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.

Blog Assignment 4 - US Health Care

Health care is one of the most popular topics in the United States today. For this week’s blog assignment, we watched the documentary “US Health Care: The Good News”. This documentary examines an array of health care systems around the world and reports the their positives, negatives and differences between each system.

The Dartmouth Atlas Project started in 1973. At that time, researchers studied different towns in Vermont in order to track differences in treatment and cost. In Vermont, the researcher wanted to study the places that were not getting enough medical care. Instead of under service, they found extreme variation. In more recent studies with this project, researchers studied Medicare billing records. This resulting in the same findings in Vermont in 1973, which were huge variations in treatment and spending.

Access to health care is a very important concept in the world. Is it a right or a privilege to have this access? Personally, I believe that access to health care is more of a right than a privilege. There are many different factors that prevent Americans from getting health care and insurance, however, many Americans cannot help these factors. For example, a person does not usually choose to get cancer, but unfortunately it can happen. This person might or might not get the adequate health care for various operations to fight the cancer. This person could not receive the health care due to a preexisting condition or some other cause. One of the biggest reasons why I think everyone should have access to health care is the fact that the healthier a population is, the more productive a society will be. If every American had access to quality, affordable health care coverage, the whole nation would benefit from it. Another basic reason is that a nation could save a lot of money in the long run if every citizen had access to its health care. There will always be the problem of people abusing their right to health care, but it would be worse to have everyone earn it when there are many outlying factors that could prevent someone from getting the same access to health care.

This documentary visited various places in the United States and reviewed their health care systems. The first stop was Grand Junction, Colorado. This spot is thought to be the best medical system of them all, being a model for health care delivery. Here, doctors decided to take care of everyone in the town and get paid the same fee for the same treatment regardless of if the patient was rich or poor. In addition, a small portion of each doctor’s payment is withheld until the end of the year and then gets distributed based on the doctor’s overall performance. This system is interesting because there was little objection. The next stop, Seattle, Washington, had an innovation called coops, which was businesses being owned by their customers. In Seattle, the medical system that was examined was a corporation that was big on using technology to communicate with their patients. Doctors would use emails to treat their patients, and would increase face-to-face time with the patient when the latter would physically come into the office for a visit. I thought this was interesting because many medical systems today use technology for records, communication and more, but this corporation was astounded at how well the technology worked for them. The third place, Everett, Washington, had a system where the doctors owned the clinic. This stop was big on controlling the costs of health care and trying to reduce or even eliminate unneeded tests. This, in turn, would lower the cost of care for patients. I thought this place was intriguing because it was able to eliminate pharmaceutical representatives and samples, and actually lower the costs for patients overtime. Finally, the documentary stops near Dartmouth College to examine Hitchcock Medical Center. This center emphasizes patient involvement in treatment choices. By giving the patients more of a say in their treatments, this system was more successful because there were less surgeries and less unnecessary tests that saved a lot of money.

I believe that the way medical care is delivered in the places visited in this documentary can certainly be duplicated in the area I am from. One of the main reasons why I think this is because using modern technology in a medical system was proven to be more efficient, as shown in the documentary. This is an easy innovation to implement in modern medical systems and a good way to improve efficiency and reduce costs. However, it is essential to have strong leadership and commitment within the community for these programs to be effective, and these are some things that not every city has. There could be multiple reasons why the area that I am from has not implemented these elements into the medical system yet. Everyone, doctors, hospitals, physicians and insurance companies, must all be on board and cooperate together for the system to be successful.

Blog Assignment 3 - Vaccine Wars

For this week’s blog assignment, we watched the Frontline Special “Vaccine Wars” which outlines the debate over vaccines in our world today. The video begins by showing various cases where vaccines have been linked to having serious side effects. One of the biggest side effects studied from vaccinations was autism. Through various interviews of normal, everyday people, this video effectively shows both sides of this debate over having a choice with vaccinations.

This video did influence the way I think about vaccinations. Before watching, I did not know that there was such a controversy over the issue. I also was unaware that vaccines could have the various side effects as big as autism. I was under the impression that everyone gets vaccines without question because they will keep you healthy. However, after watching this video, it is clearer why some people may object to getting some vaccines due to the side effects.

As explained in the video, herd immunity is the idea that when a group of people in a population is vaccinated against a disease, it will provide protection for other people in the population who are not vaccinated. This term is very important in the public health world today. When the small group of people is vaccinated, other people who live in the same area as that group may not have to worry as much about contracting the disease. That is to say, the risk of contracting the contagious disease becomes much lower because of the idea of herd immunity.

Vaccination can be different from other types of personal health decisions because it starts right at infancy. As explained in the video, newborns begin getting vaccines almost right after they are born. Because of this, parents and doctors are the ones who decide which vaccinations, if any, a child should get. Infants and children are incapable of making these decisions for themselves, so it is up to their parents more often than not to make the decisions for them.

There are many different reasons why children might not receive the recommended vaccinations. It is clear from the video that many parents wish that their children have a sort of natural lifestyle so they choose to skip some vaccinations. Another reason could be that a certain disease, like polio, is not prevalent in our world anymore. In this case, many parents do not have their children get that vaccination because they see no point to it. One of the biggest reasons, which is clear after watching this video, is that parents fear the side effects related to these vaccinations, so they opt out of having their children get the vaccines.

