Consuming Chronic Illnesses



Consuming Chronic IllnessesBy Deborah JonesCapstone ProjectIntroductionNutrition, Health Promotion, and Health Administration are disciplines taught throughout the country and the world. Now, more than ever, our government is looking to these disciplines to help our nation combat the obesity epidemic, as well as the epidemic of chronic illness that has plague Americans. With the passage of the Affordable Care Act, the federal government has now begun to focus its efforts on prevention and wellness rather than curative care or health maintenance. Each of the disciplines named above are instrumental in helping Americans live happier healthier lives. Whether it be through practicing good nutrition, or participating in classes teaching stress or change management techniques, or gaining access to healthcare that was previously unavailable, individuals, undoubtedly, benefit from each of these disciplines at some point in their lifetime.Nutrition is defined by Turley and Thompson (2012), “The science of foods and the nutrients and other substances they contain, and of their actions within the body, as well as the social, economic, cultural, and psychological implications of food and eating” (p. 506). Nutrition deals with more than just the foods that are consumed. There are social, cultural, economic, and psychological implications of nutrition that many don’t consider. According to Cottrell, Girvan and McKenzie (2012), “Health promotion is any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities” (p. 370). Finally, Health Administration can be defined as the field relating to leadership, administration, and management, of hospitals, their networks, health care systems, and public health systems. Health care administrators are considered to be health care professionals. Healthcare Administration is also concerned with helping individuals to modify behaviors to improve health status. This is known as Change Management. Because African Americans have some of the highest rates of chronic illnesses, integrating these disciplines were very beneficial and produced a two (2) hour wellness class in which topics such as nutrition, stress management techniques, and the importance of utilizing skills gained during the class were emphasized. Material informing participants about access to healthcare were distributed. Participants were asked to complete a pre and post survey indicating the knowledge about each of these disciplines prior to the wellness class and immediate following the class. Participation during the class was high, and the post-test results indicated an increased knowledge about nutrition, health status, and how to achieve better health outcomes. The information was well received. A PowerPoint presentation discussing the African-American diet, and the benefits of using the MyPlate, which is an online tool were thoroughly discussed. Participants were asked to volunteer their time to learn more about MyPlate and the numerous health benefits of eating the recommended portions of fruits, vegetables, whole grains, dairy, and meat. Participants were given actual MyPlates that were donated by Salt Lake County for the wellness class. Literature regarding stress management, and gaining access to healthcare was also provided for participants. Change management tips were shared, and at least two (2) of the attendees have asked for assistance in losing weight or maintaining their current weight. Both have used the change management techniques to change their eating habits, and have reported using the MyPlate, the web-based tool to track calories, and the actual MyPlate distributed at the wellness class to ensure they are eating a healthy diet. The wellness class was a holistic approach to wellness. A large percentage of the attendees were African-American living with chronic illnesses, or African Americans who know someone with a current illness. Healthy refreshment along were provided, and low-fat southern-style recipes were also provided. The PowerPoint presentation addressed the common myths and misconceptions among African-Americans; provided statistics supporting claims that African Americans have higher rates of chronic illness that other ethnicities; introduced the MyPlate online tool; discussed health benefits of eating the recommended amounts from each food group; discussed good calories versus empty calories, and finally, encouraged participants to learn more about stress management, and access to healthcare through the Affordable Care Act. The wellness class was a holistic approach to health, discussing serious issues that affect the African-American community such as stress, access to healthcare, change management, and nutrition. To understand the African-American diet, one must first understand the importance of food in this community, and the social, and cultural aspect of food among this ethnic group.Social and cultural aspect of foodFood sharing among African Americans is a social activity that is often accompanied by conversation and gaiety. Food is lovingly prepared for friends and family, and is a significant factor in the cohesiveness of the African American community (Kittler, Sucher & Nelms, 2012). In the South, food is usually the catalyst for social interaction, and “Southern Hospitality” is renowned (Kittler et al., 2012). Some Blacks view eating with others from their ethnic community as an intimate or a spiritual experience (Kittler et al., 2012). This research paper will discuss the contemporary food habits for African Americans which include holidays, typical meals and meal patterns, staple foods, and overall, eating practices among this ethnic group. A sample diet of a middle-age African American female will be reviewed using diet analysis software. Recommendations to increase fitness levels and to improve dietary behaviors will be discussed. Interventions must begin early, and should be focused in order to be successful among this target population. This paper will discuss why early intervention is necessary if health education specialist and other health professionals are going to be successful in modifying behaviors regarding diet and fitness among this ethnic group. Food habits for this population today typically