Community Nutrition in Action (2016) - PDF

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editor...

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN, author, title, or keyword for materials in your areas of interest. Important notice: Media content referenced within the product description or the product text may not be available in the eBook version. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  Dietary Reference Intakes (DRIs) T he Dietary Reference Intakes (DRIs) include two sets of values that serve as goals for nutrient intake—Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs). The RDA reflects the average daily amount of a nutrient considered adequate to meet the needs of most healthy people. If there is insufficient evidence to determine an RDA, an AI is set. The DRIs also include a set of values called Tolerable Upper Intake Levels (ULs). The UL represents the maximum amount of a nutrient that appears safe for most healthy people to consume on a regular basis. Turn the page for a listing of the ULs for selected vitamins and minerals. Estimated Energy Requirements (EERs), Recommended Dietary Allowances (RDAs), and Adequate Intakes (AIs) for Water, Energy, and the Macronutrients , , ht ht ) eig ay ig y) ay id c MI da e y) d (in e he /d da t y) /d cid (lb e w /m 2 e B A ( dra (g ic ac kg da ) al/ ) ) ) /d r y) ay ay ay AI leic a AI l fibe (kg renc cm renc kg enc RD ohy AI fat g/ da g/ g/ ) (kc n AI er a RD n /d ) RD n /d EE gy ) Life-Stage ole tei tei A( A( (L / fer (g (g tal (g rb Rb er fe fe ta o t Pro Pro Wa Group Lin Lin Ca En Re Re Re To To AI Males 0–6 mo — 62 (24) 6 (13) 0.7e 570 60 — 31 4.4 0.5 9.1 1.52 7–12mo — 71 (28) 9 (20) 0.8f 743 95 — 30 4.6 0.5 11 1.2 1–3 yg — 86 (34) 12 (27) 1.3 1046 130 19 — 7 0.7 13 1.05 4–8 yg 15.3 115 (45) 20 (44) 1.7 1742 130 25 — 10 0.9 19 0.95 9–13 y 17.2 144 (57) 36 (79) 2.4 2279 130 31 — 12 1.2 34 0.95 14–18 y 20.5 174 (68) 61 (134) 3.3 3152 130 38 — 16 1.6 52 0.85 19–30 y 22.5 177 (70) 70 (154) 3.7 3067h 130 38 — 17 1.6 56 0.8 31–50 y 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 38 — 17 1.6 56 0.8 $ 51 y 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 30 — 14 1.6 56 0.8 Females 0–6 mo — 62 (24) 6 (13) 0.7e 520 60 — 31 4.4 0.5 9.1 1.52 7–12 mo — 71 (28) 9 (20) 0.8f 676 95 — 30 4.6 0.5 11 1.2 1–3 yg — 86 (34) 12 (27) 1.3 992 130 19 — 7 0.7 13 1.05 4–8 yg 15.3 115 (45) 20 (44) 1.7 1642 130 25 — 10 0.9 19 0.95 9–13 y 17.4 144 (57) 37 (81) 2.1 2071 130 26 — 10 1.0 34 0.95 14–18 y 20.4 163 (64) 54 (119) 2.3 2368 130 26 — 11 1.1 46 0.85 19–30 y 21.5 163 (64) 57 (126) 2.7 2403j 130 25 — 12 1.1 46 0.8 31–50 y 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 25 — 12 1.1 46 0.8 $ 51 y 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 21 — 11 1.1 46 0.8 Pregnancy 1st trimester 3.0 10 175 28 — 13 1.4 71 1.1 2nd trimester 3.0 1340 175 28 — 13 1.4 71 1.1 3rd trimester 3.0 1452 175 28 — 13 1.4 71 1.1 Lactation 1st six months postpartum 3.8 1330 210 29 — 13 1.3 71 1.3 2nd six months postpartum 3.8 1400 210 29 — 13 1.3 71 1.3 Note: For all nutrients, values for infants are AIs. Dashes indicate that values have not been d The values listed are based on reference body weights. determined. e Assumed to be from human milk. a The water AI includes drinking water, water in beverages, and water in foods; in general, f Assumed to be from human milk and complementary foods and beverages. This drinking water and other beverages contribute about 70 to 80%, and foods, the remainder. includes approximately 0.6 L (~3 cups) as total fluid including formula, juices, and Conversion factors: 1 L 5 33.8 fluid oz; 1 L 5 1.06 qt; 1 cup 5 8 fluid oz. drinking water. b The Estimated Energy Requirement (EER) represents the average dietary energy intake g For energy, the age groups for young children are 1–2 years and 3–8 years. that will maintain neutral energy balance in a healthy person of a given sex, age, weight, h For males, subtract 10 kilocalories per day for each year of age above 19. height, and physical activity level. The values listed are based on an “active” person at the i Because weight need not change as adults age if activity is maintained, reference weights reference height and weight and at the midpoint ages for each group until age 19. Go to for adults 19 through 30 are applied to all adult age groups. www.choosemyplate.gov for tools to determine Estimated Energy Requirements. j For females, subtract 7 kilocalories per day for each year of age above 19. c The linolenic acid referred to in this table and text is the omega-3 fatty acid known as alpha-linolenic acid. Source: Adapted from the Dietary Reference Intakes series, National Academies Press. Copyright 1997, 1998, 2000, 2001, 2002, 2004, 2005, 2011 by the National Academy of Sciences. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs) for Vitamins da cid ay a ay e ay d ay b ay c ) ) ) ) ) ) ) ) ay ) ) ay g/ c a ay ay ay y) y) /d y) y) /d /d /d /d /d (m ni /d /d mg 2 /d /d A( n da A ( B6 A ( B1 A( D A( C A( A da da (m K A( E mg mg mg mg AI othe mg RD flavi mg mg mg mg RD min RD in RD in RD in e RD in in g/ RD n RD n g/ g/ Life-Stage n i i RD in e am A( am am AI in A( am am am A( am (m oli (m lat o ia nt ac t Group Rib Bio Th Vit RD Ch Vit Vit Vit Vit Vit Vit Pa Fo Ni AI AI Infants 0–6 mo 0.2 0.3 2 5 1.7 0.1 65 0.4 125 40 400 10 4 2.0 7–12 mo 0.3 0.4 4 6 1.8 0.3 80 0.5 150 50 500 10 5 2.5 Children 1–3 y 0.5 0.5 6 8 2 0.5 150 0.9 200 15 300 15 6 30 4–8 y 0.6 0.6 8 12 3 0.6 200 1.2 250 25 400 15 7 55 Males 9–13 y 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60 14–18 y 1.2 1.3 16 25 5 1.3 400 2.4 550 75 900 15 15 75 19–30 y 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120 31–50 y 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120 51–70 y 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 15 15 120. 