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199 Cards in this Set
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focus of public health practice
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prevention!!
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target of public health practice
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populations (not individuals)
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setting of public health practice:
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communitites (as opposed to hospitals etc)
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strategies for public health practice
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multiple, and reinforcing (as opposed to counseling and edu)
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4 components of a community
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1. location
2. shared values 3. social interaction 4. people |
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community size is defined as:
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any size. Global to local.
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community:
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grouping of people residing in a specific locality, who interact and connect through a definite social structure.
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Focus of community nutriton:
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People
Policy Programs (Prevention = overall focus) |
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Another focus of public health
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promote health through actions of society
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mortality has decreased in these two chronic diseases
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CAD and stroke
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proper definition of health:
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focuses on interaction of humans among themselves and their environment
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health promotion focuses on:
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changing behaviors and lifestyles
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3 types/levels of prevention
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primary, secondary and tertiary
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primary prevention
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control risk factors, prevent disease
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secondary prevention
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detect disease early by screening and risk appraisal
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tertiary prevention
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treat people who have had illness or injury
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low fat cooking class = what degree of prevention
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primary
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HTN screening = what degree of prevention
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secondary
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diabetes management program = what degreee of prevention
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tertiary
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2 overarching goals for healthy people 2010
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1. discourage disparities
2. increase length and quality of years of life |
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4 of the leading causes of death are related to nutrition:
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stroke
CAD diabetes some cancers |
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ave life expectancy is
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77 years
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how are we doing on disparities?
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remain evident. significant differences.
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how are we doing on 2010 goals of decreasing obesity?
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not good.
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how many states have a liscensure law about the definition of a nutritionist?
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46
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3 responsibilities of community nutritionists
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1. data gathering
2. policy/program management issues 3. determining effectiveness of programs |
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initials that people recognize as accredited
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LD
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food security compoent: quantity?
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is there access to sufficient food?
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food security component: quality
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is food nutritionally adequate
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food security component: suitability?
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culturally acceptable, appropriate capacity for storage and prep
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food secutiy component: psychological?
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does the type of food alleviate anxiety, lack of choice, and feelings of deprivation?
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food security component: social?
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are methods of aquiring food socially acceptable
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5 components of food security:
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psychological, social, quantity, quality, suitability
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what determines eligability for most federal assistance programs?
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official poverty line
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poverty threshold is:
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defined dollar amount that is updated yearly, and factors in a food budget that is barely adeuqate.
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food budget used to determine the poverty threshold:
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barely adequate- designed for short term, emergency diets
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poverty guidelines are:
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simplified version of poverty thresholds.
determines elegibility in food stamp programs and Headstart programs |
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2009 poverty guidlines for 1
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10830
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2009 poverty guidelines for 8
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37,010
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for each additional family member after 8 add ___ for poverty guidelines
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3740
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high food securtiy:
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no problems consistently accessing adequate food
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marginal food security
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problems at times, or anxiety about, accessing adequate food, but quality, variety, and quantity of food was not substantially reduced
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low food security
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reduced QUALITY, variety, and desirability of diets, but the QUANTITY of food intake and normal eating patters were not significantly disrupted
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very low food security
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at times during the year, eating patterns of one or more household members were disrupted and food intake reduced because of limited money and other resources for food
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percent of population that experiences hunger or risk of hunger?
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10%
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hunger increasing or decreasing?
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increasing
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what percent of our nation experiences hunger?
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4%
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what percent of housholds are at risk of hunger?
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7%
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problems that come along with children from hunger or risk of hunger homes?
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more chronic illnesses, behavior problems, depression and anxiety problems
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where is food insecurity above average?
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mostly the southern states (fig 10-5)
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do most of the homelss have children?
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yes
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chronic cause of hunger in US?
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food insecurity
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what percent of housholds are at risk of hunger?
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7%
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problems that come along with children from hunger or risk of hunger homes?
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more chronic illnesses, behavior problems, depression and anxiety problems
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where is food insecurity above average?
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mostly the southern states (fig 10-5)
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do most of the homelss have children?
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yes
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chronic cause of hunger in US?
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food insecurity
low paying job |
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Is the poverty line appropriate?
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no. fails to account for any adjustments based on cost of living etc
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when was the federal government was given the authority to buy and distribute excess food commodities
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during the depression
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when was the national school lunch act?
