NUTR 456 Community Nutrition Exam 1 Review Notes

Hi guys!

For those of you like me, studying to become a Registered Dietitian and Nutritionist, I thought that I would take some time and upload my exam review notes as I go through the semesters.  Please note that information may change with time, especially for years ending in a 5 or a 0 since major nutrition related policies and guidelines are updated every five years.  For example, 2015 will mean the reinstatement of programs like WIC, SNAP, and the US Dietary Guidelines.

If you have any questions about anything please feel free to message me! :D  Together we'll become RDNs so that we can prevent, treat, or even reverse chronic diseases.

Marquita

Nutritional Sciences Major | Kinesiology Minor |

Pennsylvania State University 2017

Text book: Community Nutrition

Nutrition 456  

Exam 1 Review questions Spring 2015

Introduction 

1. What is community nutrition?  

1. The study of public health and nutrition issues related to particular communities 

2. What are three goals of community nutrition?  

1. Health Promotion  

1. Enabling increased control over dietary factors known to promote good health 

2. Disease Prevention  

1. Primary DP – early intervention by controlling dietary factors that increase health risk) 

2. Secondary DP – disease identification before signs and symptoms emerge via screening 

3. Tertiary DP – minimizing the severity and/or longevity of a dietary induced disease to prevent disability or death 

3. Disease Management 

Community assessment 

1. What is community nutrition/needs assessment?   

1. A nutrition based process analyzing a community to discover its risks, needs, and problems while identifying community strengths and resources 

2. What is the purpose? 

1. To find important nutrition-related needs in the community while also finding opportunities for intervention 

2. Understands the community’s nutrition needs and areas to improve with interventions 

2. Why would a community needs assessment be conducted? 

1. One hasn’t been done before or was done too long ago for the information to be relevant 

2. To identify health/nutrition priorities and develop public health recommendations 

3. To determine the success of prior interventions 

4. To identify groups/subgroups that may be at a higher health risk 

3. What types of information should be collected in a needs assessment? 

1. ABCDs: Anthro, Biochem, Clinical/Physical, Dietary Intake 

2. Social, political, economic, environmental, and personal factors 

4. What kinds of general questions are addressed in a needs assessment? 

1. Who has health/nutritional problems 

2. How did the problem(s) develop 

3. What programs/services exist to deal with the problem(s) 

4. Why aren’t the existing programs working? 

5. How can the nutritional status be improved? 

Page Break 

5. What are steps in conduction a needs assessment?  Be familiar with these. 

1. Develop an assessment plan/action plan 

2. Define the important community issues/needs 

1. Who is affect? Health impacts. Knowledge gaps. 

3. Set goals/objects 

4. Set the parameters of assessment 

1. What is the community?  Is it a sub-group? 

2. How will you define the community? 

1. Distance, common ideals/beliefs, socioeconomic status? 

3. How will you gather data?  What data, if any, is already available? 

5. Collect the data 

1. Create assessment tools 

2. Train assessment team on how to use the tools 

3. Implement assessment tools 

6. Analyze the collected data for: 

1. State of health, pattern of health care, relationship between community and health care facilities 

7. Share your findings! 

1. Ask for clarification on data if needed 

2. Share with the community and community leaders 

3. Identify any other organizations that may want the data and share with them 

8. Set priorities based on the findings 

9. Choose a plan of action 

6. Why is it important to identify the community?  

1. To narrow the scope of the work and to ensure you’re collected relevant data 

2. a target population?  Same as above. 

3. community leaders?  They have an influence on the community, they’re familiar with the community, and they’re more comfortable addressing the community and they community is more comfortable with them. 

