RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Coca-Cola Crisis: The relationship between soda consumption and BMI in a Marion County clinic Project Date: 10/12/2009 During a time where childhood and adult obesity is reaching epidemic proportions, the American Society of Family Physicians announced a highly controversial merger with Coca-Cola to promote consumption of its products as part of a healthy life style. This raised a highly charged debate as to whether or not family physicians could ethically support soft drink consumption in the face of numerous studies linking soft drink or soda consumption to increasing BMI. In Marion County, obesity rates are even higher than Oregon in general. This study sought to create a snap shot of the current obesity trends within a specific Marion County clinic and assess the association between soda consumption and BMI. Additionally, the study sought to assess the motivational factors that contribute to soda consumption. Soda consumption was assessed through surveys that were self reported and correlated to the most recently recorded clinic BMI. Over 200 patients were surveyed with only 74 responders. Of those responding, only 18 self identified as soda consumers. When assessed, it was found that there was a statistically significant positive association between soda consumption and BMI with an average BMI for soda consumers of 33.4 with a 95% CI (29.86-36.99) compared to 29.4 in the control group with a p-value of 0.012. This positive association supports numerous studies that have addressed a caloric as well as hormonal association between BMI and soda consumption. This relationship calls into question the ethics of supporting a healthy lifestyle that includes soda consumption that is associated with obesity and its myriad of co-morbidities. Interest and Barriers to a new Nutrition Curriculum in Grants Pass Elementary Schools Project Date: 10/12/2009 Obesity and the related health events have become an epidemic throughout America. Health related habits are learned at a young age and reinforced throughout childhood. There are currently multiple movements to introduce more nutrition and health education to schools in an attempt to curb this epidemic. Specifically, in Grants Pass elementary schools a group wants to implement a nutrition and health curriculum however little was known about the status of the health education system and potential barriers. The goal of this project was to assess the interest and potential barriers to implementing the “Be a Fit Kid” nutrition and health curriculum in Grants Pass elementary schools. Interest was strong among the 5 physical education teachers interviewed. Each pointed out potential barriers to consider with implementation of the curriculum. Results of these interviews were used as a foundation for writing a grant to fund the program. Early Formation of Lifelong Health Habits in Baker City, Oregon: a Brief Assessment and Educational Tool Project Date: 9/7/2009 The adult population seen at the Baker Clinic has been noted to have a number of health problems associated with lifelong negative health habits, including tobacco use, alcohol abuse, and poor nutrition/obesity. Even when faced with serious health consequences of these negative habits, many patients find it extremely difficult to make these life changes as adults. The school-based clinic staffed by the Baker Clinic was noted to be an ideal venue to approach high school students at a time when lifelong habits are still being formed, in order to encourage healthy habit formation which might lead to improved lifelong health. A brief 6-question questionnaire was distributed among students at the clinic in order to obtain a rough estimate of knowledge in the areas of nutrition, exercise, tobacco and alcohol abuse. A one page educational tool was subsequently created for distribution to this same population, focusing on areas of weakest knowledge/poorest habit formation, namely poor calcium intake and excessive soda consumption. Vitamin D Explained: Question and Answer Handouts Project Date: 8/3/2009 Vitamin D deficiency or insufficiency is estimated to be a common condition in the U.S. population. Long-term bone health is the most common context for vitamin D deficiency discussions, but there is a growing body of literature associating vitamin D deficiency or insufficiency with other health issues including cardiovascular disease, fall prevention, cancer, multiple sclerosis, depression, diabetes, hypertension, all cause mortality, and health costs. The prevalence of vitamin D inadequacy, and the associated health concerns, in combination with my own experiences, has led me to conclude that public knowledge regarding vitamin D could be improved. In an effort to help patients educate themselves, as well as solidify my own understanding for use in patient encounters, I developed two vitamin D question and answer handouts for use by patients and/or providers; one in brief and one with more detail including references for people wanting additional information. These handouts include a basic overview of vitamin D function, health considerations, deficiency/insufficiency risk factors, deficiency/insufficiency prevalence, dietary sources, and intake recommendations. Improving