HL367 Major Project Fall 2013

To increase minority communities awareness of the link between obesity and diabetes through education

Hyacinthi Mwangu

Katie Tourville

__________________________________________________________________________________________ http://www.ironmagazine.com/blog/2010/obesity-and-diabetes-immune-cells-in-fat-tissue-explain-the-link/

Table of Contents Section 1: Missionpg. 4-5 Section 2: Review of the Related Literaturepg. 6-18 Section 3: Synthesis of the Related Literaturepg. 19-27 Section 4: Evaluation Design/Mission Fitpg. 28 Section 5: Marketing and Communicationpg. 29 Section 6: Granting Agencypg. 30 Section 7: Webliographypg. 31-32 Section 8: Reflectionpg. 33-34 Section 9: Powerpoint Presentation

Introduction Hyacinthi Mwangu Hello!! I am currently a senior student at Northern Michigan University. My major is Community Health Education, and I am interested in raising awareness on issues related to obesity and diabetes in minority communities here in the USA and in Africa. I am originally from Tanzania, East Africa; however, I am newly an American Citizen trying to chase my American dream in this land of opportunities. As we know as Americans we have a rising problem of obesity and diabetes in our communities. I am interested in this topic, because my mom has diabetes and it has caused me to become passionate about this issue.

Katie Tourville I am a junior majoring in Community Health/Pre-PA. I have grown up in Marquette and lived here my whole life! I am on the NMU Dance Team and teach dance classes at New Attitudes Dance Studios. I have always had an interest in diabetes and the effects it has on the body. We decided to research how we could make people more aware of the link between obesity and diabetes, and make it a more preventable illness. Since it is such a global epidemic, we believe we will be able to make a difference through educating others from a medical standpoint, and a community health educator standpoint.

Section 1: Mission 1. What is our mission? Our mission is to increase minority communities awareness of the link between obesity and diabetes through education. 2. What are the variables in our mission? The variables are: Dependent Variable: awareness of the link between obesity and diabetes Target Population: minority communities Independent Variable: education 3. In what agency could we realize this mission? We could realize this mission in the Chicago Department of Public Health whose mission is to make Chicago a safer and healthier place by working with community partners to promote health, prevent disease, reduce environmental hazards and ensure access to health care for all Chicagoans. http://www.cityofchicago.org/city/en/depts/cdph/auto_generated/cdph_mission.html

4. What job could we have in this agency and what is the job description for that job? We would have the job as a Community Health Educator on the Chicago Board of Health. The job description of a Community Health Educator at the Chicago Department of Public Health is as follows: it shall be the duty of the board of health to be well informed regarding all matters affecting the health of the citizens of Chicago. It shall formulate policies and otherwise advise the mayor of the city and the commissioner of health on all health issues. http://www.cityofchicago.org/city/en/depts/cdph/provdrs/boh.html 4b. What is our job for this particular project? Our job is to develop a program plan and evaluation plan to meet our mission of increasing minority communities awareness of the link between obesity and diabetes through education. As such, we shall: Assess the need to increase awareness of the link between obesity and diabetes in minority communities Identify measurable objectives designed to reflect an increased awareness of the link between obesity and diabetes in minority communities Plan an evidence-based program that has shown to increase awareness of the link between obesity and diabetes in minority communities Implement the program/intervention Evaluate to see if we have met our objectives/need and increased awareness of the link between obesity and diabetes in minority communities through our program, and therefore, met our mission.

Section 2: Review of the Related Literature 5. What is our Mission (i.e. Program Goal) and the 4 Questions for Analyzing the Literature in Order to Develop our Program Plan and Evaluation Plan in order to do our job as listed in 4b? Our mission is: to increase minority communities awareness of the link between obesity and diabetes through education. The mission variables are: DV= awareness of the link between obesity and diabetes TP= minority communities IV= education The 4 Questions: To analyze the literature for relevant information, our four questions with our mission dv and tp in are: Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Question B: Does this piece theoretically define awareness of the link between obesity and diabetes? Question C: Does the piece tell us how to measure awareness of the link between obesity and diabetes? Question D: Does the piece give us a model program that has shown to increase awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?)

6. Which pieces shall we use to analyze the literature to develop our program plan and evaluation plan designed to meet our mission? We shall use the following pieces: Abate. N, and Chandalia, M. (2003, January). The impact of ethnicity on type 2 diabetes. Journal of Diabetes and its Complications. Volume 17. Issue 1. Retrieved September 28th, 2013, from http://www.sciencedirect.com/science/article/pii/S1056872702001903 Abstract: The rapid increase of diabetes prevalence in the US population and across all westernized world has been associated with environmental changes that promote obesity. Although dietary factors, such as total caloric intake, relative excess of dietary saturated fats content and lack of fibers, together with reduced level of physical activity clearly determine the main features of the obesogenic environment typical of western societies, the impact of lifestyle factors on obesity and diabetes appears to differ in various ethnic groups. Although ethnic-related differences in lifestyle factors may account for some of the predisposition to obesity and diabetes of various ethnic groups, genetic factors may play a more determinant role. These observations pose important public health questions in regard to strategies for treatment and prevention of diabetes both within the multiethnic US population and in the population of origin of various ethnicities. The elucidation of the pathophysiologic mechanisms responsible for the heterogeneous relationship between obesity and type 2 diabetes in various ethnicities may give important contributions to better understand the complex mechanisms involved in the development of this disease. This review examines epidemiological and pathophysiological aspects of the interaction between environment and ethnic predisposition to type 2 diabetes. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!!Because in this study they found that different ethnic groups living in US have high prevalence of develop obesity and type 2 diabetes compare to those who are living in their country of origin. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes?

NO! In the article they did not theoretically define the awareness, obesity or diabetes. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!! By measuring weight loss and HbA1c level. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! Through nutrition therapy for three months. American Diabetes Association. (1999). Emerging Epidemic of Type 2 Diabetes in Youth. Retrieved September 24, 2013, from http://care.diabetesjournals.org/content/22/2/345.short. Abstract: This review considers the epidemiologic evidence of an increasing incidence of type 2 diabetes in youth, the classification and diagnostic issues related to diabetes in young populations, pathophysiologic mechanisms relevant to the increasing incidence, the role of genetics and environment, and the community challenge for prevention and treatment. Type 2 diabetes in youth has been recognized to be frequent in populations of native North Americans and to comprise some 30 percent of new cases of diabetes in the 2nd decade of life, largely accounted for by minority populations and associated with obesity. Among Japanese schoolchildren, type 2 diabetes is seven times more common than type 1, and its incidence has increased more than 30-fold over the past 20 years, concomitant with changing food patterns and increasing obesity rates. The forms of diabetes seen in children and youth include typical type 1, occurring in all races; type 2, seen predominantly in minority youth; atypical diabetes, seen as an autosomal dominantly transmitted disorder in African-American populations; and maturity-onset diabetes of the young (MODY), seen rarely and only in Caucasians. Of the nonautoimmune forms of diabetes seen in youth, only type 2 diabetes is increasing in incidence. Proper classification requires consideration of onset (acute/severe versus insidious), ethnicity, family history, presence of obesity, and if necessary, studies of diabetes related autoimmunity. Insulin resistance predicts the development of diabetes in Pima Indians, in offspring of parents with type 2 diabetes, and in other high-risk populations. African-American children and youth have greater insulin responses during glucose tolerance testing and during hyperglycemic clamp study than do whites. There is also evidence of altered beta-cell function preceding the development of hyperglycemia. Of particular interest is the evidence that abnormal fetal and infantile nutrition is associated with the development of type 2 diabetes in adulthood. The thrifty phenotype hypothesis states that poor nutrition in fetal and infant life is detrimental to the development and function of the beta-cells and insulin sensitive tissues, leading to insulin resistance under the stress of obesity. The thrifty genotype hypothesis proposes that defective insulin action in utero results in decreased fetal growth as a conservation mechanism, but at the cost of obesity-induced diabetes in later childhood or adulthood. The vast majority of type 2 diabetes in adults is polygenic and associated with obesity. Monogenic forms (MODY, maternally transmitted mitochondrial mutations) are rare, but are more likely to appear in childhood. Linkage studies of the common polygenic type 2 diabetes have emphasized the heterogeneity of the disorder. The prevention and treatment of type 2 diabetes in children and youth is a daunting challenge because of the enormous behavioral influence, difficulty in reversing obesity, and typical nonadherence in this age-group. The emerging epidemic of type 2 diabetes in the pediatric population, especially among minorities whose proportion in the U.S. population is increasing, presents a serious public health problem. The full effect of this epidemic will be felt as these children become adults and develop the long-term complications of diabetes. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes, it explains that There may be lack of familiarity with recommended food items, which may be costly, difficult for families to obtain, and require special preparation (4,80). Finally, many youth who are obese nd it difficult to engage in strenuous physical activity. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? Yes, it states Children have hyperinsulinism as a result of obesity, as do adults, and childhood obesity is commonly associated with impaired glucose tolerance.

Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, it can be measured through various hormones and factors in the B-cell, such as glucokinase and amylin. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes, for treatment it suggests diet and exercise. Also, a recent study suggests that patient adherence may be facilitated if the healthcare provider actively involves the patient in developing the self-care regimen. Attia, P. (2013). Is the obesity crisis hiding a bigger problem? [video file]. Retrieved from http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html Abstract: As a young surgeon, Peter Attia felt contempt for a patient with diabetes. She was overweight, he thought, and thus responsible for the fact that she needed a foot amputation. But years later, Attia received an unpleasant medical surprise that led him to wonder: is our understanding of diabetes right? Could the precursors to diabetes cause obesity, and not the other way around? A look at how assumptions may be leading us to wage the wrong medical war. Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes, it identifies how strongly diabetes and obesity are related, and suggests that insulin resistance causes weight gain and the diseases associated with obesity. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? Yes, it defines insulin resistance as the reduced capacity of ourselves to partition fuel, taking those calories that we take in and burning some appropriately and storing some appropriately. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, it tells us to measure through our increased intake of refined grains, sugars and starches and insulin resistance. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes it is evidence-based, and it provides more of the idea of insulin resistance causing weight gain and obesity, rather than the other way around that it is normally looked at as. This model program could help this epidemic. Community Tool Box, (2013). Section 6. Using Outreach to Increase Access. Accessed October 10, 2013. http://ctb.ku.edu/en/table-of-contents/implement/access-barriers-opportunities/outreachto-increase-access/main Abstract: Outreach can be the foundation of an effort to improve the health and well-being of a population, or one component of it. In whatever measure you employ outreach, it will be most effective if you know your users and community, and are creative, trustworthy and very determined. No single outreach practice works for all initiatives. Likewise, in one initiative, what works in one community might not work in another. A broad repertoire of options increases the chances of success in an outreach effort. Practitioners of outreach identify certain factors that seem to impact success: timing; credibility and sensitivity of outreach staff; organization and publicity of the outreach effort; and the local culture and attitudes. People need to hear about your program and efforts from several different sources before they will use your service or contact you. While your initiative might not have the magical allure of the cornfield ballpark in "Field of Dreams," you can definitely build it outwards to reach those you want to serve. The better you know your potential users, the more effective your outreach will be.

Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? It doesnt specifically address this, but it provides different methods of how to increase awareness through this outreach program model. Question B: Does this piece theoretically define awareness of the link between obesity and diabetes? No, it doesnt theoretically define since it is a more generic model for community health educators to use for communities and issues. Question C: Does the piece tell us how to measure awareness of the link between obesity and diabetes? No, it doesnt measure awareness of the link between obesity and diabetes. It doesnt specify obesity and diabetes, so there is no measurement provided. Question D: Does the piece give us a model program that has shown to increase awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes, it provides an outreach model that can be used in the health community. It goes into great detail about how to plan and implement the model, as well as the most important details and actions that must take place. Dandona, P., Aljada, A., & and Bandyopadhyay, A. (2004). Trends in Immunology Inflammation: The Link Between Insulin Resistance, Obesity and Diabetes. Retrieved September 24, 2013. http://www.cell.com/trends/immunology//retrieve/pii/S1471490603003363?_returnURL=http://lin kinghub.elsevier.com/retrieve/pii/S1471490603003363?showall=true. Abstract: Recent data have revealed that the plasma concentration of inflammatory mediators, such as tumour necrosis factor- (TNF-) and interleukin-6 (IL-6), is increased in the insulin resistant states of obesity and type 2 diabetes, raising questions about the mechanisms underlying inflammation in these two conditions. It is also intriguing that an increase in inflammatory mediators or indices predicts the future development of obesity and diabetes. Two mechanisms might be involved in the pathogenesis of inflammation. Firstly, glucose and macronutrient intake causes oxidative stress and inflammatory changes. Chronic overnutrition (obesity) might thus be a proinflammatory state with oxidative stress. Secondly, the increased concentrations of TNF- and IL-6, associated with obesity and type 2 diabetes, might interfere with insulin action by suppressing insulin signal transduction. This might interfere with the anti-inflammatory effect of insulin, which in turn might promote inflammation. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? It doesnt specifically identify this need in minority communities. It is more of an informational piece describing the cause and link between diabetes and obesity. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? It defines obesity as state of chronic inammation, as indicated by increased plasma concentrations of CRP, IL-6, and PAI-1 and defines type 2 diabetes as an inflammatory condition. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? In a medical form, this piece discusses that plasma adiponectin concentration has an inverse relationship with adiposity (waist:hip ratio), insulin resistance, diastolic pressure, triglyceride concentration and TNF-a receptor concentration. This indicates that plasma adiponectin can be used a way to measure the awareness of the link between obesity and diabetes. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) No, there are not any forms of education or model programs described to be used in minority communities. DeVille-Almond J., Tahrani AA, Grant J., Gray M., Thomas GN., Taheri S. (2011). Awareness of Obesity and Diabetes: a Survey... [Am J Mens Health. 2011] - PubMed - NCBI. Retrieved September 24, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/20413385.

Abstract: Behavior modification necessary to tackle obesity and type 2 diabetes mellitus (T2DM) requires individual awareness of the existing problem. OBJECTIVES: This study aimed to assess body weight perception, awareness of the relation between adiposity and T2DM, and the relation between adiposity and weight loss attempts. METHODS: Male drivers were recruited randomly from motorway service stations between May and July 2007, completed a questionnaire and had body mass index (BMI), waist circumference (WC), and body composition. RESULTS: Participants included 266 men, median age 52 years, and BMI 28.25 kg/m2. Obesity prevalence was 46% based on BMI and 73% based on WC. Participants underestimated their WC (94.3 10.2 vs. 102.9 11.41 cm, estimated vs. actual, p < .001). Of participants with normal BMI, 18% thought they were overweight, whereas 26% of overweight thought they were "just right" and 19% of obese recognized their obesity. Based on WC, 30% of participants with normal WC thought they were obese and 9% of obese realized they were obese. Only 25% and 42% of participants recognized that T2DM is associated with large waist and obesity, respectively. A total of 81% of overweight and 62% of obese participants (based on BMI) believed that they were not at increased risk of T2DM. Self-perception of adiposity weakly predicted weight loss attempts ( = 0.28, p = .008). CONCLUSION: Male drivers significantly underestimate their adiposity and risk of T2DM. Further public education regarding obesity, its associated health risks, and the benefits of weight loss is needed. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes, it explains that behavior modification is necessary to tackle obesity and type 2 diabetes and it requires individual awareness of the existing problemit doesnt specify minority communities though. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No, it doesnt theoretically define the awareness of the link between obesity and diabetes. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, it can be measured through BMI, waist circumference and body composition were measured. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes, it states that further public education, regarding obesity, its associated health risks, and the benefits of weight loss is needed. Diabetic Care Services, (2013). A Codependent Relationship: Diabetes and Obesity. Retrieved October 10, 2013, from http://www.diabeticcareservices.com/diabetes-education/diabetes-andobesity Abstract: The International Diabetes Foundation (IDF) says that, Diabetes and obesity are the biggest public health challenge of the 21st century. The supporting statistics they cite are staggering: As of 1999, diabetes affected 16 million (six percent) of Americans an increase of 40 percent in just ten years. During the same period, the obesity rate climbed from 12 percent to almost 20 percent. Of the children born in 2000, one in three will eventually develop diabetes. Both diabetes and obesity risk factors are often associated with race, age, and family history, its becoming more and more clear that the conveniences of modern life also contribute to the development of both diseases. There is a link between obesity and diabetes. Of the people diagnosed with type II diabetes, about 80 to 90 percent are also diagnosed as obese. Being overweight places extra stress on your body in a variety of ways, including your bodys ability to maintain proper blood glucose levels. In fact, being overweight can cause your body to become resistant to insulin. Weight gain is common in people who take insulin to treat diabetes. The absorbed glucose is stored as fat, which makes you gain weight. In an effort to close the information gap, a group of researchers from The University of North Carolina at Chapel Hill

