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Midterm Exam 2019 Health Promotion BHSC 4010 2019 Please review the levels of prevention in your text. Choose a disease process or a health related outcome and briefly describe primary , secondary and tertiary prevention strategies for this disease process (examples of disease processes include Hepatitis B, Type 2 Diabetes Mellitus, Osteoporosis, Cervical Cancer). Please provide at least two evidence-based and peer-reviewed references for your information. Wikipedia is not an acceptable source. 50 points I am very passionate about nutrition and exercise; therefore, I will be discussing the levels of prevention for the disease of obesity. According to Kopelman (2000) obesity is defined as a body mass index (BMI) of 30 or greater and became formally instated as a disease by the American Medical Association in 2013. Obesity can cause or exacerbate many health problems such as Type 2 Diabetes Mellitus, Coronary Heart Disease, increased risk of cancers, respiratory complications, and Osteoarthritis. Many factors play into becoming obese such as genetics, metabolic rate, exercise, food intake, and culture (some of which are in the individual’s control). Obesity has now become a serious medical problem due to its fast increase in prevalence; it is beginning to replace undernutrition and infectious diseases as the most significant contributor to ill health. The first level of prevention is primary; this level occurs before the disease is active and includes health promotion, education, protection, genetic screening, examinations, etc. I personally believe when it comes to obesity, health and nutrition education is the most important step of the primary level of prevention. According to Sharma (2011) there are about 25 school-based interventions for preventing childhood and adolescent obesity available. This number is astonishingly low compared to how prevalent obesity is. The interventions focused on dietary and physical components. For example, high school students often skip breakfast, drink unhealthy beverages, and eat unhealthy meals and snacks throughout the day. As the primary level of prevention goes, there should be dietary and physical education on topics such as body image, food label reading, self-esteem, portion size, benefits of healthy body weight, etc. Schools can also provide healthier options, social support, garden-based activities, and more to promote healthy living. Promoting healthy lifestyles have even made their way to social media, which has in turn motivated a ton of people to lose weight. Adults can be proactive about their futures by doing genetic screenings and evaluations to test for any genetic predispositions, but as mentioned education must come first. Next are the secondary and tertiary levels of prevention which occur after the disease has arisen. The secondary level of prevention is similar to the primary but applied to a person who already has the disease. Measures such as screening and education are taken to detect the disease at its earliest stages or to educate how to prevent the disease from worsening. In the case of obesity, a person could be approaching the BMI of 30 or already there during the secondary level of prevention. The individual would consult with a doctor and be given pamphlets, referrals to nutritionists and trainers, and screenings for any obesity related health issues. At this stage, obesity is still reversible and can be

treated with dedication to their health. Once people reach this stage, gastric band surgery is considered. This surgery shrinks the stomach so the individual would eat less, therefore gain less. Many individuals use this surgery as a start to their weight loss journey Lastly, the tertiary level of prevention is when the disease is irreversible and is used to maintain, rehabilitate, and prevent further complications. Obesity is a tough disease to conquer, and many people do not. At the tertiary level, the individual is usually considered morbidly obese and not functioning. This level aims to help the individual find a place in society, which is difficult when that weight. Gastric band surgery can also be considered in this level as a preventative and comforting measure so the individual does not gain more weight. Overall, I firmly believe that the United States needs to address its obesity problem in a more succinct manner. Kopelman, P. G. (2000). Obesity as a medical problem. Nature, 404(6778), 635. Sharma, M. (2011). Dietary education in school-based childhood obesity prevention programs. Advances in nutrition, 2(2), 207S-216S. Please review Emerging Populations and Health in your text Please choose an emerging population, ethnic group or minority group and a health related outcome or disease process that is very common in this population. Briefly explain what strategies you would consider in tailoring a health education intervention/program geared towards this population in your community. Please provide at least two evidence-based and peer-reviewed references for your information. Wikipedia is not an acceptable source. 50 points I am going on a trip to Alaska this summer which sparked my interest in Natives. According to Edelman, Kudzma, and Mandle (2014), although they were the first inhabitants of America, the Native Americans and Alaska Natives only comprise of 1.7% of the total population in the United State; this equates to 52 million people. Native Americans are typically located in in Oklahoma, California, Arizona, New Mexico, Alaska, Washington, North Carolina, Texas, New York, and Michigan. Only 13% of Native Americans have obtained a bachelor’s degree; low education rates combined with higher poverty rates can quickly affect the living conditions and health status of Natives. Mental health is a hot topic right now, and for a great reason: The United States needs better access to mental health services. However, the Native Americans and Alaska Natives are suffering in silence. According to Dillard et al. (2017) suicide is disproportionately high for this population compared to all of the United States. The numbers show suicide is 50% higher in Native Americans and Alaska Natives, making it the leading cause of injury and/or death for this population. Roughly 70% of Native Americans and Alaska Natives live in non-metropolitan areas, including rural areas, that tend to neglect mental health and suicide prevention strategies. Programs are already being put in place to provide mental health practitioners loan forgiveness as an inventive to come to the rural areas. There is a huge cultural stigma that seeking mental health care is “for the weak.” Health education programs must start at breaking this stigma apart and teaching populations that seeking care is more important than your ego. Alcoholism is also very prominent in these populations and leads to suicide. By educating youth, the population

