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Friday, 30 May 2014 14:00

Obesity in San Joaquin Featured

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Obesity in San Joaquin

Health Preparedness in San Joaquin County, California

San Joaquin is one of the populous counties in California, with a population of over 680,000 people (San Joaquin County Public Health Services, 2012). The human population of this county has grown significantly with the largest proportion of growth exhibited among minority ethnic groups. Approximately, 28% of adults in San Joaquin lack health insurance. The rate of uninsured is much higher among African American and Hispanic Americans than other ethnic groups (San Joaquin County Public Health Services, 2012). Lack of healthcare insurance affects the ability of these individuals to maintain health. The region is characterized by high preterm birth rates and low birth weight, which have increased the rate of infant mortality.

The region suffers from various communicable disease including AIDS, Amoebiasis, tuberculosis, Chlamydia, and gonorrhea. There are huge ethnic disparities in terms of the spread of communicable diseases, with the African American community recording the highest rate. Chronic disease such as coronary heart disease, stroke, cancer, and diabetes are the major health concern in the region (San Joaquin County Public Health Services, 2012). These diseases are not only the major causes of deaths but also the major causes of disability. Diseases of the heart are the number one causes of death in the county followed by cancer. There are also significant ethnic disparities in terms of prevalence of chronic illnesses. African Americans have the highest rates.

 Sociopolitical, Economic and Ethnic Characteristics affecting Health

Economic status is one of the factors that have a significant impact on the health of African American community. Generally, San Joaquin is poorer that California as whole. A large percentage of the population lives below the federal poverty line (San Joaquin County Public Health Services, 2012). In Addition, African Americans have lower median income than whites and Asian American. Statistics reveal that 30% of African Americans in San Joaquin while living in poverty as compared to 8% of white Americans and 15% of Asian Americans (San Joaquin County Public Health Services, 2012).

Consequently, many African American have low standards of living that white and Asian American. Due to their economic status, many African Americans live in neighborhoods that have fewer opportunities for physical activities, high insecurity, and poor sanitation (Blanchard, 2009). Black neighborhoods are least likely to have parks, beaches, pools and green spaces. Other barriers to physical activities include transportation problems, and neighborhood safety.The social economic status of African American communities also limits their access to affordable healthy foods (Blanchard, 2009).

 A study revealed that white neighborhoods have 4 times as many supermarkets than Black neighborhoods. The presence of supermarkets is often associated with accessibility to vegetables and fruits. It has also been noted that African American children spend more hours on television that their white and Hispanic peers. Spending many hours on television not only limits the children’s physical activities, but also exposes these children to food advertisement, which influence their eating habits. Spending many hours on television is also associated with increased intake of food. Researches indicate that an extra hour spent on television leads to consumption of 127 additional calories per day.

Low socioeconomic status is also associated with high levels of stress, especially among African American women (Blanchard, 2009). Research indicates that high stress level may lead to the development of metabolic syndrome that alters the capacity of the body to clear glucose. Poverty also leads to social withdrawal that reducing participation in physical activities. Ethnic patterns also have an impact on the health status of African American people. African American parents use the term “big bone” to refer to their obese children (Stevenson, 2011). They encourage obesity among children by claiming that the obese children take after them. They view obesity as of little health concern. Genetics is also a major risk factor for the development of obesity among African American (Alio & Salihu, 2006)

 Educational Level of African Americans in San Joaquin County

Education level of African Americans living in Stockton was assessed by comparing education attainment of the African American with that of other ethnic community. The assessment revealed that though education attainment among African American was lower compared to Asian and Non-Hispanic Whites, the rate of attainment was higher than in Hispanic and Native Americans (National Center for Education Statistics, 2013). Education attainment of this community was also assessed by comparing education attainment of Stockton population with that of the entire country. The education level in Stockton City is lower compared to the general education level in the entire country. For population above 25 years, only 75% have attained a high-school level education compared to rate of 90% in the entire country (City Data.com, 2013).

