problem statement
DESCRIPTION
Group 2 Tara Braun, Stephanie Bycroft , Kristine Cargill, Jeanette Depue , Jennifer Hanson, Laryn Phillips, Aundrea Robinson-Burris, Alicia Williamson Nurs 340. Low income African-American residents of Kent County at risk of excessive rates of morbidity and mortality from CVD R/T : - PowerPoint PPT PresentationTRANSCRIPT
Group 2 Tara Braun, Stephanie Bycroft, Kristine Cargill, Jeanette Depue, Jennifer Hanson,
Laryn Phillips, Aundrea Robinson-Burris, Alicia WilliamsonNurs 340
Proble
m
Sta
tem
ent
Low income African-American residents of Kent County at risk of excessive rates of morbidity and mortality from CVD
R/T :
High rates of obesity
Lower rates of physical activity
Dietary choices
Limited access to health care
Genetic predisposition
AEB The rates of obesity in Kent County have increased from 17% in 1993 to 23.6% in 2008 (Kent County Health Department, 2010).
One of the risk factors for heart disease is obesity. 31.3% of the Michigan population is obese compared to 27.8 % of the US population (Centers for Disease Control and Prevention, 2007). African Americans and low income residents (<$20,000) are at highest risks for obesity and heart disease (Kent County Health Department, 2010).
Who? Low Income African Americans
WH
AT
Heart Disease related
to Obesity.
Obesity is a modifiable
risk factor for cardiovascular disease
(Centers for Disease
Control and Prevention, 2012c)
The African American
community has an
increased prevalence of
these diseases in Michigan
and in Kent County.
African Americans and low
income residents
(<$20,000) are at highest
risks for obesity and heart
disease (Kent County
Health Department, 2010).
WH
Y Physical
inactivity and
diet are
modifiable risk
factors of
obesity"
Centers for
Disease Control
and
Prevention,
2009).
Obesity, physical
inactivity and
diet are all
modifiable risk
factors of heart
disease and
should be the
focus of an
initiative that
seeks to reduce
the prevalence of
heart
disease”(Centers
for Disease
Control and
Prevention,
2009).
CH
EC
K T
HIS
QU
ICK
V
IDEO
OU
Thttp://www.youtube.co
m/watch?v=oj_yTXtFe
Wo
Curr
entl
y
Currently 31.3% of the
Michigan population is
obese compared to 27.8 %
of the US population
(Centers for Disease
Control and Prevention,
2007).
The rates of obesity in Kent
County have increased
from 17% in 1993 to 23.6%
in 2008 (Kent County
Health Department, 2010).
Obesity Risks are Disproportionate
Among Minority and Low Income Populations
( Robert Wood Johnson Foundation, 2012)
blog.jonolan.nethcwreview.com thegbigsangle.blogspot.co
m
These populations occupy the same areas and in high concentrations; which
is central and Midwest Grand Rapids
Take a look at the distribution of Low
Income and Minority Populations in The Kent
County Area on the following slide:
http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/Appendix_A_Clinic_Mapping_Project_Report_2005.pdf
Minorities are disproportionately represented in low-income neighborhoods and are most likely
to be affected by programs that target low-income communities (Kent County Health
Department, 2005).
Location, Location, Location…
Community Health Centers
“The community clinic catchment area includes 60% of Kent County’s low-income population and 74% of Kent County’s minority population" Kent County Health Department, 2006).
Using these clinics for intervention sites would make the intervention accessible to the target population.
Interventions to prevent and reduce obesity in Kent County will reduce the prevalence and disparate impact of heart disease.
Primary Prevention
“MAXIMIZING
HEALTH AND
WELLNESS
THROUGH
STRATEGIES
THAT ARE SET
IN PLACE
BEFORE
ILLNESS AND
INJURY ARE
PRESENT.”
(HARKNESS AND DEMARCO,
2012, P 65).
Secondary
Prevention
“MAXIMIZING
HEALTH AND
WELLNESS
THROUGH
STRATEGIES
THAT ARE SET IN
PLACE AT THE
EARLY AND
CHRONIC STAGES
OF
PATHOGENESISO
F ILLNESS AND
INJURY”
(HARKNESS AND
DEMARCO, 2012,
P 65).
Nutritional Education
Classes (Baptist Health South Florida, 2012).
Fitness classes (Baptist Health South
Florida, 2012).Health Screenings for
Heart Disease and Diabetes(Baptist Health South Florida, 2012).