studied the metabolism process in mice. In December 2007, the group reported in Cell Metabolism that mice lacking an enzyme are lean and resistant to weight gain, even when placed on a high fat diet. To reduce the chances that you will develop diabetes, maintain a healthy weight and increase your physical activity. You may also want to try a diabetes vitamin, specially formulated for people with diabetes. If you are overweight, even a small weight loss (five to 10 percent) can prevent diabetes. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! According to diabetic care services document that, there is a need to increase awareness of the link between diabetes and obesity not only in minority but in all communities. Question B: Does the piece theoretically define awareness of the link between obesity and diabetes? Yes!! They define what obesity and diabetes are, but not awareness. Question C: Does the piece tell us how to measure awareness of the link between obesity and diabetes? Yes!! The piece measure how obesity link to diabetes, but did not talk about awareness. Question D: Does the piece give us a model program that has shown to increase awareness of the link between obesity and diabetes in minority communities? NO!! The piece did not specific talk of the program for minority community, however they talk about exercising, eating foods in high fiber, and low carbohydrates will help your body to lose weight. Fisher-Hoch. S, R. A, Wilson. G, S. J, Reininger. B, R. B, Mc Cornmik. J, and Perez, A. (2010, May, 7th). Socioeconomic Status and Prevalence of Obesity and Diabetes in a Mexican American Community, Cameron County, Texas, 2004-2007. Preventing Chronic Diseases. Public Health Research, Practice and Polices. Retrieved September 28th, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879985/ Abstract: Mexican Americans are at increased risk for obesity and diabetes. We established a cohort on the United States-Mexico border to determine the prevalence of obesity and diabetes in this Mexican American population and to see whether minor economic advantages had any effect on health. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! Mexican Americans are at increased risk for obesity and diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No! In the article they did not theoretically define the awareness, obesity or diabetes Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!! By measuring variables, including BMI, waist circumference, and fasting blood glucose and insulin by participants fasting for 10 hours before test. They used the homeostasis model assessment equation to determine insulin resistance (HOMA-IR = glucose (mg/dL)/18 insulin (mU/L)/22.5 Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! Participants have two days of engaging on medical lab test such as blood pressure, MBI, and hemoglobin A1c. Fitzgibbon. M, S.M, Dyer. A, VanHom. L and Christoffel. K. (2002, February). A CommunityBased Obesity Prevention Program for Minority Children: Rationale and Study Design for HipHop to Health Jr. Prevention Medicine. Volume 37. Issue 2. Retrieved from http://www.sciencedirect.com/science/article/pii/S0091743501909776 Abstract: Background. The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities?

Yes!! Because there are higher rates of overweight/obesity among minority women and their children. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? NO! In the article they did not theoretically define the awareness, obesity or diabetes Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes! Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. Goran. M, Ball. G and Cruz. M, (2003, April). Obesity and Risk of Type 2 Diabetes and Cardiovascular Disease in Children and Adolescents. The journal of clinical endocrinology and Metabolism. Retrieved September 28th, 2013, from http://jcem.endojournals.org/content/88/4/1417.full Abstract: Overweight/obesity continues to increase in children and adolescents, and annual obesityrelated hospital costs in 617 yr olds have reached $127 million per year. Overweight children and adolescents are now being diagnosed with impaired glucose tolerance and type 2 diabetes, and they show early signs of the insulin resistance syndrome and cardiovascular risk. Several risk factors have been identified as contributors to the development of type 2 diabetes and cardiovascular risk in youth. These factors include increased body fat and abdominal fat, insulin resistance, ethnicity (with greater risk in African-American, Hispanic, and Native American children), and onset of puberty. There is no clear explanation of how these factors increase risk, but they appear to act in an additive fashion. We hypothesize that the constellation of these risk factors may be especially problematic during the critical period of adolescent development, especially in individuals who may have compromised -cell function and an inability to compensate for severe insulin resistance. Therefore, the purpose of this paper is to review the pathophysiology of type 2 diabetes and cardiovascular risk in obese children and adolescents. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes! African-American, Hispanic, and Native American children are at great risk of being diagnosed with impaired glucose tolerance and type 2 diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? Yes!! They define obesity as a BMI above the 85th percentile for age and gender. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!! They use BMI, glucose tolerance test, insulin sensitivity and dual energy x-ray absorptiometry (DEXA). Also they use HDL and LDL levels to determine obesity and the risk for diabetes. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! The program model is education. Horowitz, C. (2004). American Public Health Association - Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities. Retrieved September 24, 2013, from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.9.1549. Abstract: Objectives. A community coalition compared the availability and cost of diabetes-healthy foods in a racial/ethnic minority neighborhood in East Harlem, with those in the adjacent, largely White and affluent Upper East Side in New York City. Methods. We documented which of 173 East Harlem and 152 Upper East Side grocery stores stocked 5 recommended foods.

Results. Overall, 18% of East Harlem stores stocked recommended foods, compared with 58% of stores in the Upper East Side (P < .0001). Only 9% of East Harlem bodegas (neighborhood stores) carried all items (vs 48% of Upper East Side bodegas), though East Harlem had more bodegas. East Harlem residents were more likely than Upper East Side residents (50% vs 24%) to have stores on their block that did not stock recommended foods and less likely (26% vs 30%) to have stores on their block that stocked recommended foods. Conclusions. A greater effort needs to be made to make available stores that carry diabetes-healthy foods. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes it identifies the need, because it evaluates the environmental disparities of those with diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? There was not a theoretical definition provided. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? There is not a measure provided; the only measure used was of the availability and cost of diabeteshealthy food. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) There was not a specific model program, just the idea of a greater effort needing to be made to make available stores that carry diabetes-healthy foods. Kumanyika, S., & Grier, S. (2006). Project MUSE - Targeting Interventions for Ethnic Minority and Low-Income Populations. Retrieved September 24, 2013., from http://muse.jhu.edu/journals/foc/summary/v016/16.1kumanyika.html. Abstract: Although rates of childhood obesity among the general population are alarmingly high, they are higher still in ethnic minority and low-income communities. The disparities pose a major challenge for policymakers and practitioners planning strategies for obesity prevention. In this article Shiriki Kumanyika and Sonya Grier summarize differences in childhood obesity prevalence by race and ethnicity and by socioeconomic status. They show how various environmental factors can have larger effects on disadvantaged and minority children than on their advantaged white peersand thus contribute to disparities in obesity rates. The authors show, for example, that low-income and minority children watch more television than white, non-poor children and are potentially exposed to more commercials advertising high-calorie, low-nutrient food during an average hour of TV programming. They note that neighborhoods where low-income and minority children live typically have more fast-food restaurants and fewer vendors of healthful foods than do wealthier or predominantly white neighborhoods. They cite such obstacles to physical activity as unsafe streets, dilapidated parks, and lack of facilities. In the schools that lowincome and minority children attend, however, they see opportunities to lead the way to effective obesity prevention. Finally, the authors examine several aspects of the home environmentbreastfeeding, television viewing, and parental behaviorsthat may contribute to childhood obesity but be amenable to change through targeted intervention. Kumanyika and Grier point out that policymakers aiming to prevent obesity can use many existing policy levers to reach ethnic minority and low-income children and families: Medicaid, the State Child Health Insurance Program, and federal nutrition "safety net" programs. Ultimately, winning the fight against childhood obesity in minority and low-income communities will depend on the nation's will to change the social and physical environments in which these communities exist. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes it does, because it states Preventing obesity for all children may be a way to reduce socioeconomic and ethnic health disparities. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes?

Yes, it defines it through expressing Obesity-related diseases seen in children include precursors of cardiovascular disease, type 2 diabetes, and sleep-disordered breathing. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, one of the measures provided in reference to the frequency of youth eating at fast food restaurants compares body weight in kilograms. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes it does, because it explains Because ethnic minority and low-income children are exposed to more media than other children, policies that improve marketing and advertising may be most beneficial for these groups of children. Researchers have also suggested that schools can reduce the negative effects of advertising on minority and low-income children by teaching media literacy courses that make children aware of the many messages they receive daily from the media and how those messages can affect their attitudes and behavior. Lipton. R, D. M, Burnet. D, R. B, Cooper. A, B. E, and Hagopian. W. (2005, May 1st). Obesity at the Onset of Diabetes in an Ethnically Diverse Population of Children: What Does It Mean for Epidemiologists and Clinicians? Journal of the American Academy of Pediatrics. Retrieved September, 28th, 2013, from http://pediatrics.aappublications.org/content/115/5/e553.full#contentblock Abstract: It is often difficult to determine the pathophysiology of childhood diabetes at onset, particularly in overweight children, because obesity has been associated with both type 1 and type 2 diabetes. We compared children at the diagnosis of diabetes in a multiethnic population-based registry to understand the epidemiology of the disease during a time of rapidly changing diagnostic and treatment norms. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! There are increasing number of children with obesity and type 2 diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No! In the article they did not theoretically define the awareness, obesity or diabetes Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!! They use medical record to determine obesity and diabetes among minority children. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! Through education. Mokdad, A., Bowman, B., Ford, E.,Vinicor, F., Marks, J., Koplan, J. (2001). JAMA Network | JAMA | The Continuing Epidemics of Obesity and Diabetes in the United States. Retrieved September 24, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=194179. Abstract: Evidence from several studies indicates that obesity and weight gain are associated with an increased risk of diabetes. Each year, an estimated 300 000 US adults die of causes related to obesity. Obesity also substantially increases morbidity and impairs quality of life. Overall, the direct costs of obesity and physical inactivity account for approximately 9.4% of US health care expenditures. The direct and indirect costs of health care associated with diabetes in 1997 were an estimated $98 billion. We recently reported that the prevalence of obesity among US adults (body mass index [BMI; calculated as weight in kilograms divided by the square of height in meters] 30 kg/m2), based on selfreported weight and height, increased from 1991 to 1999, and that the prevalence of diagnosed diabetes based on self-reported data increased from 1990 to 1999. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) in 2000 to examine whether these increases in obesity and diabetes are continuing, the prevalence of attempting to lose or maintain weight, and the strategies used by the US adults to lose or maintain weight.

Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes, it identifies the issues of death, impaired quality of life, and direct costs of health care related with obesity and weight gain. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? Yes, they are defined as major causes of morbidity and mortality in the United States. Although this provides somewhat of a definition, it isnt very thorough. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, it was measured through body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes, it gives us a model program that involves increasing physical activity, improving diet, and sustaining these lifestyle changes can reduce the risk of both diabetes and increased weight. Yes, it is evidence-based, because the percentages of US adults changing these factors are provided. Nevins, S., and Hoffman, J. (2012, May 10th). The Weight of the Nation: Children in Crisis. Top Documentary Films. Retrieved from http://topdocumentaryfilms.com/weight-nation-childrencrisis/ Abstract: Childhood obesity is much more than a cosmetic concern. The health consequences of childhood obesity include greater risk of heart disease, type 2 diabetes, high blood pressure, asthma and other serious illnesses. The combination of these health effects and the dramatic increase in childhood obesity rates over the past three decades causes some experts to fear this may be the first generation of American children who will have a shorter life expectancy than their parents. Strategies like cutting out TV and sugar-sweetened drinks may help reduce a childs weight or prevent future weight gain, but not always for the reasons we expect. There is a link between TV watching and overweight and obesity among children. While the act of watching TV being sedentary and possibly eating snacks while taking in a favorite show is part of the problem, experts are now looking at what kids watch as well. There is a growing debate over the effects of food marketing on the childhood obesity epidemic and what should be done about it. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! The documentary shows that, many parents are not aware of their children being obese because they are eating unhealthy meals, long hours of watching TV, and lack of exercises put those children on high risk of developing type 2 diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? Yes!! They define obesity as measure of height to age and weight to age. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!!How much the children are losing weight, eating healthy and doing exercises. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!!Through education program model. Obrosova. I, Ilnytska . O, Lyzogubov. V, Pavlov. I, Mashtalir. N, and Drel. D http://diabetes.diabetesjournals.org/content/56/10/2598.short Abstract: Subjects with dietary obesity and pre-diabetes have an increased risk for developing both nerve conduction slowing and small sensory fiber neuropathy. Animal models of this type of neuropathy have not been described. This study evaluated neuropathic changes and their amenability to dietary and

pharmacological interventions in mice fed a high-fat diet (HFD), a model of pre-diabetes and alimentary obesity. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? No!! Because they did research on mice Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No!! They did not define obesity or diabetes Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? No!! They did their measurements on mice then relate to human. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! Through education. Oldroyd. J, Banerjee. M, and Heald. A, (2005, September, 18th). Diabetes and ethnic minorities. Postgraduate Medical Journal. Volume 81, Issue 958 . Retrieved September, 28th, 2013, from http://pmj.bmj.com/content/81/958/486.full.html#ref-list-1 Abstract: The global prevalence of diabetes for all age groups is estimated to be 2.8%. Type2 diabetes accounts for at least 90% of diabetes worldwide. Diabetes incidence, prevalence, and disease progression varies by ethnic group. This review highlights unique aspects of the risk of developing diabetes, its overwhelming vascular complications, and their management mainly using data among South Asians and African-Caribbeans in the UK but also using non-UK data. It is concluded that although the origin of the ethnic differences in incidence need further clarification, many factors should be amenable to prevention and treatment in all ethnic groups worldwide. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! Ethnic groups are at high risk of developing obesity and diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No! In the article they did not theoretically define the awareness, obesity or diabetes. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes!! They measure fasting plasma glucose or HbA1c, blood pressure and cholesterol HDL, and LDL. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! They follow the patients for nine years to check their healthy status. Ornish, D. (2013). The killer American diet that's sweeping the planet [video file]. Retrieved from http://www.ted.com/talks/dean_ornish_on_the_world_s_killer_diet.html Abstract: Stop wringing your hands over AIDS, cancer and the avian flu. Cardiovascular disease kills more people than everything else combined -- and its mostly preventable. Dr. Dean Ornish explains how changing our eating habits will save lives. Dean Ornish is a clinical professor at UCSF and founder of the Preventive Medicine Research Institute. He's a leading expert on fighting illness -- particularly heart disease with dietary and lifestyle changes. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes it does, because he compares the globalization effect we could have if we increased this awareness. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No, there is not a theoretical definition. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, it is measured through diet and exercise.

Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes, he has worked with big companies like McDonalds to provide healthier foods like salads for the population, in hopes that this will help lower the numbers of those who are obese and have diabetes. It is not specifically evidence-based, but the numbers of those suffering obesity are evidence-based. Rushing Josh. (2012, October, 9th). Fast Food, Fat Profits: Obesity in America. Top Documentary Film. Retrieved from http://topdocumentaryfilms.com/fast-food-fat-profits-obesity-america/ Abstract: Obesity in America has reached a crisis point. Two out of every three Americans are overweight, one out of every three is obese. One in three are expected to have diabetes by 2050. Minorities have been even more profoundly affected. African-Americans have a 50 per cent higher prevalence of obesity and Hispanics 25 per cent higher when compared with whites. How did the situation get so out of hand? Josh Rushing explores the world of cheap food for Americans living at the margins. What opportunities do people have to eat healthy? Who is responsible for food deserts and processed food in American schools? Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Yes!! He shows how minorities have been more affected by obesity and put them on high risk of developing type 2 diabetes. Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes? No!! They did not define obesity and diabetes. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes! If people start to eat healthy and stop buying unhealthy food. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes!! Through education entertainment. Shimabukuro, M. (1998). Fatty Acid-induced Cell Apoptosis: A Link Between Obesity andDiabetes. Retrieved September 24, 2013, from http://www.pnas.org/content/95/5/2498.short. Abstract: Like obese humans, Zucker diabetic fatty (ZDF) rats exhibit early cell compensation for insulin resistance (4-fold cell hyperplasia) followed by decompensation (>50% loss of cells). In prediabetic and diabetic ZDF islets, apoptosis measured by DNA laddering is increased 3- and >7-fold, respectively, compared with lean ZDF controls. Ceramide, a fatty acid-containing messenger in cytokine-induced apoptosis, was significantly increased (P < 0.01) in prediabetic and diabetic islets. Free fatty acids (FFAs) in plasma are high (>1 mM) in prediabetic and diabetic ZDF rats; therefore, we cultured prediabetic islets in 1 mM FFA. DNA laddering rose to 19.6% vs. 4.6% in lean control islets, preceded by an 82% increase in ceramide. C2-Ceramide without FFA induced DNA laddering, but fumonisin B1, a ceramide synthetase inhibitor, completely blocked FFA-induced DNA laddering in cultured ZDF islets. [3H]Palmitate incorporation in [3H]ceramide in ZDF islets was twice that of controls, but [3H]palmitate oxidation was 77% less. Triacsin C, an inhibitor of fatty acyl-CoA synthetase, and troglitazone, an enhancer of FFA oxidation in ZDF islets, both blocked DNA laddering. These agents also reduced inducible nitric oxide (NO) synthase mRNA and NO production, which are involved in FFA-induced apoptosis. In ZDF obesity, cell apoptosis is induced by increased FFA via de novo ceramide formation and increased NO production. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? No, it doesnt identify the need to increase awareness. It is an experiment that explores the link, but not one that tries to achieve awareness in minority communities Question B: Does this piece theoretically define the awareness of the link between obesity and diabetes?

Yes, it states that There is compelling in vitro evidence that the modest 5- to 10-fold increase in islet fat content that occurs in vivo in the prediabetic phase of the disease causes the compensatory b cell hyperplasia and hyperinsulinemia; a further increase in islet fat to ;50 times normal reverses the foregoing compensatory changes and causes b cell dysfunction, a reduction in the number of b cells, and diabetes. Question C: Does the piece tell us how to measure the awareness of the link between obesity and diabetes? Yes, through the experimentation with rats, it states Elevated levels of circulating FFA (4) and lipoproteins transport to islets of obese ZDF rats far more FFA than can be oxidized. Question D: Does the piece give us a model program or education that has shown to change the awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Yes a model program of prophylactic interventions is suggested in the conclusion of the experiment, for they state It is therefore possible that prophylactic interventions that reduce fat accumulation and NO production in islets will prevent the anticipated epidemic of obesity associated NIDDM in the U.S. This is evidence-based. In addition, we used an article dealing with The Model for Healthy Living from Church Health Center. (Church Health Center, 2010). Model for Healthy Living. Retrieved November 19, 2013 from, http://chreader.org/contentPage.aspx?resource_id=621.

