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Death and disability worldwide


Chronic diseases are the leading causes of death and disability worldwide. Poor diet and physical inactivity are recognized as the leading modifiable risk factors for these diseases. Of particular concern is the fact that certain population groups-people with social and economic inequities- are disproportionately affected by chronic disease. Statistics show that the incidence of all chronic diseases studied was higher for people in the two lowest-income groups than for those in the three upper-income groups (Chaudhary, 2007). Overweight and obesity are the major forms of malnutrition in homeless families (Schwarz, 2007) and mortality rates of the homeless in North America are at least 3-5 times greater than that seen in the general populations of Canada and the U.S ( Jones, 2009). Evidence also suggests that low income groups have more risk behaviors, such as cigarette smoking, unhealthy diet, and lack of physical activity, as well as lower literacy levels than groups with higher incomes (Chaudhary, 2007). Homeless people eat food prepared, by municipal and charity shelters, drop-in centers, fast food restaurants, 24 hour convenience stores and from garbage bins (Jones, 2007). Research has suggested that because diets high in refined grains, added sugars, and added fats generally cost less than healthful diets composed of lean meats and fresh fruits and vegetables, the poorer segment of the population has greater exposure to an unhealthful diet. (Dammann, 2009). Such calorie-dense food items are more cost-effective alternatives to healthful food choices and are easily accessible in low-income neighborhoods. Consuming these food items may cause overweight and obesity and lead to chronic disease.

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Interventions focusing on the primary prevention of chronic disease, with an intention to alter nutrition and/or physical activity have been developed and reviewed in the past. Investigators employed an experiential or interactive approach to nutrition education or physical activity. Outcome measures for these programs raged from an increase of fruit and vegetable consumption, physical activity and fat reduction (Chaudhary, 2007).

Nutrition intervention programs with successful outcomes involved some form of food preparation and tasting (Chaudhary, 2007). As part of the intervention, the goal of this approach was to address the 5 -A -Day message (consuming 5 servings of fruits and vegetables per day) with colorful displays, while also providing participants with an opportunity to smell and taste food samples in an informal learning environment. Presenters also demonstrated easy and inexpensive ways to prepare and serve vegetables and fruit, and provided promotional take-home materials such as recipes, brochures, stickers and magnets.

Methods of nutrition counseling with behavioral dietary counseling have proved beneficial in increasing low-income adults' long term changes in consumption of fruit and vegetables (Steptoe et al, 2003). The combination of addressing the importance of fruit and vegetable consumption and its benefits to health with personalized, specific advice and short-term and long-term goal-setting proved to be a winning combination to induce change in this population.

Results of nutrition and physical activity intervention programs targeted at low-income audiences with the most successful outcomes tend to be delivered in an interactive visual format, to be culturally appropriate, provide tailored materials, administered in accessible primary care settings, and to give incentives to act on the information provided (Chaudhary, 2007).

Statement of problem: The purpose of this study is to determine the effectiveness of a community-based nutrition education and physical activity intervention program to a low-income population. The intervention will be implemented by a registered dietitian in traditional group sessions consisting of one hour each week for five weeks. Participants are enrolled in the Inland Temporary Homes program in Loma Linda, California where they are provided with a place to live and resources from students ad professionals in the area to re-establish their lives and get back on their feet. Funds for the program will be provided by the City of Loma Linda through the California Healthy Cities grant.

Hypotheses: The nutrition and physical activity intervention program will have positive health outcomes of participants according to pre and post intervention survey, data collection and evaluation.

Null Hypothesis: There will be no difference between the pre and post intervention surveys of the participants evaluating the effectiveness of the nutrition and physical activity intervention.

Delimitations: Delimitations of this study included geographical location and cost measurement. Participants are limited to those of the Inland Temporary Homes during the time of the study. The results of this study may not be generalized to other locations or income classes.

Limitations: This study was limited by the self-reporting accuracy of the participants. Specifically, participants provided information on statements of their personal lifestyle habits, nutritional, physical activity level. Any inaccuracies in these self-reports impacted the study results.

Assumptions: The following assumptions were made: a) the participants' self-report survey was honest, accurate, and complete.

Operational Definition: 1) Inland Temporary Homes. Residents living in temporary homes and provided with resources to get back on their feet.

References: Still to come when I get more help with Endnote!!!

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