Community Nutrition FINAL

Can you define advocacy

"Active support; especially the act of pleading or arguing for something" "Building support for an idea, cause or change"

Can you define public policy

"In any society, governmental entities enact laws, make policies, and allocate resources. This is true at all levels. Public policy can be generally defined as a system of laws, regulatory measures, courses of action, and funding priorities concerning a given topic promulgated by a governmental entity or its representatives."

Can you define legislative advocacy

"Influencing public policy through the legislative process"

Can you define legislation

"Law which has been enacted by a legislature or other governing body, or the process of making it"

Can you define "food insecurity"

"Limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways."

Can you define policy making

"The process by which authorities decide which actions to take to address a problem or set of problems"

Can you define poverty?

"The state of having too little money to meet minimum needs for food, clothing, and shelter. As of 2015, the US DHHS defined a poverty-line income as $24,250 for a family of four."

Can you define policy

"course of action chosen by public authorities to address a given problem"

Can you define building coalitions

(networks and other alliances) Joining with smaller groups to influence the political system

Public Policy and Nutrition

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World hunger and food insecurity

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Gaining cultural competence in community nutrition

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Food insecurity and assistance programs

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What is the National School Lunch Program (NSLP)?

-A federally assisted meal program operating in public and nonprofit private schools and residential child care institutions -Provides nutritionally balanced, low-cost or free lunches to children each school day. -The program was established under the -National School Lunch Act, signed by President Harry Truman in 1946.

Can you explain the importance of the gaining cultural competence?

-Changes in demographics in the US: Increasing minority groups -Increased utilization of traditional therapies (Complementary and Alternative Medicine) -Health disparities (Health inequalities) -Under-representation of health care providers from culturally and linguistically diverse groups

What are purposes of the Affordable Care Act?

-Contain costs -Improve patients' experience of care: quality and satisfaction -Improve population health -CHIP benefits are different in each state. But all states provide comprehensive coverage, Including: -Routine check-ups -Immunizations -Doctor visits -Prescriptions -Dental and vision care -Inpatient and outpatient hospital care -Laboratory and X-ray services -Emergency services

What items can't be purchased?

-Food products that contain alcohol or tobacco products -Items that are not intended for human consumption (e.g. paper products, pet foods, etc.) -Food that will be eaten in the store -Hot foods -Vitamins and supplements

Who is at high risk for very low food security?

-Households with children headed by a single woman (12.8 percent), -Women living alone and men living alone (7.2 percent), -Black, non-Hispanic households (10.4 percent), -Hispanic households (6.9 percent), -Households with incomes below 185 percent of the poverty line (14.5 percent), and -Households located in principal cities of metropolitan areas (7.3 percent).

Who is eligible for the program?

-Pregnant, breastfeeding or postpartum women, infants, & children up to age 5 -Must meet income guidelines, a State residency requirement, & be individually determined to be at "nutritional risk" by a health professional -To be eligible on the basis of income, family income must fall at or <185 % of the US Poverty Income Guidelines

Referrals?

-Prenatal, Pediatric, & Maternal Care -Lactation Consultant -Lactation Peer Counselors -Lead Screening -Smoking cessation classes -Substance abuse counseling -Family-planning services -Maternal and Infant Health Program (MIHP) -Early-On -Medicaid, Healthy Kids -SNAP -Expanded Food and Nutrition Education -Program (EFNEP)

Managed Care Insurance

-Prepaid group practice plans that offer health care services through groups of medical practitioners. -The goal is to improve quality of care with decreased costs. -The managed care system manages the cost, delivery, quality, and access of health care services. -Heath Maintenance Organizations (HMOs): A prepaid plan that both finances & delivers health care; Fixed fee/yr; Must use the plan's providers or face financial penalties (17%) -Preferred Provider Organizations (PPOs): A group of providers (hospitals & doctors who contracts with fee-for-service insurance company) to provide medical care for a discounted fee. (55%) -Point-of-Service (POS): Option of receiving services from participating/nonparticipating providers (10%) (HMO+PPS)

What are two major categories of the health insurance system in the US?

