Blog 11 - Action Plan

Because my topic deals with childhood obesity, I think a good specific intervention to act on would be going to the school cafeterias and providing better or healthier options for the kids’ meals. I would plan to implement this strategy in the schools of the children, especially the schools that are in areas with the highest obesity rates. I could also implement part of this strategy in the food companies that sell their food to the school cafeterias. By doing this, I could attempt to stop the problem before it occurred, because then there would not be the unhealthy food options in the cafeterias in the first place. A main barrier to this, on the implementation stage, would be cost because in most cases the more unhealthy food options are the cheaper foods. It is easier to get mass amounts of the more unhealthy food for less money, which is why the cafeterias would look to buy that type of food first. This barrier could be easily managed, however, with a little more money from various outside funds.

For the communication section, the key stakeholders that would need to be on board with this strategy would be the children with obesity, the parents of the children with obesity, the schools’ cafeteria’s employees and/or manager and the food companies that currently sell food to the cafeterias and the companies that will sell the healthier options to the cafeterias. A way to inform the actual kids with obesity and their parents of the new food change in the cafeterias could be just mass emails or postings on the school’s website. I could also send letters to their houses about the change, but that could take a lot of time and money to do. To inform the other groups of stakeholders, I would set up a conference in order to bring the cafeteria employees together with the previous and future food companies and discuss the new plan. Although there could be disagreement among the groups, I think that they could collectively come up with solutions and agreements.

To evaluate the effectiveness of this intervention, I could use surveys to get people’s opinions on the changes. From these surveys, I could make even more changes to the strategy, or less changes if the majority of the surveys show disapproval. Another way to evaluate the effectiveness of this intervention would be to look at the medical records of the obese children before my intervention strategy and then after a few weeks with the strategy in place. Therefore, I could see if the obese children have lost any weight at all due to changing the food in their cafeterias.

Blog 10 - Interventions

Current intervention strategy: Soda taxes. An article says that current soda taxes, which are usually not much higher than 4% in grocery stores, do not have a huge affect on levels of soda consumption or obesity rates. However, children who are already obese, children who are in a family with a low income, or children who are a “minority” seem to be affected more than normal weight children. The article discusses the affect that more taxes could help other obesity prevention efforts. This intervention could be included in the political determinant section because it is a law that has been created in an attempt to reduce obesity rates.

One potential strategy that could address my problem would be to create educational programs in cities in order to inform children and their families about obesity. The programs could explain what obesity is, its various causes, ways to prevent it and ways to reduce the rates once people are already obese. This type of strategy could fall under the political determinant section and could be primary, secondary and tertiary intervention, depending on what stage the person being informed is at. Another strategy that could address my problem would be creating a law making local schools provide healthier food options in their cafeterias. Again, this strategy could fall under the political determinant section because the government would be making this law in an attempt to reduce the obesity rates in the nation. This strategy could be primary, secondary and tertiary intervention as well, depending on what stage of obesity the person is at. A final strategy to address my problem would relate to the food deserts in various cities. The strategy would be to provide the corner stores or various local markets with healthier food options for their menus. This strategy could fall under the environmental determinant section as well as the economic determinant section. It would be more tertiary intervention.

If I were to order or prioritize the above strategies to address my problem, I would implement the third strategy first (reducing food deserts), the law for school cafeterias second, and finally the educational programs third. I chose to order my strategies this way because I believe this order will be most effective at addressing my problem directly. Although the food deserts do not affect everyone, it is a big issue that causes obesity in many cases. If the food deserts were reduced or even eliminated, the obesity rates of many cities would decrease immensely, in children and adults both.

http://content.healthaffairs.org/content/29/5/1052.short

Blog 9 - Stakeholders

My current problem definition is "The rise in obesity among 12 to 18 year olds in the United States over the past 15 years. This week’s blog assignment deals with stakeholders. Stakeholders are persons, organizations or other groups who share a stake in the issue, that is to say those who might be affected by the problem and/or its solution.

For my problem, some stakeholders could be children with obesity, fast food companies, pediatricians, parents of children with obesity, health food companies, hospitals and the FDA to throw a few out there. Some stakeholders would be affected more directly by my problem than others, but they are nevertheless considered a possible stakeholder.

When thinking about interventions, one possible intervention could be to inform the public about proper nutrition and good, healthy diets. With posters or speakers around schools or communities that typically have high levels of obesity among the children. This intervention could be tough because although the information would be provided, it would be the responsibility of the actual children with obesity to utilize the information for effectiveness. Another intervention would be to start the intervention earlier in a child’s life to make it more effective. Programs for infants or toddlers could be set up and utilized early on that would help prevent obesity before it even began.

Blog 8 - Key Determinants

My current problem definition is: The rise in obesity among 12 to 18 year olds in the United States over the past 15 years. This week’s blog post deals with the key determinants for my problem. Key determinants can be the biological, social/cultural, environmental, economic and political factors that relate to the problem and provide a framework for where to look for interventions.

