TEST BANK forCommunity Nutrition in Action 8th Edition Marie Boyle

TEST BANK Community Nutrition in Action 8th Edition by Marie Boyle

TABLE OF CONTENTS Chapter 1. Opportunities in Community Nutrition Chapter 2. Principles of Epidemiology Chapter 3. A National Nutrition Agenda for the Public’s Health Chapter 4. Understanding and Achieving Behavior Change Chapter 5. Community Needs Assessment Chapter 6. Program Planning for Success Chapter 7. The Art and Science of Policymaking Chapter 8. Addressing the Obesity Epidemic Chapter 9. Health-Care Systems and Policy Chapter 10. Food Insecurity and the Food Assistance Programs Chapter 11. Mothers and Infants: Nutrition Assessment, Services, and Programs Chapter 12. Children and Adolescents: Nutrition Issues, Services, and Programs Chapter 13. Healthy Aging: Nutrition Assessment, Services, and Programs Chapter 14. Global Food and Nutrition Security: Challenges and Opportunities Chapter 15. Gaining Cultural Competence in Community Nutrition Introduction Chapter 16. Principles of Nutrition Education Chapter 17. Marketing Nutrition and Health Promotion Chapter 18. Managing Community Nutrition Programs Chapter 19. Building Grantsmanship Skills

Chapter 01: Opportunities in Community Nutrition True / False 1. A community is a grouping of people who reside in a specific locality and interact and connect through social structure to fulfill a wide range of daily needs. a. True b. False ANSWER: True 2. Communities exist only on local and regional levels. a. True b. False ANSWER: False 3. Community nutrition is a discipline that strives to improve the health, nutrition, and well-being of individuals and groups within communities. a. True b. False ANSWER: True 4. Policy is an essential aspect of the work of a community nutritionist. a. True b. False ANSWER: True 5. The leading causes of morbidity and mortality in the United States today are chronic diseases. a. True b. False ANSWER: True 6. The scope of modern-day public health is restricted to matters of sanitation. a. True b. False ANSWER: False 7. The aim of public health work is to protect, promote, and restore people’s health through the application of science, practical skills, and collective actions. a. True b. False ANSWER: True

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Chapter 01: Opportunities in Community Nutrition 8. The community nutritionist identifies nutritional needs in the community, but is not involved in planning new programming or services for the community. a. True b. False ANSWER: False 9. Most community nutrition positions require registration as a dietitian by the Academy of Nutrition and Dietetics. a. True b. False ANSWER: True 10. Marketing is an important skill for the community nutritionist. a. True b. False ANSWER: True 11. Community nutritionists are expected to plan, evaluate, manage, and market nutrition services, programs, and interventions. a. True b. False ANSWER: True 12. In most cases, the practice setting of community nutritionists is limited to schools and public health departments. a. True b. False ANSWER: False 13. Nutrition and dietetic technicians are restricted from working in community nutrition. a. True b. False ANSWER: False 14. Medical nutrition therapy is outside the scope of practice for community nutritionists. a. True b. False ANSWER: False

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Chapter 01: Opportunities in Community Nutrition 15. Community nutritionists are expected to be multiskilled practitioners. a. True b. False ANSWER: True Multiple Choice 16. Which of the following is an institutional–organizational-level setting? a. High school b. Public Park c. Residential district d. Family home ANSWER: a 17. Which of the following would be a job responsibility of a community nutritionist? a. Providing discharge instructions to patients leaving the hospital b. Formulating diet plans for inpatients recovering from surgery c. Estimating energy needs for ventilated patients in the ICU d. Assessing the nutrition status of local children and adolescents ANSWER: d 18. What is entrepreneurship? a. the act of using community nutrition resources responsibly b. the marketing and delivering of a product or service c. the proposal to start a business d. the creation of something of value through the creation of organization ANSWER: d 19. What is one of the essences of entrepreneurship? a. organization b. innovation c. marketing d. dependability ANSWER: b

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Chapter 01: Opportunities in Community Nutrition 20. Examples of how community nutritionists engage in entrepreneurial activities include all of the following EXCEPT: a. recognizing opportunities to deliver health messaging b. developing a marketing plan c. building the team to deliver nutrition programs or services d. reading research ANSWER: d 21. What is the focus of secondary prevention? a. prevention of disease by controlling risk factors b. treatment and rehabilitation of people who have suffered illness or injury c. support of individual factors such as knowledge and skills d. early detection of disease through screening and risk appraisal ANSWER: d 22. Which of the following is a social determinant of health? a. Genetic predisposition b. Race c. Gender d. Education level ANSWER: d 23. Which description best applies to Healthy People 2030? a. A national strategy for improving the health of the United States b. A set of goals and objectives that focuses on healthcare industry reforms c. A plan to study the health statistics of the United States population d. A bipartisan framework for disease prevention through genetic testing ANSWER: a 24. Access to health services; educational and community-based programs; and health communication and health information technology are all what? a. Basic focuses for entrepreneurs b. Voluntary global targets for 2025 c. Components of sustainable food systems d. Healthy People 2030 topic areas ANSWER: d

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Chapter 01: Opportunities in Community Nutrition 25. A community nutrition practitioner is providing nutrition advice to older adults in the community. These clients are uncomfortable with technology and are skeptical of providing any more personal information than is absolutely necessary. These clients are most likely from which generational cohort? a. Millennials b. Baby Boomers c. Generation X d. Matures/Traditionalists ANSWER: d 26. A community nutrition practitioner is providing nutrition advice to parents in the community whose children are leaving for college. They find that these clients are inclined to aggressively question authority and want versatility and challenge in their lives. These clients are most likely from which generational cohort? a. Generation Z b. Matures/Traditionalists c. Baby Boomers d. Generation X ANSWER: c 27. What occurs when a segment of the population bears a disproportionate incidence of a condition or illness? a. Chronic disease b. Bioterrorism c. Pandemic d. Health disparity ANSWER: d 28. Which statement is true about current demographic trends in the United States? a. The population is significantly decreasing their incidence of obesity b. The country is becoming more ethnically diverse. c. The proportion of older Americans has decreased significantly. d. The birth rate has significantly increased.

ANSWER: b 29. Which of the following is a leading cause of overweight and obesity? a. lack of nutrition education b. excess fiber intake c. physical inactivity d. lack of interest in health promotion ANSWER: c

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Chapter 01: Opportunities in Community Nutrition 30. Production, processing, distribution, and consumption must all be integrated to maintain natural resources in order to achieve what? a. Healthy People 2030 goals b. A sustainable food system c. Social determinants of health d. A built environment ANSWER: b 31. A(n) has four components: people, space, social interaction, and shared values. a. population b. community c. government d. ecosystem ANSWER: b 32. The discipline that strives to prevent disease and improve the health and well-being of individuals is a. epidemiology b. community nutrition

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c. food sciences d. public health ANSWER: b 33. A is a course of action chosen by public authorities to address a given problem. a. law b. regulation c. policy d. procedure ANSWER: c 34. Programs are used by community nutritionist to a. change laws

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b. maintain natural resources c. enact new policies d. promote behavioral changes that improve health ANSWER: d

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Chapter 01: Opportunities in Community Nutrition 35. The leading cause of morbidity and mortality in the United States is a. cancer

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b. HIV c. cardiovascular disease d. diabetes mellitus ANSWER: c 36. Nonchronic diseases include . a. coronary artery disease and stroke b. cancer c. diabetes mellitus d. influenza and pneumonia ANSWER: d 37. Which intervention is considered a secondary prevention technique? a. screenings and periodic examinations b. treatment and acute care c. rehabilitation d. promotion of healthy behaviors and environments ANSWER: a 38. A public health office is developing a program to reduce the risk of skin cancer in a local farming community. Which activity would be considered a primary prevention technique? a. A nutritional program for people with skin cancer b. A program that promotes the use of sunscreen c. A wellness fair that provides skin cancer screenings d. A program designed to help skin cancer survivors with self-management ANSWER: b 39. Which set of characteristics is associated with lifestyle determinants of health? a. age and race b. housing and education c. physical activity and diet d. cultural beliefs and values ANSWER: c

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Chapter 01: Opportunities in Community Nutrition 40. Health focuses on changing human behaviors by encouraging people to eat healthy, be active, get regular rest and achieve balance in life. a. promotion b. intervention c. prevention d. awareness ANSWER: a 41. The model emphasizes the idea that all elements of society combine to shape an individual’s health behaviors and chronic disease risk. a. social–biological b. social–psychological c. social–ecological d. environmental–ecological ANSWER: c 42. According to the social-ecological model, interpersonal levels of influence include a. local, state, and federal laws

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b. social norms and standards c. family, peers, and health professionals d. attitudes, beliefs, and behaviors ANSWER: c 43. A city council makes plans to update recreational areas to promote and facilitate physical activity. According to the social–ecological model, this is an example of changes at the level. a. structures, policies and systems b. community c. interpersonal d. institutional or organizational ANSWER: a 44. Since the year 2000, almost no progress was made toward the Healthy People 2020 targets for a. life expectancy

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b. death rates for heart disease and stroke c. nutrition and obesity d. calcium intake ANSWER: c

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Chapter 01: Opportunities in Community Nutrition 45. Healthy People 2030 aims to redirect the focus of the national health agenda from health care to what? a. healthcare reform b. nutrition c. health maintenance d. social determinants of health ANSWER: d 46. Which of the following is not an essential practice for a community nutritionist? a. To participate in nutrition surveillance and monitoring of communities b. To participate in screening activities c. To work independently to develop nutritional programs d. To conduct outcomes assessment of community-based food programs ANSWER: c 47. Which term refers to community-based nutrition programs conducted by a government agency? a. public health nutrition b. private policy nutrition c. community nutrition d. health care nutrition ANSWER: a 48. In which workplace setting might you find a public health nutritionist? a. fitness centers b. daycare centers c. hospitals d. state health department ANSWER: d 49. The minimum educational requirements for a community nutritionist include . a. a bachelor’s degree in nutrition or dietetics from an accredited college or university b. registration with the Academy of Nutrition and Dietetics as a registered dietitian c. graduate-level training in nutrition d. an associate’s degree in nutrition or dietetics from an accredited college ANSWER: a

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Chapter 01: Opportunities in Community Nutrition 50. Registered dietetic technicians are most often employed in a. government agencies

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b. public health research offices c. food-service and clinical settings d. universities ANSWER: c 51. Which of these is an approach for creating interventions and prevention strategies to reduce health disparities? a. Surveillance b. Health promotion c. Community-based participatory research d. Healthy People ANSWER: c 52. Which term refers to the process of enabling people to achieve their maximum potential for good health? a. Intervention b. Tertiary prevention c. Health promotion d. Surveillance ANSWER: c 53. Which basic competency of the community dietitian addresses participation in public policy activities? a. practice management and use of resources b. clinical and customer services c. professional practice expectations d. scientific and evidence base of practice ANSWER: a 54. Which of the following is an example of how a community nutritionist might be involved in policy? a. Connect with clients on social media b. Deliver nutrition education in the community c. Teach clients how to read nutrition labels d. Advise their local governments ANSWER: d

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Chapter 01: Opportunities in Community Nutrition 55. Which of the following is not a part of the public health system? a. Grocery stores b. Environmental agencies c. Public health agencies d. Healthcare providers ANSWER: a 56. Why is health promotion that focuses on prevention increasingly important? a. The leading causes of morbidity and mortality are nonchronic diseases. b. The medical community is moving towards a holistic approach to health. c. Genetic testing and screening will soon become mandatory. d. Americans in general are increasingly committed to healthy diets and exercise.

