Cassandra Olier

Health Promotion-HS 490 Need Assessment Assignment- 100

Due Date-March 7, 2019

Step 1- Big Picture- Purpose and Scope of the Assessment – 5 pts

The specific health issue that I am researching is obesity among females around the ages
of 10-15. The Healthy People 2020 goal/objective that is related to my topic is NWS – 10.3 which
states, “Reduce the proportion of adolescents ages 12 to 19 years who are considered obese”
(Office of Disease Prevention and Health Promotion). This topic is very important because the
health of adolescents in this population is one of concern in life now with short term health
consequences, as well as consequences into their adult future. Having a high BMI as a child
indicates a high BMI into adulthood (Ogden, Carroll, Curtin, Lamb & Flegal, 2010). This is
especially concerning considering that in 2009-2010 the prevalence of obesity was 35.8%
amongst adult females (Flegal, Carroll & Ogden, 2012). Childhood obesity can be, and often is, a
lifelong health concern with lifelong health consequences.

Step 2- Quality of Life and Social Assessment- 10 pts

Figure 1 (Community Commons).

Data Indicator Kootenai County Idaho
Population 150,128 1,657,375
Poverty (Adult) 12.59 % 14.51 %
Education (No High School 7.15 % 9.75 %
Diploma at 25+ Years Old)
Race/Ethnicity (White) 94.27 % 90.98 %
SNAP Participation 10.9% 11.4%
Urban Population 71.03% 70.6%
Poverty (Child) 18.92 % 17.83 %
No health insurance 13.3 % 19.3 %

The quality of life in the area of Kootenai County in Idaho is a high one based off of my
personal experience as well as figure 1. Based off personal experience from living in
Kootenai County for the majority of my life, the quality of life is high. The area is very
clean and family friendly. There is a small homeless population comparatively to other
counties in the area such as Spokane County. In Kootenai County there are form of public
transportation, family friendly parks and attractions, as well as walkable sidewalks and
bike paths. However, I have noticed a large number of fast food and unhealthy restaurant
chains in the area as well as sections of the county that are not as well off.
The quality of life in the area of Kootenai County in Idaho is high based off of figure 1
as well. The poverty data indicator for both child and adult is the population below 100%
federal poverty level. The education data indicator is the percent of the population that
does not have their high school diploma at 25 years old. Comparatively to Idaho as a
whole, Kootenai county does well in regard to adult poverty, education, SNAP
participation rates, and to the percent of the population with no health insurance. These
 are all indicators that the quality of life is high in this area. However, the data indicators
where Kootenai County does not stand up to Idaho as a whole are also very important
ones in relation to my health topic. These indicators being child poverty and the
percentage of the population living in an urban setting. Living in an urban setting,
compared to a rural one, has negative impacts on your health from air pollution,
overcrowding, and distance from nature. This leads me to believe that for the majority of
the population in Kootenai County, quality of life is high, with access to their health
needs. However, there is a population in Kootenai County that is not meeting the
“standard Idaho” quality of life.

Step 3-Epidemiological Assessment- 15 pts.

Figure 2 (CARES Engagement Network 2011-2015).

Data Indicator Kootenai County Idaho US
Diabetes (Adult) 6.8 % 7.66 % 9.28 %
Heart Disease 3.8 % 3.9 % 4.4 %
(Adult)
High Blood Pressure 24 % 26.3 % 28.16 %
(Adult)
Mortality rate of 84.8 83.93 99.6
coronary heart
disease (per
100,000 pop.)
Obesity (Adult) 25.2 % 28.2 % 28.3 %
Obesity (Child) No Data 15 % 16 %
Depression 16.5 % No Data 16.7 %

Comparatively to Idaho as a whole and the rest of the United States, Kootenai County
has lesser risk of specific health outcomes. The outcomes looked at are adult diabetes,
adult heart disease, adult high blood pressure, mortality rate of coronary heart disease,
adult obesity, child obesity, and depression. I believe it is very important, as noted
before, to look at the adults of the area when assessing childhood obesity, as childhood
obesity often results in adulthood obesity. As per Figure 2, in every indicator, Kootenai
County has a lesser risk of it, even if it is barely less. This indicates that Kootenai County is
doing well in these specific health areas, but that does not mean that Kootenai County
can stop there. In order to maintain and/or lessen these risks even more, a continual
effort is required.
Although Kootenai County is doing well compared to state and national levels for
these specific health outcomes, there remains health disparities. A recent report done by
the Center for Disease Control and Prevention (CDC) (2013) states, “Non-Hispanic black
adults are at least 50% more likely to die of heart disease or stroke prematurely (i.e.,
before age 75 years) than their non-Hispanic white counterparts” (pg.1). This could mean
 that non-Hispanic black children that are obese have a higher chance of dying
prematurely from heart disease or stroke. Another disparity that is related to my health
topic is the fact that the risk of adult diabetes is higher among adults without college
degrees and who have lower household incomes (CDC, 2013, pg. 1).

