Public Health Nutrition Final

What to limit for children

1200-2000 calories per day for ages 4-8 1400-2600 calories per day for ages 9-13 25-35% of total calories from fat less than 10% of total calories from saturated fat less than 1900 mg per day sodium for ages 408 less than 2200 mg per day sodium for ages 9-13 Consume less than 10% of calories per day from added sugar

Describe the extent to which Americans are meeting PA guidelines

20% meet guidelines that are 18 or over 30% between 18-24 25% between 18-64 15% between 64 and 74 less than 10% over 75

Give examples of cultural sensitivity in health promotion.

Cultural sensitivity is the heightened knowledge of the needs of the client/target audience

Explain the concept of "compression of morbidity."

Delaying the onset of disabilities caused by chronic disease, extending healthy life span

Physical activity recommendations for children 6-17 y/o

60 minutes or more of moderate to vigorous PA each day Aerobic: most should be moderate or vigorous intensity aerobic PA and should include vigorous PA on at least 3 days a week Muscle strengthening: include muscle strengthening PA at least three days a week Bone strengthening: include bone strengthening PA on at least 3 days per week

Suggest strategies for health promotion in the workplace, and give examples of successful worksite wellness programs

Access to nutritionist/health coaches/personal trainers Tobacco cessation support Healthy food/vending options on site Standing/treadmill desks Stress management programs Access to PA facilities and/or workday opportunities to be active

Define acculturation and ethnocentrism, and describe why these concepts are important for public health nutrition.

Acculturation: a process by which a cultural group adapts or learns cultural norms of another group Ethnocentrism: a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media As people become acculturated in the US, their dietary habits begin to change from whole grain to refined carbohydrate and high fat intake, which can lead to obesity and heart disease

The Home-Delivered Nutrition Program (Meals on Wheels)

Established in 1978 Provides healthy meals in the home Provides informal "safety check" for homebound older individuals Serves as primary access point for other home and community based services Administered by volunteers and paid staff who deliver meals Often spend time with participants and help decrease feelings of isolation

What is a risk factor

A behavior, environmental exposure or inherent human characteristic associated with an important health related condition Risk factors are associated with an increased probability of a particular negative health outcome

Metabolic Syndrome

A cluster of cardiometabolic risk factors associated with increased risk of multiple chronic diseases including cancer and CVD Metabolic risk factors (3 or more =metabolic syndrome) are large waistline/excess abdominal fats, high triglycerides, low HDL, hypertension, and high fasting blood glucose Can be prevented or delayed with lifestyle changes

What is the WIC program

A short term intervention program designed to safeguard the health of low income women, infants, and children up to 5 years old who are at nutritional risk

Describe the current prevalence of obesity in the United States

About 40% of all Americans are obese

Explain the relationship between alcohol and health

About 88,000 people die from alcohol-related causes each year Third leading preventable cause of death Includes effects of chronic use and accidents Alcohol misuse cost 249 billion in 2010 3/4 of which was contributed to binge drinking Binge drinking are drinking patterns that bring BAC to beyong 0.08 g/dL (4 drinks for women, 5 for men in 2 hours)

Summarize the 2018 Physical Activity Guidelines recommendations for adults

Adults should move more and sit less Some PA is better than none Additional health benefits are gained by engaging in PA beyond 300 minutes of moderate-intensity physical activity a week Adults should do muscle strengthening activities (moderate or greater intensity) that involve all major muscle groups 2 or more days a week

What is advocacy

Advocacy is the act of supporting or promoting a cause

Four broad steps for creating policy:

Agenda setting: identify the problem and potential solutions, convince others of the need to act Policy formulation: create a policy to address the issue, develop alternatives, debate and modify the policy as needed, attempt to pass into law Policy implementation: Translate law into rules and regulations, ensure adequate funding Policy evaluation: Determine whether the policy was successful, make changes as necessary

Describe social marketing's role in health promotion

Aimed at changing peoples behavior for the benefits of individuals and society as a whole Widely used in public health to market for social good instead of social profit Family planning/condom use, HIV prevention, tobacco cessation, sunscreen use, physical activity promotion, breastfeeding, etc.

Prevalence

All cases/All individuals in a population Measures presence of disease Useful for resource allocation and surveillance

WHO and UNICE's global recommendations

Exclusive breastfeeding for 6 months Nutritionally adequate and safe complementary feeding starting from age of 6 months with continued breastfeeding for 2 years of age or beyond

Describe the changing race/ethnicity demographics of the United States and the implications of these shifts for public health nutrition efforts.