7. What are the major tools for community needs assessment? What are some advantages/disadvantages for each tool? 

1. Surveys 

1. Done via interviews, self-administered, phone, mail, online, or in person 

2. Strengths: 

1. Whole population can be surveyed 

2. Quick to give (though time on consuming if done in person one-on-one) 

3. Weaknesses: 

1. Labor intensive [Symbol] expensive 

2. Survey could be difficult to design 

3. Difficult to train interviewers to ensure they remain on topic 

2. Focus Groups 

1. Generally 8 – 12 people answering open ended questions 

2. Strengths: 

1. Social/community focused 

2. Moderator can probe and get clarification on the spot 

3. High face validity – easily understood and believable 

4. Generally low cost 

5. Can be quick 

3. Weaknesses: 

1. One vocal group member can derail or intimidate the group 

2. Moderator could guide the group instead of being passive 

3. Have to find ways to get people to come to you 

3. Nutritional Assessment 

4. Existing Data 

8. What ways can you reach individuals for a survey? 

1. Community advertising, mailing, phone calls, ads 

9. What is survey validity and reliability?  

1. Reliability – degree to which a tool gets consistent results 

2. Validity – how accurate a tool is 

Nutritional Epidemiology 

1. What is epidemiology? 

1. The study of distribution and determinants of health related states or events and the application of that knowledge to control diseases and other health problems 

2. What does the distribution of disease/health conditions refer to? 

1. Number of people affected 

2. Place and time of occurrence 

3. Characteristics of those affected 

4. Patterns of exposure 

3. What is a determinant of disease?  What are examples of agent, host, and environmental factors?  

1. Cause and risk factors (ex. compromised immune system due to malnutrition) 

2. Agent – the cause 

3. Host – who is affected/infected 

4. Environment – what allows the spread 

4. What is a case? 

1. Single instance of dz, injury, or social condition 

2. Self-reported or reported by an investigator 

5. What is a cohort? 

1. Group of people who are studied over a period of time to determine the rates of dz, injury, or death 

6. What are incidence and prevalence? 

1. Incidence – risk of developing a condition over time 

2. Prevalence – amount of people (in a defined population) with dz/condition at a specific time 

7. What is an epidemic?  

1. New cases of dz occurring during a specific period at higher than expected rates 

8. Briefly describe different study types, strengths and weaknesses of each, and what kind of information/evidence they would be able to provide for us regarding the relationship between a factor/behavior and an outcome (e.g. nutritional/health status or disease).  

1. Cross-sectional 

1. Ex. NHANS  

2. Gives a prevalence of dz/condition of population at specific time 

3. Can measure large populations 

4. gives no intervention or links cause 

5. Only measured in one day 

2. Cohort 

1. Ex. Framingham heart study (FHS) 

2. Group of people (cohort) w/o dz are followed over time 

3. Gives incidence  

4. Can study many dz/outcomes 

5. No intervention/follow-up 

6. High cost 

3. Case-control 

1. Identify people w/ dz (cases) and w/o dz (controls) then compare exposures 

2. Helpful is dz is rare 

3. Can NOT estimate prevalence or incidence 

4. Randomized trials 

1. Experimental 

2. People are randomly assigned an exposure (e.g. diet) and are followed to measure the health outcome. 

3. Tests the effects of an intervention 

4. Can be expensive 

5. Can be unethical 

9. Which study type is good for rare diseases?   

1. Case-control 

10. Which study type can allow you to calculate prevalence? Incidence? 

1. Prevalence 

1. Cross-sectional (NHANES) 

2. Incidence 

1. Cohort (Framingham heart study FHS) 

Poverty, hunger, and food insecurity 

1. Define poverty 

1. Lack of access to basic human needs, health care, sanitation, and/or education 

1. Lacking all of these things is “absolute poverty” 

2. How is the poverty level set in the US? 

1. By analyzing the cost of food 

2. Poverty level is 3x the cost of buying food for a healthy diet (Thrifty Food Plan) 

3. How is poverty monitored in the US?  

1. Poverty 

1. Current Population Survey – Annual Social and Economic Supplement (100,000 households)  

2. How is food insecurity monitored in the US?  

1. Current Population Survey – Food Security Module (50,000 households)   

3. What agency conducts the survey?  

1. US Census B 

4. What is the prevalence of poverty?   

1. Prevalence 

1. 15% people, 46.5 million people.   

