Nur 4010 summer 2017 Midterm Examination
1A. Detailed model of the web of causation for diabetes mellitus:
See model of web of causation attached
Diabetes is a grave and complex disease that can affect one’s entire body. This epidemic is not only wreaking havoc in our country, but it’s a global phenomenon and burden. Cultural, environmental, socioeconomic conditions, social & community, and lifestyle factors all have a role to play in how they can lead to development of diabetes mellitus. Serious steps must be taken to help prevent the disease, successfully manage those who have it, and prevent progression and complication of diabetes mellitus.
General Cultural, Environmental, and Socioeconomic Conditions:
Cultural: Diabetes is a disease that does not discriminate. However, certain ethnic groups are more affected than others. According to the American Diabetes Association, Blacks, Hispanics, Asian Americans, and American Indians/Alaskan Natives have higher rates of developing the disease. It is believed that these populations are more overweight and have high blood pressure. Being overweight is a precursor for diabetes. Weight loss, which can help reverse Diabetes mellitus, is not perceived as “healthy” by some of the mentioned ethnic groups.
Environment: The environment in which we live in America is greatly westernized. The food of choice is fast food due to its convenience and ease of availability. Such foods are usually processed, high in fat, sugar and carbohydrates, and offer little to no nutritional content. Habitual partaking of these foods and the ability to “supersize” or purchase larger portions can lead to obesity and diabetes.
Continuous exposure to air pollution, pesticides/herbicides, and other chemical contaminants are responsible for uncontrolled weigh gain. “Epidemiological data indicate that chronic exposure to pollutants disturbs glucose metabolism and induces insulin resistance” (Murea, Ma, & Freedman, 2012, p.12). Although pollutants and chemicals contaminants are present everywhere, individuals living in urban environments are at a greater risk.
Socioeconomic conditions: The socioeconomically disadvantaged are also at great risk for developing diabetes. It’s most often difficult for low-income individuals to access fresh and affordable healthy foods. This population is usually limited to buying cheap and unhealthy foods sold at local “bodegas” and fast food chains. According to Junnus, (2010), families living in poverty, worry from day to day about paying the bills and homelessness. As single parents struggle to feed their families, the concern is placed on putting food on the table, not on how healthy or nutritious the meal is.
Those who are uneducated, lack the literacy skills needed to maintain adequate health. They may avoid seeking assistance due to embarrassment. Lack of health insurance is also a barrier. People of limited income would rather use their money to cover human basic needs (food and shelter), than using it to seek medical help.
Social and Community Influences:
Social: we live in a fast paced society in which working long hours and multiple jobs have become the norm. Instead of preparing home cooked meals, the solution is to eat out or purchase fast food instead. Balancing numerous responsibilities such as work and family can be physically and emotionally taxing. “Cortisol is a hormone released when the body is under stress. While it helps the body deal with stress, constantly elevated levels can cause high blood sugar levels and high blood pressure” (Jannus, 2010).
To cope with stress, most individuals indulge in “comfort foods” such as ice cream, cookies, and chocolate instead of engaging in exercise and weight gain/obesity ensues.
Community: Children no longer partake in recreational activities as the age of electronics has taken over. Instead of playing outside, riding bicycles, and jumping rope, they choose to play video games, watch T.V., or spend time on smart phones. The lack of physical activity, the consumption of “junk food”, and the closing of community centers due to lack of funding, has led to the epidemic of childhood obesity.
The ability to purchase organic and affordable fruits and vegetables may be impossibility for those who are poverty stricken in a community, thus, leading to eating unhealthy foods. Eating frequently and in large quantities has become socially acceptable. In addition to this, salty and high fat foods served at social gatherings can be detrimental one’s health.
Individual Lifestyle Factors:
Lifestyle factors: plays a great role as well. Inadequate physical activity, sedentary lifestyle, and consuming fast foods are major contributors. People do not like to walk anymore. Even if their jobs or schools are within close proximity of their home, they’ll rather drive or take public transportation as oppose to walking.
