Abstract

1. Community As Partner Model to assess obesity prevention efforts in a college population. Karen R. Dawn, RN, MSN, PHCNS-BC, CDE, DNP candidate The University of Virginia School of Nursing Introduction Conclusions Methods Results Abstract Obesity rates in the U.S have increased dramatically over the last 30 years, leading to a rise in preventable diseases including type 2 diabetes and heart disease. Overweight young adults are at risk of becoming obese adults, which increases their risk of developing type 2 diabetes and heart disease. There is little published data pertaining to college obesity prevention efforts. The Community as Partner Model (CAP) provides a useful approach to assess a college population regarding primary and secondary weight gain prevention efforts. The CAP fosters a partnership between a college community and the advanced practice public health nurse that addresses the community assessment, analysis, and health plan targeting obesity prevention efforts. The population assessment of this young adult community is a unique approach in identifying current factors associated with a student’s potential for weight gain. Prevention efforts, based on a thorough community assessment, can help public health program planners develop targeted, specific strategies to reduce weight gain and the diseases related to excess weight. In addition, the use of the CAP and the partnership it fosters between the healthcare system and the college community, allows for the identification of available community resources necessary to promote health and prevent chronic diseases related to weight gain. Learning Objectives: At the end of this presentation the participants will be able to:  1. Describe the Community as Partner Model as a guide for implementing a population assessment of a suburban college community as it relates to obesity prevention. 2. Identify community resources which target primary and secondary weight gain prevention in this college population, based on the community assessment. Background Overweight and obesity in childhood and adolescence negatively impacts health later in life. Hyperlipidemia, hypertension, glucose intolerance and type 2 diabetes mellitus (t2DM) are associated with a Body Mass Index (BMI) greater than 25 (Must, 1992, Freedman, 1999, Arslanian, 2002). The prevalence of t2DM is reaching epidemic proportions in the United States, with more than 11.3% (25.8 million) of adults with the disease. There are 79 million adults with pre-diabetes (35% of the US. adults and 50% of those over 65 years), defined by impaired glucose tolerance (IGT), which is a risk for the development of t2DM (CDC, 2011, Mokdad, et al, 2001, ADA, 2011). Lightwood, et al (2009) reported that current adolescent overweight is projected to result in 161 million life-years complicated by obesity, diabetes, or chronic heart disease and 1.5 million life-years lost. The cumulative excess attributable total costs are estimated at $254 billion: $208 billion because of lost productivity from earlier death or morbidity and $46 billion from direct medical costs. Numerous studies have suggested that the transition to college can be a time of significant and rapid weight gain (Anderson, Shapiro, & Lundgren, 2003; Holm-Denoma, Joiner, & Vohs, 2008; Levitsky, Halbmaier, & Mrdjenovic, 2004). The average weight gain in the first semester of college ranged from 3.5 pounds (Holm-Denoma, et al ,2008) to 7.8 pounds (Lloyd-Richardson, Bailey, Fava, &Wing, 2006). These findings are alarming because a relatively small weight gain can place an individual's BMI in the overweight range (Levitsky, et al, 2004). Indeed, in one study, the percentage of individuals classified as overweight increased from 21% to 32% in the first semester of college (Anderson et al., 2003). Overweight college students are at-risk of becoming obese adults (Mokdad, 2001). College food availability in dorm rooms of 100 college students was studied. The mean number of food and beverage items per student was 47 (range: 0-208). The average number of calories per dorm room was 22,888 (Nelson & Story, 2009). Based on interviews with 50 freshman and sophomore students, factors that they perceived as influencing body weight, dietary intake, and physical activity included: unhealthful food availability on campus, snacking, late-night eating, alcohol-related eating, eating because of stress-boredom, and food in student dorm rooms (Nelson & Story, 2009). Because overweight and obesity are associated with several negative health and psychosocial outcomes (McTigue, Garrett, Popkin, 2002, Neumark-Sztainer & Haines, 2004), it is important to develop prevention programs for college students as they enter this high-risk transition period. • The public university was founded in 1957 and has grown to become the largest college in the state of Virginia. There are over 5,000 residential students living in university sponsored housing (Student Handbook, 2011). • Figure 2: College Demographics • Community Strengths: • Student and staff diversity. • Varied academics and student organizations that promote active student participation. • Transportation, including university buses and public buses and trains and alternatives to driving: cycling racks, incentives to bike to campus – including competitions between other colleges, and well lit walking paths. • Full use of four indoor athletic facilities, open 6 am until 11 pm, which offer indoor tracks, swimming pools, a variety of cardio, isometric and group exercise classes. • A variety of food choices including vegetarian, vegan, low fat, fresh fruits and vegetables, Halal, gluten free, alternatives to dairy; and includes extended hours at numerous eateries throughout campus. • Health information is available through a variety of sources throughout campus and on the various group websites: Student Health, The Office of Alcohol, Drug, and Health Education (OADHE), The Wellness Education Resource Room, University Life, Healthy Eating web resources, and COMPASS - a proactive web-based tool for freshmen that emphasizes healthy decision-making, through the use of technology. • Nutritionist available for 1:1 consultation, at no cost to the students. • Figure 3: Athletic Facility Usage • Community Stressors: • Change in environment, which can negatively impact lifestyle habits including eating and exercise. • Change in responsibilities related to living away from the family. • Unhealthy (high fat, overly processed and refined ) food options that are value priced and appealing to college students and are readily available and frequented by the students. • Lack of visual health