reflect their socioeconomic status, work schedule, geographic location, more than their Southern or African heritage (Kittler et al., 2012). History of African American food and cultureMany of the foods consumed by African Americans today have their influence from West Africa. When Black indentured servants were taken from West Africa forcefully by Dutch traders, they brought with them their traditions as well as their foods. After leaving their homeland, many Africans tried to maintain their cultural values despite their exposure to slaves of other tribes, white owners, or other ethnic groups. Today’s African American diet often includes elements from West Africa, and foods that were eaten by slaves. However, food habits changed among Africans as they were introduced to “New World” foods. What little is known about this cuisine and what was recorded resembles much of what we see in today’s African American diet and what was also seen during the time of slavery (Kittler et al., 2012). The slave dietSlavery is the primary historical circumstance that altered indigenous African food practices (Di Noia et al., 2013). Slaves began to incorporate “New World” foods such as chilies, peanuts, pumpkins, and tomatoes, into their diet, but brought with them food such as black-eye peas also called “cow peas”, okra, watermelon, sesame and taro. Substitutions and adaptations were made based on foods that were available. West African preparations were added to French, British, Native American, and Spanish techniques by black cooks in order to create an American Southern Cuisine. Southern cuisine emphasized methods of cooking such as roasting, frying, and boiling dishes. These cuisines included pork fat, sweet potatoes, corn, and local green leafy vegetables. Other African regions, unfortunately, have had very little impact on the typical American diet although immigrants who have recently arrived in the United States continue to consume traditional meals (Kittler et al., 2012). The traditional African diet was low in meats and fat and was high in complex carbohydrates and parallel with current dietary recommendations. During slavery, changes in diet were likely influenced by forces such as limited time for food preparation; selection; procurement (lack of food preparation equipment and utensils); lack of adequate storage facilities; lack of written recipes for food preparation; the use of spices to flavor spoilage; the need for extended boiling in order to tenderize tough cuts of meat and wild vegetation; and finally, the practice of seasoning food with fat in order to make the food taste more desirable. Passed down through several generations, many of the food practices founded during slavery are common today (Di Noia et al., 2013). The pressures of a fast-pace society, however, have directly affected the meal patterns and traditional foods of many African Americans (Kittler et al., 2012). Contemporary food habits for African AmericansDietary choices today for African Americans are influenced by numerous factors, including taste, cost, convenience, nutrition, and cultural preferences for food. Research indicates that taste and cost may be the two most important factors in food choice for this ethnic group (Fulp, Rachael, McManus, & Johnson, 2009). Some positive aspects of a contemporary diet for blacks include a high intake of foods such as legumes, poultry and fish, and the family tradition of eating together. Many of the negative aspects; however, include, but are not limited to, food-preparation methods such as flavoring foods with fat, salt and sugar. Other negative aspects of food preparation include the use of boiling food for long periods, which lowers the potency of water-soluble vitamins, and the use of frying and deep-fat frying methods which adds calories from saturated fats (Di Noia et al., 2013). Consumption of fast foods in place of home prepared meals is another negative aspect of the African American contemporary diet. Unfortunately, this is also the case of the typical American diet. Today’s African American diet is generally low in calcium due to low dairy food consumption. Approximately 60 to 95 percent of African Americans are lactose intolerant. As a result, milk or milk-based products are generally avoided by this ethnic group substantiating reports that African Americans consume less dairy products; and thus, diets are generally lower in minerals such as calcium (Kittler et al., 2012). Although lactose intolerance plays a role in contemporary diets being lower in calcium, culturally determined food preferences and dietary practices also play a significant role (Di Noia et al., 2013). Soul food is a modern term used to describe traditional Southern black cuisine such as vegetables or meat that is freshly made, or thoroughly cooked. African Americans usually prefer their food “well-seasoned” or “well spiced”, and view soul food as a cuisine that symbolizes solidarity regardless of where they reside, or their socioeconomic status. Many African Americans consider Soul food to be an emblem of identity and recognition of black history (Kittler et al., 2012). Many of the staple foods that African Americans enjoy include pork products such as bacon, sausage, barbecued pork ribs, ham hocks, pig feet, pig ears, and crackling- fried pork pieces with the fat still attached (Kittler et al., 2012). Pork chitterlings are a favorite among African Americans and are generally cooked on holidays such as Thanksgiving and Christmas. Pork cuts are eaten roasted, pickled, boiled and fried. It is not uncommon for African American families to have their own special barbecue sauce (Kittler et al., 2012). Sauces are usually spicy, or extremely sweet as often times they are prepared using brown sugar, maple syrup or molasses to sweeten them to perfection. Poultry, fish, small game are other meats are frequently consumed by African Americans (Kittler et al., 2012). Legumes such as black-eye peas, pinto, kidney, and red beans are also common staples found in the African-American home. Popular vegetables eaten most frequently in the African American home are kale, mustard, collard and turnip greens. Okra, fried, or boiled, beets, broccoli, onions, cabbage, corn, green peas, spinach, green