Rates of both diabetes and low health literacy are higher in populations from low socioeconomic backgrounds (1). There is a direct correlation between low health literacy in adults and higher rates of overweight and obesity classifications of children in the United States. A study done by the STRONG Kids Study, a Midwest panel survey among parents of preschool aged children showed that only 24% of parents with low health literacy would approve using multiple strategies for healthy weight loss for their children compared to 59% among their counterparts with adequate health literacy (2). With children in the United States suffering with high prevalence of obesity in America the CDC data rates are alarming. Data shows that 18.5% of children aged 2-19 are obese, and by 2020 the prevalence of obesity was 19.7% affecting 14.7 million youth (3).
To narrow the scope of this national data, I will be focusing on students in Duval County schools that are at or below the poverty line and the correlation of poverty, food insecurity, and lack of parent or caregiver health literacy as adverse childhood events leading to obesity. In Duval County, 72.2% of students enrolled in the 2022-2023 school year qualified for free or reduced price lunch (n=92,383) with a total of 67.9% of those students being non-white (5). The 2021 U.S. Census showed that in Duval County 21% of children under age 18 are below the poverty line, which places them at a rate 10% higher than the state of Florida and 20% higher than the rate of all children in the United States (4). With poverty being identified as an ACE, children in Duval County are susceptible to greater health harm than their peers across the state of Florida and the country as a whole.
The intervention is going to be called 'Switch it Up and Swap it Out' and will be based around increasing health literacy for parents and care givers as well as children. By creating infographics about healthy snack foods for kids and meal plan ideas based off of the local sales in the area, I will approach the intervention to help build resilience in families through education. Goals are to swap out high sugar and high fat snacks with fresh food items and healthier options and present on what healthy food choices are, and how to keep in the weekly SNAP/EBT family food budgets.
Recruitment through local community centers and school systems will give us a chance to reach those most in need. Offering food and education-based nutrition family counseling sessions with dieticians and gift cards for weekly food shopping as compensation will help with recruitment.
Using the CDC's social ecological model all 4 elements will be covered. At the individual level we will work with parents and caregivers in 1:1 counseling sessions to increase health literacy around nutrition. The goal here is to create an environment where open dialogue helps lead caregivers and parents to self-efficacy in food choices. At the interpersonal level we can take knowledge from the individual level intervention with caregivers and parents to then help educate children about healthy foods. Working in family and group counseling sessions with registered dieticians to foster a learning environment around food choices and household nutrition will give us a chance to get feedback and alter the program as need be. At the community level by leveraging Duval County Schools to be a host site for the individual and interpersonal interventions will bring in educators from the area to team up and create a win for families. Students in programs like nursing and public health at the Universities in Jacksonville can participate in the interventions for practical hours. Also, our local leaders can participate and will be encouraged to go back to the county and state representatives to advocate for additional funding for the program. Finally at the societal level by working with the Duval County government and school systems to become a change agent to improve health literacy we can raise awareness about the social determinants of health in low-income areas and food deserts.
References
1- Alsaedi, Rulla, and Kimberly McKeirnan. “Literature Review of Type 2 Diabetes Management and Health Literacy.” Diabetes Spectrum 34, no. 4 (July 27, 2021): 399–406. https://doi.org/10.2337/ds21-0014
2- Liechty, Janet M., Jaclyn A. Saltzman, and Salma M. Musaad. “Health Literacy and Parent Attitudes about Weight Control for Children.” Appetite 91 (August 1, 2015): 200–208. https://doi.org/10.1016/j.appet.2015.04.010
3- “Childhood Obesity Facts | Overweight & Obesity | CDC,” July 27, 2022. https://www.cdc.gov/obesity/data/childhood.html.
4- Census Reporter. “Census Profile: Duval County, FL.” http://censusreporter.org/prof...031-duval-county-fl/.
5- “Students,” November 22, 2022. https://www.fldoe.org/accounta...eports/students.stml.
6- McLeroy, Kenneth R., Daniel Bibeau, Allan Steckler, and Karen Glanz. “An Ecological Perspective on Health Promotion Programs.” Health Education Quarterly 15, no. 4 (December 1, 1988): 351–77. https://doi.org/10.1177/109019818801500401.
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