70 y 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 20 15 120 Females 9–13 y 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60 14–18 y 1.0 1.0 14 25 5 1.2 400 2.4 400 65 700 15 15 75 19–30 y 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90 31–50 y 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90 51–70 y 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 15 15 90. 70 y 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 20 15 90 Pregnancy 14–18 y 1.4 1.4 18 30 6 1.9 600 2.6 450 80 750 15 15 75 19–30 y 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90 31–50 y 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90 Lactation 14–18 y 1.4 1.6 17 35 7 2.0 500 2.8 550 115 1200 15 19 75 19–30 y 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90 31–50 y 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90 Note: For all nutrients, values for infants are AIs. c Vitamin A recommendations are expressed as retinol activity equivalents (RAE). a Niacin recommendations are expressed as niacin equivalents (NE), except for recommen- d Vitamin D recommendations are expressed as cholecalciferol. dations for infants younger than six months, which are expressed as preformed niacin. e Vitamin E recommendations are expressed as a-tocopherol. b Folate recommendations are expressed as dietary folate equivalents (DFE). Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs) for Minerals ) ) ) ) ) ) ) ) ) ay ay ay ay ay mg m ay ay ay ay y) y) y) y) y) y) A ( rus A ( um /d /d se /d /d A ( nu /d /d /d /d /d da da (m m da da da AI sium da AI ane RD um mg mg mg mg mg RD de mg RD pho mg AI miu mg e RD nesi g/ e g/ g/ g/ g/ RD m AI um g/ d RD er d RD ne Life-Stage lyb i A( A( i A( A( A( ng (m u A( (m (m (m tas i len (m lor pp or os ro lci g di c n i Iod Mo Group Zin Ma RD Ma RD Iro Flu Ch Po Ch Ph Co Se So AI Ca AI Infants 0–6 mo 120 180 400 200 100 30 0.27 2 110 15 200 0.003 0.01 0.2 2 7–12 mo 370 570 700 260 275 75 11 3 130 20 220 0.6 0.5 5.5 3 Children 1–3 y 1000 1500 3000 700 460 80 7 3 90 20 340 1.2 0.7 11 17 4–8 y 1200 1900 3800 1000 500 130 10 5 90 30 440 1.5 1 15 22 Males 9–13 y 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.9 2 25 34 14–18 y 1500 2300 4700 1300 1250 410 11 11 150 55 890 2.2 3 35 43 19–30 y 1500 2300 4700 1000 700 400 8 11 150 55 900 2.3 4 35 45 31–50 y 1500 2300 4700 1000 700 420 8 11 150 55 900 2.3 4 35 45 51–70 y 1300 2000 4700 1000 700 420 8 11 150 55 900 2.3 4 30 45. 70 y 1200 1800 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45 Females 9–13 y 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.6 2 21 34 14–18 y 1500 2300 4700 1300 1250 360 15 9 150 55 890 1.6 3 24 43 19–30 y 1500 2300 4700 1000 700 310 18 8 150 55 900 1.8 3 25 45 31–50 y 1500 2300 4700 1000 700 320 18 8 150 55 900 1.8 3 25 45 51–70 y 1300 2000 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45. 70 y 1200 1800 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45 Pregnancy 14–18 y 1500 2300 4700 1300 1250 400 27 12 220 60 1000 2.0 3 29 50 19–30 y 1500 2300 4700 1000 700 350 27 11 220 60 1000 2.0 3 30 50 31–50 y 1500 2300 4700 1000 700 360 27 11 220 60 1000 2.0 3 30 50 Lactation 14–18 y 1500 2300 5100 1300 1250 360 10 13 290 70 1300 2.6 3 44 50 19–30 y 1500 2300 5100 1000 700 310 9 12 290 70 1300 2.6 3 45 50 31–50 y 1500 2300 5100 1000 700 320 9 12 290 70 1300 2.6 3 45 50 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  Tolerable Upper Intake Levels (ULs) for Vitamins y) c y) a y) a y) b g/ B6 g/ n D g/ n A g/ C g/ E y) y) y) y) (m min ( m in ( m in da da ( m ne da da da da da da i i ( m in Life-Stage (m e am am am am oli g/ g/ la t g/ ac a Group Vit Vit Vit Vit Vit Ch Fo (m (m Ni Infants 0–6 mo — — — — — 600 25 — 7–12 mo — — — — — 600 38 — Children 1–3 y 10 30 300 1000 400 600 63 200 4–8 y 15 40 400 1000 650 900 75 300 Adolescents 9–13 y 20 60 600 2000 1200 1700 100 600 14–18 y 30 80 800 3000 1800 2800 100 800 Adults 19–70 y 35 100 1000 3500 2000 3000 100 1000. 70 y 35 100 1000 3500 2000 3000 100 1000 Pregnancy 14–18 y 30 80 800 3000 1800 2800 100 800 19–50 y 35 100 1000 3500 2000 3000 100 1000 Lactation 14–18 y 30 80 800 3000 1800 2800 100 800 19–50 y 35 100 1000 3500 2000 3000 100 1000 a The ULs for niacin and folate apply to synthetic forms bThe UL for vitamin A applies to the preformed vitamin only. obtained from supplements, fortified foods, or a cThe UL for vitamin E applies to any form of supplemental combination of the two. a-tocopherol, fortified foods, or a combination of the two. Tolerable Upper Intake Levels (ULs) for Minerals y) m g/ rus g/ um g/ denu g/ ese y) d y) y) y) y) y) y) y) y) y) y) (m ium y) y) y) (m pho (m de (m esi (m an (m ide (m um da da (m um da da da da da da da da da (m er da da da da lyb ine (m l Life-Stage i (m n gn ng cke lor len g/ g/ pp g/ g/ g/ g/ or g/ g/ os lci ro g/ di g/ g/ c n Mo Iod Ma Ma Zin Group Flu Ch Ph (m So Ca (m Iro Co Bo Se (m (m Ni Infants 0–6 mo —e —e 1000 — — 40 4 — 45 — — 0.7 — — — 7–12 mo —e —e 1500 — — 40 5 — 60 — — 0.9 — — — Children 1–3 y 1500 2300 2500 3000 65 40 7 200 90 1000 2 1.3 300 3 0.2 4–8 y 1900 2900 2500 3000 110 40 12 300 150 3000 3 2.2 600 6 0.3 Adolescents 9–13 y 2200 3400 3000 4000 350 40 23 600 280 5000 6 10 1100 11 0.6 14–18 y 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 Adults 19–70 y 2300 3600 2500f 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0. 