Running head: MASSILLON COMMUNITY 1

Transcription

1 Running head: MASSILLON COMMUNITY 1 Massillon Community Julia Apostolescu, Kristine Becher, Taysha Demetro, Kerry Anne Harbaugh, Stephanie Lane, Dan Laskey, Megan Riedy, Meghan Shenot, Elora Socotch, Erika Tallman Kent State University

2 MASSILLON COMMUNITY 2 Introduction Based on our community assessment tool that was done on the Massillon population we found several health problems that need improved, such as Diabetes Mellitus, hypertension (HTN), obesity, and high cholesterol. Diabetes is a chronic metabolic disorder marked by hyperglycemia that results from a failure of the pancreas to provide insulin in type I or from insulin resistance in type II. Diabetes Mellitus may damage the blood vessels, nerves, retina, and kidneys. Massillon community has diabetic rate of 11.5% compared to Stark County that has a rate of 6% (Find the Data, 2012). HTN is a condition that is marked by a systolic reading above 120 mmhg and a diastolic reading above 90 mmhg. HTN is one of the major risk factors for Coronary Artery Disease (CAD), stroke, Peripheral Vascular Disease, kidney failure, and retinopathy. Obesity is the most common metabolic, nutritional, disease in the United States and is characterized by an unhealthy accumulation of body fat. Damaging effects of excess body weight is characterized by a body mass index (BMI) exceeding 25%. Massillon has an obesity rate of 30.8%, which is above the state obesity rate of 29.2% (Find the Data, 2012). According to Taber s Medical Dictionary (2008), high cholesterol increases a person s risk of developing CAD, which is the buildup of atherosclerotic plaque found in our arteries. Massillon s cholesterol rate is 33.6% (Department of health, 2012). The Massillon community has many resources including several hospitals, clinics, libraries, churches, preschools, elementary schools, organizations, clubs, newspapers, ESPN 990 radio station, Massillon TV cable, and various parks. These resources are not being utilized effectively by the citizens of Massillon due to lack of awareness and knowledge. The identified nursing diagnosis for the Massillon community is knowledge deficit related to consequences associated with poor nutrition and eating habits on health outcomes and

3 MASSILLON COMMUNITY 3 disease development for the citizens of Massillon. This is evidenced by high rates of heart disease, which is the leading cause of death in Stark County according to the community assessment tool, high rates of cholesterol (e.g., 33.6%), hypertension: (e.g., 27.0%), high rates of Diabetes Mellitus (e.g., 6%), high obesity rates (e.g., 23.6%), high percentage of low income households (e.g., below poverty 14.8%, Massillon median income $38,437), poor public knowledge of available resources and sources of health related information, and above average percent of the population that are of African American descent (e.g., 11.5% African American). Content The problem in the Massillon community previously mentioned was knowledge deficit related to consequences associated with poor nutrition and eating habits on health outcomes and disease development for the citizens of Massillon. This is due to high rates of heart disease, Diabetes Mellitus, high obesity rates, and high percentage of low income households. This is all attributable to the fact that there is a poor public knowledge of available resources and a high percentage of a minority population within the community. Healthy People 2010 stated that obesity is the number one health problem in the United States (Karnik & Kanekar, 2012). As described previously, the leading cause of death in Stark County is heart disease and the community members of Massillon are at a higher percentage than that of the Ohio average. The Massillon population is also at a higher average for high cholesterol, where Stark is 33.6% and Ohio is 32.4%, hypertension, where Stark is at 27% and Ohio is at 26.3%, and diabetes mellitus, where Stark is at 6% and Ohio is at 6.5% (Find the Data, 2012; National Conference of State Legislatures, 2012). According to the community assessment, Massillon is below the national average of high school graduates at a rate of 85.2%, while Stark County has a rate of 87.2% and Ohio has a rate

