Community Nutr Test 2 Flashcards
Food bill cont. crop subsidies
Was stopped in 2014 and replaced with crop insurance only for commodity crops
2 changes - illegal to promote any food programs
(Didn’t go over 2nd one
farm Bill
usda–> fns –> Farm bill
Comes up every 5 yrs for renewal. More about food insecurity in USA ie Wic, snap, tefap
Reauthorize - can make changes during this time. Decides how much $ but does not fund the program. Has to do with appropriations bill to determine how much $ they get
SNAP is the largest in the USA
Two kinds of food we grow in the USA
Commodities - wheat corn rice cotton sugar (all the same)
Speciality crops - fruits, veggies, nuts (can be different)
Collecting data
Should first share with stakeholders (or boss first)
Community needs assessment - see asset mapping
Stakeholders first to be informed
Key informants
Qualitative - peoples thoughts or opinions. Questions you can’t count ie demographic shifts, historical data, why questions
Quantitative data things you can count
Vital statistics
Birth
Death
Marriage
GIS
Geographical information system
Takes info and puts on map ie grocery stores in the USA
ERS/ USDA
Economic research service.
Collects data about the way we eat in the USA
Fringe rate
Includes items such as social security, health ins, workman’s comp, unemployment, disability, life ins. Different rate for ft/pt
Indirect rate
Rent, cleaning bathrooms, parking lot snow removal, portions of hierarchy of employees (Hosp, public health has to be approved by dept of health and human services
Money pots
Federal or state
Administrative
Food
Peer counseling
The monies in these 3 pots can never cross each other
USDA did survey about why we eat the foods we eat. Included:
lifestyle factors ie physical activity, leisure, stress mgnt techniques, smoking status, drug & etoh use, single vs married
Individual factors - self efficacy - can make a change that will work
Environmental ie broad sense –> bad neighborhood
Living and working conditions
Accessibility, price/cost, storage, prep time, culture, age, educational level, other health issues, religion, knowledge, demographics, social environments, vanity
Cognition
Knowledge about environment and what I do about it. Pg 71 the knowledge and awareness that people have of their environment and the judgement they make related to it.
Attitudes
An individual’s positive or negative evaluation of performing a behavior or engaging in an activity.
Neg/pos feelings about something
Ways to collect info
Surveys
Health risk assessment hra
Screening focus groups
Interview with key informant
Surveys
Systematic study of cross section of individuals who represent the target population
HRA health risk assessment - has 3 components
Questionnaire device
Scoring behavior
Education piece
These help people change their behavior
Screening
Done in public health and refer elsewhere ie 9 health fair if have elevated A1c will refer to PCP
Focus groups
These are popular. Usually have 5-12 people. Should be trained to do focus groups. Have to pay people to participate ie $50. PEOPLE LIE. Ie ford co about the Edsel..was worse car ever made
Interview with key informants
The people “in the know” about the community
Ways to assess a nutritional status A-D
A - anthropometric ht wt head circumference skin folds BMI
B- biochemical labs ie urine, glucose, WBC etc
C - clinical assessment look at someone and make subjective assessment
D- diet history method 24 hr recall, food frequency food records diet history
Sensitivity versus specificity Page 88
Sensitivity - ie bld test. Screening iron deficient low Hgb, has to be low to Dx iron deficiency. Proportion of subjects with disease that have a positive test. No false negatives.
Specificity - proportion of subjects without the disease that have a negative test. Do bld test for cholesterol and not a finger test.
Validity versus reliability
Validity is accuracy.
Reliability - ability to keep getting the same answer off the same sample. Same answer repeatedly
RD’s job
MD’s job
RD screens and refers
MD diagnose and treat
Program planning for success. (7 steps). Page 102
1) Review community needs assessment - study the problem
2) Define program goals (broad goals) & objectives (3 items)
3) develop a program plan
Design intervention
Design nutrition education component
Delelop the marketing plan
4) Develop a management system
5) Identity funding sources
6) Implement the program
7) Evaluate your program
Mission statement. Page 101
All organization must have this.