70 y 2300 3600 2000 3000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 Pregnancy 14–18 y 2300 3600 3000 3500 350 45 34 900 400 8000 9 10 1700 17 1.0 19–50 y 2300 3600 2500 3500 350 45 40 1100 400 10,000 11 10 2000 20 1.0 Lactation 14–18 y 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 19–50 y 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 d The UL for magnesium applies to synthetic forms obtained from supplements or drugs only. Source: Adapted with permission from the Dietary Reference Intakes series, National Academies e Source of intake should be from human milk (or formula) and food only. Press. Copyright 1997, 1998, 2000, 2001, 2011, by the National Academy of Sciences. Courtesy f The UL for calcium for 19–50 y is 2500 mg/day; the UL for calcium is reduced to 2000 mg/day of the National Academies Press, Washington, D.C. for 51–70 y. Note: An upper limit was not established for vitamins and minerals not listed and for those age groups listed with a dash (—) because of a lack of data, not because these nutrients are safe to consume at any level of intake. All nutrients can have adverse effects when intakes are excessive. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  SEVENTH edition Community Nutrition in Action AN ENTREPRENEURIAL APPROACH Marie A. Boyle, PhD, RD College of Saint Elizabeth Australia Brazil Mexico Singapore United Kingdom United States Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 Community Nutrition in Action, ©2017, 2013 Cengage Learning Seventh Edition WCN: 01-100-101 Marie A. Boyle ALL RIGHTS RESERVED. 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Photo Researcher: Lumina Datamatics For permission to use material from this text or product, Text Researcher: Lumina Datamatics submit all requests online at www.cengage.com/permissions. Text Designer: Riezebos Holzbaur/Andrei Further permissions questions can be e-mailed to Pasternak; Ellen Pettengell Design [email protected]. Cover Designer: Michael Cook Library of Congress Control Number: 2016936074 Compositor: SPi-Global Cover Image: Istock/FangXiaoNuo (main), ISBN: 978-1-305-63799-3 Istock/SolStock (top), Istock/gpointstudio Loose-leaf Edition: (middle), Istock/monkeybusinessimages (bottom ISBN: 978-1-305-88235-5 Cengage Learning 20 Channel Center Street Boston MA 02210 USA Cengage Learning is a leading provider of customized learning solutions with employees residing in nearly 40 different countries and sales in more than 125 countries around the world. Find your local representative at www.cengage.com. Cengage Learning products are represented in Canada by Nelson Education, Ltd. To learn more about Cengage Learning Solutions, visit www.cengage.com. Purchase any of our products at your local college store or at our preferred online store www.cengagebrain.com. Printed in the United States of America Print Number: 01 Print Year: 2016 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 Dedication In memory of Jesse, Dylan, Kate, and McCauley—my twinkling stars in the night sky. And to Maggie, Rex, Elvis, and Tess—may there always be time for footprints in the sand. —Marie A. Boyle About the Author MARIE A. BOYLE, PhD, RD, received her BA in psychology from the University of Southern Maine and her MS and PhD in nutrition from Florida State University. She is author of the basic nutrition textbook Personal Nutrition. Dr. Boyle serves as Chair of the Foods and Nutrition Program and Director of the Graduate Program in Nutrition at the College of Saint Elizabeth in Morristown, New Jersey. Her other professional activities include serving as an author and reviewer for the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior. Dr. Boyle coauthored the current position paper of the Academy of Nutrition and Dietetics, titled Nutrition Security in Developing Nations: Sustainable Food, Water and Health, and serves as editor-in-chief of the Journal of Hunger and Environmental Nutrition by Taylor & Francis. She is a member of the Academy of Nutrition and Dietetics, the American Public Health Association, and the Society for Nutrition Education and Behavior. iii Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 Contents in Brief Preface xi Section One Community Nutritionists in Action: Working in the Community 1 1 Opportunities in Community Nutrition 3 6 The Art and Science of Policymaking 191 2 Principles of Epidemiology 41 7 A National Nutrition Agenda for the Public’s 3 Understanding and Achieving Behavior Health 231 Change 73 8 Addressing the Obesity Epidemic: An Issue for 4 Community Needs Assessment 99 Public Health Policy 275 5 Program Planning for Success 149 9 Health Care Systems and Policy 329 Section Two Community Nutritionists in Action: Delivering Programs 367 10 Food Insecurity and the Food Assistance 13 Healthy Aging: Nutrition Assessment, Services, Programs 369 and Programs 503 11 Mothers and Infants: Nutrition Assessment, 14 Global Food and Nutrition Security: Challenges Services, and Programs 421 and Opportunities 547 12 Children and Adolescents: Nutrition Issues, Services, and Programs 459 Section Three Community Nutritionists in Action: Planning Nutrition Interventions 595 15 Gaining Cultural Competence in Community 17 Marketing Nutrition and Health Promotion 659 Nutrition 597 18 Managing Community Nutrition Programs 691 16 Principles of Nutrition Education 633 19 Building Grantsmanship Skills 713 Appendixes 753 Index 774 iv Copyright 2017 Cengage Learning. 