4 MASSILLON COMMUNITY 4 of 86.8% (U.S. Census Bureau, 2012). These rates are similar to the number of college graduates within the Massillon community. The percentage of Massillon citizens with a college degree is 13.5% while the rate of Stark community residents who hold a degree is 20.04% and Ohio is 24.1% (U.S. Census Bureau, 2012). This contributes to low income households, the high poverty level, and the lack of knowledge of resources available within the community. A community s lack of accessibility and affordability of healthy food can affect the nutrition of the whole family (Karnik & Kanekar, 2012). Also found in the community assessment tool is the high unemployment rate of 10.3% in Massillon compared to that of the United States which is 9.1%. The average income is also lower in Massillon, with an average of $38,825, Stark County of $44,363 and the United States of $52,945 (Zip Atlas, 2011). The barriers within the community include the previously stated high unemployment rate and high number of low income households. There is a high rate of heart disease in the community and many resources available for the community to utilize based on health; however, the community is not well aware of the resources available to them. The community of Massillon has plenty of resources available where citizens can get information and education on nutrition and the consequences associated with poor nutrition and eating habits. Nevertheless, the public knowledge of these resources is poor. In return, utilization of the resources by the community is slim. There is a possible correlation between poor public knowledge or utilization of resources and the high rates of different health problems in the community. Many of the community resources are offered to poverty-level households and the general public. Local hospitals for example, such as Mercy, Aultman, and Affinity, offer free clinics that deal with education, screenings, and offer low cost cholesterol checks to the public. This is something that anyone can use; poverty-level households or not. Aultman also has a

5 MASSILLON COMMUNITY 5 meals-on-wheels program that provides the needy and elderly with meals. The Massillon Senior center offers geriatric nutrition services, which is a great service since Massillon has a high number of seniors living in the community (U.S. Census Bureau, 2010). According to the Massillon City Health Department, the Women Infants and Children (WIC) Nutrition Program helps women and children who are at a health risk due to inadequate nutrition. Many churches also offer wellness education. On the contrary, the Massillon community offers only four natural food stores compared to the eight fast food chains, with each chain having at least three different locations. Consuming fast food is associated with approximately two to three fold higher odds of having a poorer quality diet (Moore, Roux, Nettleton, Jacobs & Franco, 2009, p. 5). These are all aspects of the community that are leading to the high rates of health problems. The resources which are available to the community do not seem to be advertised enough to the public. Other reasons why the community does not utilize these resources includes limited access to internet, busy schedules, and uneducated individuals who simply do not know the correlation between eating habits and disease development (N.J. Kazakis, personal communication, April 6, 2012). There is a definite relationship between poor nutrition and heart disease and obesity. Not only eating unhealthy, but also an individual s health and activity have huge effects on health outcomes and disease development. The more recent problem which the community faces is seeing more and more young adolescents that are obese or morbidly obese. For example, lately physicians have been making more referrals to dieticians and nutritionists for a much younger population, such as teenagers (N.J. Kazakis, personal communication, April 6, 2012). The prevalence of obesity has become an epidemic in the United States. When the prevalence of obesity in the United States was compared to other nations such as Canada and European countries, it appeared to be lower in Canada and European nations. Obesity is a risk

6 MASSILLON COMMUNITY 6 factor for a variety of chronic conditions including diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancers, and arthritis (Flegal, Carroll, Ogden, & Curtain, 2010). A Massillon nutritionist, Nancy Kazakis, was asked if the citizens would benefit from educational information and resources about the consequences associated with poor nutrition and eating habits. She was also asked if that could help to decrease the obesity and heart disease rates. The following perception was provided: I don t think that it would necessarily decrease these rates, but education and information can only help overcome this problem that our community faces, and pretty much the nation as well (N.J. Kazakis, personal communication, April 6, 2012). A more obvious problem that she observed is that of noncompliance. Even though she and her colleagues provide our community and patients with information, education, and resources, it is extremely hard to get individuals to see how their food choices are affecting their health and their lives. Other compliance problems involve family issues, different cultures, and work schedules (N.J. Kazakis, personal communication, April 6, 2012). Review of Literature Childhood Obesity: A Global Public Health Crisis This article reviews several reasons as to why childhood obesity is a growing problem in the United States. It attributes obesity to environmental, genetic, and behavioral factors. Environmental factors include the parent-child interaction, home life, school, and settings within the community. Sedentary lifestyles, video games, the higher prices of healthy food, and the lack of parental influence for healthy eating habits all affect childhood obesity rates. Genetic factors include metabolism and body fat percentage. Behavioral factors include how much physical activity the child participates in and the amount of food intake.

