Exam 2 Flashcards
Farm bill comes up for renewal
Every 5 years
Majority of mandatory spending and percent
Social security and Medicare - 65%
Largest part of the farm bill
SNAP
Effect of farm bill on nutrition
Creates budget and reauthorizes food programs (SNAP, WIC, TEFAP) and when comes up to pass allows Congress to tinker with them
Commodities def
Wheat corn rice cotton sugar. Crops that if you combine them you cannot pick them apart
Specialty def
Fruits, vegetables, nuts. Foods that theoretically would look different if combined.
Crop subsidies
Payment to farmers to grow commodity crops or sometimes not to grow them
Crop insurance
Farmers go to insurance company and can get insurance that will pay them a certain price for their crop. If crop sells for less the farmers get the guaranteed price. If it sells for more the farmers get the profits. For any kind of crop but only commodities have the price history acceptable to the insurance companies. Government pays 72% of the cost.
Vital statistics
Statistics about life events - birth, death and marriage
Walkabout
When you are doing a CNA you go around the neighborhood and talk to the people there about issues
GIS
Geographic information system - information from different electronic public info sources that are put together on a map
Things that affect what we eat and nutrition status
Accessibility, price, storage, preparation, culture, age, education level, allergies/health issues, religion, knowledge, social environment, vanity, lifestyle factors, individual factors, environment, living/working conditions
Self efficacy
Your belief that you can make a change that will work
Cognitions
Knowledge and awareness people have of their environment and what they choose to do with the knowledge/awareness
Attitudes
Your negative or positive feelings about something
Survey
Systematic study of a cross-section of individuals
3 components of health risk appraisals
1) questionnaire
2) scoring device
3) educational piece
Screening
What is done in public health - screen and refer instead of diagnose and treat
Focus group
Typically 5-12 people with a leader who should be trained
ABCDs of nutrition assessment
Anthropometrics - weight, height, waist circ
Biomedical - labs
Clinical - subjective judgment
Dietary - 24 hr recall, FFQ, food records, diet hist
Health halo bias
Once a food is categorized as “healthy” you eat more of it
Focus group break point to get people to come
$50
Sensitivity
No false negatives - want to find everyone that has the condition - ok with some false positives
In public health want tests with really good sensitivity then send them to a doctor to weed out false positives
Tests with high sensitivity tend to be inexpensive
Specificity
Rule out false positives
Tests with high specificity tend to be very expensive
Public health’s job vs medicine’s job
Public health screens and refers while medicine treats and diagnoses
Reliability
The ability to keep getting the same answer off the same sample
Validity
Does your test actually tell you what you think your test tells you - are you measuring what you think you are measuring?
Steps to planning a program
1) review CNA
2) define program goals and objectives
3) develop a program plan
- design intervention
- design the nutrition educ component
- design marketing plan
4) develop a management plan
5) find funding resources
6) implement program
7) evaluate program
Creating a program - very first thing before formal process
Review your mission statement
3 kinds of objectives
1) outcome objectives
2) process objectives
3) structure objectives
Outcome objectives
Changes that occur in people’s health that we can measure
Eg, increase breastfeeding
Process objectives
Things we are doing to meet the outcome objectives
Eg, people will receive breastfeeding education every time they come in the door
Structure objectives
About how we do business
Eg, staff to client ratio will be 15:1000
Levels of interventions
Level 1 - Education
Level 2 - try to change behavior (usually 1:1 or small group) - someone is interacting with you
Level 3 - building a supportive environment and making it easier to change
For interventions - education alone
Usually does very little but is important for a foundation - need education so people will accept Level 3.
People get mad at Level 3 if they don’t understand - need legitimacy
What you need for the education component of interventions
Lecturing does not work
Need a written plan
- must be short
- 3-4 principle topics
- must be active
- must be interestingTag line
Something that would stick in people’s minds to reinforce what you teach
Purpose of marketing plan
To draw people in to your intervention
If intervention not attended, who’s fault and what should you do?
Your fault because bad marketing plan - you didn’t make it interesting enough
Need to reevaluate and think what else you have to do
Why make a management plan?
Because people will go towards entropy unless they are forced to do something else. Will take shortcuts, etc.
