Running head: CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 1 Cardiovascular Disease Risks Related to Obesity with Inactivity in the Lower Socioeconomic Population of Norfolk, Virginia Angela Clarke, Charles Clemmer, Mary Cox, Heather Craig, Bobbi Crawford, Whitney Crowder, Everardo Cuevas Espinoza Submitted in partial fulfillment of the requirements in the course Nurs 492: Community Health Nursing Old Dominion University NORFOLK, VIRGINIA Summer, 2014
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 2 Health Planning Project We are a group of BSN students at Old Dominion University in our last semester of the program. As nurses we are tasked with making a difference in the health of our patients and communities. In this particular class we are studying community health nursing. This paper is an exercise in identifying a health concern and building a health plan that addresses that concern in a specific aggregate. We have focused on the overweight and obese population of lower socioeconomic status in the city of Norfolk, Virginia. This aggregate has increased risk of developing cardiovascular disease (CVD) (Borrell & Samuel, 2014). CVD represents the most significant cause of disease and death in the U.S. and in Virginia (Virginia Department of Health, (A), 2014). Developing an educational intervention program for this population can impact the CVD deaths in the city of Norfolk. Assessment We chose to design a health planning project for an aggregate of Norfolk, Virginia residents aged 30-40 with increased risk of CVD caused by obesity related to inactivity. We chose this age group because people are starting to have health problems and they are more receptive to health teaching. Health changes in this aggregate would affect others in the household including children and elderly family members. Entry to the aggregate will be gained via free clinics, churches, schools and community centers. In 2013, the estimated population in Norfolk, Virginia was 246,000 people (United States Census Bureau [USCB], 2014). Population disbursement is 49% white alone compared to 71% for the state of Virginia and 43% black alone compared with 20% statewide (USCB, 2014). Home ownership between 2008 and 2012 was 46% compared with 68% statewide (USCB,
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 3 2014). Multi-unit housing structures accounted for 42% of housing available compare to 21% statewide (USCB, 2014). The median household income is $44,164 in Norfolk compared to $63,636 throughout Virginia (USCB, 2014). The percent of persons living below the poverty level in Norfolk is 18.2% compared to 11.1% statewide (USCB, 2014). The number of residents per square mile in Norfolk is 4,486 compared to 203 statewide (USCB, 2014). There are three hospitals and five health departments in Norfolk (USCB, 2014). Norfolk has many outdoor amenities including more than 400 acres of park space, 15 square miles of recreational water, 14 miles of marked bike lanes, 100 playgrounds, 12 dog parks, 3 outdoor pools and 2 spray pools (Norfolk, 2014). In 2012, the obesity rate in Virginia was 27.4% (Virginia Department of Health, (B), 2014). In 2012, the obesity rate in the Eastern part of Virginia was 35.6% compared to Northern Virginia rate of 20.4% (VDH, (B), 2014). An August 2013 report published by the Trust for America s Health (TFAH) and the Robert Wood Johnson Foundation warns that: if current efforts to alter the average American s diet and exercise habits are not maintained and even strengthened the adult obesity rate in the United states would soar to 50-60 percent (or higher) in all but a handful of states by 2030 (VDH, (B), 2014, para. 7). Chen, Lee, Cavey, and Ho (2012) stated individuals living with low socioeconomic status (SES) consistently experience greater mortality and morbidity from cardiovascular disease. Low SES is also associated with CVD risk factors such as high cholesterol and obesity (Chen et al., 2012). Inactivity is a contributing factor to obesity. Borrell and Samuel (2014) found obesityrelated deaths advanced death rates by at least 1.6 years for all-cause mortalities.
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 4 Cardiovascular disease is the leading cause of death for the city of Norfolk (VDH, (B), 2014). Many factors contribute to CVD including heredity, poor diet, obesity, and inactivity. Heredity cannot be changed. Obesity can be changed by choosing a healthy diet and increasing leisure time activity. Healthy diets are sometimes expensive to maintain. Since there is a high rate of poverty in Norfolk, the easiest risk factor to impact would be inactivity. There is a large body of consistent and high-quality evidence showing that childhood obesity has significant health risks in both the short term (for the obese child) and in the long term (for the adult who was obese as a child) (Hughes, Reilly, 2008, p. 255). While children are not specifically in the aggregate that we have chosen we feel that the children s long term health can be influenced by this program. Parents would be encouraged to include their children when they exercise. By attending meetings and exercise sessions the children would be exposed to healthy lifestyle choices. Our hope is that this exposure would break the cycle of obesity in their family. Planning In 2005, the World Health Organization (WHO) stated that 17.5 million deaths were credited to CVD (Stephens & Allen, 2013). There are many contributing risk factors associated with CVD and physical inactivity has been ranked alongside cigarette smoking, high blood pressure, and increased cholesterol (Yazid, 2012). The ultimate goal to decrease the prevalence of cardiovascular disease focuses on increasing physical activity and awareness among the citizens of Norfolk, Virginia.