peppers, sweet potatoes, squash, tomatoes and yams are also favorites among this ethnic group. Popular fruits include, but are not limited to watermelon, apples, berries and peaches (Kittler et al., 2012). Hot sauce, usually made from hot peppers, is a staple that can be found in most African American homes. Biscuits and cornbread are a favorite among this group, and are served frequently with meals. Butter, meat drippings, lard and vegetable shortening are still preferred fats used for cooking. Consumption of sugary drinks such as soft drinks and sweetened tea are high. Coffee, fruit drinks and wine are also consumed frequently (Kittler et al., 2012). African Americans celebrate Thanksgiving, Christmas, Easter and New Years with food being an integral part of these holidays. Holidays are a time for socializing and spending time with friends and family. For some holidays such as New Years, certain foods may be symbolic. For example, black eye peas may be eaten for good luck; fish may be eaten for motivation; greens such as collared or kale greens may be eaten for money, and rice for prosperity in the upcoming year. During slavery, Sunday dinner was a large family meal. This meal became the main meal following emancipation. Today, Sunday dinner is still considered an important meal that is accompanied with food sharing with family and friends. It is also a time to extend hospitality to neighbors (Kittler et al., 2012). Kwanza, an African American holiday, which recognizes the African dispersion of Africans from their homeland, is celebrated from December 26th to January 1st of each year. The unity of all Africans is celebrated during Kwanza. Juneteenth celebrations are celebrated around the country in African American communities to commemorate the emancipation of slaves. Traditional southern fares, as well as African and Caribbean cuisines are served during these celebrations (Kittler et al., 2012). Sample diet Research has shown that eating a diet rich in fruits, vegetables, low fat dairy products, and whole grain while reducing sodium intake and increasing potassium intake can help lower blood pressure among African-Americans with high blood pressure. This diet is known as the DASH diet (Dietary Approach to Stop Hypertension). Studies have shown that the DASH diet has been successful in lowering blood pressure among African-Americans with hypertension an average of 13 points. This is a decrease comparable to that typically achieved with medications (Geriatrics, 1999). This DASH diet, an eating plan, encourages a diet low in fat and sodium, and rich in fruits, vegetables, whole grains and potassium (Treatment of Hypertension, 2015). There are no unusual recipes or foods. The DASH diet is consistent with other nutritional recommendations such as MyPlate and the TLC diet which are aimed at reducing obesity, heart diseases and other diet related chronic illnesses. MyPlate is stylized plate graphic that has been divided into four wedges. The four wedges represents fruits and vegetables (which take up half of the "plate"), grains and "protein" (which includes sources such as poultry, eggs, meat, peas, beans and seeds). MyPlate is definitely a dramatic shift from how most Americans?plan their meals. For example, the "protein" wedge represents a little less than a quarter of the plate which is not usually the amount that Americans consume. Generally speaking, most Americans consume significantly more meat than is nutritionally recommended. A circle adjoining the plate icon suggests a place for dairy, such as a glass of skim or reduced-fat milk or reduced fat yogurt. In short, my plate encourages Americans to fill half their plates with fruits and vegetables, and to control their portion sizes of meats. It also recommends that at least half of the grains consumed daily by Americans should be whole grains. Americans can enjoy their food while eat less of it. This simplified plate imagery omits any depiction of solid fats (saturated and trans fats) and sodium, as well as added sugars unlike the Food Guide Pyramid should. It is assumed that these items should be consumed in moderation (“How to Make ‘MyPlate’ Your Plate”, 2011).The Therapeutic Lifestyle Changes which is known as the TLC?diet was designed primarily for people with high levels of LDL which is the bad cholesterol. This diet monitors and helps to cap the percentage of calories consumed from fat. It also places limits on dietary cholesterol, sodium, and total calories consumed daily. It also encourages the consumption of soluble fiber and plant stanols. As with the other eating plans such as the DASH diet, and MyPlate, the TLC diet also encourages physical activity, and weight management in addition to consuming a healthy diet to prevent or delay the onset of chronic illnesses (“16 Tips to Lower Your Cholesterol”, 2016). Lifestyle measures can help lower blood pressure and keep it at a healthy level. These changes include losing weight if you are overweight; following an eating plan such as the Dietary Approaches to Stop Hypertension (DASH) diet, the TLC diet or MyPlate. These eating plans not only encourage eating healthier, but they also encourage regular physical activity; and moderating alcohol consumption. Incorporating these changes into one’s lifestyle and continuing them over a long period of time can have a significant effect on preventing and treating chronic illnesses such as hypertension (“Treatment of Hypertension”, 2015)A one day sample diet of a middle-aged African American women between the ages of 40-45 was analyzed using a data analysis software. The results indicate that the African American women consume excessive amounts of sodium, saturated fat, cholesterol, and sugar. This report also indicates that consumption of vegetables, fruits, and whole grains are below the recommended levels. According to the nutrient report found on page 17, macronutrients such as carbohydrates, protein, and fiber were met when analyzing this one day diet; however, this report indicates that the intake of fats, saturated fats and cholesterol exceed recommended levels. The nutrients report shows a deficiency in micronutrients such as calcium, but also indicates that there is an over consumption of sodium for this ethnic group