The first type of key determinant is the biological determinants. These would be the anatomic, physical or medical reasons that a problem might exist. A biological key determinant could be relating to genetics. If a parent is obese, his or her child has a 25-50% chance of becoming obese in their life. This percentage can increase to about 75% if both parents are obese.

The next type of determinant is the social and cultural determinants. When looking at childhood obesity, there are many different social/cultural determinants. For example, race/ethnicity affects obesity trends all over the world. “Minority and low-socioeconomic-status groups are disproportionately affected” by obesity (5). Various statistics show that minorities, such as Blacks, Hispanics, Asian/Pacific Islanders and American Indians, all show higher percentages of obesity. This can be due to the different foods they eat, lower rate of physical activity, or other factors. Another social/cultural determinant could be one’s social environment, especially in children. At school, for example, kids could choose the unhealthier foods because their friends choose those foods. (This also relates to peer pressure). Finally, a person’s income definitely helps determine obesity rates. Those with lower income tend to not be able to afford healthier foods, which leads to obesity in the long run.

The next determinant is environmental. These might include weather conditions, geography, air quality levels, and more. One important environmental determinant deals with geography with the food deserts in various cities. A food desert is “a district with little of no access to large grocery stores that offer fresh and affordable foods needed to maintain a healthy diet” (6). Food deserts can lead to higher rates of obesity simply for the reason that those living in a food desert only have access to the more unhealthy foods.

There are many individual economic determinants when looking at childhood obesity trends. For example, families with lower income simply cannot afford the healthier foods that are needed to maintain a healthy diet. According to the CDC, “1 or 7 low-income children is obese” (2).

Finally, there are political determinants, which can be the factors that occur because of the executive, legislative or judicial decisions that exist during a particular time period. One big political determinant could be the lack of universal health care in our nation. Medical care can be crucial for obese patients, but not everyone can afford it. Lack of universal health care can help lead to higher obesity rates in our nation because of the amount of people who are obese and uninsured who cannot get the medical care they need.

http://www.nasbe.org/healthy_schools/hs/bytopics.php?topicid=3115

http://www.cdc.gov/obesity/data/childhood.html

http://cpj.sagepub.com/content/early/2013/03/27/0009922813482750.full.pdf+html

http://www.cdc.gov/features/obesity/

http://epirev.oxfordjournals.org/content/29/1/6.short

http://en.wikipedia.org/wiki/Food_desert

Blog 7 - Magnitude and Indicators

I have decided to further narrow my problem definition in this way: The rise in obesity among 12 to 18 year olds in the United States over the past 15 years. I have decided to define obesity as having a body mass index (BMI) of 30 or more. I have decided to use BMI for my definition of “obese” because it has been proven to be a reliable measure of body fat among the United States population.

When looking at the magnitude of childhood obesity in the United States, it is clear that it has grown and continues to do so overtime. In fact, “since 1980, obesity prevalence among children and adolescents has almost tripled” (source 3). Obesity is the #2 cause of preventable death in the United States and 9 million children/teens (ages 6-19) are defined as overweight. “From 1998 to 2003, the prevalence of obesity increased from 13.05% to 15.21%” (source 3). With these data and stats, childhood obesity is definitely a rapidly rising issue in the United States.

There are numerous surveillance systems used in the United States to track obesity rates. Some examples of the collection of data include personal household interviews, physical examinations and surveys.

A direct indicator directly measures the problem. An example of a direct indicator could be the percentage of kids who drink more than one sugary drink per day. This could be a big indicator because “sugar drinks are the largest source of added sugar and an important contributor of calories in the diets of children in the United States” (source 5). These drinks add calories quickly to a child’s diet, which overtime contributes to the increasing obesity rates. Another indicator could be the amount of television that a child watches each day. Watching television is a sedentary activity, which contributes to the lack of physical activity for a child each day. For another direct indicator, one could look at the percentage of middle and high schools that offer less healthy foods in their cafeterias. The majority of children get their lunch at their school’s cafeteria, so it is important to look at what kind of foods the cafeteria offers each day.

On the other hand, an indirect indicator instead measures the related factors. A main indirect indicator of childhood obesity would be the lack of physical activity. A healthy diet includes physical activity, so it is essential that a person exercise regularly along with eating a balanced diet. Another indirect indicator could be genetics. A researcher could look at a child’s genetic history, especially his or her parents, in order to see any trends dealing with obesity that may occur. Looking at these stats could help a researcher determine any trends early and possibly prevent any causes of obesity before they begin. More indirect indicators could include the environment where a child lives and his or her eating habits. If a child lives in a house that is in a food desert, he will most likely have less healthy foods in his house to eat. When thinking about eating habits, the foods that a child eats early on in life tend to become his favorite foods later on in life or foods that he eats most often. If these are unhealthy foods, it could lead to unhealthy eating habits for the rest of the child’s childhood.

