CO Department of Public Health and Environment, Prevention Services Division Obesity Integration Steering Committee Presentation

1. Prioritizing Obesity Strategies
Obesity Integration Steering Committee Meetings
2.29.12, 3.19.12, 4.2.12

2. Welcome & Importance
Obesity is:
 a Colorado winnable battle
top priority of the Prevention Services
Division
PSD has rated the evidence on
strategies to increase physical activity
and healthy eating.
Need your help in prioritizing these
evidence-based strategies

3. Obesity Integration Project
in PSD
 Purpose: Identify, prioritize, align with
CDPHE’s role, and implement
evidence-based strategies that
prevent obesity.
 Goal: stop the obesity epidemic
 Steering committee purpose:
prioritize evidence-based strategies
by 4/6

4. Introductions
Briefly state your
Name
Organization
Position
What is your biggest hope for this process?

5. Agenda Review
 Welcome and Project Purpose
 Where We Are Now/Recap of Process
 Where We Are Headed
 Roles of Committees
 Overview of Timeline and Prioritization Process
 Closure

6. Where we are now:
A recap of what has been done to date
Gabriel Kaplan, PhD, Director, Epidemiology,
Planning, and Evaluation Branch, CDPHE

7. Obesity in Colorado
Prevalence of obesity has doubled in the past 15 years
21.4
14.2
10.1
Source: 1995 – 2010, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado
Department of Public Health & Environment.

8. Why use Evidence-Based
Public Health?
Evidence-based public health is
a systematic method for
identifying and selecting public
health strategies.
 Higher likelihood of a successful program
 Greater impact on the population
 Reduction in costs (streamline funding)

9. An Evidence-based Public
Health Framework
Step 1
Step 7 Step 2
Step 6 Step 3
Logic Model(s)
based on Steps 4 & 5
Step 5 Step 4
Slide adopted from presentation by Ross Brownson, PhD (2011)

10. Comparing & Overlaying PSD’s EBPH
to OPP’s CHAPs
EBPH in PSD Colorado Health Assessment and Planning System (CHAPS)
All steps Phase 1: Plan the Process
Steps 1, 5, 6 Phase 2: Engage Stakeholders
Steps 1, 2 Phase 3: Assess Community Health
(Step 1 or 5) Phase 4: Assess System Capacity
Steps 1-3 Phase 5: Prioritize Issues (Step 4)
Steps 5 & 6 Phase 6: Create a Local Health Plan (prioritize strategies)
Steps 6 & 7 Phase 7: Implement, Monitor, and Communicate the Plan
& logic model
Outputs from all Phase 8: Inform the Statewide Plan
steps

11. Steps 1 & 2: Understanding
Obesity in Colorado
Understand the population
Ensure interventions will
maximize benefit to
communities
Identify where to focus
resources and interventions

12. Step 1: Community Assessment
What questions were answered?
1. What are the characteristics of our community?
2. What are barriers to physical activity and healthy
eating in our community?
3. What is important to the community?
4. What are the community’s assets?
5. What are the threats to increasing physical activity
and healthy eating?
6. What are the opportunities for increasing physical
activity and healthy eating?
7. What are the competencies and capacities of the
public health system?
8. What are the current activities of the public health
system?

13. Step 2: Quantify the issue
What questions were answered?
Q1. Obesity prevalence, trend, disparities
Q2. Physical activity
prevalence, trend, disparities
 Physically inactive
 Moderate/vigorous activity
 Commuting to work
 Physical education class
 Sports
 Screen time
Q3. Nutrition prevalence, trend, disparities
 Fruit/vegetable consumption
 Soda, sweets, and fast food consumption

14. Step 3: Develop a concise
statement of the issue
 The state health department has been
charged by the governor with developing
and implementing prevention and control strategies
to reduce the obesity prevalence in Colorado.
 Obesity has been identified as a CDPHE Winnable
Battle and is a priority for the Prevention Services
Division at CDPHE.
 Six local public health agencies have identified
obesity as a Winnable Battle and priority issue as part
of their CHAPS planning process. Additional agencies
could follow suit.

15. Step 3: Concise Statement
 The prevalence of obesity in Colorado is increasing,
particularly among adults, and the state’s population is
aging. Over the same period the prevalence of physical
activity and fruit & vegetable consumption have been
stable among adults.
However, the majority of adults, adolescents, and
children do not meet the recommended levels for
weekly physical activity or daily fruit and vegetable
consumption. Too many Coloradans eat and drink high-
caloric, low-nutrient, and processed food too often.
Older adults are less active than younger adults, but
they eat fruits and vegetables more often.
The Hispanic population is increasing, and its members
have a higher prevalence of obesity, lower levels of
physical activity, and lower fruit & vegetable
consumption than Whites.
Females and adults with low income or low education
are less active than their counterparts.