in their one day diet. Deficiencies in vitamin D were also noted in this report. According to Food Groups and Calories report listed on page 16, this one day diet for a middle-aged African Americans reflects low intake of whole grains, and excessive consumption of refined grains. The Food Group and Calories Report indicate that middle-aged black women are consuming large amounts of empty calories which can be problematic for any ethnic group. In addition to consumption of excessive calories, both the Food Group and Calories Report and the Nutrients report indicate and overconsumption of calories. The average African American women according this report consume 2,000 more calories than what is recommended.Meals from 11/12/15 - 11/12/15The Subject’s Meals Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.Date?BreakfastLunchDinnerSnacks11/12/15?57150666752 regular slice Bread, 100% whole wheat57150666751 cup Collards, fresh, cooked (with salt and vegetable shortening) 4762566675?1 cup Cabbage, mustard, salted?EMPTY ?57150571503 large egg(s) Eggs, fried, with butter57150571501 medium breast Fried chicken, breast, fried in oil, skin/breading eaten4762557150?1 fillet (5" x 2-1/2" x 3/8") Catfish, floured or breaded, fried in shortening?? ?57150571501 cup Grits, corn or hominy, quick, cooked (with salt and margarine)57150571501 cup Macaroni and cheese, made from mix with prepared cheese (Velveeta Shells and Cheese, Kraft Deluxe)4762557150?1 piece (1/8 of 9" pie) Pie, sweet potato?? ?57150571501? cup Hash browns, frozen potatoes57150571501 cup Mashed potatoes, with milk and margarine or butter4762557150?1 cup Potato salad, with egg, no dressing?? ?57150571501 cup Orange juice, frozen (reconstituted with water)57150571501 piece (1/8 of 9" pie) Pie, lemon meringue4762557150?1 cup Red beans and rice, cooked with vegetable oil ?? ?57150666752 patty Sausage, pork, cooked57150666751 mug (8 fl oz) Tea, brewed, sweetened with sugar4762566675?1 can (12 fl oz) Soft drink, cola (Pepsi, Coke)????????The Subject’s Food Groups and Calories Report 11/12/15 - 11/12/15Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.Food GroupsTargetAverage EatenStatusGrains7 ounce(s)11? ounce(s)OverWhole Grains≥ 3? ounce(s)2 ounce(s)UnderRefined Grains≤ 3? ounce(s)9? ounce(s)OverVegetables3 cup(s)6? cup(s)OverDark Green2 cup(s)/week1 cup(s)UnderRed & Orange6 cup(s)/week? cup(s)UnderBeans & Peas2 cup(s)/week? cup(s)UnderStarchy6 cup(s)/week3? cup(s)UnderOther5 cup(s)/week1? cup(s)UnderFruits2 cup(s)1 cup(s)UnderWhole FruitNo Specific Target0 cup(s)No Specific TargetFruit JuiceNo Specific Target1 cup(s)No Specific TargetDairy3 cup(s)? cup(s)UnderMilk & YogurtNo Specific Target? cup(s)No Specific TargetCheeseNo Specific Target? cup(s)No Specific TargetProtein Foods6 ounce(s)10? ounce(s)OverSeafood9 ounce(s)/week2 ounce(s)UnderMeat, Poultry & EggsNo Specific Target8? ounce(s)No Specific TargetNuts, Seeds & SoyNo Specific Target0 ounce(s)No Specific TargetOils6 teaspoon4 teaspoonUnderLimitsAllowanceAverage EatenStatusTotal Calories2200 Calories4178 CaloriesOverEmpty Calories*≤ 266 Calories1231 CaloriesOverSolid Fats*896 Calories*Added Sugars*335 Calories**Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories. Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.The Subject’s Nutrients Report 11/12/15 - 11/12/15Your personal Calorie goal is 2200. Your plan amounts are based on meeting your nutrient needs.NutrientsTargetAverage EatenStatusTotal Calories2200 Calories4178 CaloriesOverProtein (g)***46 g139 gOKProtein (% Calories)***10 - 35% Calories13% CaloriesOKCarbohydrate (g)***130 g491 gOKCarbohydrate (% Calories)***45 - 65% Calories47% CaloriesOKDietary Fiber25 g40 gOKTotal SugarsNo Daily Target or Limit138 gNo Daily Target or LimitAdded SugarsNo Daily Target or Limit84 gNo Daily Target or LimitTotal Fat20 - 35% Calories41% CaloriesOverSaturated Fat< 10% Calories11% CaloriesOverPolyunsaturated FatNo Daily Target or Limit9% CaloriesNo Daily Target or LimitMonounsaturated FatNo Daily Target or Limit17% CaloriesNo Daily Target or LimitLinoleic Acid (g)***12 g39 gOKLinoleic Acid (% Calories)***5 - 10% Calories8% CaloriesOKα-Linolenic Acid (% Calories)***0.6 - 1.2% Calories0.7% CaloriesOKα-Linolenic Acid (g)***1.1 g3.4 gOKOmega 3 - EPANo Daily Target or Limit74 mgNo Daily Target or LimitOmega 3 - DHANo Daily Target or Limit259 mgNo Daily Target or LimitCholesterol< 300 mg1082 mgOverMineralsTargetAverage EatenStatusCalcium1000 mg954 mgUnderPotassium4700 mg4997 mgOKSodium**< 2300 mg8229 mgOverCopper900 ?g2317 ?gOKIron18 mg21 mgOKMagnesium320 mg457 mgOKPhosphorus700 mg2150 mgOKSelenium55 ?g203 ?gOKZinc8 mg14 mgOKVitaminsTargetAverage EatenStatusVitamin A700 ?g RAE1723 ?g RAEOKVitamin B61.3 mg4.1 mgOKVitamin B122.4 ?g5.5 ?gOKVitamin C75 mg178 mgOKVitamin D15 ?g4 ?gUnderVitamin E15 mg AT15 mg ATOKVitamin K90 ?g829 ?gOKFolate400 ?g DFE1019 ?g DFEOverThiamin1.1 mg3.2 mgOKRiboflavin1.1 mg3.1 mgOKNiacin14 mg40 mgOKCholine425 mg827 mgOKInformation about dietary supplements. ** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-linolenic acid) have two separate recommendations: 1) Amount eaten (in grams) compared to your minimum recommended intake. 2) Percent of Calories eaten from that nutrient compared to the recommended range. You may see different messages in the status column for these 2 different recommendations.Health status disparitiesAfrican Americans are disproportionately affected by obesity, hypertension, diabetes, cardiovascular diseases, cancer, other chronic illnesses related, in part, to dietary factors. This population urgently needs interventions to improve their dietary practices in order to reduce morbidity and mortality from diet-related diseases. Interventions must be culturally sensitive. In order to enhance the impact and relevance of an intervention, the intervention(s) should incorporate into their design, experiences, values, behavioral patterns, norms, environmental and social influences on behavior (Di Noia et al., 2013). Higher incidents of chronic illnesses have been linked to a diet high in saturated fat, sodium, refined grains, and sugar. Nutrients such as complex carbohydrates, fiber, and EPA (Omega 3) are generally consumed below the recommended levels to maintain health for African