America is becoming more culturally diverse therefore it is necessary to understand these cultures to direct public health efforts

Obesity and "eating out"

Americans spend about 1/2 of their food dollars eating out Consumption of FAFH associated with obesity due to larger portions and greater calorie-density Higher FAFH availability is linked to obesity

Global Undernutrition

An estimated 815 million people undernourished in 2016 up from 777 million in 2015 Confined to developing countries Many economic, social and political factors contribute to food insecurity, hunger and undernutrition Conflict and climate events further exacerbate these food and health crises

Food swamps

Areas with a high concentration of energy-dense, obesogenic foods Obesity has been more strongly linked to presence of these outlets than the absence of grocery stores

Food deserts

Areas with limited access to nutritious foods Few/no supermarkets within defined radius (often "walkable distance," or 1 mile) Often in low-income communities Urban environment typically has more robust, more formal food assistance systems than rural Associated with poorer diets and poorer health outcomes

SNAP restrictions

Benefits may only be used for food and beverages with a nutrition label as well as seeds to grow food Alcohol and tobacco purchases are prohibited Generally cannot be used at restaurants or for prepared foods

Defining childhood overweight and obesity

BMI= weight in kg/(height in m)^2 Because children are growing we expect BMI to increase with age so instead we measure weight status using BMI percentiles Underweight: less than 5th percentile Healthy weight: 5-85th percentile Overweight: 85-95 percentile Obese: 95th percentile or greater

Describe the economic burden of chronic disease in the United States

Baby boomers began retiring in 2011 and are relying on government programs such as Medicare and Social Security. Most have one or more chronic disabilities and trouble with routine activities. This poor health is possibly linked to post-WW2 changes in the food supply. 90% of healthcare expenditures in the US are for people with chronic and mental health conditions (3 trillion a year) By 2030 medical costs associated with obesity are expected to increase by at least 48 billion annually, with annual loss in productivity totaling 390-580 billion

Where are WIC services provided

County health departments Hospitals Mobile clinics Community centers Schools Public housing sites Migrant health centers and camps Indian health service facilities

Define creativity and explain why it is important for public health nutrition practitioners

Creativity is the ability to make new things or think of new ideas and it is important for making public health interventions that will work

Explain the four steps to acquiring cultural competence.

Cultural awareness: Developing an understanding and sensitivity to another ethnic's groups values, beliefs, practices, lifestyles, and problem solving strategies Cultural knowledge: Acclimitizing to selected cultural characteristics. Acquiring information relevant to effective health promotion Cultural skill: Applying cultural awareness/knowledge to meet participants needs Cultural encounter: To preserve participants cultural values, beliefs and behaviors that support good health

What are health disparities

Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged population Populations can be defined by factors such as race/ethnicity, gender, education, income, disability, geographic location or sexual orientation

Most prevalent diet-related chronic diseases in the United States

CVD Type 2 Diabetes Metabolic Syndrome

Nutrition needs in older adults

Calcium and vitamin D to maintain bone health: consuming 3 servings of dairy, fortified cereals/juices, dark green vegetables, canned fish with soft bones Vitamin B12: absorption decreases with age so increased consumption of fortified cereal, lean meat/fish recommended Fiber: to promote regularity, lower risk of heart disease, control weight, prevent type 2 diabetes; eat WG breads, cereals, beans, FV Potassium: can help lower blood pressure (if salt also reduced); consume FV, dairy and yogurt Fluids: important for avoiding dehydration since thirst sensation decreases

Explain the pros and cons of using taxes to shift health behaviors

Can cause individuals to make a healthy change. Taxes can be used for health education, healthy food subsidies or other public health efforts. May seem unfair May not change habits depending on price elasticity of demand

Explain the importance of physical activity for older adults, and summarize recommendations for physical activity.

Can help maintain healthy longer lives, prevent chronic disease, help retain bone and muscle mass, prevent cognitive decline, and improve mood Recommendations: Same as for adults At least 150 minutes moderate PA per week or 75 minutes vigorous PA per week Muscle strengthening activities at least 2x per week Be active as abilities allow Engage in exercises that support balance Seek guidance from healthcare provider about how to engage safely in PA

Define cultural competence and explain why it is important for public health nutritionists and other health practitioners.

Cultural competence is having the ability to work effectively with individuals from different cultural and ethnic backgrounds It is important for public health nutrtionists because: it helps in understanding the importance of social and cultural influences on individuals health beliefs and behaviors. Considering how these factors interact at multiple levels of the healthcare delivery system Devising interventions that take these issue into account to ensure quality of care Cultural competence can help increase the effectiveness of public health nutrition programs and policies and help eliminate health disparities

The social-ecological model

Child/Cellular Clan Community Country Culture

Describe the relationship between diet and chronic disease

Chronic disease rates have increased in the US following major changes in diet and lifestyle after WWII. These changes occurred due to industrialization of the food supply, federal agricultural policies increased the availability of energy dense, highly processed foods high in salt, sugar and fat and an increasingly sedentary lifestyle. The major risk factors for chronic disease are modifiable by addressing diet, physical activity and tobacco and alcohol.

