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134 Cards in this Set

  • Front
  • Back
goal of community nutrition
prevent disease and promote health
arenas of a community nutrition professional
1. people (assessing nutr status and forming plan)
2. policy
3. programs
policy
political decisions for implementing programs to achieve societal goals
program
tools used to change eating patterns and physical activity behaviors to promote health and prevent disease

i.e. "Got Milk?"
health
state of complete physical, mental, and social well-being (not merely absence of disease)
public health
focuses on protecting and promoting people's health through actions of society
reasons for public health (4)
1. societal goal of adequate nutrition to all
2. dietary contributions to leading causes of death
3. nutr risks vary by population group
4. behavior change isn't easy
interventions
health promotion activity aimed at changing the behavior of a target audience
goal of nutrition interventions
promote health and prevent disease through behavioral changes
strategies of nutrition interventions (3)
1. build awareness
2. change behavior/lifestyles
3. create supportive environments
primary prevention efforts
absolute disease prevention

i.e. nutrition education, food policies

(no disease)
secondary prevention efforts
identifying risks or screening to identify diseases early on

i.e. mammograms, health fairs

(asymptomatic disease)
tertiary prevention efforts
treatment and rehabilitation after onset of disease to reduce further complications

i.e. disease mgmt, in-patient hospitals

(clinical disease)
levels of nutrition interventions
1. individual-based
2. community-based
3. systems-based
individual-based NUTR interventions
change knowledge, attitudes, behaviors of individuals

(+) personalization
(-) lot of work for small outcome
community-based NUTR interventions
population-based or subgroups

(+) potential to change norms to influence behavior
(-) lacks personalization, costs, not always effective for all ppl
systems-based NUTR interventions
policies, laws, regulations

(+) potential to influence behaviors among large number of people
(-) lacks personalization, costly, not applicable to everyone
10 essential public health services
1. monitor
2. diagnose and investigate
3. inform/educate/empower
4. mobilize
5. develop policies/plans
6. enforce
7. link (ppl to health services)
8. assure
9. evaluate
10. research
responsibilities of public health nutritionists (3)
1. assessment
2. policy development
3. assurance
assessment
process of identifying problems existing within community
policy development
finding solutions based on programs with evidence of being effective
assurance
assuring implementation and evaluation of programs developed
licensure
process to ensure that only qualified, trained dietetics professionals provide NUTR services or advice to individuals requiring/seeking NUTR counseling

non-licensed practitioners may be subject to prosecution for practicing w/o a license
purpose of HP initiatives
set goals and objectives for the US population's health
2 goals of HP 2010
1. increase quality and years of healthy life
2. eliminate health disparities
3 HP 2010 physical activity objectives that have made insufficient progress
1. moderate PA grades 9-12 (-25%)
2. vigorous PA grades 9-12 (-10%)
3. participating in daily PA in school grades 9-12 (-5%)
3 HP 2010 nutrition objectives that have made insufficient progress
1. healthy weight: 20+ years (-50%)
2. obesity: 20+ years (-88%)
3. overweight/obesity: 6-19 years (-83%)
possible contributing factors to observed health disparities (5)
1. culture
2. access to use of health care services/lack of health insurance
3. SES gradients
4. environment
5. discrimination
government programs responsible for monitoring nation's nutrition status (2)
1. department of health and human services (DHHS)
2. united states department of agriculture (USDA)
NNMRRP
'national nutrition monitoring and research related program"

federal and state NUTR monitoring and related research activities

jointly implemented by USDA and HHS
goals of NNMRRP (4)
1. stimulate research (produce science)
2. collect data (5 areas)
3. identify high risk groups
4. provides baseline data for monitoring and surveillance
areas of data collection in NNMRRP (5)
1. nutr and health-related assessment
2. food and nutrient intake
3. measures of knowledge, attitudes, behaviors
4. food composition and nutr databases
5. food-supply adequacy
examples of NNMRRP: nutrition and health related assessment surveys (2)
1. national health and nutrition examination survey (NHANES)
2. pediatric nutrition surveillance system (PedNSS)
NHANES
national health and nutrition examination surveys

annual data collection since 1999
combines interviews with physical exams (wt, ht, bld tests)
PedNSS
"pediatric nutritional surveillance system"

monitor the nutritional status of low-income infants, children, and women in federally funded maternal and child health programs
examples of NNMRRP: food and nutrient intake surveys
1. continuing survey of food intakes by individuals (CSFII)
2. what we eat in america (WWEIA)
CSFII
USDA - "continuing survey of food intakes by individuals"

USDA, CSFII merged with HHS, NHANES to create integrated federal food survey = WWEIA (what we eat in america)
WWEIA
"what we eat in america"