Nutritional Awareness among Pregnant Teens in Columbia County, OR: Design of a Patient Handout on “Eating Right in Pregnancy” Project Date: 3/16/2009 Teen pregnancy continues to be a controversial issue in the United States. A recent increase in the national teen birth rate in 2006 and 2007 may be reflected in the recent “epidemic” of teen pregnancies in Columbia County. Pregnant teens frequently present later for prenatal care and are more likely to suffer from nutritional deficiencies, failure to gain appropriate weight, and higher smoking rates associated with medical complications such as poor maternal weight gain, maternal anemia, low birth weight, prematurity, and developmental disabilities. Recent studies have suggested that many of these medical issues can be resolved when teens receive adequate prenatal care. This study focused on increasing nutritional awareness among pregnant teens in Columbia County as a means of improving pregnancy outcomes. The attitudes of local girls towards body weight and dieting suggest that they may be at risk for nutritional deficiencies and failure to gain appropriate weight during pregnancy. This was an observational study of resources available to teens in the OHSU Family Medicine Clinic in Scappoose, OR, including prenatal visits and one-on-one childbirth education. A review of the literature on teen pregnancy and nutrition during pregnancy was also combined with an examination of statistics on local teen pregnancy and birth rates as well as attitudes of 11th-grade girls towards body weight and dieting. A handout on nutritional issues was created written for a tenth-grade reading level and intended to be provided to pregnant teens during prenatal visits. Reedsport Nutrition Information Site Project Date: 12/29/2008 Good nutrition is becoming rarer and rarer in Oregon as well as the nation, leading to troubling trends in obesity. The purpose of this project was to provide an easily accessible resource that contained information on good nutrition and had tools for self-evaluation. It was decided the best medium for this project would be a website. Clinicians could then provide the site address to patients interested in nutrition or those struggling with being overweight or obese. Further, patients who benefitted from the site could refer friends as well, increasing the target population to all residents of the county and beyond. The interactive nature of the site was aimed at making it more personal than a handout and thus serving as a personal nutrition consultation. As a consolidated source of information, its utility is hoped to be greater than other sources on the web that may contain each of its individual aspects. Eating Well on a Budget Project Date: 10/13/2008 Obesity is an epidemic in this country, affecting young people more and more. It is an epidemic that is seen in all social classes, but disproportionately affects people of lower socioeconomic status. The Coos Bay area is generally of lower income than the state as a whole. Several barriers to healthful shopping were identified throughout the project. While overweight and obese children were identified at the clinic, and all children had inquiry into their diets at each well child check, there lacked a comprehensive handout for patients who have trouble creating a menu to keep to their shopping budgets, while providing nutritious meals. This project was designed with the goal of creating an educational handout that would have nutritional information as well as a menu and recipes to demonstrate how a family of four might eat healthy meals for one month while sticking to a $400 budget, (this number based on DHS data showing that, on average, a person receiving food stamps is allotted approximately $100/month). Through working with a local chef, this pamphlet was created with the goal of being handed out in clinic, with the possibility of future distribution at local DHS offices. Childhood obesity in a rural setting Project Date: 10/13/2008 The prevalence of childhood obesity among US children has increased between 2-4 folds in the last 40 years. The state or Oregon has not been an exception from this nationwide epidemic and in fact one in four eighth-graders in Oregon are now overweight or at risk of becoming overweight. Studies have been conducted looking at the causes and origins of this potential disaster. However, few of these studies have been done in a rural setting. An array of environmental and social changes that severely challenge a family’s ability to make healthy choices for their children have contributed to this epidemic, including barriers to safe and accessible physical activity and fresh, nutritious foods, coupled with an increase in sedentary pastimes such as television and computers, known as "screen time", and more frequent use of automotive vehicles rather than walking and biking for transportation. This article is intended as a very preliminary beginning at studying childhood obesity in a rural setting with the ultimate goal of providing additional insight into this problem as well as potential possible solutions. Phase 2 of Ontario Greenhouse Project: Learning from other successful programs, estimating initial cost, and initiating community involvement Project Date: 9/8/2008 The children