A weakness in my information could be dealing with a person’s BMI. Although it is a proper measure of a person’s body fat, it does not really take muscle into account. This could cause problems because a person’s BMI could say they are obese when they are in fact simply very muscular. My indicators could also be weak because of the bias they may include. However, the surveillance systems that are used for my topic could be seen as strengths because the data from surveillance systems is concrete evidence or documentation of one’s personal information when dealing with weight and obesity.

Sources:

http://ajcn.nutrition.org/content/70/1/123s.full.pdf+html

http://www.getamericafit.org/statistics-obesity-in-america.html

http://www.cdc.gov/obesity/data/childhood.html

http://www.cdc.gov/obesity/data/surveillance.html#npao

http://www.cdc.gov/obesity/downloads/childrensfoodenvironment.pdf

Blog 6 - Problem Definition

Rise in obesity among 12 to 18 year olds in the United States over the past 30 years

Obesity is becoming a big public health issue in the world. The percentage of obese children is rapidly increasing in the United States. In fact, only about six percent of school-aged children were obese. That figure rose to 18 percent in 2010. Although obesity can have many different causes, one of the main ones among children in middle and high school is the nutritional content of the school lunches. The Robert Wood Johnson Foundation recorded that the food that children consume at school accounts for between 35 and 50 percent of their overall diet. Other statistics include 40 percent of the students eat one or more snacks daily and 68 percent of the students drink at least one sugary drink. That being said, it is important to study what kind of food these kids are choosing to eat at school.

This topic is interesting to me because I am already interested in nutrition and food in our society. Obesity has become a huge issue in our nation more recently due to the change in diets all over the country. It is also an interesting topic to me because it could be fixed, with creative solution plans. Although there have been some solutions in the past, obesity still seems to be an issue that is rising in our nation. I am looking forward to researching more about this topic and possibly coming up with solutions to the problem on my own.

Blog Assignment 5 - Contagion

This week’s blog assignment focused on the 2011 hit movie “Contagion”. This movie shows the United States health care system in action as a small disease spreads worldwide. The virus is traced back to China and it quickly spreads to the United States through human interaction. The movie follows various public health practitioners to show the many steps of a public health system. As the disease continues to spread, the movie shows how the health system must adapt and what it must do in times of disaster. At the end of the movie, the audience learns that the disease started with bat feces and ended up causing complete chaos worldwide. I really enjoyed watching this movie. It helped me understand actually how much work is put into a health system like ours. Yes, this movie was a bit exaggerated, but it is true that an epidemic like this could occur. It was interesting to see how various types of people reacted to the disease and how they planned on doing something about it.

A few public health terms directly relate to this movie in a big way. An outbreak is when the number of cases recorded of a disease is more than the expected number. This term relates to the movie “Contagion” because the virus started in one person and rapidly spread across the globe, ending up an epidemic. An outbreak investigation is a study of the disease; that is, the causes, symptoms, number of cases, etc. This term relates to the movie because it is essentially the whole plot. “Contagion” spends the majority of the movie showing the problem, portraying the symptoms, studying the disease, and brainstorming ways to stop the epidemic. In the movie, an epidemiologist goes to China to research the disease while researchers stay in the United States to study the magnitude of the epidemic and begin to devise the next steps that should be taken to stop it. The next term, isolation, means the separation of those people who are infected with the disease from the people who are not. In “Contagion”, various patients who were already infected were put in a gymnasium so that they were kept away from the patients who were still healthy. This was the very first precautionary step that the health system took to begin to stop the epidemic. The final term, quarantine, is when people who may have been exposed to the certain disease are separated from the outside world to observe whether or not they will contract the disease. In the movie, the main character, the man whose wife and stepson die, is quarantined, but the researchers discover he is immune.

Since 9/11, Public Health Preparedness has certainly become an important topic in our nation because when something unexpected occurs, the public health system must act quickly. This issue is apparent in “Contagion” because when the outbreak occurs, the population goes into a state of panic and chaos. I believe that there are a few instances in the movie where the public health agencies could have been more “prepared”. For example, the government utilized a “first come, first served” system to distribute the low amount of food portions to the town residents. This could have been better done because there are many different factors that cause a sort of “unfairness” in the society. The public health agencies should try to lessen those factors to create a more even access to the food portions, for example, among the population. Another situation in the movie that could have been done better is the way the government distributed the vaccines. The government implemented a lottery style system that used birthdays to determine who would get the limited number of vaccines for that day. Although this type of system is a randomized one, the public health agencies could have distributed the vaccines to those individuals who needed it most. Addressing these issues and solving them would improve the overall effectiveness of the public health system of our nation.