ANSWER: b 57. What does the social–ecological model provide? a. A list of goals for the nation’s health b. Guidance for developing successful health prevention and promotion programs c. Recommendations for healthy eating d. A structured approach to building public health organizations ANSWER: b 58. A local community nutrition specialist designs a nutrition education program designed for individuals diagnosed with HIV. What is this program an example of? a. public health b. secondary prevention c. primary prevention d. tertiary prevention ANSWER: d 59. Today’s community dietitians will need to understand the characteristics of aging population. a. Generation X b. Baby Boomers

to better serve the needs of the

c. Generation Y d. Millennials ANSWER: b

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Chapter 01: Opportunities in Community Nutrition 60. One of the major challenges facing community nutritionist in North America is a. the lack of population diversity

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b. the decrease in educational levels c. an aging population d. a decrease in life expectancy ANSWER: c 61. Among which group do health disparities, including the incidence of chronic disease, disability, and death, tend to be lowest? a. American Indians and Alaska Natives b. Black or African Americans c. Hispanic or Latinos d. Caucasians ANSWER: d 62. Which of the following is a major lifestyle trend in the twenty-first-century United States? a. decreased portion sizes served by fast food establishments b. decreased amount of time spent in sedentary activities by children and adults c. increased number of families living in communities that are not conducive to regular outdoor activity d. increased number of vending machines offering juice and water ANSWER: c 63. Which demographic category is expected to grow to reach nearly a quarter of the population by 2060? a. children under 10 b. Caucasians c. adults over age 65 d. American Indians and Alaska Natives ANSWER: c 64. Which statement is correct regarding sustainability? a. Demand for sustainably produced food products in the United States is increasing. b. Awareness of sustainably produced food products is decreasing in the United States. c. As interest in sustainability rises, global food insecurity is decreasing. d. The amount of food waste produced by an individual has little impact on the larger community.

ANSWER: a

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Chapter 01: Opportunities in Community Nutrition 65. Which generation prefers being tech-savvy, multi-tasking, and working in collaborative efforts? a. Generation Z (1997-?) b. Baby Boomers (1946-1964) c. Generation X (1965-1980) d. Generation Y/ Millennials (1981-1995) ANSWER: d 66. Which generation is focused on personal growth, and interested in removing outdated work models? a. Matures/Traditionalists (pre 1946) b. Baby Boomers (1946-1964) c. Generation X (1965-1980) d. Generation Y/ Millennials (1981-1995) ANSWER: c 67. Which was the first generation to be born into a digital world? a. Generation Z (1997-?) b. Baby Boomers (1946-1964) c. Generation X (1965-1980) d. Generation Y/ Millennials (1981-1995) ANSWER: a 68. Which generation gives information on a “need to know” basis, and is respectful of authority? a. Mature’s/Traditionalists (pre 1946) b. Baby Boomers (1946-1964) c. Generation X (1965-1980) d. Generation Y/ Millennials (1981-1995) ANSWER: a 69. Which generation is interested in interpersonal communication, gently questions the status quo, and wants to see the big picture of the organization? a. Mature’s/Traditionalists (pre 1946) b. Baby Boomers (1946-1964) c. Generation X (1965-1980) d. Generation Y/ Millennials (1981-1995) ANSWER: a

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Chapter 01: Opportunities in Community Nutrition 70. Which of these is an approach to collecting data on a population’s health and nutritional status in which data collection occurs regularly and repeatedly? a. policy b. surveillance c. public health d. intervention ANSWER: b 71. A property of a group that consists of its sharing cultural traditions, having a common linguistic heritage, and originating from the same land is: a. race b. ethnicity c. culture d. community ANSWER: b 72. One who undertakes the risk of a business or enterprise. a. business executive b. entrepreneur c. manager d. healthcare worker ANSWER: b 73. Health promotion activities are likely to have a greater impact if they focus on what? a. Tertiary interventions b. Policy-, system-, and environmental-level settings c. Treatment of chronic diseases d. Improving physical activity ANSWER: b 74. Why is it important to identify risk factors that contribute to the development of chronic diseases? a. Health professionals need to monitor them. b. Genetic predispositions may be altered. c. Many of them are preventable. d. They vary by region of residence.

ANSWER: c

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Chapter 01: Opportunities in Community Nutrition 75. Anatomic integrity and the ability to perform personally valued family, work, and community roles are aspects of what? a. Entrepreneurship b. Social determinants of health c. Health d. Community ANSWER: c 76. Street layout, zoning, transportation options, stairs, public and green spaces, and business areas are all elements of what? a. Built environment b. Sustainable food systems c. Public health systems d. Health ANSWER: a 77. Which term describes a health promotion activity aimed at changing the behavior of a target audience? a. policy b. intervention c. public health d. programs ANSWER: b 78. A group of individuals with a common interest who agree to work together towards a common goal. a. community b. coalition c. community action committee d. practice group ANSWER: b 79. Instruments used by community nutritionists to seek behavior changes that improve nutritional status and health. a. policies b. research studies c. health promotion d. programs ANSWER: d

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Chapter 01: Opportunities in Community Nutrition Subjective Short Answer 80. List three challenges a community nutritionist faces.

ANSWER:

The challenge of improving the nutritional status of diverse groups of people with varying education and income levels and different health and nutrition needs The challenge of forming partnerships with colleagues, business leaders, and the public to advocate for change The challenge of influencing lawmakers and other key citizens to enact laws, regulations, and policies that protect and improve the public’s health.

The challenge of studying the scientific literature for new angles on how to help people make good food choices for good health The challenge of connecting food choice with sustainability of the food system and planetary health The challenge of mastering technologies to help meet the needs of clients and communities

81. List five different practice settings in which a community nutritionist may work.

ANSWER: Any five of the following: schools, worksites, cooperative extension agencies, universities, colleges, medical schools, nonprofit health organizations, public health departments, home health care agencies, daycare centers, residential facilities, fitness centers, sports clinics, hospital outpatient facilities, food companies, wellness programs, private practice.

82. What are the three arenas of focus for community nutrition?

ANSWER: People, policy, and programs.

83. List three ways in which a community nutritionist might be involved in public policy.

ANSWER: • Letter writing to government officials • Policy making at the local or state level • Lobbying to legislators, advocating for a public policy change • Networking with other community nutritionists and health professionals on issues related to overall health and well-being

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Chapter 01: Opportunities in Community Nutrition 84. List the five goals of Healthy People 2030.

ANSWER: The five goals of Healthy People 2030 are as follows: Goal 1: Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.

Goal 2: Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

Goal 3: Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.

Goal 4:Promote healthy development, healthy behaviors, and well-being across all life stages.

Goal 5: Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

85. Why is entrepreneurship an important skill for the community nutritionist?

ANSWER: Community nutritionists who want to change people’s eating habits must be able to see new ways of reaching desired target groups. Creativity and innovation are hallmarks of entrepreneurs and these characteristics help the community nutritionist improve health for all by delivering relevant products, services, and health messaging.

Use the following case scenario to answer short answer items 86-89.

Aisha is a newly graduated registered and licensed dietitian who will begin her career as a WIC nutritionist in a small, rural Midwest community. In this role, she will be primarily responsible for a case load of 300 clients within her county. Answer the questions below based on this brief scenario.

86. Define the communities in which Aisha will be providing nutrition interventions.

ANSWER: Aisha will work in a variety of communities: pregnant, lactating, and postpartum low-income women; infants and children under the age of 5; her geographical community of the county; and perhaps lowliteracy groups.

87. What policies might Aisha need to become familiar with as she starts her new job?

ANSWER: The policies of WIC; her county office’s policies; WIC legislation; and reimbursement and qualifying guidelines are all examples of policies that Aisha would need to become familiar with.

88. What health disparities might Aisha need to be aware of in this role?

ANSWER: Aisha would need to be aware of the specific health disparities affecting the low income population, as WIC serves individuals below a certain income level. Aisha would also need to be aware of the specific racial and ethnic demographics of her clientele to determine if further health disparities may exist.

89. Which of the Healthy People 2030 objectives might Aisha be most interested in reviewing?

ANSWER: Those objectives related to breastfeeding, healthy pregnancies, and the health and well-being of children, and perhaps those related to health disparities among low-income families.

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Chapter 01: Opportunities in Community Nutrition Essay 90. Explain how the three arenas of community nutrition are interconnected.

ANSWER: The three arenas of community nutrition practices are people, policy, and programs. Policy is a course of action chose by public authorities to address a given problem. Programs are based on the needs identified by policy. Within the policy, target audiences (people) who have the greatest need for the programming are identified.

91. Define “health” and explain why it is imperative that the community nutritionist be familiar with the social determinants of health.

ANSWER: Health can be viewed as the absence of disease and pain, or it can be pictured as a continuum along which the total living experience can be placed. On this continuum, the presence of disease, impairment, or disability is placed at one end and freedom from disease or injury at the other. Many times, we define health simply as feeling “good,” when in essence, health is inclusive of the physical, mental, and spiritual capacity to live, work, and interact joyfully with other human beings. The community nutritionist must recognize that the factors that influence health are complex and not as well understood as the factors that influence disease. Familiarity with the social determinants of health will give the community nutritionist an empathetic approach as they interact with the community.

92. Explain how community nutrition practice fits into the larger realm of public health.

ANSWER: Community nutrition is one piece of public health that focuses on the improvement of health, nutrition, and well-being of individuals within communities. Public health can be defined as an effort organized by society to protect, promote, and restore the people’s health through the application of science, practical skills, and collective actions.

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Chapter 01: Opportunities in Community Nutrition 93. Describe three practice areas for the community nutritionist including the population served and examples of practice sites.

ANSWER: • Aging: child and adult food programs, long-term care dietitian, Area on Aging Program director • Child Nutrition: WIC, school nutrition director, Head Start dietitian • Culinary: media, educator, researcher • Global Health Nutrition: public health departments, Doctors Without Borders, UNICEF • Government: USDA food and nutrition services, FDA consumer safety officer, research scientist, etc.

• Hunger/Food Insecurity: nutritionist for food bank, coordinator of community gardens • HIV/AIDS: nutritionist for WHO, nutritionist for community agency serving HIV population • Industry: spokesperson for industry partner • Media: radio show contributor, writer/ blogger, podcast developer, spokesperson • Military: RD for one of the branches of the armed forces • Nonprofit: nutrition educator for health care organization • Public Health: public health nutritionist for health department • Private Practice: can focus on a variety of populations • Public Policy/Advocacy: director of policy for nonprofit, public health nutritionist • Research • Retail: corporate or consultant retail dietitian • Sports Nutrition: team dietitian, RD for university athletic department, consultant 94. Discuss how the “health continuum” could be utilized when planning health promotion.

ANSWER: The “health continuum” (see Figure 1-5) depicts health as a continuum from a well population to a population at risk to a population with an established disease to one with a controlled chronic disease.

Health promotion is more effective when the programming is targeted to the level of health within the population. Primary prevention activities are best for those who are well whereas tertiary prevention activities are more appropriate for those with an established chronic disease.

95. Describe and give an example of each of the three levels of prevention.

ANSWER: The three types of prevention efforts are primary, secondary, and tertiary. Primary prevention is aimed at preventing disease by controlling risk factors that are related to injury and disease. Heart-healthy cooking classes are an example. Secondary prevention focuses on detecting disease early through screening and other forms of risk appraisal. Public screenings for hypertension, diabetes, or anemia at a health fair are examples of secondary prevention efforts. Tertiary programs aim to treat and rehabilitate people who have experienced illness or injury. Education programs for people recently diagnosed with diabetes or heart disease are examples of tertiary efforts.

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Chapter 01: Opportunities in Community Nutrition 96. Briefly discuss the trend of sustainability in regards to our food systems and explain why this is important for the community nutritionist to understand.

ANSWER: Sustainability exists when something is maintained over the long term. A sustainable food system exists when production, processing, distribution, and consumption are integrated and related practices that regenerate rather than degrade natural resources, are socially just and accessible, and support the development of local communities and economies. Sustainability is gaining consumer attention and influencing consumer decision making. The Academy of Nutrition and Dietetics has authored a position statement on this encouraging dietitians to become educated on sustainability so we can guide consumers toward more sustainable food choices to conserve and protect the global food system.

97. Discuss the premise of the Healthy People initiative.

ANSWER: Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the U.S. For the past four decades, Healthy People has provided a framework for promoting health and avoiding preventable disease.

