Running head: LEHIGHTON EPIDEMIOLOGY STUDY

Lehighton Epidemiology Study

Cedar Crest College
Lauren Bozilesky, Shawnee Cuthbert, and Amber Lamb

LEHIGHTON EPIDEMIOLOGY STUDY

2
Abstract

This paper is an epidemiology study on inadequate nutritional intake among the community of
Lehighton, Pennsylvania. Statistics show that a high percentage of Lehighton residents are
overweight and have an increased body mass index. About half of the residents do not consume a
healthy diet. Being overweight and eating unhealthy foods are the main problems noted for the
community of Lehighton. The purpose of this paper is to outline a community nursing diagnosis,
explain the effects on the community, and identify primary, secondary, and tertiary interventions
that can be implemented to increase the overall health of the community. A literature search was
completed through CINAHL and PubMed to identify evidence based interventions.
Keywords: Lehighton, nutrition, interventions, overweight, nursing diagnosis, community

LEHIGHTON EPIDEMIOLOGY STUDY

Lehighton Epidemiology Study

The basis of living a healthy lifestyle begins with what a person consumes. Healthy
eating and exercise has a significant impact on a persons health status. There are certain
characteristics that help a community select the right food and exercise choices. The
characteristics include: proper education, adequate resources such as health food stores, and
sufficient funds. Buying healthy foods can be a challenge if poverty is present. While creating a
data assessment of Lehighton, located in Carbon County, it was noted that nutrition is a problem
for the community. In the borough of Lehighton 35.8% of residents are overweight, with an
average body mass index of 28.4 (City-Data, 2015a). With the statistics of residents who are
overweight being so high, further information was compiled about the residents nutritional
intake. The percent of residents who eat a healthy diet is 55.8%, leaving 44.2% of the population
of Lehighton to consume unhealthy diets (City-Data, 2015a).
In order to gain a better understanding of why the community does not eat healthy;
education, resources, and income were taken into consideration. There is a much higher
percentage of individuals in Leighton without a high school diploma than throughout Carbon
County. In Lehighton, 13.3% of residents did not receive a high school diploma (United States
Census Bureau, 2010a). In addition, only 6.7% of the community has received a Bachelors
Degree (United States Census Bureau, 2010b). During a windshield survey of Lehighton, it was
noted that residents have access to Giant and Walmart for buying groceries. However, these
chain stores are located on the outskirts of town, making it difficult for residents to get to without
transportation. In contrast, McDonalds and Burger King were identified as being within walking
distance for most residents of Lehighton. There were also no health food stores located in the
borough of Lehighton. In addition, the average income per capita in Lehighton is $19,518,

LEHIGHTON EPIDEMIOLOGY STUDY

whereas, it is $25,294 for Carbon County (Census Bureau, 2010h). Currently, 11.9% of residents
in Lehighton are living below the poverty level and 15.7% are living in poverty (City-Data,
2015a). The goal of this paper is to describe the effects of inadequate nutrition on the
community and to outline interventions that can be implemented in order to increase healthy
eating and decrease the percentage of overweight people in the community.
Nursing Diagnosis
After an in depth review of the data collection assessment completed on Lehighton,
Pennsylvania, a community nursing diagnosis was created for this community. Risk for
inadequate nutritional intake among the residents of Lehighton related to lack of education, lack
of resources, and poverty. The problem identified in the nursing diagnosis has negative effects on
the community.
Effect of the Problem on the Community
One effect that increased body mass index related to inadequate nutrition has on the
community is increased mortality. People who are overweight and/or obese are at an increased
risk of all-cause mortality (The Lancet, 2016). The average body mass index of overweight
residents of Lehighton is 28.4. A body mass index of 25 or above has a steep relationship to
mortality (The Lancet, 2016). The study included participants who did not have modifiable risk
factors such as smoking and were otherwise healthy except for an increased body mass index.
Based on this study, 35.8% of Lehightons residents have an increased risk for all-cause
mortality. A large portion of the community has a chance of early and/or avoidable death. Allcause mortality of overweight residents has the potential to also have negative effects on family
members. Family members may end up with a decline in mental health. All-cause mortality also

