Community Nutrition WEEK 2

NHANES today (2 of 3)

"What we Eat in america survey" -this is the dietary interview component of NHANES -conducted annually through a DHHS and USDA partnerhip -participants are asked questions about their health status, disease history, and diet -dietary 24 hour recalls

Nutrient intake standards (3 of 3)

-dietary recommendations of other countries and groups -the food and agriculture organization (FAO) and the World Health Organization (WHO) recommendations are considered sufficient for the maintenance of health in nearly all people -they differ from the DRIs because they are based on slightly different judgement factors and serve different purposes, such as take into consideration people worldwide -DRI and FAO/WHO recommendations generally fall within the same general range

Nutrient Intake Standards (2 of 3)

-dietary reference intakes ( DRIs) -set of nutrient standards used in planning and assessing the diets of individuals and groups -are major shift from prevention of nutrient deficiencies to prevention of chronic disease -include change in role of dietary supplements in achieving good health -the DRIs include the estimated average requirement, recommended dietary allowance, adequate intake, estimated energy requirement, acceptable macronutrient distribution range, and tolerable upper intake level

direct assessment of nutrition status (1 of 3)

-direct assessment methods include: -diet history -twenty-four-hour recall -diet record -food frequency -other methods include photographs, laboratory, anthropometric, and clinical

The National Nutrition Monitoring and Related Research Program (NNMRRP)

-established by congress in 1990 -the USdA and DHHS jointly implemented and coordinated activities of the NNMRRP NNMRRP data are used to assess the dietary, nutritional, and related health status of the population -currently, more than 50 surveillance systems are operative in the U.S.

Elements of nutrition policy

-food assistance programs -national nutrition and health objectives (healthy people 2030 initiative) -regulations to safeguard food supply to ensure proper handling of food -dietary guidance systems -dietary reference intakes, the Dietary Guidelines for Americans, and the MyPlate Food Guide -monitoring and surveillance programs -food labeling legislation

Food Intake Patterns

-food group plans have been provided to the US population since the turn of the century -in 2011, myplate replaced mypyramid -myplate was developed to help consumers obtain the nutrients and substances needed for good health by eating a variety of foods -aims to maintain consistency with the Dietary Guidelines for Americans

setting the parameters of the assessment (2 of 2)

-goals: broad statements that indicate what the assessment is expected to accomplish -objectives: statements of outcomes and activities needed to reach a goal -a measurable outcome -usually begins with a strong verb like identify, assess, determine, or measure -goals and objectives determine the types of data collected and how they will be used

Cultural issues to consider:

-health beliefs and practices -health attitudes -demographic information about group -age and literacy, language, and amount of time they're willing to spend

step 7: choose a plan of action

-key findings shared with community leaders -advocate for change -make information available to the public -develop new program or pilot intervention

step 3: collect data

-methods of obtaining data about the target population -survey -health risk appraisal -screening -focus groups -interviews with key informants -direct assessments of nutrition status

Gap Between Current Recommendations and Practices

-most recent NHANES survey shows gap between current recommendation and consumers' practices -eating away from home -increased portion sizes -USDA Healthy Eating Index (HEI) was developed jointly by the USDA and the National Cancer Institute -measures the degree to which a person's diet conforms to federal dietary guidelines

Nutritional Status and Nutrition-related health measurements (1 of 3)

-national health and nutrition examination survey (NHANES) series -designed to collect and disseminate data that could be obtained best or only by direct physical examination, lab and clinical tests, and related measurements -NHANES is considered cornerstone in national nutrition policymaking decisions

Triggers for community needs assessment

-need for new data due to outdated or missing data bout about health and nutritional status of community -mandate from state or federal agency -research findings -raised awareness in community -availability of funds

Describe the relationship of nutrition research and nutrition monitoring to U.S. national nutrition policy

-nutrition research and monitoring guides the national nutrition policies. Through providing more information on the effects of specific foods, nutrient levels, and demographics on health, better policies can be put in place. Research to find food insecurity and malnutrition fuels policy making.

setting the parameters of the assessment (1 of 2)

-parameters set the direction for the assessment -define community -what is the scope -determine the purpose of the needs assessment -understand the target population -set goals and objectives for the needs assessment