Consuming high calorie and high sugary foods can lead to obesity. People who are overweight place added pressure on their body’s ability to use insulin to adequately control insulin. Most of us Americans are couch potatoes. We spend a great deal of time watching T.V and playing video games instead of exercising and playing sports. As per Black, (2002), lifestyle factors such as smoking and alcohol consumption can lead to the development of diabetes.
1B. Levels of Prevention
Cultural, Environmental, and Socioeconomic Conditions:
Primary prevention will consist of educating individuals on the importance of eating foods high in fiber, low in sodium, saturated fats and sugar. Conveying the importance of choosing whole wheat and brown rice, and drinking plenty water as opposed to fruit juices and sodas. Advise them to avoid as much as possible going out during busy hours to decrease inhalation of pollutants and irritants, and use environmental friendly cleaners such as baking soda and vinegar.
Secondary prevention will require screening of minorities and immigrants who are at risk for dysglycemia. It will include oral fasting glucose test and hemoglobin A1C, and finger sticks. Blood pressure and BMI screening can also be incorporated.
Tertiary prevention involves teaching individuals how to self -monitor blood glucose levels via finger sticks, how to read and draw up insulin in a syringe, how to administer it adequately, and importance of complying with regimen. Instruct on how to prepare ethnic foods that’s economically feasible and healthier. Instruct to wear a mask when going outside to decrease inhalation of pollutants.
Social and Community
Primary prevention aims at providing healthier foods to the community. Local community gardens can be built in order to offer the impoverished the opportunity for healthy eating. Encourage residents to join community centers such as YMCA, where they may engage in constructive physical activity, and to exhibit self-control while in the presence of great amount of food.
Secondary prevention will include the development of positive stress management techniques such as yoga or meditation (not eating junk foods), and the placement of mobile health vans in the community to provide screening, counseling, and referrals as needed.
Tertiary prevention involves having those who are overwhelmed by the disease to join diabetic support groups/peer support. Such programs can empower individuals and provide the courage and discipline needed to manage the illness effectively.
Individual Lifestyle
Primary prevention will aim at teaching individuals that habitually eating fast food, and lack of exercise can lead to being overweight, which can ultimately lead to diabetes. Parents will be encouraged to minimize the time that the children spend on video games and watching T.V., and take them to the park to run or ride bicycles. Those who take public transportation to work/school should get off at least one stop before the destination, and walk, as it is a form of exercise. They’ll be advised to prepare more meals at home and eat out/buy food less.
Secondary prevention involves teaching individuals to check glucose levels at least once a week. Those who are overweight will have BMI monitored and will be referred to support program for weight loss. Others that smoke will be referred to smoking cessation programs.
Tertiary prevention will aim at referring eligible candidates who have not been successful at losing weight, to have gastric bypass surgery. Losing excess weight can help decrease the tremendous effects of uncontrolled diabetes. In addition, reinforce compliance with doctor visits, diet, and medications.
- Negative Impact on Minority Residents Living Near Landfills and Superfund Sites
2A. Stakeholders:
- Community residents are the people most affected directly and are one of the most important stakeholders. They provide useful information about the neighborhood they live in. Involving them will give them the opportunity to voice their concerns and provide input. Resident who are involved in the planning and decision making process, are more likely to support the project.
- Clergy members are people that convey influence. It is imperative to include them in this project, as their members will listen to them because they trust them. They are respected, highly regarded, can help raise awareness, and promote participation and involvement.
- Schools/educators. Teachers, administration, and school personnel will have firsthand knowledge of community health issues affecting their students. Some may actually live in the community, and can influence parents and kids to get involved in the project of making their community a safer and healthier one.
- Local clinics and hospitals know the health trends going on in the community. They can provide data to environmental health organizations such as EPA, to substantiate the claims of negative environmental effects on residents of this community.
- Elected officials most often are residents of the community and are affected by the negative environmental impact. They’re elected by the community, to represent the community, and are key people that can advocate for social justice and financial assistance to address the ills of the environment.
- Local business owners spend most of their time in the community and will also be affected by the negative effects. Since they contribute a tremendous amount of revenue via tax dollars to the community, they will have a large influence on local elected officials. They may also have a network of business owners that can also influence the government to act on their behalf. Healthy individuals equal to more working people, and can lead to more business for them.
