Transcript Community As Partner Model to assess obesity prevention efforts in a college population. Karen R.

Community As Partner Model to assess obesity prevention efforts in a college population.
Karen R. Dawn, RN, MSN, PHCNS-BC, CDE, DNP candidate
The University of Virginia School of Nursing
Introduction
Background
Overweight and obesity in childhood and adolescence negatively impacts
health later in life. Hyperlipidemia, hypertension, glucose intolerance and
type 2 diabetes mellitus (t2DM) are associated with a Body Mass Index
(BMI) greater than 25 (Must, 1992, Freedman, 1999, Arslanian, 2002).
The prevalence of t2DM is reaching epidemic proportions in the United
States, with more than 11.3% (25.8 million) of adults with the disease.
There are 79 million adults with pre-diabetes (35% of the US. adults and
50% of those over 65 years), defined by impaired glucose tolerance (IGT),
which is a risk for the development of t2DM (CDC, 2011, Mokdad, et al,
2001, ADA, 2011). Lightwood, et al (2009) reported that current adolescent
overweight is projected to result in 161 million life-years complicated by
obesity, diabetes, or chronic heart disease and 1.5 million life-years lost.
The cumulative excess attributable total costs are estimated at $254 billion:
$208 billion because of lost productivity from earlier death or morbidity and
$46 billion from direct medical costs.
Numerous studies have suggested that the transition to college can be a
time of significant and rapid weight gain (Anderson, Shapiro, & Lundgren,
2003; Holm-Denoma, Joiner, & Vohs, 2008; Levitsky, Halbmaier, &
Mrdjenovic, 2004). The average weight gain in the first semester of college
ranged from 3.5 pounds (Holm-Denoma, et al ,2008) to 7.8 pounds (LloydRichardson, Bailey, Fava, &Wing, 2006). These findings are alarming
because a relatively small weight gain can place an individual's BMI in the
overweight range (Levitsky, et al, 2004). Indeed, in one study, the
percentage of individuals classified as overweight increased from 21% to
32% in the first semester of college (Anderson et al., 2003). Overweight
college students are at-risk of becoming obese adults (Mokdad, 2001).
College food availability in dorm rooms of 100 college students was
studied. The mean number of food and beverage items per student was 47
(range: 0-208). The average number of calories per dorm room was 22,888
(Nelson & Story, 2009). Based on interviews with 50 freshman and
sophomore students, factors that they perceived as influencing body
weight, dietary intake, and physical activity included: unhealthful food
availability on campus, snacking, late-night eating, alcohol-related eating,
eating because of stress-boredom, and food in student dorm rooms
(Nelson & Story, 2009).
Because overweight and obesity are associated with several negative
health and psychosocial outcomes (McTigue, Garrett, Popkin, 2002,
Neumark-Sztainer & Haines, 2004), it is important to develop prevention
programs for college students as they enter this high-risk transition period.
The public university was founded in 1957 and has grown to become the largest
college in the state of Virginia. There are over 5,000 residential students living in
university sponsored housing (Student Handbook, 2011).
2010 College Demographics
32,562
35,000
30,000
25,000
19,623
20,000
The backbone of the CAP model is the assessment wheel, which
represents the people in the community. In this particular case, it
represents the students, staff, and faculty of the university. The
people are affected by and influence the eight subsystems of the
community, which make up the wheel. The community stressors
(based on the Stress Adaptation Theory) are incorporated into the
CAP. The stressors (both internal and external to the community)
are tension producing stimuli that have the potential for causing
disequilibrium in the system. The intervention focus is based on the
disequilibrium caused by the stressors, which impact the
community’s ability to function in a healthful way. These
interventions are controlled by the community, who can identify their
own problems and strengthen their line of defense against stressors
(Anderson & McFarlane, 2008).
This college environment, which was evaluated using the CAP, demonstrates
excellent programs currently in place to keep the students healthy and
engaged. The issue is an integration between these resources and
programs and how they are communicated throughout the community,
delivered in a median the students can readily use.
7,945
10,000
2,457
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The Community as Partner Model (CAP) was developed by
Anderson and McFarlane as a model to guide community nursing
practice (1972). This model is based on Neuman’s model, which is a
total person approach to patient problems using a systems model,
which means the whole is greater than the sum of the parts, with an
emphasis on the interconnection between the systems’ parts. An
individual, group or community is considered an open system that
works within the environment. The CAP focuses on the people in the
community as the core piece of the assessment. The goals of the
model are system equilibrium and a healthy community through
promotion of health, on a primary, secondary and tertiary level
(Anderson & McFarlane, 2008).
4,091
2,603
2,417
61
0
Total
enrollment
Undergraduate
Graduate
African
Americans
Asian
Americans
Hispanic
Americans
Native
Americans
Full Time
Freshman
Figure 2: College Demographics
Community Strengths:
• Student and staff diversity.
•Varied academics and student organizations that promote active student
participation.
• Transportation, including university buses and public buses and trains and
alternatives to driving: cycling racks, incentives to bike to campus – including
competitions between other colleges, and well lit walking paths.
• Full use of four indoor athletic facilities, open 6 am until 11 pm, which offer indoor
tracks, swimming pools, a variety of cardio, isometric and group exercise classes.
• A variety of food choices including vegetarian, vegan, low fat, fresh fruits and
vegetables, Halal, gluten free, alternatives to dairy; and includes extended hours at
numerous eateries throughout campus.
• Health information is available through a variety of sources throughout campus and
on the various group websites: Student Health, The Office of Alcohol, Drug, and
Health Education (OADHE), The Wellness Education Resource Room, University
Life, Healthy Eating web resources, and COMPASS - a proactive web-based tool for
freshmen that emphasizes healthy decision-making, through the use of technology.