of Malheur County are greatly affected by obesity with a current rate of obesity that is 13% greater than the rest of Oregon. Obesity among children can be partially explained by the fact that children of Malheur County are eating fruits and vegetables far below the USDA recommendations. The goal of this project is to work towards introducing a greenhouse program at an Ontario school that will involve the student body in growing fruits and vegetables. Hopefully, such a program would curve the students’ food preferences towards more fruits and vegetables and help reduce obesity among the children. This will be a multiphase project, of which this is the second phase. The aims of this phase include: (1) learn from other greenhouse programs (2) estimate the cost of starting the program, and (3) initiate community involvement. These aims will be accomplished through review of available literature, interviews with members of the Ontario community, and contacting people from other greenhouse programs in Oregon. One can get many ideas and resources from other programs. The estimated original cost may range from $5-20K depending on the size and complexity of the greenhouse. Community involvement may be at an individual level, business level, and may include the local hospital and Malheur County Experiment Station. The Oregon Wellness Policy and Input from Local Providers in the North Santiam School District Project Date: 4/28/2008 Purpose: The prevalence of childhood obesity has increased over the past several decades. Wellness Policies have been developed at both the national and state levels to combat this epidemic by providing healthy food in schools, promoting nutrition education and encouraging physical activity. This project attempted to gain a solid understanding of the Oregon Wellness policy requirements and ascertain what input the North Santiam School District, which encompasses the town of Stayton, receives from local health care providers. This information was compared to nearby districts including the similar Cascade and the much larger Salem-Keizer School Districts. Design and Methods: This was an observational study. Methods included in-depth interviews with food service directors in the North Santiam, Cascade and Salem-Keizer School Districts along with the cooks at the private St. Mary’s Elementary in Stayton (Appendix B). A thorough Ovid Pub Med search of the terms “nutrition” and “school” was also conducted and papers read for background information. Results: The Oregon Wellness Policy is an evolving set of guidelines for schools relating to all food, including entrees, al la carte items and beverages served on school property during an extended school day (Appendix A). Involvement from local health care providers, in all districts interviewed, was minimal. No district had a physician currently serving on their Wellness Committee. Future: This study was intended to identify areas for future research, including: surveying clinicians’ knowledge regarding the Oregon Wellness Policy and identifying barriers to their involvement with local school wellness committees. Action should then be taken to educate local providers on areas where they could participate in school nutrition. Patient and Provider views on vitamin and mineral supplement use in Roseburg, Oregon Project Date: 2/11/2008 Background: Dietary supplements in the form of multivitamins, single nutrients, and other supplements are consumed by half of Americans and continue to increase in use. However, they are also poorly regulated, which creates a challenge among providers and researchers to establish clinical guidelines for use. Safety and effectiveness are among the greatest challenges given the variable doses available and potential interaction with other supplements and medications. This study aims to characterize use (type, amount, rationale, barriers to use) of dietary supplements, with focus on vitamins and minerals, from both patients and physicians. Methods: This is a descriptive, cross-sectional qualitative and quantitative analysis of patient and provider use and views on dietary supplements. Questionnaires were distributed and analyzed for patients and providers at Evergreen Family Medicine in Roseburg, Oregon and family medicine providers at OHSU. Results: 54% of participants reported regular use of dietary supplements. Of participants reporting use, 73% used multivitamins/minerals, 73% used single nutrients, and 44% used other supplements. Participants who consumed supplements were older, more educated, less physically active, and more likely to have a chronic disease compared to those who did not consume supplements. Provider recommendation was the top reason participants began using supplements. Regardless of current supplement use, 67% of all participants wished to have regular discussions about supplements with their providers. There was a limited response among providers (n=20), but among those 80% regularly recommend supplements (80% single nutrients, 50% multivitamins/minerals), and 71% of doses were within the Recommended Dietary Allowance. Conclusions: Dietary supplements are a relatively simple and inexpensive intervention with potential to replete nutrient deficient diets, treat, or even prevent diseases. These must