-Private health insurance -Public health insurance

The Children's Health Insurance Program (CHIP)

-Provides health coverage to eligible children, through both Medicaid and separate CHIP programs. -Administered by states, according to federal requirements. -Funded jointly by states and the federal government. -Serves uninsured children up to age 19 in families with income too high to qualify them for Medicaid. -The financial requirement varies by state (next slides) -The State Children's Health Insurance Program (SCHIP) in Ohio is for uninsured children up to age 19 in families with incomes above 175% and at or below 250% of FPL

What is WIC?

-Provides nutritious foods, nutrition education, & referrals to health and other social services to participants at no charge. -Serves low-income pregnant, postpartum & breastfeeding women, and infants and children up to age 5 who are at nutrition risk -Not an entitlement program -FNS funds to WIC State agencies (state health departments or comparable agencies) to pay WIC foods, nutrition education and administrative costs

Traditional Fee-for-Service Insurance:

-Relatively uncommon; the physician set a price for each type of service delivered, and then the patient or his/her insurer pays this price - Greater flexibility and unrestricted access to physicians, tests, hospitals or treatments - Main concern: it encourages physicians to provide unnecessary services (lab tests or procedures)

Is SNAP an entitlement program?

-SNAP is not a welfare program. It is a nutrition assistance program designed to help low-income individuals and families buy and consume nutritious foods. -SNAP is an entitlement program. In other words, everyone who applies and who is determined to be eligible will get SNAP benefits.

What causes health disparity in the US?

-Socioeconomic status (SES) -Lack of health insurance -Culture -Access to and utilization of quality health care services -Discrimination/racism/stereotyping -Environment **Causes of health disparities is avoidable modifiable.** **Our role is to reduce health disparities by providing the appropriate nutrition/health care.**

Implementing and Enforcing Nutrition Policy in the US

-The laws that affect nutrition, food, and health are passed to the USDA or the DHHS for implementation. -They interpret the law and provide the detailed regulations or rules. -The regulations are sometimes called secondary legislation. -Code of Federal Regulations (CFR) is a comprehensive summary of all regulations currently in force.

Who are the largest participant groups of the WIC among children, infants, and women?

Children have always been the largest category of WIC participants

What information do you need to know to provide adequate nutrition service or care for people who are from different cultures?

Common values and beliefs Types of food available Accepted and/or preferred foods Most commonly used foods Food preparation methods Dietary practices in different religious groups Communication styles of various cultural groups

Home-delivered meals (Meals on Wheels)

Delivered to homebound older adults who are unable to travel to a congregate meal site. Volunteers who deliver meals spend time with homebound seniors & provide social interaction that the seniors might not otherwise get.

What are the focus areas of USDA and DHHS and the programs they provide?

Department of Health and Human Services (DHHS) administers the majority of public health & nutrition programs. The department includes more than 300 programs including: -Health and social science research -Disease prevention, including immunization services -Food and drug safety -Medicare and Medicaid -Health information technology -Financial assistance and services for low-income families -Head Start -Faith-based and community initiatives -Child abuse and domestic violence prevention -Improvement in maternal and infant health -Substance abuse treatment and prevention -Services for older Americans -Comprehensive health services for Native Americans -Medical preparedness for emergencies, including potential terrorism U.S. Department of Agriculture (USDA) administers its programming through the Food and Nutrition Service (FNS) programs. -Leads the federal anti-hunger effort with the Food Stamp, School Lunch, School Breakfast, and the WIC programs. -Responsible for the safety of meat, poultry, and egg products -Conducts research in human nutrition and new crop technologies -Ensures open markets for U.S. agricultural products -Provides food aid to people in need overseas

What is the Fresh Fruit and Vegetable Program (FFVP)? What is the purpose of the program? Which agency operates this program?