information, for example, nutrition labeling at the eating establishments. • Large variety of on-line, non-interconnected health information. Evidence demonstrates that college students gain weight and once the weight is gained in early adulthood, it is rarely lost (Anderson, et al, 2003; Holm-Denoma, et al, 2008; Levitsky, et al, 2004). This rapid weight gain lays the foundation for the development of chronic diseases, including type 2 diabetes (Lightwood, et al, 2009). Nelson & Story (2009), suggests that universities take an active role in designing and evaluating weight-related health promotion intervention strategies focusing on a variety of targets, including individual, social, and environmental level influences. This college environment, which was evaluated using the CAP, demonstrates excellent programs currently in place to keep the students healthy and engaged. The issue is an integration between these resources and programs and how they are communicated throughout the community, delivered in a median the students can readily use. The use of social networks, when developing interventions for this age group, may prove to have a lasting impact on weight gain prevention. Based on research by Strong, et al (2008) and Christalas & Fowler (2007), social networks have a significant impact on one’s weight, eating and exercise habits. Interventions should include social networks for communicating health promotion messages that focus on preventing freshman weight gain (Strong, et al, 2008). In addition to considering social networks, a Readiness to Change intervention program, which assesses each student’s readiness to change behavior, would help motivate an individual to improve lifestyle choices, at any current level of change (pre-contemplative, contemplative, preparation, action and maintenance) (Prochaska & Norcross, 2001). In addition to the information median, peer health message development should be considered. Healthy messages developed and shared by peers were found by Kickligherand colleagues (2010) to be effective in behavior change. Targeted intervention by peers, as described by Kicklighter (2010) and Reyes-Velazquez (2011), may prove to be a simple intervention that could be shared with college freshman through the university website, email, Facebook link, classroom, and health fairs. Adolescence is a time of autonomy and personal and intellectual growth. This unique period of growth and development offers health providers, educators and community liaisons an opportunity to improve the long term health of this population by developing intervention strategies that take advantage of this age group’s fierce independence. This age group is fully capable of implementing autonomous health interventions related to food intake and exercise expenditure. Targeted health messages, developed by peers and shared through social networks may prove to help the students reach a higher level of health and the college environment is a perfect median to implement this type of intervention. • Specific Aims: • 1. To use the Community as Partner Model to implement a community assessment of a suburban college community as it relates to obesity prevention. • 2. To identify community resources which target primary and secondary weight gain prevention in this college population. • 3. Identify, through a cross sectional survey, college student’s knowledge and healthy lifestyle practices as it relates to modifiable risk factors in the development of type 2 diabetes mellitus. • The Community as Partner Model (CAP) was developed by Anderson and McFarlane as a model to guide community nursing practice (1972). This model is based on Neuman’s model, which is a total person approach to patient problems using a systems model, which means the whole is greater than the sum of the parts, with an emphasis on the interconnection between the systems’ parts. An individual, group or community is considered an open system that works within the environment. The CAP focuses on the people in the community as the core piece of the assessment. The goals of the model are system equilibrium and a healthy community through promotion of health, on a primary, secondary and tertiary level (Anderson & McFarlane, 2008). • The backbone of the CAP model is the assessment wheel, which represents the people in the community. In this particular case, it represents the students, staff, and faculty of the university. The people are affected by and influence the eight subsystems of the community, which make up the wheel. The community stressors (based on the Stress Adaptation Theory) are incorporated into the CAP. The stressors (both internal and external to the community) are tension producing stimuli that have the potential for causing disequilibrium in the system. The intervention focus is based on the disequilibrium caused by the stressors, which impact the community’s ability to function in a healthful way. These interventions are controlled by the community, who can identify their own problems and strengthen their line of defense against stressors (Anderson & McFarlane, 2008). • The community assessment was performed over two months and included windshield surveys, interviews with key personnel (student health, recreation facility managers, food managers and nutritionists) and student focus groups. All eight sections of the assessment wheel were evaluated as it relates to change in student weight and lifestyle. • In addition to the community assessment using the CAP, first year, freshman residential students will be surveyed to determine their knowledge and lifestyle practices that impact weight (awaiting IRB approval). References American Diabetes Association (2011) National Diabetes Fact Sheet. 2011. Retrieved from: www.diabetes.org/in-my-community/local- offices/miami-florida/assets/files/national-diabetes-fact-sheet.pdf Anderson, E.T., McFarlane, J. (2008) Community as Partner Theory and Practice in Nursing. Philadelphia, PA. WoltersKluwer.  Anderson, DA, Shapiro, JR, Lundgren JD. (2003) The freshman year of college as a critical period for weight gain: an initial evaluation. Eat Behav; 4:363-367 ArslanianS. (2002) Type 2 diabetes in children: Clinical aspects and risk factors. HormRes57(suppl 1): 19-28. Centers for Disease Control and Prevention (2011). 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Weight Gain Prevention: Identifying Theory-Based Targets for Change in Young Adults Health Behavior Journal of the American Dietetic Association 108 (10): 1708-1715. Contact: karendawn@virginia.edu Figure 1: Community as Partner Assessment Wheel Adapted from Anderson & McFarlane, 2008