A broad statement or declaration of an organizations purpose or reason for being
2) Goals and objectives 3 basic objectives
Outcome objectives - changes that can be measured
Process objectives - what are we doing to achieve outcome objectives
Structure objectives - how we do business ie staffing to client ratio
3) Develop a program plan. Page 106. See chart on pg 108
a —> c
a) Design intervention
Level 1 ie education
Level 2 ie try to change behavior, work one on one or in small groups
Level 3 build supportive environment, this works well ie broccoli truck
Examples of different levels
Quit line - level 2
Can’t smoke in bars level 3
HRA level 2, smoking and seat belts are good examples
b) design nutritional education component
Ie written plan for metro caring
Keep it short
3-4 principle topics ie how much sugar in soda
Active ie have conversation - change people
Be interesting ie Vit C bruise
Tag lines ie strive for five. Ad council
c) marketing plan
If plan doesn’t work it’s not the publics fault
Try again.
If fails it’s your fault try a different plan. I have to make it work
4) develop a management plan
Make sure the program will work
7) evaluate the program. Page 119-122
a) Formative evaluation - do this as you are formulating the program. Could run a focus group such as pilot program**
b) process evaluation - focuses on how program is delivered. Pull charts @ random and look at process
c) impact evaluation - goals, are we meeting the goals
d) outcome evaluation - are we making people healthy
e) structure evaluation - ie late for works get fired
f) fiscal evaluation - audits, physically running program properly
Should publish results. Yes
Front cover Summary - abstract Background info - introduction Description of evaluation Results Discussion Conclusion & recommendation
If failed in program still publish to helps others
How to get money to run Programs
Grants
Have to apply every year
Types of grants
Formula grants Block grants Planning grants Demonstration grants Training grants Matching grants Government grants Private grants
Formula grant
A mathematical formula ie WIC # of people served Overall population % served Growth and % served Poverty rates. Colo 1/50 of population
Block grants
Highly controversial, not many rules
ie obesity - put aside a block of money and it can be given out in any way to help with obesity
Planning grants
Given only one time
How will this be funded in the future
Demonstration grants
Will allow to run a program one time, how will this be funded in the future as only give out once
Training grants
Grants awarded to an organization to support costs of training students, personnel or prospective employees in research.
Matching grants or In Kind. Page 669
I will give you money in exchange you would have to give money
In kind gifts - matched dollar for dollar, or gifts such as donated products, supplies, equipment or services from another source
Government grants usually federal and free
National science foundation 10,000 grants every yr. 7 billion dollars
Chance is 1 in 4
NIH 30.3 billion medical research and 50,000 applications
Private grants
Corporate – foundations – give money away ie Ford Kaiser
Family foundations
Community foundations – Denver foundation (700 in the World)
2014 86,192 private foundations
2013 gave away $54.76 billion
RFP
RFQ
IRB
RFP request for proposal - general ideas
RFQ request for quotation - more specific idea, how much to charge
IRB institutional review board - if publish must go through them. IRB deals with people and animals. HHS train people for this and has to be done before, not after the facts. Make sure treating people and animals properly and ethically treated.
Robert Wood Johnson. Obesity concern
Marketing and epidemiology
Marketing - need to sell product. Look at it and if doesn’t work look at self - keep trying. A way to get what you want
**focus on customers
Social marketing
Big in public health
Sell a change in society ie convincd breast feeding is best
Not for money. Change attitudes, behaviors and ideas
Use all normal commercial techniques ie Eat Fresh
Social marketing steps (7)
1) determine needs and wants for target population
2) identify benefits of product to the target population
3) conduct a situational analysis SWOT (strengths, weaknesses, opportunities,threats)
4) marketing strategy - 4 P’s product, place, price, promotion
5) develop budget & timeline
6) implement the marketing strategy
7) evaluate
Public relations
An organized effort to make the message look good ie tide detergent
Brand image
Branding. ie what people think of Harvard
Tools tv radio internet print-newspaper magazines public service announcements PSA
PSA
Public service announcements - 30-60 seconds
Bulletin boards
TV shows and mostly for free
Timing matters ie talk slowly and only about 30 sec
Professionally done
Get audience involved
Market service, not just topic
Need to go beyond PSA ie give phone # for people to respond
Be nice to the press
Types of change. (4)
1) cognitive change - easiest, change knowledge in head, education. Lease effective
2) action change - one time deal ie have bld test done for DM
3) behavior change - repetitive change ie change diet qd for DM
4) value change - hardest, ie breast feeding natzis, change ideas about something ie eating meat vs vegan
Ad council
Largest makers of PSA in the world. Started in 1941 prior go WWII ie war bonds (savings bonds), Rosie the riveter, loose lips sink ships.
