Shaping America's Youth organized a series of town meetings in order to engage families and communities in the process of deliberating on solutions and barriers to improving the health and nutrition of youth.
Problems and Purpose
Shaping America’s Youth (SAY) is a non-profit organization, which has urged a national initiative to help find ways of slowing down the rapidly increasing numbers of overweight and obese children and adolescents. SAY’s main goal is to ensure that the voices of families and communities are especially heard and reflected in national and regional policies, created to improve the health and nutrition of youth. To work towards achieving this, SAY launched five day-long town meetings to find out what participants believe to be the barriers and solutions of the issue and how their opinions differ from those of experts. Then, SAY collected the input received from a range of social demographics and analyzed the statistics that formed. The analysis revealed that there is a significant disconnect between where changes are being implemented and where realistic solutions to better nutrition and increase physical activity should actually be implemented.
Background History and Context
Obesity is still a prevailing problem in the United States. It is also the second leading cause of preventable death. Statistics show that about 33.8% of American adults are obese. The percentage of children who are considered overweight is also an alarming approximate 17%. The issue has provoked large reactions from various foundations, government and private organizations to support organized interventions. However, many of the established programs have been designed solely by professionals in the field of healthcare and have often left the main stakeholder groups out of the process. These two groups are the family and the community.
Organizing, Supporting, and Funding Entities
There following were instrumental in initiating SAY in 2003:
- Sponsors Group: Cadbury Schweppes, Campbell Soup Company, FedEx Corporation, McNeil Nutritionals, a Johnson and Johnson company, NIKE, CIGNA and ConAgra Foods
- The Office of the United States Surgeon General
- National Health Organizations:The American Academy of Family Physicians (AAFP), The American Academy of Pediatrics, The American College of Obstetricians and Gynecologists (ACOG), The American College of Sports Medicine (ACSM), The American Diabetes Association, The Cooper Institute, The Department of Nutrition at the University of California, Davis
- Expert Panel of Advisors: Susan Barr, PhD, RD; Dennis Bier, MD, PhD; William Caplan, MD; William Dietz, MD, PhD; John Foreyt, PhD; Brenda Greene; Eric Hentges; Richard Kahn, PhD; RADM Woodie Kessel, MD, MPH; Richard Killingsworth; Mel Kohn, MD, MPH; Ronald Krauss, MD; Sarah Levin Martin, PhD; Esther Myers, PhD, RD; Roberto Salazar; James Sallis, PhD; Karen Silberman; Judith Stern, ScD; Roger Suchyta, MD; Reginald Washington, MD
Participant Recruitment and Selection
Participants were recruited with the help of a local host organization and local community firms, selected by SAY and AmericaSpeaks. “The Healthy Memphis Common Table, the Dallas Area Coalition for the Prevention of Childhood Obesity, the Childhood Origins of Disease of Adulthood (CODA) in Philadelphia, the Consortium to Lower Obesity in Chicago Children (CLOCC), and Iowans Fit for Life” all had the goal to develop a widespread community-outreach campaign to encourage participation in the town meeting. Their goal was to attract participants who were most representative of their community in terms of age, gender, income, education, occupation, religion, and racial and ethnic background. To make this process easier, data from the US census was used to establish the targeted groups for each characteristic. These host communities also provided feedback on the original outreach plan. The most successful strategy seemed to be direct face-to-face contact at various community events, conferences, fairs and other social gatherings. However, phone calls and e-mails were also utilized. In addition, the media was involved through the local television, the radio, announcements in regional magazines and newsletters, blog posts and community websites. Demographic details of the participants were analyzed to ensure that diversity targets were met and adjust outreach strategies if needed.
Selection of Event Sites
The five town meetings took place during 2006-2007 in Memphis, Tennessee, Dallas Texas, Philadelphia, Pennsylvania, Chicago, Illinois, and Iowa. The cities were selected based on whether or not there was an established organization dealing with youth obesity, dedication to support the town meeting, diverse demographics of the area, and the capability to meet rigorous time lines. Even though there was large interest in and support for the initiative from more cities, budget and other arrangement restrictions limited the number of town meetings to only 5 in the preliminary round.
Town-Meeting Sites (5 meetings = total of 2700 participants):
- January 2006 – Memphis, TN (1000 people)
- April 2006 – Dallas, TX (500 people)
- April 2007 – Philadelphia, PA (350 people)
- May 2007 – Chicago, IL (600 people)
- August 2007 – Des Moines, IA (250 people)
Methods and Tools Used
Through a nationwide survey, SAY chose AmericaSpeaks to be their partner in the process since it is an organization that has great experience in citizen-engagement initiatives. The 21st Century Town Meeting model was selected as the best method to involve the general public in acquiring input on the health issue. It is a process which aimed to ensure “neutrality, fairness and balance in all stages, including participant recruitment, meeting content and presentation, and data analysis”. SAY and AmericaSpeaks intended to develop an effective dialogue distinguished by three main characteristics:
- Diverse representation: Participants had to be representative of their region and meet preset demographic targets such as age, gender, race, social status, etc.
- Informed participation: Participants were provided with a 30 page “participant guide” describing the initiative and the objectives of the meeting. In addition, they were given a 4 page “issue overview”, which briefly pointed out the essential problems concerning youth obesity.
- Facilitated deliberation: The meetings were designed to ensure everyone’s participation and to encourage individual to comfortably express their ideas and opinions.
