184847 5-4-3-2-1-Go! Coordinating Health Care Provider Training and Community-Based Health Education to Lower Childhood Obesity

Wednesday, October 29, 2008: 11:30 AM

Christiane Ellen Stahl, MD , Dept of Pediatrics, University of Illinois at Chicago, Chicago, IL
Jay H. Mayefsky, MD, MPH , Dept of Pediatrics, John Stroger Hospital, Rosalind Franklin University of Medicine and Science, Chicago, IL
Jonathan Necheles, MD, MPH , Consortium to Lower Obesity in Chicago Children, Childrens Memorial Hospital, Chicago, IL
Background: The Consortium to Lower Obesity in Chicago Children (www.clocc.net) and Chicago Community in Schools are conducting community-based dissemination of a core message: 5-4-3-2-1 GO! (daily : ≥ 5 servings fruit and vegetables , 4 servings water, 3 servings low-fat dairy consumption, < 2 hours screen time, and ≥ 1 hour physical activity(PA)). If trained, clinical providers could reinforce this message and help parents or teens develop an individualized change plan. Objective: Determine feasibility of web-based training to coordinate clinic-based counseling by pediatrics residents with community-based health education Design/Methods: Residents from 3 Chicago training programs participated in a study of counseling patients age 2 to 18 about healthy eating and PA based on the 5-4-3-2-1-GO! message in their continuity clinics. Residents completed a web-based training program which included pre and post-testing on message content and strategies for engaging parents and teens in behavior change (including video segments illustrating clinic-based use of materials). A double-sided handout/behavior plan was provided for use in clinic and all clinic encounters logged. After 4 clinic sessions, we conducted a structured interview with trainees. Results: 19 residents trained, and 17 attended 1 clinic sessions. They counseled 28 of 74 patients seen over this period. Illness severity (n=22), lack of time (n=11), and parents declining (n=9) were the most common reasons for not providing counseling. After web-training residents were more likely to recognize appropriate serving size and number of servings for fruits/vegetables and dairy products as well as recommended PA time. Strategies selected for initial counseling shifted from more confrontational to more engagement-based. (pre vs. post-test score p<.001 by paired t-test) Most residents reported learning new material and being better prepared to counsel. Time barriers and uncertainty of how to proceed when patients could not identify goals for change were cited as problems. Conclusions: Web-based training of pediatric residents for clinic-based counseling on healthy eating and PA is feasible, well-received, and can be temporally and materially coordinated with a community-based health education campaign.

Learning Objectives:
1. review a model for coordinating health professional training and community health education 2. consider the effectiveness of web-based training to enhance clinical providers' ability to address the prevention of childhood obesity

Keywords: Children and Adolescents, Obesity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Currently Clinical Asst Professor of Pediatrics at the University of Illinois at Chicago, director of adolescent medicine training for pediatric residents, health care provider for overweight teens in 3 multidisciplinary settings, co-chair of the Clinical Practices Working Group, Consortium for Lowering Obesity in the Children of Chicago (CLOCC)and past chair of the Nutrition and Physical Activity Special Interest Group for the Society of Adolescent Medicine. Relevant Presentations/Publications 1. Duffecy, J, Bleil, M, Labott, S, Browne, A, Stahl, C, Browne, N, Galvani, C, Holterman, A-X, Holterman, M. Psychological Issues of Adolescents Presenting for Laparoscopic Banding. Poster Presentation, Society for Behavioral Medicine, March 2007. 2. Fritz, N, Stahl, C, Mourikes, N. Elevated Fasting Insulin Levels Observed in Obese Teens using Medroxyprogesterone. Poster presentation, Society for Adolescent Medicine. Abstract published in JAH(2006); 38(2):116-7. 3. Stahl, C. Physical Activity Counseling for the Overweight Adolescent: A Pediatricianís View. Illinois Pediatrician, Fall 2005 23(4):10-11 4. Fritz, N, Stahl, C, Mourikes, N. Fasting Insulin as a Marker for Weight Loss Potential in Teens. Poster presentation at Society for Pediatric Research, May 2005. 5. Stahl, C. Fritz N, Mourikes, N. Reducing the Risks of Type 2 Diabetes in Adolescence: Intervention in the School-Based Health Center. Poster presentation. Society for Adolescent Medicine. Abstract published in JAH (2005) ; 36(2):151-152. 6. Browne, A, Holterman, A-X, Holterman, M, Tkacz, N, Stahl, C. Morbidly Obese Adolescents: Who are they? Where are they going? What can be done? Illinois Pediatrician, Summer 2004 22(3):6-7. 7. Fritz, N, Stahl, C, Mourikes, N, Corbin, S, Driscoll, M. Screening and Behavioral Intervention for Minority Students at risk for Type 2 Diabetes: Experience in the School-Based Health Center. Platform Presentation by C. Stahl at the American Public Health Association, November 2003. 8. Fritz N, Stahl C, Corbin S, Mourikes N, Driscoll M. Teens talk fat: Minority students and their families discuss experience and ideas for healthy eating and physical activity. Presented at the American Public Health Association Meeting, November 2002.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.