1. Childhood Overweight in Sacramento County, 2001 Cassius Lockett, Ph.D., MS Epidemiology Program Manager Epidemiology Services Department of Health and Human Services Sacramento County

2. Overview Public Health Importance Defining BMI Results Summarize

3. Public Health Importance Adult Obesity and Overweight among children is the largest health problem in the U.S. >70% of overweight adolescents are expected to remain overweight into adulthood (Guo et al. Am J Clin Nutr 1994;59:810-819) Prevalence U.S. adults, adolescents and children In 2002: 55.9% of adults were overweight (BMI >25 and <29.9) 30.5% of adults were obese (BMI > 30) 16.1% of adolescents aged 12-19 were overweight 15.8% of children aged 6-11 years were overweight 15.3% of children aged 2-5 years were overweight (year 2000) (NHANES III, Centers for Disease Control and Prevention) Source: CDC/NCHS: NHANES III (2002)

4. Public Health Importance Trends in U.S. adults, adolescents and children increasing –From 1988-1994 to 1999-2000: Children aged 2-5 years-increased from 7.2% to 10.4% –44.4% increase Children aged 6-11 years-increased from 11.3% to 15.3% –35.4% increase Children aged 12-19 years-increased from 10.5% to 15.5% –47.6% increase Source: CDC/NCHS: NHANES III (1988-94, 1999-2000)

5. Defining BMI Body Mass Index (BMI) is the recommended weight-for-height assessment method for all children >2 years old and adults BMI = weight (kg) / height2 (m2) Age and gender-specific cut-off values must be used for individuals < 18 years of age

6. Defining Overweight At-risk for overweight –BMI > 85th but < 95th percentile for age and gender Overweight –BMI > 95th percentile for age and gender

7. California Health Interview Survey (CHIS) 2001 population based survey for CA civilian, non-institutionalized pop Largest health survey in California Provides pop-based estimates for CA Counties Major content includes –Health related behaviors, health status and conditions, health insurance coverage and access to health care services

8. RESULTS

9. Prevalence of Overweight Children by Age Group, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

10. Prevalence of Overweight Children by Age and Sex, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

11. Physical Activity

12. Prevalence of Overweight Adolescents by Activity during the past 7 days, Sacramento County, 2001 Prevalence of Overweight Adolescents by Activity during the past 7 days, Sacramento County, 2001 Moderate-at least 30 minutes of walking, slow skating, or household chores Vigorous-at least 20 minutes of basketball, soccer, running, fast dancing or aerobics Strengthen or muscle toning- (push-ups, sit ups or weight lifting Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

13. Television Viewing and Video Game Hours

14. Prevalence of Overweight Adolescents by Television Viewing and Video Game Playing M-F, Sacramento County, 2001 Prevalence of Overweight Adolescents by Television Viewing and Video Game Playing M-F, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

15. Prevalence of Overweight by At Least 2 Hours of Computer Use, M-F and Sat-Sun, Sacramento County, 2001 Prevalence of Overweight by At Least 2 Hours of Computer Use, M-F and Sat-Sun, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

16. Self Reported Food and Beverage Intake

17. Prevalence of Food and Beverage Consumption, Sacramento County, 2001 Prevalence of Food and Beverage Consumption, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

18. Prevalence of Soda Consumption among Overweight Children by Age Group, Sacramento, County 2001 Prevalence of Soda Consumption among Overweight Children by Age Group, Sacramento, County 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

19. Prevalence of Food and Beverage Consumption by Age Group, Sacramento County, 2001 Prevalence of Food and Beverage Consumption by Age Group, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

20. Prevalence of Overweight Adolescents by Soda Consumption, Sacramento County, 2001 Prevalence of Overweight Adolescents by Soda Consumption, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

21. Type of Insurance & Poverty Level

22. Prevalence of Overweight Adolescents by Type of Insurance, Sacramento County, 2001 Prevalence of Overweight Adolescents by Type of Insurance, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