Efforts to combat childhood obesity by helping children learn more healthful eating habits. FFVP is consistent with and supports the recommendations of a recent report by the Institute of Medicine (IOM) to provide healthier snack choices in schools, including fruits and vegetables. Where? Classrooms, hallways, and as part of classroom activities (e.g., nutrition education) Ohio Dept of Education's (ODE's) Office for Safety, Health and Nutrition awards Fresh Fruit and Vegetable Grants to Ohio schools each year as part of a USDA. EXTRA: Participants in the program must be elementary schools in which at least 50 percent of the student enrollment qualifies for free or reduced-price school meal benefits. (Elementary schools with the highest percentage of students receiving free and reduced-price meals receive the highest priority consideration for the grants.)

The Medicare program

Eligibility: People aged 65yr or older; persons with end-stage renal disease; people eligible for Social Security/Railroad Retirement Board disability programs for 24 mo; Medicare-covered government employees, possibly others Benefits: Part A (Hospital Insurance): helps pay for inpatient hospital care, skilled nursing facility care, home health care, hospice care Part B (Medical Insurance): helps pay for physicians' services, outpatient hospital services, home visits, diagnostic X-ray, lab test, physical & occupational therapy, MNT for people with diabetes, kidney disease, and kidney transplant in the last 36 mo, and a referral by doctor or other health care provider. Typical not covered by Part A & Part B: Long-term care, most dental care and dentures, eye examinations related to prescribing glasses, hearing aides and exams for fitting them, routine food care, acupuncture, cosmetic surgery.

Can you define and distinguish the concepts of high food security, marginal food security, low food security, and very low food security?

For households with one or more children: zero—High food security 1-2—Marginal food security 3-7—Low food security 8-18—Very low food security For households with no child present: zero—High food security 1-2—Marginal food security 3-5—Low food security 6-10—Very low food security

Nutrition education?

Group Education Individual Education Nutrition Education on the Web

High food security:

Households had no problems or anxiety about consistently accessing adequate food.

Marginal food security:

Households had problems at times or anxiety about accessing adequate food but the quality, variety, and quantity of their food intake were not substantially reduced.

Low food security:

Households reduced the quality, variety, and desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted.

What are the physiological changes in older adults?

Increase in total body fat mass & Decrease in fat-free mass (muscle & bone) Taste bud atrophy & impaired olfactory senses lead to a decreased appetite Dry mouth, tooth loss, gum diseases can cause trouble chewing Decrease in visual & hearing acuity -Leads to difficulty reading labels & recipes -Difficulty hearing in noisy environments Can be less mobile due to: Disabling conditions; arthritis; stroke; fractures; osteoporosis; fear of falling

Can you explain the concept of cross-cultural interaction and ethnocentric?

Interaction between/among individuals who represent distinctly different culture

What is the Elderly Nutrition Program?

Largest federal nutrition assistance program for older adults Promotes health & well-being; decreases malnutrition; prevents physical/mental deterioration; reduces social isolation and hunger & food insecurity Targets those at greatest social & economic need with particular attention to low income minorities & individuals in rural communities. Provides meals, congregate & home-delivered, and nutrition screening, education, & counseling Links to other supportive in-home & community-based services.

Can you explain how we can advocate a legislation process (making a law)?

Make your opinion known: -Present ideas at public meetings -Write letters to the editor of a newspaper, magazine, or scientific journal -Write letters to local, state, or federal legislators -Make telephone calls or send emails to elected officials -Conduct a public forum on an issue Become directly involved: -Run for political office -Collect signatures for a petition to send to legislature

Congregate meals

Meals are offered to older adults in groups at social & community centers such as senior centers, churches, and schools. Congregate sites provide older adults with social interaction and the chance to get involved in the community.

What is the After School Snack Program (ASSP)?

NSLP offers cash reimbursement to help schools serve snacks to children after their regular school day ends. Afterschool snacks give children a nutritional boost and draw them into supervised activities that are safe, fun and filled with learning opportunities.