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 5 Exercise combats against CVD by decreasing blood pressure, increasing HDL levels, maintaining desirable weight, and prevent or controlling diabetes (Yazid, 2012, p. 285). In addition, the WHO has found that women who incorporate three hours of walking a week into their schedule have cut their risk of a heart attack and stroke in half (Yazid, 2012). Statistics such as these are the motivating factor behind an increase in community programs to decrease the risk factors of CVD and promote awareness. Interventions designed to increase awareness of CVD can be run by local free clinics, which could hold information sessions at local churches, schools, or community centers. These places are ideal because they have parking and seating already within the facility, as well as free or low cost of renting the facility. In addition, healthy snacks and water may be used to entice an audience, as well as foster healthy snacking habits. Suggestions could be made by the group after opening with vegetable and/or fruit trays and water. Warehouse stores such as Sam s Club and Costco provide these at low cost and sometimes will donate items for community projects. Promoting these group meetings that focus on CVD awareness can be accomplished through social media sites and flyers placed in local churches and community centers and at schools for distribution at PTA meetings and sporting events. Advertising includes flyers in health departments, free clinics, and schools; newspaper, local free papers, craigslist, radio, and social media. Resources would include staffing for activity, refreshment costs including serving and clean up; costs of advertising would only include cost of printing flyers and placing on location. Most advertising venues chosen are free of charge further lowering the overall cost of the program. The Center for Disease Control (CDC) has defined physical inactivity as the lack of physical activity during leisure time. Physical inactivity increases the risk of CVD related risk
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 6 factors by 30-50% (Yazid, 2012), and, in 2008, the CDC stated that physical inactivity and its resulting side effects were costing the healthcare industry $147 billion. Interventions to increase physical activity can be decided at the community group meetings. For example, run/walks, local fitness sessions, or community exercise participation at Lafayette Park could be scheduled through the free clinic and churches. Part of our plan for decreasing inactivity in our target population is to use two facilities maintained by the City of Norfolk. Lafayette Park, located at 3500 Granby Street, would be utilized during the warmer months. The Park Place Community Center, 606 West 29 th Street, would be used during the colder months. Both offer areas for aerobic exercise and meeting space. The use of these public spaces would help control the cost of providing facilities for walking year round and meeting room space. In 2013, the number of smartphone subscribers reached 163.9 million individuals in the U.S. (FierceWireless, 2014). Technology has become a major part of our everyday lives, and there are copious means to enhance weight loss through the use of apps on smart phones. Researchers Stephens and Allen (2013) have focused on the correlation between smartphone applications to a reduction in weight and have found that: text messaging or smartphone applications are well accepted by participants and may provide beneficial effects on reducing weight, decreasing waist circumference, decreasing BMI, decreasing fat mass, increasing physical activity, decreasing sugar-sweetened beverage intake, decreasing screen time, and encouraging healthier eating patterns (Stephen & Allen, 2013, pg. 328). Promoting different free applications at group meetings is an excellent way to promote awareness, encourage an individual s initiative in their wellness, and a convenient way to
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 7 measure progress. Evaluation The planned intervention can be evaluated using the case study evaluation strategy. The data collected during a case study include observations with program personnel, statistical summaries of program activities, unstructured conversations with program personnel, reports prepared of program activities, structured or unstructured interview data, and information collected through questionnaires (Anderson & McFarlane, 2011). Another way to evaluate the intervention is to record the participants weight at the beginning of the project and then every two weeks until they achieve their goals. Participants can also weigh themselves at home and email their weight to the community health nurses. Studies showed that the use of e-mail can be an effective strategy to evaluate and assist the participants with the maintenance of weight loss (Thomas, Vydelingum, & Lawrence, 2011). The evaluation will be an ongoing process during each of the community meetings at the park or community center. It is difficult to change the unhealthy habits that people have such as sedentary lifestyle. Community health nurses will be able to evaluate the outcomes several months after the implementation of the project. The progress of the planned intervention can be evaluated by having participants sign in on sign in sheets before each session. The attendance will then be tracked to ensure that the attendance is growing instead of declining. The effectiveness of the program will be evaluated by using surveys and questionnaires to see if the objectives were met. Were the clients satisfied with the program? Do the clients know the signs, symptoms, and risk factors for CVD? Do the clients incorporate physical activity into their daily routine?
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 8 At the end of 6 months the program will be evaluated for the number of participants enrolled in the program and the length of enrollment. A year after the start of the program and every yearly anniversary thereafter the number of participants and the average weight loss will be calculated. Conclusion You can be eating a healthy diet and still be overweight due to a sedentary lifestyle. Inactivity during leisure time can put you on the fast track to CVD. By using mobile phone apps and email reminders, our program will keep participants involved. The use of community meeting rooms will control costs to make the program affordable for obese and overweight people of low socioeconomic status. Encouraging parents to bring their children to walk with them will remove the need for a baby sitter and teach the next generation the value of exercise in their overall health plan. A healthy diet will also be encouraged by serving healthy snacks at our meetings, although it is not the main focus of this program. If our program is successful, the community health nurse can promote growth of the program by expanding to other areas within the Norfolk community. Expansion of the program can be communicated by flyers, newspaper ads, and social media sites. The results of the program can also be sent to the Virginia Department of Health with the hopes that the program can be implemented in other areas within the state. With the help of community health nurses, and the expansion of our program, we can successfully decrease the risk of CVD by increasing physical activity in people ages 30-40 in the Norfolk and possibly across the state of Virginia.