NNMRRP: food and nutrient intake survey

integrated federal food survey of CSFII (of USDA) and NHANES (of DHHS)
examples of NNMRRP: measures of knowledge, attitudes, and behaviors surveys (2)
1. behavioral risk factor surveillance system (BRFSS)
2. youth risk behavior survey
BRFSS
CDC - "behavioral risk factor surveillance system"

NNMRRP: measures of knowledge, attitudes, and behaviors survey

largest phone survey tracking health conditions and risk behaviors in US
YRBSS
CDC - "youth risk behavior surveillance system"

NNMRRP: measures of knowledge, attitudes, and behaviors survey

monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults
examples of NNMRRP: food composition and nutrient databases (3)
1. national nutrient databank
2. nutrient database for standard reference
3. survey nutrient database
national nutrient databank
NNMRRP: food composition and nutrient database

annual conference held to foster communication among nutrient database generators and users
nutrient database for standard reference
NNMRRP: food comp and nutrient database

developed by USDA's nutrient data laboratory (NDL)

he foundation of most food and nutrition databases in the US, used in food policy, research and nutrition monitoring
survey nutrient database
NNMRRP: food comp and nutrient database

now known as food and nutrient database for scientific studies (FNDSS)

includes info used to code individual foods and portion sizes and nutrient values for calculating nutrient intakes
examples of NNMRRP: food-supply adequacy programs/surveys (2)
"food available for consumption by US population"

1. USDA's center for nutrition policy and promotion (CNPP)
2. food supply series surveys
CNPP
USDA - "center for nutrition policy and promotion"

NNMRRP: food supply adequacy program

develops and promotes dietary guidance that links scientific research to nutrition needs of consumers
food supply series surveys
NNMRRP: food supply adequacy survey

historical series measuring amount of nutrients per capita per day available for consumption in US
goals of nutrition policies (3)
1. increase public knowledge about sound dietary practices
2. unify food and nutritional policy
3. access to safe and nutritious food supply
programs overseeing US nutrition policy (2)
1. united states department of agriculture (USDA)
2. united states department of health and human services (HHS)
TDSHS
"texas department of state health services"

vision: a healthy texas
mission: to improve health and well-being in texas

surveys: TX BRFSS and YRBSS
texas diabetes council
component of texas department of state health services (TDSHS)

vision: a texas free of diabetes and its complications
mission: to effectively reduce health and economic burdens of diabetes in texas
community needs assessment
evaluating health/nutrition status of community; ID resources to meet community needs (nutrient intake, access, availability)
purpose of community needs assessment
collect info about a target population in a community
reasons for assessing community needs (4)
1. community understanding
2. generate new data
3. validate research
4. obtain funding
defining components of "community" (5)
1. target population?
2. where do they live?
3. basic community demographics?
4. major social institutions? where does community interact?
5. opinion leaders for target population?
goals
broad statements of what the activity or program is expected to do

ex: "to identify students perceptions of what constitutes healthy living"
objectives
statements of outcomes and activities needed to reach a goal

ex: "in next 2 mts, ID students perceptions of healthy eating using qualitative survey from 500 TAMU students'
advantages of needs assessments using existing data approach (4)
1. easy and quick access of data
2. can monitor trends
3. relatively inexpensive
4. lower human resource burden
disadvantages of needs assessments using existing data approach (3)
1. existing data = indirect indicators
2. info may be outdated
3. data is objectives (doesn't measure what communities WANT)
community assessments used when existing data not available (6)
1. screening
2. health risk appraisals
3. direct nutrition assessments
4. surveys
5. key informant interviews
6. focus groups
examples of existing data sources used for community nutrition assessments (9)
1. US census
2. CDC
3. NCHS
4. USDA
5. medline
6. NNMRRP survey results
7. municipal/county/state records
8. annual reports from hospitals
9. school districts web pages
developing community demographic profile
**US census bureau

-geographic location
-type of community
-total population
-gender/age/ethnicity
-education...
developing community health profile
**DSHS texas state facts

finding data through local/state health agencies
developing community nutritional status
**NHANES, collecting data yourself if limited existing

data will range by target population
dietary assessment methods (3)
1. 24-hour recalls
2. diet records
3. food-frequency questionnaires (FFQ)
24-hour recall
respondant provides detailed list on what they've eaten over past 24-hr period
advantages of 24-hour recalls (4)
1. gives current, specific information
2. doesnt change current eating behaviors
3. relatively quick and non invasive
4.more representative of population
disadvantages of 24-hour recalls (3)
1. problems remembering foods eaten
2. underreporting of socially unacceptable foods
3. diet depends on day of week survey is done
diet record
self-recorded dietary intake over 3-4 day period (either estimated or food weight record)
advantages of diet records
1. more representative than 24-hour recall
2. memory not a concern
disadvantages of diet records
1. people may change intake (bias)
2. requires literacy (not rep of overall population)
3. higher respondant burden
food frequency questionnaire (FFQ)
individual given list of foods and asked to record how often they eat those foods