What are the purposes, eligibility and benefits of the program?

PURPOSE - Provide fresh, locally grown fruits, vegetables, & herbs from farmers' markets, roadside stands & community supported agriculture programs to low-income seniors PURPOSE - Increase the domestic consumption of agricultural commodities ELIGIBLE - Low-income seniors (generally defined as individuals who are 60 yr & household incomes < 185% ) WHEN -During the harvest season (June - Oct) WHAT - Fresh, nutritious, unprocessed fruits, vegetables, and fresh-cut herbs

Causes of Hunger:

Poverty trap Lack of investment in agriculture Climate and weather War and displacement Unstable markets Food wastage

Who are the target populations?

Pregnant, breastfeeding or postpartum women, infants, & children up to age 5

Can you define lobbying

Provide technical information to policy makers to help pass legislation

What is the Special Milk Program? Who are eligible? What type of milk can be provided through the program? What is the nutritional requirement for the milk provided?

Provides milk to children in schools and childcare institutions who do not participate in other Federal meal service programs. Reimburses schools for the milk they serve. Schools in the NSLP or SBP may also participate in the Special Milk Program to provide milk to children in half-day pre-kindergarten and kindergarten programs where children do not have access to the school meal programs. When local school officials offer free milk under the program to low‐income children, any child from a family that meets income guidelines for free meals is eligible. NUTRITION: Only pasteurized fluid types of fat free or low‐fat (1%) milk that meet State and local standards. All milk should contain vitamins A and D at levels specified by the FDA - 2000 IU of Vitamin A per quart (500 IU per cup) - 400 IU of Vitamin D per quart (100 IU per cup)

Are the DRIs for older adults the same as the DRIs for adults? How are they different?

Psycho-social & cognitive changes Loss of spouse, family & friends -Leads to loneliness, social isolation, grief, depression Declines in cognitive function - Leads to increased risk for inadequate nutrient intakes 1. Reduced nutrient needs -Cr, Cl, Na, -Fe for female 2. Increased need for some nutrients relates to changes in gastric secretion, kidney function & endocrine system -Higher needs for Vit B6, B12,& D & Ca

What are the nutritional requirements for school lunch?

School lunches must meet meal pattern and nutrition standards based on the latest Dietary Guidelines for Americans. The current meal pattern increases the availability of fruits, vegetables, and whole grains in the school menu. The meal pattern's dietary specifications set specific calorie limits to ensure age-appropriate meals for grades K-5, 6-8, and 9-12. Other meal enhancements include gradual reductions in the sodium content of the meals While school lunches must meet Federal meal requirements, decisions about what specific foods to serve and how they are prepared are made by local school food authorities.

Who Are the Food Insecure in the United States?

The poor The working poor The young Ethnic minorities Inner-City and rural dwellers Certain southern and western states The homeless

Which afterschool care programs are eligible?

The school district must run the NSLP & sponsor or operate the afterschool care program. Additionally the school district must sponsor or operate an afterschool care program that provides children with regularly scheduled educational or enrichment activities in a supervised environment.

What are the eligibilities and benefits of the program - congregate meals vs. home delivery meals?

Title III: Grants to states for nutrition services, including meals Administration on Aging, provides funding for two senior nutrition programs: 1) congregate meals -Individuals at or below 60 yr, regardless of income, are eligible to participate in the ENP -The spouse of any age -Disabled persons older than 60 yr who either live in housing facilities where ENP congregate meals are served, or who accompany seniors to meal sites -Nutrition service volunteers 2) home-delivered meals -Individuals at or below 60 yr who are homebound -The spouse of an older individual regardless of age -Persons older than 60 yr with disabilities if they reside with the homebound older individual Title VI: Grants for Native Americans

What are the characteristics/trends of older populations in the US, based on the lecture?