Athletic Facility Usage
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School Term and Facility
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Fall 2009
Community Stressors:
Recreation
• Change in environment, which can negatively impact lifestyle habits including
eating and exercise.
Education
• Change in responsibilities related to living away from the family.
• Unhealthy (high fat, overly processed and refined ) food options that are value
priced and appealing to college students and are readily available and frequented by
the students.
People in the
community
Economics
Safety &
Transportation
•Lack of visual health information, for example, nutrition labeling at the eating
establishments.
•Large variety of on-line, non-interconnected health information.
Student Visits to Campus Eateries 2009-2011
1600000
Politics &
Government
Communication
Southside Dining Hall
1400000
Burrito Del Rey
Food Court
1200000
Health & Soc.
Services
In addition to the information median, peer health message development
should be considered. Healthy messages developed and shared by peers
were found by Kickligher and colleagues (2010) to be effective in behavior
change. Targeted intervention by peers, as described by Kicklighter (2010)
and Reyes-Velazquez (2011), may prove to be a simple intervention that
could be shared with college freshman through the university website, email,
Facebook link, classroom, and health fairs.
Adolescence is a time of autonomy and personal and intellectual growth.
This unique period of growth and development offers health providers,
educators and community liaisons an opportunity to improve the long term
health of this population by developing intervention strategies that take
advantage of this age group’s fierce independence. This age group is fully
capable of implementing autonomous health interventions related to food
intake and exercise expenditure. Targeted health messages, developed by
peers and shared through social networks may prove to help the students
reach a higher level of health and the college environment is a perfect
median to implement this type of intervention.
Figure 3: Athletic Facility Usage
Physical
Environment
The use of social networks, when developing interventions for this age group,
may prove to have a lasting impact on weight gain prevention. Based on
research by Strong, et al (2008) and Christalas & Fowler (2007), social
networks have a significant impact on one’s weight, eating and exercise
habits. Interventions should include social networks for communicating health
promotion messages that focus on preventing freshman weight gain (Strong,
et al, 2008). In addition to considering social networks, a Readiness to
Change intervention program, which assesses each student’s readiness to
change behavior, would help motivate an individual to improve lifestyle
choices, at any current level of change (pre-contemplative, contemplative,
preparation, action and maintenance) (Prochaska & Norcross, 2001).
•Nutritionist available for 1:1 consultation, at no cost to the students.
60000
The community assessment was performed over two months and
included windshield surveys, interviews with key personnel (student
health, recreation facility managers, food managers and nutritionists)
and student focus groups. All eight sections of the assessment wheel
were evaluated as it relates to change in student weight and lifestyle.
In addition to the community assessment using the CAP, first year,
freshman residential students will be surveyed to determine their
knowledge and lifestyle practices that impact weight (awaiting IRB
approval).
Evidence demonstrates that college students gain weight and once the
weight is gained in early adulthood, it is rarely lost (Anderson, et al, 2003;
Holm-Denoma, et al, 2008; Levitsky, et al, 2004). This rapid weight gain lays
the foundation for the development of chronic diseases, including type 2
diabetes (Lightwood, et al, 2009). Nelson & Story (2009), suggests that
universities take an active role in designing and evaluating weight-related
health promotion intervention strategies focusing on a variety of targets,
including individual, social, and environmental level influences.
15,000
Number of Students and visits
Learning Objectives: At the end of this presentation the participants will
be able to:
1. Describe the Community as Partner Model as a guide for implementing
a population assessment of a suburban college community as it relates to
obesity prevention.
2. Identify community resources which target primary and secondary
weight gain prevention in this college population, based on the community
assessment.
Specific Aims:
1. To use the Community as Partner Model to implement a
community assessment of a suburban college community as it
relates to obesity prevention.
2. To identify community resources which target primary and
secondary weight gain prevention in this college population.
3. Identify, through a cross sectional survey, college student’s
knowledge and healthy lifestyle practices as it relates to modifiable
risk factors in the development of type 2 diabetes mellitus.
Conclusions
Results
Number of Visits
Abstract
Obesity rates in the U.S have increased dramatically over the last 30 years,
leading to a rise in preventable diseases including type 2 diabetes and
heart disease. Overweight young adults are at risk of becoming obese
adults, which increases their risk of developing type 2 diabetes and heart
disease. There is little published data pertaining to college obesity
prevention efforts. The Community as Partner Model (CAP) provides a
useful approach to assess a college population regarding primary and
secondary weight gain prevention efforts. The CAP fosters a partnership
between a college community and the advanced practice public health
nurse that addresses the community assessment, analysis, and health plan
targeting obesity prevention efforts. The population assessment of this
young adult community is a unique approach in identifying current factors
associated with a student’s potential for weight gain. Prevention efforts,
based on a thorough community assessment, can help public health
program planners develop targeted, specific strategies to reduce weight
gain and the diseases related to excess weight. In addition, the use of the
CAP and the partnership it fosters between the healthcare system and the
college community, allows for the identification of available community
resources necessary to promote health and prevent chronic diseases
related to weight gain.
Methods
Bistro
Express C-store
1000000
George's Restaurant
Jazzmans
800000
Chick fil A
600000
Ikes Diner
Figure 1: Community as Partner Assessment Wheel
References
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Jazzmans @ SUB I
400000
One Stop
Adapted from Anderson & McFarlane, 2008
Starbucks
200000
Freshens RAC
Contact: [email protected]
Rathskeller
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School Year
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