2000 Freeway N Median Household Income Zip Code Boundary <100% of FPL ($0 - 17,761) >100% but <130% FPL ($17, ,089) >130% but <185% FPL ($23, ,857) >185% but <200% FPL ($32, ,522) >200% but <300% FPL ($35, ,283) >300% FPL ($53, ,001) Nearly all residents in the zip code live under 185% of Federal Poverty Line.

Approach to Defining Community Boundary Schools Clinics Parks Link between resource and community Zip code N

Patients with Diabetes Seen in 2003 at Roybal and Humphrey CHC’s

A Framework for Factors Affecting Food Consumption and Physical Activity Health and Healthy Weight Physical Activity (Energy Expenditure) Food Consumption (Energy Consumed) Informational Environment Policy Environment Economic Environment Sociocultural Environment Health/Medical Environment Built Environment

Demographic and socioeconomic data; Overall prevalence of diabetes, pre- diabetes, obesity, and co-morbidities Sources of food/nutrition; School-district boundaries, schools, student enrollment, and student demographics; Access to healthcare providers; and Levels of fitness and activity among residents. Analyze Existing Data Inventorying and Mapping Community Resources Concentration of fast-food restaurants, convenience markets, farmer’s markets, and grocery stores; Access to parks, public recreational spaces, and facilities for recreation/physical activity; Public and non-profit health and social service programs; Health center data on patients currently being served School district boundaries, schools, student enrollment, and student demographics; Locations and type of businesses and workplace health opportunities Communication methods and infrastructure; Availability of transportation to and from neighborhoods; Spiritual life organizations

Community Observations Local parks, Fast food restaurants, Full-scale and farmers’ markets, School cafeterias, and Neighborhoods Discussions with Community Leaders and Residents Knowledge, perceptions, and use of medical care; Decision-making related to food purchased and consumed by families; Knowledge and perceptions of obesity, nutrition, and the relationship between nutrition and health; Challenges faced related to food security, physical activity, and the healthy lifestyles; Experiences with public and community health and social service programs and the identification of “trusted” resources and providers; Suggestions regarding strategies to overcome barriers. Community Survey Types of food eaten in the last week, Amount of time spent exercising in the last week, How often they access community services such as breastfeeding counseling or diabetes screening Where and how people get information