U.S. Population Is Becoming More Racially and Ethnically Diverse Leading Causes of Death -By 1910, heart disease became the leading cause of death every year except 1918-1920, when the influenza epidemic took its disastrous toll. Addressing Challenges for People with Multiple Chronic Conditions -More than a quarter of all Americans and two of three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country's health care budget. Indicator 3. Oral health: tooth retention

Can you explain the purpose of the Supplemental Nutrition Assistance Program, eligibility, and benefits?

What are the benefits? -New name of the federal Food Stamp Program e.g., OH: Food Assistance Program -Entitlement program -Focus on nutrition and improvements in accessibility of foods -Nutrition education is available (optional) Who is eligible? -U.S. citizens (Some aliens who are admitted for permanent residency may qualify) -To get SNAP benefits, household must meet eligibility requirements: Resources, Income, Deductions, Employment Requirements, Special Rules for Elderly or Disabled, Immigrant Eligibility -A household gross monthly income must be 130% or less of the Federal poverty guidelines (or the household net monthly income must be 100% or less of the Federal poverty guidelines)

What does acculturation mean?

is a process by which a cultural group adapts or learns cultural norms of another group.

Can you explain what dietary acculturation means?

refers to the process that occurs when immigrants adapt the dietary practices, eating patterns/food choices of the host country.

Nutrition programs for mothers and infants

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Nutrition programs for older adults

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Health care system and policy

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Nutrition programs for children and adolescents

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Who are at high risk for food insecurity in the US? (e.g., single women with children, etc.)

-All households with children (19.2 percent), Households with children under age 6 (19.9 percent), -Households with children headed by a single woman (35.3 percent), -Households with children headed by a single man (217 percent), -Black, non-Hispanic households (26.1 percent), -Hispanic households (22.4 percent), and -Low-income households with incomes below 185 percent of the poverty threshold (33.7 percent; the Federal poverty line was $24,008 for a family of four in 2014).

What items can be purchased by using the SNAP benefits?

-Breads and cereals; fruits and vegetables; meats, fish and poultry; and dairy products. -Seeds and plants which produce food for the household to eat. -In some areas, restaurants can be authorized to accept SNAP benefits from qualified homeless, older adults, or disabled people in exchange for low-cost meals.

Who are eligible for free price meals vs. reduced price meals?

-Children from families with incomes ≤130% of the poverty level: eligible for free meals -Those with incomes between 130% & 185% of the poverty level: eligible for reduced-price meals (can be charged no more than 40 cents). -Children from families with incomes > 185% of poverty level pay a full price

What are the USDA Food and Nutrition Programs for children?

-National School Lunch Program (NSLP) -School Breakfast Program (SBP) -Fresh Fruits & Vegetables Program -Special Milk Program -Summer Food Service Program

What are the benefits of the WIC?

-Nutritious foods (Check, vouchers, or electronic benefits card) -Nutrition education -Referrals to health and other social services

Can you explain the process of generating a law and its implementation? (including enactment)

1) A concerned citizen, group, or organization brings an issue to the attention of a legislative representative at the local, state, or national level. 2) The bill is written and submitted to the clerk where it is numbered and printed. It must be sponsored by at least one legislative member (House or Senate, or both). 3) The bill is referred to a committee and subcommittee - the greatest challenge is getting out with a favorable vote. 4) Markup sessions by subcommittees and committees revise the original bill 5) Committee votes on whether to send the bill forward with a favorable vote or table it 6) Approved bills go before the full membership for debate, amendment, and vote 7) If the bill passes, it goes to the other body of legislature or Congress for the same actions 8) Finished versions of the bill will probably differ between bodies, so a conference committee meets to resolve differences 9)The modified bill that is agreed upon is sent to the President (Governor) for action 10) Presidential (Governor) Action -Sign into law -Veto and return to legislature (Congress) - need 2/3 vote by each house to override -No action while in session - automatically becomes law 11) Enactment -Law is referred to appropriate agency responsible for issuing guidelines or regulations -Publication of proposed guidelines - mandatory comment period of 30-60 days for public response

Can you explain each step of the process of policy making?