Only 17.3% of residents who are above 25 years have attained the bachelor’s degree level of education as compared to a rate of 33% in the entire country. There is a close relationship between education level and obesity. Communities with lower levels of education exhibit high rates of obesity. This is because education has a significant impact on income and economic status. For instance, the median household income in Stockton City was $ 44,310, in 2011, compared to a median household income of $57,287 in the entire California region (City Data.com, 2013). As already explained in previous sections, socioeconomic status has an impact on healthcare status of communities. In addition, education limits the capacity of the community to understand health implication of various practices.

 Community Health Diagnosis

One of the global health problems that exist in Stockton City is obesity. Obesity is a condition that is characterized by increased levels of body fats. The assessment revealed that chronic diseases are the major health concern in Joaquin County. All these chronic ailments are associated with diabetes.  The rate of obesity, in the state of California, has increased by two folds in the last 15 years. In 2011, 24.8% of adults met the threshold of obesity while 61.4% of adults were classified as overweight and obese (Center for Disease Control, 2013).

With a population of 37.2 million people, an overweight rate of 61.4% implies that over 23 million adults living in California are overweight. The consequences of increased cases of obesity and overweight are dire. The California Healthline (2012) predicts that the rate of obesity in California will double by the year 2030. Obesity has led to increased prevalence of other chronic diseases. Illness such as hypertension, diabetes, heart failure, and cancer are on the increase. Heart disease has now become the largest killer in the state and the country. It is also projects that healthcare related cost will increase by $ 66 billion by the year 2030 if the current obesity trends in state prevail (California Healthline, 2012).

Obesity rates in California differ from county to another. San Joaquin County, whose center is Stockton city, has been identified as one of the counties with obesity rates of over 30%. Obesity rates in California also vary from one ethnic group to the next (Center for Disease Control, 2013). According to the Kaiser Family Foundation (2013), the African American ethnic group had the highest overweight rate in California, in 2011. The percentage of overweight adults in the state of California stood at 72.1%. Hispanic Americans and Native American also had a high overweight rate standing at 70.1% and 69.2% respectively (Kaiser Family Foundation, 2013). The Asian and Pacific Islander had the lowest rates at 38.3%.

 Intervention Program

The intervention program focuses on addressing obesity problem among African American people living in San Joaquin County. Specifically, the program will target the city of Stockton, the largest urban center in San Joaquin County. The proposed intervention is a family outreach program that targets African American families with children with obesity problem. The student will work together with education institutions within the city to identify African American children with diabetic problem. The identified children will direct the intervention team to the family members where the educational program will be conducted. The students and the intervention team will move to different schools across the city within the 6 week period.

 Program Objectives

  1. To conduct nutritional education in 500 African American households within the 6 week period.
  2. To conduct physical education in 500 African American households within the 6 week period.

Support for the Effectiveness of this Program

            Many studies have shown a close relationship between physical activities and obesity. Individuals who have low levels of physical activities are likely to become obese. According to Jakicic and Otto (2005), obesity is a condition that is brought about by an imbalance between energy intake and energy expenditure. Individuals who have low levels of physical activities often have energy expenditures that are lower than their energy intake.

Thus, it is reasonable for any program that seeks to address the challenge of obesity to promote physical activities. Similarly, there is a close connection between obesity and nutrition. A study conducted by Swinburn, Caterson and Seidell (2004) revealed that people who take diets that are characterized by energy-dense foods, sugar sweetened foods, and micronutrient poor food have a high likelihood of become obese. The study also linked fast food culture to increased prevalence of obesity in the country. Thus, any program that seeks to address the challenge of obesity needs to consider enlightening the target population about the nutritional effects on obesity.

  This intervention program focuses on involving families and community in the obesity awareness campaign in order to enhance the effectiveness of this program. Research has revealed that; when it comes to addressing obesity, community based approaches have the highest positive outcome (Hopkins, 2013). This is because apart from being a medical problem, obesity is a social problem. Thus, interventions need to address social and environmental factors that promote this condition in order to realize the desired goals. Community based interventions take a comprehensive approach in addressing this problem. Apart from eliminating individual risks factors, community based approach eliminate social and environmental risk factors for obesity.

