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Health Planning Project Group #5Kimberly Robertson, Christine Russell, Kevin Michael Ryan,Christiana Safo, Emily Sakeman, and Janice SealUIN: Group #5Verde Campus, ArizonaSubmitted in partial fulfillment of the requirements in the course NURS 492: Community Health Nursingin the School of Nursing Old Dominion University NORFOLK, VIRGINIA Summer, 2013IntroductionChronic disease is the cause of death for 7 out of 10 Americans each year (Centers for Disease Control and Prevention, 2012). In Virginia Beach this is seen in data from the Virginia Department of health that shows 24percent of the population has hypertension and 33percent has hyperlipidemia (Virginia Department of Health, 2006). Nutrition and weight status has been directly linked to these chronic conditions. In addition the data also reveals that 67percent of the population members that have been diagnosed with hypertension and hyperlipidemia have a high school education, GED or less (Virginia Department of Health, 2006).One of the Virginia Health Departments priorities is to prevent and control chronic disease. The Board has cited as one of its core functions to educate its citizens about public health (Virginia Department of Health, 2011). Being public health nurses associated with the department of Health and in keeping with their mission, the researchers are proposing to create educational classes that will reach all children with a focus on lower income, lower educated households. The goal is to survey the parents and the children regarding food choices and physical activity, measure BMI (body mass index) of the children and educate the families on the importance of quality food choices, daily physical activity, and why they are important. These families may not ever receive the information needed to understand resources available to them and how to make informed decisions about nutrition. The researchers are proposing to focus their efforts on children. According to the Center for Disease Control, almost 1 out of every 5 American youths age 6 to 19 are obese with a BMI of >95th percentile. Hopefully this project will have a lasting lifelong effect on many citizens and will make a difference in their adult lives in Virginia Beach.AssessmentThis project proposes to study the effects of physical inactivity and dietary choices on weight control and chronic disease in lower-income children residing in Virginia Beach, Virginia. This aggregate was selected because earlier intervention in lifestyle programs should result in healthier people across their lifespan.Obesity in children is a rapidly growing threat to their future good health. The American Academy of Pediatrics found that “Over the past two decades, the prevalence of children who are obese has doubled, while the number of adolescents obese has tripled.” In addition, according to the National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, 2010) 31.9percent of children and adolescents were overweight (BMI at or above the 85th percentile) and 16.3percent were obese (BMI at or above 95th percentile) (Ogden, Carroll and Flegal, 2008). Most studies measure obesity using the (BMI) method. BMI is a measure used to determine overweight and obesity. Is calculated using a child's weight and height. BMI does not measure body fat directly, but it is a reasonable indicator of body fatness for most children and teens. A child's weight status is determined using an age- and sex-specific percentile for BMI rather than the BMI categories used for adults. This is done because the body composition of a child varies based on gender and age. The Centers for Disease Control and Prevention (CDC) growth charts are used to determine the corresponding BMI for the age and sex percentile. For children and adolescents (aged 2-19): overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex (Barlow and the Expert Committee, 2007). Childhood obesity can have a harmful effect on the body in a variety of ways. Obese children are more likely to have:High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD) in one study, 70percent of obese children had at least one CVD risk factor, and 39percent had two or more (Han, Lawlor and Kim, 2007). Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.Breathing problems, such as sleep apnea and asthma.Joint problems and musculoskeletal discomfort.Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e. heartburn).Obese children and adolescents have a greater risk of social and psychological problems, such as discrimination and low self-esteem, which can continued into adulthood and negatively impact their social future.Health risks later in life:Obese children are more likely to become obese adults (Friedman, Srinivansan and Benson, 2007). Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some forms of cancer. If children are overweight, obesity in adulthood is likely to be more severe (Han, el., 2007). Although the percentage of overweight youth has increased for all children and adolescents over time, the National Health and Nutrition Examination Survey (NHANES) data indicate disparity among racial/ethnic groups: “non-Hispanic black girls and Mexican-American girls are more likely to have high BMI for their age than non-Hispanic white girls. Among boys, "Mexican Americans are more likely to have high BMI for their age than non-Hispanic white boys” (National Health and Nutrition Examination Survey, 2010).This rise in childhood obesity is a nationwide challenge, with many contributing factors:One national survey found that 30percent of children ages 4 to 19 years of age consume fast food daily. Fast food and convenience food is inexpensive, but these foods are often high calorie and are low in nutritional value. Fast food restaurants are more common in ethnic minority neighborhoods (Fleischhacker, Evenson, Rodriguez and Ammerman, 2011) and the fast food industry disproportionately markets to ethnic minority youth (Harris, Schartz, and Brownell, 2010). Soft drinks and juice drinks make up 6 percent of all calories consumed for 2 to 5 year olds, 7 percent for 6 to11 year olds, and more than 10 percent for 12 to 19 year olds. While children 2 to 11 years old get more of their calories from milk than soda, the opposite is true for youth 12-19 years old. Female teens get 11 percent of their total calories from sodas or juice drinks but only 6 percent of their calories from milk (Troiano, Brefel, Carroll, and Bialostosky, 2000).Sodas and other sweetened beverages are readily available in our nation’s schools. Vending machines are placed in almost all of the nation’s middle and high schools and are in approximately 40 percent of our elementary schools. Both school vending machines and fast food restaurant use have been associated with an increased in sugar sweetened beverage intake in youth. When vending machines are placed in elementary schools, black children are more likely to purchase a soft drink from these machines (39 percent) compared to white children (23 percent) (Weicha, Finkelstein, Troped, Fragala, and Peterson, 2006).Opportunities for physical activity used to be a common component of each child’s school day but this opportunity is declining. While 87 percent of schools require physical education in grade eight, this declines to 47 percent in grade 10, and only 20 percent in grade 12. A minority of youth participate in intramural sports or activity clubs (less than percent) or varsity sports (less than 35 percent). Further, ethnic minority youth and those from poverty backgrounds are significantly less likely to participate in any type of sport or activity club (Johnson, Delva, and O’Malley, 2007).In 1969, approximately half of U.S. children walked or biked to school, and 87 percent of those living within one mile of their school did so. Today, less than 15 percent of U.S. school children walk or bike to school (Centers for Disease Control, 2005); among those who live within one mile of their school, only 31 percent walk, and for those living 2 miles or less from the school, only two percent bike to school. A third of U.S. children go to school on a bus and half are taken by private vehicle (Centers for Disease Control, 2002).Forms of entertainment have also impacted the levels of activity of children. Media content use has risen from more than 6 hours per day in 1999 to more than 7 hours per day in 2009 (Rideout, Foehr, and Roberts, 2010). Most notable were the large discrepancies found between minority and majority youth; Black and Hispanic youth average more than nine hours of media use per day compared to 6 hours among white children. Numerous studies have documented the link between sedentary leisure activities and a decrease in physical and psychological health; further, intervention studies have shown that lowering the amount of time spent in sedentary activities is associated with reductions in children’s body mass index (Tremblay, LeBlanc, Kho, Saunders, Larouche, Goldfield and Gorber, 2011).To summarize, this study proposes to use a random sample methodology to measure the BMI of schoolchildren aged 5-11, in 5 elementary schools in Virginia Beach, VA which are identified as lower-income schools by the Virginia Department of Education. The data that is found will then drive the planning, implementation and evaluation of the remainder of the project.PlanningIt is important for the public health nurse to examine trends in the community when planning for health interventions. Area specific data will provide information on the health and economic status of the community. The researchers plan to involve the community in a number of ways. Nursing schools in the area will be canvased for volunteers to help with the project. Similar programs in the United States will be reviewed for ideas on implementation and access to funding through grants and donations. Local government agencies and businesses