Americans (Di Noia et al., 2013). In recent years,?obesity?rates have risen to alarming rates in the United States. In fact, many developing countries as they become more industrialized are seeing growing numbers of obesity. An increase in the availability of calorie-dense food coupled with sedentary lifestyles has significantly contributed to the rise in obesity in the United States and around the world. Obesity is described as a chronic illness resulting from environmental and genetic factors. Environmental factors may include a combination of behavioral, cultural, social, and physiological influences. While genetics may contribute to overweight or?obesity, ultimately an individual’s body weight is determined by their?diet?and activity level. A family history of?obesity?may increase ones chance of becoming obese by roughly 30 percent. Obesity?risk factors such as diet and the activity level are often times influenced by an individual’s family as well. Over the long term, obesity, which is defined as a chronic illness, can result from consuming excessive calories, leading a sedentary lifestyle, or a combination of both. Obesity and diets high in saturated fats have been linked with nutritionally related chronic illnesses such as cardiovascular disease (CVD), diabetes mellitus, hypertension, high cholesterol and certain types of cancers. Unfortunately, Americans including the African American population are eating out more than ever. Fast-food restaurants are now offering a wide variety of high-fat and high-calorie menu items. Fast-food restaurants are popping up everywhere and “supersizing” menu items have become the norm. Many of these establishments are offering bigger portions in an effort to attract customers. Unfortunately, bigger doesn't always mean better, and in these instances is usually doesn't. Even the foods prepared in the home are high in fat and calories contributing to the obesity and other chronic illnesses. Other ethnicities that have migrated to the United States and adopted the typical American?diet (a diet high in fat and calories) have seen an increase in chronic illnesses. In other words,?as time in the country increase, their rates of many?diet- and physical-activity-related?chronic illnesses such as heart disease and several cancers have increased (Hensrud, 2002).NutritionAfrican Americans are more likely to have poor diets resulting from lower intakes of vegetables and dairy products, and higher intake of sodium. Moreover, African Americans have reported to have higher intakes of fat which is consistent with that of the typical U.S. diet. Fried foods, high meat intake and the consumption of fast foods are all major factors contributing to the higher intake of fats among this population. Seventy-seven percent of African American women, middle aged, were reported as having consumed over 30% of their daily calories from fat while sixty-one percent reported consuming over 10% of total calories from saturated fats. Other studies conducted on middle-aged African American women found higher intake of cholesterol within their diets (Kittler et al., 2012). There are numerous nutritional deficiencies among African Americans that are living in poverty especially older adults. African Americans eat fewer servings of vegetables, dairy and fruit than whites according to a recent survey. The African American diet is insufficient in the minerals iron, calcium and low in vitamins D, B6, as well as E (potassium, copper, zinc and selenium). A study of adolescents found a significant amount of African-American adolescents were overweight. This may be due in part to social economic status, or a more permissive attitude regarding body shape, and obesity in general. Another factor contributing to high obesity rates among African Americans is the environment in which many live that tends to promote high intake of fast foods. Limited access to healthy foods must also be considered when discussing factors for obesity in this ethnic group. African Americans are less likely to not equate being overweight with unattractiveness which may explain disordered eating is less common in this group (Kittler et al., 2012). Additionally, obesity during adolescents predicts obesity in adulthood.Hypertension is common among African Americans. Roughly 43% of African American women and 39% of African American men have high blood pressure. Hypertension is considered a risk factor for Coronary Heart Disease (CHD) and stroke. African American women have higher rates of CHD than whites. Black men, however, have a lower incidence of CHD than white men. Unfortunately, blacks have higher rates of stroke than whites likely due to higher rates of high blood pressure (hypertension) (Kittler et al., 2012). Cardiovascular disease is the leading cause of death for all Americans, but significant racial and ethnic disparities exist in the onset of CVD and outcomes in African Americans (Fulp, Rachael, McManus, & Johnson, 2009). African Americans experience a poorer overall health status than White Americans and bear a disproportionate burden of chronic disease and other illnesses. Moreover, decades of research consistently document the inverse relationship between cardiovascular disease risk and socioeconomic status between overall mortality and living in an economically disadvantaged neighborhood (Fulp et al., 2009).Health promotionAs mentioned earlier, African Americans suffer from disproportionately higher rates of chronic illnesses such as hypertension and cardiovascular disease. Psychosocial stress in addition to lifestyle may contribute to the pathogenesis of hypertension and cardiovascular disease. In a study conducted by Howard University in Washington, DC, and Maharishi University of Management Research Institute (MUMRI) in Maharishi Vedic City, Iowa, the effects of stress reduction and lifestyle modification on blood pressure, in African Americans, were evaluated. The study consisted of Forty-eight African American men and women diagnosed with stage I hypertension who had also participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either a basic health education course, an extensive health education program (EHE) for 16 weeks, or stress-reduction program (SR) with the Transcendental