Community Nutrition Education Original Program

Washington Heights

• Adults, ages 18-64 – 60% population• 72% Hispanic• Roughly 50% population using public income assistance

Justification

• Heart Disease: Highest incidence in Manhattan• Obesity: 22 %• Food insecurity: 58 % due to expense, poor quality and lack of supermarkets• Abundance of bodegas and corner stores

• Approximately 2,324 in the region• Ready to make meals are common

• Lower level of nutrition knowledge when compared to other areas of Manhattan

Lessons Learned

Other Interventions

City Harvest - Poor nutrition education in WH and healthy food is too expensiveProject H.E.A.L. - Focusing on behavioral change worksLawrence Latino Diabetes Project - Interventions can be both culturally specific, and inexpensiveThe Minnesota Heart Heath Program - Programs do not need to be long but must be culturally and socially relevant to the population.

Program Approach

• People don’t like change, so we won’t ask too much• Our goal is NOT a complete diet overhaul• Our goal is to make their existing/prefered food choices healthier

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Program Goal

Our goal is to improve health outcomes for the Washington Heights/Inwood area by teaching adults to modify sample quick serve meals to include a greater nutrient diversity and density.

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SMART outcome objectives

Specific Measurable

Achievable

Realistic Time-Bound

By the end of the program the 20 adult participants suffering from morbid obesity and at high risk of CVD, living in the Washington Heights/Inwood area will increase their total vegetable consumption by 20%, measured by analysis of the food photo journal in comparison to the food frequency survey taken at the start of the program.

By the end of the program the 20 adult participants suffering from morbid obesity and at high risk of CVD, living in the Washington Heights/Inwood area will decrease their BMI by 5%, as compared to their anthropomorphic data pre-intervention.

By the end of the program the 20 adult participants suffering from morbid obesity and at high risk of CVD, living in the Washington Heights/Inwood area will decrease their CVD risk by 3%, as compared to their data pre-intervention.

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SMART process objectives

Specific Measurable

Achievable

Realistic Time-Bound

In a 1 hour 15 minute setting, instruct 20 participants suffering from morbid obesity and at risk for CVD, living in the Washington Heights/Inwood area on how to add nutrient diversity and density (vegetables and lean proteins) to their meals, measured by completion of the lessons.

In a 1 hour 15 minute setting, instruct 20 participants suffering from morbid obesity and at risk for CVD, living in the Washington Heights/Inwood area on the importance of fiber in their meals, measured by end of lesson questionnaire.

Ninety-percent of all participants will attend all three of the instructional sessions over a three week period as measured by sign-in at start of lessons.

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Introduction to the Lessons

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Overview

Quasi-Experimental Pilot Program

Experimental Group (N=20)

Control Group (N=20)

(1) Ramen Lesson (1) Camera Lesson(2) Pizza Lesson(3) Camera Lesson

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Target population, location, duration and frequency

Target PopulationAdults, age 18-64PCP @ New York Presbyterian/Columbia University Medical CenterHigh risk for CVD (Z82.49, I11.9, E78.0, E78.5)Morbidly obese (E66.01)LocationWashington Heights Community Center, 2340 Amsterdam Avenue, New York, NY 10033DurationEach lesson is 1 hour and 15 minutesFrequencyOnce a week for three weeks; surveillance for three months following

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Lesson 1Make it a Meal: Ramen Noodles

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Learning objectives

Participants will be able to:

make the quick ramen noodle recipe more nutrient dense and healthier.

compare and contrast starches and vegetables.

identify lean proteins. explain how fiber can make you

fuller. identify foods containing a lot of

fiber.

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Activities

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Materials used

Food Equipment StaffRamen noodle packs

Forks 2 x nutritionist

Shrimp Cutting boards 2 x chefChicken breast Projector 2 x

assistantsPork loin Knifes TranslatorSalt-free adobo PlatesSpinach leaves GlovesBroccoli Ramen PosterHard boiled eggs HotplatesTilapia 4 qt. sauce panCarrots Chart of lean Fresh green beans

proteins

Green peasBlack beansRed chili powderBlack pepper

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Lesson 2Make it a Meal: Pizza

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Abbreviated Information

This lesson will be performed the same way as the ramen noodle lesson was, except instead we are buying pizza’s from the local pizza store...light on the cheese, thin crust.

The participants will learn how to add vegetables and lean proteins to their pizza to make them fuller, and have a more nutritious meal.

A little less informative about the healthy fiber-rich foods, and more about brushing up on skills they learned from the last lesson about ramen noodles.

More about what they participants will try and enjoy than about teaching healthy options and why they are healthy.

Lesson 3Make It A Meal: Food Photo Journal

Learning Objectives

Participants will be able to record food intake at a minimum of 2 entries per day for the duration of the program.

Participants will be able to accurately display their food intake using photography.

Participants will be able to compose a healthy meal and properly log it using the photograph.

Activities

Opening Activity: Participants will go around the space taking a picture of the healthiest item in the room. A volunteer will assist them in sharing the image.

Review of ideas/themes from previous lessons using healthy images just taken. (exp. only)

Participants will then take ingredients available and make healthy tacos. (no emphasis on healthy for control)

With assistance from volunteers, participants will photograph their creations to share.

Closing Activity: Participants and staff will have more healthy snacks, while participants practice once more taking and posting images.