98. Outline the educational requirements, practice settings, and roles and responsibilities of community nutritionists.

ANSWER: The minimum educational requirements for a community nutritionist include a bachelor’s degree in community nutrition, foods and nutrition, or dietetics from an accredited college or university. Most community nutrition positions require the individual to be a registered and licensed dietitian. Community nutritionists practice in schools, worksites, cooperative extension agencies, universities, colleges, medical schools, voluntary and nonprofit health organizations, public health departments, home healthcare agencies, day care centers, residential facilities, fitness centers, and many other settings. Roles and responsibilities are numerous and include managing nutrition care interventions for diverse population groups across the life span; participating in nutrition surveillance and monitoring of communities; developing and implementing community-based food and nutrition programs; managing and marketing of nutrition information; conducting outcome assessment and evaluation of community-based food and nutrition programs; and participating in screening activities.

99. What is meant by the concept that community nutritionists are expected to be multiskilled?

ANSWER: Being multiskilled, or cross-trained, occurs when the community nutritionist performs more than one function, often in more than one discipline. The multiskilled community nutritionist knows how to conduct a needs assessment and provide dietary guidance as well as how to design and conduct a survey, use the Internet for marketing health messages, and obtain funding to support a program’s promotional plan.

100. Describe the personality characteristics and personal competencies of the entrepreneur.

ANSWER: Entrepreneurs are achievers, setting high goals for themselves. They work hard, are good organizers, enjoy managing a project to completion, and accept responsibility for their ventures. They strive for excellence and are optimistic, believing that now is the best of times and anything is possible.

Entrepreneurs have competencies in areas such as planning, marketing, networking, budgeting, and team building.

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Chapter 01: Opportunities in Community Nutrition 101. You are a community nutritionist who is working a pediatric outpatient clinic specializing in the management of pediatric overweight and obesity. Give an example each of a primary, secondary, and tertiary prevention effort you might initiate in this role. List the competencies that may be needed for each prevention.

ANSWER: An example of a primary prevention would be nutrition education for school-aged children on healthy habits; an example of a secondary prevention would be screenings for elevated BMI through school nurse; and an example of a tertiary prevention would be classes offered at your facility for children and families dealing with pediatric obesity. Competencies will vary based on intervention but include the following: • Integration of research into practice • Practice in compliance with current guidelines/ rules/ scope of practice • Demonstrate professional writing skills • Design, implement, and evaluate presentations to a target audience • Use effective education and counseling skills • Refer to other professionals • Collaborate with other healthcare professionals • Demonstrate negotiation skills • Perform Nutrition care process • Demonstrate effective communication • Perform management functions • Participate in public policy

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Chapter 02: Principles of Epidemiology True / False 1. Epidemiology is the basic science of public health. a. True b. False ANSWER: True 2. Within the field of epidemiology, the term distribution refers to the relationship between the health problem or disease and the treatment options available. a. True b. False ANSWER: False 3. Factors such as race, age, sex, and a person’s physiological state are all considered determinants of disease. a. True b. False ANSWER: True 4. Vital statistics are figures pertaining to risk and development of disease and illness. a. True b. False ANSWER: False 5. Crude birth and death rates are not useful for comparisons because population characteristics may differ greatly, particularly concerning age. a. True b. False ANSWER: True 6. Prenatal alcohol exposure is one of the leading preventable causes of developmental delays or disabilities in the United States. a. True b. False ANSWER: True 7. Epidemiologic methodology can determine whether syndromes are related to each other or represent distinct conditions. a. True b. False ANSWER: True

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Chapter 02: Principles of Epidemiology 8. A single individual with a confirmed diagnosis of a disease is classified as a case. a. True b. False ANSWER: True 9. In a study on liver cancer, subjects with a high fat intake had a relative risk of 2.15, meaning they have double the risk of developing liver cancer than those with a low intake of fat. a. True b. False ANSWER: True 10. The prevalence of a disease is the number of new cases of a disease during a specific time period in a defined population. a. True b. False ANSWER: False 11. The rate of incidence of a disease is best measured using a cross-sectional study. a. True b. False ANSWER: False 12. A cohort is a well-defined group of people who are studied over a period of time to determine their incidence of disease, injury, or death. a. True b. False ANSWER: True 13. A scientific study in which participants self-selected involvement would likely show error due to selection bias. a. True b. False ANSWER: True 14. A confounding factor is a “hidden” factor or characteristic that may cause an association that the researchers attribute to other factors. a. True b. False ANSWER: True

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Chapter 02: Principles of Epidemiology 15. In an experimental study, investigators examine preventions and treatments for diseases by actively manipulating which groups receive the agent under study. a. True b. False ANSWER: True Multiple Choice 16. What is the purpose of a clear, precise hypothesis? a. To find the final answer to the research question b. To ensure that the appropriate data are collected to answer the research question(s) and helps avoid the pitfall of drawing spurious conclusions from the data set c. To identify a weak study d. To identify a valid study ANSWER: b 17. What does a retrospective cohort study observe? a. the outcomes after interventions have been placed b. the relationship between exposure and disease c. the relationship between exposure factors and outcome development d. the individuals and data collected at many intervals ANSWER: c 18. Which of the following is an example of an ecological study? a. An investigation of the correlation between fish consumption and breast cancer incidence and mortality rates in Americans over 35 b. An investigation of nutrient intakes and growth of predominantly breastfed infants, following the same small group of infants over several months c. A study that enrolls a few dozen participants to record their exposure to factors associated with increased risk of coronary heart disease for the coming decades d. A study that identifies patients who have the outcome of interest and matching them with individuals who have similar characteristics ANSWER: a 19. Which of the following is a possible explanation for the results of a research study? a. Hypothesis b. Variable c. Bias d. Incidence ANSWER: c

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Chapter 02: Principles of Epidemiology 20. What is the definition of a correlational study? a. A study that observes the determinants of health and illness in a specific population b. A study where exposure factors and outcomes are observed or measured at one point in time c. A study that determines the effect of an intervention d. A study that examines the relationship between exposure and disease with population-level data ANSWER: d 21. Which type of study would examine the relationships among dietary intake, diseases, and other variables as they exist in a particular population at one point in time? a. Cross-sectional study b. Trend study c. Observational study d. Randomized controlled trial ANSWER: a 22. What is a disadvantage of a case–control study? a. It must be double-blind. b. It requires following the same participants for years. c. It has a small participant pool. d. It is expensive.

ANSWER: d 23. What is considered a drawback of the randomized controlled trial? a. Lack of participants b. High cost c. Control of data d. Control of groups ANSWER: b 24. When is a case-control study design most useful? a. To study a rare condition b. To examine the relationship among dietary intake and other variables c. To compare the frequency of events between groups d. To observe the changes or differences that occur between groups ANSWER: a

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Chapter 02: Principles of Epidemiology 25. What is the primary concern in the area of nutritional epidemiology? a. To focus on nutritional deficiency diseases such as scurvy b. To focus on major chronic diseases such as cardiovascular disease c. To focus on diseases that affect a control group d. To design research studies that look at cause and effect ANSWER: b 26. How many days define the “true” average intake for an individual? a. 3 b. 7 c. 180 d. 365 ANSWER: d 27. Which of the following is a challenge when studying the relationship of diet to disease? a. The complexity and variability of our diets b. Identifying risk factors that play a key role in developing chronic disease c. Finding subjects to participate in clinical trials d. The inability to study the mechanism of disease ANSWER: a 28. What is the purpose of a food balance sheet? a. It measures the food ingested by a population. b. It is used to describe the nutritional inadequacies of countries. c. It measures the food available for consumption from imports and domestic food production. d. It looks for errors in calculating production, waste, and consumption.

ANSWER: c 29. Which of the following best accounts for food distribution at the national level? a. Food frequency questionnaire b. Food diary c. Food balance sheet d. 24-hour recall ANSWER: c

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Chapter 02: Principles of Epidemiology 30. Which of the following is an advantage of cohort studies? a. They do not require the researcher to gather data himself or herself. b. They make it easy to study the mechanism of the disease. c. They require relatively few study subjects. d. They can be completed quickly.

ANSWER: c 31. Which of the following is included in the study of epidemiology? a. the health and wellness of individuals b. medicine c. laboratory science d. health problems of populations ANSWER: d 32. In the context of epidemiology, which term refers to the causes and factors that affect the risk of disease? a. distribution b. determinants c. host factors d. incidence ANSWER: b 33. In the 1990s, which nutrient did epidemiologic studies determine could reduce the risk of bearing a child with neural tube birth defects? a. vitamin B b. vitamin C c. folic acid d. ascorbic acid ANSWER: c 34. Over the past decade, epidemiologic data were used to develop what kinds of methods to identify women at high risk of giving birth to children with fetal alcohol spectrum disorder? a. surveillance b. case–control c. intervention d. cohort ANSWER: a

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Chapter 02: Principles of Epidemiology 35. Which prenatal exposure is one of the leading preventable causes of birth defects and developmental disabilities in the United States? a. nicotine b. alcohol c. cocaine d. marijuana ANSWER: b 36. Which of the following is not considered a vital statistic? a. cause-specific death rate b. fetal death rate c. infant mortality rate d. drug-usage rate ANSWER: d 37. Which term refers to a particular instance of a disease or outcome of interest? a. incidence b. prevalence c. case d. risk factor ANSWER: c 38. An epidemiologic study evaluated the relationship between caffeine and developing high blood pressure. The relative risk of the group drinking five caffeinated beverages a day compared to the group drinking no caffeinated beverages a day was 0.99. What is the best interpretation for a person who drinks five caffeinated beverages each day? a. has a 99 percent chance of developing high blood pressure b. has a 99 percent chance of NOT developing high blood pressure c. is not at increased risk of high blood pressure d. will almost certainly develop particularly severe high blood pressure ANSWER: c 39. Which characteristic is associated with the incidence rate of disease development? a. All cases in a single survey are counted. b. It is measured in a single point in time. c. All individuals are examined including cases and non-cases. d. It is measured most efficiently in a cohort study.

ANSWER: d

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Chapter 02: Principles of Epidemiology 40. Which risk factor for heart disease cannot be changed by lifestyle modifications? a. genetics b. obesity c. high blood pressure d. physical activity ANSWER: a 41. Which step of the scientific method occurs immediately after the identification of the problem? a. experimental design b. data collection c. hypothesis formulation d. theory development ANSWER: c 42. During statistical analysis, what is the term for when the investigator considers searching for statistical associations among various groups that may suggest a cause-effect relationship without generating prior hypotheses about these groups? a. selection bias b. data dredging c. measurement testing d. confounding bias ANSWER: b 43. Which type of bias results when additional, uncontrolled factors, rather than the studied variable, account for the outcome? a. Confounding b. Measurement c. Selection d. Control ANSWER: a 44. One of the first extensive population studies to examine the relationship between blood cholesterol levels and risk of CHD was the Seven Countries Study. Which epidemiological method is this study an example of? a. observing b. counting cases c. relating cases to the population at risk d. making comparisons ANSWER: d

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Chapter 02: Principles of Epidemiology 45. Which type of bias may occur if study participants are not picked randomly from the population of interest? a. Confounding b. Measurement c. Sample d. Selection ANSWER: d 46. Which type of study would assign subjects to intervention alternatives based on convenience rather than by statistical assignment? a. observational b. cross-sectional c. cohort d. nonrandomized controlled ANSWER: d 47. Which type of study has exposure factors and outcomes observed or measured at a single point in time in a sample from the population studied? a. cross-sectional b. experimental c. randomized controlled d. cohort ANSWER: a 48. Which type of study reviews groups of people to examine the relationship between exposure and disease? a. trend b. ecological c. cohort d. case–control ANSWER: b 49. Which type of study uses systematic and quantitative methods to combine all relevant studies' results to produce an overall estimate? a. trend b. experimental c. non-biased d. meta-analysis ANSWER: d

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Chapter 02: Principles of Epidemiology 50. An investigation of the correlation between consumption of genetically modified corn and colon cancer incidence and mortality rates in humans is an example of which type of study? a. observational b. ecological c. experimental d. meta-analysis ANSWER: b 51. Which type of study follows a group of individuals free of the disease or condition of interest into the future? a. retrospective cohort b. prospective cohort c. retrospective cross-sectional d. prospective cross-sectional ANSWER: b 52. Which is the most appropriate use of an ecological or correlational study? a. generate hypotheses b. draw conclusions c. change public policy d. validate previous studies ANSWER: a 53. What was primary objective of the Nurse’s Health Study I? a. To investigate the development of cardiovascular disease b. To prevent or delay the development of type 2 diabetes c. To investigate diets and lifestyle risk factors for chronic disease in women d. To evaluate men’s health and fitness to the incidence of serious illness ANSWER: c 54. Which of the following is true of nutritional epidemiology? a. It is one of the oldest areas of study. b. It focuses on the role of the Western diet and chronic disease. c. It always utilizes controlled, clinical trial protocols. d. It currently focuses on deficiency diseases.

