Group 2 Tara Braun, Stephanie Bycroft, Kristine Cargill, Jeanette Depue, Jennifer Hanson,

Laryn Phillips, Aundrea Robinson-Burris, Alicia WilliamsonNurs 340

Prob

lem

St

atem

ent

Low income African-American residents of Kent County at risk of excessive rates of

morbidity and mortality from Cardiovascular Disease

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). In Kent County, residents that earned less then $34,999 63.7% are

obese Low income African Americans with low income 35.2 % are obese According to the Behavior Risk Survey in 2008, 54% reported inactivity

in Kent County African Americans rate of physical inactivity was 28.6% according to the

Behavior Risk Survey in 2008 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

WHA

T

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).

CHEC

K TH

IS Q

UICK

VI

DEO

OUT

http://www.youtube.com/watch?v=oj_yTXtFeWo

Curre

ntly

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)

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).

Interventions to prevent and reduce obesity in Kent County will reduce the prevalence and

disparate impact of heart disease.

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.

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

PATHOGENESISOF

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, )

In T

heor

y

THE SOCIAL MARKETING

THEORY CAN BEST ADDRESS THE OBESITY

AND HEART DISEASE PROBLEM IN THE AFRICAN

AMERICAN COMMUNITY IN

KENT COUNTY. THE STRATEGY FOR

ACHIEVING THIS IS BY

EATING LESS, EATING HEALTHIER FOODS, AND

EXERCISING MORE BUT

THE PRIMARY FOCUS IS

THE MAINTENANCE OF

HEALTHY BODY WEIGHT

AND SHAPE.

Why

Soc

ial

Mar

ketin

g Th

eory

Wor

ks Use of marketing principals and

practices to change health behaviors or beliefs, social or cultural norms, or community standards. ( Harkness and DeMarco, 2012).

Used to influence the behavior of individuals or the behavior of policymakers and influential persons for policy and environmental changes. (Social Marketing Resources | DNPAO | CDC. (n.d.).

The structured planning process allows you to make well-informed decisions about what audiences to target, what are their specific needs, and how you can meet those needs. (Social Marketing Resources | DNPAO | CDC. (n.d.).

designdamage.com

cnyric.org

graphicleftovers.com

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.

STAG

ES O

F CH

ANGE

:TR

ANST

HEO

RETI

CAL

MO

DEL

Precontemplation

Contemplation-intentions of starting program

Action- a developed program and intention for sustain program

Preparation-steps started to begin a program

Maintenance- program established and intended to continue

AN INTEGRATIVE, BIOPSYCHOSOCIAL MODEL TO CONCEPTUALIZE THE PROCESS OF INTENTIONAL BEHAVIORAL CHANGE.IS AN APPROACH TO BEHAVIOR CHANGES INVOLVING THE TIMELY READINESS OF THE LEARNER. (HARKNESS, G. A., & DEMARCO, R. (2012)

Change:

How quickly the message for change reaches the

target audience

Message is

easily underst

ood

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 five years after the interventions have

been initiated

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).

Nutrition

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

Cou

nty’

s Ob

esity

Initi

ative

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)

Prog

ram

s Th

at

wor

k

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).

Prog

ram

s Th

at

wor

k

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 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 Res

ourc

es to

Su

ppor

t Ini

tiativ

es

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 – Obesi

ty Initiat

ive

Task Force

on Healt

h Care for

People of

Color

STRIDES

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.o

rg/

Task

Forc

e on

Hea

lth

Care

for P

eopl

e of

Co

lor

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 to five years.

Whe

n W

ill

Chan

ges

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

Whe

n W

ill Ch

ange

s 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.)

Evaluating

Outcomes

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 betterEvaluating the effects of the

interventions

Obes

ity ra

te

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.

Hear

t Dise

ase:

Wha

t to

exp

ect f

rom

an

effec

tive

inte

rven

tion There will be 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.

Measurable

Outcom

es for

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 to produce change in the health behaviors of this community

Refe

renc

es

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

renc

es

Kent County Health Department. (2006). Health Care for

people of color: Final report 2006. Retrieved from http://

www.accesskent.com/Health/HealthDepartment/Publication

s/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/Publication

s/taskforce/Appendix_A_Clinic_Mapping_Project_Report_200

5.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/Publication

s/taskforce/Appendix_A_Clinic_Mapping_Project_Report_200

5.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/Publication

s/taskforce/Appendix_A_Clinic_Mapping_Project_Report_200

5.pdf