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 9 References Anderson, E.T., & McFarlane, J. (2010). Community as partner theory and practice in nursing. Baltimore, MD: Lippincott Williams & Wilkins. Borrell, L. N., & Samuel, L. (2014). Body mass index categories and mortality risk in US adults: The Effect of Overweight and Obesity on Advancing Death. American Journal of Public Health, 104(3), 512-519. doi:10.2105/ajph.2013.301597 Chen, E., Lee, W., Cavey, L., & Ho., A. (2012). Role models and the psychological characteristics that buffer low-socioeconomic-youth from cardiovascular risk. Child Development, 84 (4), 1241-1252. FierceWireless. (2014). emarketer: Worldwide smartphone usage to grow 25% in 2014. Retrieved from http://www.fiercewireless.com/press-releases/emarketer-worldwidesmartphone-usage-grow-25-2014 Hughes, A., & Reilly, J. (2008). Disease management programs targeting obesity in children: setting the scene for wellness in the future. Disease Management & Health Outcomes, 16(4), 255-266. Norfolk. (2014). City of Norfolk Demographics. Retrieved from http://www.norfolk.gov/index. aspx?nid=428 Stephen, J., & Allen, J., (2013). Mobile Phone Interventions to Increase Physical Activity and Reduce Weight. Journal of Cardiovascular Nursing, 28(4), 320-329
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 10 Thomas, D. D., Vydelingum, V. V., & Lawrence, J. J. (2011). E-mail contact as an effective strategy in the maintenance of weight loss in adults. Journal of Human Nutrition & Dietetics, 24(1), 32-38. United States Census Bureau (2014). Norfolk city, Virginia. Retrieved from http://quickfacts.census.gov/qfd/states/51/51710.html Virginia Department of Health, (A). (2014) Retrieved from http://www.vdh.virginia.gov/ofhs/prevention/collaborative/documents/2013/pdf/cardiova sc%20disease%20burden%20report.pdf Virginia Department of Health, (B). (2014). Virginia Performs. Retrieved from http://vaperforms.virginia.gov/indicators/healthfamily/obesity.phpl Yazid, L. (2012). PHYSICAL INACTIVITY: EXERCISE TO THE RESCUE. International Journal of Sports Sciences & Fitness, 2(2), 284-293.
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 11 Honor Code I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating and plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned. Signed: Angela Clarke, Charles Clemmer, Mary Cox, Heather Craig, Bobbi Crawford, Whitney Crowder, Everardo Cuevas Espinoza
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 12 Introduction [10 points] Community Health Nursing Health Planning Project Proposal Grade Rubric Criteria Comments Points 1. Identify yourself and your interest in making the proposal Assessment [20 points] 1. Specify level of aggregate selected for study. o Identify and provide a general orientation to the aggregate. o Include why this aggregate was selected and the method used for gaining entry. 2. Describe specific characteristics of the aggregate including o Socio-demographic characteristics o Health status o Suprasystem influences 3. Provide relevant information gained from literature review, especially in terms of characteristics, problems or needs that one would anticipate finding with this type of aggregate. o Include comparison of health status of chosen aggregate with other similar aggregates, the community, the state, and/or the nation. 4. Identify health problems and/or needs of specific aggregate based on comparative analysis and interpretation of data collection and literature review. o Include (when possible) input from clients regarding their perceptions of needs. o Give priorities to health problems and/or needs and indicate how these priorities are determined. Planning [20 points] 1. Select one health problem and/or need for intervention and identify ultimate goal of intervention. o Identify specific, measurable objectives as (mutually agreed on by student and aggregate, when possible) 2. Identify environmental planning considerations (space, resources) 3. Describe alternative interventions necessary to accomplish objectives. o Include consideration of interventions at
CARDIOVASCULAR DISEASE RELATED TO INACTIVITY 13 o each systems level where appropriate. Select and validate intervention (s) with highest probability of success. (Note: Interventions may include using existing resources and/or developing resources.) Evaluation [20 points] 1. Develop a plan for evaluation of the project including: o Strategies (tools if appropriate) o Timeframe( immediate, ongoing) 2. Make recommendations for further action based on evaluation and how to communicate these to appropriate individuals. o Discuss implications for community health nursing Conclusion [10 points] 1. Provide a summary of your proposal 2. Include your recommendation for the next step Organization [20 points] 1. Includes ODU SON title page 2. Adheres to APA format (including in text citations and reference page) 3. Uses correct spelling, grammar, syntax 4. Includes Honor Code (1 point) 5. Includes Grade Rubric (1 point) Total 100 points