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WCN 02-200-203 Contents Preface xi Section One Community Nutritionists in Action: Working in the Community 1 1 Opportunities in Community Nutrition 3 Cohort Studies 58 Case–Control Studies 60 Introduction 4 Controlled Trials 61 The Concept of Community 4 Nutritional Epidemiology 61 Opportunities in Community Nutrition 5 The Nature of Dietary Variation 62 Public Health and Community Interventions 6 Healthy People: A Report Card for the Nation’s Epidemiology and the Community Nutritionist 65 Health 15 Case Study: Epidemiology of Obesity 66 Community Nutrition Practice 20 Professional Focus: The Well-Read Community Community versus Public Health Nutrition 21 Nutritionist 67 Entrepreneurship in Community Nutrition 28 Entrepreneurs and Intrapreneurs 28 3 Understanding and Achieving Behavior Social and Economic Trends for Community Change 73 Nutrition 30 Introduction 74 Leading Indicators of Change 30 Draw from Current Research on Consumer Watchwords for the Future 35 Behavior 74 Case Study: Ethics and You 35 The Transtheoretical Model (Stages of Change) 77 Professional Focus: Community-Based Dietetics Motivational Interviewing 80 Professionals 37 The Health Belief Model 81 The Theory of Planned Behavior 83 2 Principles of Epidemiology 41 Social-Cognitive Theory 87 Introduction 42 Programs in Action: EatFit Intervention The Practice of Epidemiology 43 Program 89 Investigating Causes of Diseases 43 Cognitive-Behavioral Theory 90 The Diffusion of Innovation Model 91 Basic Epidemiologic Concepts 47 Findings Regarding Applications of Theory to Nutrition Rates and Risks 47 Interventions 92 The Epidemiologic Method 48 Hypothesis Testing 53 Put It All Together: Case Study 1 92 Explaining Research Observations 54 Programs in Action: Intrapersonal and Types of Epidemiologic Studies 55 Interpersonal Health Education 93 Ecological or Correlational Studies 57 Professional Focus: Being an Effective Cross-Sectional or Prevalence Studies 58 Speaker 94 v Copyright 2017 Cengage Learning. 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WCN 02-200-203 vi Contents 4 Community Needs Assessment 99 The People Who Make Policy 200 Legitimizing Policy 202 Introduction 100 The Legislative and Regulatory Process 203 Community Needs Assessment 101 Laws and Regulations 203 Basic Principles of Needs Assessment: Developing a Plan How an Idea Becomes Law 204 and Collecting Data 103 The Federal Budget Process 207 Methods of Obtaining Data about the Target Population 119 The Political Process 209 Issues in Data Collection 129 Current Legislation and Emerging Policy Issues 212 Case Study 1: Women and Coronary Heart Disease 133 The Community Nutritionist in Action 217 Case Study 2: Nutrition Status of Independent Older Make Your Opinion Known 217 Adults 134 Become Directly Involved 218 Basic Principles of Needs Assessment: Analyzing Data Join an Interest Group 218 and Developing a Plan of Action 136 Political Realities 223 Entrepreneurship in Community Needs Case Study: Food Safety as a Food Policy Assessment 139 Issue 223 Professional Focus: Getting Where Professional Focus: Building Media Skills 225 You Want to Go 140 Case Study: Planning a Needs Assessment 7 A National Nutrition Agenda for the Focused on School Children 142 Public’s Health 231 5 Program Planning for Success 149 Introduction 232 Introduction 150 National Nutrition Policy in the United States 232 National Nutrition Monitoring 233 Factors That Trigger Program Planning 150 Nutrient Intake Standards 247 Steps in Program Planning 151 Nutrition Survey Results: How Well Do We Eat? 249 Step 1: Review the Results of the Community Needs The National Agenda for Improving Nutrition Assessment 152 and Health 249 Step 2: Define Program Goals and Objectives 153 Dietary Guidance Systems 252 Step 3: Develop a Program Plan 156 Understanding the Nutrition Gap 259 Step 4: Develop a Management System 164 Implementing the Recommendations: From Guidelines Step 5: Identify Funding Sources 165 to Groceries 261 Step 6: Implement the Program 166 Step 7: Evaluate Program Elements and Case Study: From Guidelines to Groceries 267 Effectiveness 167 Professional Focus: Evaluating Research and Programs in Action: A Learn-and-Serve Information on Nutrition and Health 269 Nutrition Program: The Food Literacy Partners Program 175 8 Addressing the Obesity Epidemic: Spreading the Word about the Program’s Success 179 An Issue for Public Health Policy 275 Use Entrepreneurship to Steer in a New Introduction 276 Direction 180 Defining Obesity and Overweight 276 Professional Focus: The Nutrition Care Process: Epidemiology of Obesity and Overweight 277 A Road Map to Quality Care 180 Medical and Social Costs of Obesity 281 Case Study: Program Planning 188 Determinants of Obesity 282 Obesity Prevention and Treatment 6 The Art and Science of Interventions 291 Policymaking 191 Adult Interventions 292 Introduction 192 Child and Adolescent Interventions 293 The Process of Policymaking 193 Racial and Ethnic Disparities in Obesity 294 Copyright 2017 Cengage Learning. 