- Local/State/Federal environmental organizations need to be alerted and brought in as stakeholders to address the communities’ health crises. These organizations have the expertise on how to develop, implement, and monitor strategies for environmental improvement.
- College/University research department personnel have a wealth of knowledge based on research that’s been tested, and is evidence-based. It can help to inform any plan or strategy to deal with the ill effects of the environment.
2B. Research Resources and Methods
- Community health profiles provide data of important health issues facing residents of a community in districts across the city. It describes health conditions of the people, identifies major risk factors and cause of illness, and helps to identify the actions needed to address the issue.
- National priorities list of Superfund footprints is an online tool that enables community groups, stakeholders, and regulators to identify hazardous exposure of health concerns. It allows one to see pertinent data about the area and inhabitants near Superfund sites and how it affects them.
- Environmental Health Perspective Journal is a peer-reviewed journal that gives information about scientific findings and trends in the environmental health sciences. Since children are especially vulnerable to the environment they live in, EHP has a research section specific to issues concerning children’s environmental health. In a study conducted by Clark et al. (2010), the authors concluded from study and research that higher exposure to pollution in early life is associated with high risk of Asthma among preschoolers based on clinical records.
- S. Department of Education and local clinics and hospitals will provide information on the number of children in this area who missed school due to health related issues such as asthma, and those who’ve been diagnosed with learning disabilities. These findings will need to be reported to the Centers for Disease Control so that they may come in and conduct an assessment.
2C. Barriers/Obstacles that May be Encountered
- History of being ignored: most often the people directly affected by the problem voices have been ignored in the past. They may feel, as efforts will be futile. Because of this, they may not attempt to get involved out of fear of possible disappointment.
- Lack of available time can lead to lack of cooperation. Assembling a large group of people can be challenging. Work schedules may differ and some may not be able to attend scheduled meetings.
- Lack of funding: money is a critical factor to improving this community. It’ll cost millions of dollars to repair the community. Funding cuts can definitely be a hindrance to progress.
- Conflict of ideas: there may be conflict over ideas, priorities, goals, and interventions. This can also hinder progress if all involved cannot reach a mutual agreement.
2D. Local and National Policy
- Local policy change will be no landfills within a two-mile radius of the community. Gases and hazardous odors emitted from landfills leads to illness, being at least two miles away from residents will help decrease illness.
- Federal/National policy change: EPA is the United States Environmental Protection Agency. It’s a federal agency that sets and reinforces activities for environmental protection. Currently there’s a proposal to cut its budget and workforce. The optimal outcome would be for the White House not to decrease the agency’s budget and workforce, as it is needed to monitor landfills and close those operating out of compliance.
2E. Success Outcomes for the Community
- All stakeholders will be in agreement with the strategies needed to help making the project a success.
- Residents of the community will be empowered and put forth their best effort to fight for their community.
- Health Department will conduct a full and thorough assessment of the area that will confirm that Superfund sites and landfills are wreaking havoc on this community. The results will then be submitted to EPA, who will receive funding necessary to begin to fix the problem.
- Action groups within stakeholders will be formed to put the pressure on the government to clean up toxic sites.
References
American Diabetes Association. Are You At Risk? Retrieved on June 8, 2017 from http:www.diabetes.org/are-you-at-risk.html.
Black, A. (2002). Diabetes, Diversity, and Disparity: What Do We Do With the Evidence? American Public Health Association, 92(4), 543-548.
Clark et al. (2010). Effects of Early Life Exposure to Air Pollution on Development of Childhood Asthma. Environmental Health Perspective, 118(2), 284-290.
Janus, A. (2010). Poverty a Leading Cause of Type 2 Diabetes, Studies Say. Retrieved on June 8, 2017 from http://www.diabetesincontrol.com/poverty-a-leading-cause-of-type-2-diabetes-studies-say.
Murea, M., Ma, L., & Freedman, B. (2012). Genetic and Environmental Factors Associated With Type 2 Diabetes and Diabetic Vascular Complications. Journal of the Society for Biomedical Diabetes Research, 9(1), 6-22.