23. Prevalence of Overweight among Children by Federal Poverty Level, Sacramento County, 2001 Prevalence of Overweight among Children by Federal Poverty Level, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

24. Prevalence of Adolescent Overweight by Federal Poverty Level, Sacramento County, 2001 Prevalence of Adolescent Overweight by Federal Poverty Level, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

25. Multivariate analysis, particularly Logistic Regression Why? Allows the estimation of risk or odds of overweight, while controlling for confounders such as age, sex, soda consumption, etc SIMULTANEOUSLY

26. Multiple Logistic Regression of Overweight Among All Children aged 2-17 years, Sacramento County, 2001 Multiple Logistic Regression of Overweight Among All Children aged 2-17 years, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files Risk Markers AOR 95% CI Federal Poverty Level (<100%) 3.052.74 – 3.38 Medi-Cal Insurance2.972.74-3.22 Soda Intake (1+ Cans)1.941.89 – 1.99 Fruit intake (3+ Servings)0.860.84 – 0.89 Milk intake (4+ Servings)0.770.74 – 0.80 Vegetable intake (3+ Servings) 0.760.72-0.79

27. Multiple Logistic Regression for Overweight. Children aged 2-11 years, Sacramento County, 2001 Multiple Logistic Regression for Overweight. Children aged 2-11 years, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files Risk Markers AOR 95% CI Medi-Cal Insurance Medi-Cal Insurance11.67 10.60 – 12.86 Soda Intake (1+ Cans)1.701.64 – 1.76 Milk intake (4+ Servings)0.770.74 – 0.81 Fruit Intake (3+ Servings)0.530.51 – 0.55

28. Multiple Logistic Regression of Overweight Among Adolescents aged 12-17 years, Sacramento County, 2001 Multiple Logistic Regression of Overweight Among Adolescents aged 12-17 years, Sacramento County, 2001 Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files Risk Markers AOR 95% CI Federal Poverty Level (<100%) 15.8214.66 – 17.80 Television Viewing M-F (2+ Hours) 5.845.44-6.26 Soda Intake (1+ Cans)5.795.43 – 6.18 Computer Use M-F (2+ Hours) 2.792.63-2.96 Vegetable intake (3+ Servings) 0.880.81-0.95 Moderate Physical Activity (at least 30 minutes) 0.390.36-0.42 Milk intake (4+ Servings)0.190.17 – 0.22 Muscle Strengthening Activity0.170.16 – 0.19

29. Limitations Subject to at least 5 limitations –First, CHIS excludes individuals without telephones, therefore may have underestimated percent overweight –Second, data is self reported thus validity of data is unknown –Third, small sample size—thus some comparable estimates may be unreliable (e.g. percentage of overweight Latino males not accurate) –Fourth-excludes individuals with cell phones exclusively (younger, etc) –Fifth-the response rate is low (less than 40%)

30. Summary Overall, 24.4% of Children were Overweight –Of those the highest prevalence occurred among children aged 6-11 (32.3%) followed by children aged 0-5 (22.3%) and adolescents (17.8%) –Girls aged 6-11 had higher prevalence of overweight compared to boys (37.3% Vs 28.4%)

31. Summary Overall all children were more likely to be overweight if they were at <100% of the FPL, had Medi-Cal insurance, and consumed at least one soda Children aged 2-11 years were more likely to be overweight compared to their at risk counterparts if they had Medi-Cal insurance and consumed at least 1 soda

32. Summary Adolescents were more likely to be overweight compared to their at risk counterparts if were at < 100% of the FPL, viewed 2 or more hours of television or video games M-F, consumed at least one soda and used a computer at least 2 hours daily M-F. Milk intake, muscle strengthening, fruit intake, vegetable intake and moderate physical activity (at least 30 minutes daily) were associated with children being less likely to be overweight

33. Questions?