Intervention

The intervention I plan on implementing is requiring physical education and health classes throughout all schools.  In order to implement this intervention, first the school board and curriculum organizers must be contacted.  They must agree to make these classes required for all ages from first to 12th grade. Curriculum organizers must put together these classes and determine what is to be taught.  The physical education classes should have at least 30 minutes of class time in which the students participate in a fairly rigorous exercise activity.  The health classes should be designed to include nutrition education and also education on how to maintain a healthy lifestyle and the consequences of not being healthy.

For this strategy there are not a lot of barriers.  Cost is always a factor because more teachers would need to be hired and instructed for these classes and various learning tools will be needed to supply these classes adequately.  The school will have to look at their budget and cut costs on things that seem unnecessary in order to fuel this project.  Another barrier could be designing the class structure and what is going to be done in the class time.  The curriculum organizers can meet with nutritionists and doctors in order to come up with a proper education plan.

A key stakeholder that would need to be communicated with is the children's parents.  The school can send home letters and email the parents informing them on the cirriculum change.  The health classes can email the parents once a week to briefly let the parents know what was covered in class and could potentially create healthy habits at home.  The physical education class could encourage the parents to help their child get another 30 minutes of exercise each day.

To evaluate the intervention, we would need to take health screenings of the kids before the program and then take health screenings of the kids after the program.  By tracking their progress in a years time, we can evaluate if it was effective or not.  My expected outcomes for this intervention is moderate.  I believe that it could help change the life styles of some of the younger students, but the older students tend to be more apathetic.

Intervention

Once a problem has been defined, public health officials then strategize different interventions that could be implemented to prevent or treat the problem at hand.  In the case of my topic, type 2 diabetes in children, there are not many interventions in place because it is still fairly rare, but yet a growing issue.  Most interventions aim to prevent or treat obesity, which is believed to be linked to type 2 diabetes occurring in children.

         CARDIAC Kids in Tennessee is an intervention program aimed at changing the eating and exercise behaviors of elementary school children.  The program also aims to involve families of overweight/obese kids to learn about better eating habits and activity levels.  The first part of this program is nutritional intervention.  The children learn about different foods and how they affect their diet.  The second part is physical activity intervention where the kids engage in physical activity for 60 minutes.  The final part is parental/family participation in the activities.  KEY DETERMINANTS!!!!

         There are three different classifications of interventions: primary, secondary, and tertiary.  Primary intervention is a prevention strategy to help a group of people before they get into a situation that would need aid.  Secondary intervention is providing services to the at-risk group.  Tertiary intervention is helping the at-risk group after the fact.

         A possible intervention strategy for this topic can be health screenings for children aged 10-19.  These health screenings should test for blood sugar levels, blood pressure levels, and BMI.  All these things indicate a potential for being diagnosed with diabetes.  If any of the results show that they are at risk, the doctor will educate them on how to avoid becoming type 2 diabetic through nutritional education and lifestyle education.  The stakeholders for this would be the children and doctors.  The key determinants this intervention will address would be biological.  This would be mostly a primary strategy, but the follow up with the doctor would make it partly secondary because of the educational aspect.

         Another possible intervention could take place in schools.  Local governments could pass a law pertaining to dining options in school cafeterias.  School dining halls could be required to offer healthier food options and meals.  There could also be a restriction on fatty foods being sold in the cafeteria; or the unhealthy food could be eliminated all together.  This would be classified as a secondary strategy.  There is actual physical intervention being made.  The key determinants this would address would be environmental and economical.  Stakeholders for this would be the children, dining hall staff, local government, school board, and food supply companies. 

         A third intervention could be an educational program in schools.  Schools can require their students to participate in physical education classes and take health and nutrition classes. Students would get at least 30 minutes of physical activity a day.  They will also learn about their health and how to create a healthier life style for themselves.  The key determinant this addresses is environmental and social.  This strategy is educational and physical so it would be partly primary and partly secondary.  The stakeholders involved would be the children, health and physical education teachers, school board, and local governments.

         Although studies show educational programs are not always the most successful, I feel that the third intervention involving education and gym in schools will be the most successful.  This strategy requires the kids to be active for part of the day.  They are able to get physical activity in school in case they don’t get any at home.  Here, they are also able to learn about healthy lifestyles and eating habits.  I feel like once kids become educated on their health, they will be able to make conscious good decisions regarding it.

Stakeholders

            In public health, once a problem has been identified, intervention strategies are hypothesized.  When thinking of potential interventions, one must think of the people or things that will be affected by each intervention.  These are called stakeholders.  Stakeholders are people, organizations, or other groups who share a stake in the issue at hand.  These people may be directly affected by the problem or solution to the problem.  Stakeholders can also have something to gain or lose by an intended intervention or solution on a topic.

            For my public health problem, the major stakeholder would be children ages 10-19 with and without type 2 diabetes.  Other potential stakeholders would include the parents of children ages 10-19, local/state officials, local governments, school physical education programs, school dining programs, medical clinics, nutritionists, hospitals, and potentially many more depending on the intervention at hand.

            The stakeholders that would need to be negotiated with would be parents, governments, school physical education programs, and school dining programs.  Health care providers may need to discuss with parents of these children healthier eating and exercise habits and lifestyles.  Government can go hand in hand with the schools depending on the specific intervention.  Government can pass certain laws requiring schools to have physical education and health classes so students will be able to get exercise and learn how to take care of their bodies.  Government could also potentially pass laws pertaining to the school’s cafeteria options.  They can require the school’s to have healthier options available and plenty of them.  They also can restrict how much fatty foods are for sale. 