Meditation technique. The primary outcome was clinical blood pressure and the secondary outcomes were psychosocial stress factors, dietary intake, physical activity and body mass index (BMI). During this study, both men and wen also experienced a decrease in systolic blood pressure in both the stress-reduction based program (SR) and extensive health education program (EHE) group; however, according to this study, there were no significant difference in the change between the groups. Both groups reported a significant lifestyle changes related to blood pressure such as consuming lower levels of sodium intake (300-600mg/day), and a reduction in protein intake to 12-14 g/day. The health education group, however, showed a greater number of dietary changes such as lower intakes of calories, fat, and carbohydrates than the stress-reduction (SR) group. These dietary changes may have been the result of more education and active reinforcement during the study on lifestyle modifications (Duraimani et al., 2015).Linking coaching to trainingEffective change management should involve having someone else give you specific behavioral advice on how to improve. It may be difficult to know or access how well the new skills acquired are being enacted. In short, a coach is needed. For instance, a good health coach watches and then advises on what need to change to affect the result. Finally, to help reiterate training skills, it’s a good idea to make use of cues. For example, putting up charts that summarize training skills around the home or at the office will help participants remember to utilize skills learned during training or an educational class. Carrying summary cards around will also help participants remember to utilize their new skills. Putting electronic devices to work is another great idea to help. For example, create reminders that pop up every morning or afternoon reminding participant to utilize their training skills. Supporters can send video clips reminding the training participant of the skills learned or maybe video clips that even teach a subtle variation on the theme. Building tools and reminders that are tailored specifically to the skills learned during training or during an educational class will help reinforce new skills or ideas introduced during these classes or training. Global outlook In order to successfully address dietary concerns among this ethnic group, early intervention is necessary (Randel et al., 2012). Interventions targeting the home food environment are likely to improve overall diet quality in overweight African Americans populations with low-income (Hartman et al., 2015). Assessing the needs of this priority population is very important. Community empowerment which encourages people to take ownership of their health issues and use resources as well as their ability to create solutions is needed in order to change communities, not just individuals. Health promotion/education programs should be developed to assess the needs of this target population. A well conducted and well conceived needs assessment can determine if a health program is justified and appropriate for its target audience (Randall, Girvan, & Mckenzie, 2012). After a needs assessment has been conducted, intervention strategies should then be developed in order to help this ethic group modify dietary behaviors. Socioeconomic status, low education, and access to healthier food choices are, often times, barriers preventing this ethnic group from choosing and preparing healthier foods. After intervention strategies are developed, implementation of a health program should begin (Randall et al., 2012). Health education specialist must become more actively involved in the African American community if there is going to be lasting change in dietary behavior among this ethnic group. The ability to achieve dietary recommendations on an individual level is of great public concern. Numerous intervention studies focused on individual-level behavior changes have not resulted in long-term dietary changes that would reduce the risk of chronic illnesses diseases such as CVD. Individual motivation to change health behavior is influenced significantly by the social environment which includes community norms and cultural practices. Interrelated cultural practices that impact health behavior include, but are not limited to, culturally specific health and illness beliefs, religiosity, spiritual beliefs and values, social support, and culturally competent and satisfactory health services (Fisher et al., 2005).A significant challenge facing healthcare professionals is trying to encourage individuals to change their diet, and assist them maintaining that change. Incorporating cultural preferences for food has been noted as an important factor for interventions that are designed to influence food choice and reduce risks for chronic disease (Fulp et al., 2009). In order to fully understand African America culture, one must be willing to use a lens that enables appreciation for this ethnic community’s cultural heritage through sociohistorical contexts of the painful experiences of slavery, resilience, community bonding, and spiritual and religious beliefs (Burke, Joseph, Pasick, & Barker, 2009). Health administrationSome of the challenges of training or educational courses whether it be a 2-hour wellness course or a week seminar sponsored and paid for by an employer, the hope following any training, or educational course is to ensure that participants use the valuable information shared at these events. The term used most often when referring to one’s ability to utilize the information gained is known as Change Management. Change Management encourages individuals to implement strategies to ensure that change and development are implemented successfully. The ability to transfer knowledge and skills learned during training or an educational course is not an easy task. For example, the training finishes, participants leave, and as a result of their busy lifestyles, they’re immediately pulled in a dozen different directions—none of which are designed to assist with implementing what they’ve just learned into part of their daily routine. Unfortunately, many training or educational courses are designed to help