be tempered with effective and safe use. Physicians have a great influence on patients both in their decision to begin taking supplements or not to use supplements. Adult Obesity in a Rural Clinic: Prevalence, Comparison and Weight Reduction Strategies Project Date: 2/11/2008 The prevalence of obesity in the US has doubled in the past two decades so that now, almost two out of three adults are either overweight or obese[1]. This epidemic of excess body fat is a major public health concern since it leads to a higher risk of premature death, type II diabetes, hypertension, dyslipidemia, coronary heart disease and other serious diseases and health concerns. The state of Oregon is not immune to this epidemic, by no means. Although less obese than the U.S. average, more than 1/2 of the state’s population is either overweight or obese[2]. Upon investigating the prevalence of overweight/obese at a rural health clinic in Scappoose, OR, however, it was determined that the prevalence there was much worse than either the overall state or nation values - over 50% of clinic patients were obese and more than 3 out of 4 patients were either classified as overweight or obese. In order to begin to reverse these numbers, it was determined that a need existed to put together a concise resource, available to the clinic staff and patient population, to help increase awareness of all the resources for weight reduction strategies that can be safely used to achieve and maintain a body weight that optimizes health. Childhood Obesity Prevalence in John Day: A Project of Data Collection and Dissemination. Project Date: 10/15/2007 With more data and continued discussion of health effects, the obesity epidemic has become perhaps the largest health problem facing the American population today. Despite its prevalence and its proven health consequences, many communities continue to believe that obesity is not an issue. This belief is not easily altered. This study was designed to collect height and weight data from all children attending Humbolt Elementary School, calculated BMIs for each child, and then graph them on the CDC growth charts to determine the number of overweight and at risk of being overweight children in each age and gender category. On average, 32% of children in John Day are either overweight or at risk of being overweight. Research into national data, rural data, and rural Oregon data was done to provide context for the data collected in John Day, and this was presented together to the school district administration. After the presentation, a discussion of possible ways in which schools can enact change and various options for funding these changes was discussed with the school district administration. The end result of the project led to an increased awareness of the extent of the obesity issue in John Day and an increased interest in enacting change within the community to address this issue. Analysis of average body weights in selected pediatric populations between 1997 and 2007 in John Day, OR Project Date: 10/15/2007 The number of children in the United States who are overweight, or at risk of becoming overweight has reached epidemic proportions. Annual obesity-related costs in 6-17 year-olds exceed $127 million per year and project to far exceed this value in the future as these children mature into adults as obesity is a key risk factor for the development of many adverse health conditions including: hypertension, dyslipidemia, Type 2 diabetes, cardiovascular disease, sleep apnea and orthopedic pathologies. Increased consumption of foods high in calories and fat combined with decreased amounts of physical activity are environmental factors identified as key contributors to this obesity epidemic. As these environmental factors have become more prevalent in rural communities, the effect upon the body weight of children in these communities is a concern. The goal of this project was to evaluate changes in the average body weights of 5-6 year-old children, 9-10 year-old children and 13-14 year-old children in 1997, 2002 and 2007. The results of this study show that the weights of 5-6 year-old children in John Day, OR have significantly increased over the past 10 years and that the weights of both 9-10 and 13-14 year-old children are trending upwards. These results of this study were discussed with the medical community with the goal that increased awareness of this trend will lead to improved screening and implementation of preventative measures. Pahe’yoo Meals of the Wadatika (Three Meals of the Burns Paiute Tribe) Project Date: 9/10/2007 Significant morbidity and mortality can be avoided in chronic disease states such as Hypertension, Diabetes, and health complications from obesity with simple lifestyle modifications such as a healthy diet and increased exercise. Many studies have emphasized this. By using surrogate markers such as blood pressure as a measure of cardiovascular disease and Hemoglobin A1C as a measure of diabetes control, doctors can monitor the progression of disease in a population. However, the doctors in Harney County often lament the poor health and poor treatment plan compliance among their Native American patient population, based on measurements of those surrogate markers. Barriers must