            The children may also have to be negotiated with.  They might need to be persuaded to accept healthier options and participate fully in their physical education classes.

            Interventions to consider could be educational programs.  Schools can implement health classes to educate children on correct eating habits and ways to lead a healthy lifestyle.  Also implementing physical education classes in school can be helpful.  Making sure kids get exercise everyday can improve their health.  Schools could also prohibit fatty foods from their dining halls so kids cannot purchase them.  In alternative, the dining halls can be supplied with healthier food options.  Those who are at risk for type 2 diabetes and those with type 2 diabetes can meet with nutritionists to give them dieting tips and meals they can make in order to keep a healthy eating habit.

            Stakeholders that would be opposed to this could be manufacturers of unhealthy food products.  They would lose business if all schools implemented the intervention of no unhealthy food.  To address their concerns, they could create a healthier alternative to their food that could be sold in the dining halls.  For example, how Lays started manufacturing “baked” chips.

Key Determinants

Emergence of Type II Diabetes Among Children Ages 10 to 19 in the United States Over The Last 15 Years

           Biological determinants refer to the anatomic, physical, or medical/clinical reason that a problem might exist.  Pertaining to my problem definition, a biological determinant of type 2 diabetes in children would be obesity.  Being overweight or diagnosed with diabetes.  In a report, Chronic Disease—Diabetes At A Glance (2011), published by the CDC discussing diabetes, it stated, “Type 2 diabetes accounts for 90-95% of diabetes cases and is usually associated with…obesity and physical inactivity, family history of type 2 diabetes…”  Type 2 diabetes is caused by obesity and in the American Heart Association’s most recent report (2013) states “23.9 million children ages 2 to 19 are overweight or obese”.  This high and rising rate of obesity prevalence among children will eventually lead to type 2 diabetes development.  Another biological determinant is the child’s family medical history.  Children are more susceptible to getting diabetes if someone in their family has previously been diagnosed with diabetes.  Parents also have a huge influence in their child’s weight.  Michelle L. Brandt (2004) reports from the Stanford Report that “the factor that puts children at greatest risk of being overweight is having obese parents.”

            Social and cultural determinant include social class, social environment, peer influences, religion, ethnicity, norm of a particular group of people.  The American Diabetes Association writes that there are certain factors that make a person susceptible to type to diabetes that a person cannot change about their self.  One of these things is race.  “African Americans, Mexican Americans, American Indians, Native Hawaiians, Pacific Islanders, and Asian Americans have a higher risk for (diabetes)”. 

            Environmental determinants might include weather conditions, geography, air quality, levels of pollution, urban living vs suburban living, and so forth.  In the past few years a new term has emerged, “food deserts”.  The Johns Hopkins Center for a Livable Future states that a food desert is an area that does not have easy access to healthy foods, typically in the form of a supermarket.  People living location can affect their access to certain foods and could potentially affect their diet.  In these food deserts, healthy food is virtually unattainable and fast food is more easily accessible.  Another environmental determinant could be the safety of one’s living environment and ability to exercise outside or at a local rec center.

            Economic determinants refers to issues related to money, but can be thought of both from an individual level, but also as a community level.  In the situation with diabetes, economical and environmental determinants go hand in hand.  The people living in the food deserts are typically ones of lower socioeconomic classes.  These people do not have access to healthy foods, but even if they did, the costs of those food would be too high.  Poorer people don’t always have the best nutrition because they cannot afford the healthy foods that contribute to a balanced diet.  The CDC’s data report called Obesity and Overweight for Professionals: Childhood (2013), that “1 of 7 low-income children is obese.”  When low-income people are diagnosed with diabetes, it is extremely detrimental.  Andrea Janus (2010) reports on the relationship between poverty and type 2 diabetes.  “What we know about type 2 diabetes is not only are low-income and poor people more likely to get it, but they’re also the ones that, once they get it, are much more likely to suffer complications.” 

            Political determinant are usually though of as the factors that occur because of the executive, legislative, or judicial decisions, or behaviors that exist during a particular time period.  There are not necessarily any specific political determinants that directly affect the cause of type 2 diabetes among children and adolescents.  One that could possibly fall under this category is government funding for health insurance.  If children are being raised in low-income families, then the typically won’t get quality medical care or any medical care at all.  Medical care is important because health professionals can educated the patients on diet and exercise and can track a obesity problem in children and treat it before diabetes results.

Work Cited:

"Age, Race, Gender & Family History - American Diabetes Association." American Diabetes Association Home Page - American Diabetes Association. N.p., n.d. Web. 6 Apr. 2013. <http://www.diabetes.org/diabetes-basics/prevention/checkup-america/nonmodifiables.html#Race>.\Brandt, Michelle. "Obese parents increase kids' risk of being overweight." Stanford News. N.p., n.d. Web. 6 Apr. 2013. <http://news.stanford.edu/news/2004/july21/med-obesity-721.html>."CDC - Chronic Disease - Diabetes - At A Glance." Centers for Disease Control and Prevention. N.p., n.d. Web. 6 Apr. 2013. <http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm>."Obesity and Overweight for Professionals: Childhood: Data | DNPAO | CDC." Centers for Disease Control and Prevention. N.p., n.d. Web. 6 Apr. 2013. <http://www.cdc.gov/obesity/data/childhood.html>. "Overweight & Obesity Statistical Fact Sheet 2013 Update." American Heart Association 1 (2013): n. pag. American Heart Association. Web. 4 Apr. 2013.