7 MASSILLON COMMUNITY 7 These issues lead to physical and psychological problems in teen years and adulthood. Physical problems lead to diabetes, hypertension, cardiovascular disease, asthma, sleep apnea, and joint, muscle and bone problems. Psychological problems can include depression. The article then goes on to mention several family, school, and community interventions to help battle childhood obesity such as walking to school and having the schools educate their students on healthy food choices and providing those foods during school lunches (Karnik & Kanekar, 2012). Role of Apathy in the Effectiveness of Weight Management Programmes This article examines the prevalence of apathy in the obese population. Specifically, this study was aimed at the obese veteran population which accounts for 65% of the total population. Since patients with apathy (a state of profound loss of initiative, motivation, and persistence) do not actively seek treatment, the Motivate Obese Veterans Everywhere (MOVE) pilot program was initiated. The MOVE program is a weight loss program in the Veteran Affairs (VA) medical system consisting of a combination of dietary, exercise, and behavioral interventions. The behavioral interventions factored in the importance of lifestyle modifications, believing the patient has an important role, and having confidence and knowledge necessary to take action. According to Desouza (2012), obesity is the most prevalent diet-related health problem in the United States. Being overweight and obese is a risk factor for a number of common chronic diseases including diabetes, hypertension, and coronary heart disease. Apathy is becoming a recognized component in the obesity epidemic and only when this is addressed will the patient be able to be successful at achieving an optimal weight. Additionally Desouza explains that to achieve optimal weight control, individuals with obesity must have access to the integral components of care such as self-management education including recommended portions and

8 MASSILLON COMMUNITY 8 food records, weight loss clinics in order to maintain weight loss in the long run, and health care visits. In conclusion, obese patients that suffer with apathy may find it difficult to initiate and adhere to a weight loss program. Once apathy is addressed, weight loss programs can tailor motivation techniques to properly suit the individual needs. The expected outcome would be initiative and persistence, leading to enhanced motivation, and self-care thus weight loss (Desouza, 2012). Evidence to Support Church-Based Health Promotion Programmes for African Canadians at Risk for Cardiovascular Disease Church is widely recognized as the center of the African American community. Evidenced based practice has shown that the church-based health promotion programs provide resources, education, familiarity, cultural competence, and religious components to help reduce the risk of cardiovascular disease to the African American population. Furthermore, the churchbased locations are able to reach African American populations that normally would not seek preventative care. The community health nurse can volunteer or be hired by congregations to provide education regarding the disease process, provide primary care such as blood pressure checks, and plan exercise and nutrition classes (Tomlinson, 2011). Prevalence of Overweight and Obesity in Youth with Diabetes There is an increase in obesity among United States youth that has been exhibited across all ethnicities and all ages. During the past twenty to thirty years, the prevalence has doubled for youth ages two to five and has almost tripled for youth ages six to nineteen. There is an increase in type II diabetes in youth of all ages and ethnicities. It is well-known that being overweight and obese can lead to the development of cardiovascular morbidity. It is important to understand

