Final Write Up And Lesson Plan GROUP PROJECT

Lily Santangelo, Sarah White, Charlie France

Target Audience: Coronary heart disease prevention in middle aged African American professional men who travel and frequently eat out at fast casual restaurants (you were asked to give this talk at an area business employing a professional work force during their monthly business meeting)

Part 1: Final Assignment Write Up

Article Summaries

Physical Activity (PA), Inflammation, Coronary Artery Calcification (CA) in relation to Coronary Heart Disease (CHD) in African Americans [Peer Reviewed Journal]

Although it has been suggested that there is a close link between PA and CHD, very few of these studies have been done in African Americans1. Before the Jackson Heart Study, many reports suggested findings that were polar opposites of each other. In one study, there was no significant relationship between PA and CHD in African Americans but the participant group was large, and only contained women1. In another study, with smaller numbers of African Americans, there appeared to be an inverse relationship between PA and cardiovascular (CV) events1. PA works inversely with CAC, coronary artery stiffness and peripheral artery disease, all of which are associated with CHD and negates prior work that states negative findings of relationship between PA and CHD in African Americans1. With the finding that only 19.3% of African Americans obtain an ideal level of PA, this is significant1. After an initial visit and a follow up 12.8 years later, there was a recorded 164 incident CHD events1. An ideal PA level (150 min/week of moderate to vigorous activity or 75 min/week of vigorous activity) was associated with a lower rate of incident CHD compared to poor PA level (0 min/week)1. Not only this, but an ideal PA showed a lower prevalence of CAC and a lower high sensitivity c-reactive protein (hs-CRP) [which is what constitutes inflammation in blood vessel walls]1. Some key ideas were highlighted that posed the significance of PA levels in African Americans. Not only may PA be a more important risk modifier in African Amercians, even for those that are not at a high risk already, but it is also reported that African Americans have reported to be less active than other ethnic groups1. This leads to the point that an intervention to increase physical activity in African Americans can be very helpful in reducing their chance for CHD. In our lesson plan, increasing PA would be one of our targets to further educate our target group as well as help them improve their chance at living with CVD/CHD.

Financial Stress and Its Effect on Risk of Coronary Heart Disease in African Americans [Peer Reviewed Journal]

Financial stress was studied in the Jackson Heart Study, a longitudinal cohort study of CVD risks in African Americans. It was reported that financial struggles may adversely affect stress levels and is associated with rising incident CHD in African Americans2. The stress inventory levels were categorized as: did not experience financial stress as level 1, no stress as level 2, mild stress as level 3, and moderate to high stress as level 42. African Americans already experience a disproportionate burden, that being the ethnic group which faces the leading cause of death in the U.S., CHD2. Along with already being at a disadvantage because of genetic factors, including hypertension and diabetes, African Americans also have to deal with the fact that financial stress may just be another factor that increases CHD incidence in their ethnicity2. Research shows that the average white household has 1 month’s income in savings, versus 5 days of savings for African Americans2. This aspect of financial hardship, especially for someone who is working hard for themselves and maybe even a family, may influence health. This can be due to limited access to material resources, medical resources, etc2. In the Jackson Heart Study, participants with moderate to high financial stress, or level 4, were younger than those with no financial stress, or level 22. Participants with moderate to financial stress were 3 times more likely to have a CHD event, compared to those with no financial stress and participants with mild financial stress were 2 times more likely2. With this information, there has been a significance established in the relationship between financial levels, stress, and risk of CVD in African Americans. Now that it is evident that those who experience more financial stress are more likely to experience CHD, especially at a younger age, this can be a target for our lesson plan. Being that the target audience are middle aged African American businessmen, our goal is to assume that these are hard working individuals and that being a businessman can be quite stressful. In our lesson plan, we can use this information to educate our target audience on how to lower their risk of CVD by lowering stress levels, taking care of their health on a budget, and even making time to do things that are enjoyable aside from work.