16. Step 3: Concise Statement
 Few (1/14) adult workers use active means to commute
to work.
 Only 1/5 adolescents and children have daily PE class.
 Many children exceed recommendations for screen time.
 The majority of children eat fast food weekly.
 Breastfeeding exclusivity at 6 months was below the
HP2020 target.
 Perceived barriers to healthy living include lack of time
and money more than lack of access to healthy food or
facilities for physical activity.
 About 1/5 parents report that it is difficult for their child to
be active in the local park because it lacks adequate
space or equipment.

17. Step 3: Concise Statement
 Programmatic Issues:
The public health challenge of obesity is underfunded.
Obesity results from a complex interplay of various,
individual, social, economic, and environmental pressures
and incentives. Until now, there has not been a
coordinated response to the problem that reaches across
state and local government, the nonprofit community,
and the private sector.
 Future vision:
PSD Programs and Services will use evidence-based
strategies in targeted ways to efficiently and effectively
address the obesity epidemic in Colorado. PSD Programs
and Services will collaborate and coordinate with
partners to implement a multi-faceted approach to the
obesity problem, which facilitates addressing the socio-
ecological root causes.

18. Step 4: Literature Review
 Comprehensive Literature Review
 Focus on evidence-based public health
strategies to improve physical activity and
promote healthy eating in 8 sectors:
 Schools
 Childcare
 Food Systems
 Health Systems
 Worksites
 Community
 Media
 Built Environment

19. Step 4: Literature Review
Literature Review Process
 3 Boot Camps (December 16, 2011 &
January 19, 2012, and February 6, 2012)
 Over 40 CDPHE program staff participated
 Sector Team Lead: Program staff responsible
for all sector team deliverables
here today as a member of the
steering committee
EPE Coach: EPE staff responsible for
providing technical assistance

20. Step 4: Literature Review
Literature Review Process
 Task 1: Formulate a search strategy using PICO
 Task 2: Search databases
 Task 3: Identify materials to read
 Task 4: Critique materials
 Task 5: Insert into a Literature Library
 Task 6: Rate the literature
 Task 7: Assign a summary of evidence rating
 Task 8: Assign a state-level implementation score

21. Step 4: Literature Review
 Systematic reviews (Meta-analysis)
Objective
 Literature from one or more journal
articles
 Public health surveillance data
 Program evaluations
 Qualitative data
 Community members
 Other stakeholders
 Media/marketing data
 Word of mouth
 Personal experience
Slide modified from presentation by Ross Brownson, PhD (2011) Subjective

22. Step 4: Literature Review Typology
How Established Considerations for Level of Scientific Data Source Examples
Evidence
Proven Peer review via systematic or Based on study design and execution Community Guide
narrative review External validity Cochrane reviews
Potential side benefits or harms Narrative reviews based on published
Costs and cost-effectiveness literature
Likely Effective Peer Review Based on study design and execution Articles in the scientific literature
External validity Research-tested intervention programs
Potential side benefits or harms Technical reports with peer review
Costs and cost-effectiveness
Promising Written program evaluation Summative evidence of effectiveness State or federal government reports
without formal peer review Formative evaluation data (without peer review)
Theory-consistent, plausible, potentially Conference presentations
high-reach, low-cost, replicable
Emerging Ongoing work, practice-based Formative evaluation data Evaluability assessments*
summaries, or evaluation works in Theory-consistent, plausible, potentially Pilot studies
progress high-reaching, low-cost, replicable National Institute of Health (NIH)
Face validity research
(RePORT database)
Projects funded by health foundations
Not Recommended Varies. Evidence of effectiveness is conflicting Varies.
and/or of poor quality.
Weak theoretical foundation
Balance of benefit and harm cannot be
established or evidence demonstrates that
harm outweighs the benefits.
* A pre-evaluation activity that involves an assessment to establish whether or program or policy can be evaluated, what the barriers
to its evaluation might be.
Source: Adapted from Healthy People 2020 and Brownson RC, Fielding JE, Maylahn CM. Evidence-based Public Health: A Fundamental
Concept for Public Health Practices . Annual Review of Public Health. Vol. 30: 175-201

