Juvenile Diabetes

  

Please, find the attached sample of the prototype of the paper, same style and format. Seven pages minimum, exclude the cover page, and the reference page and plagiarism free.

Sincerely,

Thanks 

a)Provide an overview of the program, including the public health issue, administrating agency, time, setting, and population; include the social and behavioral risk factors that are associated with this public health issue 

b)Determine the social and behavioral risk factors that are being addressed by the program, and include the theoretical approaches used in the program to facilitate social and behavioral change in the target population, as well as the social and behavioral theoretical strategies employed by the program to engage the community 

c)Examine the social and behavioral factors that the program neglected to identify and address why these social and behavioral factors are important, justifying your response with specific examples from the literature 

d)Analyze the public health data and trends to determine whether the program has met the intended outcome 

e)Summarize the overall impact of the program, including its successes, failures, strengths, and weaknesses, and indicate and explain opportunities for improvement

PROGRAM ANALYSIS 2

PROGRAM ANALYSIS 8

Program Analysis

Sample Paper

Running head: PROGRAM ANALYSIS 1

PHE 525 Milestone Three: Program Analysis

Overview

The Massachusetts Childhood Obesity Research Demonstration Project, known as Mass In Motion, is a state-wide initiative to promote a healthy lifestyle in places where people work, live and play. The initiative was funded by in 2011 by a grant through the Affordable Care Act with a goal to create a multilevel and multisector intervention strategy to prevent and control obesity, combining interventions in the health care setting with public health interventions in the community. (Davison et al., 2015)The project was designed to be a comprehensive wellness initiative, incorporating evidence-based interventions in primary healthcare with community programs, WIC and other nutrition programs, as well as early childhood education centers and schools/afterschool programs. The goal was to form a partnership among the many different social and environmental factors that effect a child’s health and well-being, as well as to identify and target these factors to institute a change in health behaviors. (MA-CORD Study Group, 2015)

The program began as a part of a 2009 initiative started by Governor Deval Patrick which funded projects in 14 cities and towns across Massachusetts. In 2011 the state was awarded a grant through the CDC which allowed the program to be expanded to cover 52 Massachusetts cities and towns, impacting 33% of the state population, and as of 2014 there are 60 cities and towns with active Mass in Motion projects. While the main focus of the CORD component, funded by the CDC was on children 2-12 year sold, the Mass In Motion program has also developed programs for improving worksite health and overall community health. These programs have increased workplace productivity, lowered stress levels, encouraged weight loss, and improved green space across the state. (Mass in Motion, 2016)

Theoretical Approach

The framework of Mass in Motion is the social ecological model, a model which looks at the complex relationships between an individual, his/her personal relationships, community, institutional elements, community, and overall social policy. This framework is not designed to distinguish one factor as a reason or cause for the obesity, but rather looks at the interaction of these factors and how they can effect individual risk for obesity. The MA-CORD Study Group then developed interventions based on Social Cognitive Theory, recognizing and emphasizing the importance of social influence and reinforcement for behavior change.

Figure 1. MA-CORD Intervention Sectors

As seen in Figure 1, the project is designed to combat childhood obesity by impacting the individual and environmental factors that can contribute to living a non-healthy lifestyle. At the individual level, children and parents are both given information and support to develop healthy habits while in the school the child is also getting reinforcement through school-based learning programs. Because the MA-CORD grant was focused on improving childhood obesity, the Mass in Motion program focused on institutional changes in early childhood education centers, public schools, and after school programs. However, worksite programs were funded by the state legislature to work with employers across the state to improve healthy lifestyle choices in adults. At the community level there were initiatives to work with local restaurants to improve healthy menu options, expand community garden space, and improve parks and greenspace for healthy activity. The overall funding and advocacy for the program, and its continued expansions was done at the policy level of the social ecological model.

Social and Behavioral Risks

Obesity is complex global epidemic and it is increasingly effecting the health and livelihood of children. While there are genetic components to obesity risk, there are many social and behavioral risks that contribute to the epidemic. There are individual risk factors including race/ethnicity, diet, and activity level as well as social and economic factors like family income level, and living environment. In order to decrease current childhood obesity levels, and prevent obesity in future generations, all of these contributing factors must be addressed.

Diet plays a significant role in a child’s risk for obesity. While changes in diet seem like an easy way to prevent obesity, there are multiple factors that contribute to a person’s diet. Parents control the nutritional and physical environment for a child that influence the health behaviors that will develop over the child’s lifetime. In low-income families there is a higher rate of obesity, this can often be attributed to less availability of healthy foods as well as the higher cost of healthy foods. (Sonneville, LaPelle, Taveras, Gilman, & Prosser, 2009) Healthy foods are also more time consuming to prepare, and many low income families are limited in time with difficult work schedules and transportation issues. Fast food is often a convenient and affordable option for low-income working families, and the intense marketing campaigns by many fast food companies contributes to the child’s desire to eat fast food.

