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

Objectives • To give an overview of why programs like this are beneficial • 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

The Epidemic • “This generation of youth will be the first in history that 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

The Epidemic • Since 1960 the prevalence of obesity in the US ages 12 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

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

The Epidemic CDC notes: – An unhealthy diet and lack of physical activity can 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. .

The Epidemic • Health and Education are linked: – Health goes hand in hand 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

The Epidemic • African Americans (AA) suffer from conditions related to obesity at a 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

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

The Response • Target AA female youth who are overweight, and at risk of 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

Drumming to a Healthy Beat • Partners: – Village Cultural Arts Center – Metro 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

Drumming to a Healthy Beat • Program Design – Identify and recruit a cohort 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”

Drumming to a Healthy Beat: Goals • Goal 1: To decrease the age appropriate 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

Drumming to a Healthy Beat: Goals • Goal 2: To improve the self-esteem and 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

Drumming to a Healthy Beat: Goals • Goal 3: To guide youth toward making 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

Drumming to a Healthy Beat: Planned Activities • ‘Tween girls with BMI’s >95 th% 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 2 X weekly interactive nutrition classes using the Power of Choice curriculum • Monthly parents’ meeting • Quarterly report card submission

Drumming to a Healthy Beat: Reality Activities • ‘Tween girls with BMI’s >95 th% 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

Drumming to a Healthy Beat: Results • Education – Avg GA changed from a 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)

Drumming to a Healthy Beat: Results • BMI – Average BMI 31. 9 at 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

Drumming to a Healthy Beat: Conclusions • BMI measures may not be the best 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

Drumming to a Healthy Beat: Next Steps • Identify additional sources of funding to 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