23. In a nutshell…Levels of
Evidence in PSD
 Proven: systematic or narrative reviews; considers study design
and execution, external validity, body of evidence, and results
 Likely Effective: peer review articles in scientific literature;
considers study design and execution, external validity, body of
evidence, and results
 Promising: written program evaluation without formal peer
reviews; considers summative evidence of
effectiveness, theory, and formative evaluation data
 Emerging: ongoing work with little evidence so far, but sound
theory and evaluation in place
 Not Recommended: evidence of effectiveness is
conflicting and/or of poor quality and/or suggestive of harm

24. Step 4: Literature Review Results
SECTOR EVIDENCE RATINGS
Schools 7 Likely Effective; 2 Promising; 5 emerging
(Jon Gallegos)
Child Care 4 Likely Effective; 3 Emerging; 2 Not
(Tracy Miller) Recommended
Food Systems 2 Likely Effective; 3 Promising
(Patricia Daniluk)
Health Systems 1 Proven; 2 Likely Effective; 1 Promising
(Zula Solomon)
Worksites 5 Proven; 1 Likely Effective
(April Sifford)
Media 1 Likely Effective; 2 Promising; 2 Emerging; 1
(Stephanie Walton) Not Recommended
Community 1 Proven; 5 Likely Effective; 1 Emerging
(Lorena Zimmer)
Built Environment 5 Likely Effective; 2 Emerging
(Jessica Osborne)

25. Next Step 5: Prioritization of
Evidence-Based Strategies
 To be completed by the obesity
integration steering committee
 Karen Trierweiler will cover the roles of
the
 Steering Committee and
 Executive Committee

26. Roles of Committees
Karen Trierweiler, MS, CNM
Director, Programs and Services
Prevention Services Division

27. Steering Committee
 Membership:
 sector team leads and other key PSD staff,
 state partners, and
 local public health partners
 Decision-making process:
 60% super majority vote,
 one vote per steering committee member
 executive committee members do not
vote

28. Steering Committee Role
 Review (homework #1) and approve (2nd mtg):
 Final summary of community assessment (Step 1) and
quantifying the issue (Step 2)
 Concise statement of the issue (Step 3)
 Evidence rating of strategies (Step 4)
 Develop prioritization process to rank potential
strategies
 Complete survey on potential criteria (homework #1)
 Give input on CDPHE’s possible role related to each
potential strategy
 Complete survey (homework #1)

29. Steering Committee Role
 Rank or prioritize strategies (homework #2)
 Submit recommendations of prioritized strategies to
the executive committee.
 Joint role: Communicate outcomes to CDPHE staff
and leadership and to external stakeholders

30. Executive Committee
Membership: PSD leadership team plus
 Representative expert from CDC on
obesity strategies
 Representative from obesity control and
prevention programming
Decision making process: Consensus

31. Executive Committee Role
and Responsibilities
 Non-voting members of the steering committee
 Review and vet steering committee’s
recommendations:
 Final summary of community assessment and quantifying
the issue
 Concise statement of the issue
 Evidence rating of strategies
 Ranked/prioritized strategies
 Refer strategies to sector teams to develop
implementation teams
 Joint role: Communicate outcomes to CDPHE staff and
leadership and to external stakeholders

32. Summary of Timeline
 By 2/29/2012, identify evidence-based strategies to
improve physical activity and promote healthy eating
among all Coloradans.
 By 4/2/2012, prioritize evidence-based strategies to
improve physical activity and promote healthy eating
among all Coloradans.
 During April 2012 through June 30, 2013:
implementation and evaluation planning
 7/1/2013: PSD starts implementing priority strategies

33. How We’ll Get There:
Prioritization Process
When Purpose/Actions
Meeting 1 (2/29) • Getting Started
• Agreements For Moving Forward
Between Meetings Survey Coming Tomorrow (due 3/9)
(e-input) • Review/Provide Input on Proposed Criteria
• Identify State Roles for Strategies
Meeting 2 (3/19) • Review/Finalize Criteria
9:30am -12:30pm • Clarify Strategies
• Clarify State Roles
Between Meetings Prioritization Survey (sent 3/21, due 3/26)
(e-input) • Rate Strategies Using Final Criteria
Meeting 3 (4/2) • Share Results of Prioritization
9:30am – 12:30pm • Gather Additional Input for Ex Committee

34. Handouts
 Power Point
 Project charter (with roster)
 Final sector reports on strategies
 Typology of evidence
 Timeline of meetings and homework
 Gathering and Using Input to Inform the
Prioritization Process

35. Questions and Answers
Obesity Integration Steering Committee Meetings
2.29.12, 3.19.12, 4.2.12

36. Thank You and Closure
On the index card provided let us know
What is still on your mind?
 Leave note sheets on table before you leave
 For those on the phone: email your responses to:
Laurie.schneider@ucdenver.edu