clearly exist to patient compliance among the stated population. These can include mistrust of the medical community, inability to pay for services and medications, misunderstanding of treatment principles, and what types of foods constitute a healthy diet. How do you gain the trust of a patient population to help them to modify their current diet in a way that is beneficial in terms of health goals, but is also feasible, financially and culturally for them? What can be done to increase compliance and decrease the disease burden among Native Americans? While I cannot attempt to answer these huge questions in a lifetime of medicine, I can ask a smaller question which lead patient and provider in the right direction. What are the current dietary habits of the population in question, i.e., the Burns Paiute Tribe? Vitamin D Deficiency: Causes, Patients at Risk, Prevention and Treatment Project Date: 7/2/2007 Vitamin D deficiency is a common but often undiagnosed problem in both children and adults. There are many patient groups at risk for vitamin D deficiency, but currently no guidelines for vitamin D screening have been established. The patient base of my rural preceptor's practice includes many individuals who would fit into one or more of the groups at increased risk. This project began as a literature search to attempt to find suggested screening guidelines, and eventually became a project aimed at creating a useful table adapted from a recent meta-analysis of vitamin D deficiency that outlines causes of vitamin D deficiency, patients at risk, and vitamin D supplementation levels for prevention and treatment. A Closer Look at the Nutritional Habits of Scappoose High School Students Project Date: 4/30/2007 Obesity has become increasingly prevalent among school-aged children and adolescents in the United States. With obesity becoming increasingly more widespread in the U.S., especially amongst the rural population, it is probable that adolescents in their high school years will reflect this same trend. This study examines the attitudes towards nutrition of Scappoose High School students who do and do not participate in an athletic activity in Scappoose, Oregon. A survey was formulated which gathered information on their opinions on the cafeteria foods as well as on the impact of athletic or physical activity on nutritional choices. At the present, nutritional education for the general Scappoose high-school population is limited to a part of the Health class curriculum. At the clinic, nutritional habits are checked when adolescents come in for a sports physical exam. Otherwise, there was no established presentation of the nutritional values of the food offered by the school or the benefits of physical activity on their health. The results of this survey will be given to the athletic director and health class instructor to aid in their understanding of their students views on nutrition. Treatment of the prediabetic patient in a primary care practice. Study of the current practices of managing prediabetic patients in Philomath, OR Project Date: 4/30/2007 Diabetes is a serious medical condition affecting 20.8 million children and adults in the United States, or 7% of the population. The diagnosis of diabetes has far reaching consequences including adverse effects on a patient’s kidneys, heart, eyes and nerves. There is growing evidence that a pre-diabetic states exists before the development of diabetes and that individuals in this state have the opportunity to prevent the disease through lifestyle changes in their diet and exercise regimens. The purpose of this project is to identify the prevalence of a population at high risk for diabetes, to assess current methods of diabetes prevention through interviews with family practice doctors and to develop effective patient education materials, which will help to teach patients methods to modify their risk for developing the disease. Education will be focused on lifestyle modifications with the goal of preventing the development of type 2 diabetes. Future projects may assess the effectiveness of these materials by long term follow up of the identified patient population and their propensity for developing diabetes. No More Excuses Project Date: 3/19/2007 Type II Diabetes and Obesity are increasing in incidence at an alarming rate. It has been well established that diet and exercise is the treatment of choice for obesity and type II diabetes. This study attempted to identify the effectiveness of treating and managing type II diabetics with diet and exercise. The design was to document each diabetic patient seen over a 5-week period, the date they were diagnosed with diabetes, their BMI and HbA1C at diagnosis and their current BMI and HbA1C as well as the medications used to treat their diabetes. When able, patients were questioned as to reasons why they chose to not exercise. These values were put into a chart from which came the results: How many patients have managed to successfully treat his or her diabetes with diet and exercise alone. Finally, a pamphlet was made to help aid providers in educating patients on the benefits of increasing physical activity through little effort on behalf of the patient. The perioperative evaluation of the diabetic patient in Grants