Key Health Determinants-Response

Question

all sources have to be from the year 2013 to present

Answer

WRITE ONE TO TWO PARAGRAPHS RESPONDING TO EACH DISCUSSION.Each discussion needs at least 2 sources each. Focus particularly on those questions raised to which you can add comments based on shared experiences or situations. Consider how your colleagues’ postings reflect and/or differ from your own perceptions and opinions.

Respond to at least two of your colleagues on two different days in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research using an in-text citation in APA format.

• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

• Validate an idea with your own experience and additional research.

• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Discussion 1: Amanda D

Key Health Determinants in Obesity

The population health issue that is of interest to me is obesity. The five key health determinants (access to health care, individual behavior, social environment, physical environment, and genetics) are crucial when trying to improve this issue. Access to health care is critical in that patients need to have the education and tools to be able to reduce obesity or understand the importance of healthy eating and exercise. Access to health care can also provide screening tools to help reduce chronic conditions that can develop because of obesity such as Diabetes.

 Individual behavior may be one of the biggest health determinants in that it is a personal choice to eat healthy and exercise. Even if all the other determinants are readily available, without the individual having healthy behaviors the issue will not be improved. Kindig describes examples of social environment as “income, education, employment, social support, and culture” (Kindig, 2007).  If a patient does not have the education and income to understand the needs of a healthy lifestyle then definitely run the risk of obesity and its further complications. Social culture also plays a big role. If a person is raised in an environment where exercise and healthy eating is not priority then they often will learn to live the same way. Having a healthy lifestyle is a big lifestyle change and one that is often easier obtainable with social support and education to make smart choices.

 Physical environment is a big factor to obesity, if a patient doesn’t have healthy food choices available or appropriate places to exercise they are at a much higher risk of obesity. “Obesity in low-income urban areas has been associated with environmental factors such as low availability and high prices of healthy foods, especially when compared with the low prices of high-fat and high-sugar foods. A study conducted in Baltimore observed that 43% of African-American neighborhoods had low availability of healthy foods” (Sato, 2016).  

The last key health detriments are the role of genetics. I think genetics can be a leading cause of obesity however, I think the first 4 health detriments have a bigger impact. I think social and family culture plays a larger role in obesity than just genetics. If a child has obese parents I think It is a personal choice to change lifestyle and stop the line. Though to make such a change they need social support, physical access to healthy food and areas to be active, as well as the education and income to follow a healthy lifestyle. I can see genetics playing a larger role in other health issues.

                                                     Epidemiologic Data of Obesity in Population Health

             There is a lot of research done on the detrimental significance of obesity in population health. “The prevalence of obesity in the United States has tripled in the past 40 years with disproportionately higher rates in low-income children of color. Socioeconomic and racial/ethnic disparities in rates of obesity appear during the preschool years. Not surprisingly, children with an elevated body mass index before 5 years of age are at increased risk of becoming obese adults, suggesting a need to intervene early in life” (Cloutier, 2015) There is a clear need for obesity prevention and many policy initiatives have been designed to target the obesity issue in society, such as the Healthy Lunch programs initiated by Michelle Obama. “Childhood and adult obesity are national problems and growing epidemics, but the passage of the Healthy, Hunger-Free Kids Act will help end this epidemic by improving the quality of food served to our children in schools across the nation.” (White House, 2010).  There are countless amounts of research being done showing the long-term effects and cost of obesity and it is in our best interest to combat this at a young age.  It is a key objective in Healthy People 2020. “The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities” (Healthy People, 2010). I think this research should continue to be used in creating health initiatives and policies. It is much easier to make life changes at youth then later in life. We need to educate families and children on healthy eating styles that can be implemented in the home and in school. We also need to continue implementing healthy lifestyle programs in the community offering safer parks, sidewalks, and access to healthy foods such as farmer markets.