Section 3: Synthesis of the Literature Mission: Our mission is to increase minority communities awareness of the link between obesity and diabetes through education. Question A: Does this piece identify need to increase awareness of the link between diabetes and obesity in minority communities? Question B: Does this piece theoretically define awareness of the link between obesity and diabetes? Question C: Does the piece tell us how to measure awareness of the link between obesity and diabetes? Question D: Does the piece give us a model program that has shown to increase awareness of the link between obesity and diabetes in minority communities? (Is it evidence-based?) Assessing General Need (Literature Review) to Change DV in TP 1. What is the need for our mission? Please synthesize the literature for the first question under each abstract from Section 2 showing general need for your mission. The need is explained in that, There may be lack of familiarity with recommended food items, which may be costly, difficult for families to obtain, and require special preparation (4,80). Finally, many youth who are obese nd it difficult to engage in strenuous physical activity (American Diabetes Association, 1999). It is identified how strongly diabetes and obesity are related, and suggests that insulin resistance causes weight gain and the diseases associated with obesity (P. Attia, 2013). It is explained that behavior modification is necessary to tackle obesity and type 2 diabetes and it requires individual awareness of the existing problemit doesnt specify minority communities though( J. DeVille-Almond, AA Tahrani, J. Grant, M. Gray, GN. Thomas, S. Taheri, 2011). It evaluates the environmental disparities of those with diabetes (C. Horowitz, 2004). It is stated, Preventing obesity for all children may be a way to reduce socioeconomic and ethnic health disparities (S. Kumanyika & S. Grier, 2006). It identifies the issues of death, impaired quality of life, and direct costs of health care related with obesity and weight gain (A. Mokdad, B. Bowman, E. Ford, F. Vinicor, J. Marks, J. Koplan, 2001). The globalization effect we could have, if we increased this awareness, is described (D. Ornish, 2013). Abate Nicola, Chandalia, and Manisha document that, different ethnic groups living in US have high prevalence of develop obesity and type 2 diabetes compare to those who are living in their country of origin (A. Nicola & C. Manisha, 2013). According to diabetic care services document that, there is a need to increase awareness of the link between diabetes and obesity not only in minority but in all communities (Diabetic Care Services, 2013). Mexican Americans are at increased risk for obesity and diabetes (Fisher-Hoch. S, Rentfro. A, Wilson. G, Salinas. J, Reininger.B, Restrepo. B, Mc Cornmik. J, and Perez, A, 2010). African-American, Hispanic, and Native American children are at great risk of being diagnosed with impaired glucose tolerance and type 2 diabetes (Goran. M, Ball. G and Cruz. M, 2003). There are increasing number of children with obesity and type 2 diabetes in ethnic groups (Lipton. R, Drum. M, Burnet. D, Rich. B, Cooper. A, Baumann. E, and Hagopian, 2005). Ethnic groups which are minorities are at high risk of developing obesity and diabetes (Oldroyd. J, Banerjee. M, and Heald. A, 2005). Many parents are not aware of their children being obese because they are eating unhealthy meals, long hours of watching TV, and lack of exercises put those children on high risk of developing type 2 diabetes (S. Nevins and J. Hoffman, 2012). Minorities have been more affected by obesity and put them on high risk of developing type 2 diabetes (J. Rushing, 2012).

Theoretical Definition of DV 2. For the second question under each abstract, what is the way we will theoretically define our dv? Having knowledge of the link between obesity, an excessive amount of body fat which increases your risk of illness, and diabetes, a group of diseases that affects how your body uses blood glucose (Mayo Clinic, 2013). This knowledge includes: 1) knowing what obesity is; 2) knowing what diabetes is and its forms; 3) knowing of the increased risk of diabetes with obesity; 4) knowing the mechanism for the link between obesity and diabetes; and 5) knowing what to do to prevent diabesity (Diabetic Care Services, 2013) (P. Hogan, 2013). http://www.thefreedictionary.com/awareness http://www.mayoclinic.com/health/obesity/DS00314 http://www.mayoclinic.com/health/diabetes/DS01121 http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity 7a. How can we model the theoretical definition for our DV? This model should totally reflect the words/concepts from 7a.

Awareness of the link between obesity & diabetes -having knowledge of the relationship between being obese (an excessive amount of body fat which increases your risk of illness) and diabetes (a group of diseases that affects how your body uses glucose). This involves knowing what obesity is, what diabetes is and its forms are, what the relationship between the two is, what the mechanism is, and ways to prevent diabesity, a combination of obesity and diabetes. (Mayo Clinic, 2013) (Free Dictionary, 2013) (Diabetic Care Services, 2013)

Knowing what obesity is

Knowing the mechanism for the relationship between obesity and diabetes

1. Knowing what

. diabetes and its 2. Test forms are

Knowing the relationship between obesity and diabetes

Knowing how to prevent diabesity (diabetes and obesity)

Assessing Specific Need (Finding a valid test to measure DV in specific TP) 8. A test is valid if it measures what it says it will measure, and we say we will measure our dv as theoretically defined. Show the test that we developed or that we found from the literature for our dv. Also include the evaluation data: what is good, poor test score, etc. We would make a test to see how much knowledge they have over the topics of obesity and diabetes, and if they have the knowledge of the mechanism for the link between obesity and diabetes. We would make a test, shown below, to see if these dependent variable concepts are demonstrated and understood. This test would take place at a church of a minority community in Chicago. There would be a control group (a church), and a program group (a different church in the community). This test would then be taken again as a post-test in hopes of increasing their individual scores.

Test 1) 2) 3) 4)

What is obesity? (10 points) What is diabetes? (10 points) Is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk. (5 points) What to do to prevent obesity and diabetes? (15 points)

Answers to Test 1) Obesity is: having too much body fat which causes one to have a higher health risk 2) Diabetes is: a group of diseases that affect how your body uses sugar in the blood 3) Yes, there is an increased risk of diabetes if you are obese. This is because: if you are overweight, this causes more stress on your body. It can affect your ability to maintain the right amount of sugar in the blood, therefore increasing your risk of diabetes. 4) To prevent obesity and diabetes, exercising 30 minutes a day and eating properly are very important. It would be helpful to eat a high fiber, low carbohydrate diet. The awareness of the link between obesity and diabetes could be measured through our test. If they score: 10-20/40: poor understanding of the link between obesity and diabetes 21-30/40: moderate understanding of the link between obesity and diabetes 31-35/40: good understanding of the link between obesity and diabetes 36-40/40: excellent understanding of the link between obesity and diabetes 8a. Test Validity: Argue that our test has content validity, that it actually measures our dv per the theoretical definition of the dv. Our test will measure the awareness of the link between diabetes and obesity per our theoretical definition listed above. Our test consists of four questions, which are testing the individuals awareness, or knowledge of, each aspect which includes obesity, diabetes, the increased risk of diabetes if you are obese, and how to prevent obesity and diabetes (diabesity). Our theoretical definition includes all of these aspects; therefore our test has content validity, and actually measures our DV per the theoretical definition of the DV. 8b. How would we develop test-retest reliability (test consistency) for our test? We could measure our test in two different areas of minority communities in Chicago. It would take place in a different church in each of these locations, on a Tuesday and Thursday of the same week. The test results should be the same in both areas of Chicago. This would demonstrate that we have test-retest reliability (test consistency), as the results will be the same on Tuesday and Thursday. Identifying Measurable Objectives (using valid test to determine how much of your DV is in your TP) 8c. Pretend we gave our test in a pretest situation for the tp. Please identify at least 4 measureable objectives using the proper format (i.e., Ms. Jones will lose 10 lbs by the end of the 10 wk program). Participants will score at least a 9/10 on question 1 (what is obesity?) by the end of the 8 week program. Participants will score at least a 9/10 on question 2 (what is diabetes?) by the end of the 8 week program. Participants will score at least a 4/5 on question 3 (is there an increased risk of diabetes if you are obese? Explain why/why not there is an increased risk) by the end of the 8 week program. Participants will score at least a 14/15 on question 4 (what to do to prevent obesity and diabetes?) by the end of the 8 week program. Planning an Evidence-Based Program and Implementation Plan 9. Synthesize the literature relative to all the program models we found that were effective in changing our dv in a tp. Please identify and briefly explain each of the program models we found in question 4 under the abstracts. Is there evidence they are valid/effective?