9 MASSILLON COMMUNITY 9 the burden of being overweight and being obese has on the youth, because obesity can impact diabetes (Liu, Lawrence, Davis, Liese, Pettitt, Pihoker, Dabelea, Hamman, Waitzfelder & Kahn, 2010). A Systematic Review of Randomized Controlled Trials Overweight and obese children are four times more likely to become overweight adults, leading to major chronic illnesses such as type II diabetes, heart disease, and cancer. Lack of physical activity leads children to become overweight and obese. Physical inactivity is the fourth leading risk factor for global mortality. Increasing aerobic physical activity may be the first behavioral change to help decrease adiposity and decrease childhood obesity. Living a sedentary lifestyle is one of the leading causes of obesity. Physical activity has beneficial effects on the body. It can decrease adiposity, increase musculoskeletal health and fitness, improve cardiovascular health, improve blood pressure, plasma lipids, and lipoprotein levels, and improve mental health (Laframboise & DeGraauw, 2011). The Integration of a Family Systems Approach to Understanding Youth Obesity, Physical Activity, and Dietary Programs To prevent and treat obesity in youth, it is necessary to understand the relevancy of multiple factors that comprise a successful program, specifically ones that improve weight loss, physical activity, and a healthy diet. One strategy that includes all three components is the family system. It was also found that children who ate often with their family were more likely to consume greater intakes of healthy foods, such as fruits, vegetables, and milk. The authoritative parenting style, where parents incorporate shared-decision making, set appropriate boundaries, provide moderate levels of monitoring, and use conflict resolution within the context of warm parental emotive behaviors, correlates to more healthy dietary behaviors and lower rates

10 MASSILLON COMMUNITY 10 of obesity in youth. Including the family system in weight loss programs has been very effective at sustaining behavioral change and is associated with improved health. Programs that focus on improving physical activity and a healthy diet in normal weight children can guide obesity prevention programs for youth, and providing parenting skills and child management strategies may improve parents ability to effectively incorporate healthy habits for the family (Kitzman- Ulrich, Wilson, St. George, Lawman, Segal, & Fairchild, 2010). Obesity" and "Clinical Obesity" Men's Understandings of Obesity and its Relation to the Risk of Diabetes: A Qualitative Study This article studied the perceptions that adult males had on obesity and diabetes. It was found that adult males had a different definition of obesity than the clinical definition, became more aware of healthy behaviors and health problems in their 30s or 40s and only acted upon this knowledge at this age, with a low knowledge level about the link between diabetes and obesity. These men were also moderately- to-highly educated and still were lacking knowledge on how health behaviors affect weight and diabetes development. This may lead to the conclusion that those with lower education levels may be at an even bigger detriment. This study also showed that men prefer their image when the BMI is around 25, adding to the fact the concept of obesity is misunderstood. When asked about diabetes, most of the men in the study could identify one or two aspects of the disease, but had poor understanding of the disease as a whole. Differentiating between type I and type II showed an even bigger knowledge deficit (Weaver, Hayes, Unwin, & Murtagh, 2008). Recommendations for Action Nursing engaging in community assessment also uses epidemiologic methods to determine the assets and health needs of the populations, and the evidence is used to create a

11 MASSILLON COMMUNITY 11 variety of interventions (DeMarco & Harkness, 2012, p.19). Some of the possible interventions we came up with in order to lower HTN and cholesterol, decrease obesity, and Diabetes Mellitus were; organize a community walk once a week at an area park and hand out literature on how to decrease HTN. The physical activity will help strengthen the cardiovascular system, which would help decrease high blood pressure. Another option was to post fliers on how to make healthier choices at the local grocery because those are where the majority of the community shops to buy their food. Another thought was to create a section for the healthy recipe of the day to help promote ideas to eat healthier and print coupons in the newspaper for one free week s admission to the Massillon recreation center and/or area gyms in order to increase an active lifestyle. Many people read the newspaper, which makes this a good source of information. The recipes would promote better eating habits and lower cholesterol. Some other potential interventions could be to advertise free area clinic locations on the local radio station 990AM daily in order to increase annual health care visits. Another intervention would be to send educational pamphlets home with the children, in their schools about childhood obesity. Starting early education in the community will help decrease obesity in children. Asking area nursing schools to allow their nursing students to teach about the health risks of high cholesterol in community middle schools was a potential intervention. Providing handouts to area doctors offices and clinics about MyPlate so the nurses can discuss and customize the patient s own profile would also be a beneficial intervention for this community. Another intervention was to ask the local ministers to announce free blood pressure screening directly after their church service. In the African American community, church services would be a great way to screen these individuals for high blood pressure. Posting addresses of all available free clinics and health departments in the area at local libraries was another potential