Associations of Fast Food Restaurant Availability with Dietary Intake and Weight Among African Americans in the Jackson Heart Study

This study looked into the cross-sectional associations between nutritional consumption and weight, specifically BMI and waist circumference, of African Americans. From this study ⅓ of the participants were overweight, 52.6% were obese, and 10.1 were morbidly obese3. Those with more fast food availability had a connection to lower activity level and lower income3. Taking into account income, regardless of the target audience’s job, is important because it ensures that there is no bias and that every client is being treated equally. Studies also show that a higher rate of fast food access was connected to a higher caloric intake in those who were under the age of 553. Fast food availability was higher in African American neighborhoods as well as lower income neighborhoods3. For each increase of fast food availability caloric intake increased by 138 calories for males under 55, and 58 calories for women under 553. Other studies have suggested that fast food availability can affect how people form food routines and follow nutritional guidelines3. Trying to help educate and learn about African American businessmen and why they may be more likely to be eating fast food is important to create a successful lesson plan. These habits may have been formed as children and brought into adulthood. This can be due to lower income or just availability since it is more convenient, especially with a busy lifestyle.

A Systematic Review of Weight Loss, Physical Activity and Dietary Interventions Involving African American Men

African American men in general are more likely to encounter major health issues related to obesity such as diabetes, hypertension and stroke than other races4. They are also more likely to have undermanaged conditions as well as diseases that go undiagnosed4. From 1999-2008 obesity rates of African American men jumped from 28.1% to 37.3%, and 31% of those were categorized as overweight4. African Americans generally consume less fruits and vegetables, and African American men tend to eat more red meat, fat, sugar-sweetened drinks, calories, and sodium than white men4. Less African American men exercise regularly compared to white men as well, which highlights the importance of implementing more physical activity into African American lives4. In general they do not engage in the recommended amount of exercise4. They were also able to find that African American men tend to find healthy food less tasteful and not filling, and did not think about nutritional needs, and did not focus on nutritional health as needed until there was an actual health issue4. African American men tend to focus more on work and family and also may have lack of motivation due to being undereducated, labor-heavy jobs, busy, and low income4. Major motivators are social support as well as enhancing their health4. This can be incorporated into the lesson plan by providing information that is catered to African Americans, while also encouraging our listeners to try to have a support team, such as friends or family and trying to engage in these activities with others. Trying to include how their current lifestyle is affecting them may also boost the idea that the audience needs to start this plan now before the health issues begin, and that their current health will also get better. This article is important because it highlights a range of characteristics, individual to this target audience. These characteristics need to be considered when creating an intervention because the approach to the intervention can make or break the way the audience receives the information. For example, it was found that African American men don’t find healthy food as tasteful or fulfilling, so the lesson plan needs to promote alternatives that are comparable and just as tasteful as the unhealthier options.

Body Mass Index and Intake of Selected Foods in African American Men [Peer Reviewed Journal]

This study used a cohort style approach to find a correlation between the consumption of fats, vegetables, and fruits to Body Mass Index (BMI). Data was collected using surveys and questionnaires, assessing 204 African American southern men5. The goal of the study was to find if any dietary fats, vegetables, and/or fruits cause higher BMI. Findings included higher amounts of fried chicken intake correlated to higher BMI5. The men who reported eating low-fat dairy “all the time” had a lower average BMI than the men who reported eating low-fat dairy “some of the time” and “none of the time”5. The study also found the vegetable intake among the men was very low5. Among the men who did eat vegetables at dinner, the men who ate them 5-6 days per week had an average BMI lower than the men who ate vegetables 1-2 days per week5. This study shows the effect of fatty foods on BMI. Our goal is to teach African American men how to prevent Coronary Heart Disease. Having a high BMI/being obese is a risk factor for Coronary Heart Disease. Integrating this study into our lesson is crucial since it highlights the foods that can elevate BMI. One finding that stands out is that consuming 3 fatty food items was significantly associated with higher BMI5. It will be important to teach these businessmen to keep their intake of fatty foods low and their fruit and vegetable intake higher. Another finding that can be incorporated into the lesson is the success rates of lowering dietary fat in the past year. The study found that of the 150 men asked, 64% answered “successful” or “somewhat successful” in lowering their dietary fat in the past year5. This can be integrated in the lesson by showing the businessmen how to achieve a low-fat diet.