Materials Used

Food Equipment StaffTaco shells Camera

phones2 x nutritionist

Chicken breast (cooked)

Photo journal application

2 x chef

Tilapia (cooked) Projector 10 x volunteers

Lettuces KnifesSalt-free spices PlatesTomatoes GlovesPineapple (grilled)Brown riceZucchini (sautéed)Carrots (sautéed)Spinach (sautéed)

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Marketing Plan

Needs of target populationAdults, 18-64 years old Need for health improvement; obesity, CVDBenefits Participants will learn to prepare complete meals Participants will keep the camera Participants will improve their health status Timeline Contact patient services at Presbyterian hospital 3 months before the program to identify potential participants with CVD risk and morbid obesityCoordinate with participants 1 month before the programGive lessons 1x/week for 3 weeks at the community center free of charge

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SWOT

STRENGTHS

•Working directly with hospitals to get patients •Professional staff •Program is free of charge

WEAKNESSES

•It is a new program and not very well known

OPPORTUNITIES

•There is a high demand for services like nutrition education and cooking lessons •Positive impact on the well-being of the community

THREATS

•Competitors from larger well known established organization; City Harvest

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Evaluation plan

Pre-intervention Evaluation

Process Evaluation

Post-intervention Evaluation

Population selection (w/ Hospital)

Monitor food diaries at 2-wk intervals; remind

Client evaluation of lessons-survey

Biometric / Anthropomorphic Data

Client evaluation of lessons-survey

Biometric / Anthropomorphic Data

CVD Risk using NIH calculator

Attendance at Lessons

CVD Risk using NIH calculator

Serum Cholesterol Levels

Serum Cholesterol Levels

BMI / WH Ratio BMI / WH RatioFood Frequency Assay

Evaluation of food diary

Current Exercise

Exercise during pilot

Attitude towards change

Attendance at Lessons

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References

Barclay, E. (2013, August 20). Ramen To The Rescue: How Instant Noodles Fight Global Hunger. Retrieved April 12, 2016, from http://www.npr.org/sections/thesalt/2013/08/16/212671438/ramen-to-the-rescue-how-instant-noodles-fight-global-hunger

Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005-2006 https://wwwn.cdc.gov/Nchs/Nhanes/2005-2006/FFQRAW_D.htm.

Centers for Disease Control and Prevention. (2013). Leading Causes of Death. Retrieved from http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

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References

Chung, C. E., Lee, K. W., & Cho, M. S. (2010). Noodle consumption patterns of American consumers: NHANES 2001-2002. Nutrition Research and Practice, 4(3), 243–251. http://doi.org/10.4162/nrp.2010.4.3.243

Electronic searches were performed in Yelp! with final searches completed by April 12, 2016 . The main search strategy used the key term pizza and the location identifiers of Washington Heights, Manhattan, NY and Inwood, Manhattan, NY the results of which were 1,857 pizza shops.

Elinder, L. S., Brunosson, A., Bergstrom, H., Hagstromer, M., & Patterson, E. (2012). Validation of Personal Digital Photography to Assess Dietary Quality among People with Intellectual Disabilities. Journal of Intellectual Disability Research, 56(2), 221-226.

Holben, B. (2012). Community nutrition in action: Entrepreneurial appr. Belmont, CA: Cengage.

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References

Horowitz, C. R., Goldfinger, J. Z., Muller, S. E., Pulichino, R. S., Vance, T. L., Arniella, G., & Lancaster, K. J. (2008). A Model for Using Community-Based Participatory Research to Address the Diabetes Epidemic in East Harlem. Mount Sinai Journal Of Medicine, 75(1), 13-21. doi:10.1002/msj.20017

Jeffery, R. (1995). Community programs for obesity prevention: The Minnesota Heart Health Program. Obesity Research, 3 Suppl 2, 283s-288s.

King L, Hinterland K, Dragan KL, Driver CR, Harris TG, Gwynn RC, Linos N, Barbot O, Bassett MT. Community Health Profiles 2015, Manhattan Community District 12: Washington Heights and Inwood; 2015; 12(59):1-16

Lazarte, C. E., Encinas, M. E., Alegre, C., & Granfeldt, Y. (2012). Validation of digital photographs, as a tool in 24-h recall, for the improvement of dietary assessment among rural populations in developing countries. Nutrition Journal, 11, 61. http://doi.org/10.1186/1475-2891-11-61

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References

Lin, Biing-Hwan. Fruit and Vegetable Consumption Looking Ahead to 2020. United States Department of Agriculture: Economic Research Service; 2004; 792(7).

Ockene, I. S., Tellez, T. L., Rosal, M. C., Reed, G. W., Mordes, J., Merriam, P. A., & ... Ma, Y. (2012). Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project. American Journal Of Public Health, 102(2), 336-342. doi:10.2105/AJPH.2011.300357

Rhodes DG, Adler ME, Clemens JC, LaComb RP, Moshfegh AJ. Consumption of Pizza: What We Eat in America, NHANES 2007-2010. Food Surveys Research Group Dietary Data Brief No. 11. February 2014.

Suzuki, A., Miyauchi, M., Hattori, I., Egami, I., Wakai, K., Tamakoshi, A., Kawamura, T. (2002). Inter-observer agreement and validity of photographic dietary assessment. [Nihon Koshu Eisei Zasshi] Japanese Journal of Public Health, 49(8), 749-58.

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References

The World Bank. (2012). United States. Retrieved from http://data.worldbank.org/country/united-states

U.S. Census Bureau. (2010). Age and Sex Composition. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

U.S. Census Bureau. (2012). Median Household Income. Retrieved from https://www.census.gov/prod/2013pubs/acsbr12-02.pdf

U.S. Census Bureau. (2015). Quick Facts. Retrieved from http://www.census.gov/quickfacts/table/PST045215/00

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References

United States Department of Health and Human Services. (n.d.). Nutrition and Weight Status. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status

World Instant Noodles Association (WINA). (2015, March 13). Global Demand for Instant Noodles. Retrieved April 12, 2016, from http://instantnoodles.org/en/noodles/market.html

Appendix