resource: BEAM

Voluntary health agencies are non-profit organizations created by people to fill needs that are not directly funded by government organizations.  Although non-profits usually receive grants to help with specific programs, much of their support comes from individual donors.   These organizations could be large and national or small and local.  While the national non-profits like American Heart Association or American Cancer Society help millions of people nationwide, there are  many great local organizations in the Northeast Florida region. I think it is important to support them because they are helping people in our community.  This video talks about some statistics related to donating to local agencies.

This video was on the facebook page for BEAM today.  BEAM stands for Beaches Emergency Assistance Ministry and helps people in need throughout the Jacksonville area beaches. As stated on their website http://jaxbeam.org/, BEAM’s mission is to keep families in their homes and help them become self-sufficient.

resource: story of stuff

The Story of Stuff presents the problem of consumerism in our market-driven economy and how the United States appears to be too wasteful in general.  The materialistic nature of our economy and the perceived purposefulness of selling consumers goods that will be obsolete quickly either because the purchased items was intended to break (planned obsolescence) or be ‘out of style’ (perceived obsolescence).
Maybe we should think a little more about what we really need in this world.

I think this video is so interesting.  And even better are the different reactions that people have to the video.
After the video, take this online quiz to see what your ecological footprint looks like.
http://www.earthday.net

Let me know what you think....

healthy places/healthy communities

Have you ever read about something that seems brilliant and doable only to later find yourself thinking more and more about it?  And then maybe changing your mind and thinking that is impossible.  That will never happen.  And then trying to figure out if it could happen.  And if you could add to the equation and help make it happen?  Or do you know someone that can make it happen?  This concept of smart growth or new urbanism is just that.  It is one of these ideas that I learned about during a class project and I just can’t shake.  It is so smart and so necessary.  Why isn’t everyone talking about this?  The whole community would be healthier and happier.  So let’s look at the concept here for a little bit.

To start, this is the video that we watched by Dr. Howard Frumkin, MD, DrPH, the former director of CDC’s National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry. It is a quick streaming video that will help you get started on this idea

http://www.cdc.gov/healthyplaces/cdc_healthy_community_design_webserver/default.htm

But then I went further looking for other ideas.  I checked out TED.com of course.  

In case you didn’t know, TED.com is a fabulous site that gives people with all sorts of expertise the chance to have their ideas heard.   It is a non-profit organization that has grown and allows selected speakers the chance to present new ideas to a global community.  On TED.com, I found this video by Kent Larson.

 

Mr. Larson took the concepts even further.  In his video, he talks about folding cars and apartments that could change their layout.  But more importantly, compact urban cells – small towns that can provide most of what people want or need within a 20 minute walk.  Then he talked about the new mobility parkways in cities like Boulder, Colorado; Seoul, South Korea, and the hi-line in Manhattan that would provide a safe route for pedestrians between each compact urban cell.  These are great improvements for pedestrians but also some consideration should be given to biking – like in Copenhagen, Denmark where 42% of trips in city are by bike.  Electric bikes that can be used by business commuters, elderly and disable folks are also discussed in an effort to address issues related to energy, congestion, mobility, aging, and obesity simultaneously.  There are some great ideas out there.  We can only hope some of them are put into action!

confessions of a laggard

I wanted to talk a little bit about some of the newest technologies that can be used in many areas of Public Health practice.  New technologies are not always one of my strengths.  I used to think I was keeping up pretty successfully in our technical age.  It turns out, only in comparison to my mother (sorry mom!).  When I started the MPH program, I remember sitting down in class on that very first night and sighing to myself “great, I am the old lady in class.”

The other students in this program are young.  Like straight from bachelor-degree young.  Like born the year I graduated from high school young.  And smart.  There are some really smart students in my classes.  With these brains and this youth comes a high acuity when it comes to technology.

So when we talk about technology to be used by Health Educators or Public Health Practitioners, sometimes I need a little help.  This video is a nice intro to the Diffusion of Innovation Theories categories that describe the bell shaped curve by which a target audience will adopt a program.

I used it in this powerpoint that I narrated for my class.  That was a bit of a challenge for me.  But i figured it out.  So maybe I am not really a laggard.  I am being dragged along – and definitely more aware of technology because of the classes I am in and the students I am working with.    Here it is....