most affected, the dangerous effects that alcohol has, it acts as a deterrent. Being more proactive in schools and the community about suicide and educating the population about the signs to look for are extremely important. The Native populations are very community based; therefore, I would use a mix of community-based practices and individual-level programs to educate and prevent suicides. With programs such as suicide hotlines, survivor support groups, safe reporting of suicide in the media, alcohol laws and taxes, and group counseling the population can tackle the problem together. Individual based programs would gear towards substance abuse treatment, individual counseling, and other mental health services. Educating the Native people in ways they can be on the look-out for signs of mental illness, suicide, and other factors is key. Dillard, D. A., Avey, J. P., Robinson, R. F., Smith, J. J., Beals, J., Manson, S. M., & Comtois, K. A. (2017). Demographic, Clinical, and Service Utilization Factors Associated with Suicide-Related Visits among Alaska Native and American Indian Adults. Suicide & Life-Threatening Behavior, 47(1), 27–37. https://doiorg.ezproxylocal.library.nova.edu/10.1111/sltb.12259 Edelman, C., Kudzma, E. C., & Mandle, C. (2014). Health promotion throughout the life span, (8th ed.). St. Louis, MO: Elsevier. Please review Health Promotion and the Community and Family in your text. Choose a community health program or intervention in your community or in another community- and briefly describe what the program entails. Describe the impact that it has made in your community. An example of a community health education program is the “Walk safe Program” in South Florida www.walksafe.us. Please provide at least two evidence-based and peer-reviewed references for your information. Wikipedia is not an acceptable source. 50 points I am very interested in nutrition and food education. The State of New Jersey Department of Health has made it a priority to get people the healthy food they lack and to reverse the obesity problem. NJ Health has partnered with non-profit organization The Food Trust. The Food Trust originated in Philadelphia and now serves the whole United States. Their mission is, “to ensure that everyone has access to affordable, nutritious food and information to make healthy decisions. The Food Trust has four components: learn, shop, live, and grow. Food education is a priority for children and adults and enabling healthy choices at home and the community. Healthy food is made available in supermarkets, corner stores, and farmers markets. They promote wellness through community health and youth leadership. Lastly, The Food Trust connects local farmers to the people they serve through farm to school initiatives and healthy food incentives” (Our Mission, 2012). In just New Jersey alone, The Food Trust has created the Healthy Corner Store Initiative that works to improve the access to healthy food and beverages in underserved communities such as Camden and Trenton. These are the communities have high rates of obesity, heart disease, stroke, diabetes, and other chronic diseases. According to NJHealth (2017), the initiative has stocked 600 corner stores with more than 1,000 healthy items. Not only that, the participating stores offer free blood pressure checks, referrals by a Jefferson University health care provider, and in-store nutrition education lessons. Stores

showed a sales increase of 60% when healthy food kiosks, in the center of the store, were made available. This amazing program is only a few years old, but has made such a significant difference in food education, nutrition, and healthy food availability in my hometown. Our Mission. (2012). Retrieved from http://thefoodtrust.org/about/mission The New Jersey Department of Health. (2017). Nutrition and Fitness. Retrieved from https://www.nj.gov/health/nutrition/ Please review Health Promotion and the Individual in your text. Discuss the importance of the 11 functional health patterns and implications for health promotion practice. Apply the 11 functional health patterns to your own personal wellness or to a willing volunteer and provide a summary of the assessment results. Please provide at least two evidence-based and peer-reviewed references for your information. Wikipedia is not an acceptable source. 50 points Gordon’s 11 functional health patterns are used typically by nurses when assessing an individual’s lifestyle. Being able to recognize the patterns of someone’s life provides critical insight about their health status. According to the American Thoracic Society (2007), health status is an individual’s relative level of wellness and illness, taking into account the presence of biological or physiological dysfunction, symptoms, and functional impairment. The 11 functional health patterns include: health perceptionhealth management, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, sleep-rest pattern, cognitive-perceptual pattern, self-perception-self-concept pattern, roles-relationships pattern, sexuality-reproduction pattern, coping-stress tolerance pattern, and values-believes pattern. These 11 patterns collect information about the totality of the individual’s health and how they interact with their environment; with the use of these assessments, the nurse or health care practitioner can gauge the diagnoses and health promotion. The results produce a health status, which is then used to assess what areas the individual is lacking or doing well in their overall health (Edelman, Kudzma, and Mandle, 2014). Each and every one of these patterns are important to assess in order determine the lifestyle of an individual so they can receive the highest quality care. I will be assessing my own 11 functional health patterns; this will give me a better outlook on my overall health status. I perceive that I manage my health better than average due to my high activity level and balanced diet. I will be discussing the four areas that I feel are lacking in my health status. First, my nutrition is balanced most of the time, but I also love sweets. I’ve made it a rule to only eat dessert once a week which has helped me limit my sugar. Sugar is my limiting factor. Next, I try to get 8 hours of sleep but for the past four years I’ve been waking up somewhere between 4:30am to 5:30am. Thankfully, my rowing career is ending soon so I will be able to catch up on sleep. Third, my self-perception is low to medium. I have struggled with borderline anorexia a few years ago and then recovered and gained weight (muscle and fat) back so sometimes I fall into a dark place with my body image. I do try to dress up and do my makeup to boost my self-esteem. Lastly, I have learned many ways to cope with stress being a psychology major but sometimes I struggle implementing all those techniques. I have been trying to