Theory/Example of Theory Used In Lesson

The Health Belief Model (HBM) is a framework that is utilized for assessment and intervention6. Although this study is not encompassing our whole target group, it does encompass the effects of using the Health Belief Model on African Americans. It was stated that the HBM is a useful model for better understanding, addressing and conducting an intervention within the African American population6. However, an important thing to note is that using the HBM requires educating and engaging with the audience6. This means that when we introduce and present our lesson plan to the target audience it is not only important that we introduce important information, but also that we include an engaging activity like a handout or other activity. An example of this to show a way that we can use the HBM in our lesson would be to start the presentation by proposing a few questions to our audience regarding their perception of their health. Questions can range from their stance on reliance on health professionals, importance of CVD risk in their life, and nutrition habits. These questions do not have to be answered out loud and can simply be put into “yes” or “no” terms. Then, again, at the end of the presentation the questions can be proposed again. This will allow the audience to see if their perspective has changed and hopefully with the information presented, it will encourage change.

Behind The Scenes Summary

We approached the lesson plan with an open mind mentality, and prepared to change aspects of the presentation that we previously thought would be feasible. We planned it by outlining the whole presentation. First we discussed the introduction, and originally we were going to discuss the statistics behind CHD and inform our audience of the risks of CHD. Then we thought it would be better if we gauged the knowledge of our audience first, so we decided to start the presentation with polling questions. During our discussion of the introduction we did run into the problem of not knowing how we were going to facilitate these polling questions over zoom. Next we moved on to discussing what kind of questions we should include. We wanted to cover the categories of physical activity and diet in our questions. Then we moved onto the information section of our presentation. Here we discussed what information we wanted to incorporate in the presentation. We wanted to give the businessmen the hard facts of CHD and show them the risks they face. Next we wanted to discuss the risk factors. Our thought process behind this decision was that we wanted to introduce risk factors first before giving them the information on how to avoid these risk factors. After discussing risk factors we thought it would be important to start discussing heart healthy diet information. Then after this section we thought it would be a good time to include an activity, to reflect on what they learned. Originally we were going to have them write out a whole meal plan but that was going to be time consuming and hard to facilitate over zoom. So we decided to do a short quiz that included questions about choosing heart healthy foods. Next we moved onto planning the conclusion/evaluation. At first we were going to do a kahoot, as an evaluation but then thought that wouldn’t fit our target audience of businessmen. So we decided to evaluate them using a google form. We wanted to include questions on the form that would pertain to our goal/objective. Finally we decided to end the presentation by discussing the Health Belief Model and how we incorporated it into the presentation.

References

Kamimura D, Cain-Shield LR, Clark D, et al. Physical Activity, Inflammation, Coronary Artery Calcification and Incident Coronary Heart Disease in African Americans: Insight From the Jackson Heart Study. Mayo Clin Pro. 2021;96(4). https://doi.org/10.1016/j.mayocp.2020.09.042.

Moran K, Ommerborn M, Blackshear C, et al. Financial Stress and Risk of Coronary Heart Disease in the Jackson Heart Study. Amer J Prev Med. 2019;56(2). https://doi.org/10.1016/j.amepre.2018.09.022.

Hickson DA, Diez-Roux AV, Smith AE, et al. Associations of Fast Food Restaurant Availability With Dietary Intake and Weight Among African Americans in the Jackson Heart Study, 2000-20004. Amer J Public Health. 2011;101(301). https://doi.org/10.2105/AJPH.2010.300006.

Newton RL, Griffith DM, Kearney WB, et al. A systematic review of weight loss, physical activity and dietary interventions involving African American men. Obes Rev. 2014;54(15). https://doi.org/10.1111/obr.12209.

Weinrich SP, Priest J, Reynolds W, et al. Body mass index and intake of selected foods in African American men. Public Health Nurs. 2007;24(3). https://doi: 10.1111/j.1525-1446.2007.00628.x.