12 MASSILLON COMMUNITY 12 intervention. Libraries are a good source of available information, due to the fact that libraries are widely utilized by the communities. Another intervention would be to set up a mini health fair at some of the recreation centers or YMCAs and feature MyPlate. Massillon has many resources available that can be used to increase the public s awareness of potential health problems. The success of community health programs depends on well-conceived interventions and implementation plans. Selecting the most appropriate interventions requires consideration of the available resources, including people, money, facilities and time (DeMarco & Harkness, 2012, p. 146). The public health nurse in the community will have a vital role in implementing all of these interventions. Their job title encompasses many tasks. American Dental Education Association (2008, p. 1) defined the role as: Monitoring health trends and identifying health risk factors unique to specific communities, setting local priorities for health-related interventions to provide the greatest benefit to the most people, advocating with local, state and federal authorities to improve access to health services for underserved communities, designing and implementing health education campaigns and disease prevention activities, such as immunizations and screenings, telling people about locally available health care programs and services to improve access to care, and educating and providing direct health care services to vulnerable and at risk populations. According to this description, public health nurses are responsible for assessment, development, organizing, implementing, and evaluating health problems in the community and interventions aimed at reducing these problems. With the above interventions, the public health nurses in Stark county would be responsible for arranging all of the above activities and also

13 MASSILLON COMMUNITY 13 with working with the community businesses and leaders to put the interventions into action. With the interventions that deal with using a media outlet, the public health nurse would have to contact the newspaper and radio stations to set up an arrangement for buying air time or space in the newspaper. If possible, the nurse could get these resources donated. The nurse or assigned individuals would then have to develop the information that would be presented. They would have to find the healthy recipes weekly to print, or work with the newspaper staff to designate this task to one of them. They would also have to do this with the recreation centers and work with them to see if they would allow free coupons to be published in the newspaper for the community to come and try out the facility. Another task the nurse or individuals would have to coordinate would be the development of the lists of free services and clinics offered in the community so that the radio station could broadcast. This would include the hours, services, and time frame for each event, along with any changes or updates that the radio station would need to know about. For the interventions dealing with education, the public health nurse would have to talk to the various institutions (e.g., schools, doctor s offices, etc.) about giving out educational material. Another part of this intervention would be working with the staff at the different places about developing the material to handout, such as what needs does that specific population need addressed and at what level the material should be written. An additional issue the nurse or individuals would help solve would be to determine who would take on the cost of the intervention. The nurse or individuals could also work with local universities to organize nursing students to participate in blood pressure screenings at churches, teaching on certain topics to school age children, running a mini health fair, or help organizing and running community

14 MASSILLON COMMUNITY 14 events, such community walks. They could even delegate many of these activities to the nursing students and just oversee the plans and interventions the students develop. As illustrated, the public health nurse will have a huge role improving the community through the various interventions. The nurse must be able to work with all the local organizations, schools, business, and community to develop relationships that will allow him/her to implement interventions with their help. They will not be able to influence change without the community and its members cooperation. The nurse must also be educated and be able to use available resources to develop tools and activities to offer to the public. Knowing the population knowledge deficits, health problems, and resources that will be most helpful for them is required so that the nurse can increase health and wellness. Public policy needs to be developed to further improve the health and wellness of communities. A successful policy that was developed and passed in 2007 was the Smoke Free Workplace Act (Issue 5). This policy combats the effects of secondhand smoke by making it illegal to smoke in public enclosed places (Norris, 2012). Any type of tobacco smoke contains a multitude of carcinogens and has many adverse health effects, from cardiac to respiratory (Norris, 2012). Another type of policy has to do with ensuring adequate nutrition for children. Many schools have already implemented policies to offer healthy choices to students while in school. According to the Academy of Nutrition and Diabetes Foundation, (2012) The Child Nutrition Reauthorization policy has several goals: Ensure the Dietary Guidelines for Americans are the foundation of federal food assistance and nutrition programs, provide adequate funding for program implementation, strengthen nutrition education and promotion, increase funding for Child Nutrition Program research, place trained professionals in roles where policies are made, and