Brainstorming

Coined by Alex Osborn Designed to generate a large quantitiy of ideas to address a specific problem by harnessing the power of a group dynamic Osborns classic rules: Withhold judgement Encourage wild, exaggerated, unusual ideas Focus on quantity Build on the ideas of others

Plan ways to get to know your target audience in a public health nutrition intervention.

Conduct a literature review of existing data on the target population: look at prevalence of obesity, health knowledge, barrier to healthy eating and physical activity, etc. Sources of information: Government surveys, peer reviewed literature articles, health related databases, etc.

Non-randomized controlled study

Conducted when randomization is not feasible

Discuss the effects of the Berkeley, CA tax on sugar-sweetened beverages

Consumption of SSB's in Berkeley decreased by 21% but increased by 4% in comparison cities Water consumption increased more in Berkeley (+63%) than it did in other cities (+19%)

Risk reduction strategies for preconception

Counsel women of reproductive age to consume 400 mcg of folic acid/day from fortified foods and/or supplements and consume a balanced, healthy diet of folate-rich foods Achieve adequate intake of other key nutrients, including Vitamin D: 600 IU/day Calcium: 1000 mg/day Iron: 15-18 mg/day Iodine: 150 mg/day Achieve or maintain healthiest BMI possible

Summarize the physiological changes that occur with advanced age.

Decline in organ function: Liver- alcohol related sickness, detoxification hindered Gallbladder- gallstones, less bile production, decrease fat absorption Pancreas-high blood glucose, less insulin produced Kidney- loss of nephrons, decrease ability to excrete waste Decreased immune function-vulnerable to infections, major cause of death in older adults Body compositions-sarcopenia or flesh loss, loss of muscle and bone, gain in body fat

WIC's public health impact

Decrease premature births Decrease low and very low birthweight babies Decrease fetal and infant deaths Decrease incidence of iron-deficiency anemia Increase access to prenatal care earlier in pregnancy Increase immunization rates Increase access to regular healthcare Increase diet quality Increase pregnant women's consumption of iron protein calcium and vitamins A and C

Summarize the nutrition-related changes that occur with advanced age.

Decreased GI function: Constipation Reduce lactase Decrease gastric acid production Impaired absorption of B12, folate, Ca, Zn, Fe Poor dental health: Problems chewing Food choices affected Reducing vision, hearing: Limits driving ability Affects shopping Limited mobility: Under nutrition in homebound Decreased appetite: Decreased sense of smell and taste Reduced thirst sensation: Dehydration

Describe the DETERMINE method of screening for nutrition risk factors among older adults.

Disease Eating poorly Tooth loss or mouth pain Economic hardship Reduced social contact Multiple medications Involuntary weight loss or gain Needs assistance Elderly person

Distinguish between divergent and convergent thinking

Divergent thinking: create choices Convergent thinking: make choices

What formal goals are in place to guide public health efforts in the US and across the world

Domestic: Healthy People 2020 International: Sustainable development goals which have succeeded the millennium Development goals

What are some ways a policy can be enforced

Fines Criminal charges Loss of funding Seizure of non-compliant goos Civiil liability

Identify the major areas for improvement in the American diet

Eat more fruits and vegetables Ea less total grains, eat more dairy, consume more oils, less added sugars, saturated fats and sodium

What can stand in the way of good nutrtion

Economic constraints, food literacy/skills, food access, cultural influences, medical conditions and illnesses

Reducing the economic burden of chronic disease

Effective public health interventions that target chronic diseases, lead to a healthier population, lower healthcare spending, less absenteeism from work and school, increased economic productivity and improved quality of life Every 1$ spend on evidence based programs meant to improve saves 5.60 in health spending within 5 years and 6.20 in 10 Every 1$ spent on workplace wellness decreases medical costs by 3.27 and the costs of absenteeism by 2.37

Who is eligible for SNAP benefits

Eligibility based on: Income Household composition Citizenship/immigration status Resources

Cardiovascular disease

Encompasses a range of conditions such as stroke, hypertension, coronary artery disease etc. Leading cause of death for men and women (1 in 4 deaths) Risk factors are high blood pressure and cholesterol, smoking, poor diet, overweight/obesity, etc.