be more mindful about my surroundings but when I have a lot of work to get done, I tend to shut down. Looking into my health for these 11 patterns has been eye-opening and using it is so important in our health care system. American Thoracic Society. (2007). Health Status, Health Perceptions. Retrieved from http://qol.thoracic.org/sections/key-concepts/health-status-health-perceptions.html Edelman, C., Kudzma, E. C., & Mandle, C. (2014). Health promotion throughout the life span, (8th ed.). St. Louis, MO: Elsevier. Examine the role of nutrition in the etiology, prevention, and treatment of at least two of the leading nutrition-related chronic diseases of your choosing. Please provide at least two evidence-based and peer-reviewed references for your information. Wikipedia is not an acceptable source. 100 points According to the National Osteoporosis Foundation (2019), osteoporosis is a chronic bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break more easily. The disease causes bone to become more porous than the usual honeycomb in bone. Osteoporosis is influenced heavily by genetic, environmental, and lifestyle factors such as nutrition and body weight. According to Lane (2006), nutrition factors leading to osteoporosis include low calcium, protein, and vitamin D intake, eating disorders, gastrointestinal surgery, and/or obesity. A well-balanced diet and adequate calories/nutrients throughout the lifespan are critical in preventing osteoporosis. Edelman, Kudzma, and Mandle (2014) suggest consuming the appropriate amount of calcium and vitamin D in each stage of life; for a 21-year old female the recommended calcium intake is 800mg/day and vitamin D 400mg/day. Plenty of healthy food contain these nutrients such as dairy, fatty fish, cereals, and eggs. Americans are suffering from lack of calcium and vitamin D due to the increase of lactose intolerance, low consumption of produce, and increase of consumption of soft drinks. In order to prevent osteoporosis, individuals should be aware of the nutrients they are absorbing from their food and adjust as needed or use supplements. Lastly, nutrition therapy can be used to treat osteoporosis; this is the use of foods and vitamins to rehabilitate. A meal plan is given that specifically targets the disease and combats its effects. For osteoporosis, a diet of high calcium foods such as milk, yogurt, cheese, and dark leafy greens was recommended. Additionally, foods with high vitamin D were given in the meal plan such as milk, cod liver oil, and egg yolks (National Osteoporosis Foundation, 2019). These nutritional changes can slow or reverse the effects of the disease’s bone degeneration. The second chronic disease that is affected by nutrition is hypertension, or high blood pressure. According to MedlinePlus (2019), blood pressure is considered hypertensive when systolic is between 130-139 and when diastolic is between 80-89. When blood pressure is too high for long periods of time, it causes the heart to over work itself, which can lead to heart attack, stroke, heart failure, and kidney failure. Hypertension is influenced or caused typically by consuming too much salt, obesity, lifestyle, and smoking. Americans are more prone to hypertension due to their high in fat and salt diets.

Like preventing any chronic disease, a well-balanced diet is key. Since hypertension is linked to salt, it is important to limit foods high in sodium for prevention. The recommended amount of salt for an adult is 6g per day, which is 2300mg of sodium. Limiting salt can be accomplished by reading food labels, not adding additional salt to meals, limiting processed foods and meats, and eating at home more frequently. As far as treatment goes for hypertension, a plan called Dietary Approach to Stop Hypertension, or DASH, has been proven effective. DASH evaluates the sodium level in all foods and provides meal plans with whole foods, produce, and meats. The meal plan provides nearly two times the amount of nutrients the typical American consumes and substantially less sugar, fat, and salt. DASH has been proven to prevent hypertension, eliminate medication in moderate cases, and reduce the need for medication in severe cases (Edelman, Kudzma, and Mandle, 2014). Overall, both of these chronic diseases have shown that a well-balanced diet is critical in supporting a healthy and disease-free life. Edelman, C., Kudzma, E. C., & Mandle, C. (2014). Health promotion throughout the life span, (8th ed.). St. Louis, MO: Elsevier. Lane, N. E. (2006). Epidemiology, etiology, and diagnosis of osteoporosis. American journal of obstetrics and gynecology, 194(2), S3-S11. MedlinePlus. (2019). High Blood Pressure | Hypertension. Retrieved from https://medlineplus.gov/highbloodpressure.html National Osteoporosis Foundation. (2019). Learn What Osteoporosis Is and What It's Caused by. Retrieved from https://www.nof.org/patients/what-is-osteoporosis/...