individuals learn the material, but unfortunately, participants do not implement the material soon after completing the course. Without skill transference, training of any kind is merely wasted effort for many hoping to modify their behavior. Motivating and enabling a genuine change in behavior is no easy task, and ensuring that learning translates into action, can require a significant amount of effort. The real challenge begins with manipulating the forces that seem to draw people away from adopting new skills. Anyone teaching a wellness class, for example, must understand that learning is not enough. The presenter or instructor of a training course needs to find ways to ensure that attendees implement the knowledge gained, new ideas, or skills shortly after the training ends. The Influencer Model is used, often times, to supplement the learning experience. This is a multi-faceted Change Management plan. Using the Influencer Model, skill transference is gained by combining multiple sources of influence into a cohesive change strategy. This strategy should, not only motivate, but should enable individuals to adopt skills taught in training. In addition to training, Influencer tactics will help to develop a successful change strategy (Patterson, 2012). Enlist informal supportAn effective formal review process will help reinforce new ideas, and skills that are taught in training, and educational classes. For example, a formal review process may include a follow up call or meeting with attendees of a seminar or education class to reiterate skills taught during the training, or a survey may be re-administered two months later. Formal review paperwork might be distributed to these individuals, again, reiterating the specific skills taught during the seminar or class. A performance system should be established linking formal rewards to changes in behavior. If participants have started using the skills learned during a class or training, this will typically be revealed during a follow-up call, or survey. Change must be measured. Creating a formal reward system will send a message to participants that the training is not some sort of informal training, but that it is important, and can be life changing if skills are implemented. Not only will participants learn valuable information and implement the skills taught during the class or training-they will also be rewarded. It is important to ensure that rewards are aimed at the target behaviors. This is best done by enlisting spouses, family and friends of the participant. Spouses, family members and friends should discuss the new behaviors, and watch to see if the participant does what he/she has been taught. If so, the participant should be praised for their progress. People often underestimate the importance delivering praise when encouraging new behavior. When offering praise, it is very clear that a good word from a spouse, family member, friend or colleague, goes a long way to ensure that the participant continues the new behavior. A “Way to go!” is often viewed as more meaningful and sincere than more formal means of praise. Supporters may brainstorm different ways to offer informal praise.Individuals must understand the “why” behind targeted behaviors. These “whys” usually connect to their core values—or at least they should.For instance, a wellness class encouraging better nutrition might emphasis core values. Doing so, may lead people to make better choices regarding their health.Unfortunately, the idea of discussing values is often times far from the minds of instructors/trainers whose typically focus on numbers and charts. As a result, instructors/trainers miss an important opportunity to discuss what people truly care about. People do not connect strongly to figures, logic, charts, and facts. Instead, most people connect to personal stories, vicarious experiences, and of course, deeply held values. When an instructor/trainer explains how the skills and concepts links in to participants core values, the trainer/instructor breathes life into their behaviors. Instructors/trainers should never be afraid to talk about skills, theories, and values. Turning knowledge into action is not an easy task. It requires ideas to be shaped into behaviors. This requires deliberate practice. And as the old adage says,” practice doesn’t make perfect, perfect practice makes perfect” (Patterson, 2012). Access to healthcareWith the passage of the affordable care act, many African Americans gained access to healthcare. Historically, African-Americans were among those without healthcare coverage, and African-American women, in particular, lacked prenatal care. African American babies born are more likely than other ethnicities to be born with low birth weights and other health issues due to a lack of access to healthcare, especially in underserved areas. With the passage of the ACA, many Americans, including African Americans have gained access to healthcare. African-Americans are more likely to postpone treatment or seek treatment after an illnesses has develop rather than seek preventative care. This occurs primarily due to concerns with medical coverage, or lack thereof (Berkowitz, 2011).ConclusionIn summary, today’s African Americans still consume foods eaten by their ancestors which include elements of West African culture. Traditional food habits and meal patterns have changed among African Americans due to pressures of a fast-paced society (Kittler et al., 2012). Contemporary diets are generally low in micronutrients such as calcium, iron and vitamin D, and often times exceed recommendations for macronutrients such as carbohydrates, fat, saturated fat and protein (Kittler et al., 2012). African Americans celebrate major holidays such as Thanksgiving, Christmas, Easter and New Years. They continue to prepare Sunday dinners, a practice continue since emancipation. Kwanza and Juneteenth are holidays celebrated by African Americans commemorating emancipation of the slaves and unity of people of African heritage. Food is an integral part of holidays as it considered an important factor in the cohesiveness of the African American community (Kittler et al., 2012). Blacks have higher incidents of obesity, cardiovascular disease (CVD), diabetes, and