quantitative/semi-quantitative
advantages of FFQs (4)
1. can be self-administered
2. low time committment
3. inexpensive
4. can be used to describe general intake patterns
disadvantages of FFQs (3)
1. may not consider seasonality
2. all cultural backgrounds may not be represented
3. high cognitive burden (may require intake of past year)
building community environmental profile
indentify physical/social factors of environment that may impact dietary intake and PA in community
examples of physical factors of community environmental profiles
location
# grocery stores
# sidewalks
examples of social factors of community environmental profiles
proximity of food stamp office
# food banks/food pantries
the built environment
environment structures that encourage/discourage healthy eating and physical activities
influences on built environment (4)
1. walkability
2. green space
3. food availability
4. urban sprawl
tools for assessing perceptions of the community's health/nutrition status and DISADVANTAGES of each (4)
1. community meetings (bias)
2. community surveys (certain types not accessable to everyone - email, telephone..)
3. key informant surveys (bias, not rep. of whole pop)
4. focus groups (group think)
surveys
systematic study of cross section of individuals who represent the target population

qualitive data

1 on 1, mail surveys, electronic, telephone...
advantages of survey approach to community assessment (4)
1. anonymity
2. easy to administer
3. info from service recipients
4. follow-up possible
disadvantages of survey approach to community assessment (6)
1. costs
2. sample selection
3. requires time/expertise
4. response rate (can be low)
5. response clarification
6. respondant bias
survey design issues (4)
1. requires individuals trained in survey design
2. who/how will survey be implemented?
3. survey appropriateness (literacy levels of target pop, cultural appropriateness...)
4. comprehensive w/o being overwhelming
focus groups
informal group of 6-12 people who are asked to share their concerns, experiences, beliefs...

*requires trained moderator to ask open-ended questions
advantages of focus group approach to community assessment (4)
1. easy (esp to respondant)
2. data in short time period (1-2 hr)
3. social interaction promotes complete responses
4. clarification
disadvantages of focus group approach to community assessment (4)
1. requires trained moderator
2. scheduling (for respondants)
3. potential bias
4. group may not be representative
steps for community nutrition assessments (4)
1. ID community resources/assets/utilization of resources
2. analysis (ID data patterns)
3. interpretation
4. summarize findings
considerations when prioritizing problems as a result of needs assessments (7)

think: "wound"
1. cause of problem
2. size of problem
3. morbidity vs. mortality
4. serious of problem (personal vs. social)
5. likelihood of affecting community
6. support you have
7. available resources to address problem
food security
access by all people at all times to sufficient food for an active/healthy life

minimum = ready availability of nutritionally adequate/safe foods and ability to acquire them in socially acceptable ways
food insecurity
limited/uncertain ability to acquire or consume an adequate quantity of food in socially acceptable ways
low food security
households reduce quality, variety, desirability of diets

quantity of intake/normal eating patterns not usually affected
very low food security
at certain times during year, eating patterns of 1+ household members were disrupted and food intake reduced b/c household lacked money/other resources for food
factors that determine food security (6)
1. quantity
2. geographic location
3. access to preferences
4. cultural beliefs
5. socially acceptable ways of obtaining foods
6. tools for preparation of food
risk factors for food insecurity (8)
1. poverty
2. unemployment
3. food stamp participation
4. high school drop-outs
5. sudden economic changes
6. the young/the old
7. ethnic minorities
8. inner city vs. rural locale
consumer price index (CPI)
defines average costs of a marketbasket of goods/services; inflation-adjusted

determines eligibility for most income-based assistance programs in US

poverty threshold (PT) based on CPI
the working poor
population who maintains employment but incomes fall at/below poverty threshold