As a public health policymaker, I would make it a main goal to increase vaccination rates. One way I would do this would be by educating the public about vaccinations and showing them the many benefits. It is true that there can be risks with the various vaccinations out in the world, but I would be sure to show that the benefits immensely outweigh the risks. I would use specific data, statistics and results in order to prove my point in this situation that overall vaccines would benefit the population of the world more than harm it.

Blog Assignment 2 - Smoking and Lung Cancer

This week’s blog assignment, we read an article by Takeshi Hirayama titled Non-smoking Wives of Heavy Smokers Have A Higher Risk of Lung Cancer: A Study From Japan. It outlines the relationship between smoking and lung cancer, dealing with second hand smoke in particular. The experiment studied non-smoking women aged 40 and above and their risk of developing lung cancer based on their husbands’ smoking habits. These adults were followed by “establishing a record linkage system between the risk-factor records, a residence list obtained by yearly census, and death certificates”. Not so surprisingly, the results of the experiment were that the wives of heavy smokers were more at risk of getting lung cancer than wives of non-smokers and that this relationship was significant in agricultural families. The alcohol drinking habits of these husbands proved to have no effect on the wives developing lung cancer. Finally, the article talks about passive smoking versus direct smoking and their effects. The experiment showed that there was a significant relation between how much the husbands smoked and the death of their wives from lung cancer. In addition, the study proved that the effects of passive smoking were one half to one third of direct smoking.

I found it interesting that the study looked at alcohol consumption habits of the husbands as well and compared the results with the smoking habits. It seems that the results would clearly not be similar to each other because the two habits are very different when it comes to affecting the wife’s risk to getting lung cancer. However, it is possible that using the results from the husband’s alcohol consumption habits clearly support and help prove the claim that smoking habits of the husband affect his wife’s risk of developing lung cancer the most.

In this experiment, thousands of adults, 40 years of age or younger, were followed by various methods. The study followed these adults “by establishing a record linkage system between the risk-factor records, a residence list obtained by special yearly census, and death certificates” (183). By designing the study in this way, the leaders of the experiment are able to set their own parameters and change it up when needed. In addition, the experiment divided up the different variables, which made it easier to see the obvious differences in results. With the variables separated, it is less likely to have conflicting variables, meaning that the variables would not affect each other in the experiment.

The results of this study clearly support second-hand smoke as a cause of lung cancer. When comparing husbands’ smoking habits with the risk of developing lung cancer in their non-smoking wives, there seemed to be a huge relation between the two. The specific results from the experiment show this relation. In addition, it is important to note that the same relationship was followed, but instead of smoking habits, the husbands’ drinking habits were used. This results of this experiment showed that the husbands’ drinking habits had little to no effect on their wives’ risk of developing lung cancer. Therefore, it is clear that the results of this study support the claim that second-hand smoke can be a huge cause of lung cancer.

Blog 1 - Women Binge Drinking

For this week's blog assignment, we read an article called Vital Signs: Binge Drinking Among Women and High School Girls. The article stated that alcohol consumption, and more specifically, binge drinking, accounted for almost 23,000 deaths in the United States. It also highlighted the fact that drinking has lead to many other health related issues. The article defined what binge drinking is, who binge drinks, and steps that can be taken to prevent binge drinking. It summarized an experiment on binge drinking among women, recording the prevalence, frequency and intensity of drinking, and recorded its results. The experiment used two main methods to record data: BRFSS and YRBS. Although these methods acquired data for the experiment, there were some obvious flaws. In the end, the experiment concluded that binge drinking was very common, and that the women, in particular, who did binge drink often did it frequently and intensely. Also, the data recorded from high school girls was very similar to that of older women, aged 18-24 years old.

Because this article is about binge drinking and the different health issues that are produced from it, it is definitely an important public health issue. As the article states, binge drinking can not only lead to death in serious cases, but it can also lead to other health issues like liver disease, heart disease, stroke, cancer and more. These health issues associated with binge drinking are very serious in our world today because they can lead to various hospital visits at which doctors will spend countless medical supplies trying to save the person's life. In addition, one can look ahead and see that binge drinking can lead to unplanned pregnancies and injuries or even death that are associated with drunk driving. Therefore, binge drinking in general is an important public health issue that must be addressed.

In general, I am not surprised by the results. Both methods of collecting data concluded that current alcohol consumption was around 50% in high school girls, which, unfortunately, does not surprise me. The article also discussed the different results between women of different incomes, which I thought was interesting, but not surprising. People with higher income tend to binge drink more than people with lower income. It was very interesting to see the difference in prevalence of alcohol among the different races in high school girls, given that it was about a 10-20% difference. The two methods used to collect data, BRFSS and YRBS, definitely have accuracy issues because they are self-report data. Not all people in the age group used for the experiment attend school, which is where the experiment was conducted. In addition, as the article states, alcohol consumption and binge drinking results are often "underreported in surveys because of bias". It is very true that the methods used in this experiment could be flawed because of various factors such as missing kids on the day the surveys were conducted, kids not completing the surveys with total honest, and so on. It can be said that these flaws, along with others, in the methods used to collect data are enough to call for another method to compare and contrast results.

I think that the article does a good job in listing various efforts one could do to try to prevent the prevalence of binge drinking among women. The ones that stuck with me were to "maintain limits on the days and hours when alcohol is sold", increase the price of alcohol, which could cause the girls to not want to buy it, and "maintain and enforce age 21 years as the minimum age for legal drinking". The last one, however, could be enforced more in some situations in order to thoroughly prevent minors from obtaining alcohol. Various other methods can be implemented in our world in order to prevent further binge drinking among women and the other health issues that can result from binge drinking.