1) Problem definition and agenda setting -Need public recognition that problem exists -Bring together a broad-based grassroots constituency that supports addressing the problem -This begins the agenda setting process -Gain and seek support from administrators and policy makers -Have the problem placed on the institutional agenda 2) Formulation of alternatives -Interest groups, coalitions, networks of experts, and "grassroots" individuals interested in the problem can be asked to help with designing alternatives to be presented to policy makers 3) Policy adoption - Tools and instruments are selected to achieve the policy goal - such as regulations, funding, tax breaks, government-sponsored programs - Policy adoption can occur on a local, state, or national level 4) Policy implementation -Putting the policy into action after necessary modifications have been made for the target clientele -May involve a large number of people and organizations to carry out the process 5) Policy evaluation -To determine whether the program developed to support the policy is achieving its goals -To determine if program is reaching its intended audience -Use best research methods 6) Policy termination -When the public need was met -Loss of political support -Policy was too costly -Private agencies relieved the need

Practice Legislative Advocacy

1)Getting involved 2)Understanding the issues 3)Planning an advocacy practice 4)Advocating 5)Presenting information

Can you define "food security"

Access by all members at all times to enough food for an active, healthy life. Food security includes at a minimum: 1) the ready availability of nutritionally adequate and safe foods and 2) an assured ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies)."

What % of households in the US is food insecure?

Among U.S. households with children under age 18: 80.8 percent were food secure in 2014. In 9.8 percent of households with children, only adults were food insecure. Both children and adults were food insecure in 9.4 percent of households with children (3.7 million households).

What is Team Nutrition? What is the focus area of Team Nutrition? What is the goal of Team Nutrition?

An initiative of the USDA Food & Nutrition Service to support the Child Nutrition Programs through 1) training and technical assistance for foodservice, 2) nutrition education for children and their caregivers 3) school and community support for healthy eating and physical activity. Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child Nutrition Programs through training and technical assistance for foodservice, nutrition education for children and their caregivers, and school and community support for healthy eating and physical activity.

Who are eligible for free price meals vs. reduced price meals? What are the nutritional requirements for a school breakfast?

Any child at a participating school may purchase a meal through the School Breakfast Program. Children from families with incomes at or below 130%of the Federal poverty level are eligible for free meals. Those with incomes between 130%and 185%of the poverty level are eligible for reduced‐price meals, for which students can be charged no more than 30 cents. (For the period July 1, 2013, through June 30, 2014, 130 percent of the poverty level is $30,615 for a family of four; 185 percent is $43,568) NUTRITION - More fruit will be offered to students beginning SY 2014-15 and the first target for reduction of sodium.

Very low food security:

At times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food.

Can you explain the constructs of the Campinha-Bacote Model of cultural competency?

Awareness -Become appreciative of the influence of culture on the development of values, beliefs, life ways, practices, and problem-solving strategies. (Understand your own cultural background including biases and prejudice toward other cultural groups) Skill -Understand history, values, belief systems, food practices, health customs, attitudes toward seeking help from health care providers, and behaviors of the members of another ethnic group. (Understands how different cultures are similar or different from yours) Knowledge -Provide culturally sensitive assessments and intervention and feel comfortable with working with people from different cultures. Encounters -Seek and engage in face-to-face cross-cultural interactions. Desire -Have a true inner feeling of wanting to engage in the process of becoming culturally competent.

What is the mission of the Food and Nutrition Service (FNS)? What programs are provided by FNS, USDA?

