Obesity and Sexual Activity in SPAs 3 and 4

Comparing the demographics of SPAs 3 and 4, San Gabriel and Metro, revealed very similar numbers, but there are a few key differences that are noteworthy for planning area-specific interventions. While these two SPAs are comparable both to each other as well as to the LA County and national averages, two areas present as troublesome. For San Gabriel, adult obesity is a notable concern and, for Metro, teen pregnancy and sexually transmitted diseases like HIV/AIDS are significantly higher than the averages.

In terms of the physical environment, the most notable difference between San Gabriel and Metro was the residents’ perception of safety. Perceived safety from crime was 12.4% higher in San Gabriel and safe places for children were perceived to be 14.4% more available in San Gabriel than in Metro (LA County, 2009, p. 12). In terms of nursing intervention, this is not a directly significant statistic, but it can affect the activity level of residents who do not feel safe going out to exercise or let their children play, so it does open the door for possible intervention. Nutrition opportunities were inverted from this, though not as dramatic. Residents of Metro felt that quality fruits and vegetables were 5.2% more available than San Gabriel residents did (LA County, 2009, p. 12). Since this does not indicate the consumption of fruits and vegetables and it is a relatively small difference, nutritional interventions in both SPAs would not need to be significantly different, based on this statistic.

The health status of children and adults in SPAs 3 and 4 were also very similar. Children perceived to be in fair or poor health were 0.8% more common in Metro while adults who perceived themselves to be in fair or poor health were 3.4% more common in Metro (LA County, 2009, p. 16). These indicators, like availability of nutrition, are so similar that they would not have a significant effect on interventions between the two areas. One noteworthy statistic, however, had to do with disability. Children with special needs and children diagnosed with ADD/ADHD were both slightly more common in Metro while the number of adults who provided assistance to adults with illness or disability was higher in San Gabriel by 2.8% (LA County, 2009, p. 16). If this indicated a trend of less helpfulness in the area with a higher population of special needs children who might one day become special needs adults, then an intervention to encourage helpful behaviors might be in order.

Metro is significantly worse off than San Gabriel in access to care. There 8.9% more uninsured adults in Metro and 6.9% more of the population in Metro has no regular healthcare source; the discrepancies for children are less, but children are also worse off in Metro (LA County, 2009, p. 18). This difference is a critical one because it directly affects the ongoing health of residents. This is also a prime opportunity for nurse-based intervention to make a difference because outreach and education are keys to convincing residents of the importance of being insured and having regular examinations.

On the other hand, preventive services seem to be more competitive between the two areas. Mothers receiving prenatal care after the recommended timeframe or who did not receive it at all were slightly more common in San Gabriel, though not significantly so. Women with a recent (within three years) pap smear were slightly higher in Metro, 3.3% higher, while women over 40 with a recent (within 2 years) mammogram were more common in San Gabriel (LA County, 2009, p. 20). It is possible that this corresponds to the higher number of single women and a higher number of women between 18 and 39 in Metro (LA County, 2009).  It may also indicate the nature of healthcare available in Metro versus San Gabriel; the former is more geared toward young, single people and the latter toward older residents.

Most health behaviors were slightly better in Metro than in San Gabriel. While binge drinking was 4.5% more common in Metro, more children ate breakfast in Metro and in San Gabriel, though the difference was not statistically significant, and slightly more people ate the recommended servings of fruit and vegetables each day. Unhealthy eating habits like fast food and sweetened drinks were notably less in Metro (LA County, 2009, p. 22). Awareness of healthy nutrition seems to be higher in Metro than in San Gabriel, suggesting an opportunity for educational intervention in San Gabriel. Despite that difference, health outcomes were very similar in both SPAs. There were more obese children, in grades 5, 7 and 9 in Metro, but more overweight and obese adults in San Gabriel. Diabetes was slightly more common in Metro while high cholesterol was slightly more common in San Gabriel. One of the most notable differences was the rate of live births to teenage mothers, 11.6% higher in Metro than in San Gabriel (LA County, 2009, p. 24). This last statistic suggests that sexual health should be a greater concern in Metro. This conclusion is supported by the higher incidence of chlamydia in Metro than in San Gabriel (LA County, 2009, p. 5).

Compared to LA County and national figures, SPAs 3 and 4 are closely competitive. Metro was notably below LA county in terms of safety while San Gabriel was significantly above, no national figures were available (LA County, 2009, p. 12). Adults in fair or poor health were more common in both SPAs than in LA County as a whole and when compared to the nation (LA County, 2009, p. 16). Residents without health insurance in San Gabriel were comparable to LA County but higher than the national average while Metro was significantly higher than both; this trend was also true of adults with no regular source of healthcare (LA County, 2009, p. 18). Live births to teen mothers was notably higher in Metro than in LA County or nationally while San Gabriel was notably lower (LA County, 2009, p. 24). 