I am going to confess something here.  I will likely regret it.  That first day in class, I printed out the ENTIRE powerpoint – all in full page format.  But I have learned – and come a long way.  I know for Dr. Clarke and his 72 page powerpoints, you can squeeze 9 slides per page and still have room to jot down some notes.  Maybe hanging out with the younger students has helped me upgrade my status.  I don’t really think I ever really qualified as a laggard.  I think before Grad School I was probably a late majority.  Maybe now I am an early majority.  A little progress J and I am sure there is more to come!  I mean, I am writing a blog…

resource: the truth

Time for another resource: www.thetruth.com

            www.thetruth.com was an interesting website and offered a lot of insight into a well formulated media campaign directed at adolescents.  The graphics, the articles, even the language were scripted directly toward the target audience (TA).

             

            From the first click onto the website, there are references to free tickets to see bands, video games to download, ‘cooler’ teen heroes like skateboarder Tony Hawk, and a graffiti artist in action.  The overall feeling from my perspective is that there was a lot of research that went into this site, and continues to be done to help the site stay updated and relevant.  The fact that I am a bit removed from being a teen, and in fact have a daughter who is 13, makes it hard for me to know if teens would find this site as ‘cool’ as I did.  

        

            The “We (heart) Smokers” aspect of the site was a way to make sure that the teens did not feel like they were being told what to do.   The idea is that the truth campaign wants the teens to be informed and make their own decisions.  But the underlying fact is that the campaign is doing a good job of highlighting the costs of smoking while decreasing the benefits.  Farrelly (2005) discussed the impact of the truth campaign on American adolescents in his study.  It was evident that telling teens what to do was a bad idea so that was avoided.  Instead, teens were given gruesome facts about the effects of smoking and given the opportunity to draw their own conclusions.  The TA was also presented with videos of TEENS fighting back against the tobacco industry.  This borrows from Social Network Theory because it has teens introducing the concept to other teens.  The truth campaign website has the feel that teens are producing it.

            Lastly, the truth campaign definitely has a firm grasp on Social Marketing especially when it comes to social networking sites.  The campaign has a presence on facebook, twitter and youtube as well as the video games.  There is also a blog that seems to reach the TA in several ways including videos, scare tactics, events, facts, more games and even a little national policy.  It is not often that you see a website that is as up-to-date and fresh as this one.  I am sure that there are significant costs involved to keep it looking as effortless and youthful.

Farrelly, M. C., Davis, K. C., Haviland, M., Healton, C. G., & Messeri, P. (2005). Evidence of a Dose-Response Relationship Between "truth" Antismoking Ads and Youth Smoking Prevalence. American Journal Of Public Health, 95(3), 425-431. 

social marketing

The Center for Disease Control has created an educational module to learn about the basics of Social Marketing.

http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/basics/index.htm

The CDC’s Social Marketing Basics online learning module demonstrates the use of commercial marketing campaign strategies to reach a target population.  The goal is to encourage VOLUNTARY behavior that will improve their PERSONAL WELFARE as well as that of SOCIETY as a whole.  Social Marketing needs to be more than simply an advertising campaign.  It needs to involve systematic and strategic planning.  I think this is one of the most important points in the course.  Often when audiences are exposed to advertising on television, they do not realize there is more involved than simply filming a commercial. 

A Social Marking plan needs to present a total package that includes identification of:

Primary target audience (TA) – first clear target population who will benefit

Secondary audience – persons who influence the decisions made by primary audience

Formative research – which helps choose, identify and understand the TA and the best ways to reach them

Behavioral objectives – a CLEAR, SPECIFIC, MEASUREABLE and FEASIBLE goal that describes the behavior you want the TA to take on

Intervention strategy – or market strategy – a guiding plan of action of the social marketing program.  This needs careful thought as it is an all-encompassing step that includes identifying TA segment, the specifics of the behavior change goal, costs, barriers, marketing mix and activities.

Social Marketing is different from other Public Health planning campaigns because the elements are addressed collectively. Because it is so driven by the TA, it is truly a valuable tool for population-based research.  The Public Health Practitioner needs to take the time to understand the perspective of the audience.   The 4 Ps of marketing (product, price, place and promotion) are used at this point and highlight the use of commercial marketing strategies.  In the end, the detailed account of the TA and all associated factors often allow for a smaller budget but certainly for a better, clearer use of resources.  

I think the CDC was a good starting point.  But I wanted to look a little further so found this video..

It inspired me.  And even though I am still working on the end result, I started looking at using several mediums to process my message.  I will continue to work on this as time allows.  But here is a start.....

For full disclosure, I will need to work on the logo - it is the one from my business that I closed.  I need to get American added in there - but I love it and will get that graphic fixed asap.  It is supposed to be a dinner plate, in case you were wondering. 

behavior change in process

In an effort to understand the theories that we have been working with, the plan this week is to apply a mini-behavior change for ourselves or our family members.  The 3 tables below show how each of 3 different theories would address the change.