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1946
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when was the food stamp program initiated?
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several years after depression
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when did the nation realize that hunger was very prevalent in US?
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60's and 70's
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when were a food assitance programs revised and expanded and new programs initiated?
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60's and 70's
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after new programs initiated, hunger decreased until
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1980s when Reagan decreased funding for these programs
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The PRWORA encouraged
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self sufficiency
marital births marraige decline in the number on welfare When was this instated? |
1990s
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what replaced: Families with Dependent Children program?
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Temporary Assistance for Needy Families. That was a result of
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welfare reform
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who determines the eligability and benefits of needy families?
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states (side note: strict work requirements that increase yearly)
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ultimate goal of food assistance programs?
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improve food security, nutritional status and health
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how many the food assitance programs served in 2003?
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1 in 5
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top 5 federal food assistance programs that received funding?
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1. supplemental nut. assistance program
2. national school lunch program 3. special supplemental nut. prog. for WIC 4. child and adult care food program 5. school breakfast program |
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supplemental nutrition assistance program is (SNAP):
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Food stamps allow you to buy approved items. You must meet eligability requirements
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SNAP eligability is based on
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household size
income assets housing costs work requirements others |
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income requirement for SNAP
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gross monthly income below 130% of poverty line
Net montly income below 100% of poverty line |
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how are benefits issued in SNAP?
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electronic benefits on a debit card
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what can you purchase with SNAP benefits?
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food and seeds
(no ready to eat foods no vitamins no alc no meds no pet foods no nonfood items) |
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SNAP benefits are about ___ per month per person
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96 dollars per person
215 per houshold |
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2 main problems with SNAP?
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many eligible families dont use it
allotments are insufficient |
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ultimate goal of food assistance programs?
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improve food security, nutritional status and health
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how many the food assitance programs served in 2003?
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1 in 5
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top 5 federal food assistance programs that received funding?
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1. supplemental nut. assistance program
2. national school lunch program 3. special supplemental nut. prog. for WIC 4. child and adult care food program 5. school breakfast program |
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supplemental nutrition assistance program is (SNAP):
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Food stamps allow you to buy approved items. You must meet eligability requirements
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SNAP eligability is based on
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household size
income assets housing costs work requirements others |
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ultimate goal of food assistance programs?
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improve food security, nutritional status and health
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how many the food assitance programs served in 2003?
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1 in 5
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top 5 federal food assistance programs that received funding?
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1. supplemental nut. assistance program
2. national school lunch program 3. special supplemental nut. prog. for WIC 4. child and adult care food program 5. school breakfast program |
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supplemental nutrition assistance program is (SNAP):
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Food stamps allow you to buy approved items. You must meet eligability requirements
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SNAP eligability is based on
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household size
income assets housing costs work requirements others |
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what do national school breakfast/lunch programs do?
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provide assistance so every student can receive a nutritious meal
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how does school programs get benefits?
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Participating schools get cash payments on the basis of the number of meals served in the free, reduced-price, and full-price categories and also receive food commodities
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Requirements of school programs:
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meet nut. requirements
offer free or reduced lunch prices to eligable students |
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who runs school lunch programs
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national (USDA) and state level (Education dept)
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child and nutrition related programs: 4
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after school snack program
special milk program summer food service for children program child and adult care program |
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child and adult care program is for
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helps public and private nonresidential child and adult day care programs provide nutritious meals for these 3 groups:
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children under 12
elderly certain people with disabilities |
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3rd largest program the gov spends money on
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WIC. who does WIC provide for?
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children up to age 5
pregnant/breastfeeding/postpartum women |
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financial eligability for WIC is determined by
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income: 100%-185% poverty line
or: participation in medicaid or SNAP |
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Other eligibility requirement for WIC besides income
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nutritional risk (high risk pregnancy history, anemia, maternal age, inadequate dietary pattern, predisposed medical conditions, homelessness etc)
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Why can't WIC reach all eligible persons?
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It's not an entitlement program
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3 services from WIC
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-food vouchers for foods with nutrients known to be typically lacking in that group
-nutritional education -referrals to health care services |
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Gov program for elderly"
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elderly nutrition program
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who is eligible for elderly nutrition program?
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all person 60 years and older plus their spouse of any age. What do they get?
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meals delivered, or congregate meals
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what comes along with the elderly nutrition program?