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WCN 02-200-203  Contents vii Public Health Policy Options for Addressing the Private Insurance 331 Global Obesity Epidemic 295 Government/Public Insurance 333 Obesity Surveillance and Monitoring Efforts 298 The Uninsured 339 Awareness Building, Education, and Research 300 Demographic Trends and Health Care 341 Regulating Environments 304 The Need for Health Care Reform 342 Pricing Policies 311 Societal-Level Solutions 313 Health Care Reform in the United States 347 Health Care Reform: Challenges and Opportunities Where Do We Go from Here? 313 Ahead 348 Programs in Action: Whole School, Whole Nutrition as a Component of Health Community, Whole Child Programs 317 Care Reform 350 Case Study: Worksite Health Promotion Program Medical Nutrition Therapy and Medicare for Prevention of Overweight 320 Reform 355 Professional Focus: Diet Confusion: Weighing Future Changes in Health Care and Its the Evidence 322 Delivery 356 9 Health Care Systems and Policy 329 Professional Focus: Ethics and the Nutrition Introduction 330 Professional 358 An Overview of the Health Care Industry 331 Case Study: Insurance Access 363 Section Two Community Nutritionists in Action: Delivering Programs 367 10 Food Insecurity and the Food Assistance 11 Mothers and Infants: Nutrition Programs 369 Assessment, Services, and Programs 421 Introduction 370 Introduction 422 Counting the Food-Insecure in the United States 371 Trends in Maternal and Infant Health 422 Who Are the Food-Insecure in the United States? 376 National Goals for Maternal and Infant Health: Healthy Causes of Food Insecurity in the United States 384 People 2020 423 Historical Background of Food Assistance Healthy Mothers 427 Programs 385 Maternal Weight Gain 427 Welfare Reform: Issues in Moving from Welfare Adolescent Pregnancy 429 to Work 387 Nutrition Assessment in Pregnancy 429 Federal Domestic Nutrition Assistance Programs Healthy Babies 431 Today 387 Nutrient Needs and Growth Status in Filling In the Gaps to Strengthen the Food Infancy 432 Resource Safety Net 404 Breastfeeding Recommendations 434 The Rising Tide of Food Assistance Need 405 Other Recommendations on Feeding Infants 438 Programs in Action: Overcoming Barriers Primary Nutrition-Related Problems of Infancy 439 to Increasing Fruit and Vegetable Programs in Action: Using Peer Counselors Consumption 408 to Change Culturally Based Behaviors 440 Beyond Public Assistance: What Can Individuals Do? 409 Domestic Maternal and Infant Nutrition Programs 441 Case Study: Hunger in an At-Risk Population 413 The WIC Program 441 Profesional Focus: Moving Toward Community Other Nutrition Programs of the U.S. Department Food Security 414 of Agriculture 449 Copyright 2017 Cengage Learning. 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WCN 02-200-203 viii Contents Nutrition Programs of the U.S. Department of Health Healthy Adults 507 and Human Services 450 National Goals for Health Promotion 507 Looking Ahead: Improving the Health of Mothers Understanding Baby Boomers 511 and Infants 452 Nutrition Education Programs 513 Health Promotion Programs 514 Case Study: Promotion of Breastfeeding 454 Programs in Action: The Farm to Work Professional Focus: Leading for Success 455 Initiative: An Innovative Approach to Obesity Prevention 516 12 Children and Adolescents: Nutrition Aging and Nutrition Status 519 Issues, Services, and Programs 459 Primary Nutrition-Related Problems of Aging 519 Introduction 460 Nutrition Policy Recommendations for Health Promotion Healthy People 2020 National Nutrition for Older Adults 523 Objectives 460 Evaluation of Nutrition Status 524 Healthy People 2010 Final Review 460 Home- and Community-Based Programs What Are Children and Adolescents Eating? 463 and Services 528 Influences on Child and Adolescent Eating Patterns General Assistance Programs 529 and Behaviors 464 Nutrition Programs of the U.S. Department of Weighing In on the Problem of Childhood Obesity 466 Agriculture 530 Other Nutrition-Related Problems of Children and Nutrition Programs of the U.S. Department of Health Adolescents 468 and Human Services 531 Programs in Action: Combating Disordered Private-Sector Nutrition Assistance Programs 535 Nutrition in Young Female Athletes 471 Nutrition Education and Health Promotion Programs Children with Special Health Care Needs 473 for Older Adults 536 Programs in Action: Nutrition Education Strategies Programs in Action: Bringing Food and Nutrition for Preadolescent Girls 474 Services to Homebound Seniors 537 The History of Child Nutrition Programs Looking Ahead: Successful Aging 539 in Schools 475 Case Study: Postmenopausal Nutrition and Nutrition Programs of the U.S. Department Disease Prevention Program 540 of Agriculture 476 Professional Focus: Lighten Up—Be Willing to Nutrition Programs of the U.S. Department of Health Make Mistakes and Risk Failure 541 and Human Services 482 Improving Nutrition in the Childcare Setting 483 14 Global Food and Nutrition Security: Impact of Child Nutrition Programs on Children’s Diets 484 Challenges and Opportunities 547 Building Healthful School Environments 487 Introduction 548 Nutrition Education Programs 489 Mapping Poverty and Undernutrition 548 Nutrition Education in the Public and Private Malnutrition and Health Worldwide 552 Sectors 489 Food Insecurity in Developing Countries 562 Programs in Action: Empowering Teens to Make The Role of Colonialism 563 Better Nutrition Decisions 492 International Trade and Debt 563 Keeping Children and Adolescents Healthy 494 The Role of Multinational Corporations 564 The Role of Overpopulation 565 Case Study: The Child Nutrition Program 495 Distribution of Resources 566 Professional Focus: The Art of Negotiating 497 Agricultural Technology 567 A Need for Sustainable Development 569 13 Healthy Aging: Nutrition Assessment, People-Centered Development 570 Services, and Programs 503 Nutrition and Development 570 Introduction 504 Scaling Up Nutrition 575 Demographic Trends and Aging 506 Agenda for Action 576 Copyright 2017 Cengage Learning. 