Rollins L, Sy A, Crowell N, et al. Learning and Action in Community Health: Using the Health Belief Model to Assess and Educate African American Community Residents about Participation in Clinical Research. Int J Res Public Health. 2018;15(9). https://doi.org/10.3390/ijerph15091862.

Part 2: Lesson Plan

Title: A Business Man’s Guide To A Heart Healthy Diet

Target Audience: Middle-aged African American Businessman

Theory: Health Belief Model

Goal: Middle Aged African American businessmen will learn how to identify and incorporate healthy meals while traveling for business and understand how to avoid the risk factors of coronary heart disease.

Objective 1: At the end of the lesson, at least 50% of the businessmen will be able to identify 2 risk factors of coronary heart disease that they can avoid in their day.

Objective 2: At the end of the lesson, 60% of the businessmen will be willing to incorporate physical activity in their daily life for at least 25 minutes 3 times a week.

Objective 3: At the end of the lesson, 70% of the businessmen will be willing to replace at least one of their fast food options with a healthy alternative everyday.

Materials: Laptop for physical presentation, Zoom for broadcasting presentation, Powerpoint presentation for delivery of the lesson plan, polling questions that will be presented at the beginning of the lesson, and google form for evaluation of the material presented.

Lesson Description: In order to teach this lesson and ensure that the target audience learns the most information about reducing coronary heart disease (CHD) risks, the main targets of the lesson plan will be: solidifying the risk factors of CHD, the role physical activity plays in lowering these risks, healthy food and meal replacements for other, more unhealthy options, and daily changes that can be made to overall reduce the risk of CHD. The subjects that are being targeted in this lesson will be taught through a powerpoint presentation, with each subject having one or more slides. The slides will contain information from resources, visual aids, and commentary that further reinforces the information presented. The lesson will use polling questions through zoom, which will act as an icebreaker to familiarize the audience with what will be presented and also allow the presenters to see what level of knowledge the audience possesses. The lesson will also include an evaluation quiz, offered through a google form link that will be sent through the zoom chat to the audience. The google form will contain a series of questions that will reassess the audience and determine if learning improved since the beginning of the lesson.

Lesson Procedure:

Introduction: The lesson will start with polling questions that will assess the audience's knowledge on CHD. Once the polling questions are answered, the lesson plan will then be followed by the actual information that will educate the audience. This information will include statistics on CHD and the risk factors for CHD. The audience will gain attention to the presentation by being presented with the facts of CHD. Then the presentation will move towards discussing healthy eating and what it means to consume a heart healthy diet. Then the audience will be taught how to choose/identify healthy meals using pictures and diagrams. The audience will then be taught healthy alternative foods to fast food options. After the information is presented, the audience will be assessed with the use of a google form. At the end of the presentation the health belief model will be explained and how it is incorporated into the lesson.

Learning Experiences:

Polling questions: As stated before, polling questions will be used at the beginning of the lesson, before any additional information is presented. By doing this, the presenter(s) can get a better understanding of what the audience knows beforehand, which is a solid indicator of where the audience stands. Some polling questions that will be used include, but are not limited to: “Did you know that African Americans are disproportionately affected by CHD compared to other races?”, “How many African Americans are diagnosed with CHD each year?”, and “Do you see physical activity as a large contributor to your risk of CHD?”

Google Form: Another activity that will promote learning is the google form, which will be used as the evaluation tool for assessing what the audience has learned. The google form should include a combination of multiple choice, choose the following, and short answer style questions that will assess participant’s understanding after the completion of the lesson. Some questions that will be included in the google form include, but are not limited to: “Of these choices, which are potential risk factors of CHD?”, “After learning about the effects of physical activity (PA) in relation to CHD, would you be willing to add more exercise into your weekly schedule?”, and “Which meal would you be willing to adopt in your lifestyle that can replace a fast food option? (list meal options)”.

Visual Aids: Visual aids should enhance the lesson, and not confuse listeners or take away from the lesson. One visual aid in particular that will be used is on a slide in the powerpoint that will show common fast food, casual food items and a comparable, more healthy alternative. Another slide will be included that shows how easy it can be to create a simple, healthy meal for businessmen on the go.

