Programs and Communities

Obesity is a significant national public health crisis, affecting one-third of American adults. It is a complex and multifactorial disease that increases the risk of multiple chronic medical conditions including coronary heart disease, diabetes, and even leading to potential premature mortality. Moreover, increased health care utilization and escalating medical costs associated with obesity treatment are overwhelming an already burdened health care system. Obesity is nondiscriminatory, affecting individuals from various demographic and socioeconomic backgrounds, even extending to our unique population of active duty military service members and veterans.

Despite mandatory physical fitness and body composition requirements, active duty service members continue to experience an increasing prevalence of obesity. The obesity epidemic has considerable implications for military readiness, accession, and retention. Limited studies have examined weight-loss interventions including self-paced and provider-led interventions among active duty military service members with varying degrees of success. The purpose of this evidence based doctoral project was to examine the effectiveness of a twelve-week group lifestyle intervention involving education regarding healthy diet, physical activity and behavior change recommendations on weight and body mass index (BMI). The study demonstrated no significant differences in initial and post intervention weight and BMI.

This study answers the question, “In Adult Hispanic BMI ≥ 30 (P), how does development of a weight loss program that utilizes Motivational Interviewing (I) compared to counseling and educational materials only (C) affect weight loss over the period of three months (T).” There are limited published systematic reviews and randomized control trials to evaluate the effectiveness of Motivational Interviewing (MI), in conjunction with diet and exercise to promote weight loss. Participants (n = 5) were Latino patients of a local community health care center who were overweight and medically at risk due to unhealthy lifestyles that were determined through a screening test.

The 4-week clinical pathway program used motivational interviewing in one-on-one sessions every other week, and implemented the “Your Heart, Your Life” curriculum the other weeks. One expected outcome included lower anthropometric measurement numbers of participants’ WL, BMI, WC, and BP. Another expected outcome was an increase in physical activity. Participants were also expected to earn a higher score on a post-test about nutrition and healthy living. A paired t-test and power analyses were used to assess its effectiveness.

Results indicated significant decrease in weight loss (t [5] = 3.68, p = .0211, Cohen’s dz=1.647). For heart healthy habits, there were significant increases all three categories: weight management (t [5] = - 3.36, p = .0211), cholesterol and fat (t [5] = - 3.138, p =.035, salt and sodium (t [5] = - 4.899, p = .008). In addition, there was an increase in knowledge (t [5] = - 4.000, p = .016). Every participant showed small gains. Future implications should include more participants, including males, a control group, innovative activities that help to motivate a community of learners and more flexibility in allotted time for interventions.

Purpose: This project examined the effectiveness of an online educational module on basic Motivational Interviewing (MI) techniques for Nurse Practitioners (NPs) providing obesity management to middle-aged women.

Background: Middle-aged women experience distinct physiological and psychosocial factors that contribute to weight gain and make obesity management especially challenging. The evidence supports the use of motivational interviewing (MI) interventions as a highly effective approach to obesity management in combination with standard medical weight loss programs. Educating NPs that provide medical weight loss on basic MI counseling techniques is necessary to facilitate the use of this intervention.

Methods: NP providers at a group of seven medical weight loss clinics in the southwestern United States completed an online MI educational module that was developed for this project. The module content covered basic MI counseling techniques. MI knowledge was assessed using a 6-item pre/post-test. Participants completed an 8-item course evaluation to provide additional feedback.

Results: Ten of the 13 NPs eligible participated in the project. The overall response to the project was positive as demonstrated by high scores on the course evaluation. The average post-test knowledge scores increased after completion of the module, however no statistical significance was noted.

Conclusions: The basic MI education module was beneficial for NPs providing obesity management and future research should focus on developing standardized MI weight loss interventions.

In the United States obesity continues to be a growing issue in the adult population, which is compounded by the fact that many people have had antidepressant therapy at some point in their lives. Health problems such as metabolic syndrome, diabetes, skeleton/joint issues and more can stem from obesity. These comorbid health care problems can increase the costs at the state and federal levels. This paper will examine obesity and its relation to antidepressant therapy in depressed adults that are obese or endeavoring to avoid further weight gain. Research indicates that antidepressant therapies have shown a greater propensity towards weight gain, though few research studies show weight loss.

Intervention: 10 minutes of nutritional counseling during office visits. Setting: Family psychiatric clinic in the southwest of the United States.

Methods: Data collection process: Depressed adults on antidepressant therapies were randomly selected.

Instrumentation: Weight scale, National Literacy Scale, pamphlet (for teaching) and height scale. Data collected was at baseline, 4 weeks and 8 weeks.

Outcomes: 14 Participants agreed to the project, 10 completed to the 4-week mark and 4 finished the project to the 8-week mark. 10 female participants and 4 male participants. The remaining 4 participants showed 1.6% reduction in body mass index, which correlated with an increase in nutritional learning from baseline to 8-weeks.

Recommendations: Nutritional counseling is a non-pharmacological intervention for achieving and a desired weight, which has shown positive results in varying populations and clinical situations.

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.