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WCN 02-200-203  Contents ix Making the World Fit for Children 576 Personal Action: Opportunity Knocks 587 Focus on Children 578 Programs in Action: Vitamin A Field Support Focus on Women 582 Projects 590 International Nutrition Programs 583 Case Study: UNICEF’s Child Survival Looking Ahead: The Global Challenges 586 Campaign 592 Section Three Community Nutritionists in Action: Planning Nutrition Interventions 595 15 Gaining Cultural Competence Programs in Action: Making Healthy Eating Fun for Students 644 in Community Nutrition 597 Nutrition Education to Reduce CHD Risk: Case Introduction 598 Study 1 645 Gaining Cultural Competence 598 Developing Lesson Plans to Reduce CHD Risk 646 Terms Related to Cultural Competence 599 Conducting Formative Evaluation 647 Need for Cultural Competence 600 Cultural Competence Models 606 Designing Nutrition and Health Messages 648 General Ideas for Designing Messages 648 Cross-Cultural Communication 613 Communication Styles 614 Conducting Summative Evaluation 650 Suggestions for Communicating Information 616 Entrepreneurship in Nutrition Education 651 Ways in Which Discussions about Food Can Open Case Study: Developing a Nutrition Education Plan Dialogue 616 for Older Adults at Congregate Feeding Sites 651 Working with Interpreters 616 Professional Focus: Being an Effective Writer 653 Culturally Appropriate Intervention Strategies 618 Explanatory Models 618 17 Marketing Nutrition and Health LEARN Intervention Guidelines 619 Promotion 659 Practical Considerations for Community Introduction 660 Interventions 621 What Is Marketing? 660 Programs in Action: Encouraging Breastfeeding Develop a Marketing Plan 661 among African American Women 622 Develop a Marketing Strategy 668 Essential Organizational Elements of Cultural Monitor and Evaluate 674 Competence 623 Social Marketing: Community Campaigns Case Study: Gaining Cultural Competence in a for Change 675 Muslim Community 625 Social Marketing at the Community Level 679 Professional Focus: Cross-Cultural Nutrition Programs in Action: Motivating Children to Counseling 626 Change Their Eating and Activity Habits 680 A Marketing Plan for Heartworks for Women: 16 Principles of Nutrition Education 633 Case Study 1 681 Introduction 634 Entrepreneurship Leads the Way 684 Applying Educational Principles to Program Professional Focus: Social Media for Nutrition Design 634 Professionals 684 Learning across the Lifespan 636 Case Study: Marketing Nutrition and Health Developing a Nutrition Education Plan 638 Promotion 687 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 x Contents 18 Managing Community Nutrition Identify Funding Sources 719 Identify Potential Collaborators 724 Programs 691 Introduction 692 Building the Proposal 725 Components of a Proposal 725 The Four Functions of Management 692 Budget 741 Planning 692 Assembling the Final Product 745 Organizing 695 Review of the Grant Proposal 746 Leading 700 The Logic Model 747 Controlling 703 Professional Focus: Teamwork Gets Management Issues for Heartworks for Women: Results 748 Case Study 1 705 The Critical Path 705 Appendixes Programs in Action: The Better Health Restaurant Challenge 707 Appendix A Nutrition Assessment The Business of Community Nutrition 709 and Screening 753 Professional Focus: Time Management 710 Appendix B Complementary Nutrition and Health Therapies 758 Appendix C The SMOG Readability 19 Building Grantsmanship Skills 713 Formula 761 Introduction 714 Appendix D Community Needs Assessment Laying the Foundation for a Grant 714 Assignment 763 Generate Ideas 714 Describe Goals 716 Index 774 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 Preface To succeed in community nutrition today, you must be commit- the various Let’s Move! initiatives to address the epidemic of ted to lifelong learning: every day brings new research findings, childhood obesity; embraced social marketing and evidence- new legislation, new ideas about health promotion, and new based guidelines for practice; and gathered evidence and data technologies, all of which affect the ways in which community to improve public health practice and policies—in an effort to nutritionists gather information, solve problems, and reach vul- achieve the nation’s health objectives by the year 2020. nerable populations. You will probably be an entrepreneur— This new seventh edition includes new features and some one who uses innovation and creativity to guide individuals and reorganization: communities to optimal nutrition and good health. You will The epidemiology chapter (Chapter 2) has been moved up work well as a member of teams to lobby policymakers, gather to follow the introductory community nutrition discussion information about your community, and design nutrition pro- so that the incidence, distribution, and