LEHIGHTON EPIDEMIOLOGY STUDY

has the potential to worsen the issue of poverty. With the interventions that are outlined in this
paper, the all-cause mortality risk can be decreased in Lehighton.
The impact of inadequate nutrition on a community effects the overall well-being of the
residents within the community. According to Stanhope and Lancaster (2016), improved
nutrition is directly related to better immune systems, reduced illness, increased maternal and
child health, longer life spans, better psychological health and improved learning outcomes.
(Stanhope & Lancaster, 2016). An unhealthy diet can cause nutrient deficiencies and diseases
such as cardiovascular disease and diabetes (Stanhope & Lancaster, 2016). A decrease in healthy
eating results in a decrease in overall health for community members of Lehighton. The residents
have a higher chance for illness, chronic diseases, and mental health disorders.
In Lehighton, a large percentage of residents are overweight, which increases the chances
they will become obese at some point in their lives. Obesity poses more risks to health than being
overweight. Health complications caused by obesity are expensive for both the individual and the
government. According to Mareno and Annesi (2016), obesity-attributable expenses cost 146,624
billion dollars per year (Mareno & Annesi, 2016). Obesity also increases the risks of disability
and unemployment (Mareno & Annesi, 2016). It is possible that obesity contributes to the high
poverty levels in Lehighton. In addition, children with parents that are obese have a greater
chance of becoming obese. Stanhope and Lancaster (2016) explain that parents have the most
influence in how children learn feeding habits (Stanhope & Lancaster, 2016). If a child grows up
watching and experiencing unhealthy eating, that child is more likely to choose an unhealthy
lifestyle, and in turn pass it on to future generations. The nutrition problem in Lehighton is an
issue for adults today but also for future generations. Hopefully, inadequate nutrition can be
improved with the use of primary, secondary, and tertiary interventions.

LEHIGHTON EPIDEMIOLOGY STUDY

Primary Interventions
The first primary intervention that should be introduced is nutritional based education
throughout Lehightons school system. Beginning nutrition education in elementary school and
reinforcing it throughout high school would be of the greatest benefit to help increase
Lehightons nutritional food approach. One of the ways to implement nutritional based education
would be to use the Analysis Grid for Environments/Elements Linked to Obesity approach. This
is a regional model which was implemented by the Childrens Healthy Living program. The
purpose of this model will help to increase fruit and vegetable intake, water consumption,
physical activity and sleep duration. The model is to help limit the sedentary lifestyles such as
too much television usage and also to limit sugar-sweetened beverages (Braun, Nigg, Fialkowski,
Butel, Hollyer, Barber, Bersamin, Coleman, Teo-Martin, Vargo, & Novotny, 2014). The Analysis
Grid for Environments/Elements Linked to Obesity approach includes four steps. The first step is
to engage the communities. We can do this by hosting free events throughout the community and
hosting interviews within schools as well. The interviews will have the children discuss what
they currently eat, along with what kind of activities they do on a daily basis. The next step
would be to review this information along with other literature, (which was done with the data
analysis paper). The third step would be to combine the interviews and literature/ research for
data analysis. Implementing the interventions within the community would be the fourth step
(Braun et al., 2014).
A second primary intervention would be to hold an informational session about upcoming
policy changes in order to revise the Supplemental Nutritional Assistance Program. With an
increase in poverty levels in Lehighton, many individuals require government assistance. With

LEHIGHTON EPIDEMIOLOGY STUDY

the Supplemental Nutritional Assistance Program, the beneficiaries are allowed to buy any type
of food, including unhealthy junk food which in comparison to healthy food, costs less. Among
the participants in the recent Supplemental Nutritional Assistance Program, there was an average
of 18.7% of kids who were obese and 17.5% of adults who were obese (Leung, Blumenthal,
Hoffnagle, Jensen, Foerster, Nestle, Cheung, Mozaffarian, & Willet, 2013). By implementing
changes to the Supplemental Nutritional Assistance Program, this would help encourage
healthier food choices for those who utilize the program. There would be a limit on the amount
of sugary food and drinks that would be allowed to be purchased. The changes would encourage
and promote healthier food options to be purchased instead.
Secondary Interventions
One of the secondary interventions that should be put into place would be to screen for
heart disease and diabetes for those individuals who are at risk, including school aged children.
One of the newest ways to screen for coronary heart disease is by using a stress
echocardiography. This is the least invasive way to screen for coronary artery disease and has
been proven to be both safe and accurate (Shah & Senior, 2016). The stress echocardiography is
a test that assesses systolic wall thickening at rest and after stress. This test allows doctors to
screen for, diagnose and estimate the prognosis of coronary artery disease (Shah & Senior, 2016).
Coronary heart disease is prevalent among individuals who are overweight. These individuals
should be screened in order to promote early detection of and intervention for coronary heart
disease. Screening for diabetes is also pertinent for the overweight population. There is a strong
link between obesity, diabetes and metabolic syndrome and should not be overlooked among
Lehightons population (Rao, 2015). Any individual who is at risk for diabetes, such as obese

