Throughout this course, the focus of my project has been obesity and diabetes prevention in Huntsville, Alabama. As I discovered while researching over the last two weeks, type 2 diabetes increases in a linear fashion with the rate of obesity (Klein et al., 2022). In order to prevent type 2 diabetes, it is important to first prevent obesity. To do so, there must be a focus on good nutrition and educating the public about how to eat well. According to a study in the Journal of Behavioral Medicine (2020), approximately 90% of those with type 2 diabetes are either overweight or obese. In this same study, it is noted that those that are overweight have a three-fold chance of type 2 diabetes, while those that are considered obese have a seven-fold risk of developing type 2 diabetes. For the purpose of this discussion, I will reference this study several times.
In the article “Impact of weight loss interventions on patient reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review” (2020), one intervention that the researchers of this study focused on to reduce complications due to obesity and type 2 diabetes was diet intervention. Of the 1,120 participants in this study, greater weight loss was reported with dietary intervention than when there was no change in diet. Those that reported weight loss after dietary intervention also reported more energy and lower hemoglobin A1C levels (Martenstyn et al., 2020). With this information, I have developed a theory that if Huntsville were to offer nutrition programs and information throughout the city, it is possible that there will be a reduction in both obesity and diabetes cases in my community.
According to the CDC (2022), communities can encourage better nutrition by adding healthy food options throughout the city, incentivizing farmers markets and health food stores to build locations in underserved areas, and by placing nutrition information in schools, public spaces, and workplaces. If Huntsville were to make nutrition information and nutritious food more accessible, I anticipate that we would see a decrease in the number of obesity and diabetes diagnoses in the area. To measure this outcome, one idea is to offer surveys to those in the area that have recently lost weight or that are attempting to lose weight. The survey would include questions regarding the influence of a city-wide nutrition information campaign to determine if offering that information affected weight loss or the desire for weight loss. Questions could also revolve around whether those answering the surveys felt that they had adequate access to nutritious food. By using surveys, those in charge of a nutrition campaign can fine-tune interventions to bring about greater changes. To measure the efficacy of these interventions in reducing obesity and diabetes, I would recommend that the city compare the rate of obesity and diabetes diagnoses year over year after implementing better nutritional access and education. In doing so, I firmly believe that there could be a drastic change in the health of the community.
References:
Centers for Disease Control (2022). Community Efforts.
https://www.cdc.gov/obesity/strategies/community.htmlLinks to an external site.
Klein, S., Gastaldelli, A., Yki-Järvinen, H., & Scherer, P. E. (2022).
Why does obesity cause diabetes?. Cell metabolism, 34(1), 11-20. https://doi.org/10.1016/j.cmet.2021.12.012Links to an external site..
Martenstyn, J., King, M., & Rutherford, C. (2020).
Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review. Journal of Behavioral Medicine, 43, 873-891.
https://doi.org/10.1007/s10865-020-00140-7.
Week 4 Practicum
Pediatric asthma prevention has been the focus during this course, with a secondary emphasis on preventing asthma attacks. Even though there is a scant amount of knowledge on preventing asthma from developing, there has been much research on the triggers that may induce asthma attacks in children or worsen the disease. Research has found that children are at a higher risk of developing asthma symptoms and exacerbations due to their bodies taking in more air per body weight than adults (Serebrisky, 2019). Per the CDC (2020), in 2017, there were 3,564 deaths due to asthma in the United States, with 232 of those deaths being in Texas. As of late, it is estimated that 300 million people have asthma worldwide, and the number will increase to 400 million by 2025 (Serebrisky, 2019). Since there has been a significant amount of data reporting the association between asthma and allergies, the project will focus on trigger prevention and education.
While discussing pediatric asthma with the elementary school nurse (B. Pottkotter, personal communication, December 17, 2022) in Tyler, asthma is noted in more African American children than in any other ethnicity. A study by the University of Illinois at Chicago (2017) found that African American children are at a higher risk of asthma due to a unique type of airway inflammation. A higher prevalence of asthma is noted in poverty communities, homes with poor indoor ventilation, indoor allergens such as dust mites, and environmental factors such as cigarette smoke and factory pollution (Serebrisky, 2019). Another study performed by the National Survey of Children’s Health (2019) found that asthma development is 10% higher in children with a disability, such as autism or cerebral palsy, versus children without a disability.
In Cincinnati, a tool called the Pediatric Asthma Risk Score (PARS) was developed to predict asthma in children (Myers, 2019). The significance of PARS is that it can predict asthma not only in high-risk children but in mild to moderate-risk children as well. Mild to moderate-risk children are more challenging to predict, so with this tool, prevention strategies may be taken place quicker, thus preventing the disease from occurring.