~5% US labor force
usually provide no benefits
make at or slightly above minimum wage
determinants of poverty
money income (before taxes), number of people in household

counts = earnings, unemployment compensation, SS benefits, public assistance, alimony, child support

doesnt count = food assistance (SNAP), housing subsidies, capital gains/losses
nutritional consequences of food insecurity on children (vs. food secure households) - 5
1. no dietary variety w/i food groups
2. no difference in E/macronutrient intake
3. may have reduced nutrient intake (may eat less of certain food groups)
4. mas consume less dairy/meat
5. increased consumption of E-dense foods
nutritional consequences of food insecurity on adults (vs. food secure households) - 3
1. women at higher risk for nutritional compromise (feeding families first)
2. lower F&V intake
3. reduced diet quality (fewer nutrients)
challenges of eating healthy foods for low-income people (2)
1. availability of full-service grocery stores (more smaller grocery/convenience stores)
2. higher costs of healthier foods
health consequences of food insecurity on children (4)
poorer health
1. incr in hunger
2. poorer developmental outcomes
3. incr iron-deficiency anemia
4. incr hospital visits
health consequences of food insecurity on adults (3)
1. incr prevalence of chronic disease
2. poorer disease mgmt (esp DM)
3. higher rates of HIV/depression
possible explanations for association b/w poverty and obesity
1. costs
2.convenience
3. satiety (feeling of fullness)
4. satiation (controls how long fullness lasts; triggers hunger)
4. palatability
social consequences of food insecurity
1. cognition
2. productivity
3. behavior
4. social interaction
social gradients of health and disease
decreasing socioeconomic status corresponds to decrease in health
biological cause of health disparities
chronic stress due to racism and lower SES wears down body's system, resulting in higher rates of disease and early death
reasons for decreased control of stress responses (3)
1. illnesses
2. working longer hours
3. few resources
biological responses to chronic stress (4)
1. hypertension
2. inhibits memory
3. impairs immune function
4. impairs control of glucose
--> accelerates aging and increases risk of disease
hormal causes of association b/w SES and health
CORTISOL (incr BP)
higher in:
1. lower income/education
2. lower SES
3. people with little power
steps of program planning - "MAP IT"
1. mobilize - collaboration
2. assessment - data collection
3. planning - prioritizing problems, G&O's, strategies to meet G&O's
4. implementation
5. track progress - program evaluation
mission statement
a broad statement of an organization's purpose or reason for being
programs
planned, collective activities with intention of producing desired outcome (in nutrition, disease prevention/health promotion)
program planning
process of designing a program to meet a nutritional need in the community by
1. ID needs
2. exploring solutions/intervention strategies
3. designing intervention that results in desired outcome
triggers of program planning (3)
1. results of needs assessments
2. monitoring data/research findings
3. funding opportunities
components of program objectives (4)
1. action/activity to be undertaken
2. target population
3. criteria for success
4. time frame for achievement

ex: 50% of children in BISD will be able to ID healthful snacks by May 2010.
outcome objectives
measurable change in health or nutrition statues

includes:
1. action
2. criteria for success (benefit)
3. target population
4. time frame

measurable/realistic??
process objectives
specifies HOW outcome objectives will be achieved

measures IMPLEMENTATION (outcome measures success)

ex: each of the nutritionists witll conduct 2 nutrition classes per week over a 3 month period
additional factors to consider during program planning (6)
1. marketing/recruitment
2. number served
3. resources to implement
4. cost to client?
5. eligibility requirements
6. program funding (budgeted vs external funds)
program process evaluation
assesses program implementation (process objectives)
summative evaluation
did program achieve stated success target? (outcome objectives)
components of program planning (6)
1. community needs assessment
2. prioritizing nutrition problems/issues
3. goals and objectives for programming
4. plan development
5. plan implementation
6. plan evaluation
purpose of using behavior change theories in program planning
helps predict behaviors of certain populations
reciprocal causation (ecological perspective concept)
people influence other people AND their environment AND vice versa
2 key concepts of ecological perspective theories
1. levels of influence
2. reciprocal causation
level of influence (ecological perspective concept)
1. intrapersonal level
2. interpersonal level
3. community level (institution, community, public policy)
assumptions of TTM (or stages of change) - 3
1. people don't change behavior overnight (people not action-oriented)
2. nterventions more likely to succeed if stage-oriented
3. change doesnt occur in straight line
five stages of change (TTM)
1. precontemplation stage
2. contemplation stage
3. preparation stage
4. action stage
5. maintenance stage
precontemplation stage of TTM
has no intention of taking action w/i the next 6 mts

strategies = increase awareness; personalize info about risks/benefits
contemplation stage of TTM
intends to take action in next 6 mts

strategies = motivate; encourage to make specific plans
preparation stage of TTM
intends to take action w/i next 30 days; has already taken small steps towards change

strategies = assist in development/implementation of action plans; help set gradual goals
action stage of TTM
has changed behavior for less than 6 mts

strategies = assist with feedback, problem solving, social support, reinforcement
maintenance stage of TTM
has changed behavior for more than 6 months

strategies = assist with coping, reminders, finding alternatives, avoiding relapses