A portion of a health risk appraisal form

-population's general health status -used frequently in worksites as a screening tool -alerts people to risky health behaviors and provides recommendations

issues in data collection

-practical issues -choice of assessment method influenced by various factors (e.g. $$) -cultural issues -survey questions must be culturally appropriate -scientific issues -sensitivity vs specificity -validity and reliability

step 5: share the findings of the assessment

-results are useful to other agencies and organizations -prevents duplication of effort -enables more than one agency to address problem -be sure key stakeholders are informed before release of information

step 6: set priorities

-setting priorities involves who is to get what at whose expense -you want the best health outcome (effect of intervention on health of population) -limited resources require decisions based on priorities

List a minimum of eight methods for obtaining data about the target population

-survey -focus groups -health risk appraisals -interviews with key informants - direct assessments of nutritional status -screening

the 2020-2030 dietary guidelines for americans

-the 2020-2025 dietary guidelines for americans are build around five guidelines 1. follow a healthy eating pattern 2. focus on variety, nutrient density, and amount 3. limit calories from added sugar and saturated fats and reduce sodium intake 4. shift to healthier food and beverage choices 5. support health eating patterns for all

Knowledge, attitudes, and behavior assessments and nutrient consumption

-the BRFSS collects data related to: health status access to health care; tobacco and alcohol use injury control (use of seat belts) use of prevention services such as immunization and breast cancer screening treatment of high blood cholesterol frequency of intake of dietary fat, fruits, and vegetables

Nutrient Intake Standards (1 of 3)

-the food and nutrition board (FNB) established in 1940, is part of the national academies of sciences its focuses include: -to evaluate emerging knowledge of nutrient requirements and relationships between diet and reduction of risk of common chronic diseases -to relate this knowledge to strategies for promoting health and preventing disease in the US and internationally -to assess aspects of food science and technology that affect the nutritional quality and safety of food and thereby influence health maintenance and disease prevention

Nutritional Status and Nutrition-related Health Measurements (2 of 3)

-the target population of NHANES I (1971-1974) was civilian, non-institutionalized persons aged 1-74 years. -NHANES II (1976-1980) targeted civilian, non-institutionalized persons ages 6 months-74 years -Hispanic Health and Nutrition Examination Survey (HHANES) was conducted in 1982-1984. Target population consisted of "eligible" hispanics aged six months to 74 years -NHANES III (1988-1994) targeted a nationwide sample of about 34,000 persons ages 2 month and over. Divided into two, three-year surveys

step 2: develop a data collection plan

-the types of data required in a needs assessment depend on the scope, purpose, goals, and objectives of the assessment -there are three basic categories of data: 1. community data -the "big picture:" demographics, economic factors, health indicators 2. community environment and background conditions -social and cultural norms, food availability, policies 3. target population data -food preferences and attitudes, health beliefs, lifestyles

Describe the Importance of conducting a community needs assessment:

-to ensure that your plan will help the community -to see who's at risk in the population -to see what group to focus on In the community

steps in conducting a community needs assessment

1. set the parameters of the assessment 2. develop a data collection plan 3. collect data a) about the community b) about the community environment and background factors c) about individuals who represent the target population 4. analyze and interpret the data 5. share the findings 6. set priorities 7. choose a plan of action

Uses of National Nutrition-Monitoring Data (1 of 5)

Assessment of dietary intake -provide detailed benchmark data on food and nutrient intakes of the population -monitor the nutritional quality of diets -determine the nature of populations at risk of having diets low or high in certain nutrient -identify socioeconomic and attitudinal factors associated with diets

Uses of National Nutrition-monitoring data (3 of 5)

Food Programs and Guidance -develop food guides and dietary guidance materials that target nutritional problems in the US population -identify educational strategies to increase the knowledge of nutrition and to improve the eating habits of Americans -identify educational strategies to increase the knowledge of nutrition and to improve the eating habits of Americans -identify factors affecting participation in some food programs and estimate the effect of participation on food expenditures and diet quality -identify populations that might benefit from intervention programs -identify changes in food and nutrient composition that would reduce health risks -develop food guides and plans that reflect food consumption practices and meet nutritional and cost criteria -determine the amounts of food that are suitable to offer in food distribution programs

Uses of National Nutrition-Monitoring Data (5 of 5)

Historical trends -correlate food consumption and nutrition status with incidence of disease over time -follow food consumption through the life cycle -predict changes in food consumption and nutrition status as they may be influenced buy economic, technological, and other developments -track use and understanding of food label and their effect on dietary intakes

