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CDC Programs: Weight Loss and Diabetes

A. Ms. Jones' Focus Group
Ms. Jones called together ten community leaders and ten average people and asked them about the problem of type 2 in the area. They met at the local library conference room one Saturday afternoon and discussed the topic.
All but three of them thought the diabetes problem needed a renewed emphasis in that region of North Carolina.

Here are some specific quotes that were made at that meeting:
1. Ms. Jones, type 2 diabetes is indeed a real problem - my mother became blind and lost a leg because of it.
2. I think being too skinny is dangerous.
3. Exercise is fine, but we have a 30% higher mugging rate than the rest of the state of North Carolina around here and I won't use that new jogging trail the health department got funded last year.
4. The only hospital in the area has stopped its diabetes patient support group because of a lack of funds to cover the growing indigent and migrant worker population's emergency room and surgery care. Prevention and patient support/maintenance seem always to get the short end of the stick when it comes to tight financial times.
5. The large number of American Samoans that have relocated here for crop-related seasonal employment believe large, fat babies and adults are the same as truly healthy people - they are contributing to our high rates due to these folk beliefs.
6. I feel the biggest problem is the fact that our restaurants are almost all fast food with poor dietary values - let's try to close some down.
7. Ms. Jones, we need to get people to lose weight and be serious about it. 'Nough said.
8. The Bible says "Delight yourself in fatness," but the priest Eli did die when he fell because he was too "heavy."
9. Also, Daniel ate vegetables only and did better than the Hebrew Children meat-eaters in Pharaoh's charge.
10. We ought to take care of our bodies - and try to avoid anything unhealthy, like lots of carbohydrates and fats/cholesterol.
11. The statistics say we are overweight here, more than even the rest of the state, which is getting worse and worse itself. That suggest we have a lot of work we need to do.
12. Diabetes is getting worse too, and we haven't seen the final result as our heavier young people start to age. The time bomb is ticking.
13. I was looking at the picture out in the library hall of a hundred or so school kids all standing outside the old elementary school back in 1927, and absolutely none of those kids were fat or overly skinny - we have lost control, people.
14. I think the local CDC-type program planned for the 21 classes is a good one. I encourage you, Ms. Jones, in that valiant effort.
15. I am sorry, Ms. Jones, but I think that program is a waste of time: too little too late.
16. Nutrition education is always a good idea - it has a lot going for it, life-long.
17. Doctor Smith over at the valley does a lot of nutrition education as part of his primary practice, but he says it is hard to get paid for it and it takes a lot of his time.
18. I wonder -- can have some Little Debbie™ snack cakes and pineapple punch if we have another one of these focus group meeting things, since we are meeting so close to lunch time?

B. More About Ms. Jones' Pretest and Posttest
Ms. Jones also did a Pretest and Posttest, which were NOT part of the CDC program. The tests, which were to study how well the ten students in her class did in remembering diabetes-related nutrition facts, showed some interesting things that she kept on file for her own use. The pretest was applied to the ten students and to a similar group of "control" (not in the diabetes program) students of roughly the same age and weight categories as the ten students. The test was composed of twenty questions. So, to reiterate, ten students not in the program took the pretest. Ten student of the program also took the test and, following the program content being given to them, took the posttest. The posttest had the same questions as the pretest, but the question order for all tests administered, including the tests given to the control group, was randomized - the order of the questions given to each student who took the pretest and/or the posttest, was selected by a computer for just that student. Results from the Pretest and Posttest are provided (in part) in APPENDIX ZZ below).

C. CDC Program Related Evaluations for Ms. Jones Class
The central office to meet CDC evaluation expectations for success is asking very teacher to evaluate how their class did using the following mandatory evaluation minimums (see Table 1).

The results for these five evaluation categories for Ms. Jones class of ten students are given below in APPENDIX ZZ (note that some data fields are not filled in yet).

Table 1.
Five CDC Diabetes Prevention Recognition Program Requirements for Recognition (revised slightly) CDC
Requirement How Evaluated CDC Expected Units

Eval Category
1 diabetes knowledge Pre and Post Test Comparison on
Knowledge acquisition and control test group comparison Improvement averaged, per protocol (see below for desired results for all evaluation categories)
2 Session attendance during the core phase Minimum of 9 core sessions attended, on average Attendance averaged over all participants attending a minimum of 4 core sessions
3 Documentation of body weight during core phase During the core phase, on average, participants must have had body weights recorded at a minimum of 80% of the sessions attended (including makeup sessions) Documentation of body weights based on all participants attending a minimum of 4 core sessions
4 Weight loss achieved during the core phase Average weight loss achieved by participants attending a minimum of 4 core sessions must be a minimum of 5% of "starting" body weight (defined as the body weight measured at the first core session attended). End-of-core weight will be the weight recorded at the last core session attended Weight loss averaged over all participants attending a minimum of 4 core sessions
5 Documentation of body weights during the post-core phase During the post-core phase, on average, participants must have body weights recorded at a minimum of 60% of the sessions attended Documentation based on body weights of all participants attending a minimum of 1 post-core session