ANSWER: b

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Chapter 02: Principles of Epidemiology 55. Which of the following is true of a single 24-hour dietary recall? a. It is considered the best method of assessing dietary intake. b. It uses a questionnaire to assess nutrient intake. c. It requires the subject to make judgments about their usual food habits. d. It may not give an adequate picture of a specific individual’s usual intake.

ANSWER: d 56. Which method of assessing intake is considered the best, but is time-consuming and the results may not be accurate if subjects modify their eating habits during the study? a. twenty-four-hour recall b. food record c. food frequency d. diet history ANSWER: b 57. Which of the following measures the food available for consumption from imports and domestic food production minus the food through exports, waste, or spoilage? a. records b. histories c. balance sheets d. questionnaires ANSWER: c 58. In most epidemiologic studies, what is an important but very difficult factor to measure? a. Food balance b. Incidence of a disease c. Short-term vitamin deficiency d. Long-term dietary intake ANSWER: d 59. Which is an example of methods of assessing household food consumption? a. records of food wasted, spoiled, or fed to pets b. records of the number of meals eaten at home or away from the home c. per capita export data d. food disappearance data ANSWER: b

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Chapter 02: Principles of Epidemiology 60. Epidemiological data that is intuitive and reflective of other knowledge possesses which quality? a. plausibility b. consistency of findings c. intensity d. specificity of association ANSWER: a 61. Which type of study is best suited to studying rare conditions or diseases with long latency periods? a. Ecological b. Trend c. Nonrandomized controlled d. Case–control ANSWER: d 62. Which of the following study types is purely observational? a. Epidemiological b. Randomized controlled c. Trial d. Nonrandomized controlled ANSWER: a 63. What is an advantage of a cohort study? a. It can study the mechanism of a disease. b. It has the ability to study large groups. c. It can calculate and compare rates in exposed and unexposed. d. It can easily track those lost to follow-up.

ANSWER: c 64. What is a disadvantage of a cohort study? a. It is risky for people who participate in the study. b. There is a need to study large numbers of individuals, which may take years to accomplish. c. It is not effective or valid. d. It is very difficult to find trained professionals to oversee the study.

ANSWER: b

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Chapter 02: Principles of Epidemiology 65. Which type of study is considered the gold standard of study designs? a. Non-randomized controlled trial b. Cohort studies c. Randomized controlled trial d. Correlational studies ANSWER: c 66. Which term refers to the likelihood or probability of an event occurring? a. Case b. Risk c. Incidence d. Risk factor ANSWER: b 67. To achieve validity, what must the study include? a. A broad hypothesis b. A control and placebo group c. A sufficient number of participants d. Participants of the same age ANSWER: c 68. In the epidemiological model, which is the first step in the epidemiologic method of studying disease processes? a. Developing the hypothesis b. Observing c. Testing the hypothesis d. Conducting the experiment ANSWER: b 69. Which of the following reduces the possibility that the outcome of a particular study resulted from chance? a. Extensive testing and retesting b. Conducting nonrandomized trials c. Identifying participants d. Making comparisons ANSWER: a

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Chapter 02: Principles of Epidemiology 70. What is the purpose of obtaining information from large population surveys? a. To identify those who did not participate in the survey b. To study the mechanism of disease c. To determine the cost of a large survey d. To develop specific programs and services for groups whose nutrition status may be compromised ANSWER: d 71. Identify a modifiable risk factor. a. Age b. Physical activity c. Genetics d. Gender ANSWER: b 72. Which term refers to the number of existing cases of a disease in a given population? a. Risk b. Case c. Prevalence d. Determinants ANSWER: c 73. Which term refers to the number of new cases of a disease during a specific time period in a defined population? a. Incidence b. Rate c. Prevalence d. Case ANSWER: a 74. Which term refers to a well-defined group of people who are studied over a period of time? a. Cases b. Cohort c. Determinants d. Case-control participants ANSWER: b

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Chapter 02: Principles of Epidemiology 75. Which of the following types of studies involves intervention by the researcher? a. Case–control study b. Meta-analysis c. Systemic review d. Non-randomized controlled trial ANSWER: d 76. Which term describes a “hidden” characteristic that is distributed differently in the study and control groups that may cause an association that the researchers attribute to something else? a. Risk b. Confounding factor c. Vital statistics d. Selection bias ANSWER: b 77. Which term describes a national account of annual food production, changes in stocks, imports/exports, and food distribution? a. Vital statistics b. Household food consumption c. Determinants d. Food balance sheet ANSWER: d 78. Following data collection, the head researcher realizes that the people who collected the data recorded weight in different ways. One person allowed participants to keep their shoes on, while the other person did not. What kind of bias is this an example of? a. Measurement b. Confounding c. Selection d. Chance ANSWER: a 79. Which term refers to figures that pertain to certain life events? a. Determinants of health b. Risk factors c. Vital statistics d. Surveys ANSWER: c

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Chapter 02: Principles of Epidemiology 80. What is the final step of the epidemiologic method? a. Testing the hypothesis b. Drawing scientific inferences c. Conducting experimental studies d. Intervening and evaluating ANSWER: d 81. What are the causes and factors that affect the risk of disease? a. Selection bias b. Confounding factor c. Risk factors d. Determinants ANSWER: d Subjective Short Answer 82. List different controllable and non-controllable risk factors of heart disease.

ANSWER: Controllable risk factors include high LDL cholesterol, low HDL cholesterol, high blood pressure, cigarette smoking, diabetes, physical inactivity, obesity, an atherogenic diet, and stress. Non-controllable risk factors include age, gender, and genetics.

83. List the steps of the epidemiologic method in order.

ANSWER: Observation; counting cases or events; relating cases or events to the population at risk; making comparisons; developing the hypothesis; testing the hypothesis; drawing scientific inferences; conducting experimental studies; intervening and evaluating.

84. Define confounding factors. List possible confounding factors in an epidemiological study.

ANSWER: Confounding factors are “hidden” factors or characteristics that are distributed differently in the study and control groups and may cause an association that the researchers attribute to other factors. Possible confounding factors include: age, gender, race, ethnicity, and dietary or lifestyle factors.

85. Can data derived from an ecological study accurately yield a final conclusion that consumption (or lack thereof) of a specific nutrient can lead to developing a given disease? Why or why not?

ANSWER: No, the data from an ecological study cannot draw these conclusions as the dietary data obtained are based on population food disappearance data and are therefore not particularly specific.

86. What is the main difference between a retrospective and prospective cohort study?

ANSWER: A retrospective cohort study examines previous data in an effort to look back in time to reconstruct exposures and health outcomes, whereas prospective cohort studies follow a group into the future.

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Chapter 02: Principles of Epidemiology 87. Define the term relative risk and explain what a relative risk of greater than 1.0 means.

ANSWER: The relative risk is a comparison of the risk of some health-related event, such as disease or death, in two groups. If the relative risk is greater than 1.0, the exposed group is at greater risk of the healthrelated event than the unexposed group.

88. Make an observation on the diet–cancer relationship as it is understood today.

ANSWER: Answers will vary, but could include the following: Those who consume a low-fiber, low-antioxidant, low-fruit, and low-vegetable diet have an increased risk of developing cancer.

89. Develop a hypothesis to be tested that is relevant to the diet–cancer relationship.

ANSWER: Answers will vary; however, in an experimental trial, the investigator will need to identify a cause-effect comparison.

90. Would a cohort study be appropriate to investigate your hypothesis? Why or why not?

ANSWER: Answers will vary; however, in most situations a cohort study could be appropriate because it allows comparisons of groups.

91. What role might the community nutritionist play in an epidemiological study?

ANSWER: Answers will vary, but could include the following: Identifying nutritional problems within the community Interpreting the scientific literature for the public and other health professionals Critically evaluating the scientific literature before formulating new nutrition policies or offering advice about eating patterns Essay 92. Define epidemiology and its relationship to community nutrition.

ANSWER: Epidemiology is the study of the distribution and determinants of health-related states and events in specified populations and the applications of this study to the control of health problems. The epidemiologist works to identify the causes of disease and to propose strategies for controlling or preventing health and nutrition problems.

93. Describe two examples of how the results of epidemiological studies have impacted Americans’ nutritional status.

ANSWER:

The relationship between adequate folic acid consumption and the lowered risk of neural tube defects led to the national policy of all grain products being fortified with folic acid.

The relationship between diets low in fruits and vegetables and an increased risk of certain types of cancer led to an approved health claim on food labels.

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Chapter 02: Principles of Epidemiology 94. Describe major vital statistics used by epidemiologists to monitor a population’s health status.

ANSWER: Crude birth rate is the ratio of the number of live births during the year as compared to the average mid-year population multiplied by 1000.

Crude death rate is the number of deaths during the year as compared to the average midyear population multiplied by 1000.

Age-specific death rate is the ratio of the number of deaths to people in a particular age group as compared to the average midyear population in a specified age group multiplied by 1000.

Cause-specific death rate is the ratio of the number of deaths due to a particular cause during the year as compared to the average midyear population multiplied by 1000.

Infant mortality rate is the number of deaths of infants under the age of 1 as compared to the number of live births in the same year multiplied by 1000.

Neonatal mortality rate is the number of deaths of infants under the age of 28 days during the year as compared to the number of live births in the same year multiplied by 1000.

Fetal death rate is the number of fetal deaths (>20 weeks of gestation) during the year as compared to the number of live births and fetal deaths in the same year multiplied by 1000.

Maternal mortality rate is the number of pregnancy-related deaths during the year as compared to the number of live births in the same year multiplied by 100,000.

95. Explain prevalence rates and how they differ from incidence rates.

ANSWER: The prevalence rate is the fraction or proportion of a group possessing a disease or condition at a specific time, whereas the incidence rate is the fraction or proportion of a group initially free of a disease or condition that develops the disease or condition over a period of time. By calculating and comparing rates, epidemiologists can determine the strength of the association between risk factors and the health problem being studied.

96. Discuss two reasons why a study’s results may not be valid.

ANSWER: Two possible explanations for incorrect or invalid results include: The results are biased due to a systematic error in measuring one or more outcome variables or systematic differences in the populations studied.

The results are due to chance and do not represent the true state of affairs; that is, the observations made arose from random variations within the sample.

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Chapter 02: Principles of Epidemiology 97. Compare and contrast the major strengths and limitations of cohort studies and case–control studies.

ANSWER: A comparison of the major strengths and limitations is presented in Table 2-5 in the text. Essentially, a cohort study may provide complete data on the cases and stages of a disease in which calculations and comparisons can be made between those who were exposed and not exposed. These studies tend to be expensive and take many years to complete, thus increasing the amount of non-response data and limiting the control of confounding variables. Case-control studies are relatively quick and inexpensive studies that are an excellent way to study rare diseases and diseases with long latency periods.

Oftentimes, existing records can be utilized on a relatively few study subjects. Limitations of this type of study include that the mechanism of the disease is not studied, with validation of data difficult to achieve.

98. Explain how our diets’ complexity creates challenges in studying the relationship of diet to disease.

ANSWER: The following aspects of diets make studying the relationship between diet and disease highly challenging: The complexity and diversity of chemicals found in the foods and supplements we consume The need for long-term dietary intake to be examined The variety of foods consumed throughout the year The variety of foods consumed day-to-day (within-person variation) 99. Explain why the day-to-day variation in an individual’s nutrient intake can have important implications for nutritional epidemiologic studies.