Summary and Closure: It is important for the lesson plan to include the polling to pull in the audience to listen to what is being taught. The lesson will include the risk factors of coronary heart disease to explain the health risks, and then provide information on how to prevent these conditions based on nutrition and exercise interventions that are included. To conclude the lesson, there will be a google forms questionnaire sent to the audience to measure the objectives that were set up for the lesson plan. This will allow the presenters and audience to see how well the information was received and will also gauge if the goals and objectives will be feasible. The lesson plan will prove effective if the audience can use the information provided to decide how they will plan on implementing (or not implementing) the ideas into their daily lives. To mark the conclusion of the lesson plan, after the results of the google form are discussed, the theory used will also be discussed. The Health Belief Model was used to construct this lesson plan, which means the lesson plan revolves around our audiences’ willingness or perception to change. The Health Belief Model will work to highlight what the audience does not know already, enrich the audience’s knowledge on these topics, reinforce what is already known, and promote the likelihood of the audience adopting these healthy changes.

Evaluation: To ensure that the audience was able to take in the information that was provided in the lesson there will be a google forms questionnaire to ask questions based on the objectives to see if the objectives that were set for the lesson plan were met as well as other information provided was retained as well. The Google Forms will help evaluate this as these questions can be done anonymously to prevent people from not answering due to nervousness and also review over the information we provided to see if people were able to evaluate their choices as well as remember the information that was taught over the lesson.

References (Retrieved from Progress Report and Needs Assessment)

Rich JA. The Health of African American Men. Ann Am Acad Political Soc Sci. 200;569(1). https://doi.org/10.1177/000271620056900111.

McNeish R, Simmons C, Watson J, et al. Perceptions of emotional and physical wellness among African American men as predictors of perceived overall health. Ethn Health. 2021;26(4). https://doi.org/10.1080/13557858.2018.1530738.

Gould E, Jones J, Mokhiber Z. Black workers have made no progress in closing earnings gaps with white men since 2000. Econ Policy Inst. 2018. https://www.epi.org/blog/black-workers-have-made-no-progress-in-closing-earnings-gaps-with-white-men-since-2000/.

Assari S. Family income reduces risk of obesity for white but not black children. Obes Met Dys Chi. 2018;5(6). https://doi.org/10.3390/children5060073.

Non AL, Gravlee CC, Mulligan CJ. Education, Genetic Ancestry, and Blood Pressure in African Americans and Whites. Amer J Public Health. 2012;102(1559). https://doi.org/10.2105/AJPH.2011.300448.

Griffith DM, Gunter K, Allen JO. Male Gender Role Strain as a Barrier to African American Men’s Physical Activity. Health Educ Behav. 2011;38(5). https://doi:10.1177/1090198110383660.

Shakiba M, Mansournia MA, Salari A, et al. Accounting for Time-Varying Confounding in the Relationship Between Obesity and Coronary Heart Disease: Analysis with G-Estimation: The ARIC Study. Amer J Epi. 2017;187(6). https://doi:10.1093/aje/kwx360.

Gotto AM, Brinton EA. Assessing low levels of high-density lipoprotein cholesterol as a risk factor in coronary heart disease: A working group report and update. 2004;43(5). https://doi:10.1016/j.jacc.2003.08.061.

Newton RL, Griffith DM, Kearney WB, et al. A systematic review of weight loss, physical activity and dietary interventions involving African American men. Obes Rev. 2014;54(15). https://doi.org/10.1111/obr.12209.

Rollins L, Sy A, Crowell N, et al. Learning and Action in Community Health: Using the Health Belief Model to Assess and Educate African American Community Residents about Participation in Clinical Research. Int J Res Public Health. 2018;15(9). https://doi.org/10.3390/ijerph15091862.

Picture Reference:

1. peangdao. Top view of fresh fruits and vegetables organic on table, Frame of multicolor fresh fruits and vegetables with copy space on blue plank. Adobe Stock. Accessed April 14, 2022.