I demonstrated the Health Belief Model (HBM), Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) and Transtheoretical Model and Precaution Adoption Process Model (TTM/PAPM).  In the first column, I explained the construct or guideline.  For the second column, I described the activity that would be used to enact that specific construct.  In the third column, I provided the rational for the actions.

For my behavior change, I decided that I would like to increase the amount of time I spend exercising with my children.  It would increase their exposure to this healthy behavior and incorporate it into their routine as well as improve my activity level on evenings when my husband is not home and I cannot make it to my regular exercise classes.  Increase exercise with children by 30-45 minutes 3 times per week

Health Belief Model (HBM)

Construct	Activity	Rationale
Perceived susceptibility: the degree to which a person feels at risk for a health problem	Review an article about the need to increase activity levels of children related to a decrease in physical education in schools	This article will emphasize the need to be proactive when it comes to teaching healthy habits to children specifically regarding incorporating fitness into our lives.  This is a habit that needs to be encouraged early in life.
Perceived severity: the degree to which a person believes the consequences of the health problem will be severe	Review statistics about the decrease in fitness levels of adolescent American students in the past 10 years and the increased health risks associated with this decrease. Ask the children to complete an exercise log for 1 week	If it is apparent that there is not enough physical fitness in schools, it will inspire me to increase their activities at home. I also want the children to see for themselves the severity of the situation and review our thoughts in a discussion.
Perceived benefits: the positive outcomes a person believes will result from the action	Look through the website www.letsmove.gov with the children for ideas for new activities.  This activity would also provide the time for the kids to see the importance of exercise.	Research indicates that exercising as a family leads to a ‘less-stress, more talk’ benefit for all members.  It would also provide an opportunity to commit to quality time together.
Perceived barriers: the negative outcomes a person believes will result from the action	Reorganize evening activities to allow for exercise time.  Plan ahead for dinner.  Make sure the children know to finish homework at extended day.	When life gets busy, extra activities get abandoned.  If the evening events are properly planned, nothing will get skipped because of busy schedules. Use of the incentive system to encourage the behavior.  Allow the children to work towards a reward.
Cues to action: an external event that motivates a person to act	Schedule the activities on Sunday nights for the following week.	The schedule of a busy family changes from week to week.  Taking the time on Sunday night to look at the whole week will best ensure the proper preparations have been made to be successful.  We will work together on this to employ the buddy-system.  Log of activities to track progress.
Self-efficacy: a person’s belief in his or her ability to take action	Track the exercises on Outlook calendar in a specified color so that it is easy to count the number of days per week. Put stickers on the calendar on the refrigerator so the children can track as well.	Working as a family will give us the chance to encourage each other to stay on track.  Weekly review of goals as well as incentives.  Also, we can incorporate review of role models that follow this health behavior.

Theory of Reasoned Action/Theory of Planned Behavior TRA/TPB

Construct	Activity	Rationale
Behavioral intention (BI):  perceived likelihood of performing the behavior (likely to unlikely scale)	Get some brochures that talk about the benefits of exercise for adolescents.  Discuss the healthy lifestyle choices that work best for our family.  Plan the events as fun ‘family time’ instead of required exercise time.	The children have to take accountability and be involved in the process.  They need to be included so they have ownership of the ideas.  An important construct as this is the strongest predictor of behavior.
Attitude toward behavior (Ab): evolution of behavior (good to bad scale)	Schedule the weekly plan together on Sunday evenings.  Put it on the calendars – both on refrigerator and Outlook.  Make sure the children think about how the behavior is good for them.  Plan an activity for them to identify incentives that will encourage their participation.	Evaluate the questions “is the behavior good? Cool? And easy?”  They need to feel confident in the changes. Will the activity be ‘cooler’ if there is a shopping expedition as a reward for my daughter or a new lego set for my son?
Subjective norms (SN): belief about whether each referent approves or disapproves of the behavior (disagree - agree)   Do others think I should behave this way?	Review the website www.letsmove.gov to find tips and suggestions for getting active as a family.  Show the children that many families are also attempting to make this lifestyle change.	Self-labels and self-identity are important determinants of behavior.  It helps to convince the participants that mom expects them to exercise (subjective norm), that this is part of how they would like to be defined (social identity) and for it to become part of how they define themselves (self-identity)
Perceived behavior control (PBC): overall measure of the perceived control over the behavior (up to me – not up to me)	Find stories about other adolescents that make this change, the ease of the transition and their positive accounts of how it made them feel.  Boost their confidence by allowing them to choose activities.  Make sure the children feel as though they have the tools necessary to accomplish our goals.	Maximize the control beliefs (perceived likelihood of occurrence of each facilitating or constraining condition) and perceived power (perceived effect of each condition in making behavioral performance difficult or easy) for the children.

