Giridhar Mallya

Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the Philadelphia, Pennsylvania, School District, 2006–2010

Introduction Epidemic increases in obesity negatively affect the health of US children, individually and at the population level. Although surveillance of childhood obesity at the local level is challenging, height and weight data routinely collected by school districts are valuable and often underused public health resources. Methods We analyzed data from the School District of Philadelphia for 4 school years (2006–2007 through 2009–2010) to assess the prevalence of and trends in obesity and severe obesity among public school children. Results The prevalence of obesity decreased from 21.5% in 2006–2007 to 20.5% in 2009–2010, and the prevalence of severe obesity decreased from 8.5% to 7.9%. Both obesity and severe obesity were more common among students in grades 6 through 8 than among children in lower grades or among high school students. Hispanic boys and African American girls had the highest prevalence of obesity and severe obesity; Asian girls had much lower rates of obesity and severe obesity than any other group. Although obesity and severe obesity declined during the 4-year period in almost all demographic groups, the decreases were generally smaller in the groups with the highest prevalence, including high school students, Hispanic males, and African American females. Conclusion Although these data suggest that the epidemic of childhood obesity may have begun to recede in Philadelphia, unacceptably high rates of obesity and severe obesity continue to threaten the health and futures of many school children.

Nutrition environments in corner stores in Philadelphia

OBJECTIVE To examine the availability, quality, and price of key types of healthy and less-healthy foods found in corner stores in low-income urban neighborhoods and the associations between store characteristics and store food environments. METHOD A sample of 246 corner stores was selected from all corner stores participating in the Philadelphia Healthy Corner Store Initiative (HCSI). The Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to assess the availability, quality, and price of foods and beverages in 11 common categories between February and May, 2011. RESULTS NEMS-CS measures were completed in 233 stores, 94.7% of the 246 stores approached. The healthier options were significantly less available in all food categories and often more expensive. Baked goods, bread, chips and cereals were sold at nearly all stores, with significantly fewer offering low-fat baked goods (5.7%, p<0.0001), whole grain bread (56.2%, p<0.0001), or baked chips (35.2%, p<0.0001). Number of aisles was positively associated with availability score (p<0.05). CONCLUSION Findings from this study point toward potential targets for intervention to improve the corner store food environment and dietary choices among low-income urban populations. Availability of certain healthier foods could be improved.

Improving Fruit and Vegetable Consumption Among Low-Income Customers at Farmers Markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011

Introduction We evaluated whether Philly Food Bucks, a bonus incentive program at farmers markets, is associated with increased fruit and vegetable consumption and Supplemental Nutrition Assistance Program (SNAP) sales at farmers markets in low-income areas. Methods A convenience sample of 662 customers at 22 farmers markets in low-income neighborhoods in Philadelphia, Pennsylvania, was surveyed via face-to-face interviews. Questions addressed shopping characteristics, self-reported change in fruit and vegetable consumption, whether customers tried new fruits or vegetables, use of Philly Food Bucks, and demographic information. Market-level SNAP sales and Philly Food Bucks redemption data were also collected to monitor sales patterns. Results Philly Food Bucks users were significantly more likely than nonusers to report increasing fruit and vegetable consumption (OR, 2.4; 95% CI, 1.6–3.7; P < .001) and to report trying new fruits or vegetables (OR 1.8; 95% CI, 1.2–2.7; P = .006). At the market level, average SNAP sales more than doubled at farmers markets in low-income areas in the first 2 years of the Philly Food Bucks program. At the city’s largest farmers market in a low-income area, the program was associated with an almost 5-fold higher increase in annual SNAP sales compared with baseline. Conclusion Results from this study demonstrate that a bonus incentive program tied to SNAP was associated with self-reported increases in fruit and vegetable consumption and increased SNAP sales at participating farmers markets in low-income communities. More research is warranted to evaluate the long-term impact of bonus incentives on farmers market use, dietary behaviors, and health outcomes.