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nutrition counseling services
low cost nutritious meals transportation social opportunities referral to social services shopping assistance |
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are food assistance programs doing their jobs?
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kind of. there is still great demand at shelters and places like that
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who is the increased demand for food at shelters coming from?
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working poor with kids
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in an effort to reduce hunger, USDA has partnered with states to create
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Community Food Service Initiative. These include:
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farmer's markets and community gardens
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how many people sought out food by relying on shelters etc?
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25 million
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are we keeping up with the demand for food for poor?
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nope
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largest supplier of surplus food
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second harvest. what does it do?
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distributes food to food banks and other agencies
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Steps of assessing a community
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Evaluate nutritional status
Determine nutritional needs identify where those needs aren't being met |
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nutritional status is
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condition of populations health as affected by nutrient and non nutrient intakes and utilization
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purpose of community assessment
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obtain info about the health and nutritional status of group
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steps of community needs assessment 7
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1.define the nutritional problem
2. set the parameters of the assessment 3. Collect Data 4. analyze and interpret 5. share the findings 6. set priorities 7. choose a plan of action |
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develop a concise statement of the problem of concern is which step of comm. assess.
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1
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purpose of nutritional statement
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plan the assessment and motivate other agencies to do join in as well
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the problem statement of step 1 of comm. assess. should include:
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-who is affected
-how many people affected -impact of the problem on general heatlh -areas where there are gaps in the communities knowledge of a nutritional problem - |
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what is included in step 2 of comm. assess. parameters?
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everything.
defined community target pop types of data needed define purpose of needs assess. |
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what do you collect data on first in comm. needs assess.?
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data on community that pop. lives in
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where is qualitative data found?
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interviews with people who are knowledgeable about the community (key informants)
stake holders |
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key informants are:
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peole who are knowledgeable about the community (provide qualitative data)
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stake holders are
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those with a vested interest in identigying and addressing the nutritional problem
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3 types of data to collect in comm assess.?
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socioeconomic
environmental community |
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environmental characteristics include:
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food systems
housing geography and climate health systems recreation transportation water supply |
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food systems goes under what type of characteristics in data collection?
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environment
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anything that has to do with work, finances, or education goes under
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socioeconomic characteristics
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step 4 of comm. assess. is analyze and interpret data. there are 4 steps to do this:
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1. interpret the state of health
2. interpret the pattern of health care services and programs for the target pop 3. interpret the relationship between the state of health of the target pop and the health care in the community 4. summarize evidence |
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health outcome is:
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effect of an intervention on the health and well being of an individual population
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what should findings of comm. assess. be compared to
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health people 2010
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easily preventable or more difficult to prevent problems have higher priority?
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easier to prevent problems
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3 steps that are included in the plan for obtaining data
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1. review purpose, goals, objectives
2. ask questions related to the nutritional problem 3. determine the best method to find anwers to those questions |
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food supply determines
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which foods are available to the target pop
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low socioeconomic status is associated with
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increased chronic disease
increased stress increased poor outcomes following treatment reduced access to care |
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strongest association with health in children
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poverty
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exerts the most influence on health and nutritional status
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family
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what kind of data do surveys collect
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quantitative and qualitative
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validity?
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does it measure what it is intended to measure
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reliability?
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will it produce the same results on separate occasions?
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accuracy is
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same as validity
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three parts of health risk appraisal
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questionaire
calculations report |
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screening is intended to
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be a preventative health activity designed to reverse, retard or halt the progress of disease by detecting as soon as possible
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focus groups are
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informal groups of 5 - 12 people who meet and share their concerns, beliefs, experiences, opinions or problems
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focuse groups can be used to
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research data and information about key variables used in quantitative studies
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who leads focus groups?
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trained moderator
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most important skill of focus groups?
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listening
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what kind of info do focus groups provide?
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qualitative
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2 things focus groups helps RDs udnerstand?
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1. how a nutritional problem developed
2. whether the target pop perceives a problem |
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informant interviews can be used to assess this info:
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complete a cultural assessment of target pop
help determine if target pop thinks there is a problem |
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key informants connection to community?
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may have conducted research
or worked with target pop |
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4 primary ways of obtaining dietary history?
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food frequency
24 hr recall food record food history. These are all direct assessment |
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two other ways of obtaining direct dietary assessment?