Nutritional needs in adulthood

Energy and nutrients needed to maintain and repair body tissue, support activity, and maintain weight Goals are to prevent deficiencies, control weight, support the immune system, and prevent chronic disease

Contributors to energy imbalance

Energy in: Large portions Frequent eating away from home Ubiquity of low cost, energy dense, nutrient poor foods Over consumption of SSB's Food advertising/marketing aimed at children Energy out: Declines in PA Physical education and recess cuts Changes "built" environment Both: Less sleep Multi-media saturation

What is the food environment

Environmental and structural factors that influence food choice Defined by the 3 A's: food availability, accessibility, and affordability An important modifiable target for public health nutrition interventions

What do we get from epidemiology

Epidemiology is a statement of what is upon the people Provides the basis for understanding health related problems including how a disease is distributed in a population, how diseases originate and progress, how to prevent disease and promote health

Goals of epidemiology

Epidemiology is data-driven and the goal is to identify targets for intervention that could reduce the burden of disease in a population

The Congregate Nutrition Program

Established in 1972 that serves healthy meals while presenting opportunities for social engagement, health and wellness activities and meaningful volunteer roles

Describe the four domains of creative thinking and give examples of how each domain can be expressed

Fluency: the ability to produce a quantity of ideas or alternate solutions to a problems such as alternate uses for a paper clip Flexibility: the ability to generate ideas that show a variety of possibilities or realms of though; see tings from different points of view;use many different approaches or strategies. What kind of car would you be, what does your dog think of your morning routine. Originality: the ability to generate unique or unusual ideas and to synthesize information in a new way. Find an original use for a beach ball, design a better back pack, strongest way to set the table Elaboration: the ability to enhance ideas by providing more detail. Story telling describe best meal ever with every detail, product enhancement, what could you add to improve performance to a coffee maker.

Commonly used dietary assessment tools

Food record 24 hour recall Food frequency questionnaire Diet history Digital dietary assessment

Describe the Older Americans Act Nutrition Programs

Formerly known as the Elderly Nutrition Program Includes the Congregate NutrItion Program and the Home-Delivered Nutrition Program Grants provided through the Administration on Aging (Dept. of Health and Human Services) to support nutrition services to older adults Aimed at reducing hunger and food insecurity, promoting socialization, health and wellbeing and to delay adverse health conditions Meals provide at least 1/3 of the recommended Dietary Reference Intakes and align with the Dietary Guidelines for Americans Anyone over 60+ is eligible and there are no income/means tests

What foods can be purchased with SFMNP benefits

Fresh, unprepared and locally grown fruits, vegetables, herbs and honey States define locally grown as produce grown within state borders but may also include areas in neighboring states adjacent to its borders

Shape up Somerville

Goal: To change multiple environments schools, restaurants, healthcare providers, media, after school to shift both sides of the energy equation Large multi-component community based participatory interventions led by Christina Economos at Tufts Embraced a systems approach to prevent pediatric obesity

Randomized controlled trial

Gold standard Individuals are recruited based on eligibility criteria and are randomized to intervention or control group

Post-Brainstorming Procedures

Group evaluation: Review list of ideas Debate merits, pitfalls and relevant details of various ideas Record new ideas as they surface Identify the most promising ideas Discuss ways to refine and test the chosen ideas

US Department of Health and Human Services

HHS is the US governments primary agency for protecting and advancing the health of all Americans, providing health services, helping vulnerable populations Issue the Dietary Guidelines for Americans (with USDA) Includes more than 300 programs that engage in disease prevention, health and social science research, Food and and drug safety (CDC, FDA, NIH, etc.)

Ranges of food security and insecurity by the Usda

High food security: No reported indications of food access problems Marginal food security: 1-2 reported indications of food access problems or limitations-typically over food sufficiency shortage in the house Little or no indications of changes in diets or food intake Low food security: Reports of reduced quality, variety, or desirability of diet, but little or no indication of reduced food intake Very low food security: Reports of multiple indications of disrupted eating patterns and reduced food intake

Consequences of food insecurity

Hunger Physical impairments such as illness and fatigue Stress and psychological suffering Diminished diet quality showing decreases in FV's and micronutrients Reliance on energy dense, nutrient poor foods Increased risk of chronic disease Among children: poor overall health status, psychosocial problems, lower cognitive and academic performance and poor nutrition status

Health benefits of physical activity young children/adolescents

Improved bone health and weight status (3-17 y/o) Improved cardiorespiratory and muscular fitness and health (6-17 y/o) Improved cognition and reduced risk of depression (6-13 y/o)

Describe the human burden of chronic disease in the United States

In 2012 about half of all adults reported having one or more chronic diseased, and 1 in four had two or more. 7 out of 10 deaths are from chronic disease with heart disease and cancer accounting for 46% of yearly deaths. Obesity affects more than 39% of adults and 18% of children Diabetes is the leading cause of kidney failure, lower-limb amputations and adult blindness.

Stunting

Low height for age Chronic undernutrition Consequences: impaired brain development, lower IQ, weakened immune systems, greater risk of chronic disease later in life

Describe the relationship between inactivity and aging.

