Here is a challenge for you: drive along any of the food swamps in and near Rhode Island – Reservoir Avenue in Cranston, Route 6 in Seekonk, Mass., Route 2 in Warwick – and count the number of fat, er, fast food emporiums.
How quickly can you reach 20? In 15 seconds? in 30 seconds? In a minute?
Here’s another challenge: count the number of TV ads for fast foods and sugar-laden drinks
during an hour of watching.
Then count the number of TV ads for medication related to the chronic disease of Type II diabetes and its numerous symptoms.
The other side of food swamps is, of course, food deserts, where access to markets selling
nutritious fresh fruits and vegetables are few and far between.
Weight is Trending in the Wrong Direction
Between large number of food swamps and food deserts that proliferate in Rhode Island,
it is not surprising that many children and teens in Rhode Island are trending toward
being overweight and obese, according to public health researchers.
What is surprising is that there is no shared, accessible public health database that tracks
body mass index, of BMI, broken down by age, sex, race, ethnicity, and town, for the
nearly 250,000 children and teens between the ages of 2 and 17 [as of Dec. 31, 2016].
BMI is not only an indicator for obesity but also considered a precursor for the
development of Type II diabetes, a chronic disease that is one of the scourges of our
culture, devouring more and more of our health care dollars each year, with the insatiable
appetite of a very hungry parasite.
A recent data mining effort conducted under the auspices of the State Innovation Model,
called the “Clinical Child BMI Data Work Group,” was able to cull BMI data from some
44,000 de-identified records from health IT from health insurers, the state’s health
information exchange, CurrentCare, and the state’s database for children, KIDSNET.
Looking into the mirror of the results of what the work group’s preliminary data mining
found, obesity among Rhode Island children and teens is a fundamental health disparity
tied to race and ethnicity.
Some 28 percent of Hispanic children and 21 percent of black children in Rhode Island were found to be obese, compared to 15 percent of white children. Nearly one-third of Hispanic boys and more than one-quarter of Hispanic girls were found to be obese.
Further, the obesity numbers using BMI metrics showed the prevalence throughout the
• The highest rates [21 to 32 percent] of obesity for children and teens in Rhode
Island were found in Woonsocket, Central Falls, Pawtucket, Providence, Portsmouth,
Middletown and Little Compton.
• The next highest rates [18 to 21 percent] of obesity in children and teens were
found in East Providence, Newport, Narragansett, Johnston, Charlestown, Tiverton, West
Warwick and Block Island.
• The third highest rates [15 to 18 percent] of obesity in children and teens were found
in Cranston, Lincoln, South Kingstown, Richmond, Warren and Burrillville.
Translated, more than half of the communities in Rhode Island had rates of obesity based
upon BMI metrics for children and teens between the ages of 2 and 18 greater than 15
• The lowest rates [7 to 12 percent] of obesity in children and teens were found in
Barrington, East Greenwich, North Kingstown, Exeter, Scituate, Glocester, North
Smithfield and Smithfield.
Not in Isolation
The data mining for obesity in children and teens, however, should not be considered in
isolation. Instead, it should become part of a more integrated, collaborative data screening effort that includes metrics for intervention, where the information is shared across numerous public health platforms.
Those should include the Warren Alpert Medical School, the network of community health centers, and primary care accountable care organizations.
One such positive intervention, for example is the data-driven effort announced on
Monday, Aug. 20, at the R.I. Children’s Cabinet meeting, to better coordinate the state’s
response to child “maltreatment” fatalities and near fatalities.
In the last two years, there have been 8 such fatalities and 23 near fatalities in Rhode
Island, according to a presentation at the Children’s Cabinet. The analysis of the data
showed that 19 of the 31 children had a R.I. Department of Health Newborn
Developmental Risk Screening, and that 16 of those 19 of these births, 84 percent, were
Reviews of the individual cases that parental mental health issues were identified in 13 of
those 19 births, 68 percent, and 7 of the 19 births were to first-time mothers.
Translated, although the screenings were successful in identifying the children and
parents who were most at risk, the data analysis provided the direction for better
prevention strategies in the future: to identify families at risk for persistent outreach, to
strengthen engagement with pregnant moms, and to strengthen data sharing and
monitoring between the R.I. Department of Health and R.I. DCYF.
Just referring a family to services isn’t always enough, as Trista Piccola, director of R.I.
DCYF, said at the meeting, according to reporting by The Providence Journal. There
need to be more intentional efforts to ensure that the families ultimately get connected
with those agencies, she said.
Questions To Ask
In light of the release of grand jury report documenting some 3,000 incidents of child
sexual abuse by priests in Pennsylvania over the last four decades, and plans by
legislators and perhaps the next R.I. Attorney General to revise current legal reporting
restrictions, the potential is that a similar grand jury could be convened in Rhode Island
in the future to make the numbers of childhood sexual assaults public, removing civil
statutes of limitation – not just as related to the Catholic church but also to other public
and private educational institutions.
What would happen if you were to cull that de-indentified data and tabulate it data about
substance use disorders, eating disorders, suicides, and domestic violence?
Another lurking question is the follow-up on childhood lead poisoning data in Rhode
Island and its connection to violence and future incarceration. What are the connections?
A third opportunity would be to ask: how much money is spent every year advertising fast-food and soft drinks in Rhode Island? What a great public health intervention it would be to make those advertising purchases known. And, perhaps as a public health intervention, once those sums are known, create a surcharge to fund the medical costs for caring for Type II diabetes.
That would be a reach. But it would be worth having the conversation, once the data is public and shared.