ANSWER: If only one day’s intake is determined, then the true long-term nutrient intake may be misrepresented, leading to a false assessment of nutritional status.

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Chapter 02: Principles of Epidemiology 100. Differentiate among the methods of collecting food consumption data at the national, household, and individual levels.

ANSWER:

The primary method of assessing the available food supply at the national level is based on food balance sheets. Food balance sheets measure the food available for consumption from imports and domestic food production, less the food “lost” through exports, waste, or spoilage, on a per capita basis. It is not a measure of actual food consumption but availability.

Methods of assessing household food consumption consider the household’s per capita food consumption, taking into account the age and sex of persons in the household (or institution), the number of meals eaten at home or away from home, income, shopping practices, and other factors.

Four different methods used to assess food consumption at the individual level include diet history, 24-hour dietary recall, food record or diary, and food frequency questionnaire.

Dietary recalls are appropriate for assessing groups of people’s intakes, but a single 24hour recall may not give an adequate picture of a specific individual’s usual intake.

Food records are often considered the best method of assessing dietary intake. Still, they are time-consuming, and the results may not be accurate if subjects modify their eating habits during the study.

Diet histories can provide detailed information, but they require subjects to judge their usual food habits.

Food frequency questionnaires provide less detailed information but are well-suited for large groups.

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Chapter 03: A National Nutrition Agenda for the Public’s Health 1. The determination of the adverse effects of excessive amounts of nutrients is a form of nutrition monitoring. a. True b. False ANSWER: False 2. A systematic method of data collection to prevent disease spread in the U.S. has only been in place for the past 50 years. a. True b. False ANSWER: False 3. The NNMRRP includes more than 50 surveillance activities that monitor and evaluate Americans’ health and nutritional status. a. True b. False ANSWER: True 4. There are three parts to the NHANES survey. a. True b. False ANSWER: False 5. In 2000, the decision was made to merge NHANES and CSFII into a single, more cost-effective survey. a. True b. False ANSWER: True 6. The NHANES results have been used to diagnosis the root cause of hypertension in today’s society. a. True b. False ANSWER: False 7. Food disappearance data represents the food that “disappears” into the marketplace and is available for human consumption. a. True b. False ANSWER: True

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Chapter 03: A National Nutrition Agenda for the Public’s Health 8. The Institute of Medicine (IOM) acts as an adviser to the federal government on medical care, research, and education issues. a. True b. False ANSWER: True 9. The Food and Nutrition Board is responsible for evaluating emerging knowledge of nutrient requirements and

(with Health Canada) establishing the DRIs. a. True b. False ANSWER: True 10. The focus of the nutrition and weight status objectives for Healthy People 2030 was expanded to include a

broader range of policies and environmental factors that support eating a healthful diet and maintaining a healthy body weight. a. True b. False ANSWER: True 11. Nongovernmental, nonprofit health organizations issue dietary recommendations. a. True b. False ANSWER: True 12. Food group plans promoted in the first half of the 20th century focused on limiting certain nutrients such as fat and

sodium. a. True b. False ANSWER: False 13. Even with the abundance of research that has been conducted, there is still a considerable gap between current nutrition recommendations and consumers’ practices. a. True b. False ANSWER: True 14. The high-risk behaviors of youths are assessed in YRBS. a. True b. False ANSWER: True Page 2

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Chapter 03: A National Nutrition Agenda for the Public’s Health 15. Policymakers use BRFSS data to monitor progress toward Healthy People 2030 objectives. a. True b. False ANSWER: True 16. What is an approach to improving the public’s knowledge about healthful eating? a. Disseminate dietary guidelines and food group plans b. Monitor eating habits c. Create surveys d. Perform a cross-sectional research study ANSWER: a 17. Which of the following is one of the five components of the National Nutrition Monitoring and Related Research Program (NNMRRP)? a. Nutrition and weight status objectives b. Analysis of state-to-state differences in key health issues c. The Acceptable Macronutrient Distribution Range d. Knowledge, attitudes, and behavior assessments ANSWER: d 18. What is one difference between the recommendations of FAO/WHO and the Dietary Reference Intakes (DRIs)? a. The DRIs include risk assessment. b. The DRIs are considered sufficient for the maintenance of health for all people. c. The FAO/WHO recommendations take into consideration people worldwide. d. The FAO/WHO recommendations focus on prevention of chronic disease.

ANSWER: c 19. How is the BRFSS conducted? a. In person during a routine physical exam b. Computer questionnaire c. Telephone interview d. Paper questionnaire ANSWER: c 20. What does the Healthy Eating Index (HEI) tool measure? a. Fruit and vegetable consumption b. Overall diet quality c. Specific nutrient deficiencies d. Adherence to MyPlate ANSWER: b Page 3

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Chapter 03: A National Nutrition Agenda for the Public’s Health 21. What target population was considered eligible in the Hispanic Health and Nutrition Examination Survey? a. Specific populations of Hispanic Americans aged six months to 74 years b. Mexican Americans in New York and New Jersey c. Puerto Ricans in California and Arizona d. Specific populations of Hispanic Americans with a malnutrition diagnosis ANSWER: a 22. Data from which survey are used to change dietary and mineral fortification regulations of foods? a. Pediatric Nutrition Surveillance System b. Pregnancy Nutrition Surveillance System c. National Health and Nutrition Examination Survey d. School Nutrition Dietary Assessment ANSWER: c 23. The NNMRRP aims to monitor which high-risk group’s nutrition and health status? a. Overweight Americans b. Malnourished children c. Pregnant women d. White males over 40 ANSWER: c 24. Which of the following provides essential raw data to inform national nutrition policymaking decisions? a. Dietary Guidelines for Americans b. NHANES c. Healthy People 2030 d. Dietary Reference Intakes ANSWER: b 25. Which of the following is an example of a policy decision undertaken by a community nutritionist? a. Consuming the recommended amount of fruits and vegetables b. Becoming certified by the Commission on Dietetic Registration c. Including the Dietary Reference Intakes (DRIs) in educational materials d. Surveying community members for nutrient deficits ANSWER: c

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Chapter 03: A National Nutrition Agenda for the Public’s Health 26. The United States utilizes a

approach with no single Federal Nutrition Office coordinating its nutrition policy

efforts. a. unified b. focused c. decentralized d. food assistance ANSWER: c 27. The National Nutrition Monitoring and Related Research Program is operated by the a. USDA

.

b. DHHS c. Centers for Disease Control and Prevention d. USDA and DHHS ANSWER: d 28. The nation’s first comprehensive nutrition survey was the a. Ten-State Nutrition Survey

.

b. CSFII c. NHANES I d. Total Diet Study ANSWER: a 29. A set of nationwide guidelines that specify how the nutritional needs of the population will be met is a. food disappearance data

.

b. a national nutrition policy c. a nutrition screening d. nutrition assessment ANSWER: b 30. Which survey uses clinical, anthropometric, biochemical, and dietary data to assess Americans’ nutrition status? a. American Epidemiological Survey b. Ten-State Nutrition Survey c. National Health and Nutrition Examination Surveys d. Nationwide Food Consumption Surveys ANSWER: c

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Chapter 03: A National Nutrition Agenda for the Public’s Health 31. What is the difference between NHANES I and NHANES II? a. NHANES II was only conducted for one year. b. Three-day food records were used in NHANES II. c. Food frequency questionnaires were used only in NHANES I. d. NHANES II included persons aged six months to 74 years.

ANSWER: d 32. The first National Health and Nutrition Examination Survey (NHANES I) was conducted in a. 1961-1965

.

b. 1971-1974 c. 1975-1979 d. 1981-1983 ANSWER: b 33. The NHANES series . a. uses a non-representative sample of the civilian population b. uses a sample that has not had a good response rate c. influenced the development of the CDC Growth Charts in 2000 d. is poorly designed and is in need of revision ANSWER: c 34. The sample studied in the HHANES included a. all Mexican Americans living in the U.S.

.

b. all Mexican Americans, Puerto Ricans, and Cubans living in the U.S. c. a sample of Mexican Americans, Puerto Ricans, and Cubans living in select areas of the U.S. d. all Mexican Americans and Puerto Ricans living in the U.S. ANSWER: c 35. NHANES III testing between the ages of 1 and 19 years includes

.

a. bone density tests b. fitness testing c. a physician’s exam d. tests for protein in urine ANSWER: c

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Chapter 03: A National Nutrition Agenda for the Public’s Health 36. The

has the responsibility for processing the dietary data derived from the food recalls within the What We Eat in America survey. a. National Center for Health Statistics b. Agricultural Research Service c. National Institutes of Health d. Centers for Disease Control and Prevention ANSWER: b

37. The is the dietary interview component of the current NHANES program. a. Diet and Health Knowledge Survey b. Total Diet Survey c. What We Eat in America Survey d. Youth Risk Behavior Survey ANSWER: c 38. Which statement about the Total Diet Study is accurate? a. The survey is conducted quarterly by the Food and Drug Administration. b. The study assesses various nutritional components of the U.S. food supply. c. The Selected Minerals in Food Survey is a component testing 23 essential minerals. d. The TDS focuses on food consumption by children and adolescents.

ANSWER: b 39. Which activity is designed to gather data about food available for consumption in the U.S.? a. Behavioral Risk Factor Surveillance System b. Diet and Health Knowledge Survey c. Weight Loss Practices Survey d. Food Supply Series surveys ANSWER: d 40. The primary purpose of the National Nutrition Monitoring and Related Research Program is to

.

a. provide health care to the community b. obtain information needed to ensure the population’s adequate nutrition c. establish Dietary Reference Intakes d. educate the public about nutrition issues that can affect health and development ANSWER: b

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Chapter 03: A National Nutrition Agenda for the Public’s Health 41. Food disappearance data has been available since a. 1959

.

b. 1944 c. 1939 d. 1909 ANSWER: d 42. Data collected for monitoring and surveillance purposes are used for a. planning the next year’s farm crops

.

b. optimizingmarketing strategies c. eliminating food assistance programs that are no longer needed d. identifying groups at high risk of nutrition-related problems ANSWER: d 43. Acceptable uses of the Dietary Reference Intakes include a. establishment of standards for food assistance programs

.

b. marketing products as “organic” c. making health claims about a supplement d. assessment of an individual’s overall health status ANSWER: a 44. Who develops the reference values for the Dietary Reference Intake? a. World Health Organization b. Food and Nutrition Board of the National Academy of Sciences c. U.S. Department of Health and Human Services d. U.S. Department of Agriculture ANSWER: b 45. The BRFSS includes questions about

.

a. seat belt use b. multivitaminuse c. protein consumption d. switching to a vegetarian diet ANSWER: a

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Chapter 03: A National Nutrition Agenda for the Public’s Health 46. How did the focus of the nutrition and weight status objectives change for Healthy People 2030? a. They broadened to include specific guidelines on sampling policies for research. b. They were determined to have largely been met and were relaxed. c. They narrowed to focus primarily on increased consumption of vitamins. d. They expanded to include a broader range of policies to support a healthful diet.

ANSWER: d 47. What is defined as a system that identifies specific individuals for nutrition or public health interventions? a. nutrition screening b. nutrition assessment c. nutritionmonitoring d. nutrition surveillance ANSWER: a 48. The Dietary Guidelines for Americans are revised every a. 3

years.

b. 5 c. 7 d. 10 ANSWER: b 49. The Dietary Guidelines for Americans were guided by the reality that about

of U.S. adults are obese or

overweight. a. one-third b. half c. three-quarters d. two-thirds ANSWER: d 50. Which statement about the Dietary Guidelines for Americans is most accurate? a. Theyemphasizeuniformity. b. They include general guidelines for physical activity. c. They emphasize calorie restriction. d. They dictate specific foods for each meal.

ANSWER: b

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Chapter 03: A National Nutrition Agenda for the Public’s Health 51. Which of the following is an example of putting the Dietary Guidelines for Americans into action? a. Eat more fatty meats weekly. b. Eat fewer whole grains daily. c. Take a supplement to obtain vitamins and minerals. d. Eat more low-fat dairy products.