Inactivity decreases muscle mass and strength, decreases aerobic capacity, flexibility, balance, and bone density Aging increases fat mass, glucose intolerance, depression, and sleep problems and causes inactivity

Major nutrition issues in developing countries

Inadequate Sanitation: Largest nutrition problem in the worlds Affects over 30% of the population Infant mortality: Increases with malnutrition Could be reduced with breastfeeding Childhood undernutrition (stunting and wasting): Related to poverty, hunger, and infectious diseases "Hidden Hunger": Micronutrient deficiencies such as vitamin A, iron, iodine, and folate

Healthy People 2020 Preconception Objectives

Increase proportion of women at healthy weight prior to pregnancy by 10% Reduce the proportion of women aged 18 to 44 who have impaired fecundity by 10% Reduce iron deficiency among females of childbearing age by 10% Reduce the proportion of women of childbearing potential who have low red cell folate concentrations by 10%

Give examples of key Healthy People 2020 goals for older adults.

Increase the proportion of older adults who are up to date on care clinical preventative services Increase proportion of adults confident in managing their chronic conditions Reduce proportion of older adults with moderate to sever functional limitations Increase proportion of older adults with reduced physical/cognitive function who engage in PA Reduce rate of ED visits among older adults due to falls

Describe the health and nutrition needs that emerge in older adulthood.

Increased risk of chronic disease and falls

Risks of not breastfeeding for the child

Increased risk of diarrhea, pneumonia, ear infections, celiac disease, type 1 diabetes, leukemia, lower iq scores Infants not breastfed are 6-10 times more likely to die in the first months of life

Risks of not breastfeeding for the mother

Increased risk of postpartum hemorrhage, breast cancer, ovarian cancer

Describe why worksite wellness interventions are an important strategy for adult health promotion

Influence social norms Establish health-promoting policies Improve employees health and knowledge skills Help employees get necessary health screenings, immunizations and follow-up care Prevent disease and negative health outcomes support morale and employee retention Enhance productivity and reduce absences Reduce healthcare costs Improve diet and physical activity behaviors

Common micronutrient deficiencies in developing nations

Iron Vitamin A Iodine Folate Zinc

Wasting

Low weight for health acute starvation Consequences: Child mortality, increased susceptibility to infection, poor growth and development

What is SNAP

Largest federal hunger assistance program Permits low-income households to obtain a more nutritious diet by increasing their purchasing power (not a cash benefit)

Type 2 diabetes

Leading cause of kidney failure, lower-limb amputations, and adult blindness More than 20% of healthcare spending is for individuals with diabetes. Risk factors include, race/ethnicity, age, overweight/obesity, family history and physical inactivity Complications include heart disease and stroke, blindness, cataracts, glaucoma, kidney disease and amputations

Who influences public policy

Legislators Federal agencies Private companies Nonprofits The media Scientists and professionals

Explain the demographic shifts that are increasing the burden of chronic disease in the United States and throughout the world

Longer life expectancies and declining birthrates lead to an increased percentage of elderly Americans. This causes higher chronic disease rates which leads to higher health care costs. This shift is intensified by the aging Baby Boomer generation born between 1946 and 1964

What is food security

Means by having access by all people at all times to sufficient foods for an active and healthy life

Why is dietary intake notoriously difficult to measure

Memories are imperfect Estimating portion size is difficult Don't want to be judged

Explain the risks associated with carrying excess weight

Metabolic syndrome and type 2 diabetes Coronary heart disease Stroke Hypertension Nonalcoholic fatty liver disease Gallbladder disease Osteoarthritis Sleep apnea and other respiratory problems Certain cancers Complications of pregnancy Hormonal and menstrual irregularities

Example of social marketing campaign to promote adult health

NYC don't drink yourself fat saw a 35% decrease in consumption of SSB's per day

Incidence

New cases/Individuals at risk of disease Measures risk of disease Useful for risk assessment and surveillance

Why target sugar-sweetened beverages

No nutritional benefit Biggest source of added sugar in American's diets (39 pounds per person per year) Body doesn't register liquid calories the same making it easy to disrupt energy balance SSB consumption linked to obesity, diabetes, weight gain, heart disease, fatty liver, kidney disease, tooth decay, gout

Key components of US nutrition policy

Nutrition assistance Nutrition education Nutrition information (labeling) Nutrition research

Why science

Nutrition science involves the study of nutrients and how they are digested absorbed, transported, metabolized, and stored Draws upon scientific fields Data allows us to examine population wide patterns investigate causes of disease and evaluate programs and policies

Case series

Observational study Collection of individual case reports on a particular topic

Case control study

Observational study Recruit participants who already have the outcome of interest and match them with similar individuals without the outcome Useful when the outcome is rare Assess past exposures to see what might be associated with the outcome

Case report

Observational study in depth description of an individual case; commonly used when little is known about a condition

Cross-sectional study

Observational study measures an exposure and outcome at one snapshot in time; allows us to determine the prevalence of an exposure and/or outcome

Ecological study

Observational study population-level data; examines the correlation between an aggregate exposure and aggregate outcome

Cohort Study

Observational study recruit a group of people without the outcome of interest Collect data on exposures and risk factors Follow them over time to see who develops the disease/outcome The strongest observational design

Summarize the nutrition-related changes and psychosocial changes that occur with advanced age.

