# Presentation: 666108

## Collaborating Partners

**Edward R. Roybal Comprehensive Health Center** (East Los Angeles)
**Hubert H. Humphrey Comprehensive Health Center**
- (South Los Angeles)

***Childrens Hospital ***
***Los Angeles***
**Division of Endocrinology **
**Health Services and Community Health Research Program**

***USC Keck School of Medicine***
**USC Clinical Diabetes Program**

***Los Angeles County Department of Health Services***

**Funded by the W.M. Keck Foundation**

## Overview of Project

- _Goals_
- Reduce the prevalence of obesity and diabetes in two communities in Los Angeles
- Enhance prevention and treatment of obesity and diabetes by improving services aimed at reducing these chronic conditions
- _Ten-Year Timeline_
- Phase I (2004-2006): Planning Phase--funded by a $2 million grant from the Keck Foundation
- Phase II (2006-2012): Intervention Phase
- Phase III (2012-2014): Evaluation and Dissemination

## Why a Diabetes Focus?

## Lifetime Risk of Diabetes--NonCaucasian

## Years of Life Lost Due to Diabetes by Age of Onset

**Age at Diabetes Onset**

***Narayan et al JAMA 2003;290:1884-1890***

## US HealthcareWhere Does the Money Go?

**US Healthcare****Where Does the Money Go?**

*Source: Medical Expenditure Panel Survey, 1998*

*Source: Medical Standards Analytical File, 1999*

## Selection of Communities

**A USERS GUIDE TO COLOR**
- Each SPA is designated by a specific color corresponding with the map and Key Indicator Chart.

## Characteristics of 90022

- Population Size: 68,688
- The population is primarily Latino ( over 95%). The vast majority of these individuals are of Mexican descent.
- Nearly all residents in the zip code live under 185% of Federal Poverty Line.
- Percent of children in grades 5, 7 & 9 who are at risk for overweight (85th percentile ≤ BMI < 95th percentile): 20.0%.
- Percent of children in grades 5, 7 & 9 who are overweight (BMI above the 95th percentile): 25.6%.

- Proximity of Fast Food to Schools and Clinics

## Characteristics of 90059

- Population Size: 38,123
- Approximately half (45%) of residents are African-American, though the makeup of the population is changing as the percentage of Latinos increases.
- Nearly all residents in the zip code live under 185% of Federal Poverty Line.
- Percent of children in grades 5, 7 & 9 who are at risk for overweight (85th percentile ≤ BMI < 95th percentile): 19.1%.
- Percent of children in grades 5, 7 & 9 who are overweight (BMI above the 95th percentile): 25.1%

- Proximity of Fast Food to Schools and Clinics

## Phase I funding provides support for formative research and planning to lead to a large-scale, multi-year diabetes prevention intervention

**During Phase I, the Initiative aims to:**
- 1) identify the factors that contribute to diet, physical activity, and healthcare utilization within the targeted communities;
- 2) develop strategies to prevent diabetes and promote healthy lifestyle choices that are appropriate for the populations served; and
- 3) engage and mobilize experts, government officials, community leaders, and local residents in these efforts.

## Community Engagement

- Key Informants
- Community Advisory Boards
- Community Residents
- Observational Assessments
- Parks
- Grocery Store/Food Outlets

## Community Advisory Board (CAB)

**Community Advisory Board (CAB)**

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## Intervention Ideas E.L.A.

- To reach people in this community, approaches must be personal, and there must be time built into an intervention to get to know the people and allow change to take place
- Activities must be family oriented, involve parents and extended families
- Need to give people time and take a “step-by-step” approach to educating people to make changes as fundamental as eating and physical activity
- Education and information related to food, its nutritional value and the impact it on health.  Education should also include how to budget and stretch your money.  Education needs to be available, delivered in an understandable and accessible way.
- Tap into the popular Spanish language and other media and business advertisements as a vehicle for information and role modeling.
- Involve community leaders in mobilizing the community around this issue and identify a well-respected leader to lead the campaign against diabetes and obesity
- Farmers Markets and community gardens would be widely used.  This will lighten the financial burden and address the transportation barriers to accessing healthy foods.
- Create year-round opportunities for free or low-cost physical activities.  Train youth and adult residents to participate in community walk/runs.
- Address the cultural underpinnings of food and physical activity

## Intervention Ideas S.L.A.

- Education and information about how food you eat affects the body, what are healthy food choices and why you should consider changing food choices
- Education about the importance of exercise
- Education and information needs to be available throughout the community
- Schools and after-school programs in parks should be key outlets for information
- Utilize popular media
- Churches can play a significant role in providing information and education, offering safer places for exercise and activities after school and on weekends
- Find a celebrity spokesperson from the African American community to take on this issue, like Magic Johnson did with HIV/AIDS
- Neighborhood councils should take this issue on as a priority
- Build gyms and other outlets for exercise that are within close proximity to residents
- Use of neighborhood watch groups and parks to create safer exercise outlets.
- Expand the number and availability of venues in which affordable, healthy choices are available, including farmers markets. In these venues, clearly identify foods that are nutritionally sound.

## Intervention Ideas for Physical Activity

- Suggestions for promoting physical activity in both communities
- Create more parks
- Have childcare available
- Solicit private sector support to sponsor camps
- Create walking paths and skate parks
- Apply for funding and solicit schools to hold classes on the grounds
- Community organization should work with state and federal partners to optimize the utilization and creation of open space

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