Increases food security & reduces hunger in partnership with cooperating organizations by providing children and low-income people access to food, a healthy diet, and nutrition education in a manner that supports American agriculture and inspires public confidence. -Supplemental Nutrition Assistance Program (SNAP) -Food Distribution Disaster Assistance -The Emergency Food Assistance Program (TEFAP) -WIC -School meals -Child and Ault Care Food Program (CACFP) -Summer Food Service Program -Farmers Markets Nutrition Program

The Medicaid Program

Medicaid provides health coverage to low-income adults, children, pregnant women, elderly adults and people with disabilities Within broad national guidelines each state must: -establish its own eligibility standards (e.g. income ) -determine the type, amount, duration, and scope of services -set the rate of payment for services -administer the program Mandatory Benefits: -Inpatient hospital services -Outpatient hospital services -EPSDT (Early and Periodic Screening, Diagnostic, and Treatment Services) -Nursing facility services -Home health services -Physician services -Rural health clinic services -Federally qualified health center services -Laboratory and X-ray services -Family planning services -Nurse Midwife services -Certified Pediatric and Family Nurse Practitioner services -Freestanding Birth Center services (when licensed or otherwise recognized by the state) -Transportation to medical care -Tobacco cessation counseling for pregnant women

What are the nutrition quality standards for the program?

Meet the most recent Dietary Guidelines for Americans One meal must provide at least 1/3 of Dietary Reference Intakes

What is the Senior Farmers' Market Nutrition Program (SFMNP)?

Provide low-income seniors with coupons that can be exchanged for eligible foods at farmers' markets, roadside stands, and community supported agriculture programs. In Fiscal Year (FY) 2014, 787,139 older adults received SFMNP coupons.

What is the School Breakfast Program (SBP)?

Provides cash assistance to States to operate nonprofit breakfast programs in schools and residential childcare institutions. Administered at the Federal level by FNS. State education agencies administer the SBP at the State level, and local school food authorities operate it in schools.

What is the SNAP-ED program?

SNAP-Ed is designed to improve the likelihood that persons eligible for SNAP will make healthy choices within a limited budget and choose active lifestyles consistent with the current Dietary Guidelines for Americans and MyPlate.

Government/Public Insurance

The Centers for Medicare and Medicaid Services (CMS) is the federal agency responsibility for administering the public insurances. -The Medicare program -The Medicaid Program -The Children's Health Insurance Program (CHIP)

What are the purpose and benefits of the Emergency Food Assistance Program and Food Distribution Disaster Assistance programs, respectively?

The Emergency Food Assistance Program (TEFAP) -Helps supplement the diets of low-income needy persons, including older adults, by providing them with emergency food and nutrition assistance at no cost Eligibility requirements: -Public or private nonprofit organizations that provide food and nutrition assistance to the needy through the distribution of food for home use or the preparation of meals to be served in a congregate setting. -Households that meet State eligibility criteria. -USDA States (typically food banks) the public (soup kitchens & food pantries) Food Distribution Disaster Assistance -In need following a storm, earthquake, flood, or other disaster emergency. -The Food and Nutrition Service (FNS) coordinates with State, local and voluntary organizations to: - Provide food for shelters & other mass feeding sites - Provide disaster SNAP benefits - Provide food for distribution directly to households in need in limited circumstances -Canned food and drink (e.g., canned juice, meat, fruits and vegetables)

What are the requirements for the type of snacks that can be provided through the program?

The snacks must contain at least two different components of the following four categories: a serving of fluid milk a serving of meat or meat alternate a serving of vegetables or fruits or full strength vegetable or fruit juice a serving of whole grain or enriched bread/cereal

What is the Summer Food Service Program?

To ensure that low-income children continue to receive nutritious meals when school is not in session. Free meals, that meet Federal nutrition guidelines, are provided to all children at approved SFSP sites in areas with significant concentrations of low-income children.

What is the purpose of the program?

To provide breakfasts that meets Federal requirements, and they must offer free or reduced price breakfasts to eligible children

Private insurance

Traditional Fee-for-Service Insurance Managed Care Insurance - Preferred Provider Organization (PPO) - Heath Maintenance Organization (HMO) - Point-of-service (POS)

What does "nutritional risk" mean?