“Transform marketing
and messages about
physical activity
and nutrition.”(Robert Wood
Johnson Foundation, 2012, )
The PLAN
Reduction in Obesity and Heart Disease Rates
Interpersonal programs where participants can
interact and receive emotional support
(Hanan, 2009).
“Transform marketing and messages about physical activity and
nutrition.”(Robert Wood Johnson Foundation,
2012, )
“Create food and beverage environments that ensure healthy food and beverage
options are the routine, easy choice.” (Robert Wood
Johnson Foundation, 2012, )“Integrate physical activity into people's daily lives.” (Robert
Wood Johnson Foundation, 2012, )
Change based on research is a continuous system of assessment, policy development and assurance that the community needs to move from the preparation
phase of change to the action phase of change.
Increase public access to places that enable people to participate in physical activity (Robert Wood Johnson Foundation, 2012)
Low income neighborhoods are 50% less likely to have close proximity to recreational facilities. (Active Living Research, 2012)
Communities that are socioeconomically disadvantaged are likely to lack clean sidewalks and scenery; factors which promote the involvement of its population to participate in physical activity (Active Living Research, 2012).
Community Interventions The building of sporting facilities and
playgrounds, mapping out of walking itineraries
The offering of cooking classes to families, offering to 'at risk' families of counseling and overweight children.
Changes to school menus, the introduction of fruit to menus
Encouraging reductions in television watching and increases in physical activity after school .
Food pricing adjustments such as subsidies on fruit and vegetables and taxation applied to energy-dense nutrient-poor food;
Increasing exposure to healthy food (and decreasing exposure to unhealthy food) via zoning and restrictions on the display of foods in locations such as supermarkets
Improving the image of healthy food (and making unhealthy food less attractive) via restrictions on advertising and the presentation of caloric contents of restaurant meals.
(Walls, H., Peetas, A., Proietto, J., & McNeil, J. (n.d.).
Kent
County
’s
Obesi
ty Init
iati
ve
South East Area Farmer’s Market Targets underserved
population of city Participates in Double
Up Food Bucks program Grocery Store Tour
program(Kent County Health Department, 2011)
Pro
gra
ms
That
work
Nutrition “•In Los Angeles, California, several
communities with high rates of obesity and poverty restricted proliferation of fast–food restaurants within a half–mile radius of existing fast–food restaurants. As a result, approximately 800,000 residents now have the benefit of reduced exposure to unhealthy food options, and retailers offering healthy options have an opportunity to enter the communities.” (Centers for Disease Control and Prevention, 2011).
“•In La Crosse County, Wisconsin, 21 convenience stores became members of Gunderson Lutheran Medical Center's "500 Club," which promotes healthier food options. Their participation will provide the over 113,000 residents of La Crosse County with greater access to healthy food.” (Centers for disease Control and prevention, 2011).
“•San Diego, California, is improving access to affordable healthy foods by increasing the number of farmers' markets that accept food stamps or Electronic Benefits Transfer (EBT) cards. EBT cards enable low–income residents to use food–stamp credits via a debit card. In a five–month period, EBT sales exceeded $29,600 at two farmers' markets. Four more markets are expected to accept EBT cards by March 2012.”
(Centers for Disease Control and Prevention, 2011).
Pro
gra
ms
That
work
Europe adopted a program entitled “EPODE”, to reduce obesity in two towns in northern France (Dalton, 2009). The cities of Fleurbaix and Laventie implemented this program which targeted children and reduced the obesity rates from 11.2% to 8.8% between 1992 and 2004 (Dalton, 2009).
Two nearby towns that did not adopt the program increased their obesity rates obesity rates during this same time period from 12.6% to 17.8% (Dalton, 2009).
The programs included an interpersonal program that provided dietitians and sports educators to counsel families in schools, implemented, “walk-to-school days”, and new sporting facilities were built within the city to make physical activity accessible (Dalton, 2009).
Loca
l Reso
urc
es
to
Support
Init
iati
ves
Kent County Health Department 4 Departments:
Administration, Community Clinical Services, Community Nursing, Environmental Health
(Kent County Health Department, 2011)
Nutritional Counseling along
with Monthly cholesterol and blood pressure
screenings
Administration – Obesity Initiative
Task Force on Health
Care for People of
Color
STR
IDES
Project Takeoff
Coalition.
In an effort to encourage
physical activity and
decrease obesity, Kent
County has formed the
Project Takeoff Coalition.