Transtheoretical Model and Precaution Adoption Process Model TTM/PAPM

Construct	Activity	Rationale
Stage of change: precontempation/preparation	Discuss plan of action with children and talk to them about the initial stages of our plans.  Identifying the stage is a little difficult for us as a group because while I have been planning and am in the preparation stage, the children are likely in the pre-contemplation stage.  They do not realize this is something that I feel needs to change in such a direct manner.	I have certainly said to each of my children ‘you need to spend more time outside’ or ‘why don’t you run around the block’.  I don’t think they realize how serious I am about creating a plan to change their general attitude in regard to regular exercise.  It is something we need to tackle together as a family unit.
Process of change:
Consciousness raising          (precontemplation stage for children only)	Sit down with children and discuss concerns about the need for more daily exercise.  Make a plan to work together to incorporate more fun fitness activities into our week.	This is an opportunity to introduce the idea and highlight tips that will support the healthy behavior change.
Self-reevaluation (contemplation stage)	Identify role models that the children have that are active and healthy individuals.	Start the process of helping the children identify themselves as active.  It will be a little different for each of them.  My daughter, because she is older, is often in the neighborhood on her bike with her friends.  My son tends to gravitate to the television more than his sister but also will spend hours in the pool on the surfboard or with the snorkel gear on.
Self-liberation (preparation stage)	Activity schedule will be posted on refrigerator and Outlook calendar.  Stickers will reinforce the activity was accomplished.	Make a public commitment.  We will share the goals with family and friends.  Especially friends with common exercise goals for their children.
Helping relationship (action stage)	Find an exercise event to work towards with some family friends.	Use the buddy system.  My friend’s children and my children did a triathalon last spring.  Find a similar event for the kids to prepare for.
Decisional balance	As an activity, ask the children to list the pros and cons of more family fitness activities.	Must point out the benefits for the children while minimizing the cons.  Constantly remind them that they will feel better, look better, have more energy.  And remind myself that there is a strong correlation between exercise and academic performance.
Self-efficacy	Ask the children to write a story about the impact that exercise can have on their life, describing times when being healthy and fit will be to their advantage.	Constant reinforcement that the changed behavior is working.  Increase the children’s confidence in their improved fitness change and constantly look for opportunities to reduce temptation to skip exercising in lieu of television time.

The CDC offers a lot of information about getting kids moving.  There are powerpoint presentations on the website that can be used to explain new guidelines to educators and community centers.
http://www.cdc.gov/healthyyouth/npao/pdf/presentationslides.pdf 

There are even podcasts available about avoiding sodas, eating well at school, school policies and programs and keeping your kids moving.  It definitely is a good idea and a worthy use of family time.  So get your kids and get out there!  Keep them moving - it will help keep you moving as well!

health belief model

I would like to take some time to further explore one of the Health Behavior Theories.  Health Belief Model is a good starting point for practitioners and used quite often.  Here are some of the points that I would like to highlight…

Health Belief Model (HBM)

•           Oldest of individual behavior theories used in Public Health (1950s)
•         One of the most widely used theories
•          Originated by Godfrey Hochbaum, Irwin Rosenstock and Stephen Kegels
•           In response to ‘why weren’t people taking advantage of free tb screening (chest x-rays)?’

Behavior is an outcome based on … (6 constructs)

Perceived susceptibility: the degree to which a person feels at risk for a health problem

Perceived severity or seriousness: the degree to which a person believes the consequences of the health problem will be severe

Perceived benefits: the positive outcomes a person believes will result from the action

Perceived barriers: the negative outcomes a person believes will result from the action

Cues to action: an external event that motivates a person to act

Self-efficacy: a person’s belief in his or her ability to take action

                                                                                                                                                                                                http://muse.jhu.edu/journals/southeastern_geographer/v050/50.3.butterworth_fig01.html

     

•        Also known as the Value Expectancy Model:  People will engage in healthy behavior if:

They value the outcome (being healthy) related to the behavior

They think the behavior is likely to result in that outcome

•           Critiques of HBM

                  It focuses on individual decisions and does not address social and environmental factors

It assumes that everyone has equal access to info to make a rational calculation

This model is a good choice when addressing problem behaviors that may lead to health concerns.  The constructs listed above act as a starting point to develop short or long term behavioral change strategies.  An important point to remember, the practitioner MUST understand the target population’s perspective.  Their thoughts and feelings regarding susceptibility, severity, benefits, barriers, cues to action and self-efficacy are paramount.  Changing attitudes and behaviors is never easy.  A clear understanding of the target population could make the difference between success and failure.

resource: FRAC

I have another resource I would like to highlight!  Since much of my background includes food-related jobs, and my future will likely include work to resolve these issues either through research, non-profit organizations, policy development or education, I like to follow what is happening in these settings.

