Obesity among American youths has become a national epidemic. Both developed and developing nations face a crisis of rising trends of obesity and overweight among adolescent youths (Centers for Disease Control and Prevention, 2004). Approximately 10 % of school children are overweight with US alone reporting 25 % of overweight children while 11 % of them are obese (Centers for Disease Control and Prevention, 2004). Preliminary data from the National Health and Nutrition Survey (NHANES), strong evidence of overeight and obesity is linked to increased mortality and morbidity in United States. Likewise, Houston Department of Health and Human Sciences reports that the prevalence of overweight and obesity among youths of ages 14-18 is 34.4 % compared to the Hispanic youths of 37 % and African American at 23.5 % of similar age group (Centers for Disease Control and Prevention, 2004). As such, the Fit Kids Fit Families has launched a national social marketing to provide awareness of physical activity as a preventive measure of obesity and overweight. Fit Kids Fit Families group was founded in 2003, purposefully for promoting optimal weight and improving life quality among the African American people. The FKFF has selected activity as the target behaviour with the middle school youths as the target audience. The group mimics the PRECEDE-PROCEED model in several ways to provide physical activity intervention. As such, this paper describes the efforts of the group within the context of PRECEDE-PROCEED model as described by Green and Kreuter (2005).
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Phase 1: Quality of Life Diagnosis
Youths suffer numerous consequences of obesity due to increased overweight and obesity. Polhamus, Dalenius, Thompson, Scanlon, Borland, Smith & Grummer- Strawn, (2003) writes that the excess body calories are converted into fats and finally stored in adipose tissue thus accumulates in the body of the youth. The individual is likely to develop a poor big body due to additional weight that adds more flesh. The children suffering from obesity are at risk of contacting multiple adverse health complications, some of which are fatal. Previous studies observe that high blood pressure while childhood is a weak predictor of premature death; however, high cholesterol had no relationship with early bereavement. Besides, health experts admit that factors causing obesity and high cholesterol were easier to control through exercise and medication. Researchers have identified children as the rapidly growing demographic in the global overweight population. For instance, approximately 31.9 percent of African American youths in have body indices that categorize them as overweight. Also, Polhamus et al. (2003) reports that 12 percent of obese people are likely to suffer from anxiety, impaired social interaction 17 %, and depression 34 %.
Phase 2: Epidemiological Diagnosis
The challenge of overweight and obesity epidemic is not limited to concerns about weight and bulk. According to Polhamus et al. (2003), 7 % of cases of obesity have resulted into disabilities through physiologic and psychological points of view. The increased waist to hip girth ratio is linked to increased risk of hyperlipidemia, cardiovascular disease, diabetes and hypertension. Likewise, obesity and overweight has been related to elevated risk of cancer, sleep apnea, musculoskeletal disorders, gallbladder disease, diverticulitis, and intracranial hypertension. Research shows that the prevalence of obesity among American youths has increased from 5 % to 12.4 % in this time period and the age group of 14 – 18 years it has increased from 6.4 % to 17 % (CDC, 2009). From the viewpoint of health, 20 % of youths have been reported to exhibit clinical obesity and overweight characteristics.
Phase 3: Behavioural and Environmental Diagnosis
In December 2014, NHANES provided FKFF with summary of current data to assist them narrow to the target behaviour and audience for social marketing intervention. Therefore, FKFF decided to prevent obesity among youths that were segmented into pre-school, middle school, elementary school, and high school. Since obesity has numerous environmental and behavioural determinants and because appropriate interventions may differ between the groups, it was significant to narrow the focus. Data presented by NHANES provides that 15.3 % of pre-school, 13.9 % of elementary school, 22.8% of middle school and 13.6% of high school youths are either slightly overweight or overweight. Also, 12.5 % of pre-school, 15.9 % of elementary school, 3.2 % of middle school and 10.5 % of high school youths are extremely overweight or overweight Polhamus et al. (2003) reports. Because the FKFF was aware that they would be using social marketing for obesity prevention, the information concerning developmental and cognitive characteristics of every age group assisted in narrowing to the high school as the target group.Further, FKFF chose physical activity as the target behaviour. The potential behavioural objectives were based on the objects set by health People 2010 related to physical activity. According to Health people 2010, national behavioural objectives of physical activity were to increase the youth proportion that participates in moderate physical activity for at least 30 minutes, 3-5 times a week. Secondly, it aimed to increase the proportion of youths engaging in vigorous physical activity that promotes cardiorespiratory fitness 4-5 times a week for 20 minutes per occasion. Lastly, Healthy People 2010 supports the increase in proportion of adolescent that participate in daily school physical education.