An evidence-based model provides more of the idea of insulin resistance causing weight gain and obesity, rather than the other way aroundin which the issue is normally viewed. This model program could help this epidemic (P. Attia, 2013). Kumanyika and Griers program model is effective as it explains, Because ethnic minority and lowincome children are exposed to more media than other children, policies that improve marketing and advertising may be most beneficial for these groups of children. Researchers have also suggested that schools can reduce the negative effects of advertising on minority and low-income children by teaching media literacy courses that make children aware of the many messages they receive daily from the media and how those messages can affect their attitudes and behavior, (S. Kumanyika & S. Grier, 2013). For treatment, diet and exercise are suggested. Also, a recent study suggests that patient adherence may be facilitated if the healthcare provider actively involves the patient in developing the self-care regimen (American Diabetes Association, 1999). Further public education, regarding obesity, its associated health risks, and the benefits of weight loss are ways we can maintain our health (J. DeVille-Almond, AA Tahrani, J. Grant, M. Gray, GN. Thomas, S. Taheri, 2011). Mokdad, Bowman, and others give us a model program that involves increasing physical activity, improving diet, and sustaining these lifestyle changes can reduce the risk of both diabetes and increased weight. Yes, it is evidence-based, because the percentages of US adults changing these factors are provided (A. Mokdad, B. Bowman, E. Ford, F. Vinicor, J. Marks, J. Koplan, 2001). Diet and exercise are important factors of the program model. (D. Ornish, 2013). An outreach model is provided that can be used in the health community. It goes into great detail about how to plan and implement the model, as well as the most important details and actions that must take place (Community Tool Box, 2013). Education to public through work places and communities infrastructures that promote healthy diet and physical activity and rewards weight maintenance (A. Nicola & C. Manisha, 2013). An education program is a model that was described for reducing chances of diabetes (Diabetic Care Services, 2013). Educating the community and improving their social and economic status of the people by opening more job marketing (Fisher-Hoch. S, Rentfro. A, Wilson. G, Salinas. J, Reininger.B, Restrepo. B, Mc Cornmik. J, and Perez, A, 2010). Education about healthy eating help to prevent obesity and diabetes (Goran. M, Ball. G and Cruz. M, 2003). Through education model to young black and Latino youth (Lipton. R, Drum. M, Burnet. D, Rich. B, Cooper. A, Baumann. E, and Hagopian, 2005). Opening more availability to access to health care will reduce diabetes and obesity in minorities (Oldroyd. J, Banerjee. M, and Heald. A, 2005). Physical activities and healthy diet help to prevent minorities to get diabetes and obesity (S. Nevins and J. Hoffman, 2012). Educating people through medial by showing how fast food affects minority and low income people; showing healthy eating and physical activities help in preventing obesity and diabetes (J. Rushing, 2012). The Model for Healthy Living visually illustrates how the seven key dimensions (faith, medical, emotional, friends & family, nutrition, movement, and work) of our body-and-spirit experience overlap at the core of our lives. (The Church Health Center, 2010)

9b. Based on the literature review, which program model from #9 will we use? Identify the model and then go into very specific detail about what it is, what we will cover, and how we will implement it. This is the program model we will use to try to change our DV. We will use the Outreach Model (Community Tool Box, 2013), and the Model for Healthy Living (The Church Health Center, 2010). Outreach is reaching out, but the type and degree of outreach depends on an

efforts purpose, goals and target population. We are reaching out to minority communities in Chicago, our target population. The participants in our program must know that the program exists, be willing to use it, and have access to it. We need to make sure that the minority communities have access to the church at convenient times of the day for the individuals. They also must have transportation to the church; rides can be coordinated to get to the church, or we could work with a local taxi company to provide reduced fare rides. Another factor involves not all individuals being literate. If there is some of our target population who cannot read or write, we will have helpers to read the information or write the answers for them on their tests. Once we have begun our program, it will last for eight weeks to ensure they have awareness of the link between obesity and diabetes. We will make sure to have sustained interaction with our target population at the churches. When executing our program, based off of the Model for Health Living (The Church Health Center, 2010), we will focus on the 7 factors of the model: faith, movement, medical, work, emotional, nutrition, and friends and family. Based off of these factors, we have created a program that is based on what diabetes and obesity are, how they are related, and what to do to prevent them. We incorporated all of these aspects together to formulate our 8 week program. We can educate in smaller groups so there is more interaction. This will ensure that they really understand and have a better awareness of the link between diabetes and obesity. Our personal approach will be empowering our target population, showing that we care for them by increasing their knowledge and awareness. As community health educators, we will possess communication skills, interpersonal skills, service coordination skills, capacity building skills, teaching skills, organizational skills, and a knowledge base. In order to implement effective outreach: we will meet people where they are, be respectful, listen to the communities, build trust and relationships, get the word out in a non-stigmatizing manner, offer service and information in a variety of locations and at non-traditional times, especially after work hours, make written information friendly and easy to understand, provide information in the primary language of those who will use the service, and make sure to follow-up. Keeping in mind that people need to hear about something three to seven times before they act, our outreach will be varied and constant. Repeating information is very important to make it the most effective possible (Community Tool Box, 2013). This image is the Model for Healthy Living from the Church Health Center (The Church Health Center, 2010).

Model Program-The Church Health Center: Model for Healthy Living (Church Health Center, 2010) Introduction: Living healthy lives doesn't just mean that you see the doctor regularly. Rather, healthy living means that all aspects of your life are in balance. Your faith, work, nutrition, movement, family and friends, emotions and medical health all contribute to a life filled with more joy, more love and more connection with God. The Model for Healthy Living visually illustrates how these seven key dimensions of our body-and-spirit experience overlap at the core of our lives. Faith Life: Building a relationship with God, your neighbors, and yourself. We have moved a universe away from seeing faith as an important part of health, and its time to bring the two back together. This affirms that we are body-and-spirit beings created and loved by God. Even if you dont consider yourself religious, you can explore a richer faith life and enjoy the benefits this experience will bring to your overall wellness.

Our Program Model: Diabesity Awareness Program Week 1 Introduction: Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. On Tuesday, collect pre-test data on knowledge of obesity and diabetes. Confirm that the participants have access to the church; arrange different methods of transportation if necessary. On Thursday, show them the pre-test results and motivate them to want to learn about the material (nutrition, movement, and medical health) throughout our outreach program. Week 2 Focusing on a relationship with themselves: the link between their body and their health Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. In the church setting, we will establish a link between their body and health, and the importance of how these two relate. Educate on the topic of obesity. What is obesity? How do you become obese? How does obesity affect your body? We will focus on these aspects of the topic, and use these questions to enhance their understanding. On Tuesday, we will separate them into small groups so they feel comfortable sharing their knowledge or lack of knowledge. The small groups will be more effective in their understanding in the long run. On Thursday, we will review and meet as an entire group to discuss these three questions and obesity more in depth. We will show an informational video on obesity as well, so they have a visual of what it is. Week 3 Medical Aspects of Diabetes Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. As diabetes is an important factor of medical care, we will explore this topic in detail. Since they may not

Medical: Partnering with your healthcare provider to manage your medical care. You are the expert in your own health care. Your doctor is your partner. Yes,

doctors have education, training, and experience you dont have, but you know yourself better than any doctor ever will. When it comes to your medical care, you bring something important to the conversation. You can build a partnership with your health care provider that lets you participate in managing your medical care.

have healthcare providers, we will help aid their knowledge of diabetes. Educate on the topic of diabetes. What is diabetes? How do you get diabetes? How does diabetes affect your body? On Tuesday, we will separate into the same small groups as Week 2 and discuss these three questions. On Thursday, we will review and meet as an entire group to discuss these questions more in depth. We will bring in 10 different foods, all varying in sugar content. We will ask them to rank the foods from least amount of sugar to most amount of sugar. Then explain how sugar (such as high fructose corn syrup) is a large contributor to diabetes. Week 4 Emotional: Managing your weight to address diabetes issues. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. We will help them understand the connection between obesity and diabetes in relation to their stress, emotions, and feelings. Educate on the how obesity and diabetes are related. Does the increase of one factor influence the other? Is it dangerous to your health to be both obese and diabetic? On Tuesday, we will separate into the same small groups and discuss these questions above, exploring the relationship between obesity and diabetes. On Thursday, we will review and meet as an entire group to make sure they understand the relationship between obesity and diabetes. We will show the movie Weight of the Nation. This displays how fast food affects our health and how it can put you at risk for diabetes, due to obesity. Week 5 The Role of Family/Friends and environment in diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on how to prevent obesity and diabetes, in regards to the power of a support system of family and friends. What can we do to prevent them from occurring? What lifestyle changes can we make? What are ways we can make these lifestyle changes have longevity and be consistent?