ANSWER: d 52. Based on current research, how would you rate the effectiveness of the dietary guidance information to the

population? a. It has been ineffective and has resulted in poor dietary habits among consumers by failing to address the need to limit dietary fat and sodium. b. It has been so effective that it has prevented trends such as eating away from home or increased portion sizes from affecting consumers’ nutritional status. c. There is still much room for improvement because a considerable gap remains between current nutrition recommendations and consumers’ practices. d. There is little room for improvement because people continue to make food choices based solely on taste and ignore health concerns.

ANSWER: c 53. The current U.S. food guidance system is called a. the Basic Four Food Groups

.

b. the Food Guide Pyramid c. My Pyramid d. My Plate ANSWER: d 54. In order for the Dietary Guidelines for Americans to be implemented, they must be

.

a. promoted and glamorized by the media b. translated into food-specific behaviors for consumers c. compared with the Dietary Reference Intakes d. reduced in number so they are easier to remember ANSWER: b

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Chapter 03: A National Nutrition Agenda for the Public’s Health 55. One of the key recommendations from the Dietary Guidelines is: “Reduce daily sodium intake to less than 2,300

mg per day.” This could be translated into which food-specific behavior? a. Be able to read food product labels. b. Choose processed foods for convenience. c. Add salt early in cooking so it cooks away. d. Use canned foods whenever possible.

ANSWER: a 56. Based on the uses of data from the NNMRRP surveys, which is used to provide detailed benchmark data on the population’s food and nutrient intakes? a. assessment of dietary intake b. food programs and guidance c. historical trends d. monitoring and surveillance ANSWER: a 57. Recommending guidelines for preventing, detecting, and managing nutrition and health conditions falls under which category of use of NNMRRP data? a. monitoring and surveillance b. scientific research c. historical trends d. food programs and guidance ANSWER: a 58. Which of the following is an example of using NNMRRP data for regulatory purposes? a. Monitoring the nutritional quality of diets b. Developing food label policies c. Conducting food composition analysis d. Following food consumption through the life cycle ANSWER: b 59. Identifying populations that might benefit from dietary intervention programs is an example of which use of NNMRRP data? a. Regulatory purposes b. Historical trends c. Scientific research d. Food programs and guidance ANSWER: d

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Chapter 03: A National Nutrition Agenda for the Public’s Health 60. A graduate student of dietetics decides to use data from the NNMRRP to conduct a food composition analysis. This is an example of using NNMRRP data for which purpose? a. assessment of dietary intake b. food programs and guidance c. scientific research d. monitoring and surveillance ANSWER: c 61. Using NNMRRP data to correlate food consumption and dietary status with disease incidence over time is an example of which type of usage? a. monitoring and surveillance b. scientific research c. tracking historical trends d. assessment of dietary intake ANSWER: c 62. Which of the following methods measures indicators for dietary status in order to identify impaired nutritional status? a. nutrition assessment b. nutrition monitoring c. nutrition screening d. nutrition surveillance ANSWER: a 63. Which term describes a measurement of dietary or nutritional status at intermittent times to detect changes in a population’s status? a. nutrition assessment b. nutrition monitoring c. nutrition screening d. nutrition surveillance ANSWER: b 64. Which method is a continuous measurement of nutritional status for the purpose of detecting changes in trends or distributions so that corrective measures can be taken? a. nutrition assessment b. nutrition monitoring c. nutrition screening d. nutrition surveillance ANSWER: d

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Chapter 03: A National Nutrition Agenda for the Public’s Health 65. Which method is a system that identifies specific individuals for nutrition or public health intervention, often at the community level? a. nutrition assessment b. nutrition monitoring c. nutrition screening d. nutrition surveillance ANSWER: c 66. A community nutritionist uses NNMRRP data to identify attitudinal factors associated with diets. This is an example of using NNMRRP data for which purpose? a. scientific research b. tracking historical trends c. assessment of dietary intake d. monitoring and surveillance ANSWER: c 67. Developing dietary educational materials falls under which use of NNMRRP data? a. assessment of dietary intake b. monitoring and surveillance c. regulatory purposes d. food programs and guidance ANSWER: d 68. Which of the following uses of NNMRRP data would fall under scientific research purposes? a. establishing nutrient requirements such as DRI b. monitoring the nutritional quality of diets c. establishing food safety guidelines d. following food consumption through the life cycle ANSWER: a 69. Which of the following is an example of using NNMRRP data to assess dietary intake? a. Assessing progress toward achieving nutrition and health objectives b. Determining the nature of populations at risk of having diets low or high in certain nutrients c. Establishing nutrient requirements d. Conducting food composition analysis ANSWER: b

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Chapter 03: A National Nutrition Agenda for the Public’s Health 70. Developing food labeling policies falls under which use of data from the NNMRRP? a. food programs and guidance b. historical trends c. regulatory purposes d. scientific research ANSWER: c 71. Which of the following is an example of using NNMRRP data for monitoring and surveillance purposes? a. Developing nutrient requirements b. Assessing progress towards achieving the objectives in Healthy People 2030 c. Creating food guides that target nutritional problems d. Providing food safety guidelines ANSWER: b 72. Which policy tool would a director of health promotion use to write a segment of a program that includes information about healthy dietary fats? a. Dietary Guidelines for Americans b. Labeling regulations c. Credentialing requirements d. Dietary Reference Intakes (DRIs) ANSWER: d 73. Which policy tool would help a director of health promotion develop a program that includes a discussion of healthful eating patterns? a. Dietary Guidelines for Americans b. Labeling regulations c. Credentialing requirements d. Dietary Reference Intakes (DRIs) ANSWER: a 74. Which agency is responsible for the credentialing requirements of a registered dietitian (RD)? a. Food and Drug Administration b. Food and Nutrition Board c. Commission on Dietetic Registration d. U.S. Department of Agriculture ANSWER: c

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Chapter 03: A National Nutrition Agenda for the Public’s Health 75. Which policy tool would help a director of health promotion develop a program that includes a segment on reading food product information? a. Dietary Guidelines for Americans b. Labeling regulations c. Credentialing requirements d. Dietary Reference Intakes (DRIs) ANSWER: b 76. Which agency is responsible for the Food Label and Package Survey? a. Food and Nutrition Service b. NCI c. U.S. Bureau of Labor and Statistics d. FDA ANSWER: d 77. Which agency is responsible for the School Nutrition Dietary Assessment? a. Food and Nutrition Service b. NCI c. U.S. Bureau of Labor and Statistics d. FDA ANSWER: a 78. Which agency is responsible for the Health and Diet Survey? a. Food and Nutrition Service b. NCI c. U.S. Bureau of Labor and Statistics d. FDA ANSWER: c 79. Which agency is responsible for the Consumer Expenditure Survey? a. Food and Nutrition Service b. NCI c. U.S. Bureau of Labor and Statistics d. FDA ANSWER: c

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Chapter 03: A National Nutrition Agenda for the Public’s Health 80. Which agency is responsible for the 5 a Day for Better Health Baseline Survey? a. Food and Nutrition Service b. NCI c. U.S. Bureau of Labor and Statistics d. FDA ANSWER: b 81. Does the United States have a national nutrition policy? Justify your answer.

ANSWER: The answer is both yes and no. It is no in the sense that no one federal body or agency has as its sole

mandate to establish, implement, and evaluate national nutrition policy. However, the U.S. has food assistance programs, national nutrition and health objectives as found in the Healthy People 2030 initiative, regulations to safeguard the food supply, and the proper handling of food products, dietary guidance systems, monitoring and surveillance programs, and food labeling legislation.

82. Discuss the history of food and nutrition consumption surveys in the United States.

ANSWER: The U.S. government has been involved in tracking specific food supply and food consumption elements for the last century, beginning with the USDA’s Food Supply Series undertaken in 1909. In the 1930s, the first USDA Household Food Consumption Survey was conducted. In 1965, this survey became known as the Nationwide Food Consumption Survey. The Ten-State Nutrition Survey was conducted between 1968 and 1970. In the 1970s other surveys, such as the NHANES I and Pediatric Nutrition Surveillance System, were administered. In the 1980s and 1990s, NHANES II, NHANES III, and the HHANES studies were conducted. In 1990, legislation was passed that established the NNMRRP, which includes more than 50 surveillance activities that monitor and evaluate the health and nutritional issues of the U.S. population. Currently, the What We Eat in America Survey and the Total Diet Study are utilized.

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Chapter 03: A National Nutrition Agenda for the Public’s Health 83. Explain the goals and purpose of the National Nutrition Monitoring and Related Research Program (NNMRRP).

ANSWER: The NNMRRP takes a multidisciplinary approach to monitoring Americans'’ nutritional and health status in general and of high-risk groups, such as low-income families, pregnant women, and minorities.

The USDA and DHHS work together to implement and coordinate the activities. The NNMRRP includes all data collection and analysis activities of the federal government related to (1) measuring the health and nutritional status, food consumption, dietary knowledge, and attitudes about diet and health of the U.S. population; and (2) measuring food consumption and the quality of the food supply.

The goals of the NNMRRP include the following: a. Provide the scientific foundation for the maintenance and improvement of the nutritional status of the U.S. population and the nutritional quality and healthfulness of the national food supply. b. Collect, analyze, and disseminate timely data on the nutritional and dietary status of the U.S. population, the nutritional quality of the food supply, food consumption patterns, and consumer knowledge and attitudes concerning nutrition. c. Identify high-risk groups and geographical areas, as well as nutrition-related problems and trends, to facilitate prompt implementation of nutrition intervention activities. d. Establish national baseline data and develop and improve uniform standards, methods, criteria, policies, and procedures for nutrition monitoring. e. Provide data for evaluating the implications of changes in agricultural policy related to food

production, processing, and distribution that may affect the nutritional quality and healthfulness of the U.S. food supply.

84. What are the five areas of the NNMRRP surveys? Provide an example of their interrelatedness.

ANSWER: The NNMRRP surveys are grouped into five areas: nutritional status and nutrition-related health

measurements; food and nutrient consumption; knowledge, attitudes, and behavior assessment; food composition and nutrient databases; and food supply determinations. Two examples illustrating their interrelatedness include: (1) An individual’s health and nutritional status is influenced by his or her food intake, which includes the food prepared and eaten at home and away from the home. (2) Food intake is influenced by an individual’s knowledge about the relationship between diet and health, use of supplements, nutrient requirements, and attitudes about food and dietary and health practices.

85. Describe how the Dietary Reference Intakes (DRIs) differ from the Recommended Dietary Allowances (RDA).

ANSWER: The RDA is just one of the DRIs. The RDA is the average daily amount of a nutrient that is sufficient

to meet the nutrient needs of 97%-98% of healthy individuals of a specific age and gender. The DRIs are a set of reference values for energy and nutrients that can be used for planning and assessing diets for healthy people. The DRIs include the Estimated Average Requirements, the Recommended Dietary Allowances, the Adequate Intakes, and the Tolerable Upper Intake Levels.

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Chapter 03: A National Nutrition Agenda for the Public’s Health 86. Explain how the dietary recommendations of the Food and Agriculture Organization/World Health Organization

(FAO/WHO) differ from the Dietary Reference Intakes.

ANSWER: The FAO and WHO recommendations are considered sufficient for the maintenance of health in

nearly all people. They differ from the DRIs because they are based on slightly different judgment factors and serve different purposes. The FAO/WHO recommendations take into consideration people worldwide; however, for the most part, the various recommendations fall within the same general range.

87. What do nutrition survey results suggest about Americans’ nutritional status?

ANSWER: Overall, survey results suggest that we are well-nourished but are generally overweight, underexercised, and beset to some extent with nutrient deficiencies. We do not consume enough fruits, vegetables, and dairy. We tend to be somewhat knowledgeable about nutrition, but our behaviors do not illustrate that.

88. Provide at least five suggestions for implementing the Dietary Guidelines into one’s lifestyle.

ANSWER: Answers will vary and are numerous. Some suggestions include the following: Eat a variety of foods each day.