Uses of National Nutrition-Monitoring Data (4 of 5)

Scientific research -establish nutrient requirements -study diet-health relationships and the significance of knowledge and attitudes toward dietary and health behavior -conduct national nutrition monitoring research -conduct food composition analysis

Discuss the dietary reference intakes and explain how they are used to plan and assess diets

Set of nutrient standards used in planning and assessing the diets of individuals and groups Are major shift from prevention of nutrient deficiencies to prevention of chronic disease Include change in role of dietary supplements in achieving good health The DRIs include the estimated average requirement, recommended dietary allowance, adequate intake, estimated energy requirement, acceptable macronutrient distribution range, and tolerable upper intake level

Validity and Reliability

Validity: the accuracy of the data Reliability: the ability to replicate data

does the U.S. have a national nutrition policy?

YES and No - No - no single federal agency has mandate to handle national nutrition policy as its sole function. YES - responsibility is divided among congressional committees, federal agencies, and major departments

Community needs assessment purpose

a community needs assessment is the process of evaluating the health and nutrition status of a community -determines the community's health and nutrition needs -identifies places where needs are not being met -identifies resources available to address those needs the assessment is a "snapshot" of the community that identifies areas where it performs well and areas where it does not

NNMRRP components (1)

activities associated with NNMRRP grouped into five measurement components: -nutritional status and nutrition-related health measurements -food and nutrient consumption -knowledge, attitudes, and behavior assessments -food consumption and nutrient databases -food supply determinations

NHANES today

beginning in 1999, NHANeS program took a new direction as a continuous survey that can be linked to related government surveys of the U.S. population -in 2000, NHANES merged with the continuing survey of food intakes by individuals (CSFII) to be more cost-effective and enable them to be conducted annually - the dietary portion of the integrated survey-- "What we eat in America"-- is administered as part of the NHANES.

entrepreneurship in community needs assessment

community nutritionists can apply the principles of entrepreneurship to community needs assessment by: -developing new strategies for collecting information about hard-to-reach populations -forging new partnerships with food producers, retailers, distributors, and marketers to collect information about dietary patterns and beliefs at the local level -developing new methods of assessing nutrition needs and problems

Policymaking Does not stand still (1 of 2)

community nutritionists can serve as liasions between policymakers and the general public -legislation related to healthcare reform -third-party reimbursement medical nutrition therapy -food and supplement labeling requirements -new evidence-based dietary guidlines -healthy people 2020 objectives with a focus on the social and environmental determinants of health -the increasing use of social media -market focus in the health care field and the food industry

Step 4: Analyze and Interpret the Data

data collected is analyzed -data is collected about the community, any background conditions that may have influenced the target population -data is coded, entered into the computer, checked for errors, analyzed using accepted statistical methods -data then used to diagnose the community -executive summary is prepared -given to stakeholders, media, etc

step 4: analyze and interpret the data (2 of 2)

diagnosing the community 1. nutrition status of the target population 2. pattern of health-care services/programs 3. relationship between target populations nutritional status and community characteristics 4. evidence linking the target pop's nutritional status to the community environment -cost of treating vs cost of preventing -social consequences of not intervening

Policymaking does not stand still (2 of 2)

formulating a national nutrition agenda is a daunting task -government must make a commitment to develop and promote a coordinated plan to improve the nation's nutrition and health statu -scientists must reach a consensus on the interpretation on scientific findings and appropriate dietary advice for all americans -sufficient financial resources must be allocated to implementing the policy

food composition and nutrient databases

information about the nutrient content of foods: -food label and package survey (FLAPS) -monitors labeling practices of food manufacturers to check nutrient value on food labels -USDA's national nutrient database for standard reference -the foundation of most food and nutrition databases in the US, and is used in food policy, research, and nutrition montioring

key informants and stakeholders

key informants: people who are knowledgeable about the community stakeholders: people with vested interest in the populations

nutrition monitoring

methods of deriving data to apply in national nutrition policies include: -nutrition screening -nutrition assessment -nutrition monitoring -nutrition surveillance nutrition monitoring analyzes relationship between diet and health in the population tracking of food supply and consumption began in 1909

national nutrition policy

nationwide guidelines which specify how nutritional needs of the american people will be met address issues of: -food insecurity and malnutrition -food safety -food labeling and menu labeling -food fortification -sustainable agricultural practices -nutrition research

issues in data collection

scientific issues -sensitivity: proportion with the disease who test positive -false positive -used for screening -specificity: proportion without the disease who test negative -false negative -use for confirmation of diagnosis validity: accuracy of results reliability: reproducibility of results

