1. Discussion: Child Obesity in Harlem
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PAPERS ON Discussion: Child Obesity in HarlemDeliverable 2: Cultural, Socioeconomic, and
Behavioral Factors Concept Map.CompetencyAnalyze the influence of cultural,
socioeconomic, and behavioral factors on public health.ScenarioAs a public health nurse at a
community clinic, your supervisor has asked you to research and examine childhood
obesity in the community. You have been asked to create a visual concept map to be shared
during a staff meeting to illustrate your findings on the cultural, socioeconomic, and
behavioral factors that are contributing to childhood obesity as well as determining how the
community clinic can promote healthy behaviors to address childhood obesity. Discussion:
Child Obesity in HarlemInstructionsCreate a visual concept map on child obesity and the
factors influencing childhood obesity that:Identifies a specific community to research and
provides statistical data on childhood obesity in the selected community.Analyzes the
cultural, socioeconomic, and behavioral factors that influence childhood obesity.Illustrates
the connection between childhood obesity, behavior, culture, and socioeconomic
status.Describes how the promotion of health behaviors will help to reduce and ultimately
eliminate childhood obesity.Explains ways the public health nurse can support healthy
behaviors while responding to the diverse needs in the community.Provides stated ideas
with professional language and attribution for credible sources with correct APA citation,
spelling, and grammar in the visual concept map.ResourcesLibrary DatabasesHealth Source:
Nursing/Academic Edition Database FAQWebsitesPolicy MapGuides & FAQsConcept Map
FAQPolicy Map TutorialsSearching the MapSearch by Census Tract and Block GroupData
Layer LegendAPA GuideCredible Sources FAQNursing GuideRasmussen’s
Answers/FAQsDiscussion: Child Obesity in Harlemattachment_1Unformatted Attachment
PreviewNUR4244 Public Health Material Deliv 2 Socioeconomic Causes of Health
Disparities In the last twenty years, professionals involved in setting the Healthy People
objectives have taken into consideration the social and economic factors that can affect
health status. These can include living in a rural versus metropolitan versus crowded urban
location, varying levels of income and financial resources, education levels, family structure,
race and ethnicity, gender, sexual orientation, genetic predisposition, and occupation. Each
of these variables can be factored into reasons for varying health outcomes for specific
diseases, as well as for overall perceptions of well-being. Geography Geography affects both
the environment and the ability to access health care services. The residents of rural
communities are much the same as urban communities with varying levels of education,

2. professions, and beliefs about disease prevention and health promotion. Disease and life
expectancy are affected by income. Higher levels of income improve access to health care.
However, even the wealthy may have to travel long distances for health services and
specialty care, so access continues to be a factor for all. Education and Income Higher
educational levels are associated with higher incomes. Those with regular employment are
more likely to have health insurance, access to safe housing, the resources for adequate
nutrition, and good schools for their children. Those with lower education levels often have
poorer health outcomes for a multitude of reasons, including less income for affordable and
safe housing, food, and healthcare. Families with lower incomes and no health insurance
tend to put off primary preventive care and seek healthcare only when ill. Poverty and
crowded inner city communities have higher rates of youth and gun violence, higher
reported rates of mental health issues and substance abuse, as well as prostitution. Sub-
standard living conditions can contribute to asthma, lead poisoning, and poor immune
status due to less access to healthy food. Occupation Exposure to occupational injury and
the potential for disabling conditions are higher in certain professions than others are.
Those who work in mines, meat processing, building trades, and manufacturing have poorer
health outcomes than those who work in white-collar jobs. These jobs are also less likely to
offer health insurance, another confounding variable. Race and Ethnicity Minorities in the
United States have higher morbidity and mortality for certain disease conditions, including
hypertension and diabetes, certain cancers, and HIV/AIDS. While statistics are available for
black and Latino populations, increasing inter-marriage is blurring this distinction in
generations that are more recent. Discussion: Child Obesity in HarlemAsians account for an
increasing minority in the US, and health outcomes vary according to economic status.
Smaller populations such as those of Middle Eastern descent are still too small to be
statistically significant in estimating overall health disparities. Gender and Genetics Women
are at more risk for female reproductive disorders, as males are for prostate and testicular
cancer. In general, women seek out medical and mental health services more often than
men do, and their life expectancy is longer. Whether this is related to gender, genetics, or
selfcare is poorly understood. The opioid epidemic of the 2010s has resulted in decreased
life expectancy in white males, as this epidemic has disproportionately affected low and
middle-income males in their midlife years. Men have more vehicular accidents and are
more likely to have untreated hypertension than women are. Genetic predisposition is also
a cause of health disparities and is an area of substantial research interest in the years since
the human genome was mapped. This rapidly evolving area is one to watch in the future.