Eat foods higher in fiber, such as fresh fruits and vegetables, legumes, and whole-grain products.

Eat foods low in fat, saturated fats, trans fat, and cholesterol.

Grill, bake, or broil seafood in place of meat.

Consume the equivalent of 3 cups of milk daily.

89. Choose one of the Dietary Guidelines for Americans and translate the guideline into food-specific advice that

consumers can implement in their homes, at the grocery store, or in restaurants.

ANSWER: Answers will vary. Table 7-8 translates the Dietary Guideline that recommends reducing sodium

intake to <2,300 mg.

90. Describe appropriate uses of current dietary guidance systems.

ANSWER: There are many appropriate uses, with a sampling below: Menu planning in institutional settings, such as schools, hospitals, and long-term care facilities Evaluation of eating habits, such as in the NNMRRP programs

Development of nutrition policy and nutrition education efforts

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Chapter 03: A National Nutrition Agenda for the Public’s Health 91. Differentiate among nutrition screening, nutrition assessment, nutrition monitoring, and nutrition

surveillance.

ANSWER: Essentially the differences are in the timing of data collection, the extent and nature of the data collected, and the purpose or use of the data. Nutrition screening is a system that identifies specific individuals for nutrition or public health intervention, often at the community level. Nutrition assessment is the measurement of indicators of dietary status and nutrition-related health status to identify the possible occurrence, nature, and extent of impaired nutritional status (ranging from deficiency to toxicity). Nutrition monitoring is the assessment of dietary or nutritional status at intermittent times with the aim of detecting changes in dietary or nutritional status. Nutrition

surveillance is the continuous assessment of nutritional status for the purpose of detecting changes in trends or distributions so that corrective measures can be taken.

92. Define public health surveillance and discuss its purpose.

ANSWER: Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of data

essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control. Its purpose is to monitor the health and nutritional status of a population as a means of deciding how to allocate scarce resources, enhance the quality of life, and improve productivity.

93. Briefly discuss the relationship of nutrition research and nutrition monitoring to U.S. national nutrition policy.

ANSWER: The data collected from the nutrition research and nutrition monitoring programs help to formulate the

U.S. national nutrition policy. Additionally, the research and monitoring programs are a part of the national nutrition policy.

94. List the five key components of the National Nutrition Monitoring and Related Research Program.

ANSWER: The five key components are: 1) food supply determinations; 2) food and nutrient consumption; 3)

nutritional status and nutrition-related health measurements; 4) knowledge, attitudes, and behavior assessments; and 5) food composition and nutrient databases.

95. What is the Healthy Eating Index?

ANSWER: The Health Eating Index was developed by jointly by the USDA and the National Cancer Institute to

assess and score various components of the diet to give an indication of overall diet quality by measuring the degree to which a person’s diet conforms to federal dietary guidelines.

96. Imagine you are giving a presentation to students about official U.S. guidelines for a healthy diet. Develop an outline of what information you would present.

ANSWER: Answers will vary, but could include the following topics: • My Plate • Dietary Guidelines for Americans • DRIs

•

Healthy Eating Index

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Chapter 03: A National Nutrition Agenda for the Public’s Health 97. How might you involve the students in your presentation about official U.S. dietary guidelines?

ANSWER: Answers will vary, but could include: • Question/answer time • Asking open-ended questions during the presentation • Written activities or other hands-on activities

•

Incorporation of a game

98. What are some recommendations that you could include in your presentation about official U.S. dietary guidelines

that could assist the students in better following the dietary guidance system you presented?

ANSWER: Answers will vary, but could include providing tips on healthy snacking; the importance of eating a

variety of fruits, vegetables, and dairy products every day; and the importance of eating breakfast.

The student should make an effort to translate the information into behaviors that this particular audience could successfully practice.

99. What type of visual aids might you use in a presentation about official U.S. dietary guidelines?

ANSWER: Answers will vary, but may include visuals from the My Plate website (colored food plate), specific

servings of different foods, or examples of each food category.

100. Explain how the Dietary Reference Intakes (DRIs) can assess and plan diets.

ANSWER: The DRIs represent nutrient goals to be achieved over time. They set standards for food assistance programs and licensing group facilities such as daycare centers and nursing homes, design nutrition education programs, and develop new food products. The DRIs represent a major shift in thinking about nutrient requirements for humans—a shift from prevention of nutrient deficiencies to chronic disease prevention.

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Chapter 04: Understanding and Achieving Behavior Change True / False 1. An intervention is a health promotion activity aimed at changing the behavior of a target population. a. True b. False ANSWER: True 2. A subjective norm is the perceived social pressure to perform or not perform a behavior. a. True b. False ANSWER: True 3. Behavior change theories provide evidence-based methods that are not empirically tested. a. True b. False ANSWER: False 4. Motivational interviewing targets changes in attitudes and beliefs. a. True b. False ANSWER: True 5. The incorporation of behavior change theories into program planning is critical to the nutrition care process. a. True b. False ANSWER: True 6. The New York City Department of Health and Mental Hygiene’s television ad campaign, “Are You Pouring on the Pounds?” is an example of a social marketing campaign. a. True b. False ANSWER: True 7. Frequently, practitioners incorporate concepts from more than one theory into an intervention design. a. True b. False ANSWER: True

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Chapter 04: Understanding and Achieving Behavior Change 8. The diffusion of innovation model addresses the process by which people adopt new ideas and behaviors. a. True b. False ANSWER: True 9. The transtheoretical model describes an individual's motivation and readiness for change. a. True b. False ANSWER: True 10. The stages of change model assumes that individuals will pass through each stage in a linear fashion. a. True b. False ANSWER: False 11. The stages of change model can only be applied at the individual level and is not appropriate for community-based interventions. a. True b. False ANSWER: False 12. In motivational interviewing, the counselor takes the lead in the counseling session and directs the client by providing information and suggesting "fixes." a. True b. False ANSWER: False 13. The health belief model was developed as a way to explain why people in high-risk groups failed to participate in programs designed to detect or prevent disease. a. True b. False ANSWER: True 14. Self-efficacy is the determination to act in a certain way. a. True b. False ANSWER: False

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Chapter 04: Understanding and Achieving Behavior Change 15. In social cognitive theory, the environment refers exclusively to the physical realm (e.g., the workplace, the layout of the kitchen, etc.). a. True b. False ANSWER: False Multiple Choice 16. Which of the following were developed specifically to explain why and how people alter their routine activities? a. Behavior change theories and models b. Nutrition education programs c. Cognitive-behavioral approaches d. Surveys and focus groups ANSWER: a 17. In nutrition counseling, what is the counselor trying to achieve? a. Educating on nutrition-related knowledge b. Fostering the responsibility for self-care to promote health or treat a health condition c. Increasing the acceptability of a social idea d. Training the individual to voluntarily adopt healthier lifestyle behaviors ANSWER: b 18. What is a key function of self-efficacy? a. To identify readiness to change b. To challenge pattern of thinking c. To increase the probability of making a behavior change d. To express empathy ANSWER: c 19. Cognitive-behavioral theory is based on what assumption? a. The process is goal-oriented. b. All behavior is learned and directly related to internal factors. c. All people are ready to change. d. Behaviors cannot be changed.

ANSWER: b

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Chapter 04: Understanding and Achieving Behavior Change 20. When would cognitive-behavioral theory be appropriate to use? a. When a client is in the precontemplation stage b. When other approaches have failed c. When the client is actively ready to make a change d. When nutrition education has been applied ANSWER: c 21. How many stages are there in the diffusion of innovation model? a. Four b. Two c. Six d. Five ANSWER: a 22. Which descriptor typically applies to innovators? a. Unwilling to consider change b. Cautious c. Financially privileged d. Undereducated ANSWER: c 23. According to the transtheoretical model, at which stage is an individual thinking about making a change by weighing the risks of the change's benefits? a. Preparation b. Contemplation c. Precontemplation d. Maintenance ANSWER: b 24. Identify an intervention strategy for the action stage of change of the transtheoretical model. a. Provide tailored self-help material b. Reinforce small accomplishments c. Build self-awareness d. Acknowledge emotions related to the condition ANSWER: a

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Chapter 04: Understanding and Achieving Behavior Change 25. In motivational interviewing, who would be considered the "lifestyle expert"? a. Nutrition counselor b. Educator c. Client d. Community nutritionist ANSWER: c 26. According to the American Cancer Society's dietary recommendations in 2012, which level of intake is above the recommended level among Americans? a. Canned foods b. Whole grains c. Saturated fat d. Fruits and vegetables ANSWER: c 27. What does the expansion of the health belief model include? a. all preventative and health behaviors b. social influences c. a diverse population d. nutrient deficiencies ANSWER: a 28. What is a key concept of the social-cognitive theory? a. Self-efficacy increases the probability of making a behavior change. b. Learning occurs through taking action and observation of others taking action. c. Motivation is fundamental to change. d. Behavior change is described as a series of changes.

ANSWER: b 29. What was the outcome of the Diabetes Prevention Program (DPP) Research Group? a. Lifestyle intervention was significantly more effective than drug therapy. b. There was a high dropout rate, rendering the results invalid. c. Patients were more likely to comply with medications. d. Researchers were unable to determine outcome due to a small number of participants.

ANSWER: a

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Chapter 04: Understanding and Achieving Behavior Change 30. What is the purpose of the diffusion of innovation model? a. It explains why an individual forms an attitude either in favor of or against an innovation. b. It identifies a client’s willingness to change behavior. c. It explains how a product or idea becomes accepted by a majority of consumers. d. It separates the innovators from the early adaptors.

ANSWER: c 31. Which term describes the formal process to instruct or train individuals in a skill to facilitate voluntary adoption of nutrition-related behaviors to improve or maintain health? a. nutrition education b. nutrition counseling c. social marketing d. motivational counseling ANSWER: a 32. Which behavior change approach characterizes individuals as early adopters or laggards? a. diffusion of innovation model b. health belief model c. social cognitive theory d. cognitive behavioral theory ANSWER: a 33. In which approach are self-defined behavior change goals essential? a. health belief model b. diffusion of innovation model c. theory of trying d. motivational interviewing ANSWER: d 34. Which behavior change theory focuses on the assumption that people and their environment interact continuously, each influencing the other? a. health belief model b. stages of change model c. social cognitive theory d. theory of trying ANSWER: c

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Chapter 04: Understanding and Achieving Behavior Change 35. According to the transtheoretical model, individuals are in the stage when they have incorporated a behavior change into their daily routine and sustained it for six months or longer. a. precontemplation b. preparation c. action d. maintenance ANSWER: d 36. Which model of behavior change was developed by Prochaska and DiClemente? a. health belief model b. transtheoretical model c. diffusion of innovation d. theory of planned behavior ANSWER: b 37. According to the transtheoretical model, when an individual actively decides to change and plans a change that will usually take place within one month, he or she is in the stage. a. precontemplation b. contemplation c. preparation d. action ANSWER: c 38. Which intervention strategy is most appropriate for someone in the precontemplation stage of change? a. encouraging a support network b. coaching on preparation for high-risk situations c. facilitating the development of an action plan d. exploring ambivalence about change ANSWER: d 39. The transtheoretical model is also referred to as the a. diffusion of innovation model b. stages of change model c. theory of reasoned action

.

d. health belief model ANSWER: b

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Chapter 04: Understanding and Achieving Behavior Change 40. Which intervention strategy is most appropriate for an individual with hypertension in the preparation stage? a. attending a health fair to learn more about hypertension b. acknowledging that he has hypertension c. setting small, specific, realistic goals d. actively preparing foods that are lower in salt and sodium ANSWER: c 41. What is the best description of motivational interviewing? a. It is a counselor-focused technique utilized by many health educators. b. It was developed by dietitians to determine why consumers don't eat more healthful diets. c. It is designed to help clients build commitment and reach a decision to change. d. It conceptualizes relapse as a way to grow and mature.

ANSWER: c 42. When a counselor utilizes motivational interviewing, how would promoting self-efficacy benefit the client? a. It helps the counselor to listen with empathy. b. It empowers the client by encouraging hope that change is possible. c. It is used only in the final stages of the intervention strategy. d. It reminds the client that only he or she is responsible.