Describe appropriate uses of current dietary guidance systems

to implement policy and improve nutrition status of people in america, especially those who struggle from health disparities and food insecurity.

food and nutrient consumption

various other surveys over the years, including -the 5-a-day for better health baseline survey -the nationwide food consumption survey -the vitamin and mineral supplement survey Total Diet Study (TDS) -assesses for nutrients and contaminants in foods -targets eight age groups, infant through older persons -collects and analyzes 234 food from retail markets in urban areas

Food Supply Determinations

-Food Supply series surveys (annually) US civilian population -quantities of food energy, nutrients, and food components provided by these foods (calculated)

quantitative vs qualitative data

-Quantitative- numerical -Qualitative- descriptive observations ex. colors

focus groups

-a group of 5-12 people who are asked to share concerns, experiences, beliefs, opinions, problems -focus groups are helpful for: -assessing needs -generating information -developing plans -testing new programs and ideas -improving existing programs -evaluating outcomes

The national agenda for improving nutrition and health

-almost no progress was made toward the health people 2020 targets for objectives in the nutrition and overweight focus area -the focus of the nutrition and weight status objective for healthy people 2030 was expanded to -include a broader range of policies and environmental factors that support eating a healthful diet and maintaining a health body weight in setting such as schools, worksites, health-care organizations, and communities

Nutrition Survey Results: how well do we eat?

-although most americans are well nourished, they are also generally overfat, under exercised, and at risk of some nutrient deficiencies -caution must be exercised in interpreting the NHANES data -when average nutrient intakes are examined, severe deficiencies in individuals can be missed -however, finding based on one or two days of dietary intake can overestimate the extent of undernutrition

Knowledge, attitudes, and behavior assessments

-behavioral risk factor surveillance system (BRFSS) is the main source of information on risk behaviors among adult populations -adults 18 years of age and older residing in households with telephones in participating states -the high-risk behaviors of teenagers, such as smoking, alcohol use, eating practices, and weight management practices, are assessed in the Youth Risk Behavior Survey (YRBS) -youth attending school in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands

principles involved in setting priorities

-community priorities, preferences, and concerns should be given priority -higher priority should be given to serious problems than to less serious ones -the health problems that can easily be prevented should have a higher priority than those that are more difficult to prevent -higher priority should be given to health problems whose frequencies are increasing over time than to those whose frequencies are declining or remaining static

Describe seven steps in conducting a community needs assessment

-defining parameters -develop a data collection plan -collect data -about community -about community environment and background factors -about individuals who represent the target population -analyze and interpret data -share the findings -set priorities -set a plan of action

Dietary guidance systems

-dietary guidelines for americans -were developed to promote health and reduce chronic disease risks -includes basic guidelines for healthy eating and physical activity -must be revised every 5 years, beginning in 1995 -newest revision 2020-2025

Uses of National Nutrition-monitoring Data (2 of 5)

Monitoring and surveillance -identify high-risk groups and geographical areas with nutrition-related problems to facilitate implementation of public health intervention programs and food assistance programs -evaluate changes in agricultural policy that may affect the nutritional quality and healthfulness of the US food supply -assess progress toward achieving the nutrition and health objectives in the healthy people initiatives -evaluate the effectiveness of nutritional initiatives for military feeding systems -recommend guidelines for the prevention, detection, and management of nutrition and health conditions -monitor food production and marketing marketing -develop food labeling policies -document the need for food fortification policies and monitor such policies -establish food safety guidelines

Describe key components of the National nutrition monitoring and related research program

NNMRRP data are used to assess the dietary, nutritional, and related health status of the population Activities associated with NNMRRP grouped into five measurement components: Food supply determinations Food composition and nutrient databases Food and nutrient consumption Knowledge, attitudes, and behavior assessments Nutrition status and nutrition-related health measurements

Describe 3 categories of data that can be collected a part of a community needs assessment and indicate how to obtain these data

Quantitative data is measurable and typically a number or specific value. This type of data can be gathered through means of survey, screening, health risk appraisals, and direct assessments of nutrition status. Qualitative data is not measurable. It is made up of opinions or insights. This can also be gathered through means of survey but also focus groups and interviews with key informant.