control of disease grams and services. You will be skilled in assessing the activities in a population may be examined before trying to under- of “the competition”—the myriad messages about foods, dietary stand and achieve behavior change (Chapter 3). The chapter supplements, and research findings that appear in the media. also precedes the program planning chapter (Chapter 5) to We spoke, in the first edition of this book, about a sea showcase the role of research in developing an evidence change—a shift toward globalization of the workforce and base on which to build policy and programming. communications, reflected in the growth of the Internet—a Chapter 3 “Understanding and Achieving Behavior Change” virtual tsunami in communications, and a shift from clinical describes several evidence-based theories and strategies to dietetics to community-based practice. In the last two decades, consider when designing a nutrition intervention program the public health arena in the United States has documented targeting lifestyle change related to eating patterns and the possibilities of health care reform, the rise of complemen- physical activity and includes practical applications of moti- tary and alternative medicine, and the sequencing of all of the vational interviewing, the transtheoretical model (stages of human genes—together known as the human genome. change), health belief model, theory of planned behavior, Food insecurity has not significantly changed in the last social-cognitive theory, and cognitive-behavioral theory. 20 years, while obesity, diabetes, and other chronic diseases, The chapter is now positioned before the program plan- including heart disease, are increasingly prevalent in both ning chapter to provide students with a theoretical base for developed and developing countries. Our society acknowl- planning program activities. edges that current modes of food production have contributed The material on community needs assessment is now to some of the adverse environmental changes that we see. The presented in one chapter (Chapter 4) so that this impor- concept of sustainable food systems is gaining mainstream tant topic is as clear and concise as possible. A new case attention—with numerous groups encouraging consumers to study “Planning a Needs Assessment Focused on School increase their awareness of sustainability issues and how these Children” helps guide students through a sample needs apply to food systems and the health of communities. The assessment scenario. A new Appendix D provides a sample growing connectedness of the human race—through increas- community needs assessment assignment, as well as an ing use of mobile devices and social media—promises to create example of a completed assignment. new opportunities for community nutritionists to enhance the The text’s program planning chapter (Chapter 5) follows nutrition and health of all peoples. the chapter on community needs assessment in order to Since the last edition was published, our society has devel- facilitate students’ projects in program planning earlier oped wellness policies for its schools; proposed new policies in the semester. The program planning chapter includes and legislation to prevent obesity and overweight in school, more examples to help students write objectives for the workplace, and community environments; rallied behind program planning process, and new tools used in program xi Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 xii Preface evaluation. In the case study following Chapter 5, students The Programs in Action feature “Whole School, Whole practice their program planning skills for designing and Community, Whole Child Programs” describes a model implementing a worksite wellness program. that views the school in a multidimensional and systems- The text further illustrates the importance of demonstrating level fashion, in which all components at the school level meaningful outcomes for nutrition services by including a work together to maintain consistent, healthful messages, Professional Focus following Chapter 5 that introduces the including the surrounding community and environment. nutrition care process (NCP) to enable community nutrition Nutrition-related environmental concerns and sustain- professionals to compete successfully in a rapidly changing ability issues such as how our food and agricultural system environment. Examples of applying the nutrition care pro- impacts our food choices, nutrition, and environment. cess for heart disease in different community practice set- Program planning tools including community nutrition tings are given. Two case studies also incorporate the NCP mapping tools and the Logic Model; the Logic Model is to give students practice in writing a nutrition diagnosis as included to provide a framework for planning, imple- a problem, etiology, signs, and symptoms (PES) statement. menting, managing, and evaluating community nutrition New and expanded topics include: programs. Breastfeeding promotion efforts by WIC, including efforts Coverage of the nation’s new guidelines for healthy meals to improve exclusive breastfeeding rates; UNICEF’s Pro- and snacks in schools. gramming for Infant and Young Child Feeding, including Expanded inclusion of medical nutrition therapy as a ben- interventions for improved breastfeeding and complemen- efit to certain Medicare recipients; new legislative priorities tary