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photograph method
picture sort |
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other direct assessment methods:
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labroatory values
anthropometric measurements physical exam medical history |
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sensitivity is
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the proportion of subjects with the disease or condition who have a positive test for the disease or condition
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how accurate is a sensitive test?
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rarely misses people with the disease
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when is a sensitive test used?
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when a disease is typically in people who appear asymptomatic
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specificity
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proportion of subjects without the disease
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what are specific tests used for?
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to confirm a diagnosis
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highly specific test is?
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OGTT
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an assessment method should be both
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sensitive and specific
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this is needed before data collection can begin. esp before one on one interviews
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cultural assessment
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cultural assessment is:
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identifies inappropriate and appropriate behaviors in a population
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data collected in community needs asses. is typically compared with
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DRIs
US National center for health statistics NHANEs |
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3 strategies for solving nutritonal problems
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food assistance programs
nutrient recommendations reimbursment mechanisms for nutrition services |
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steps of policy making:
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1. problem definition, agenda setting
2. formulation of alternatives 3. policy adoption 4. policy implementation 5. policy evaluation 6. policy termination |
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what happens in step 1 of policy making
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convince others that it is a problem
get it on the policy agenda then get it on the institutional agenda (defined by each legislative body) |
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step 2 (formulation of alternatives ) in the policy making. what happens?
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possible solutions are discussed and devised
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who formulates policies?
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each branch at each level of government
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what two organizations primarily deal with nutrition policies at the federal level?
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DHHS
USDA |
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policy adoption is
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the tools/programs/regulations used to deal with the nutrition problem
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three organizations that are a part of DHHS public health services?
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FDA
NIH CDC |
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mission of DHHS
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protect, promote and advance human physical and mental health
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three organizations thatare a part of DHHS's human resources dept?
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CMS (centers for medicare and medicaid services)
administration for children and families administration for aging |
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USDAs mission is:
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enhance quality of life, ensuring a safe, affordable, nutritious food supply
supporting agriculture reduce hunger |
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what dept delivers the food assistance programs?
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FNS part of USDA
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USDA's research service does:
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research related to nutrient needs through the life cycle, food trends, composition of the diet, and bioavailability of nutrients
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policy implementation involves which levels of government?
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federal to local
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legitimizing is
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belief by citizens that the policy is proper and beneficial and the govt is legal in administering it.
Does each policy have to be legitimized? |
yes.
(court, legislative or regulatory process does this) |
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laws passes by congress are specific or vague?
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vague. who makes them specific?
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USDA or other administrative bodies
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weekly publication containing all regulations and proposed regulations
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federal register
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compendium of all federal regulations currently in force?
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code of federal regulations
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once bills are passed they get...
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a designation public law and number. ex:
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PL 92-433
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law/regulations have no effect unless there are:
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funds to support them
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receipts are
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revenue
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budget authority is
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amount gov agencies are allowed to spend in implementing their plans
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budget outlays
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amount gov agnecies actually paid out by gov agencies
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an authorization
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defines the program and sets ceiling on how much it can spend
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appropriations
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bills passed that allows certain amount of money for a program (all different areas of gov pass on. the ave is basically taken)
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political action committees
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work to raise funds to support candidates or parties
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lobbying:
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talking to public officials and legislators to persuade them to consider the information you provide on an issue you believe is important.
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critical points of lobbying:
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know who and when to do it to
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shift from preventing deficiency diseases to
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preventing chronic diseases
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does the US have a national nutrition policy?
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yes and no.
no, there is no one agency that solely mandates and implements national nutrition policy. yes, there is an array of agencies that promote nutrition policy |
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nutrition research leads to
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nutiriont policy. which leads to
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nut. monitoring
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nut monitoring includes
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nut assessment
nut monitoring nut surveilance nut screening |
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nations monitor nutrition to...
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to decide how to allocate scarce resources, enhance the quality of life, and improve productivity.
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iron status is an example of
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nut assess
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nut surveillance is
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continuous assess of nut status
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nut monitorin gis a
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assess. at intermitent times
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NNMRP
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over 50 surveillance activities to monitor nut status of US
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NHANES contains
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home interview
24 hr recal health exam |
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CARS
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credibility (credentials)
accuracy Reasonableness Support |
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unusual red flag to spot quakcs
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promoter uses computer scored questionnaire for diagnosing nutrient deficiencies
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