Emotional: Managing stress and understanding your feelings to better care for yourself. Its pretty easy to turn to unhealthy habits in response to stress in our lives. For many people, that habitwhether food, mindless television, excessive spending, alcohol, or something else makes us momentarily feel better even though we know its bad in the long term. Through understanding your feelings and emotional needs, you can make changes to take better care of yourself and manage stress in healthier ways.

Friends & Family: Giving and receiving support through relationships. God, Jesus, and Holy Spirit were the very first relationship. Even God exists in community. Coping with life is sometimes hard, but friends and family make it easier. You can both give and receive support through the relationships in your life.

On Tuesday, we will separate into the same small groups and discuss these questions above, and see what ideas the group members have in order to prevent diabetes and obesity from occurring. On Thursday, we will review and meet as an entire group to hear what ideas were discussed on Tuesday. We will explore as a group how to make these ideas into permanent lifestyle changes. Also, we will focus on commitment to yourself and internal and/or external motivators (such as family and friends). Week 6 Making smart food choices in preventing/managing diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on one of the main ways to prevent obesity and diabetes, which is nutrition. What is nutrition? How does it pertain to what I eat every day? On Tuesday, we will separate into the same small groups and discuss the importance of nutrition and the food we consume. We will ask them to log their meals from the previous day, then share with the group what that consists of. We will explore alternatives of some of the more unhealthy foods they are eating. On Thursday, we will review and meet as an entire group to address as a group the important factors of nutrition. We will play This or That? where we have two different foods in which they decide what the healthier alternative is. After the alternative is known, we will explain why that alternative is beneficial and an option they should consider. Week 7 Movement: making healthy physical activity choices for preventing/managing your diabetes. Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. Educate on one of the other main ways to prevent obesity and diabetes, which is exercise, or movement. What is exercise? What are different ways we can exercise? Why is exercise beneficial to our health? What safety/health concerns do we need to be aware of before we exercise? On Tuesday, we will separate into the same small groups and discuss the questions above; making sure each member understands exercise and its benefits, but

Nutrition: Making smart food choices and developing healthy eating habits. Good nutrition builds strong bodies that can lead to being whole people better connected to God. What you eat matters. Whatever your eating habits are now, you can increase your understanding of how food affects your overall well-being, learn to make smart food choices, and develop healthy eating habits.

Movement: Discovering ways to enjoy physical activity. We were created to move. When you consider the way the parts of the body are hinged together and rotate and reach in every direction, its easy to see that God means for us to move. Its part of how we celebrate our body-and-spirit connection to God. No matter what your physical activity level is now, you can discover ways to enjoy movement.

also the safety concerns that accompany it. On Thursday, we will review and meet as an entire group to make sure everyone understands the importance of exercise and safety while exercising. Then we will talk about different ways to exercise and the benefits of exercising with others, such as friends or family. We will teach a few simple stretching techniques as well for their warm-up and cool-down to exercising. Week 8 Wrap Up: Review of previous weeks... Meet Tuesday and Thursday for 1 hour each, for a total of 2 hours per week. On Tuesday, we will review as an entire group the topics we have covered over the last 7 weeks. As we are reviewing, we will help them appreciate the learning they have accomplished, and the work they have put in to do so. The topics will include: what is obesity, what is diabetes, how are obesity and diabetes related, and how can we prevent obesity and diabetes? We can play jeopardy as a fun game to keep everyone engaged in the material. On Thursday, we will conduct post-test and collect results.

Work: Appreciating your skills, talents, and gifts. We were made to work, and the value of work is intrinsic. You can appreciate the skills, talents, and gifts you bring to your work situation, whatever it is. You can find meaning for your life through your job or volunteer commitments.

9C. What apps are out there that would help us with our programming? Id and explain and link to them. Virtual Gastric Band Hypnosis-Lose Weight Fast is an app that features 6 unique sessions of relaxing hypnotherapy, food photo diary and water diary (track your daily meals and water intake, before and after photo record, 100 weight loss tips eBook, and a free Facebook support group of other successful users online. It can be found for $6.99 at https://itunes.apple.com/us/app/virtual-gastric-bandhypnosis/id504835984?mt=8. Diabetes Nutrition & Diet Tracker is an app that discovers and discusses the best foods to help you manage your diabetes/low carb diet. It features carbs, net carbs, and diabetes specific advice for over 200,000 products, healthier alternatives that are low carb/diabetes friendly, GMO info, support, and personalized ratings for pregnancy, lactation, heart health, low cholesterol, hypertension, vegetarian, and vegan profiles. It can be found for $9.99 at https://itunes.apple.com/us/app/diabetes-nutrition-diettracker/id545282286?mt=8. 9d. First do NO harm and then do good. What safety considerations for our program are there? Explain. We do not have any specific safety concerns. Their transportation is covered on their own, not affecting our education and awareness program. The church, the location of the program, has their own insurance in covering the people and creating a safe environment. Our intervention is specifically a mental activity. The only harm we may do is hurting someones feelings about not having a good awareness, after they have taken the pre-test.

9e. Social Cognitive Theory Light says people are more likely to engage the prescribed program behaviors if they know what to do (change the dv), know how to do it (enact your program), want to do it (are motivated), believe they can do it (have good self-efficacy), and have a supportive environment. How would we determine that: Our tp knows what to do? We will ask our tp if they know that they should be aware of the link between obesity and diabetes. We will explain our program and how it will increase their awareness of this link. Our tp knows how to do it? We will explain the structure of our program, meeting for 8 weeks, twice a week on Tuesday and Thursday for an hour each. It will take place at a church in Chicago. Our tp wants to do it (is motivated)? We will give them incentive to want to learn and have an increased awareness. We can apply the information to their family and friends that may suffer diabetes or obesity, and cause them to want to help these individuals live longer and happier lives. Our tp believes it can do it (is self-efficacious)? We will empower them to want to learn and increase their awareness. We will use positive reinforcement to motivate them. Our tp has a supportive environment? The members of the church, priests, family and friends, employees of the health department, and us as community health workers will all provide a supportive environment. We will explain they have enough support succeed through the program, and get through any barriers of the environment.

Section 4: Evaluation Design/Mission Fit 10. What evaluation design will we use? Please show it in Os and Xs and label each group if we use the control group and label what each O and X is. Document whose program model we are using. Pre-Test On Diabesity Awareness Test Program Group: Results: 10/40 Intervention Post-Test On Diabesity Awareness Test

Results: 36/40

-Outreach Model (Community Tool Box, 2013) -Model for Healthy Living (Church Health Center, 2010) Control Group: Results: 10/40

Results: 10/40

11. Internal validity has to do with your ability to say that your IV/intervention/program caused the change in the DV, and not something else. What threats to internal validity accompany the evaluation design we selected in #10? Identify and briefly explain. The threats to internal validity that may accompany our evaluation design since they are not randomized are selection of our program and control groups. Since they are picked to be in the group, they could decide to not participate or alter their results. It is voluntary to participate in our program model. 12. Evaluation in program planning is about mission fit. What is our mission fit question and what is the evidence that we met our mission? Our mission fit question is: Did we increase the awareness of the link between diabetes and obesity in minority communities? Our evidence that we met our mission is that the scores in the program group increased, as they were supposed to. The program group went from receiving a 10/40 on the pre-test, to receiving a 36/40 on the post-test. And the control group did not change, so our program made the difference.

Section 5: Marketing and Communication 13. How can we use social media or traditional media to market our program (make our target population aware that it exists and make them want to come to the program)? Develop at least one marketing tool related to our program and show it/and link to it. Place our agency logo on the material. We would market through posters/flyers posted around the city with visuals to make those aware in the churches of our education program. Our social marketing campaign can be executed through the radio, television newscasts, or the newspapers. We could display posters and pass out flyers with images that convey our education program; we would give this to the priest as well to hand out. The goal of our marketing will be to increase awareness of the link between obesity and diabetes.

14. How can you use social media or traditional media to communicate with the members in our program about the program? Develop at least one communication tool related to our program and show/link to it. Please place the agency logo on our material. Because were dealing with a minority and low-income population, computers wont be accessible. Therefore, Facebook and other social media wouldnt be as effective for communicating throughout our program. We would communicate with local radio stations and newspapers. We could have a local television channel through the church we are working at in Chicago, aid in communicating with the members in our group.