Physical Activity Patterns of Inner-City Elementary Schoolchildren

PURPOSE This study aimed to objectively measure the physical activity (PA) characteristics of a racially and ethnically diverse sample of inner-city elementary schoolchildren and to examine the influence of sex, race/ethnicity, grade level, and weight status on PA. METHODS A total of 470 students in grades 4-6 from six inner-city schools in Philadelphia wore an ActiGraph GT3X+ accelerometer (Actigraph, Pensacola, FL) for up to 7 d. The resultant data were uploaded to a customized Visual Basic EXCEL macro to determine the time spent in sedentary (SED), light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). RESULTS On average, students accumulated 48 min of MVPA daily. Expressed as a percentage of monitoring time, students were sedentary for 63% of the time, in LPA 31% of the time, and in MVPA 6% of the time. Across all race/ethnicity and grade level groups, boys exhibited significantly higher levels of MVPA than girls did; fifth-grade boys exhibited significantly lower MVPA levels than fourth- and sixth-grade boys did, and sixth-grade girls exhibited significantly lower MVPA levels than fourth- and fifth-grade girls did. Hispanic children exhibited lower levels of MVPA than children from other racial/ethnic groups did, and overweight and obese children exhibited significantly lower MVPA levels than children in the healthy weight range did. Across the entire sample, only 24.3% met the current public health guidelines for PA. Physical inactivity was significantly greater among females, Hispanics, and overweight and obese students. CONCLUSIONS Fewer than one in four inner-city schoolchildren accumulated the recommended 60 min of MVPA daily. These findings highlight the need for effective and sustainable programs to promote PA in inner-city youth.

Developing Media Interventions to Reduce Household Sugar-Sweetened Beverage Consumption

In 2010, the city of Philadelphia launched a media campaign to reduce the consumption of sugar-sweetened beverages (SSBs) in homes with children as a strategy to combat obesity. Using the integrative model (IM) of behavioral change and prediction, a theory-based precampaign survey of Philadelphia parents was conducted to determine the most effective message content. Results indicated that intention to eliminate SSB consumption is attitudinally driven and suggested that effective messages should highlight feelings of nurturing and concern about child weight gain. Focus group testing led to the selection of a television ad, transit/print ad, and a radio spot that incorporated aspects of the theory-based results from the baseline survey. An online message testing experiment found that exposure to campaign messages increased intention to reduce SSBs and supported the underlying beliefs in the correct direction. These results illustrate how the IM can be applied to the development of a public health intervention.

Corner store purchases made by adults, adolescents and children: items, nutritional characteristics and amount spent

OBJECTIVE Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment. DESIGN Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases. SETTING Intercepts were collected at 192 corner stores in Philadelphia, PA, USA. SUBJECTS Participants were adult, adolescent and child corner store shoppers. RESULTS Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2.2 (sd 2.1) items (1.3 (sd 2.0) foods and 0.9 (sd 0.9) beverages) that cost

Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the School District of Philadelphia, Pennsylvania, 2006–2013

US 2.74 (sd

Sugar-Sweetened Beverage Consumption by Adult Caregivers and Their Children: The Role of Drink Features and Advertising Exposure

US 3.52) and contained 2786.5 (sd 4454.2) kJ (666.0 (sd 1064.6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65.9% of intercepts and accounted for 39.2% of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66.2 g of sugar, 921.1 mg of sodium and 2.5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy. CONCLUSIONS Urban corner store shoppers spent almost

Beliefs Associated With Intention to Ban Smoking in Households With Smokers

US 3.00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.

Knowledge, Perceptions, and Behaviors Related to Salt Use Among Philadelphia Chinese Take-Out Restaurant Owners and Chefs

Introduction Recent analyses suggest that increases in rates of childhood obesity have plateaued nationally and may be decreasing among certain populations and communities, including Philadelphia, Pennsylvania. We examined 7 years of data, including 3 years not previously reported, to assess recent trends in major demographic groups. Methods We analyzed nurse-measured data from the School District of Philadelphia for school years 2006–07 through 2012–13 to assess trends in obesity (body mass index [BMI] ≥95th percentile) and severe obesity (BMI ≥120% of the 95th percentile) among all children aged 5 to 18 years for whom measurements were recorded. Results Over 7 school years, the prevalence of childhood obesity declined from 21.7% to 20.3% (P = .01); the prevalence of severe obesity declined from 8.5% to 7.3% (P < .001). Declines were larger among boys than among girls and among African Americans and Asians than among non-Hispanic whites and Hispanics. Over the final 3 years of study, the prevalence of obesity continued to decrease significantly among boys (including African Americans and Asians) but increased significantly among Hispanic girls and girls in grades kindergarten through 5. At the end of the study period, Hispanics had the highest prevalence of obesity among boys (25.9%) and girls (23.0%). The prevalence of severe obesity continued to trend downward in boys and decrease significantly among girls (including African American girls) but remained highest among Hispanic boys (10.1%) and African American girls (8.3%). Conclusion The prevalence of obesity and severe obesity continued to decline among children in Philadelphia, but in some groups initial reductions were reversed in the later period. Further monitoring, community engagement, and targeted interventions are needed to address childhood obesity in urban communities.