Pass, OR: A patient guide for long-term disease management Project Date: 3/19/2007 Diabetic patients remain amongst the more vulnerable and complicated surgical candidates. Experts agree that the most effective measure taken to minimize peri-operative morbidity is maintaining long-term glycemic control. During a family medicine clerkship in Grants Pass, Oregon, it was noted that both patients and providers felt that improving patient awareness regarding diabetes management is key in achieving the optimal glycemic control. Given the complexity and scarcity of local diabetes educational resources, a summarized guideline was designed in the form of a patient hand-out to enhance peri-operative cooperation amongst patients and their various health care providers. Based on the request of local family doctors, a portion of this hand-out was dedicated to dietary instructions and risk factor modifications that can serve as a supplement to in-office discussions between the physician and the patient. Striving for Healthier Children: A Closer Look at the Scappoose School District’s Local Wellness Policy Project Date: 3/19/2007 The prevalence of obesity and its associated diseases in the U.S. has been increasing over the last decades at an alarming rate. The OHSU clinic in Scappoose was noted to have a particularly high prevalence of obesity amongst its adult patient population. Obesity rates in the U.S. of young children have doubled and that of adolescents have tripled over the past twenty years. Prevention is the most effective tool in reversing the obesity epidemic, as well as increasing overall health, and generally the earlier the intervention, the more potentially effective it is. One particularly important site for prevention measures are the public schools, since children often receive most of their nutrition, exercise, and lifelong nutritional and physical education at school. Three years ago, the federal government signed into law an act that requires each local education agency or school district participating in the National School Lunch Program and/or School Breakfast Program to develop a local wellness policy that promotes the health of students and addresses the growing problem of childhood obesity. This project focuses on analyzing and discussing the Scappoose school district Local Wellness Policy along with some of the major obstacles to its implementation. Eastern Oregon Medical Associates Weighs In: Assessment of the prevalence of overweight and obese patients in a rural community health clinic and provider education about screening, prevention, and treatment of obesity. Project Date: 2/12/2007 The obesity epidemic in the United States is well known to primary care providers. Obesity is a contributing factor to patients acquiring diabetes, hypertension, coronary artery disease, arthritis, certain cancers, and other diseases. Lowering an overweight or obese patient’s weight by just 10% can decreased their cardiac risk factors and can increase their quality of life.1 Primary care clinics are the cornerstone of prevention, screening, and treatment of obesity but according to providers at Eastern Oregon Medical Associates (EOMA), advice on healthy eating and exercise often falls on deaf ears. Physicians at this rural health clinic feel that they have an overwhelming number of overweight and obese patients but are unaware of the most effective ways of counseling these patients about weight loss. They were also eager to learn of any new treatment options. This project aimed to determine just what the rates of overweight and obese adult patients were in the clinic and to educate the providers on the most recent research and recommendations on screening, prevention, and treatment. EOMA uses an electronic medical record system that automatically calculates BMI with each patient visit. To determine the prevalence of overweight and obesity, data was collected for all patients 15 years and older who had a BMI of greater than 24 by using the EMR system’s search function. Data was categorized by overweight (BMI>24 but <30) and obese (BMI>/=30) and then further categorized into gender and age. It was found that EOMA has a prevalence of 12.6% overweight patients and 13.5% obese patients; much lower than the national prevalence. Research using several different methods (Medline database search, Cochrane database search, and use of NIH and CDC data) was used to find the most current information and recommendations on screening, prevention, and treatment of obesity. This information was compiled into a report that included the clinic data and was presented to all providers at EOMA. Managing Medical Complications of Eating Disorders in the Outpatient Setting Project Date: 10/16/2006 "Eating disorder patients can be challenging for physicians to manage since there are many medical complications that arise in the setting of starvation or persistent purging. These medical complications put patients at risk and can add considerable cost to the health care system if not addressed properly. The purpose of this project was two-fold: 1) to identify the most important medical problems experienced by eating disorder patients that should be looked for and treated, and 2) to develop a screening tool for physicians to follow the symptoms