APPENDIX ZZ

These are 5 Raw Evaluation Data Tables for Ms. Jones' Class/Group for the 5 CDC Evaluation Categories (see Table 1 on the page previous to this page) -- students may need to calculate certain fields which have been left vacant in some tables

Category 1: pre and post-test and control group (= not involved in the program at all)

Student's number pretest score post-test score
(NOTE: the control group of 10 people got 50%)
1 2 1
2 4 9
3 10 10
4 6 10
5 2 9
6 6 10
7 4 3
8 3 10
9 7 5
10 5 4
total 49 71

avg 4.9 (or 49%) 7.1

Category 2: Core Session Attendance (9 out of 10 required as the average)

Student number Attendance out of 10 Core classes

1 9
2 9
3 10
4 10
5 7
6 10
7 10
8 10
9 7
10 9
total ?
avg ?

Category 3: Body weight
documentation during core phase sessions
Student number WAS BODY WEIGHT DOCUMENTED AT EACH SESSION? Y = yes
session 1 2 3 4 5 6 7 8 9 10
1 y y y y y y n y y y
2 n y y y y y y y y y
3 n n y y y y y y y y
4 y y y y y n n y y y
5 y n y y y y y y y y
6 y n y y y y y y y n
7 y n y y y y y y y n
8 y n y y y y n y y y
9 y y y y y y y y y y
10 y n y y y y n y y y
Totals ?
Avg ?

Note: a snowstorm prevented many students from reaching class for session 2

Category 4: Weight loss achieved during the core phase (average of at least 5% total for all students is required) - many fields need yet to be calculated

Student number beginning weight ending weight amt
lost percentage lost
to nearest percentage

1 100 93
2 200 190
3 105 100
4 120 114
5 300 260
6 90 91
7 89 89
8 115 103
9 140 111
10 113 101

totals 1372 1252

avg

Category 5: Documentation of body weights during post core sessions (each student must go to at least one of the 3 sessions and all students must have his/her BW recorded at least 60% of those sessions attended)

Student number session 1 BW measured? session 2 BW measured? session 3 BW measured?

1 y y y n y y
2 n n y y y y
3 y y y y y y
4 y y n n n n
5 y y y y n n
6 y y y n y n
7 n n y y y y
8 y y y y y y
9 n n y y y y
10 y y n n y y

total
avg

End of Resource Packet ##

Questions

D. Using the contents of Appendix ZZ of the Resource Packet and other material in the Packet and in the course, did the program meet all 5 CDC expectations (see Table 1, p. 15-16, of the Resource Packet) as far as Ms. Jones' class was concerned? If not, which ones were missed and by how much? Of those that were met, did any exceed the CDC expectations? If so, by how much did they exceed the CDC expectations?

E. Suggest 2 excellent ideas for why the results mentioned in Question D above might have been the case, based on the material presented in the Resource Packet and throughout the course.

F. What arguments could be given to an agency thinking of funding this program again, for allowing this program to have even more funds next time, given the most positive possible interpretation of the results in Ms. Jones' class alone?

G. Discuss a suggestion invented by you for how this CDC program could be improved the next time in Ms. Jones' class, and suggest also how the improvement could best be communicated to people like those in the North Carolina central office program staff who might implement that change in other classes.

H. List 3 ways this scenario/exercise could be improved for students, including at least 1 way that is based on the evaluation data and theories contained in the course readings to date.

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Questions

D. Using the contents of Appendix ZZ of the Resource Packet and other material in the Packet and in the course, did the program meet all 5 CDC expectations (see Table 1, p. 15-16, of the Resource Packet) as far as Ms. Jones' class was concerned? If not, which ones were missed and by how much? Of those that were met, did any exceed the CDC expectations? If so, by how much did they exceed the CDC expectations?

Category 1)
A Pretest and Posttest on knowledge about diabetes were conducted. Results were compared with control test group. The improvements were averaged.

There were no numerical CDC expectations, so it is not possible to say if CDC expectations were exceeded.

Category 2)
CDC expectations were: Minimum of 9 core sessions attended, on average.
Average number of core sessions attended by the 10 students was 9.1, which 9 by 0.1.

Category 3)
1 student had body weight recorded during 10 of the sessions.
3 students had body weight recorded during 9 of the sessions.
6 students had body weight recorded during 8 of the sessions.

Student # core phase sessions body weight was recorded
1 9
2 9
3 8
4 8
5 9
6 8
7 8
8 8
9 10
10 8
8.5 <average

8.5/10 = 85%

Average % of core phase sessions, on average, where participants had body weights recorded, out of the sessions attended, is 85%.

CDC expectations were: on ...

Solution Summary

All questions have been answered in a Word file. Step-by-step computations are shown.

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