Two major types of nutrition risk are recognized for WIC eligibility: -Medically-based risks such as anemia, underweight, overweight, history of pregnancy complications, or poor pregnancy outcomes. -Dietary risks, such as failure to meet the dietary guidelines or inappropriate nutrition practices. Nutrition risk is determined by a health professional such as a physician, nutritionist, or nurse, and is based on Federal guidelines. Examples of nutritional risks Women: -Conditions complicating the prenatal and /or postpartum periods -General obstetrical risk -Nutrition-Related Risk Conditions Infants and Children: -Low-birth weight or preterm infants -Inadequate growth -Elevated blood lead levels -Inborn errors of metabolism -Inadequate dietary status by WIC standards

How is Food Security Measured in the US?

US Household food insecurity can be measured using the Food Security Survey Module. It includes a total of 18 items: -10 items on adult -8 items on children under 18 years old

What are the trends of hunger in the world and negative outcomes? (major locations and prevalent malnutrition issues) What are major nutrition concerns?

Under-nourishment (not enough calorie intake to meet minimum physiological needs for an active life): ~795 million undernourished people worldwide, mainly in developing countries Malnutrition (inadequate intake of protein, energy and micronutrients), measured through body weight or height by age. Protein-energy malnutrition (PEM) - most widespread form of malnutrition in the world Consists of: -Kwashiorkor - inadequate protein intake -Marasmus - inadequate food intake (starvation) -Iron deficiency is the most prevalent form of malnutrition, affecting billions of people worldwide. Iron deficiency damages a country's productivity and impedes cognitive development. -Vitamin A deficiency is a leading cause of child blindness across developing countries. It affects 140 million pre-school children in 118 countries. -Deficiency in vitamin A can increase the risk of dying from diarrhea, measles and malaria. -Iodine deficiency affects 780 million people worldwide. Some 20 million children are born mentally impaired because their mothers did not consume enough iodine during pregnancy. -Zinc deficiency contributes to growth failure and weakened immunity in young children; it results in some 800,000 child deaths per year.

Can you explain the cultural competence continuum model including the six stages?

Understanding the importance of social and cultural influences on individuals' health beliefs and behaviors The ability to work effectively with individuals from different cultural and ethnic backgrounds Cultural destructiveness -Attitudes, practices, and polices that are destructive to other cultures Cultural incapacity -Paternalistic attitude toward the "unfortunates." No capacity to help. Cultural blindness -Belief that culture makes no difference. Everyone is treated the same. Approaches of the dominant culture are applicable to everyone. Cultural precompetence -Weaknesses in serving culturally diverse populations are realized, and there are some attempts to make accommodations Cultural competence -Differences are accepted and respected, self-evaluations are continuous, cultural skills are acquired, and a variety of adaptions are made to better serve culturally diverse populations. Situations can be evaluated from multiple frames of reference Cultural proficiency -Engages in activities that add to the knowledge base, conducts research, develops new approaches, publishes, encourages organizational cultural competence, and works in society to improve cultural relations.

What is the poverty guideline?

Used to determine financial eligibility for certain federal programs Issued each year in the Federal Register by the Department of Health and Human Services (HHS).

What foods are typically provided for a woman, infant, and child, respectively?

WIC foods include: iron-fortified infant formula and infant cereal, iron-fortified breakfast cereal, vitamin C-rich fruit or vegetable juice, eggs, milk, cheese, peanut butter, dried beans and peas, canned fish, and fruits and vegetables. New foods added in 2009 include: whole-grain tortillas; brown rice; soy beverages; tofu; a wider choice of fruits and vegetables for ethnic variety; canned salmon, mackerel, and sardines; and baby foods.

What is the purpose of the State Children's Health Insurance program?

a partnership between the Federal and state governments that provides health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private coverage.

What is the definition of health disparity?

are the differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population.

ethnocentric

consider the belief, values, customs, and viewpoints of one's own group superior to those of other groups