will be asked to participate through donations and materials needed for the project.Once the five schools have been selected, students will be asked to take move a permission slip for their parents to sign. Some initial information about the project will be provided and this will give the public health nurses the authorization measure and survey the students. No measurement information will be shared with the students. The parents will also be asked to complete a survey to about nutrition knowledge, family diet, and physical activities. The children will complete a similar survey. Both will be used as baseline data along with the measurements of the starting BMI of each child.According to a study by the Pediatric Nutrition Surveillance System (PedNSS), which looked at preschool children in the United States from 1998-2010 who are eligible for federally funded nutrition programs such as WIC (Woman, Infants and Children), the national rates of obesity has declined overall. This program appears to be helping change the trend.1998-2003 – obesity rates rose from 13.5percent to 15.21percent, extreme obesity rates rose from 1.75percent to 2.22percent2003-2010 – obesity rates declined from 15.21percent to 14.94percent, extreme obesity rates declined from 2.22percent to 2.07percentThe rise in national preschool obesity rates followed by a long period of slowly declining rates may indicate improved access to educational information. Some sources of information include school programs, Ms. Obama’s “Let’s Move” initiative, media advertisements, and internet resources. Obesity is a BMI at or above the 95th percentile for children of the same age and sex, whereas extreme obesity is defined as a BMI at or above 120percent of the 95th percentile for children of the same age and sex (Centers for Disease Control, 2012).About 19.5percent of people are obese in Virginia Beach compared to 24percent of people in the United States. Statistics show that in Virginia Beach about 19.8 percent of people do not exercise (Find the Data 2013). One of the goals of the project is to reduce obesity and to increase the percentage of young people and families that do exercise on a regular basis. Virginia Beach appears to have slightly lower rates of obesity than the nation, and this could be related to the number of Medicaid recipients (31,544) who are in lower income households and now have more opportunities for healthy food choices. Research conducted by the US Department of Agriculture found that participants in the National School Lunch Program, through which the federal government provides reimbursable meals to schools, were more likely to consume vegetables, milk and milk products, meat and other protein rich foods than non-participants (Virginia Commission on Youth 2003). According to the “Cool Kids Program” in Virginia, parents are responsible for the eating habits of their children. Children are following in the nutritional footsteps of their parents, who were predominately overweight and obese (Virginia Commission on Youth 2003). This is why the project must involve the parents and hopefully the entire family.The public health nurse may look at ways to improve the WIC program by suggesting the addition fruits and vegetables, along with fewer high fat cheeses and high sugar juices choices. Promoting physical activity through community programs will also help. The dangerous trend of obesity is in part due to the increase in sedentary activities such as video games, television and social media. Educational information on healthy choices does exist on the internet, and the public health nurse can provide guidance additional sources of information for parents in the community.EvaluationObservationPortion sizes of meal prior to initiation of project and after project completed. Nutritional content of food prior to initiation of project and after project completed.Amount of physical activity prior to initiation of project and after project completed.Timeframe: Ongoing for duration of project and should be assessed every three months.Pre-Test and Post-TestPre-Testing would include a baseline BMI and the current amount of time the participants spend doing physical activity during school hour and after school.Post-Test would include any changes in BMI, amount of time spent doing physical activity.Timeframe: Immediate and ongoing.SurveyParticipants would be asked to complete a simple questionnaire related to current food choices, amount of time spent doing physical activity, amount of time spent performing sedentary activities (ex: video game, watching TV, social media).Timeline: Ongoing for duration of project and should be assessed every three months to track success of project.MonitorSuccess of program can be measured by the decrease in BMI of participants, increase amount of physical activity, and changes in eating habits and food choices.Timeline: Ongoing for duration of project and should be assessed every three months to