The increasing sedentary lifestyle lives by most Americans also contributes to the overall obesity crisis, and particularly to childhood obesity. Many schools have reduced recess time and physical education programs. Children in low-income homes are less likely to participate in sports because of costs and often these communities do not have safe outdoor spaces where children can play. (Sonneville et al., 2009) The increase of television, tablets, and computers has created the concern of sedentary “screen time” activities and the impact they may have on childhood obesity. The Harvard School of Public Health (2016) found that the more TV a child watched, the more likely they were to be overweight or obese and that in addition to screen time contributing to weight by reducing physical activity there is evidence that the food marketing on TV is having an impact on diet. (HSPH, 2016)

The MA-CORD Mass in Motion project partnered with early childhood and public schools to implement several national programs including “I Am Moving, I am Learning”, “Eat Well, Keep Moving”, and “Planet Health”. These are school-based programs that give children the knowledge, skills, and support to lead healthier lives, make healthy food choices, and be more physically active. These programs have been implemented in many early childhood centers and schools nationwide, and they incorporate education with physical activity and nutrition education which teach children that healthier choices are the better choices. In early childhood centers, like Head Start, the children participate in movement activities and teachers use music and dance to help children get daily exercise. “Eat Well and Keep Moving” and “Planet Health” elementary students have physical and problem-solving activities to teach children to make healthy food choices, reduce screen time, and increase physical activity. Children spend a significant amount of time in the school environment which makes this an idea place to influence health behavior, in addition the programs are designed to educate and include parents to help children reinforce healthy behaviors at home.

Neglected Factors

While overall Mass in Motion, and the MA-CORD project, are positive steps in the fight against childhood obesity, there are some areas where the programs are lacking. There is no program or initiative in either program to address the many economic factors that impact a child’s health. In a 2009 focus group (Sonneville et al., 2009), economic factors was one of the biggest barriers to healthy eating. The Mass in Motion program is adequately educating parents and children on the importance of healthy choices, but it is not addressing the problem of a parent not being able afford to buy a healthier cereal option or fresh fruits and vegetables.

The Mass in Motion program also does not address problems with food access. Many low income communities have low access to healthy food options, often defined as “Food Deserts” by the USDA. These areas often lack grocery stores or farmers markets, and residents rely on convenience stores and fast-food chains. This limits food choices to fast food, convenience foods (frozen dinners/vegetables), or snack foods like chips and candy. (Food Empowerment Project, n.d.) Parents and children in Mass in Motion communities may be getting the education they need about healthy food choices, but without access to grocery stores that provide these foods there is little opportunity to make change. While some Mass in Motion communities have begun working with farmer’s markets to create more health food access, this is not a complete solution to the food access problem.

Overall Impact

Actual data on the outcomes of the MA-CORD program, as part of Mass in Motion, will be released this summer, but the Commonwealth of Massachusetts has released two reports for 2012 and 2013 highlighting different MIM projects and successes. These outcomes include the improvement of healthy menu options at 126 restaurants across 14 Massachusetts communities. Improved school nutrition programs, including partnerships with local farms to provide produce and allowing children recess time before lunch so they can build up an appetite and avoid eating in a rush. Since the adoption of the program, Mass in Motion communities have expanded walking in bike trails and implemented a safe routes program allowing students to increase physical activity by walking or biking to school. In many communities previously abandoned lots have been changed into green spaces and parks, and community garden space has been expanded to allow families to grow fresh fruits and vegetables. (MHHS, 2015)

The general success of Mass in Motion, and programs using a wide-scale community intervention approach show promise in reducing childhood obesity. A 2005 study looking at school-based program in Florida (HOPS/OWG) found that the programs show positive outcomes in improving health and academic achievement in low-income students. Children in these programs had improvement in body mass and blood pressure, as well as showing academic improvement in reading and math. These programs were not as comprehensive an approach as Mass in Motion, and were subject to some loss of value over the summer when children were out of school. (Hollar et al., 2010) Programs like Mass in Motion, and the other CORD projects, show that a comprehensive childhood obesity strategy must use a multisector approach, incorporating public policy, healthcare centers and providers, community, legislative and financial tools, and a range of settings where children and families can be reached.

References

Davison, PhD, K. K., Falbe, ScD, MPH, J., Taveras, MD, MPH, E. M., Gortmaker, SD, S., Kulldorff, PhD, M., Perkins, MPH, M., … Land, PhD, T. (2015). Evaluation Overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Project. Childhood Obesity, 11. http://dx.doi.org/10.1089

Food Empowerment Project. (n.d.). http://www.foodispower.org/

Harvard School of Public Health. (2016). Television Watching and “Sit Time”. Retrieved from http://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/television-and-sedentary-behavior-and-obesity/

Hollar, PhD, MHA, MS, D., Lombardo, DC, M., Lopez-Mitnik, MS, MPhil, G., Hollar, PhD, T., Almon, MS, RD, M., Agatston, MD, A., & Messiah, PhD, MPH, S. E. (2010). E!ective Multi-level, Multi-sector, School-basedObesity Prevention Programming Improves Weight,Blood Pressure, and Academic Performance,Especially among Low-Income, Minority Children. Journal of Health Care for the Poor and Underserved, 21, 93-108. Retrieved from https://www.researchgate.net/profile/T_Hollar/publication/44583434_Effective_Multi-level_Multi-sector_School-based_Obesity_Prevention_Programming_Improves_Weight_Blood_Pressure_and_Academic_Performance_Especially_among_Low-Income_Minority_Children/links/552554a30cf223aa5573f5e9

MA-CORD Study Group. (2015, February). Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study. Childhood Obesity, 11. http://dx.doi.org/10.1089

Mass in Motion. (2016). http://www.mass.gov/eohhs/gov/departments/dph/programs/community-health/mass-in-motion/

Mass in Motion Kids. (n.d.). http://massinmotionnewbedford.org/mim-kids/mass-in-motion-kidsabout-mim-kids/

Massachusetts Department of Health and Human Services. (2015). Mass in Motion: Community Success Stories. Retrieved from http://www.mass.gov/eohhs/gov/departments/dph/programs/community-health/mass-in-motion/community/stories/

Sonneville, K. R., LaPelle, N., Taveras, E., Gilman, M., & Prosser, L. (2009, December 21). Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents. BMC Pediatrics. http://dx.doi.org/10.1186/1471-2431-9-81