Psychological changes: Depression high in nursing home residents Death of loved ones Loss of appetite and motivation Economic changes: Fixed income Living arrangements Affects food choices and eating habits Social changes: Isolation, loneliness directly related to nutritional inadequacies Men who live alone eat less than men living with others

Why babies LOVE to breastfeed

Optimal nutrition Strong nutrition Safe, fresh milk Enhanced immune system Protection against allergies and intolerance Correct development of teeth adn jaw Higher IQ and school performance

US Food and Drug Administration

Scientific regulatory and public health agency part of HHS Responsible for ensuring the food supply is safe and wholesome Jurisdiction is cosmetics, supplements, infant formulas, prescription and over the counter drugs

What is public policy

Policy is a framework that directs the actions to be followed by an individual, organization, government, or community to meet the needs of society and individuals Or a set of rules to solve a problem Policy is considered public if it is created by federal, state, or local government

Why can nutrition policy can be controversial

Policy requires a balance of autonomy and beneficence Some believe that the government should create conditions that make healthy choices easier and unhealthy choices harder, and that society should share the responsibility for a persons health Others believe government should limit its role and that individuals should have responsibility for their own health

List the leading risk factors for chronic disease

Poor diet Physical inactivity Tobacco use and exposure Excess alcohol consumption

Who is WIC for

Pregnant women Breastfeeding women who have had a baby in the last 12 months Non-breastfeeding postpartum women who have had a baby in the last 6 months Infants up to 1st birthday Children up to 5th birthday

Strategies for successful policymaking

Prepare a scientific base Develop broad support Analyze the opposition Develop alternative approaches or compromise positions Estimate needed resources and time Adopt successful strategies from others Set a clear direction before starting

explain how the price elasticity of demand can affect the outcome of a tax

Price elasticity of demand is the extent to which people buy the product regardless of changes in price. High price elasticity of demand means that purchasing habits are responsive to price changes Low means they are not.

Describe the 4 P's of the Marketing Mix, and how they can be used to develop a social marketing approach

Product: emphasis on benefits of physical product, services or ideas Price: consideration of economic, social and psycological costs required to adopt the behavior. Want to demonstrate that the benefits outweigh the cost. Place: Attention to way the product, service or message reaches the consumer. Promotion: efforts to tell people about the product, service, or idea using advertising, POS displays, events, and public relations

Strategies to improve adult nutrition and health

Program approaches Policy approaches Mass media and social marketing campaigns Changes to built environment

Suggest program, policy, social marketing, and environmental strategies to improve adult nutrition and health

Program: Workplace wellness intervention Community based programs to promote nutrition and PA Policy: Taxing unhealthy food, subsidizing health food Regulating food supply and nutrition labels Social marketing: Don't drink yourself fat Changes to built environment: Creating walkable communities, bike lanes, green space Increasing access to supermarkets, farmers markets, etc.

Recommendations in adulthood set by the dietary guidelines for americans

Promote: Variety of whole fruits and vegetables whole grains low fat dairy or dairy alternatives a variety of protein foods healthy oils Limit: saturated and trans fats (<10% of daily calories) added sugars (<10% of daily calories) Sodium (<2,300 mg/day) Alcohol (less than 1 drink per day for women and 2 for men)

USDA

Provides leadership on food, agriculture, natural resources, and related issues based on good public policy the best available science and efficient management Issues the dietary guidelines for Americans with HHS Food and Nutrition service administers several nutrition service administers several nutrition programs including SNAP, WIC, School meal programs

Six core functions of epidemiology

Public health surveillance Field investigation Analytic studies Evaluation Linkages Policy development

Distinguish between race and ethnicity

Race/ethnicity classifications are based on self identification and individuals may select more than one race category Race is primarily a social classification that relies on physical markers Ethnicity is the shared feeling of people among a group, including nationality, language, and beliefs An ethnicity or ethnic group, is a socially defined category of people who identify with each other based on common ancestral, social, cultural, or national experience The US government uses a binary classification for measuring ethnicity (are you hispanic/latino yes or no) Public health research examining cultural factors would require gathering data across more granular categories (nation, region, or another designation that is meaningful to the study).