Through this agency, a
number of educational
opportunities have been
developed in Kent County
to decrease obesity and
improve overall health. The
Kent County Health
Department offers
“Walking into Wellness,”
nutrition and walking
program that also offers
cardiovascular screening.
Other programs include
Champion Health and
Fitness for persons aged
17 and older, Gymco Sports
for ages 18 months to
adult, East Hills Athletic
Club “Baby on Board,” and
Priority Health-“Learn”
which promotes lifestyle
change through exercise
and stress management.
These programs may help
to encourage motivation
and social support.
(Kikstra, A. The Project
Takeoff Coalition accessed
10/20/12)
RACE FOR HEALTHY KIDS
Race for Healthy Kids takes
place in Rockford, Michigan.
It’s intent is to involve
families in physical activity
and fund raising for health
promotion programs.
http://www.raceforhealthykids
.org/
The South East area Farmers
Market
The South East area
Farmers Market offers
locally grown fresh fruits
and vegetables and has
began accepting EBT and
Bridge cards, allowing
access to these healthy
food choices among
individuals who are low
income. Healthy Kent
2020
http://www.healthykent.
org/
Task
Forc
e o
n H
ealt
h
Care
for
People
of
Colo
r
http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/Task_Force_Final_Report_2006.pdf
The mission of this Task Force is “to examine the issue of health care for people of color, determine what the county is doing to resolve existing barriers and to develop proposals for community action “ (Task Force on Health Care
for People of Color, 2005).
Succ
ess
!A successful intervention will reduce the number of
new cases of heart disease in the Kent County African American community
when monitored over
a period of two years.
When W
ill
Changes
be S
een? According to the research performed by
Macdiarmid et al., improved health will likely
not be seen until roughly five years after the
interventions have been implemented
(2010)Improved health can be seen as weight loss,
lower rates of obesity, lower blood pressure,
lower cholesterol, and a decrease in the
number of cases of diabetes
It takes many stops and starts before changes
become permanent and the outcome of
improved health is seen
Should be considered a long-term goal
Changes in people’s beliefs and attitudes will
occur sooner (Centers for Disease Control
and Prevention [CDC], n.d.)
Will likely be the first changes seen
Should be seen within one year of the
interventions being initiated
Changing people’s attitudes about healthy
eating, physical activity and their role in
reducing obesity and heart disease should be a
short-term goal
When W
ill
Changes
be
Seen?
The citizens of Kent County should
begin improving their diet and
physical activity between two and
three years after the interventions
have been initiated The changes in behavior are
intermediate goals (Macdiarmid et
al., 2010) This period of time is difficult as
people struggle to maintain those
changes The rate at which change is seen
is also effected by: how quickly the message for change
reaches the target audience
if it is easily understood
how long the message is advertised
(CDC, n.d.)
Change:
How quickly the message for change reaches the
target audience
Message is easily
understood
Length of time the
message is advertised
(CDC, n.d.)
The citizens of Kent County should begin
improving their diet and physical activity between
two and three years after the interventions have
been initiated
Eva
luatin
g
Outco
mes
In order for a program to be effective, it must
have measurable outcomes.
This allows for review of results and ability to
make adjustments to the program where
needed.
Outcomes to measure include the availability
of healthy food and drinks in schools, the
facilitation of active transportation, the
number of farmer’s markets accepting
food benefits such as SNAP, EBT, and
Bridge cards, and the physical activity
requirements of schools.
Getting better
and better
Evaluating the effects of the
interventions
Obesi
ty r
ate
Click icon to add picture
Noticeable decrease in the obesity rate
of the African American residents of Kent
county. Due to improved diet practices
and improved exercise practices.
Heart
Dis
ease
There will a marked decrease in new cases of
heart disease among the
residents of Kent county.
As well as an increase in
compliance to treatment
of current residents with
heart disease.
Measu
rable
Outco
mes fo
r
Change
Short term outcomes
contributing to diet-
related behavior
include attitudes,
values, knowledge
and skills (Devine,
Brunson, Jastran, and
Bisogni , 2006, p2)
It has been proposed
that “a participant-
centered approach
could contribute to
improved program
management,
accountability, and
satisfaction.” (Devine
et al. (2006, p. 2)
“Program context, as
presented in
participants’ current
worlds, could make or
break a program”
(Devine et al. 2006
p.4)
“Outcomes related to
content in resource
management, diet
quality, meal
planning, food safety,
parenting, and
personal
development” (Devine et
al. 2006, pp. 4 -5)
“Motivational
approaches may be
most important for
people who have yet
to attend to or engage
with nutrition” (Devine
et al. 2006, p.6)
“In particular the
many social outcomes
that were expressed
by these participants
may have importance
for reinforcement,
social support, and
sustainability of new
practices.” (Devine et
al. (2006, p.6)
Environments for Action
Change in the prevalence of heart disease in the
African American community in The Kent County area requires a
collaborative effort toward change in many factors
that also influence obesity: Change in the schools,
physical activity environments, food and beverage environments and the health care and
work environments . These will all be influenced by the
message environments
Refe
rence
s
Centers for Disease Control and Prevention. (2007). Surveillance of Certain Health Behaviors Among States and Selected Local Areas: United States, 2005. Morbidity and Mortality Weekly, 67(SS4), 1-164 Retrieved from http://www.cdc.gov/mmwr/PDF/ss/ss5604.pdf
Centers for Disease Control and Prevention. (2009). Heart disease behavior. Retrieved from http://www.cdc.gov/heartdisease/behavior.htm
Center for Disease Control and Prevention. (2011c). CDC Newsroom, African-American Media Resources. Retrieved fromhttp://www.cdc.gov/media/subtopic/resources/aaresource.htm
Centers for Disease Control and prevention,. (2011). Communities putting prevention to work. Retrieved from http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/action/index.htm
Centers for Disease Control and Prevention (CDC). (n.d.) Introduction to program evaluation for public health programs. Retrieved from http://www.cdc.gov/getsmart/program-planner/Step3.pdf
Dalton, M. (2009, November 10). Fighting obesity may take a village. Wall Street Journal , Retrieved from http://online.wsj.com/article/SB10001424052748703808904574525462710954426.html
Devine, C.& Brunson, R. & Jastran, M. & Bisogni, C. 2006 It Just Really Clicked: Participant-Perceived Outcomes of Community Nutrition Education Programs https://fsulearn.ferris.edu/@@/C46F23C6651BEFC64498D6EFC4C35BDD/courses/1/XLIST_80400.201208/db/_123273_1/It%20Just%20Really%20Clicked%20Participant-Perceived%20Outcomes%20of.pdf
Hanan, M. (2009). Interpersonal and mass media campaign for HIV/AIDS prevention: an integrated approach. Journal of Development Communication, 20 (1), 10-30.
Harkness, G.A., & DeMarco, R.F. (2012). Frameworks for health promotion, disease prevention and risk reduction. In Community and public health nursing: Evidence for practice (pp. 65-85). Philadelphia, PA: Wolters Kluwer Health/ Lipincott Williams & Wilkins.
Healthy Kent 2020(n.d.). Community Health through community action. Retrieved from http://www.healthykent.org/
Refe
rence
s
Kent County Health Department. (2006). Health Care for
people of color: Final report 2006. Retrieved from http://
www.accesskent.com/Health/HealthDepartment/Publicatio
ns/taskforce/Task_Force_Final_Report_2006.pdf
Kent County Health Department Task Force on Health Care
for People of Color. (2005). [Spot map comparison of
minority population concentration in Kent County]. Clinic
mapping project report: Access to health care services.
Retrieved from http://
www.accesskent.com/Health/HealthDepartment/Publicatio
ns/taskforce/Appendix_A_Clinic_Mapping_Project_Report_2
005.pdf
Kent County Health Department Task Force on Health
Care for People of Color. (2005). [Spot map community
health centers in Kent County]. Clinic mapping project
report: Access to health care services. Retrieved from
http://www.accesskent.com/Health/HealthDepartment/Publicatio
ns/taskforce/Appendix_A_Clinic_Mapping_Project_Report_2
005.pdf
Kikstra, A., Kent County Health Department, The Project
Takeoff Coalition, accessed 10/20/12
Macdiarmid, J.I., Loe, J., Douglas, F., Ludbrook, A.,
Comerford, C., & McNeill, G. (2010). Developing a timeline
for evaluating public health nutrition policy interventions.
What are the outcomes and when should we expect to see
them. Public Health Nutrition, 1-11. doi:
10.1017/S1368980010002168
Race for Healthy Kids. (n.d.). Race for healthy kids.
Retrieved from http://www.raceforhealthykids.org/
Task Force on Health Care for People of Color. (2005).
Clinic consortium clinic mapping project: Access to health
care services. Retrieved from http://
www.accesskent.com/Health/HealthDepartment/Publicatio
ns/taskforce/Appendix_A_Clinic_Mapping_Project_Report_2
005.pdf