Sexual Orientation While there are some studies suggesting health disparities between the
LGBT population and the heterosexual population, little is known about whether this is
related to fear of discrimination, stress, and anxiety related to societal norms, or physical
health related conditions. Public Health Nursing and Disparities Public health nurses are
frequently in contact with those who are considered at risk for health disparities. Most
often, these are poor, minority populations. It is important for understanding and
acceptance, as there are many complicating educational, economic, and social factors.
Health and language literacy may be factors in communication and compliance. Lack of
resources may restrict the ability to obtain healthy foods and medications. It is critical to

3. advocate for your population, regardless of socio-economic handicaps. Source(s) Adler, N. E.
& Rehkopf, D. H. (2018). U.S. disparities in health: Descriptions, Causes, and Mechanisms.
Annual Review of Public Health Vol. 29:235-252. Retrieved from
https://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.29.02 0907.090852
Robert Wood Johnson Foundation: Home. (2019, January 10). Retrieved from
https://www.rwjf.org/ Role of Culture on Health Behaviors Culture means many things to
different people. Culture may be tied to the country of origin, such as Ireland, India, or Cuba.
Even among cultures that are often put into categories such as Asians and Latinos have
different countries of origins, with their unique cultural values, norms, and habits. As
different cultures adapt to new regions, there are generational differences in attitudes and
beliefs. Religion and religious upbringing can also be cultural influences. Even regions of the
United States celebrate different cultures and stereotypes. Culture can influence health
behaviors, which is why it is important to understand that generalizing behaviors among
populations can blind us to hearing what individuals have to say. Arab and Muslim Cultures
Looking at specific health habits and issues in the Kingdom of Saudi Arabia can provide
some insights into how culture influences health decisions. It is seen as an entry into
manhood when males begin smoking. The wealthier one is, the less one does manual labor
and the richer the diet. Women may not exercise in public and are limited to private gyms
and studios. As a result, obesity is an epidemic in the Kingdom, with heart disease, diabetes,
and lung cancer rates as the leading contributors to morbidity and mortality. Changing
these social norms is challenging for a culture where these values are set. Asian Cultures
The traditional Asian concept of health involves a balance of energy or chi. Immigrants may
see health and illness differently from Western practitioners and rely more on herbal
remedies and traditional methods such as acupuncture. Practitioners of Western medicine
in countries like Vietnam, China, and Thailand do not have access to the level of care that is
common in America and may not be accustomed to participating in care decisions. Asian
societies often do not acknowledge mental illness or disability, as it may make marrying
into the family undesirable. Family Relationships and the Role of Women Cultures that
value family, like many Latino and Asian cultures, may have strong support for family
members during illness. Discussion: Child Obesity in HarlemThis type of family value may
also mean that key family members should be included when making an end of life
decisions. The family matriarch or patriarch may make decisions on the allocation of health
resources and the support for mental health services. In some cultures, women are not
allowed to seek treatment or make their own health decisions. This lack of independence
can be a cause of conflict and ethical concern in American healthcare settings.
Understanding these cultural differences and respecting the wishes of the family decision-
maker may be key to getting women any care at all. Religious Decisions Religious Beliefs can
also influence decisions about healthcare services. Traditional Catholics may follow church
teachings on the use of birth control, sterilization procedures, and abortion. Traditional
Jewish families chose circumcision for their male children, as do many non-Jewish families.
Faiths may incorporate fasting days or dietary restrictions that can affect nutrition needs.
Nursing Actions The Agency for Health Care Research and Quality (AHRQ) suggests key
questions for nurses to ask when addressing culture and health decisionmaking. Noted

4. nursing researcher Madeline Leininger first published her Theory of Transcultural Nursing
in 1961. She has since developed that theory into the Culture Care Theory. Her core
precepts are that culturally sensitive care helps others to achieve their optimal level of
health, as everyone defines it. Culture care diversity refers to different meanings, values,
and acceptable forms of care. Nurses are encouraged to use this information to encourage
the adoption of acceptable behaviors that improve the human condition while retaining
each person’s cultural values. This theoretical framework is beneficial in public health
nursing when encountering different cultural norms and values. Source(s) AHRQ Health
Literacy Universal Precautions Toolkit. (2015, February 20). Retrieved from
https://www.ahrq.gov/professionals/quality-patientsafety/quality-
resources/tools/literacy-toolkit/index.html Leininger’s Culture Care Theory. (n.d.).