Step 4- Health Behavior Data -This step identifies behavior and lifestyle risks for health issues. 15
points

Figure 3 (CARES Engagement Network (2011-2015))

Data Indicator Kootenai County Idaho US
Physical inactivity 18.2 % 18.5 % 21.6 %
(entire population)
Family meals every No Data 45.5 % 43.3 %
day
No preventative No Data 18.6 % 17.8 %
checkup (past 12
months)
4+ hours spent on No Data 6.4 % 8.1 %
TV or video games
4+ hours spent on No Data 9.0 % 11.1 %
electronic devices

The health behaviors/ lifestyle factors that are related to my health topic and that are
listed in Figure 3 are physical inactivity, whether the family eats meals together daily,
whether the child has had a checkup in the past year, and if they spend 4+ hours on an
electronic device, watching TV, or playing video games. According to a recent article,
watching TV for 2 or less hours a day is one of the most important and modifiable health
behaviors related to adolescent obesity (Sharma, Wagner & Wilkerson, 2004, pg. 192).
This is backed up by another recent article, this time by the Counsel of Communication
and Media (2011) which states, “Pediatricians should continue to counsel parents to limit
total noneducational screen time to no more than 2 hours/day” (pg. 204).

Step 5- Environmental Data- see the four types of environmental data described in class/ICW-10
pts
There is a lot of environmental data available for my health topic. This includes all four
types, although political environment is the hardest to find. For the natural and physical
environment, you can find information on access to primary care, recreation and fitness
facilities access per 100,000 pop., fast food restaurants per 100,000 pop., access to grocery
stores, and whether or not there is a food desert in the area. Looking at Kootenai County,
many of these data points reinforce the idea that Kootenai County has a high quality of life
for the most part, but for a certain population it is not a high quality of life comparatively to
Idaho as a whole. For example, recreation and fitness facilities access per 100,000 pop. is
 15.89 while Idaho as a whole is 10.08, which suggests a higher quality of life. However, fast
food restaurants per 100,000 pop. is 77.98 in Kootenai County while for Idaho it is 69.09,
which suggests the opposite. For the social environment you can find information on young
people not in school and not working, amount of people with no high school diploma, and
households with no motor vehicle. For the economic environment, you can find information
on poverty levels for both adults and children, the unemployment rate, and uninsured
population. All of these data points facilitate understanding of why obesity is happening at
such a high and increasing rate. For the political environment there are policies and laws in
place that are already protecting and advocating for the health of adolescents, especially in
schools. An example of such laws and policies in Idaho is the fact that insurance now has
coverage for obesity prevention and treatment (National Conference of State Legislatures
(NCSL), 2014). However, changes need to be made and additions added in order to keep on
tract of better the health of adolescents. For example, Idaho has not enacted any legislation
based on school nutrition, physical education, physical activity, school wellness, or task
forces (NCSL, 2014). Without this requirement of the schools, the likelihood of obese
adolescent females receiving adequate teaching on these health topics is low. With only
32.4% of school districts adopting a policy requiring health education teachers to receive
professional development on chronic disease prevention (i.g. obesity and diabetes) (CDC,
2016), there is room for vast improvement for policies in relation to my health topic. Of the
four environmental factors related to my health topic, I believe the political environment is
most important to change, especially in schools, because of how much time is spent in school
and the skills and interests that are developed and honed in a school setting at this age.
There are a lot of primary data points that is needed to learn about environmental factors.
These can include but are not limited to age, race, income level, housing situation, education,
household size, parents being together or divorced, access to transportation, safe
neighborhoods, etc. However, a lot of the information out does not include the age group I
am looking at, being ages 10-15, but rather looks at the high school age group. It is important
to gather information on dietary behaviors, physical activity levels, and dieting behaviors for
children ages 10-15 because this is around the age where they can begin to make either
healthy or unhealthy decisions for themselves. Having more data available pertaining to
those indicators would help further the Healthy People 2020 goal to, “Reduce the proportion
of adolescents ages 12 to 19 years who are considered obese”. More information is also
needed at a local level. There is plenty of data points and information on each state and the
country as a whole, however when it comes to a local level, there is missing information. It is
very important to provide the same data points on a local level to further the health of
adolescent girls facing obesity. Without knowing how a specific area, in this case Kootenai
County, is doing with different obesity indicators, it is difficult to see what is contributing to
adolescent female obesity the most. I believe for my health topic, especially considering the
age group, I suggest methods of surveys and interviews to gather this data because it allows
for personalized answers and they are the methods that are used the most in the existing
literature.