The higher rate of overweight and obese adults in San Gabriel suggests that a valued intervention in this area would be to reduce and counter adult obesity. Two possible angles from which to approach an obesity intervention would be physical activities for community members with the explicit purpose of managing weight and educational interventions to equip families to serve as their own self-contained weight management groups. Both activities would require time to show results. Though the first option would likely have faster results for those involved, the latter would have more widespread and longer-lasting results, if it was successful. While a matter of months is enough to show the effectiveness of a weight-loss activity plan, it would take much longer for participation in the program to spread wide enough to have a significant effect on the SPA data. Results could be hoped for within the first year, but should not be expected until the second and data should be gathered for the third and fourth year to begin to identify a trend.

A community program for weight management would need to be specifically designed for overweight and obese participants. While it might appear to be prejudicial, there are physiological considerations that have to be taken into account when designing an athletic regimen for obese adults. Obese individuals move differently and even think about moving differently, as evidenced in a study by Gill and Walsh (2012). Balance and walking proficiency are debilitated in obese adults because of their weight and the longer an adult is obese, the more natural it is for them to walk slower, take shorter steps, and spend more time regaining balance between steps. They also suffer reduced bone strength and joint durability (Gill & Walsh 2012, p. 1429). Because of these limitations, an organized activity designed for normal-weight individuals would be prejudicial toward obese participants without some preparation for the obese participants. Gill and Walsh (2012) advocated the use of “implicit learning” activities that are designed to help obese individuals adapt to the physical demands of exercise so they are better able to participate in physical activities that are suited to normal-weight participants (p. 1430). This type of intervention would be best executed in stages. New members of the community activity program would be part of a beginner stage that focuses on activities dense with implicit learning to help bring them physically up to speed for the more intense activities that would not necessarily have to be targeted to a particular body type.

The family-based intervention program would possibly be better received because it would not need to be so publicly segregated. While different programs for different levels of physical ability are necessary, they might not be well received by participants. Focusing on what a family can do among its members to encourage healthy behaviors might be a better use of time and resources. Gruber and Haldeman (2009) found that a family environment allowed for a cycle of teaching and learning between adults and children that encouraged everyone to pay more attention to both nutrition and activity levels and help each other stick to healthy behaviors. The same principles of the community scale activity program could be implemented but would be more focused on each individual’s needs because the family would be able to respond on a more precise level than a community-wide program. Approaching the family unit would also make outreach and education easier because it could be done through the school; parents often pay closer attention to their children’s needs than their own (Gruber & Haldeman, 2009). By providing the nutrition and physical activity recommendations to the children or about the children, the adults would also be exposed and encouraged to participate for the good of their children. Outcomes of this intervention would likely be seen over a much longer period of time, possibly even on the scale of generations.

For the Metro SPA, interventions regarding the high rates of teen pregnancy need to be considered. Much like the obesity intervention, the two primary approaches involve a community-based education and activity program and a greater focus on family-based intervention. The community program would depend on nurses even more heavily than the obesity program because sexual activity in teens is a much more delicate subject with much more immediate consequences. Sieving et al. (2011) conducted a study on the Prime Time intervention program that used multiple elements to encourage healthy sexual behaviors in teens. Specialized case managers were assigned and educational and social programming was provided to participants to encourage heightened awareness and practice of safe sex, for those who chose to engage in sexual activity. After one year of the program’s activity, results indicated not only healthier, safer sexual behavior, but also general improvements at home and school attributed to higher self-esteem and increased self-awareness of the participants (Sieving et al., 2011). This kind of intervention would be expensive and complicated to put into place, but the effectiveness is clear and results are quick. Results could be expected in as little as a year.

The family alternative would attempt to incorporate the principles of the Prime Time program into the more intimate, trusting environment of the home. The effectiveness of cooperative education and intervention that was evidenced for healthy nutritional and physical activity choices could also be applied to healthy social and sexual choices in a family with open communication. The role of the nurse, in this case, would be more direct than in the case of a community-wide program. Education and outreach would occur between the nurse and the individual families which would require more time resources as a whole, but would also mean that more relevant information is conveyed to the families in a more attentive environment. It would also require less organization as a whole, since making contact would be a matter of a standard checkup, possibly augmented by a community outreach effort to get families to get a checkup. This type of intervention would likely be slower than the community program. The structure provided by an organized, large scale intervention would help make a difference to larger numbers faster. But any improvements to the rates of sexually transmitted diseases and teen pregnancy would be a success.

References

Gill, S. V., & Walsh, M. K. (2012). Use of motor learning principles to improve motor adaptation in adult obesity. Health, 4(12A), 1428-1433. 

Gruber, K. J., & Haldeman, L. A. (2009). Using the family to combat childhood and adult obesity. Preventing Chronic Disease, 6(3). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722397/ 

LA County Department of Health. (2009). Key indicators of healthy by service planning area. Los Angeles, CA: Los Angeles County Department of Public Health. 

Sieving, R. E., McMorris, B. J., Beckman, K. J., Pettingell, S. L., Secor-Turner, M.,… Bearinger, L. H. (2011). Prime time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors. Journal of Adolescent Health, 49(2), 172-179. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143373/