track success of project. RecommendationsThe community health nurse will have a key role to play in providing education to both the participants and parents. According to O’Connor (2011), “Despite efforts to get children to be more active, a large portion are not meeting government physical activity requirements” (p. 55). The community health nurse can advocate for an increase in physical education activities during school hours and encourage participants and their parents to also increase amount of time doing physical activity after school hours. This is another area where local businesses and national grants and funding may be available to pay for lower income children to participate in activities they normally could not afford. To achieve this goal, the community health nurse can establish a relationship with school administrators in the five schools and the school nurse to encourage an increase in physical activity during physical education classes. O’Connor (2011) states “Environmental factors such as lack of time for physical education in schools and reduced time for play are thought to contribute to low levels of physical activity” (p. 55). In addition to the public researchers can work with local schools identify and encourage those children in need to participate physical activity by connecting them with local community programs such as the YMCA, Boys and Girls clubs, and other groups in an effort to promote an increase in physical activity after school hours. If the project proves to be successful in reducing the participant’s BMI and increasing the amount of physical activity both during and after school hours, the community health nurse will have data to support the importance of promoting an increase in physical activity to reduce childhood obesity. Stodd (2007) states, “Community based nursing should get to know and partner with their community, identify community strengths and resources, access local schools, use existing evidence based guidelines, report their data, apply data for intervention and policy change” (p. 7). The community health nurse can help provide data that weight is an issue by assessing and documenting the BMI percentile for the participants involved in the project (Stodd, 2007). Support for an increase in physical activity can be bolstered when the data shows a decrease in BMI when physical activity is increased. Because the evaluation strategies have an ongoing timeline of assessing and collecting data every three months, the community health nurse will be able to monitor the effectiveness and progress of the program.ConclusionAccording to healthy people 2020 objectives, “For a community to improve its health, its members must often change aspects of the physical, social, organizational, and even political environments in order to eliminate or reduce factors that contribute to health problems or to introduce new elements that promote better health” (U.S. Department of Health and Human Services, 2013) To address gaps in services and create improvements, the whole community needs to be involved in addressing the issue of nutrition and weight status. Local government needs to invest in the health of the people in the community. School nurses and school authorities need to get involved to help kids make better nutritional and physical choices at school and to learn more about their health regardless of income status. Science communities and other research institutes should be allowed to explore new ways and means of achieving optimal health in our community. As the front line advocates public health nurses can help in many ways. Conducting research, direct involvement with the community, and coordination between public and private efforts can increase the impact of the limited resources that are available to combat these public health risks.ReferencesBarlow, S.E., and the Expert Committee. (2007). Expert committee recommendations regarding the prevention assessment and treatment of children and adolescent overweight and obesity: summary report. Pediatrics 120 (Supplement December 2007), S164-S192.Center for Disease Control and Prevention (2010). National Health and Nutrition Examination Survey. Retrieved July 20, 2013 from for Disease Control and Prevention. (2012). Chronic Diseases and Health Promotion. Retrieved July 18, 2013 from /index.htm.Centers for Disease Control and Prevention. (2012). Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families from 1998-2010. JAMA 308(24). 2563-2565. Retrieved July 20, 2013 from the Data. (2013). Virginia Beach City County, Virginia Health Report. Retrieved from , S. E., Evenson, K. R., Rodriguez, D. A., and Ammerman, A. S. (2011). Asystemic review a fast food access studies. Obesity Reviews, 12, 460-71. doi: 10.111/j.1467-789X.2010.00715.x.Friedman, D. S., Mei, Z., Srinivansan, S. R., Brenson, G. S., and Diets, W. H. (2007). Cardiovascular risk factors and access adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatric. 