Step 6- Identifying the Program Purpose - 30 pts.

 Predisposing Factors- Assess knowledge, attitudes, beliefs, and self-efficacy -20 pts.
The first article I found regarding predisposing factors to adolescent females who are obese
is from 1967, however I believe the information to hold true today as well. In their article,
Dwyer, Feldman, and Mayer conclude that dieting behavior is based partially on perception of
self and that knowledge of nutrition was low amongst this age group (females), but higher
amongst those that were dieting and obese (1967). I learned from this article that regardless of
their knowledge on the subject, many of these adolescent girls partake in dieting to some
degree. This is worrisome because with lack of knowledge comes lack of responsibility, especially
amongst this younger population. This could lead to very unhealthy diets, even starvation. The
second article I found regarding predisposing factors to adolescent females who are obese also
relates to the amount of knowledge this population holds on this topic. According to the findings
of Bullen, Monello, Cohen, and Mayer, many of the adolescent obese females are not aware of
the connection between obesity and non-active lifestyles (1963). This can be and is harmful lack
of knowledge. From both of these articles, I have learned that these females usually are more
concerned with their diet than with their physical activity. At such a young age, focusing on your
diet and restricting what, when, and how much you eat could lead to eating disorders and other
mental health disorders rather than helping them get to and maintain a healthy weight.
To better understand the predisposing factors of this population, it is important to get
primary data. Some primary data points that I believe to be necessary to do so is on self-efficacy
of whether they can get to a healthy body weight, self-perception of one’s body, self-perception
of one’s place and acceptance, what they know about nutrition and physical activity, and what
they know about how physical activity and nutrition affect one’s health. I believe the best way to
obtain this primary data is through questionnaires, surveys, and interviews. I believe this because
existing literature uses them, and because these questions are based around qualitative data
rather than quantitative data. Both of the articles mentioned above used questionnaires as their
data gathering method.

 Enabling Factors- 5 pts.

There is a multitude of enabling factors that art important to this topic. These include
access to primary health care, access to places to partake in physical activity safely (parks, gyms,
playgrounds, gyms, etc.), access to healthy food in schools which includes school policies and
programs, time to play and partake in physical activity which also includes school policies and
programs, and family involvement and support. I believe school policies, procedures, and
programs play a large role in female adolescent obesity. With that being said, I believe that all
schools should implement teaching healthy lifestyle behaviors including nutrition and physical
activity at all levels. Schools that already do this should evaluate their programs and teachings to
ensure that they are still effective and up to date. I also believe that schools should be evaluated
and check in on periodically to ensure they are adhering to existing policies that abandon
vending machine snacks that are unhealthy as well as all sugary beverages such as soda and
juice. Many students get two of their three daily meals from school and spend 8+ hours of the
day there, so there should only be healthy options for them to choose from.

 Reinforcing Factors- 5 pts.

 In Kootenai County there are many reinforcing factors for adolescent females who are
obese. It is a walk and bike friendly environment with new rental bike systems being put in place.
There are many fitness facilities, as mentioned before, including ones with sliding fee prices. One
of the biggest community assets is the Kroc Center located in Coeur d’ Alene, Idaho. Not only is
this a gym, but it includes an active teen hangout spot, basketball courts, waterpark, and pools.
They also hold classes and special events each week to get people involved in the community
and active. Although there are many fast food and unhealthy restaurant chains, there are plenty
of food places that are healthy or at least provide healthy options. There are many juice bars and
wellness bars around the Kootenai County area, offering healthy alternatives to places like Taco
Bell and McDonald’s, for the same price. As far as people go, your family are very important
reinforcing factors, with their support one would be able to succeed in obtaining and
maintaining a healthy weight easier.

Steps 7- Validating needs and conclusion- 5 pts

The most important target for this health issue is parents. I believe this to be true because
around the ages 10-15 years old, you are normally still living at home with parents. Parents make
the buying decisions of the house as far as groceries go, they can determine how much time is
spent on screens as a younger child and into adolescents, and they have a better understanding
of nutrition. Not only can they effect the at-home environment but the school one as well.
Parents have the power to petition schools, get involved, and change policies, procedures, and
programs. The predisposing factor that seems most important to address adolescent obesity in
females is the knowledge on this health topic. I believe this because without knowledge of how
one’s unhealthy behaviors effect their health, they will not know or care about changing them to
become healthier. This could and does turn into an unhealthy cycle that only progresses without
intervention or knowledge. The enabling factor that I believe is most important are school
policies, procedures, and programs. I believe this because, as previously mentioned, many
students get 2 of the 3 meals while in school, they spend 8+ hours a day there, and this is where
they learn and practice many either healthy or unhealthy behaviors. The reinforcing factor that
seems the most important to address this health topic is family support. Especially when it
comes to this age group, parents are often in control of many aspects of your life. If they are
supportive then they will make the healthier decisions to enable you to be healthier, and vice
versa.