Discussion 2: Molly H

Population health is defined as “the health outcomes of a group of individuals, and the distribution of outcomes within that group” (Knickman and Kovner, 2015, p. 374).  Population health assesses multiple factors or determinants that affect the health status between different groups and analyzes the information to determine causes leading to poor outcomes.  The five determinants help identify the origin of the health issue and include:  access to care, individual behavior, social environment, physical environment, and genetics (Knickman and Kovner, 2015).  My selected health issue is test anxiety in students, particularly, nursing students.  Working with students throughout my career and now as an instructor at a local allied health college in the nursing division, I have seen the devastation of students suffering from test anxiety.   Mental health is one of the 12 topic areas identified in the Healthy People 2020 Leading Health Indicators (U.S. Department of Health and Human Services, 2012).   When thinking of population health, one must consider the multiple variants that influence and affect health outcomes.  By addressing the five health determinants, a holistic picture is created, and healthcare professionals may be proactive instead of reactive and institute prevention and wellness programs. 

Access to Care

Access to care may be difficult for students during their college years.   If the student is over 26 and not covered under their parental health insurance policy it may be challenging to obtain health coverage.  The Affordable Care Act (Knickman and Kovner, 2015) may help alleviate the availability of the insurance concern by offering the healthcare exchanges where a student may purchase a subsidized health policy.  Even with the subsidies, the plans offered may be too costly for a college student on a tight budget.  If the student attends a college or university a considerable distance from home, the student may not be able to access their primary care provider readily and put off care until they return home for school breaks.  Accessibility to treatment may be a large obstacle for nursing students in the management of their test anxiety (Markum, Balik, Braunstein-Bercovitz, &Ehrenfeld, 2011).

Individual Behavior

The choices a person makes in their lifestyle influences health outcomes.  Certain behaviors demonstrated by students increase test anxiety.  The amount of time and quality of study habits, use of resources, sleep, nutrition, number of work hours per week, and chronic stress all play a role in the level of test anxiety experienced by students (Augner, 2015; Chaniotis, Soultatou, Artemiadis, Papadimitriou, &Darviri, 2013; Damer&Melendres, 2011; Gibson, 2014).  Students must prepare for exams by studying ample time throughout their coursework, and not cram at the last minute.  When they study, it needs to be quality study time without distractions such as their cell phone, the television, children, spouses or significant others, or household chores.  Seeking out tutoring, faculty guidance, library assistance, and other resources available assists the student feel more prepared.  Overlooking the importance of rest and sleep, the student tries to complete coursework and potentially job and family responsibilities.  Unhealthy eating habits were exhibited (Chaniotis et al., 2013) as a coping mechanism for stressful academic situations.  Efforts need to be made to make healthy choices the easy option (Knickman&Kovner, 2015).

Social Environment

Social environment considers factors such as education, income, culture, and social support (Knickman&Kovner, 2015).  Nursing school culture differs from non-healthcare majors in that the stakes are higher for healthcare education.  Nursing majors may only fail one or two nursing courses before being dismissed from the program and grading tends to be tougher with less than a C being considered a failing grade.  Test anxiety reveals itself during the strict assessment and testing processes throughout the curriculum (Gibson, 2014).  While at school, the nursing student may be away from home and the support of family and friends.  Peer relationships from classmates may be supportive or destructive. Peers may unintentionally increase anxiety by discussing their successes or failures, dissecting assessments after completion, or disrupting study sessions.  A supportive social environment is crucial to student success.

Physical Environment

The testing or assessment environments are stressful and play a role in anxiety for students (Johnson, 2014).  The physical environment may consist of the classroom, skills lab, and the students’ body.  The classroom and skills lab may be hot or cold, large or small, quiet or noisy.  The skills lab may feel foreign to students with little to no patient care experience. Testing conditions are strict and the tension palpable creating physiologic changes in the student (Prato &Yucha, 2013).  A racing heart, cold sweat, increased respirations, trembling, nausea, and headaches alter how a student copes with the anxious event.  According to a study (Rea-Jeng, Yu-ying, Mei-Ling, & Shu-Fang, 2014), 94.6% of participants were “most anxious about the attitudes of the teachers proctoring the tests” and 92.2% “by the test atmosphere” (p. 586).  Attitudes create not only an emotional environment but a physical one felt by the student.  Creating a physical environment conducive to learning is vital.

Genetics

Genetics is the science of heredity and how traits pass from one generation to another causing similarities and differences (Dictionary.com, 2016).  According to Augner (2014), depression, chronic stress, and emotional stability are predictive of test anxiety.  Lui and Lu’s (2013) study showed genetic significance in test anxiety by showing that the “data confirmed that the 4-repeat allele of the MAOA gene was related to a higher level of anxiety” (p.1105).   Anxiety has a genetic basis and should be considered when developing an intervention program.