hypertension when compared to whites. The African American diet, high in fat, saturated fats, sodium and refined grains is, in part, a contributing factor to higher incidents of chronic illnesses among this population. The African American diet is also low in vegetables, fruits, and whole-grain products also playing a significant role in higher incidents of chronic illnesses (Kittler et al., 2012). African American women are more likely to be overweight or obese that whites. Children and adolescents are also at risk for obesity (Kittler et al., 2012). A sample diet an African American female between the ages of 40-45 was observed. The dietary analysis report determined that African American women who consume traditional foods on a consistent or regular basis are likely exceeded dietary recommendations for macronutrients, and exceed recommendations for caloric and sodium intake. Intervention is necessary if dietary behaviors are to change within this ethnic group. Psychosocial stressors in addition to lifestyle may contribute to the pathogenesis of hypertension and cardiovascular disease among African Americans. Strong evidence suggests that psychosocial and environmental stress contribute to disproportionate rates of hypertension and CVD among this ethnic group. Lifestyle modifications such as aerobic exercise, salt restriction, weight loss and the use of Conventional Alternative Medicine, (CAM) such as Transcendental Meditation techniques have been shown to be effective in lowering high blood pressure among this target group (Duraimani et al., 2015). Without skill transference, wellness training of any kind is merely wasted effort for many hoping to modify their behavior. Motivating and enabling a genuine change in behavior is not an easy task that will likely require the support of family members, or even a health coach to ensure that learning translates into action. Change Management encourages individuals to implement strategies to ensure that change and development are implemented successfully. Finally, the passage of the Affordable Care Act, many African Americans gained access to healthcare. African Americans are more likely to give birth to babies with lower birth weight, and to postpone treatment until their condition requires immediate care. If the initiatives of this law are successful, African Americans will gain better access to healthcare including preventative care, minimize the risk of developing chronic illnesses (Berkowitz, 2011). Dietary and fitness recommendationsA sedentary lifestyle is more common among African Americans regardless of education level, marital status, income, or other factors regarding social status (Kittler, et al., 2012). According to Turley and Thompson (2013), Individuals should participate in moderate to vigorous physical activity for 30 minutes a day minimally to maintain health. Recommendations from MyPlate encourage individuals to balance calories, and avoid overeating. It also encourages people to make half of their plate fruits and vegetables. Half of the grains consumed should be whole grains, and individuals should switch from whole or 2% milk to fat-free or 1% milk. MyPlate also recommends individuals compare food labels, and chose foods with lower sodium. It is also suggested that people drink water instead of sugary drinks. Finally, MyPlate recommends a caloric intake level be determined in order to establish a food pattern that will promote moderation, variety, balance, adequacy, and calorie control (Turley & Thompson, 2013). Recommendations for a diet using nonhydrogenated/unsaturated fats as the predominant form of dietary fat, whole grains as the primary form of carbohydrates, a substantial amount of fruits and vegetables, and sufficient omega-3 fatty acids should be encouraged for African Americans as following these recommendations can protect against heart disease as well as other chronic illnesses (Fulp et al., 2009).ReferencesBerkowitz, E. N., (2011). Essentials of Health Care Marketing. Sudbury, MA: Jones and Bartlett Learning. Burke, N. J., Joseph, G., Pasick, R. J., & Barker, J. C. (2009a). Theorizing social context: Rethinking behavioral theory. Health Education & Behavior, 36(Suppl.1),55S–77S.DASH diet decreases BP in African-Americans. (1999). Geriatrics, 54(5), 12. Di Noia, J., Furst, G., Park, K., & Byrd-Bredbenner, C. (2013). Designing culturally sensitive dietary interventions for African Americans: review and recommendations. Nutrition Reviews, 71(4), 224-238. Duraimani, S., Schneider, R. H., Randall, O.S., Nidich, S. I., Xu, S., Ketete, M., et al. (2015). Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans. PLoSONE 10(11): E0142689. doi: 10. 1371/journal.pone.0142689.Fisher, E. B., Brownson, C. A., O’Toole, M. L., Gown, S., Anwuri, V. V., & Glassgow, R. E. (2005). Ecological approaches to self-management: The case of diabetes. American Journal of Public Health, 95, 1523–1535.Fulp, R. S., McManus, K. D., & Johnson, P. A. (2009). Barriers to purchasing foods for a high-quality, healthy diet in a low-income African American community. Family & Community Health, 32(3), 206-217. doi:10.1097/FCH.0b013e3181ab3b1dHartman, T. J., Haard?rfer, R., Whitaker, L. L., Addison, A., Zlotorzynska, M., Gazmararian, J. A., (2015). Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women. Journal Of The American College Of Nutrition, 34(5), 416-424. Hensrud, D. D., (2002). What causes obesity?. Mayo Clinic on Healthy Weight.How to Make “MyPlate” Your Plate. (2011). Tuffs University Health & Nutrition Letter. 29(6) 4-5.Kittler, P. G., Sucher, K. P., & Nelms-Nahikian, M. (2015). Food and culture. Belmont, CA: Wadsworth, Cengage Learning.Randall, R., Girvan, J. T., & McKenzie, J. F. (2012). Principles & Foundations of Health Promotion and Education. San Francisco, CA: Pearson Education, Inc.Patterson, K., (2012). Why learning is never enough: implementing a mulit-faceted change-management strategy. Retrieved from Treatment of Hypertension. (2015). Hypertension & Stroke, 14-36.Turley, J., Thompson, J. (2013). Nutrition: Your life science. Belmont, CA: Wadsworth, Cengage Learning. Retrieved from on 11/20/2015.Retrieved from HYPERLINK "" from on 07/05/2016. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download