A Community-Based Approach to Childhood Obesity Prevention in Indian Country. LCDR Tom Faber, MD, MPH LT Nimmy Mathews, PharmD

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1 The Zuni Youth Enrichment Project (ZYEP) A Community-Based Approach to Childhood Obesity Prevention in Indian Country LCDR Tom Faber, MD, MPH LT Nimmy Mathews, PharmD

2 Disclosures No Financial Conflicts of Interest Meant to tell the story of how the Commissioned Corps and IHS have partnered with the Zuni Tribe to address childhood obesity- not present a scientific study

3 Overview: The Zuni Pueblo Background Childhood Obesity in Zuni The Zuni Youth Enrichment Project (ZYEP) Program philosophy Program Components Evaluation Results Future Plans

4 The Zuni Pueblo Zuni

5 The Zuni Pueblo Population: 10,500 Tribal Government: Elected Governor & 6 member Council Remote Community Zuni language, religion, traditions remain an integral part of everyday life

6 The Zuni Pueblo Age Adjusted Death Rates, Zuni , US Rate per 100, Cirrhosis Diabetes Suicide Injuries Heart Cancer Disease

7 The Zuni Pueblo Diabetes rate is at least three times the national average - lifetime prevalence of 65% Alcohol-related disease is the leading cause of death; 25% of deaths (even excluding injuries)

8 Weight Status of Zuni Youth Zuni Kindergardeners % 23% 14% 60% Underweight Healthy Weight Overweight Obese

9 Weight Status of Zuni Youth Zuni 5th Graders % 36% 41% 21% Underweight Healthy Weight Overweight Obese

10 Childhood Obesity in Zuni Complex, multifactorial Problem Poverty (53% of families with children < 5) Access to Fresh, Healthy Foods (Food Desert) Drought and Loss of Traditional Agriculture Psychosocial and Family Stress (Teen Parents, EtOH) Lack of opportunities for youth to engage in fun, enriching activities which promote self-esteem and healthy lifestyles

11 ZYEP Non-profit organization formed in 2008 by PHS Officers to address the lack of positive, after-school activities available for kids

12 ZYEP: Program Philosophy Need For Change (Childhood Obesity) Identification of Community Strengths (e.g. Tribal Collaboration, Culture) Provide Opportunities for Development of these Strengths (e.g. Community Summer Camp, Sports Leagues) Continued Development of Competencies Higher Expectations Positive Experiences

13 Summer Camp 65 kids aged 6-11 & 17 adolescent counselors 8 weeks, 9am-1pm, Monday-Friday 5th Annual Camp Planned for June, 2013

14 Zuni Culture

15 Gardening

16 Sports

17 Swimming

18 Nutrition Education

19 Yoga

20 Hiking

21 Biking

22 Games

23 Counselor Program 17 adolescents aged are serve as counselors, role models, mentors to campers Enrolled in a positive youth development program: Serving as a mentor Paid summer job Weekend wilderness retreats Leadership Training and

24 Program Evaluation Designed to assess changes in: Health behaviors & attitudes Fitness Pre and post assessments of: Camper surveys of knowledge, attitudes, and behaviors regarding nutrition and physical activity Objective measures of fitness

25 Camp Results Significant Improvements: Flexibility Speed on a timed 200m run (decrease of 6 sec) Improved strength (bicep curl increased 6 lbs) Strong trend towards: Reduced body fat (1.4%) Decreased weight (mean= 2.9lbs)

26 Change in Home Physical Activity Summer Camps

27 Fruit and Vegetable Consumption Summer Camps

28 ZYEP Soccer League

29 3rd Annual League: 10 week fall season 145 kids (12 teams aged 5-11) 35 volunteer coaches Practice twice per week & games on Saturdays

30 ZYEP Youth Basketball Completed 3rd annual season in week spring season 145 kids (12 teams) ages 6-12 >50 volunteer coaches Practice twice per week with weekly games

31 School Gardens Partnered with local schools to create two school-based gardens since 2010 with a new garden added in 2013 Gardens are used as part of a Nutrition, Zuni Culture, and Health Curriculum Developed by ZYEP

32 ZYEP Farmer s Market Produce from the Summer Camp 6 Saturdays at ZYEP Soccer Games and Local Grocery Customers per day engaged in lifestyle education, nutrition games, BP checks, and more. Participants earned veggie bucks which were used to buy produce

33 Youth Involved in ZYEP Programs Boy Scouts School Gardens DY MESA Program Sports Leagues Counselor Program Summer Camp Year 1 Year 2 Year 3 Year 4

34 Future Directions Create Systemic, Sustainable Changes Supported by CDC s Community Transformation Grant Working with local grocer to promote healthy foods and incorporate nutrition education School Wellness Policy Creating a network of walking and biking trails Developing a referral system between schools and IHS where at risk kids are enrolled in a health and fitness program

35 E lahkwa Questions: Program Website:

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