 Teaching Aids

Two main teaching aids with be used in this program; the nutritional manual and physical activity manual. The nutritional manual will contain a list of healthy foods including fruits and vegetables. The nutrition manual will also provide information about portion sizes of every food for a given age group. The nutritional manual will be tailored to reflect locally available and affordable foods in order to cater for the social economic status of this ethnic group. The purpose of the nutritional manual is to educated families about healthy nutrition. A copy of the nutritional manual will be left with the family for reference.

The physical activity manual will contain simple direction of physical activities in which African American families can participate. The manual will identify activities that reflect the social economic status of the African American people. These activities will not require heavy investment of finances in order to encourage all families to participate. The goal of this manual is to promote physical exercise within this community. A copy of the manual will also be left with the family for future reference. Other teaching aids include video files and charts.

 Evaluation of Results

            Results of this intervention program will be evaluated based on the objectives of the program. Both formative and summative evaluation will be conducted. Formative evaluations are usually conducted when the program is in progress in order to establish whether the program is on track. Key milestones will be identified that will assist in the formative evaluation. For instance, the first milestone may target to reach 100 families at the end of the first week. A formative evaluation that is based on this milestone will enable the intervention team to determine whether the progress is on course in terms of meeting the objectives.

            Summative evaluation is performed at the end of the program to examine the effectiveness of the program in meeting its target. For instance, the summative evaluation may focus on examining the number of families that the program was able to reach at the end of the 6 weeks period. Evaluation will also focus on assessing the impact of the outreach program on the target population. Impact evaluation will focus on assessing the obesity trends among African American with the city. However, it will take time before the impact of the outreach program become visible and, therefore, impact assessment can only be conducted a few months after the program is completed.


Alio A. & Salihu H. (2006). Obesity Research and the Forgotten African American Child. Ethnicity and Disease. 16: 569- 574

Blanchard S. (2009). Variables Associated with Obesity among African-American Women. The American Journal of Occupational Therapy. 63 (1): 58- 68\

California Healthline (2012). California Obesity Rate to Double by 2030. November 5, 2013. http://www.californiahealthline.org/articles/2012/9/19/california-obesity-rate-to-double-by-2030-new-report-projects

City Data.com (2013). Stockton, California. November 5, 2013. http://www.city-data.com/city/Stockton-California.html

Hopkins J. (2013). Community-based Intervention Programs more effective at Preventing Obesity on Children. Bloomberg School of Public Health

Jakicic J. & Otto A. (2005). Physical Activity Considerations for the Treatment and Prevention of Obesity. American Journal of Clinical Nutrition. 82 (1): 2265- 2295

Kaiser Family Foundation (2013). Overweight and Obesity Rates for Adults. November 5, 2013. http://kff.org/other/state-indicator/adult-overweightobesity-rate-by-re/

National Center for Education Statistics (2013). Education Attainment. November 5, 2013. http://nces.ed.gov/fastfacts/display.asp?id=27

San Joaquin County Public Health Services (2012). Community Health Status Report. November 5, 2013. http://www.sjcphs.org/disease/documents/FINAL%20Updated%20Health%20Status%204-1-11.pdf

Stevenson N. (2011). Family Environmental Factors associated with Obesity among African Americans. November 5, 2013. http://drum.lib.umd.edu/bitstream/1903/10727/1/Stevenson.pdf

Swinburn B. Caterson I. and Seidell J. (2004). Diet, Nutrition and the Prevention of Excess Weight Gain and Obesity. Public Health Nutrition. 7 (1): 123- 146

The Center for Disease Control (2013). California’s Response to Obesity. November 5, 2013. http://www.cdc.gov/obesity/stateprograms/fundedstates/california.html


Appendix I: Obesity and Overweight Rates in California by Ethnic Group


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