Grant Application

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Dec 6, 2023

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CHSC 421 The Albany Park Coalition for Combating Childhood Obesity (AP3CO) Purpose The Albany Park Coalition for Combating Childhood Obesity (AP3CO) is seeking $50,000 from the Handler Community Trust to plan a theory-informed initiative to reduce the high obesity rate in children between the ages of 0-17 residing in the Albany Park community area in Chicago. The initiative will be led by the Stoller Center for Health Equity in conjunction with 5 community partners. Albany Park Introduction and Background Albany Park is a community area in the Far North Side of Chicago that has a history rich in diversity. Albany Park was primarily settled by Russian Jews as well as German and Swedish immigrants until 1990 when it became a port of entry for a large number of immigrants from Asia and Latin America (Encyclopedia of Chicago, 2005). Since the start of the 21 st century, the community area has been occupied by over 50% foreign-born residents, largely due to its status as a gateway community for many middle-class ethnic groups (Theodore & Martin, 2007; Encyclopedia of Chicago, 2005). Today, the community area is mostly Hispanic/Latinx and 26.7% of the population is between the ages of 0-19 (CMAP, 2020). The rate of limited English proficiency is roughly 35%, which is more than two times the Chicago rate of 15% (City Tech Collaborative, 2019). Any health interventions must therefore consider the cultures and languages that should be incorporated into implementation. Though 85.4% of residents report receiving needed care, the uninsured rate is high at 24% (City Tech Collaborative, 2019). The area is served by two Federally Qualified Health Centers (FQHC) which help to provide care to the uninsured. It should be noted that Albany Park does have lower rates of cancer screenings, annual dental cleanings, and routine checkups when compared to city averages (City Tech Collaborative, 2019). All together, these trends may reflect access to care issues or lack of knowledge about the importance of preventive care. The community area’s assets include a robust network of organizations that work together to provide much needed services to Albany Park. The community area residents also report a high rate of belonging compared to the city of Chicago (City Tech Collaborative, 2019). Additionally, driving through Albany park one can find 12 grocery stores including several Latinx grocery stores that are able to provide residents with fresh food. The community area also contains Gompers Park and also has additional nearby parks in surrounding community areas as well as bike paths for physical activity (Yonek & Hasnain-Wynia, 2011). Statement of Need AP3CO is focused on reducing the high rate of childhood obesity in Albany Park. Albany Park has the highest child obesity rate of the Far North Side at 24.5%, while the region average is 18.1% (City Tech Collaborative, 2019). The community area rate of childhood obesity is also much higher than the Healthy People 2020 goal of 14.5% (ODPHP, 2020). The stark disparity

CHSC 421 between the rates in this community area and the larger region suggests additional support is required in order to implement an effective prevention program for childhood obesity. Childhood obesity is a significant health concern due to its associated immediate and future health risks. According to the CDC, children who have obesity are more likely to have high blood pressure, type 2 diabetes, asthma, joint problems, and fatty liver disease (2020). In addition to these physical issues, childhood obesity is also associated with anxiety, depression, low self-esteem and social problems such as bullying. Children who have obesity are also more likely to become adults with obesity, and the disease risk factors in these adults are more severe (CDC, 2020). A 2011 profile of Chicago community area health and health resources showed that Albany Park residents reported childhood obesity as being common in the area but investigators found that what is deemed a healthy weight varied between cultures (Yonek & Hasnain-Wynia, 2011). Residents were also unaware of obesity prevention programs operating in Albany Park, despite a Head Start program provided by the Community Center and education on healthy eating and exercise by Heartland Health Center. Head Start programs provide services to low- income families and are not specifically focused on childhood obesity, but the programs do offer nutritious meals to the preschool-age children that attend and also encourage healthy habits (About Head Start Programs, 2020). Racial and Socioeconomic Disparities in Childhood Obesity Childhood obesity in an area in which significant racial disparities persist. Research suggests that this racial disparity cannot be explained completely by neighborhood SES or the built environment, though neighborhood SES does appear to play a larger role (Sharifi et al., 2016). In Chicago as of 2018, the highest rates of obesity at the kindergarten, 6 th grade and 9 th grade levels were all observed in Latinx children (Chicago Department of Public Health, 2019). Black children had the second-highest obesity rates at all three age levels. Albany Park also faces a high rate of child poverty at over 34% which is likely linked to the higher rate of childhood obesity. In planning any intervention in childhood obesity, the racial and socioeconomic disparities must be considered to ensure the proposed solution ameliorates the situation rather than worsening existing inequities. Community Partnerships The Coalition is supported by the following community partners:  Heartland Health Center (HHC) Albany Park  Albany Park Community Center  Centro Autonomo  Communities United  Greater Chicago Food Depository – Albany Park Food Pantry The primary partner for this initiative is Heartland Health Center (HHC) Albany Park. This Federally Qualified Health Center is well-integrated in the community due to its vital work on many health initiatives. HHC Albany Park also has a strong presence in area public schools, which allows for better rollout of initiatives aimed at improving children’s health. Most

CHSC 421 importantly, HHC Albany Park has already been providing some obesity prevention and management education in the community area. HHC also has the capacity to connect residents with other services such as assistance with immigration and WIC. The remaining community partners are also well-integrated into the community and will help to ensure program success. The community center and Communities United both provide important services to residents. Centro Autonomo is the largest organization serving the Latinx population in the area and is so well-known that it is able to advertise services by word of mouth (Galvan Morales, personal communication, 2020). Finally, though food insecurity and childhood obesity have not been causally linked, the Food Pantry is an important partner in addressing the equity issues around food caused by structural issues and poverty. Theory-Informed Program Development AP3CO seeks to design a program that looks beyond the individual and the individual’s health behaviors. Many interventions focus solely on children’s diet and exercise, and more current research suggests these interventions fail to acknowledge the environment of the child as well as the determinants of health (Chaufan et al., 2014). The social nature of eating as well as the limitation in a child’s autonomy in making food choices are important factors that cannot be ignored when designing any intervention in this area (Mata et al., 2015). Though this intervention will consider health behaviors related to eating and exercising that should be adopted, the design of the program will be more nuanced than past programs. To develop an effective intervention, the Coalition will use theory to inform the planning process. The Social Cognitive Theory (SCT) is one of the most used health behavior theories and it is helpful for working at the interpersonal level (National Cancer Institute, 2005). SCT posits that an individual will change health behavior based on (1) self-efficacy, (2) goals and (3) outcome expectancies. Importantly, it allows the focus to go beyond individual behavior to consider environmental factors. The below Table 1 highlights how SCT will be used in the planning process. Table 1. Social cognitive theory concepts applied to AP3CO’s program development SCT Concept Description Questions in Planning Reciprocal determinism How the individual, behavior, and environment interact How is the environment in Albany Park homes, schools, etc. affecting children’s eating and exercise? Behavioral capability Knowledge or skills related to the behavior What is the current level of knowledge and skills around maintaining healthy weight in children? What skills training is required? Expectations The outcomes expected to be achieved through the behavior What is the current understanding of the positive outcomes of healthy eating and exercise? How can the information about positive outcomes be effectively communicated? Self-efficacy Individual’s confidence in being able to take recommended action despite barriers What is the current level of confidence families have in being able to achieve or maintain healthy weight in children? What are the common barriers that need to be addressed? Observational learning Learning of behavior by watching others Through whom are children learning their food and exercise behaviors (family members, teachers,

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