15 MASSILLON COMMUNITY 15 ensuring directors of the School Nutrition Program at the district level are certified Registered Dietitians; Dietetic Technicians, Registered; or School Nutrition Association School Nutrition Specialists. The National School Lunch Program is an example of a policy that is currently in effect. This federally funded program offers nutritionally balanced, low cost meals in schools to the students daily (USDA Food and Nutrition Service, 2012). Also, to improve upon public knowledge of nutrition and increase awareness, a policy could be developed where restaurants and other food services have to offer the nutrition information on the items on their menu. Some restaurants already do this, but many do not. The public would benefit greatly if it was understood exactly what is being consumed and how that affects their health and wellness. Implementation of Recommendations Implemented Intervention: MyPlate After reviewing the interventions, the recommended program for implementation in the city of Massillon was to hold a miniature health fair at the Massillon Recreation Center. The health fair had focused on the MyPlate national initiative which educated the public on making healthier food choices in order to contend with the obesity epidemic in the United States (Nappo- Dattoma, 2011) and specifically the population of Massillon. The health fair offered four teaching sections. The following is a brief description of the teaching provided at each station. The first section of the teaching had a demonstration of the SuperTracker web page by navigating the audience through the resources offered on an ipad and computer. Furthermore, the group offered assistance in creating a profile through SuperTracker for those who were interested in creating an account. The first section incorporated My Coach Center including

16 MASSILLON COMMUNITY 16 :Food-A-Pedia, Food Tracker, Physical Activity Tracker, My Weight Manager, My Top 5 Goals, and My Reports. The second section of the teaching had a poster board providing information on topics such as eat this, not that. This included understanding the difference between marketed foods and what is served in restaurants compared to other healthy food choices. This also focused on educating on what foods to avoid and what to eat in its place. Other topics included understanding how portion sizes have changed over the years, how many calories are contained in common foods, discussing the concept of the empty calories and which foods contain them, how to get the most out of the food one eats, tips for eating healthy and less when going out, and tips and strategies identified to save calories and pick healthy foods when eating out. Knowledge and information was provided about common restaurants and food offered at restaurants and the calorie and nutrient composition of foods offered. The third section of the teaching had a poster board providing tips such as: coupons and grocery shopping, planning your shopping trip, buying in bulk, and buying vegetables in season. Other strategies included frozen dinners versus making dinners from scratch and preparing larger portions of a meal and freezing it so there are leftovers throughout the week. Also, the group advised the population to find new recipes that one can use for leftovers, such as using leftover meat or chicken for stir fry or chili, and tips for eating out at restaurants. The fourth section of the teaching had a poster board with information for being a healthy role model as a parent. The topics addressed involved: ten tips for setting good examples, how to lead by example, the do s and don'ts of eating habits for kids, and an explanation for the importance of physical activity. The group also addressed ways to keep kids physically active and index cards with pictures and tips for making fun, healthy snacks for kids.