A study in Odessa, Texas, a rural part of the state, performed substantial asthma education intervention with 102 participants and compared the number of emergency room (ER) visits, hospitalizations, and school absences before and after the education (Agusala, 2018). Before the educational intervention, ER visits were approximately 41 people out of 102 and lowered to 10 out of 102 after the intervention. Hospitalizations went from 14 out of 102 to 4 out of 102 people. Total attendance in school rose from only 56 out of 102 students to 83 out of 102 students.
Taking note of the research that others have performed, we can see that education is the ultimate primary intervention for childhood asthma. Providing resources, education, and screenings, especially for those at a higher risk for development, is crucial to lowering disease risk. Since there is no cure for asthma, public health community leaders must ensure that the public is adequately educated and understands the importance of prevention strategies. With an increase in education, knowledge, and screenings for the community, we should see a substantial decrease in the prevalence of childhood asthma.
References:
Agusala, V. O. (2018). Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas. Journal of International Medical Research, 3172-3182.
John, J. B.-C. (2020, January 7). Regional Disparity in Asthma Prevalence and Distribution of Asthma Education Programs in Texas. Retrieved from Journal of Environmental and Public Health, Volume 2020: https://www.hindawi.com/journals/jeph/2020/9498124/
Myers, J. S. (2019). A Pediatric Asthma Risk Score to better predict asthma development in young children. Journal of Allergy and Clinical Immunology, Volume 143, Issue 5, 1803-1810. Retrieved from Science Direct.
Serebrisky, D. &. (2019, January 22). Pediatric Asthma: A Global Epidemic. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052318/
University of Illinois at Chicago. (2017, January 6). Why is asthma worse in black patients? Retrieved from Science News: https://www.sciencedaily.com/releases/2017/01/170106133056.htm
Xie, L. G. (2019, November 15). Association between Asthma and Developmental Disability and Delay in the United States Pediatric Population. Retrieved from SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3489305
Millions of Americans are at risk for developing type 2 diabetes, they have prediabetes, or already have type 2 diabetes and are unaware. According to the Centers for Disease Control and Prevention (CDC) ( n.d.), 1 in 3 adults have prediabetes. Type 2 diabetes can be prevented in people that are at risk of developing it with lifestyle behavior changes. A healthy diet and exercise are the key to prevention. Recommendations include eating a low-sugar, low-fat diet and exercising 30 minutes a day. If adults who are high-risk for developing diabetes have weight loss of 5-7%, there diabetes risk is decreased by 58% (Ely, 2017).
The first step in offering diabetes prevention is identifying those at risk. Many people in this low-income community do not have easy access to healthcare or transportation. Setting up a diabetes screening health table outside of different food marts in the neighborhood could be an easy way to find people who are at risk who would not normally find out through a healthcare provider. The CDC and the American Diabetes Association offer a prediabetes risk test that could be given to willing participants to find out if they are low risk or high risk. Once the high-risk individuals are identified then diabetes prevention tips can be given.
It would be ideal to set these high-risk people up with the National Diabetes Prevention Program (National DPP), which works with people for at least a year to help them implement lifestyle changes. Although this program has been proven to be highly effective, there are no programs in Atlanta that accept Medicare or Medicaid so it not feasible for this community.
Education is key in the prevention of diabetes. The National Diabetes Education Program lends it’s success of the program to the extensive array of education materials that are culturally diverse and may range from empathetic to motivational (Siminerio et al., 2018). Once high-risk individuals have been identified, they will be given information about diabetes and diabetes prevention. In low-income areas the literacy level tends to be low so the information will be simplified and easy to understand. Once they have been given the education they will be connected with Grady and how to get a primary care provider and enrolled in the Food as Medicine Prescription program. The success could be measured by determining the number of people that enrolled in the program after they were given the education. The outcome expected after being enrolled in the program for at least six months would be some weight loss and subsequent reduction in the risk of developing diabetes.
Centers for Disease Control and Prevention (n.d.). What is diabetes?
https://www.cdc.gov/diabetes/basics/diabetes.htmlLinks to an external site.
Ely, E. K., Gruss, S.M., Luman, E.T., Gregg, E.W., Ali, M.K., Nhim, K., Rolka, D.B., Albright,
A.L. (2017). A national effort to prevent type 2 diabetes: Participant-level evaluation of
CDC’s National Diabetes Prevention Program. Diabetes Care, 40 (10), 1331– 1341.
https://doi.org/10.2337/dc16-2099Links to an external site.
Siminerio, L.M., Albright, A., Fradkin, J., Gallivan, J., McDivitt, J., Rodriguez, B., Tuncer, D.,
Wong, F. (2018). The National Diabetes Education Program at 20 years: Lessons
learned and plans for the future. Diabetes Care, 41(2), 209-218.
https://doi.org/10.2337/dc17-0976Links to an external site.