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