17 MASSILLON COMMUNITY 17 Measurable and Non-Measurable Outcomes After the population miniature health fair teaching had taken place, the feedback from the population was compiled and assessed. The initial behavior goals were met and the measurable and non-measurable outcomes were identified. The first measurable outcome was that the audience would verbalize having a better understanding of the additional resources provided through MyPlate such as SuperTracker and LetsMove by the end of the miniature health fair. For instance, the audience expressed that they were surprised to learn that the SuperTracker program offered through the MyPlate website was a free service offered. The second measurable outcome was that the audience would report having a better understanding of good food substitutions, healthy choices, and appropriate portions by the end of the miniature health fair teaching as rated on the evaluation tool. Additionally, the audience verbalized a better understanding throughout the miniature health fair. One such statement was the expressed shock regarding the information provided at the eat this not that table of the teaching. The third measurable outcome was that the audience would verbalize ways to save money while grocery shopping and ways to prepare a healthy meal with leftovers by the end of the presentation. For example, both the ants on a log and the bean-less chili were very well liked by each person who tasted it. The fourth measurable outcome was that the audience would report having a better knowledge of the importance of healthy eating habits starting at young ages by the end of the miniature health fair by rating positively on the evaluation tool. Furthermore, grandparents who came to the teaching especially enjoyed the recipe cards which contained healthy kid friendly snacks. The non-measurable outcomes would be an increase in balanced nutrition after attending the miniature health fair. Furthermore, the audience would begin to look for community

18 MASSILLON COMMUNITY 18 resources that offered nutrition based cooking programs to control obesity, prevent chronic disease risk factors, and chronic diseases such as church-based resources, library health fairs, and hospital funded programs. Additionally, the audience would establish individual goals and plan to control weight. Based on the community tool assessment of the population, the group discovered that the city of Massillon, Ohio had various health problems linked to modifiable behaviors such as diet and nutrition. The miniature health fair dealt with educating the community and population about these health risks with education about alternative choices and places to get information. The group decided to do the education at the local recreation center in Massillon, Ohio. Overall the community liked the presentation and the group provided ideas on improving health and decreasing the risk factors of the local community along with the community giving feedback and their own ideas and thoughts on the subject. The group had people of all ages and genders come up to the tables and ask questions to get information. It was interesting how much the younger generations already knew and even were educating the group on subjects they were asked about. The adult population liked the kid s snack ideas along with the eat this not that for themselves and their children and gave their own opinions about what they thought was healthy for them. The intervention that the group implemented could be continued in Massillon and any other areas due to the fact that no matter where one is, in any community, being healthy and reducing risk factors is always an issue. Although, changes would have to be made to adapt to that community in a way that would appeal to them more personally than another community. For example, the group gave away a cheap healthy turkey chili to the community at the recreation center. Due to the cold climate in Ohio, chili was a fitting option. In the southern

19 MASSILLON COMMUNITY 19 states, chili may not be a viable choice due to the warmer climate. Also, the restaurant choices that were used in the teaching in Massillon may be changed to fit other communities with different restaurant availability. Conclusion Massillon as a whole has a knowledge deficit related to consequences associated with poor nutrition and eating habits on health outcomes and disease developments. The community has less graduates and a high unemployment rate creating a high poverty level. When poverty levels rise, the rates of heart disease, Diabetes Mellitus, and obesity begin to rise, also. Massillon is leading the categories in Diabetes Mellitus, obesity, and HTN. The obesity epidemic is starting younger and is being carried into adulthood which leads to Diabetes Mellitus and cardiovascular disease. Physical inactivity and expensive food make this a difficult solution, but there are resources available. The community health nurse in this area needs to be aggressive with this issue and advocate for better access to healthier foods and other resources. The nurse will need to work with communities to help educate and make recourses more readily available. By knowing and understanding the population deficits, health problems, and the potential resources that would be of the most help would be the greatest advantage to the community. Policy needs to continue to change in the right direction to make healthier lifestyles easier to obtain. Not only do they need to educate the public on healthier lifestyles, the rest of the community needs to step up to the plate. Healthy food choices should be promoted more in grocery stores and free clinics need to be advertised more. The tactics the group utilized to tackle this issue was to educate members of the Massillon Recreation Center and families on how to implement easy healthy lifestyle changes.