Nothing to do with the govt
Goes to best advertising agencies and usually free
**non political, nondenominational, no commercial interests, no laws
They like education, family and community, health, safety
Send to 33k media outlets tv radio etc. done for free
Putting this together and distributing does cost money
Only nonprofit organizations or govt agencies - only Fed, not state govt
Community check off program
Created by Fed govt. need 51% of vote in favor of. Pays a fee to USDA and money goes to a board to set up advertising and money is generally used for advertising that product. Great place for job.
Epidemiology
Mother science of public health. Looks for determinants of disease
Count – figure out how to make people healthier
John snow is father of epidemiology – founded reason for cholera
Epidemic versus pandemic
Epidemic - more cases that would be considered normal. Could be 2 people ie Ebola measles
Pandemic - epidemic that crosses international boundaries and usually effects a lot of people ie Ebola, 1918 Spanish flu, HIV
Determinants of disease
Host factors - genetics, sex, race, nutritional status, physiologic state
Environmental factors - food environment (soda, snacks), advertising, lifestyle, occupations, geographical locations
Vital statistics equation - birth, death, marriage
What are the 3 best indicators of the health of a country
Life expectancy
Infant mortality rate
Maternal mortality rate
These are the 3 best universal indicators of health of a country
Equations for mortality rates
Infant = # of infants died within 1st yr of life / # of live births in same yr x 1000
Maternal = # of maternal deaths related to preg/ # of live births x 100,000
Cases
Risk
Risk factor
Relative risk RR
Cases ie everyone who has cholera
Risk probability of getting disease or happening to you
Risk factor clinically important ie smoking and lung cancer
Relative risk RR ie research paper
Relative risk RR
Risk of disease if you are exposed to a risk factor / risk of disease if you are NOT exposed to risk factor
ie tv in bedroom and obesity 131/100 = 1.31 RR therefore if TV in bedroom are at a 31% chance of becoming obese
RR
RR = 1 NO effect RR = > 1 exposure may cause disease RR = < 1 is protective against disease
Quintiles
5 different grouping, compare highest and lowest
Examples of RR
> 5 fruits & veggies & < 1 fruits & veggies = RR 1.00 cancers
Hearth disease RR = 0.88 = 12% chance of reducing heart disease
Sugar sweetened beverages and type 2 DM
1-2 sweetened beverages qd RR 1.26 = 26% chance of getting DM
CVD & whole grain consumption / CVD and very few whole grains = RR 0.67 = 33% less likely to have CVD
Relative risk
Odds ratio
Hazard risk
All of these mean the same thing but calculated differently
Incidence verses prevalence
Incidence - # of NEW causes during a specific period of time (new people with DM in 2013)
Prevalence - snap shot in time ie people with red shirts in class
ie 2014 birth = incidence as only happened once
Epidemiological method. (9)
1) observe
2) count cases or events
3) relate cases to population at risk
4) make Comparisions
5) develop hypothesis
6) test hypothesis
7) draw scientific influence
8) conduct experimental studies
9) intervene and evaluate
How much of research is false or overturned
85%
Correlation
Why does this not show cause and effect?
Confounding factors - those that cannot be accounted for ie difference in age, exercises education.