of medical complications and guide treatment decisions. Visiting residents of an outpatient residential eating disorders treatment program outside of Eugene provided a unique opportunity to have good continuity with eating disorder patients and deal specifically with the medical (as opposed to psychiatric) aspects of their care. The population studied was a group of female patients diagnosed with either anorexia nervosa or bulimia nervosa that were currently undergoing medical, nutritional, and psychological intervention for their eating disorders. After reviewing the literature and conducting patient interviews, a worksheet of medical symptoms was created. The final product is designed to be filled-out by patients prior to seeing their doctor for medical appointments. The utility of such a tool is to focus the patient encounter towards relevant medical problems, to consolidate symptom information into one place, and to allow for the consistent tracking of the persistence or resolution of symptoms with treatment." Implementing Nurse Visits for Prenatal Care in Scappoose Family Medicine Rural Health Clinic Project Date: 10/16/2006 Prenatal care provides benefits of reduced incidence of low and very low birth weight babies, reduction of infant mortality, and decreased rates of preventable maternal complications during delivery. In Columbia County, there are two main sources of prenatal care, only one of which is provided by MDs. The goal of this project was to help to implement the vision of restructuring the way prenatal care is given at Scappoose Family Medicine Clinic to include once a trimester visits to a trained nurse who will discuss things to expect in the upcoming trimester, answer questions about common pregnancy complaints, and provide a packet of resources specially designed for the current trimester. Are We Still a Fast Food…County? – A Look into Dining Options and Overconsumption in Madras, Oregon Project Date: 2/13/2006 Obesity continues to be a major public health concern and has become a prime target for health promotion and disease prevention efforts over the years. Previously, a rural health community research project was conducted to investigate the prevalence of obesity and metabolic syndrome in Madras, Or with results indicating rates comparable to, if not higher than those of Jefferson County and the country. I based my research off these findings and qualitatively studied how the lack of healthful dining options and societal barriers contribute to poor dietary choices and overconsumption in people in Madras. Methods for this study included utilizing the Jefferson County surveillance data with emphasis on ethnic and socioeconomic disparities to establish a background understanding of the population. Various fast food and dining locations were then visited, and managers and working staff interviewed to obtain subjective perspective on the dietary preferences of members in the community. Findings from this research included consumer interests in heartier portions, meatier options with condiments, special value meals, and cheaper, highly advertised items, regardless of their nutritional value. Furthermore, literature reviews demonstrated correlations between culture and socioeconomic status with rates of obesity, specifically a higher percentage of Hispanics and lower income households with poorer dietary habits. Based on these findings, a brochure on weight loss and management was designed in both English and Spanish to increase community awareness in a culturally sensitive and population-specific manner. Emphasis was placed on preventive measures, proper diet, exercise and healthy lifestyle choices to minimize risk factors for obesity and its related comorbidities. You Are What You Eat! Project Date: 9/13/2004 My community project was aimed at educating teen athletes about eating healthy diets to maximize their success in sports and to maintain their health. I picked this topic because all teens that want to play school sports must get a sports physical before they can participate in the sports. This allows physicians a good opportunity to educate the athletes before they start to train. The second reason that I decided to educate teens about a healthy diet is because it may be confusing for teens. I was also hoping to educate the teens about eating disorders so that they may recognize the signs and seek help if needed. Lastly, I wanted to educate teens about nutrition because for them, this is the time to develop proper eating habits that will serve as a foundation for healthy eating as an adult. I decided that the best way to educate teen athletes was by making an informative flyer that could easily be handed out at their sports physical. In this flyer, I provide information about main things to consider with respect to diet as an athlete, helpful eating habit hints, pre and post game eating tips, and eating disorder signs. I hope that this information will contribute to the success of teen athletes in developing healthy eating habits for the present time and for later on in life. Attitudes and Behaviors Regarding Nutrition and Exercise At Scappoose High School Project Date: 3/29/2004 The rates of obesity have been steadily increasing in rural and urban communities across the United