LEHIGHTON EPIDEMIOLOGY STUDY

residents and those with sedentary lifestyles, should be screened. Additionally, factors such as
race, ethnicity, and family history should be taken into consideration when screening patients
(Rao, 2015). Screening for diabetes allows early intervention and early care if diagnosed, which
decreases the disease progression and increases the medical outcome of the individual.
Another secondary intervention which should be put in place would be to implement a
free diet and exercise program for those who are at risk for obesity and/or any other medical
illness that is associated with obesity. Even implementing an exercise program in Lehightons
school system would help decrease the overweight population. Introducing programs such as a
family-focus program is also an idea to help increase physical activity within the home. ParraMedina, Liang, Yin, Esparze, and Lopez (2015) conducted a twelve week family-focused
exercise program. The individuals who stuck to the program, reduced their body mass index,
waist circumference, and the percentage of their body fat (Parra-Medina, Liang, Yin, Esparza, &
Lopez, 2015). Programs such as this one are able to help decrease the risk of obesity and
improve the overall health outcomes among the Lehighton population. Implementing a free
program or one within the school system will also help due to the poverty level being so high
among the Lehighton population.
Tertiary Interventions
The first tertiary intervention that would be implemented would be a weight loss program
for any of the Lehighton residents with a body mass index of greater than twenty-five. This
program also should be cost-free. It should include education on preparing healthy meals, how to
count calories, how to recognize healthy food alternatives, free exercise trainers, and how to
complete exercise regimens. A personal trainer and nutrition counselor would also be provided

LEHIGHTON EPIDEMIOLOGY STUDY

and be available to be contacted when needed. The participants would be required to check in
with their nutrition counselor weekly to ensure progress. The goal of this intervention would be
to help the individuals maintain a nutritious diet and achieve a healthier lifestyle.
The second tertiary intervention that would be implemented would be support groups for
the individuals who are going through the weight loss journey or who have been diagnosed with
medical issues which have resulted from being obese. These support groups would have a nurse
available to help provide leadership, education and support for the individuals who attend. The
support groups would allow free discussion of the individuals problems and feedback from
people who have been on the same journey or who are currently facing the same obstacles. This
will help the participants know that they are not alone and that there is support available.
Conclusion
Through this epidemiology study, a nursing diagnosis of inadequate nutritional intake
among the community of Lehighton relating to lack of education, lack of resources, and poverty
was produced. The effects that inadequate nutrition has on the community were identified. Six
interventions were outlined to help decrease the average body mass index of the community. The
interventions were categorized as primary, secondary and tertiary. The interventions are
supported with evidence based research and a rationale. Changing unhealthy eating habits is a
challenge for nurses working with communities like Lehighton. However, utilizing these
evidence based interventions could lead to improved outcomes for a healthier community.

LEHIGHTON EPIDEMIOLOGY STUDY

10

References
Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239
prospective studies in four continents. (2016). The Lancet.
Braun, K. L., Nigg, C. R., Fialkowski, M. K., Butel, J., Hollyer, J. R., Barber, L. R., & Novotny,
R. (2014). Using the ANGELO model to develop the children's healthy living program
multilevel intervention to promote obesity preventing behaviors for young children in the
US-Affiliated pacific region. Childhood Obesity, 10(6), 474-481.
City-Data. (2015a). Retrieved from City-Data:
http://www.city-data.com/city/Lehighton-Pennsylvania.html
Leung, C. W., Blumenthal, S. J., Hoffnagle, E. E., Jensen, H. H., Foerster, S. B., Nestle, M., &
Willett, W. C. (2013). Associations of food stamp participation with dietary quality and
obesity in children. Pediatrics, 131(3), 463-472.
Mareno, N., & Annesi, J. J. (2016). A statement synthesis of emotional eating and body size
recognition: Advancing nursing science related to obesity research. Journal of Advanced
Nursing, 75(5), 1023-1029.
Parra-Medina, D., Liang, Y., Yin, Z., Esparza, L., & Lopez, L. (2015). Weight outcomes of
Latino adults and children participating in the Y living program, a family-focused

LEHIGHTON EPIDEMIOLOGY STUDY

11

lifestyle intervention, San Antonio, 20122013. Preventing Chronic Disease Public

Health Research, Practice, and Policy, 219(12).
Rao, P. (2015). Type 2 diabetes in children: Clinical aspects and risk factors. Indian Journal of
Endocrinology and Metabolism, 19(7), 47.
Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in
the community (9th ed.). St. Louis, MO: Mosby Elsevier.
Shah, B. N., & Senior, R. (2016). Stress echocardiography in patients with morbid obesity. Echo
Research and Practice, 3(2).
United States Census Bureau. (2010a). Retrieved from United States Census Bureau: American
Fact Finder: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?
src=CF
United States Census Bureau. (2010b). Retrieved from United States Census Bureau: American
Fact Finder: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?
src=CF
United States Census Bureau (2010h). Retrieved from United States Census Bureau: American
Fact Finder:
http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none