US childhood obesity trends

Rates of obesity among ages 2-5 has nearly tripled since 1963 Rates of obesity among ages 6-11 and 12-19 has quadruples since 1963

SNAP work requirements

Requires able bodied adult recipients to work or be in a training program 20 hours/week Able-bodied adult recipients can only get SNAP benefits can only get SNAP benefits for 3 months in 3 years unless they meet work requirements

Experimental Studies

Researchers assign/manipulate variables to test a hypothesis

Sisters Together campaign

Researchers in Boston wanted to develop a campaign to address disproportionately high rates of obesity and heart disease among African American women. Conducted background data on health outcomes for AA women in MA, found 20% prevalence of obesity, low rate of PA, and high risk for health problems among black low income young black women. Profiled target communities Defined target population: black women 18-35 living in three communities of boston area (secondary targets were children and mothers of target group) Goal was to develop a media based intervention strategy to prevent obesity among young black women that could be replicable for populations in other communities. Wanted to increase awareness of benefits of healthy eating and PA and provide information to lead to healthier lifestyles Got to know the target population. Conducted focus group discussions among community women to find needs preferences and current activities. Interviewed community nutritionists to get perspective and observed stores to find available food and costs. Found the womens definition of healthy eating was variable, and that cooking methods often included frying. Found that these women believed healthy eating improved physical appearance. Found barriers to healthy eating included taste, cost, lack of time and information, lack of understanding and reluctance to change. Found that barriers to physical activity included hair care, lack of companion, neighborhood safety concerns, weather, and lack of access to indoor facilities Found that being overweight was culturally more acceptable and not deemed unhealthy, chronic diseases were deemed uncontrollable and inevitable. Tried to create a normative shift in behavior and shift attitude to moving more and eating better Environmental changes to facilitate new behaviors Rose awareness with a kickoff event to create a community and conduct formative research Did a warm-up and walk, cooking demonstrations, recruitment, evaluated the event Asked participants about the theme and logo (move more eat better) and about the days event and what they liked the best Evaluated responses on style, content, recipes, and evaluation. Designed a walking program, recruited walking group leaders, developed safe walking routes and safe havens and developed indoor sites for bad weather Created value in membership and made attempts at scaling up the program

Protein-Energy Malnutrition (PEM)

Results from insufficient food intake When energy deficiency is quite severe, marasmus can result When protein deficiency is quite severe and is combined with an existing infection, kwashiorkor can result Primarily seen in children

What causes health disparities

Rooted in inequities in access to healthcare, education, and economic, political, social and environmental resources

Why art

Scientific knowledge is not always complete Applying science means bringing it into the real world Context affects program design and outcomes Political, logistical, cultural factors must be considered Multiple stakeholders involved

Explain the relationship between tobacco and health

Smokers have an increased risk of developing heart disease (2-4x) stroke (2-4x) and lung cancer (25x) Smoking is also linked to overall diminished health, increased absenteeism from work, and increased healthcare utilization cost

Define social marketing

Social marketing uses concepts from commercial marketing to design, implement, and evaluate programs aimed at increasing acceptability of a social idea or cause within a target group

Benefits of Breastfeeding for the mother

Strong bonding with infant Increased energy expenditure Faster shrinkage of uterus Reduced postpartum bleeding Improved bone density and decreased risk for hip fracture Increased self-esteem

What benefits does WIC provide

Supplemental nutritious foods: limited to a specific package of healthy options, supports specific quantities of certain foods and cash-value allowances for FV's Nutrition education and counseling: at WIC clinics, includes breastfeeding promotion and support Screening and referrals: to other health, welfare and social services

What is the current level of funding of the SFMNP

The 2014 Farm Bill provided 20.6 million annually to operate the program through 2018, but funding cuts reduced this amount to 19.178 million

How does the SFMNP operate

The USDA FNS provides cash grants to state agencies Responsible state agencies include agriculture departments, area agencies on aging, and ITO's To apply each state agency must submit an annual state plan describing how they intend to implement operate and administer all aspects of the SFMNP Participants are given coupons or checks to buy eligible foods- vendors submit the redeemed coupons to a bank or the state agency for reimbursement Benefits must be between 20 and 50 dollars a year State agencies can supplement with state, local or private funds Nutrtion education is provided to participants via the state agency; focuses on helping improve and expand diets to include more fresh fruits and vegetable, educating participants on how to store, select and prepare fresh produce

What are the social determinants of health

The circumstances in which people are born, grow up, live, work, and age that affect a wide range of health functioning and quality of life outcomes These circumstances are shaped by the distribution of power, money and resources at global, national and local levels

Define culture and its relevance for public health nutrItion

The customary beliefs, social norms and material traits of a racial, religious, or social group Culture can affect child-rearing practices, dietary habits, religious practices, family structure and values, attitudes, and more

Give examples of ways creativity has been used to address problems in nutrition

The lucky iron fish The fun theory (volkswagen) Provo city schools child nutrition services The drink up campaign

National Institutes of Health

The nations medical research agency part of HHS Mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability

What is a determinant

The range of personal, social, economic and environmental factors that influence health status

Observational studies

The researcher does not assign an intervention or manipulate variables; observe whats happening in a population

What is public health nutrtion

The science and art of preventing disease

What is epidemiology?