4 types of change
1) cognitive (change in knowledge)
2) action (do it once)
3) behavior (do it repetitive)
4) value (shift in your actual values)
Biggest maker of PSAs
Ad Council
Types of evaluations for an intervention
- Formative - as you are creating program - start small before rolling it out - eg, pilot program
- Process - did they do the process?
- Impact - did you meet the goals?
- Outcome - are you making people healthier?
- Structure - about how you do business
- Fiscal - auditing books, is program running properly?
What you need when you publish the results of an intervention (should always publish)
Front cover Summary Background info Description of evaluation Results Discussion Conclusion and recommendations
What do most public health programs run off of for funds?
Grants
Different kinds of grants
Formula grants Block grants Planning grants Demonstration grants Training grants Matching grants
Formula grant
Some kind of math formula determines how much money you get
Block grants
Money from the government (Fed to states) where government says here is a problem and you decide how to deal with it. Not a lot of rules. Liberals hate them and conservatives love them, except the opposite for mother and child block grant.
Planning grants
Money to plan a program
Demonstration grants
Money to run a program one time. Usually need to explain how you will fund the program after the grant is done in order to get one.
Training grants
Pay you a good salary plus living expenses. You pick up and move to the best eg, pediatric hospital and learn how to become the best pediatric dietitian. Gov pays you.
Matching grants
You get money to do something but you also have to come up with part of the money. Can sometimes come up with your part “in kind” eg, University would waive their indirect rate and fringe rate
Where to get a grant?
Government grants
Private grants
Examples of government grants
National science foundation - about 10,000 per year and $ 7 billion. 40,000 applicants
National Institutes of Medicine $30.3 billion, only fund 16% of the applicants
Types of private grants
Corporate - form foundations and give away grants to get rid of profits and lower their taxes
Family
Community foundations - people in the community donate and the foundation decides where to give the money. Only 700 in the world and one is in Denver - Denver Foundation
RFP
Request for Proposal - grant givers have a general idea of what they want to fund - send them something that looks plausible
RFQ
Request for Quotation - grant givers have a very specific idea but don’t have the staff to do it so asking for people to bid on it and will choose who they want to pay
IRB
Institutional Review Board - need their preapproval if you intend to publish. Is to protect humans and animals. Usually need IRB approval before applying for a grant.
Marketing
Process by which individuals and groups get what they want by exchanging things
- focus should be on customer
Social marketing
Trying to sell change in society not a product - about changing social behavior, changing society for the public good
Steps in marketing
1) determine needs/wants of target population (sometimes public doesn’t want the change and you have to figure out the buy in)
2) identify benefits of product to target population
3) conduct situational analysis - SWOT
4) marketing strategy - 4 Ps
5) develop budget and timeline
6) implement marketing strategy
7) evaluation
SWOT for situational analysis
Strengths
Weaknesses
Opportunities
Threats
4 Ps of marketing strategy
Product
Place
Price
Promotion
Public relations
Organized effort to promote a favorable image through news, media
Brand image-branding
Image that public relations creates - what people think of your product
Public Service Announcements (PSAs)
30 or 60 sec announcements - typically on TV but can be radio or print. TV stations show for free late night or early morning
Two big promotions for nutrition
1) Ad Council
2) Commodity Checkoff Program
Ad Council
- started prior to WWII for war bonds
- will do work for nonprofit or gov
- go to biggest ad agencies and get them to provide free service
Areas the Ad Council concentrates on
Education
Family and community
Health
Safety
Commodity Checkoff program
People that grow the same commodity get together and vote, and if majority agree they impose a mandatory Checkoff tax on all the growers of that commodity and USDA forms a board and decide how to use the money - promotion, if a crop blight happens
Epidemiology
Study of distribution and determinate of health related states and using that info to figure out the cause and how to prevent that disease
Father of epidemiology
John Snow
Cholera in London - looked at incidences on map, interviewed people, and figured out that hose who got sick drank water from the same pump
Epidemic
When there are cases in excess of normal - can be as few as 2.
Common usage is affects lots of people
Pandemic
Epidemic across international borders
1) crosses international borders
2) affects a large number of people
3) affects a large area
Determinants of disease
Causes or factors that promote disease
Eg - unprotected sex for aids
TV in bedroom for obesity
Host factors (determinants of disease)
Genetics, metabolism, sex, race, nutritional status, physiological state
Environmental factors
Food environment, advertising, social-lifestyle, occupations, geographical location
3 vital statistics that are considered to be the best indicators of the health of a country
Life expectancy
Infant mortality rate
Maternal mortality rate
Life expectancy
Number of years an average person born in that year will live
- US not even in the top 10
- spend 20% vs Mexico’s 6% and LE is the same
Infant mortality rate
of infant deaths during the first year of life ➗ # of live births in same year x 1000
- US’s infant mortality rate is the same as a developing country and no one knows why
Maternal mortality rate
Maternal deaths related to pregnancy ➗ # live births x 100,000
Cases (def)
People affected with disease
Risk (def)
Probability of getting a disease
Risk factors (def)
Things that are clinically important and associated with the likelihood of getting the disease
Relative Risk (RR)
Risk of a disease if you are exposed to a risk factor ➗ your risk of the disease if you are not exposed to the risk factor
RR = 1.31 means
You are 31% more likely to get the disease if exposed to the risk factor
RR = 0.75 means
25% less likely to get the disease if exposed to the risk factor
RR interpretation
RR = 1 - the factor has no effect
RR > 1 - factor is related with an increase
RR
Other words that mean the same as relative risk but calculated different
Odds ratio (more predictive of a population) Hazard ratio
Incidence
Number of NEW cases during a specific period of time
Prevalence
Like a snapshot in time - how many people have this disease at this moment in time
Epidemiological methods
1) observe
2) count cases or events
3) relate cases to population at risk
4) make comparisons
5) develop a hypothesis
6) test hypothesis
7) draw scientific inference
8) conduct experimental studies
9) intervene and evaluate
Why correlation does not establish cause and effect
Confounding factors
Ecologic/correlational study
Using group data to find a correlation (instead of individual data) - comparing group data to group data
Ancel Keyes
Found correlation between heart disease and types of fat consumed by using group data - ecologic study
Ecologic fallacy
Wrong to assume that because something occurs in group data that it would occur in individual data. Group correlation can give you false data because it does not tell you what is going on inside the group
Cross-sectional study aka prevalence study
Done in a moment in time, do the measurements once, but collecting individual data
Cohort study
Using individual data, find a group of healthy people and study them through time
Considered the best epidemiological study
Two types of cohort studies
Prospective - following into the future at intervals
Retrospective - go back in time and get data - not considered as good as prospective
Case control study
If condition is so rare that not enough subjects to do a study - match people that have the disease with people of same age, socioeconomic class, etc, that don’t have the disease and study the differences. Can be cross- sectional or cohort.
Controlled trials
Randomly divide people into two groups and treat them differently. Randomization and being blinded is important. This is gold standard of studies.
Definition of poverty
Thrifty meal plan x 3
How did def of poverty come about
Molly Orchanski - worked for social security in the 1960s - went back to 1955 paper that said people spend 1/3 of their income in food. Went to Economic Meal Plan (now Thrifty Meal Plan) and found cost of cheapest meal that could meet the RDAs, multiply by 3, and poverty is below that.
How US measures food security
US Census people do Current Population Survey every month - choose 45,000 families to be representative to look for unemployment and poverty. Every December questions are added for good insecurity. Data is given to USDA who reports it.
Food security definition
Access by all members of the family at all times to enough food for an active healthy life
Assumptions: access = food is readily available, nutritionally adequate and safe; food has to be available in a socially acceptable manner
Levels of food secure
High food security - no anxiety and no problems getting food (most Americans)
Marginal food security - have anxiety about buying food but not any trouble
Levels of food insecurity
Low food security - anxiety about enough money for food and have changed the quality of food bought
Very low food security - changing quality and quantity, and don’t have enough food to eat
TANF
Temporary Assistance for Needy Families
- “welfare”
Now a block grant to states with guidelines that (1) assistance so children raised at home; (2) promote job prep, work, marriage; (3) reduce out of wedlock births; (4) encourage 2 parent families
- only can be on program for 60 months lifetime limit
- states have to show 1/2 families are working 30 or 20 hrs/week
Earned Income Tax Credit
Can get if you have a job and work, credit increases the more you work, plateaus and decreases
Cut off around $50,000
Can get back more $ then you pay in
SSI
Supplemental Security Income
- like welfare for seniors
- run by Soc Sec Admin
- created for poor people that are: 1) 65 or older; (2) blind; (3) people with disabilities
LEAP
Low Income Energy Assistance Program