The FKFF underwent formal environmental diagnosis in where the community researchers collected data to determine places youth say they participate in physical activity.
Phase 4: Educational Diagnosis
Green et al. (2005) described that enabling factors, predisposing factors, and reinforcing factors are the three major broad categories of factors influencing health behavior. The predisposing factors include motivation, desire for competition, parents and peers. Likewise, the barriers to physical activity included poor body image and desire not to mess up makeup hair. The influencing enabling factors included the availability of facilities and the opportunity to showcase talent while barriers of enabling factors were homework and V and computer games. Lastly, influencers of the reinforcing factors were active people on TV and peers while the barriers included self-concept and poor body image.
Phase 5 & 6: Policy and Administration Diagnosis and Implementation
The goal of intervention alignment is to try and fit the components of intervention program with various micro and macro-ecological levels of community. The key terms in this PRECEDE-PROCEED model are mapping. Matching, pooling, and patching where the ecological levels are matched to intervention components, where evidence is lacking, interventions that show promise are patched to fill the gaps, practice-based intervention programs are mapped to health problem determinants and evidence-based intervention are pooled and reviewed (Polhamus, Dalenius, Thompson, Scanlon, Borland, Smith & Grummer- Strawn, 2003). Therefore, the FKFF pooled and reviewed numerously existing physical intervention programs.
The administrative assessment includes resource assessment needed to implement the program, incorporating timeline developmental and budget. FKFF personnel reviewed the steps of community –based prevention marketing and communicated time involved in the development of evidence-based intervention. Likewise, the committee prepared a one-year budget with consultation from the healthy people department. The appraisal of the organization implementing the program highlighted the commitment of FKFF consistency in obesity intervention program.
The scorecard pilot program of FKFF is in the beginning stages of implementation. The members of the group continue to actively recruit members who will in turn provide incentives for youth to participate in physical activity through the reduced cost programs. www.fkff.com has been developed to provide information to the youth. Also, the local radio network has ben contacted for media coverage of the program. Finally, YMCA locations are set for free in the country to promote cool, fun opportunities for youths to be active. Recently, FKFF staffed fresh graduates from universities to provide a cool appearance and direct the youth fun and creative activities as well as providing ideas on creating fun without sports equipment. The programs for local events are underway with the recreation and parks department commencing the summer scorecard with youth beach run.
Phases 7, 8, & 9—Process, Impact, and Outcome Evaluation
The quantitative component of the evaluation seeks to provide answers for number of youths recruited, website hits, and youths registered, local events, and youths that participated in the grand finale. The group designed impact evaluation to determine if the behavioural objectives set are being met and will consist of the qualitative component. Impact evaluation addresses the level of a moderate increase in moderate and vigorous physical activity among the youths. Likewise, it will determine the level of physical education among the youths. This provides the achievements of health objective through quantitative measures. This provides answers for decrease or increase of risk for overweight among the youths. The baseline data obtained from the Healthy People 2010 will be used to conduct a follow-up on particular youths for the program.ConclusionThe PRECEDE-PROCEED model adopted by Fit Kids Families First in designing the obesity prevention intervention is beneficial for summarizing the work done and insert what might have been done within the PRECEDE-PROCEED model framework. In particular, the explicit priority and objective setting was an essential proponent of the model. The model further assisted in determining the facets of the program evaluation.
Centers for Disease Control and Prevention. (2004). Obesity campaign overview. Retrieved April 16, 2006, from http://www.cdc.gov/youthcampaign/overview.htm.Green, L.W., & Kreuter, M.W. (2005). Health program planning: An educational and ecological approach (4Th ed.). New York: McGraw-Hill.
Polhamus, B., Dalenius, K., Thompson, D., Scanlon, K., Borland, E., Smith, B., & Grummer- Strawn, L. (2003). Pediatric Nutrition Surveillance 2001 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved March 2004 from http://www.cdc.gov/nccdphp/dnpa/pdf/2001_ped_nutrition_report.pdf.