The study of the distribution and determinants of disease in human population and the application of this study to the control of health problems Can also be defined by the 3D's: The study of the distribution, determinants, and deterrents of morbidity or mortality in human populations Involves assessing the relationship between an exposure and an outcome

What is the goal of nutrition policy

To assure conditions in which people can be healthy through dietary means

SFSP program goals

To serve areas where low income children at risk for inadequate nutrition during the summer reside and to provide them with free, nutritious meals when school is not in session

Using Frieden's health impact pyramid, describe which health promotion strategies have the most far-reaching impact

Top of triangle to bottom: Counseling and education Clinical interventions Long-lasting protective interventions Changing context to make individuals default decisions healthy Socioeconomic factors Top requires more individual effort Bottom most population impact

How does WIC support breastfeeding

Trained personnel to provide education and help mothers make informed infant feeding choices Peer counselors to provide mother-to-mother counseling Breastfeeding aids such as breast pumps Enhanced food packages for women who exclusively breastfeed

List key information needed for providing adequate nutritional guidance for a specific cultural group.

Types of food available, accepted/preferred foods, safety of food supply and related health problems, food preparation methods and how they are divided among family/community, energy and nutrient quality of major foods chosen, etc.

Describe the Senior Farmers Market Nutrition Program and explain its importance for public health nutrition.

USDA program that fives grants to states to provide low income seniors with coupons that can be used at farmers markets, roadside stands, and community supported agriculture programs Up to 10% of grant funds may be used for administration but the remaining funds must be used for benefits Intended to provide fresh nutrtious unprepared and locally grown fruits, vegetables, herbs, and honey through farmers markets, roadside stands, and CSA programs to low-income seniors and to increase the consumption of agricultural commodities by expanding, developing, or aiding in the development and expansion of local food outlets/programs Low income seniors 60+ with a household income below 185% of the federal poverty line are eligible In 2017 over 800,000 people received SFMNP benefits and 52 state agencies, US territories and federally recognized indian tribal organizations received grants to operate the SFMNP

Determine an individual's weight status based on their BMI

Underweight BMI<18.5 Healthy weight BMI between 18.5 and 24.9 Overweight between 25 and 29.9 Obese 30 and above

Recommend strategies for someone who wants to improve their creative thinking skills

Unplug Five minutes to problem solve Take a walk Be alone with your thoughts Read at whim Keep a notepad on hand Learn from creative people Welcome new environments and experiences

Explain the importance of evidence-based practice in adult health promotion

Uses scientific research as basis for developing programs that use resources optimally Increases odds of success and minimizes odds of harm Enables continued evaluation and improvement

How to advocate for change

Vote Attend town hall meetings Know your elected officials and develop professional relationships with them Join an advocacy group or professional organization Write Op-Eds or letters to the editor when you have a strong position on a health or nutrition issue

Evidenced based guidelines for children

Whole fruits and vegetables: 2.5 to 5 cups of FV's per day Young children 1-6 should not consume more than 4-6 fluid ounces of 100% fruit juice per day At least half of grains consumes should be whole grain 3-6.5 ounces of protein per day 2.5-3 cup per day of fat-free or low fat milk and milk products or fortified soy beverages

Why is import from PHN to be advocate

Without advocacy by nutrition and public health professionals, policy development would be dominated by special interest groups and motivated by profit

What is a confounder

associated with both the exposure and the outcome

What is the SFSP

federally funded state administered program that provides reimbursements to program operators who serve free, healthy meals and snacks to children and teens in low-income areas

Barriers to breastfeeding

lack of knowledge social norms Poor family and social support embarrassment lactation problems employment and child care barriers related to health services

Health benefits of physical activity adults and older adults

lower risk of all cause mortality lower risk of CVD improved cognition improved sleep lower risk of falls improved bone health slowed or reduced weight gain

Careers in public health nutrition

registered dietitians/nutritionists researchers lactation consultants policymakers journalists

What is food insecurity

the limited or uncertain ability to obtain nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways

Sarcopenia

the loss of muscle mass, strength, and function that comes with aging and can be decreased by PA