What Went On: Process, Interaction, and Participation
Town Meeting Format
SAY and AmericaSpeaks created a detailed agenda for each of the town meetings, which included a full description of the schedule and all meeting procedures such as discussions, feedback, polls, reflections, breaks, quizzes, raffles, etc. Roundtables were set up at each meeting, which each held 10 participants. Each participant was given a keypad polling device for anonymous and confidential input. All their ideas and suggestions were sent to a central computer and then discussed. This allowed everyone to give their contribution. In addition, two AmericaSpeaks moderators opened up each of the five meetings by introducing the guest speakers and important individuals. These individuals included “state governors, city mayors, city and county council members, state and city health commissioners, and the US Surgeon General and State Senators using videotape”. The moderators introduced the topics, explained procedures and reviewed suggestions after every round of questions. Last but not least, a trained and experienced neutral facilitator was placed at each table to ensure that every participant was on track with the discussion and was engaged.
Town Meeting Content
At each of the meetings the following topics were discussed in the following order:
- Family Actions: How can families improve nutrition and increase physical activity among their children? To deliberate on this issue, different portions of the participants focused on different age ranges (0-5; 6-11 and 12-19 year olds).
- Barriers to Family Actions: What prevents families from taking actions they would normally be willing to take?
- Supporting Families: How could stakeholder groups such as educators and schools, health care members, policy makers, corporations and the private sector help families to positively affect and change their children’s behavior. All participants were divided in 5 equal sections and each section was assigned a given stakeholder group as their focus.
- Creating Partnerships: How could stakeholder groups work together to create a stronger and better impact?
- National Actions: How could national leaders and organizations help improve nutrition and increase physical activity among children?
- Next Steps/Local Action: In the end of the day, participants were asked to make a personal commitment on what they would individually do to help fight obesity. All participants were then asked to read a 4-page summary report of the meeting content and evaluate the reached results.
Influence, Outcomes, and Effects
Overall, the statistical analyses of the results demonstrate that participants are very well aware of the serious risk of poor nutrition and lack of physical activity among American youth. The results also indicated that participants believe the solutions of the problem need to be focused primarily on the family. It was agreed that families and schools were instrumental in reversing the process. Therefore, they should be the primary target areas for improvement. Participants identified two major barriers for families to enhance nutrition and physical activity. The first one is a family’s ability to devote enough time to ensure that their children have a healthy lifestyle. The second factor is access to and affordability of food, and whether or not there is an efficient environment that encourages physical activity. It was agreed that a universal approach created and implemented by the government would not be sufficient to solving this crisis. Instead, participants recognized important steps that could be taken on the national and regional level to support family and community efforts. Last but not least, the data demonstrates that participants agreed on the importance of the earliest stages in life for developing habits and promoting healthy weight. The bottom line of the analysis was that in order to solve the crises, there needs to be better and equal access to healthy food, an environment that promotes physical activity, and community-based partnership to incorporate healthcare, education, businesses and the government.
Analysis and Lessons Learned
Even though the five town meetings generated some very valuable insight about the issue, there are a number of limitations which should be considered when assessing the legitimacy of the process. First of all, the generated data reflected the views and opinions of participants who could be considered to be a convenient sample of adolescents and adults who are interested enough in the subject to devote their time to this deliberative process. In addition, factors such as what exactly leaders had said and how they had portrayed the issue at the opening of the meetings may have affected the opinions of the participants. Furthermore, there was no one assigned to monitor how table recorders and team members filtered, translated and worded the suggestions made by participants. Therefore, their personal views may have affected the wording of the suggestions made by participants. Last but not least, there is some evidence of missing data that needs to also be taken into consideration. For example, 3% of the participants did not record their gender, race, age or income. However, the high degree of consistency among participants’ opinions demonstrates that the expressed views were generally applicable and representative of the whole US population.
[UPDATE]: An analysis of this event was published in 2017 in the open access Journal of Public Deliberation available at https://www.publicdeliberation.net/cgi/viewcontent.cgi?article=1485&cont...
Heath, Renee G.; Lewis, Ninon; Schneider, Brit; and Majors, Elisa (2017) "Beyond Aggregation: “The Wisdom of Crowds” Meets Dialogue in the Case Study of Shaping America’s Youth,"Journal of Public Deliberation: Vol. 13 : Iss. 2 , Article 3. Available at: https://www.publicdeliberation.net/jpd/vol13/iss2/art3
Centers for Disease Control and Prevention - Childhood Obesity Facts. Available at: http://www.cdc.gov/obesity/data/childhood.html
http://www.shapingamericasyouth.org/Page.aspx?nid=8 [DEAD LINK]
http://www.shapingamericasyouth.org/Page.aspx?hid=45 [DEAD LINK]
http://www.shapingamericasyouth.org/Page.aspx?nid=13 [DEAD LINK]
http://www.shapingamericasyouth.org/Page.aspx?hid=9 [DEAD LINK]
McCarron, David A., Richartz, Ninon, Brigham, Steve, White, Molly K., Klein, Stephen P. and Kessel, Samuel S. (2010). Community-Based Priorities for Improving Nutrition and Physical Activity in Childhood." Pediatrics vol. 126. Available at http://www.americaspeaks.org/wp-content/uploads/2010/12/Community_Based_Priorities_SAY.pdf
AmericaSpeaks. (2007). "Shaping America's Youth." Available at: http://americaspeaks.org/projects/topics/health-care/shaping-americas-yo...