According to Healthy People 2020:

“complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health. For all Americans, other influences on health include the availability of and access to …. Nutritious food…”

                                                               http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx

Many organizations worldwide work to improve the overall wellness of specific communities or populations.  I often wonder about the amount of overlap that is caused when multiple organizations are working to help the same population and if there was a way to consolidate the efforts more effectively.

The Food Research and Action Center (FRAC) is a national nonprofit that works to address issues related to hunger, food insecurity and poverty.  FRAC encourages relationships with hundreds of national, state and local nonprofit organizations, public agencies, corporations and labor organizations by

•           Conducting research to document the extent of hunger, its impact and effective solutions
•           Seeking to  improve federal, state and local  public policies to reduce hunger and undernutrition
•           Monitoring the implementation of laws and serving as a watchdog of programs
•           Providing coordination, training, technical assistance and support on nutrition and anti-poverty issues to a nationwide network of advocates, service providers, food banks, program administrators and participants, and policymakers
•           Conducting  public information campaigns to help promote changes in attitude and policies
•           Offers access to data, publications and statistics

http://frac.org/

health disparities

In our class this semester, we spent some time discussing health disparities.  We have addressed this issue in several classes now.

“Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”

                                                                                                http://www.cdc.gov/healthyyouth/disparities/index.htm

Last year we watched a very interesting video called “Unnatural Causes.”  It was very informative documentary that looks closely at the inequality of healthcare according to a persons’ socioeconomic status (SES) in a community.  The series examined several different employees with different life circumstances from the same company to highlight the differences regarding access to care.  If you have some time, I recommend it.

http://www.unnaturalcauses.org/

Health disparities should really include so many factors but at the very least, socioeconomic status, physical environment, access to healthcare and access to nutritious foods.  When these circumstances are compounded with additional stressors, there are detrimental effects on health status.  The stressors could lead to higher rates of injury, illness and premature death related to unsafe living environment or unhealthy lifestyle choices.

I found a visual that illustrated the causes of health disparities. 

I liked the simplicity of that model but felt like there were missing elements.  I started looking at many options on the internet but was not quite satisfied with the results.  I decided to take the information that I was collecting and turn it into a more complete model.  Below is the model that I have created.  I think it still needs some work – and there are always other outside influences that could be added. 

I definitely wanted the core of the matter to be individual behavior.  You cannot resolve certain  issues by eating right and exercising – but it always seems to be a good place to start.

Overall I am happy with the result.  What do you think?

resource: NCI

When trying to solve a problem, sometimes it is more important to know WHO to call or WHERE to find the right info than what to do.  Trying to keep track of all the resources available can be overwhelming.  I will highlight some strong resources here every few months.

The National Cancer Institute (NCI) produces a guide for Health Promotion Practice that explains the theories that many Health Educators use to create their campaigns.  Here is a link to that article.

  

http://www.cancer.gov/cancertopics/cancerlibrary/theory.pdf

While it is produced by the NCI, the theories presented are useful across the spectrum of the public health field.  It is a valuable resource for small health departments who may not have the budget to complete the necessary research to support the changes being proposed. 

  

This guide lends credibility to the theories and clarifies the constructs involved.  The article explains that no ONE theory is necessarily going to be the script for a health care promotion.  A good practitioner will draw from several theories to develop an approach that is uniquely tailored to the situation.  The theory needs to answer the questions why, what and how.  These answers will dictate the direction the health promotion will take.

Theories also need to be fluid, to have the ability to evolve and change with the times.  It is particularly relevant to me because we, as practitioners, need to grasp the audience in the most advantageous venue from their point of view.  If you are trying to teach teenagers about fitness, new technology might help engage their interest while imparting the lesson.  If however, you are trying to teach an older generation about fitness, new technology would simply make the lessons that much harder to grasp. 

The solution needs to be tailored to the situation.  In this example, the solution that would work best and be more current for the younger generation would not be relevant for the older generation.

Acknowledging the different issues for populations of people will help bridge some of the health disparities that exist currently.  But I will explore more about health disparities in the next post.