Section 6: Granting Agency 15. Identify a granting agency to help us fund our program. Indicate the agency and the mission and tell what the grant is and how it is compatible with our mission. Put in the granting agency logo and link to the granting agency. The granting agency is the United States Department of Health and Human Services. The mission of this agency is The mission of the Department of Health and Human Services is to help provide the building blocks that Americans need to live healthy, successful lives. We fulfill that mission every day by providing millions of children, families, and seniors with access to high-quality health care, by helping people find jobs and parents find affordable child care, by keeping the food on Americans shelves safe and infectious diseases at bay, and by pushing the boundaries of how we diagnose and treat disease, (US Department of Health and Human Services, 2013). The grants purpose is to test practical, sustainable, and cost efficient adaptations of efficacious strategies or approaches to prevent and treat diabetes and/or obesity. Our mission is to increase awareness of the link between obesity and diabetes. Therefore it is compatible with our mission, as the grant is aiming to prevent and treat diabetes and/or obesity. This is the link to the granting agency: http://www.hhs.gov. This is the link to the explanation of the grant: http://grants.nih.gov/grants/guide/pa-files/PA-13-352.html. There is not an amount of money specified for the grant.

Section 7: Webliography American Diabetes Association. (1999). Emerging Epidemic of Type 2 Diabetes in Youth. Retrieved September 24, 2013, from http://care.diabetesjournals.org/content/22/2/345.short Abate. N, and Chandalia, M. (2003, January). The impact of ethnicity on type 2 diabetes. Journal of Diabetes and its Complications. Volume 17. Issue 1. Retrieved September 28th, 2013, from http://www.sciencedirect.com/science/article/pii/S1056872702001903 Attia, P. (2013). Is the obesity crisis hiding a bigger problem? [video file]. Retrieved from http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html (Church Health Center, 2010). Model for Healthy Living. Retrieved November 19, 2013 from, http://chreader.org/contentPage.aspx?resource_id=621. Community Tool Box, (2013). Section 6. Using Outreach to Increase Access. Retrieved October 10, 2013, from http://ctb.ku.edu/en/table-of-contents/implement/access-barriers-opportunities/outreach-to-increaseaccess/main Dandona, P., Aljada, A., & and Bandyopadhyay, A. (2004). Trends in Immunology - Inflammation: The Link Between Insulin Resistance, Obesity and Diabetes. Retrieved September 24, 2013. DeVille-Almond J., Tahrani AA, Grant J., Gray M., Thomas GN., Taheri S. (2011). Awareness of Obesity and Diabetes: a Survey... [Am J Mens Health. 2011] - PubMed - NCBI. Retrieved September 24, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/20413385. Diabetic Care Services, (2013). A Codependent Relationship: Diabetes and Obesity. Retrieved October, 20th, 2013, from http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity Fisher-Hoch. S, R. A, Wilson. G, S. J, Reininger. B, R. B, Mc Cornmik. J, and Perez, A. (2010, May, 7th). Socioeconomic Status and Prevalence of Obesity and Diabetes in a Mexican American Community, Cameron County, Texas, 2004-2007. Preventing Chronic Diseases. Public Health Research, Practice and Polices. Retrieved September 28th, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879985/ Fitzgibbon. M, S.M, Dyer. A, VanHom. L and Christoffel. K. (2002, February). A Community-Based Obesity Prevention Program for Minority Children: Rationale and Study Design for Hip-Hop to Health Jr. Prevention Medicine. Volume 37. Issue 2. Retrieved from http://www.sciencedirect.com/science/article/pii/S0091743501909776 Goran. M, Ball. G and Cruz. M, (2003, April). Obesity and Risk of Type 2 Diabetes and Cardiovascular Disease in Children and Adolescents. The journal of clinical endocrinology and Metabolism. Retrieved September 28th, 2013, from http://jcem.endojournals.org/content/88/4/1417.full Horowitz, C. (2004). American Public Health Association - Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities. Retrieved September 24, 2013, from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.9.1549 Kumanyika, S., & Grier, S. (2006). Project MUSE - Targeting Interventions for Ethnic Minority and LowIncome Populations. Retrieved September 24, 2013, from http://muse.jhu.edu/journals/foc/summary/v016/16.1kumanyika.html

Lipton. R, D. M, Burnet. D, R. B, Cooper. A, B. E, and Hagopian. W. (2005, May 1st). Obesity at the Onset of Diabetes in an Ethnically Diverse Population of Children: What Does It Mean for Epidemiologists and Clinicians? Journal of the American Academy of Pediatrics. Retrieved September, 28th, 2013, from http://pediatrics.aappublications.org/content/115/5/e553.full#content-block Mokdad, A., Bowman, B., Ford, E.,Vinicor, F., Marks, J., Koplan, J. (2001). JAMA Network | JAMA | The Continuing Epidemics of Obesity and Diabetes in the United States. Retrieved September 24, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=194179. Oldroyd. J, Banerjee. M, and Heald. A, (2005, September, 18th). Diabetes and ethnic minorities. Postgraduate Medical Journal. Volume 81, Issue 958 . Retrieved September, 28th, 2013, from http://pmj.bmj.com/content/81/958/486.full.html#ref-list-1 Ornish, D. (2013). The killer American diet that's sweeping the planet [video file]. Retrieved from http://www.ted.com/talks/dean_ornish_on_the_world_s_killer_diet.html Nevins, S., and Hoffman, J. (2012, May 10th). The Weight of the Nation: Children in Crisis. Top Documentary Films. Retrieved from http://topdocumentaryfilms.com/weight-nation-children-crisis/ Rushing Josh. (2012, October, 9th). Fast Food, Fat Profits: Obesity in America. Top Documentary Film. Retrieved from http://topdocumentaryfilms.com/fast-food-fat-profits-obesity-america/ Shimabukuro, M. (1998). Fatty Acid-induced Cell Apoptosis: A Link Between Obesity andDiabetes. Retrieved September 24, 2013, from http://www.pnas.org/content/95/5/2498.short

Section 8: Reflection I, Hyacinthi, believe that this project has helped me develop the necessary skills intellectually, both in my personal growth and my professional growth in my field of community health education. Working with a partner on this project has made me to discover my work ethic and improve the areas I was falling short. In my opinion, you gain knowledge through learning from mistakes you made. Also, I gained knowledge by putting more time on reading materials and finding evidence from literature reviews. During the beginning of this course, the information and terminology were so difficult to understand for me. This course was very difficult, my intellect was challenged, and critical thinking skills were put to the test. I was able to develop my critical thinking skills and professional intelligence after overcoming the challenges. Also, my leadership skills and communication skills have also improved over the period of taking this course. Now I have a strong understanding of the material. I will use this knowledge to develop a program if I work at an agency. I will use a method of evaluation within that agency to help it reach its overall goal, or mission. Also, I am able to assist someone or organization in doing research and finding evidencebased information that is valid and reliable. Overall, I strongly believe that writing this paper and completing this project has made me a more knowledgeable individual. At the beginning of this project myself and my partner started off as strangers and as the work went on we gained confidence, trusted in each other, and learned how to work as a team to accomplish our program planning and evaluation goal. I will be able to use this project on my resume when I apply for jobs in the community health education field. This will show that I have experience in creating a program and that I have one implemented within the university, not just on paper. From my, Katies, perspective, I feel as though this project has helped my professional growth develop relative to the program planning/evaluation process. When the course began, I had a brief overview of what this process involved, based off the knowledge from other classes, but not a clear path of where it would go. It was difficult at first to decide on a mission with my partner. We had the idea of what we wanted; it was just the wording of our mission that was difficult. This involved evaluating who we wanted our target population to be, and how exactly we wanted to explain a relationship between obesity and diabetes. Once this was clarified and confirmed, we were able to begin researching. I have a very good understanding of how the program planning/evaluation process works and feel like I could apply this to any situation or problem. I can assess a general need to have a warrant for proceeding. I am able now to distinguish between what the dependent and independent variables are, and what the target population is. From this, I can assess the general need, identify measurable objectives, find an evidence-based program, implement it, and then evaluate. I feel confident that I could be thrown into a situation to come up with a model and program/evaluation plan and complete it successfully. The process is easy to understand and explain to others. This is what helps make it work and be successful.

My independent/self-directed learning has improved through this project. Each time Hyacinthi and I met, we were able to discuss the topic more and more in depth. Aside from meeting, we had our own individual tasks and goals we had to accomplish for the project each week. When we had to find the literature and review it, this really pushed my independent learning. It took it to a different level, as I had to not only read a piece and analyze it, but evaluate it through the program planning and evaluation process. I had to identify new parts, like the measurable objectives in the piece. This process really helped to have a grasp and good understanding of the piece. Also, my critical thinking, as far as determining what research is valid and finding/using valid materials has improved. When we had to ask the questions of each piece, I was able to sort through the false material and see what the true research of the piece was. In addition, my collaborative learning increased through this project. Working with Hyacinthi provided me with another way of thinking and understanding the material. We were able to problem solve, sort out information, and decide what would work best. Through this, we were able to understand how each of us learned and processed information. We were able to work together to achieve common goals. Diabetes and obesity are both topics we share a passion for, so it worked out well in researching them. I was able to look at them from more of a medical standpoint, and Hyacinthi was able to view them from a community health educator standpoint. I believe this helped our project have more different ways and ideas to view the concept of our mission.