Impact

Knickman and Kovner (2015) state that the five health determinants are not equal in determining the population health outcomes.  Each plays its part and is important.  Ranking the determinants in relation to test anxiety, individual behavior, and physical environment impact more than access to care, social environment, and genetics.  According to Gibson (2014), key attributes of test anxiety include “behavioral aspects such as study habits and test taking abilities” and “physical signs such as palpitations, trembling, fidgeting, nausea, jitters, or headaches” (p. 273).  Gibson (2014) utilizes case studies to exemplify the varying levels of anxiety based on individual behaviors.  Genetics are currently beyond our control, but starts the test anxiety train in early childhood (Weems et al., 2015).

Significance

Test anxiety is a critical concept to address in nursing education.  Anxiety negatively impacts learning, achieving academic and clinical success, and potentially failure of the licensing exam (Gibson, 2014). Multiple studies (Augner, 2014; Damer&Melendres, 2011; Gibson, 2014; Johnson, 2014; Rea-Jeng et al., 2014) indicate that nursing students experience higher levels of test anxiety due to the rigors and high stakes of the nursing curriculum.  With the nursing shortage, it is imperative that educators prepare qualified candidates who can meet the academic, emotional, and physical demands of the nursing profession. 

Population Health Measures and Policy Initiatives

Gibson (2014) identifies that there is minimal research, in the past five years, on test anxiety related to nursing students and even less on initiatives to prevent or treat the phenomenon.  Test anxiety is not classified as an official mental health disorder (Weems et al., 2015), so it is overlooked as an area to focus research and resources.  Prato and Yucha (2013) worked with biofeedback training to assist the nursing student to relax before testing.  Johnson (2014) utilized aromatherapy during testing.  Damer and Melendres (2011) created a support group that used cognitive-behavioral techniques combined with test taking skills.  Broderson (2017) performed an integrative review that showed utilizing “collaborative testing, humorous exam items, crib sheets, test-taking skills workshops, and exam analysis” (p. 135) were effective.  Quinn and Peters (2017) utilized Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to determine that “environmental adjustments and behavior modification” (p. 145) reduced test anxiety in nursing students.  With the lack of policy initiatives and prevention measures, it is imperative as educators we address this escalating health matter.

Conclusion

More research is necessary on test anxiety, interventions, and preventative care for students, especially nursing students.  A holistic approach, considering all five health determinants, must be implemented to move “upstream” (Knickman and Kovener, 2015, p. 80) in managing this population health issue.  For nursing education to graduate the future nursing professionals, test anxiety must be tackled.

Answer

Key Health Determinants

Response to Discussion 1

            Obesity has turned into a national health issue as a result of the large number of people that are affected by the disorder. One of the ways of curbing the health disorder is through the provision of education to help the general population understand the importance of leading a healthy life (Tinning, Philpot, & Cameron, 2016). While it is apparent that schools cannot solve the problem on their own, the need for strong school-based policies as well as programs is important as it can help in guiding a change in the behavior of the public. Modeling behavior of young people to engage in activities that help in the reduction of the chance of occurrence of obesity is important. The schools carry the largest capacity of young people hence can be effective in the promotion of lifelong healthy living and physical activity (Goldberg & Wright, 2017). The government can also engage in public education campaigns. The messages can be simplified to help the public understand the complex nutritional issues that contribute to the occurrence of the obesity epidemic.

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Response to Discussion 2

            Test anxiety affects a lot of students, especially when it is their first time to do a quiz or examination in a new level of education. In most cases the test anxiety is as a result of inadequate preparation by the students. There are other cases that are true test phobias although they occur rarely. There are several steps that can be taken to help reduce the occurrence of test anxiety. The main interventions are categorized as either behavioral or cognitive. Behavioral interventions are aimed at reducing the arousal of anxiety (Spielberger, 2013). They mostly involve relaxation training, systematic desensitization, as well as biofeedback. Cognitive interventions are mainly concerned with identification of self-defeating thoughts that are responsible for reduction of confidence (Quinn, & Peters, 2017). The negative thoughts are replaced with more realistic thoughts.