2. What is the prevalence of food insecurity?  

1. 14.5% of households 17.5 million households 

5. What is hunger?  

1. Hunger 

1. Physical sensation of wanting food, at an individual level 

2. Not measured in the US 

2. How is it related to food insecurity? 

1. Consequence/result of prolonged food insecurty 

6. Define food security/insecurity. 

1. Food security 

1. Access by all people, at all times, to enough food for an active, healthy life 

2. Food Insecurity 

1. Limited or uncertain availability of 

1. Nutritionally adequate/safe food 

2. Acquiring healthy food in a socially acceptable way 

2. Affects 21% of families 

7. Describe the USDA classification of food security levels (high to very low) in terms anxiety, quantity/quality of food, and changes in intake.  

1. High Security – food security is reported 

2. Marginal Security – having anxiety around food shortage in the house but they have enough food and in good quality 

3. Low Security – quality of food has suffered but the quantity hasn’t suffered 

4. Very Low Security – quality and quantity have suffered 

8. How is poverty related to food insecurity? 

1. Poverty is low income [Symbol] not enough funds to buy food [Symbol] food insecurity 

9. Why is food security more important for children? 

1. Lack of foods to support a healthy diet results in stunted growth and cognitive development, nutrient deficiencies, health risks, troublesome behaviors, and increases the chances of the children being arrested and being food insecure as adults. 

Community food security 

10. What is community food security?   

1. Quantity and quality of food avail to a community 

2. Affordability of the food avail to the community 

11. Give some examples of when we would consider communities to be food-insecure. 

1. Low food availability 

2. No support for locally growing food options 

3. Low support for low income families 

4. Food is not affordable 

5. Not enough support in food assistance resources to help low-income people purchase food. 

12. How would you determine whether a community is food-insecure? 

1. What would you assess or gather information on? 

1. Community socioeconomic and demographic characteristics 

2. Community food resources 

3. Food security, availability, and affordability of households in the community 

4. Community food production resources 

2. What characteristics would indicate that the community is food insecure? (e.g. food is not affordable) 

1. See above answer 

13. Why would we need to conduct a food security needs assessment in communities?  What can be done with this information? 

14. What are some strategies used to strengthen food security of a community? 

1. Food Stamp outreach programs 

2. Farmers markets 

3. Community supported agri programs 

4. Community gardens 

5. Food recovery or gleaning (taking leftovers from restaurants/grocery stores) 

National Nutrition Monitoring 

1. What is national nutrition monitoring and surveillance?  What Federal agencies (discussed in class) conduct these activities?  

1.  CDC, FDA, and USDA 

2. Why would we want to collect national nutrition data? 

1. To improve population’s health (which would also lower the cost of health insurance) 

2. To know the health and nutr status of a population 

3. Monitor changes in health/nutr over time 

4. Provide info to contribute to analysis of cause and risk factors of dz for preventative measures 

5. Provide info on relationship between health and nutr in subgroup 

6. Est the prevalence of dz, risk factors, and changes over time 

7. Monitor nutr programs and evaluate their effectiveness 

3. What general categories of nutrition-related data get collected nationally? 

1. Food supply determinations 

2. Food and nutrient consumption 

3. Food composition and nutrient database 

4. Knowledge, Attitudes, and Behavior Assessment 

5. Nutritional Status and Nutrition Related Health Measurements 

4. What populations are monitored by the Pediatric and Pregnancy Nutrition Surveillance System?  

1. Monitored by Pediatric and Pregnancy Nutrition Surveillance System 

1. Low income infants, children and women in federally funded maternal and child health programs  

2. Where do the data come from?   

1. CDC for surveillance (constant monitoring) 

5. Describe the NHANES—what it is, how often conducted, what kinds of data get collected, how the data get collected, and stages in the sampling procedure.  