States in recent years. Obesity rates among children and adolescents are growing even more rapidly than those seen for adults. There are many factors associated with the development of obesity; genetics, diet, physical activity and mental health to name a few. In an effort to address these issues, the USDA developed the Dietary Guidelines For Americans in 2002. By directing the implementation of the Dietary Guidelines For Americans towards the youth in America, we may be able to more effectively ensure the development and maintenance of healthy lifestyles. In order to better understand the health attitudes, beliefs and habits of adolescents in Scappoose, Oregon a survey was developed and conducted at Scappoose High School that addressed these issues. Nutrition and Fitness: Development of a Program to Supplement Physician Intervention in Management of the Health Risks of Obesity. Project Date: 12/30/2002 Obesity and its many associated health risks is a growing problem in the United States. This study attempted to identify strategies for physicians to increase their effectiveness in promoting dietary modification and weight loss for overweight patients at a family practice clinic in John Day, Oregon. The design was observation of physician interaction with overweight patients motivated to lose weight, and one on one dietary counseling with self selected patients. Community resources available for patients include a dietitian who visits the community monthly, and a new fitness center. Additionally patient handout availability and effectiveness was examined. While the physicians were actively discussing the importance of diet and fitness with their patients, time limitations prevented adequate follow up. Many patients expressed bewilderment at the amount of different diet information available via the popular press. Patients requested basic, simple guidelines to help them start meeting their weight loss goals. Handouts currently available at the clinic are from the American Heart Association, and while quite comprehensive were described as “confusing” and “overwhelming.” The final phase of this project thus involved the creation of a short, simple handout that outlined suggested dietary modifications for weight loss. Obesity Project Date: 12/30/2002 Obesity is a growing epidemic in the U.S. today. Currently obesity related diseases claim 300,000 lives yearly. If this trend continues, obesity will overtake smoking as the number one preventable killer of United States citizens. Obesity costs our health care system more than 330 billion dollars annually, which is approximately 12% of the national health care budget. It is an enormous problem. At the present there are no effective “quick fix” therapies for obesity. Drug therapy has been un-affective and gastric bypass is an option for very few. Good old-fashioned dietary control through lifestyle change and physical activity seem to be the most effective and long-lasting way to prevent and treat obesity. Because treatment is so difficult, the war on obesity begins with prevention. Children who are obese become adults who are obese. Obese six-year-olds become obese adults 50% of the time, while adult obesity rates from obese teens rise as high as 70-80%. Are we succeeding at preventing this obesity epidemic? Data suggests that primary care doctors are poor at screening for and treating the complications of obesity. Childhood obesity has nearly doubled since the 60’s and we are still not actively treating this epidemic. I set out to define the gravity of this problem in the West Salem Clinic. Both low-income and Hispanic populations are the populations with the greatest increase in childhood obesity in the last 15 years. The West Salem Clinic treats mostly low-income families and the majority of the patients are Hispanic. Providers at the clinic have noticed the problem for years and I set out to define the prevalence of childhood obesity in the West Salem Clinic and compare it to the U.S. population. After defining the prevalence of this at-risk population, I developed a detection and screening process to identify and treat obese and overweight children. I provided the providers of the clinic with a checklist of evidence-based guidelines for identifying the complications associated with childhood obesity. This detailed checklist includes prevalence data to convince providers of the importance of screening. I also made up a short checklist to be inserted in the chart if any child is ever identified as overweight on the BMI growth chart. Overweight is defined as a BMI >85 percentile for age and sex while obesity is >95 percentile. This checklist contains solid evidence-based screening tests that should be done on every overweight or obese child. Identifying and treating the medical complications associated with childhood obesity is responsible but the obesity itself must be treated to truly take care of your patients. Most physicians encourage diet and exercise but most folks are unresponsive to these vague suggestions. Diet and exercise is accomplished through lifestyle change. Lifestyle change is very difficult and it must be encouraged and followed in a gradual step-wise fashion to prevent failure and assure lo Back to subject search page or search by preceptor site