Step 8- Assessment Team- 10 pts

The population most affected is adolescent females around the ages 10-15 who are obese.
It is very important that they are involved in any planning and implementing processes. A way
for them to be meaningfully involved is by completing questionnaires, surveys, and interviews
to help further the research that goes into the predisposing factors of this health issue. That is
not the only way that they can be meaningfully involved in. They can help their parent’s grocery
shop and come to any planning meetings to voice their concerns and point of view of any school
policy, procedure, and/or program. Outside of the directly effected population, many partners
could potentially be affected. Most of which being the school districts and each school in the
district. They have to be involved in any planning and implementing process and meetings so
that they can voice their concerns, say what they are and are not willing to work towards, and
help understand current trends that need to be addressed. Barriers that need to be considered
are whether or not the school wants to change for any number of reasons and if they can
change within the legal parameters. To overcome the barrier of a school not wanting to change,
it is important to have a really strong case backed by existing literature and interventions as to
why the change is needed, not wanted. The more the parents are on board with the healthy
changes, the more likely the school will be on board as well. To overcome the barrier of the
school not being able to implement any given policy change, it is important to take that same
strong case to the local, state, or even federal government to push for the healthy changes
within the schools. The types of influencers that are needed for this topic are ones that parents,
school officials, and students all respect and look up to. In Kootenai County there are a number
of people who are popular and respected amongst this group. The Panhandle Health District
would be a good influencer for this, as well as the facility director of the Kroc Center. I believe
the Panhandle Health District would be a good influencer for this because they have available
resources such as a nutritionist and nurse practitioners and provide diabetes prevention
assistance and wellness exams all on a sliding fee scale. Having this organization on board would
allow for an efficient use of resources. I believe the facility director of the Kroc Center would be
another good influencer because of the popularity of the Kroc Center for the younger age
group, including 10-15 year olds and because of the resources and connections that they can
provide.
 References
Bullen, B., Monello, L., Cohen, H., & Mayer, J. (1963). Attitudes Towards Physical Activity, Food
and Family in Obese and Nonobese Adolescent Girls. The American Journal of Clinical
Nutrition., 12(1), 1-11.

CARES Engagement Network. “Health Indicators Report.” CARES Engagement Network, 2011-
2015.

Centers for Disease Control and Prevention. Health Disparities and Inequalities Report. MMWR
2013 ; 62: Page 1.

Center for Disease Control and Prevention. (2016). Results from the School Health Policies and
Practices Study. Center for Disease Control and Prevention.

Community Commons. (n.d.). Retrieved from

https://www.communitycommons.org/board/HOME

Council on Communications and Media. (2011). Children, Adolescents, Obesity, and the Media.
PEDIATRICS, 128(1), 201–208. https://doi.org/10.1542/peds.2011-1066

Data Resource Center for Child & Adolescent Health (2012). 2011/12 National Survey of
Children's Health. Retrieved from www.childhealthdata.org/

Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of Obesity and Trends in
the Distribution of Body Mass Index Among US Adults, 1999-2010. JAMA, 307(5), 491–497.
https://doi.org/10.1001/jama.2012.39

Johanna T. Dwyer, Jacob J. Feldman, Jean Mayer (1967); Adolescent Dieters: Who Are They?:
Physical Characteristics, Attitudes and Dieting Practices of Adolescent Girls, The American
Journal of Clinical Nutrition, Volume 20, Issue 10, Pages 1045–
1056, https://doi.org/10.1093/ajcn/20.10.1045

National Conference of State Legislatures. (2014, March 1). CHILDHOOD OBESITY LEGISLATION -
2013 UPDATE OF POLICY OPTIONS. Retrieved from
http://www.ncsl.org/research/health/childhood-obesity-legislation-2013.aspx

Office of Disease Prevention and Health Promotion. (2014). Healthy People.

Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-
Health/objectives

Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of High
Body Mass Index in US Children and Adolescents, 2007-2008. JAMA, 303(3), 242–249.
Sharma, M., Wagner, D. I., & Wilkerson, J. (2004). Predicting Childhood Obesity Prevention
Behaviors Using Social Cognitive Theory. International Quarterly of Community Health
Education, 24(3), 191–203. https://doi.org/10.2190/CPVX-075A-L30Q-2PVM