150(1), 12-17.e2.Han, J. C., Lawlor, D. A. and Kimm, S. Y. (2010, May 15). Childhood obesity. Lancet. 375(9727),1737-1748.Johnson, L. D., Delva, J., and O’Malley, P. M. (2007). Sport participation in physical education in American secondary schools. American Journal of Preventive Medicine. 33, S195-S207. Doi:10.1016/j.amepre.2007.07.015. O’Connor, A. (2011). Promoting healthy eating and an active lifestyle in schoolchildren. Nursing Standard, 25(48), 48-56.Ogden, C.L.,?Carroll, M.D. and?Flegal, K.M. (2008, May 28). High body mass index for age among US children and adolescents 2003-2006. Journal of American Medical Association. 299, 2401-2405.Rideout, V., Foehr, U. and Roberts, D. (2010). Generation M2: Media in the lives of 8-to-18 year olds. (PDF, 2.73MB) Washington, D.C.: Kaiser Family Foundation. Retrieved from: , A. (2007). Obesity in undeserved school-age children. Chart, 104(2), 6-8.Tremblav, M. S., LeBlanc, A. G., Kho, M. E., Saunders, T. J., Larouche, R., Colley, R. C., Goldfield, G., and Gorber, S. C. (2011). Systemic review of sedentary behavior and health indicators in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity. A (PDF.416KB), 98. doi:10.1186/1479-5868-8-98.Troiano, R. P., Briefel, R. R., Carroll, M. D., and Bialostosky, K. (2000). Energy and fat intake in children and adolescents in the United States: Dfrom the National Health and Nutrition Examination Survey. American Journal of Clinical Nutrition, 72, 124S-153S.U.S. Department of Health and Human Services. (2013, April 13). Educational and community- based programs. Healthy People 2013. Retrieved July 20, 2013 from Department of Health. (2006). Chronic Disease Data Report. Retrieved July 20, 2013 from Disease percent20Datapercent20Report_040607.pdfVirginia Department of Health. (2011). Mission, Roles, Priorities and Functions. Retrieved July 17, 2013 from mission.htm.Virginia Commission on Youth. (2003). Childhood Obesity Commission on Youth Document. Retrieved July 20, 2013 from , J. L., Finkelstein, D., Troped, P. J., Fragala, M., and Peterson, K. C. (2006). School vending machines use and fast-food restaurant use are associated with sugar sweetened beverage intake in youth. Journal of American Dietetic Association, 106, 1624-1630. doi: 10.1016/j.jada.2006.07.007Honor Code:I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violations of the Honor Code. I will report to a hearing if summoned.Kimberly Robertson Christine RussellKevin Michael RyanKimberly Robertson Christine RussellKevin Michael RyanChristiana SafoEmily SakemanJaniceSealChristiana SafoEmily SakemanJanice Seal Introduction [10 points]Identify yourself and your interest in making the proposalAssessment??[20 points] Specify level of aggregate selected for study. Identify and provide a general orientation to the aggregate. Include why this aggregate was selected and the method used for gaining entry.Describe specific characteristics of the aggregate including Socio-demographic characteristics Health status Suprasystem influencesProvide relevant information gained from literature review, especially in terms of characteristics, problems or needs that one would anticipate finding with this type of aggregate. Include comparison of health status of chosen aggregate with other similar aggregates, the community, the state, and/or the nation.Identify health problems and/or needs of specific aggregate based on comparative analysis and interpretation of data collection and literature review. Include (when possible) input from clients regarding their perceptions of needs. Give priorities to health problems and/or needs and indicate how these priorities are determined.Planning??[20 points] Select one health problem and/or need for intervention and identify ultimate goal of intervention. Identify specific, measurable objectives as (mutually agreed on by student and aggregate, when possible)Identify environmental planning considerations (space, resources)Describe alternative interventions necessary to accomplish objectives. Include consideration of interventions at each systems level where appropriate. Select and validate intervention (s) with highest probability of success. (Note: Interventions may include using existing resources and/or developing resources.)Evaluation??[20 points] Develop a plan for evaluation of the project including: Strategies (tools if appropriate) Timeframe( immediate, ongoing) Make recommendations for further action based on evaluation and how to communicate these to appropriate individuals. Discuss implications for community health nursingConclusion [10 points]Provide a summary of your proposalInclude your recommendation for “the next step”Organization [20 points]Includes ODU SON title pageAdheres to APA format (including in text citations and reference page)Uses correct spelling, grammar, syntaxIncludes Honor Code (1 point)Includes Grade Rubric (1 point)Total 100 points ................
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