1. Conducted by CDC 

2. Cross-sectional survey to assess the health and nutrition status of the US pop 

3. Annual but data isn’t released annually 

4. Data collected for: chronic diseases, nutrition, hearing loss, anemia, etc 

1. Data collected with surveys and physical exams  

2. Date is for various age ranges 

6. Why does the NHANES use a complex sampling strategy? 

1. Because they only have a sample size of 5000 people to represent the country 

7. What is the BRFSS and what kinds of data are collected? How is the information collected? 

1. Conducted by CDC 

2. When:Performed annually, with data released quickly 

3. How:Telephone interview, no physical exam 

4. Type of Data:Data related to behavior and disease risk 

5. Who:Data is on ADULTS ONLY!!  No children 

8. Approximately how many people are surveyed annually in the NHANES and BRFSS?  

1. NHANES:5000   

2. BRFSS? 500,000 

9. Compare the type of people measured in the NHANES vs. BRFSS.  (Hint: which survey gives us data on child obesity rates?) 

1. BRFSS:State-based data collection program designed to measure behavioral risk factors in adult, 18+.  Done via telephone interview with 500,000 people, so no anthropometric data is taken just family hx and behaviors 

2. NHANES:Gives anthropometric and clinical data from 5,000 in portable “offices” that can test for DM, HTN, wt, ht, family hx, dz, and dx. 

Nutrition Policy 

1. What is a policy?  What is the purpose of policy?  

1. An attempt by the government to address a public issue by using laws, regulations, decisions, and action. 

1. Public policy can contain lows but do not have to!   

2. Policies are MORE BROAD than laws 

2. How does a policy idea become a law in the US? (basic steps in the process) 

1. Idea is introduced to a committee by a member of congress 

2. Committee determines if there will be a hearing or a “mark-up” (members offer amendments) and then head to hearing or be cut 

1. Hearing is held by subcommittee 

2. Mark up can be done by subcommittee or full committee 

3. Committee provides their report on the bill 

4. Flood debate and votes 

1. Majority vote is needed for an amendment and for final passage of the bill 

5. Referral to the other side of congress that hasn’t debated and the process repeats. 

6. If bill makes it through both committees it goes to be the president 

1. President can request amendments 

2. Veto it where congress can attempt to override the veto 

3. Approve the bill and it’s turned into low and then given to a subsection of government for enforcement (secondary legislation) 

3. How can a community nutritionist/Registered Dietitian be involved in nutrition policy in the US? 

1. At sub-committee and committee levels they can come in and offer opinion 

2. Used as a specialist or reference 

4. What percentage of the Farm Bill/Agricultural Act budget goes to nutrition? 

1. 80% 

5. What US law regulates SNAP?   

1. Law 

1. Farm Bill 

2. How often is it updated?   

1. 5 years 

6. What US law regulates  

1. WIC  

1. WIC Reauthorization Act  

2. School lunch?  

1. Healthy, Hunger-Free Kids Act 2010 and Child Nutrition and WIC Reauthorization Act 2004  

3. How often is it updated?  

1. Every 5 years 

7. What US law regulates national nutrition monitoring? The Dietary Guidelines for Americans?   

1. National Nutrition Monitoring and Related Research Act   

8. What is “secondary legislation”?  Who writes these regulations? 

1. Federal says a law must be passed, the secondary legislation is created and regulated by a division of the government, like the USDA, FDA,   

1. FNS (primary) [Symbol] USDA (secondary) 

World poverty, hunger, and malnutrition 

1. How is poverty defined worldwide?  

1. Living on $1.25/day 

2. Highest poverty rate: 

1. Sub-Sahara Africa, India, South Asia w/o India 

2. What contributes to food insecurity and hunger worldwide?   

1. Conflict, war, can contribute 

2. A complex issue involving economics, poverty, access and availability to food 

3. Where do most of the people suffering from hunger live? 

1. Developing countries, rural areas 

1. 500 million in Asia (Highest INCIDENCE) 

2. 25% Subsaharan Africa (Highest PREVALENCE) 

4. What is the double burden of malnutrition? 

1. Having an obesity problem AND a malnutrition problem at the same time. 

2. Results in developing countries because those in rural areas are still in poverty and those in industrial areas have access to food but often choose unhealthy, “popular” food options. 

5. Describe the cycle of poverty and malnutrition.