Retrieved from http://www.nursing-theory.org/theories-and-models/leininger-
culturecare-theory.php Promotion of Health and Well-being The ten leading causes of death
in the United States accounted for 75% of all deaths in 2017 were heart disease, cancer,
chronic lower respiratory disease, stroke, unintentional injury, Alzheimer’s, diabetes
mellitus, pneumonia/flu, nephritis/nephrotic syndrome, and suicide. Seven of the ten
leading causes of death in the United States are attributable to a chronic illness that can be
reduced with five behavioral health factors, including not smoking, maintaining normal
body weight, being physically active, moderate to no alcohol intake, and getting sufficient
sleep. Smoking Unfortunately, approximately 25% of American adults continue to smoke.
Although smoking rates for adolescents has declined over time, the increase in vaping
activity presents unknown health risks. The legalization of recreational marijuana is also
not being factored into the risks of lung damage and lung cancer. Discussion: Child Obesity
in HarlemObesity American adult obesity in 2017 was reported for 39.8% of the population
or 9.3 million adults. Hispanics were most impacted at 47% and the black population at
37.9%. Those with higher education and income level were less likely to be obese. Obesity
contributes to rising rates of diabetes mellitus, which in turn is affecting the rates of kidney
disease, cardiovascular disease, and other morbidities. Childhood obesity is a particular
concern, as children become more sedentary and eat significant amounts of fast food.
Childhood obesity rates have continued to rise in the last decade, which puts children at
higher risk for early onset of hypertension and diabetes. Physical Activity The Centers for
Disease Control and Prevention Center for Health Statistics reported that only 20% of
American adults met the recommended physical activity for aerobic and strength exercise
in 2017. Only 1 in 3 children participate in regular exercise activity, spending an average of
seven and a half hours in screen time each day. Twenty percent of Americans are physically
inactive. Physical activity improves overall cardiovascular health, muscle strength and
balance, and overall well-being. While some areas are not near parks or sidewalk areas,
there are numerous exercise regimens of all levels available on television, smartphones, and
IPad. Many community facilities such as recreation centers and the YMCA have exercise and
healthy eating programs, as well as organized sports for all ages. The decision to participate
in regular exercise can have a significant impact on health and well-being. Alcohol Use The
Centers for Disease Control and Prevention Center for Health Statistics reported that
excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential

5. life lost between 2006 and 2010. Excessive alcohol use is responsible for 1 in ten deaths
among working adults ages 20 to 64 years. Short-term risks include injuries, violence, and
risky sexual behaviors. Those who binge drink (more than five drinks during a single
occasion) are at risk for acute alcohol poisoning, often seen among young men of college
age. Discussion: Child Obesity in HarlemWomen who drink while pregnant risk miscarriage
or stillbirth. Those who use alcohol regularly during pregnancy have an increased risk of
fetal alcohol syndrome in their children. Fetal alcohol syndrome is a condition where the
child has facial and other congenital abnormalities and intellectual disabilities. Long-term
health risks include hypertension, liver disease, and digestive problems. Mental health and
social problems, as well as memory issues, are common in those who drink excessively.
Alcoholism, or alcohol dependence, requires both physical and mental health services, often
in a rehabilitation setting. Other programs such as Alcoholics Anonymous offer peer
support for abstinence. Sleep and Health Harvard University School of Medicine has taken a
leadership role in addressing how insufficient sleep contributes to the development of
disease. Research suggests that sleep is just as important to health as nutrition and exercise.
Sleeping fewer than eight hours per night has been associated with weight gain, diabetes,
cardiovascular disease, hypertension, compromised immune response, and increase in the
risk for a common cold. Rates of sleep apnea, a condition where the individual stops
breathing during sleep, have been increasing in parallel to the rates of obesity. Obesity is
also a known risk factor for the development of sleep apnea. Public Health Nursing Public
health nurses have the opportunity to work with individuals, families, and communities to
educate constituents about the top three factors that account for over 75% of chronic
diseases. While education is important, clients need to know what they can do to change
their behaviors. It is important to know where programs are in the community that can
assist with exercise, weight management, smoking, alcohol cessation, and addressing sleep
disturbances. Support for accessing programs and then following through with behavior
change is important to reversing risk factors. Source(s) CDC – Fact Sheets-Alcohol Use And
Health – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-
use.htm Overweight & Obesity. (2018, August 13). Retrieved from
https://www.cdc.gov/obesity/data/adult.html Physical Activity. (2018, November 13).
Retrieved from https://www.cdc.gov/physicalactivity/data/index.html Sleep and Health.
(n.d.). Retrieved from http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-
foryou/health …Discussion: Child Obesity in Harlem