feeding. and the current strategic plan of the Academy of Nutrition Since connecting program objectives with appropriate and Dietetics. activities is an important program planning skill, new tips Complete coverage of the 2015–2020 Dietary Guidelines for for linking objectives with program activities for achiev- Americans, which emphasize healthy eating patterns and ing the objectives are included; several chapters place new other recommendations to improve the nutrition and health emphasis on the three levels of intervention—building status of Americans. awareness, changing lifestyles, or creating a supportive A detailed discussion of the Healthy People 2020 initiative environment—when linking objectives and activities. In a and its emphasis on health disparities and the social and new case study: “Developing a Nutrition Education Plan physical determinants of health. for Older Adults at Congregate Feeding Sites,” students use The social–ecological model, which illustrates how diverse literature and formative evaluation data to develop topics factors converge to influence food and physical activity and objectives for nutrition lessons, and include strategies choices. The Centers for Disease Control and Prevention’s that address each of the three levels of intervention. “Social Ecological Model: A Framework for Prevention” In the case study following Chapter 17, students incorpo- is introduced in Chapter 1, connected to the 2015–2020 rate social media and social marketing tools in developing Dietary Guidelines for Americans in Chapter 7, and applied a marketing plan for a weight-loss program. to child obesity in Chapter 8. Appendix A now includes both the WHO Child Growth Expanded coverage of cultural competence and health dis- Standards to monitor growth for infants and children from parities with specific examples of health disparities. birth to two years of age in the U.S. and the CDC growth Coverage of health and media literacy and informatics; a charts for use with children age two years and older in the U.S. Programs in Action feature “The Food Literacy Partners Program” focuses on food and nutrition information to help Several terms surface repeatedly in this text: change, innova- individuals make appropriate eating decisions. tion, creativity, evidence-based, community, policymaking, net- The most recent recommendations for obesity prevention working, and entrepreneurship. These watchwords herald the as found in the IOM report, Accelerating Progress in Obesity unprecedented challenges that lie ahead of us in this decade. Prevention: Solving the Weight of the Nation; new coverage Community nutritionists who succeed in this challenging envi- of proposed policies and legislation to prevent obesity and ronment are flexible, innovative, and versatile. They are focused overweight in the school, workplace, and community envi- on recognizing opportunities for improving people’s nutrition ronments; a Programs in Action feature “The Farm to Work status and health and on helping society meet its obligation Initiative: An Innovative Approach to Obesity Prevention” to alleviate food insecurity and malnutrition. It is an exciting describes a worksite wellness program that was created to time for community nutritionists. It is a time for learning new change the worksite environment in order to make opting skills and moving into new areas of practice. It is a time of great for fruits and vegetables an easy choice for employees. opportunity and incredible need. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  Preface xiii The Seventh Edition competent nutrition services. Chapter 16 gets to the heart of any program: the nutrition messages used in community inter- In this seventh edition, we continue to discuss the important ventions. Chapter 17 introduces the principles of marketing, issues in community nutrition practice and to present the core including social marketing, an important endeavor in commu- information needed by students who are interested in solv- nity nutrition practice. You are more likely to get good results ing nutrition and health problems. The book is organized into if your program is marketed successfully! Chapter 18 addresses three sections. Section One shows the community nutrition- such important management issues as how to control costs and ist in action within the community. Chapter 1 describes the manage people. Finally, Chapter 19 closes the text with a dis- activities and responsibilities of the community nutritionist cussion of grantsmanship—everything you need to know about and introduces the principles of entrepreneurship and the finding and managing funding for community programs and three arenas of community nutrition practice: people, policy, interventions. and programs. Chapter 2 reviews the basic principles of epi- Many of the unique features of the previous editions have demiology. Chapter 3 introduces several behavior change been retained: theories and discusses what research tells us about how to influence behavior. Chapter 4 gives a step-by-step analysis of Professional Focus. This feature is designed to help you the community needs assessment process and describes the develop personal and professional skills and attitudes that types and sources of data collected about the community, as will boost your effectiveness and confidence in community well as the questions you’ll ask in obtaining information about settings. The top