20 MASSILLON COMMUNITY 20 When educating the members of the Massillon Recreation Center, the plan was to educate so they could take it home and start the changes that day. The group demonstrated the benefits to MyPlate, educated the audience on how to eat healthier for less, and how to be a good role model. To ensure that those listening were given a take home message, recipe cards with healthy meals were distributed to continue the forward motion of making a healthy lifestyle change. Unfortunately, with the epidemic that is obesity, Diabetes Mellitus, and cardiovascular disease, communities need more than just education. Follow up is needed for those that want to continue the healthy changes to ensure compliance. Whether this comes from blood pressure screenings or free clinics, there needs to be encouragement for healthier living as a community.

21 MASSILLON COMMUNITY 21 References Academy of Nutrition and Dietetics Foundation. (2012). Child nutrition reauthorization. Retrieved from American Dental Education Association. (2008). Public health nurse. Retrieved from Carpenito, M. (2008). Nursing. (n.d.) Taber s dictionary. Retrieved from Skyscape Application copyright 2008 by Lynda Juall Carpenito-Moyet. DeMarco R.F. & Harkness G.A. (2012). Community and Public Health Nursing: Evidence for Practice. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins. Desouza, C. (2012). Role of Apathy in the effectiveness of weight management programmes. Diabetes, Obesity, & Metabolism, 14(5), Find the Data (2012). Diabetes and Obesity Rates by County. Retrieved from Flegal, K.M., Carroll, M.D., Ogden, C.L., & Curtin, L.R. (2010). Prevalence and trends in obesity among U.S. adults. American Medical Association, 303(3), Karnik, S. & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal of Preventive Medicine, 3(1). Retrieved from: Kitzman-Ulrich, H., Wilson, D.K., St. George, S.M., Lawman, H., Segal, M., & Fairchild, A. (2010). The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clinical Child & Family Psychology Review, 13(3), doi: /s

22 MASSILLON COMMUNITY 22 Laframboise, M.A., & DeGraauw, C. (2011). The effects of aerobic physical activity on adiposity in school-aged children and youth: A systematic review of randomized controlled trials. Journal of the Canadian Chiropractic Association, 55(4), Liu, L. L., Lawrence, J.M., Davis, C., Liese, A.D., Pettitt, D.J., Pihoker, C., Dabelea D., Hamman, R., Waitzfelder, B., & Kahn, H.S. (2010). Prevalence of overweight and obesity in youth with diabetes in USA: The search for diabetes in youth study. Pediatric Diabetes, 11(1), doi: /j x Moore, L.V., Diez Roux, A.V., Nettleton, J.A., Jacobs, D.R., & Franco, M. (2009). Fast-food consumption, diet quality, and neighborhood exposure to fast food. American Journal of Epidemiology, 170(1), doi: /aje/kwp090 Nappo-Dattoma, L. (2011). Updated dietary standards: The 2010 dietary guidelines for Americans, MyPlate and other nutrition education resources for the oral health professional. Access, 25(8), National Conference of State Legislatures (2012). Ohio State Profile and Policy Report. Retrieved from Norris, K. (2012). Stark County Health Department. Retrieved from Tomlinson, S. (2011). Evidence to support church-based health promotion programmes for African Canadians at risk for cardiovascular disease. Journal of Immigrant & Minority Health, 13(6), doi: /s USDA Food and Nutrition Service. (2012). National school lunch program. Retrieved from

23 MASSILLON COMMUNITY 23 U.S. Census Bureau, (2012). Massillon (city), Ohio. Retrieved from: U.S. Census Bureau, (2012). Stark County, Ohio. Retrieved from: Weaver, N., Hayes, L., Unwin, N., and Murtagh, M. (2008). Obesity and clinical obesity men s understanding of obesity and its relation to the risk of diabetes: a qualitative study. BMC Public Health, 8, 1-8. Wqynyslo, T., Retrieved from Zip Atlas, (2011). Percentage of population below poverty level in Ohio by city. Retrieved from: