NURS 6700 Week 1 Discussion Essay Paper

NURS 6700 Week 1 Discussion Essay Paper

NURS 6700 Week 1 Discussion Essay Paper – Walden

Epidemiology & Population Health

NURS 6700 Week 1 Discussion Essay Paper : Epidemiology and Population Health

Reflect on your nursing practice for a moment. If you could wipe out one illness, what would it be? How would that impact not just an individual patient, but your entire patient population? What would be the long-term benefits of eliminating that one illness?

The eradication of smallpox by 1979 provides an excellent example of this scenario. This eradication came about as a result of global collaborative efforts involving many countries and organizations, as well as the application of epidemiologic methods. In spite of high initial financial costs, it is estimated that millions of dollars continue to be saved around the world each year as a result of the eradication of this disease.

The eradication of smallpox illustrates the rich history of epidemiology and demonstrates the cost/benefits and implications of improving health at the population level. The application of epidemiologic methods and principles to other critical population health issues continues to play an essential role in improving health and health outcomes.

For this NURS 6700 Week 1 Discussion Essay Paper, you will identify a current population health problem, and you will examine how, and if, the problem is being addressed through the application of epidemiologic principles. You will also discuss the cost-effectiveness of dealing with the problem at the population level.

To prepare for NURS 6700 Week 1 Discussion Essay Paper:

Review the Learning Resources, focusing on the smallpox epidemic of the 1960s and 1970s and how health organizations applied principles of epidemiology to eradicate this disease.

In light of this example, consider the cost effectiveness of addressing smallpox at the population level.

Using the Learning , research a current population health problem (local or global). Select one on which to focus for this Discussion.

Think about how principles of epidemiology are being applied—or could be applied—to address the problem.

What lessons from the use of epidemiology in the eradication of smallpox might be applicable to this selected problem? What are the financial benefits of addressing this issue at the population level as opposed to the individual level?

By Day 3 of NURS 6700 Week 1 Discussion Essay Paper

Post a cohesive response that addresses the following:

Briefly summarize your selected population health problem and describe how principles of epidemiology are being applied—or could be applied—to address the problem.

Are there any lessons learned from the use of epidemiology in the eradication of smallpox that can be applied to your selected problem?

Evaluate the cost effectiveness of addressing this health problem at the population level versus the individual level.

Read a selection of your colleagues’ responses.

By Day 6 of NURS 6700 Week 1 Discussion Essay Paper

Respond to at least two of your colleagues in one or more of the following ways:

(Make sure that you respond to at least one colleague who selected a population health problem different than the one you selected.)

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

NURS 6700 WK 8 Assignment Paper

Childhood Obesity

Obesity is an ever-growing health problem in the United States.  It is defined as having excess body fat, which is measured by a screening tool to assess the body mass index (BMI) (Centers for Disease Control and Prevention [CDC], 2018). Children may gain extra weight from consuming more foods and beverages than what is required of the body, having a sedentary lifestyle, and not being active enough to burn the extra calories for healthy functioning and growth.  According to 2015 to 2020 dietary guidelines, the estimated needs for young children range from 1,000 to 2,000 calories per day; the range for older children and adolescents varies substantially from 1,400 to 3,200 calories per day, with boys generally having higher calorie needs than girls(Office of Disease Prevention and Health Promotion [ODPHP], 2018).

Since the 1976–1980 National Health and Nutrition Examination Survey (NHANES), overall childhood obesity doubled among 2- to 5-year-olds has from 5% to 13.9% and 6- to 11-year-oldsfrom 6.5% to 18.4% and quadrupled among teens ages 12 to 19from 5% to 20.6% (Robert Wood Johnson Foundation [RWJF], 2004-2018).The latest data from the NHANES show that the national obesity rate among youth ages 2 to 19 is 18.5% (RWJF, 2004-2018). This discussion will focus on theproblem of childhood obesity and research methods that will help to address the problem.

Population Health Problem – Person, Place, Time

The occurrence of disease with respect to the characteristics of person, place, and time is central to the field of descriptive epidemiology, which explains the etiology of the disease (Friis& Sellers, 2014, p. 158).The prevalence of childhood obesity in the home environment varies among the head of household education level, income level, and gender.  The following statistical data indicates the prevalence of childhood obesity with each characteristic.

• Head of household education –“An analysis of the 2007 National Survey of Children’s Health found that children of parents with less than twelve years of education had an obesity rate 3.1 times higher than those whose parents have a college degree”.2011–2014 data from the NHANES, found that among youths, the prevalence of obesity decreased with increasing level of education of the head of household: 21.6% (high school graduate or less), 18.3% (some college), and 9.6% (college graduate) (CDC, 2018).
• Income –“Children living below the federal household poverty level have an obesity rate 2.7 times higher than children living in households exceeding 400 percent of the federal poverty level and children living in low-income neighborhoods are twenty percent to sixty percent more likely to be obese or overweight than children living in high socioeconomic status neighborhoods and healthier built environments”. 2011-2014 NHANES found the prevalence of obesity among youth aged 2-19 was 18.9% among those in the lowest income group, 19.9% among those in the middle group, and 10.9% among those in the highest income group (CDC, 2018).
• Gender – Girls ages ten to seventeen living in neighbor-hoods having lower socioeconomic characteristics are more likely to be obese and overweight than girls living in neighborhoods having higher socioeconomic characteristics (RWJF, 2004-2018).From 1999–2002 to 2011–2014 the prevalence of obesity increased among females in the middle- and low-income groups and decreased among females in the highest income group (CDC, 2018).

In 2007, Mississippi had the highest rate of 22.6% of and Oregan had the lowest of 9.6 % of obesity in children between the ages of ten to seventeen (National Conference of State Legislatures [NCSL], 2018).  In 2011, North Dakota had the highest rate at 20.4% and Oregan had the lowest obesity rate at 9.9% (NCSL, 2018).  The Healthy People 2020 target goal for childhood obesity is a prevalenceless than 14.5% (CDC, 2018).

Significance of Health Problem

Childhood obesity has significantly increased in both developed and undeveloped countries.  Data from 2015-2016 shows that nearly one in five school-aged children and young people (ages six to nineteen) in the United States has obesity (CDC, 2018).  Childhood obesity can contribute to many health problems that may have a profound effect on the physical and emotional well-being and limit the quality and length of life.  It is a serious medical condition that can cause chronic health problems in adulthood such as diabetes, hypertension, high cholesterol, and asthma.  Obese children may have difficulty keeping up with other kids, joining sports and activities, and may be teased by other classmates.  All of this may lead to low self-esteem, depression, and other mental disorders, which may affect the child’s academic performance.

Research Question – Hypothesis

A good hypothesis for this topic would be the following:Children living within Baltimore, MD, have a higher percentage of obesity than other same-age children living in Baltimore who are not from low income households

Epidemiologic Study Design

The most appropriate study design is a retrospective case-control study design as ittestes the hypotheses by comparing a group of people who have the disease with a group of people without the disease.  The case-control study seeks to identify possible causes of the disease by finding out how the two groups differ with respect to an exposure that may have occurred voluntarily (e.g. through diet, exercise, or smoking) or involuntarily (e.g., through cosmic radiation, air pollution, occupational hazards, or genetic constitution) (Friis& Sellers, 2014, p. 303).  Within this study, the exposed cases (children living in a home environment with low income and head of household with low education) will be compared with nonexposed controls (children living in a home environment with high income and head of household with some education) in a given time of one year.

Assessment Strategies

An axiom of epidemiologic research design is that larger studies necessarily are more demanding than smaller ones with regard to challenges in data collection and data management (Friis& Sellers, 2014, p. 345).  Considering this, it would be appropriate to select a small number of cases of 150 exposed children to compare with 150 nonexposed.  Exposed children are defined to come from low income households, whereas non-exposed come from middle to upper income households.  For this hypothesis, the exposed participants can be easily selected through the CDC Maryland Department of Health and Mental Hygiene, pediatrician electronic health records, and households participating in the Special Supplemental Nutrition Program (SNAP) for Women, Infants, and Children (WIC).  The control participants can be selected through NHANES, which is a program of studies that is designed to assess the health and nutritional status of adults and children in the United States through interviews and physical examinations (CDC, 2017).  To determine whether this risk factor is truly associated with the disease – not indirectly or incorrectly associated because of some third (confounding factor) –the ideal controls should have the same characteristics as the cases (except for the exposure of interest) (Friis& Sellers, 2014, p.305).  Thus, NHANES is a good source in selecting participants that are similar to the case group in age and gender and free of the outcome within the Baltimore, MD area.

Data Collection Activities

Data collection is a process of collecting information from all the relevant sources to find answers to the research problem, test the hypothesis and evaluate the outcomes either through primary or secondary sources (Research Methodology, 2018).  Primary data collection methods for the hypothesis would consist of a questionnaire with open-ended questions.  Questions would be focused on collecting data regarding the home environment, income level, education level of head of household, age, and gender.  Another primary data collection method for this study would involve direct interviews with participants who consented.  Interviewing as a data collection method allows for in-depth direct observation of the home environment, a conversation in which specific questions are asked, and the collection of measurements of height and weight to determine BMI.  The questionnaire and in-depth interview will be performed at the beginning and end of the study to see if there is a trend in the increase in obesity.  Secondary data collection sources for this study would consist of growth charts from pediatrician electronic medical records. Growth charts are a good source of data collection as they have been used by pediatricians in following a child’s growth over time to determine if the child is growing appropriately for his or her age, height, and weight.

The Intervention

According to the Kids Count Data Center, obesity rates in the state of Maryland, among the youth population has increased from 29.9% in 2003 to 33.6% in 2016 (The Annie E. Casey Foundation, 2018).  Although the rates have increased overall for the youth, the rates have decreased 17.1% to 16.5% among the two to the four-year-old group who is enrolled in WIC from 2010 to 2014 in Maryland (RWJF, 2004-2018).  These results indicate the strategies implemented by the WIC program are slowly successful in implementing positive change.  The results also highlight that continued efforts are needed in the home and community environment. Strategies and interventions currently in place are through the Baltimore City Health Department (BCHD) and the Department of Pediatrics at the University of Maryland Medical Center (UMMC).

The BCHD is using the obtained grant money at implementing a project that involves working with retail stores to expand access to affordable healthy food options, providing technical assistance to these stores, focusing on the implementation of federal SNAP/food stamp changes, and employing young residents as community health educators (Maryland Department of Health [MDOH], 2018).  The program has three core elements: corner store, Youth Neighborhood Food Advocate, and grocery store-based nutrition education (MDOH, 2018).  The Department of Pediatrics at UMMC has a three-year grant that supports the Healthiest Maryland Schools program which seeks to bring together pediatricians, schools, and communities to address childhood obesity, and to support interventions in three Title I elementary schools in West Baltimore (MDOH, 2018).  This grant funding is utilized for staffing a program manager, a clinical coordinator, and a research assistant, as well as for data collection and analysis (MDOH, 2018).

The strategies implemented by BCHD and Department of Pediatrics at UMMC are targeted at addressing the problem within the community.  To properly address the problem interventions and strategies are also required within the home environment.  To successfully achieve the goal of reducing childhood obesity at home it is imperative that parents play an essential role in ensuring that children are eating a healthy well-balanced diet and getting exercise on a regular basis.  This can be best accomplished by first providing parents education about healthy habits through health education workshops at school parent meetings, health fairs, or targeting mothers or women of childbearing age to encourage breastfeeding.  Studies suggest that children who are breastfed have a lower risk of obesity, possibly because breastfed children may learn to self-regulate how much they eat — and mothers may learn to control how much they feed their children — by responding to hunger rather than other cues (The Harvard Gazette, 2012). Parents should be empowered to reduce sedentary behaviors at home (watching television, playing video games, or spending too much on the computer), remove any unhealthy foods from the home, set consistent meal and snacks times, offer nutritious choices (fresh fruits and vegetables), and encouraging walking to retail stores, parks, and schools in safe neighborhoods.  If funding allows, then another intervention would be to initiate a program that provides home visitation and health coaching by a health care provider from the local health department.

The Impact

The expected outcome of implementing the recommended strategies and interventions along with the ones in place by the by BCHD and Department of Pediatrics at UMMC is a decrease in the rate of childhood obesity.  As a result, the child’s risk of developing hypertension, high cholesterol, diabetes, and asthma decreases.  Additionally, it increases the child’s self-esteem with weight loss and increased activity through walking or participating in sports.  The social impact of implementing the strategies and interventions may impact the home and community environment due to cost and change.  To implement the interventions a large number of funds will be necessary and difficult to obtain.  If the funds are not available, then it must be decided how to best allocate the amount at hand in the community so families are receiving the necessary resources.  In the home setting, choosing healthy food options to stock at home and teaching children new behaviors will be a big change that will require patience and support.

Evaluation

It is important for the investigator to quantify and properly evaluate whether a program has achieved its intended results (Friis& Sellers, 2014, p. 399).  The interventions to be evaluated are the outcomes related to the WIC program, affordable healthy food options, community and parent education, significance of breastfeeding, and behavior modifications at home.  Each intervention will be evaluated by discussing related studies that have met the desired outcome.

• WIC program – As an initiative to prevent obesity among low income children, a study was conducted to examine the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved BMI z scores and obesity‐related behaviors among children age 2 to 4 years ((Woo Baidal et al., 2017, p. 1167). Results found that children enrolled in the intervention group (vs. comparison), had improved their consumption of sugar sweetened beverages and sleep duration, with a reduced prevalence of obesity risk factors in both groups.
• Affordable healthy food options –In another study, the B’more Healthy Communities for Kids (BHCK) implemented a multilevel intervention to improve the community food environment in low-income underserved areas of the city of Baltimoreby including the potential for impacting: (i) the food distributor (wholesaler) to improve stocking of healthier foods available to food retailers; (ii) the food retailer (corner stores and carryouts)
• to improve community food access and availability;and(iii)the consumer(children and their families) to improve healthy food purchasing (Gittelsohn et al., 2017). Results found that children increased their frequency purchase of healthy food options, which lead to a decrease in childhood obesity among low income families.
• Education – A pilot study was conducted, to develop and test an integrated nutrition and parenting education intervention for low-income families within the Expanded Food and Nutrition Education Program in New York State (Dickin, Hill, &Dollahite, 2014, p. 945). 210 parents of three to eleven-year old group, during a 21-month program, were recruited to participate in an eight week workshop and to complete a validated self-administered questionnaire.  Results found mean scores to improve significantly for most behaviors, including adult fruit and vegetable intake, adult and child low-fat dairy and soda intake, child fast-food intake, activity, and screen time (Dickin, Hill, &Dollahite, 2014, p. 945). Most significant improvement was a reduction in how often children ate fast food which was reported by >50% of parents.
• Significance of breastfeeding–A study was conducted to determine whether increased duration of breastfeeding was associated with decreased risk of overweight among 4-year-old children in Kansas families with limited means (Procter & Holcomb, 2008, p. 106). This study included 3692 children that were chosen from the Pediatric Nutrition Surveillance System and Pregnancy Nutrition Surveillance System from 1998-2002.  The duration of breastfeeding and weight status at age four were considered.  Results found that breastfeeding was a protective against obesity in non-Hispanic four-year-old children.
• Behavior modifications at home–In this study, Trials of Improved Practices (TIPs) were adapted to assess acceptability and feasibility of nutrition and parenting recommendations, using in‐depth interviews and household trials to explore families’experiences over time (Dickin&Seim, 2013, p. 897). 23 low income parents of three to eleven-year old were recruited to practice new behavior change at home, they were interviewed at two weeks and four to six months later.  The nutrition behavior changes practices consisted of increasing children’s vegetable intake, replacing sweetened beverages with water or milk, and limiting energy dense foods.  Parenting behavior change practices were role modelling, shaping home environments with other adults, involving children in decisions, and providing positive feedback.  Barriers and challenges to this study were food preferences, habits, time, resistance, and cost.  However, despite the challenges TIPs was successfully adapted to evaluate complex nutrition and parenting practices, which were determined to be a valuable guidance for childhood obesity prevention programmes(Dickin&Seim, 2013, p. 897).

All of the above studies discussed are related proof that the interventions suggested in this paper will have a positive outcome on reducing childhood obesity.  The interventions from the WIC program, accessibility of healthy food options, parental education, breastfeeding, and behavior modifications at home were all found to have a positive impact on reducing childhood obesity.  Considering, this it is assumed that the proposed program for reducing childhood obesity may be successful.

Conclusion

Childhood obesity has become an international problem that is rapidly growing among the low-income, underserved population.  The hypothesis in this discussion is focused on the problem within the Baltimore, MD area among the discussed population.  Research results from various studies discussed in the paper are consistent with the hypothesis.  The presented interventions or program have proven to be effective measures in reducing childhood obesity.  Implementing the interventions early on is necessary to prevent the problem and related high risk chronic illnesses into adulthood.

References

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