Why Schools Should Promote Physical Activity and Healthy Eating and Prevent Tobacco Use

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