ANSWER: b 43. Which term describes the belief that one can successfully make a behavior change? a. behavioral capacity b. expectation c. self-efficacy d. a subjective norm ANSWER: c 44. Which statement gives the best example of self-efficacy? a. I can find the calcium content of foods by reading food labels. b. I have never tried that vegetable. c. I don't have time to exercise. d. I'm at risk for developing heart disease.

ANSWER: a

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Chapter 04: Understanding and Achieving Behavior Change 45. The health belief model conceptualizes an individual's a. intention to change

as having two dimensions.

b. perception of threats c. past attempts at trying d. self-actualization needs ANSWER: b 46. Which theory of consumer health behavior was developed by social psychologists as a means of explaining why people in high-risk groups failed to participate in programs designed to detect or prevent disease? a. stages of change model b. social learning theory c. health belief model d. motivational interviewing ANSWER: c 47. Which statement is true about the health belief model? a. It is of limited value for primary prevention activities. b. It is applicable only to a select, limited number of health behaviors. c. It cannot be utilized until a program is in its implementation phase. d. It is only applicable for programs designed for individuals and not communities.

ANSWER: a 48. What is another name for the theory of planned behavior? a. diffusion of innovation model b. health belief model c. social cognitive theory d. theory of reasoned action ANSWER: d 49. Which theory asserts that behaviors are determined by a person's intentions to behave in specific ways, which are, in turn, influenced by past experiences with those behaviors? a. diffusion of innovation b. stages of change c. theory of reasoned action d. theory of trying ANSWER: d

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Chapter 04: Understanding and Achieving Behavior Change 50. Increasing calcium intakes in people aged 2 years and older falls is an objective of which program? a. Get Fit Now b. Healthy People 2030 c. Pathways to Change d. EatFit Intervention Program ANSWER: b 51. In the theory of planned behavior, what is another term for social pressure from others to perform or not to perform a behavior? a. personal intention b. cues to action c. perceived susceptibility d. subjective norms ANSWER: d 52. In the social cognitive theory, what are the responses to a person's behavior that increase or decrease recurrence likelihood? a. expectations b. self-regulations c. reinforcements d. self-efficacy ANSWER: c 53. In social cognitive theory, what is the term for a person's beliefs about the likely outcomes or results of a behavior? a. expectations b. capabilities c. reinforcements d. self-efficacy ANSWER: a 54. Which term refers to the phenomenon that occurs when individuals acquire a new behavior by watching others model it? a. expectations b. observational learning c. reinforcement d. behavioral capacity ANSWER: b

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Chapter 04: Understanding and Achieving Behavior Change 55. According to the social-cognitive theory, what is developed when an individual approaches behavior change in small steps that enhance their self-confidence? a. expectations b. observational learning c. reinforcement d. self-efficacy ANSWER: d 56. For which behavior change theory did Albert Bandura formulate many of the central concepts? a. diffusion of innovation model b. health belief model c. social cognitive theory d. stages of change model ANSWER: c 57. What is the focus of the social cognitive theory? a. target behaviors b. attitudes c. knowledge d. emotions ANSWER: a 58. Which of the following attitudes best aligns with the cognitive-behavioral theory? a. not yet ready to make a change b. almost ready to make a change c. actively ready to make a change d. already changing the targeted behavior ANSWER: c 59. In cognitive-behavioral theory, encouraging an individual to replace negative self-talk is a type of a. goal setting

.

b. problem-solving c. stimulus control d. cognitive restructuring ANSWER: d

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Chapter 04: Understanding and Achieving Behavior Change 60. By examining the relationship between an individual's beliefs, attitudes, intentions, and behavior, the theory of reasoned action explains which level of behavior? a. intrapersonal b. interpersonal c. community d. societal ANSWER: a 61. Which stage of the diffusion of innovation model involves an individual being aware of an innovation and having acquired some information about it? a. knowledge b. persuasion c. decision d. confirmation ANSWER: a 62. Which group of people accept an a new technology readily, usually without input from significant others? a. Early adopters b. Innovators c. Early majority d. Laggards ANSWER: b 63. In which category are "opinion leaders" often found? a. early adopters b. early majority c. laggards d. innovators ANSWER: a 64. The process of testing and assessing certain program elements before it is implemented fully is called evaluation. a. outcome b. input c. formative d. strategic ANSWER: c

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Chapter 04: Understanding and Achieving Behavior Change 65. Incentive programs and specific how-to education are part of which component of the health belief model? a. perceived benefits b. perceived susceptibility c. cues to action d. self-efficacy ANSWER: c 66. In the health belief model, when does a person explore the pros and cons of a behavior change? a. cue to action b. self-efficacy c. perceived severity d. perceived benefits ANSWER: d 67. Understanding factors influencing women's breastfeeding practices by exploring attitudes, subjective norms, and perceived behavioral controls is an application of which behavior change theory? a. theory of planned behavior b. transtheoretical model c. cognitive-behavioral theory d. diffusion of innovation model ANSWER: a 68. Which concept in social-cognitive theory refers to the dynamic interaction between the person, the behavior, and the environment in which the behavior is performed? a. self-regulation b. reciprocal determinism c. behavioral capability d. self-efficacy ANSWER: b 69. Which behavior change theory includes self-efficacy, outcome expectancies, and self-regulation, which were applied in developing, implementing, and evaluating the EatFit intervention program for young teens? a. transtheoretical model b. health belief model c. social-cognitive theory d. theory of planned behavior ANSWER: c

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Chapter 04: Understanding and Achieving Behavior Change 70. What is the best description for intention? a. A determination to act in a certain way b. Positive or negative evaluation of performing a behavior c. Awareness of our environment and the judgements we make d. Belief that one can make a behavior change ANSWER: a 71. Which term refers to the perceived social pressure to perform or not perform a behavior? a. attitude b. subjective norm c. intention d. cognition ANSWER: b 72. Which term refers to the response of an individual to their environment? a. cognition b. behavior c. intention d. modified attitude ANSWER: b 73. In which component of a cognitive-behavioral theory–based behavioral intervention would a client review and identify eating patterns? a. stimulus control b. problem solving c. self-monitoring d. goal setting ANSWER: c 74. What term refers to the positive or negative evaluation of performing a behavior? a. attitude b. subjective norm c. intention d. cognition ANSWER: a

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Chapter 04: Understanding and Achieving Behavior Change 75. Which term describes the belief that one can make a behavior change? a. intention b. self-efficacy c. reinforcement d. reciprocal determinism ANSWER: b 76. Which term refers to a person’s determination to act in a certain way? a. attitude b. self-efficacy c. behavior d. intention ANSWER: d 77. Which behavior change theory focuses on the process by which an idea or behavior spreads throughout a population? a. health belief model b. social cognitive theory c. theory of planned behavior d. diffusion of innovation model ANSWER: d 78. Which behavior change theory proposes that before adopting a new health behavior, an individual considers his vulnerability to the problem, the seriousness of the problem, and the new behavior's effectiveness for reducing the risk or preventing the problem? a. health belief model b. theory of planned behavior c. social cognitive theory d. transtheoretical model ANSWER: a 79. Which behavior change theory focuses on the ways in which people and their environment interact continuously and influence each other? a. transtheoretical model b. health belief model c. social cognitive theory d. theory of planned behavior ANSWER: c

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Chapter 04: Understanding and Achieving Behavior Change 80. Which behavior change theory considers an individual's intention to change behavior as determined by both personal attitudes and subjective norm? a. social cognitive theory b. diffusion of innovation model c. theory of planned behavior d. transtheoretical model ANSWER: c 81. Which behavior change theory describes behavior change as a series of different steps through which people must move? a. health belief model b. theory of planned behavior c. social cognitive theory d. transtheoretical model ANSWER: d 82. Which stage of the diffusion of innovation model involves the individual forming an attitude either in favor of or against the innovation? a. knowledge b. persuasion c. decision d. confirmation ANSWER: b 83. Which stage of the diffusion of innovation model involves the individual performing activities that lead to either adopting or rejecting the innovation? a. decision b. confirmation c. knowledge d. persuasion ANSWER: a 84. Which of the following is true of the knowledge stage of the diffusion of innovation model? a. The individual is aware of the innovation and has acquired some information about it. b. The individual performs activities that lead to either adopting or rejecting the innovation. c. The individual forms an attitude either in favor of or against the innovation. d. The individual looks for reinforcement for his or her decision and possibly changes it if exposed to counterreinforcing messages.

ANSWER: a

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Chapter 04: Understanding and Achieving Behavior Change 85. Which stage of the diffusion of innovation model involves the individual looking for reinforcement for his or her decision and possibly changing it if exposed to counter-reinforcing messages? a. decision b. confirmation c. knowledge d. persuasion ANSWER: b 86. Which stage of the transtheoretical model involves the individual actively deciding to change and planning a change, usually within one month? a. precontemplation b. action c. preparation d. contemplation ANSWER: c 87. Which stage of the transtheoretical model involves the individual sustaining the change for six months or longer, with the changed behavior becoming a part of his or her daily routine? a. maintenance b. action c. contemplation d. preparation ANSWER: a 88. Which stage of the transtheoretical model involves the individual being unaware of or not interested in making a change? a. precontemplation b. preparation c. contemplation d. action ANSWER: a 89. Which stage of the transtheoretical model involves the individual making changes in their environment to support the changed behavior? a. preparation b. action c. contemplation d. maintenance ANSWER: b

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Chapter 04: Understanding and Achieving Behavior Change 90. Which stage of the transtheoretical model involves the individual thinking about making a change and possibly weighing the risks and benefits of changing behavior? a. precontemplation b. maintenance c. preparation d. contemplation ANSWER: d Subjective Short Answer 91. Define motivational interviewing. How is it a useful practice in community nutrition?

ANSWER: Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence to change. It is a useful practice in that it shifts the focus of the counseling from the counselor to the client. It actively facilitates the client's exploration and resolution of his/her uncertainty about change, builds his/her confidence, and enhances commitment to change.

92. Compare and contrast intentions and subjective norms as defined within the theory of planned behavior.

ANSWER: Intentions are the "instructions people give to themselves to behave in certain ways" or the determination to act in a certain way. In forming intentions, people tend to consider the outcome of their behavior and the opinion of significant others before acting (perceived social pressure). The subjective norm is the perceived social pressure to perform or not perform the behavior.

93. What is the concept of reciprocal determinism and in which behavior change theory is it incorporated?

ANSWER: Reciprocal determinism is the dynamic interaction among the person, behavior, and the environment in which the behavior is performed. It implies that a change in one area has implications for the others.

Reciprocal determinism is a key concept of social cognitive theory.

94. What are some of the counseling strategies utilized within the cognitive-behavioral theory?

ANSWER: Some of the strategies utilized within the cognitive-behavioral theory include goal setting, self-monitoring, problem solving, social support, stress management, stimulus control, cognitive restructuring, relapse prevention, rewards, and contingency management.

95. According to the diffusion of innovation model, how does a behavior change unfold in a population? What is a key factor that influences the speed of diffusion of a behavior change?

ANSWER: Innovations spread throughout a population largely by word of mouth. The speed of diffusion is a function, in part, of the number of people who adopt the innovation.

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Chapter 04: Understanding and Achieving Behavior Change Essay 96. Briefly describe the four general principles that guide motivational interviewing.

ANSWER: The four general principles that guide motivational interviewing include:

Resist. Resist the urge to confront the client about the need to change.

Understand. Proceed in a non-judgmental way that evokes and explores the client's own perceptions about his/her current situation and own motivations for change.

Listen. Express empathy; use reflective listening skills by paraphrasing what the client says to determine the meaning of his/her statements.

Empower. Support self-efficacy by exploring how he/she can make a difference in his/her own health using the client's own ideas and resources.

97. Based on the health belief model, discuss three factors that influence an individual's intention to change a health behavior.

ANSWER: Factors that might influence an individual's intention to change include: Perceived susceptibility to contracting a disease, such as heart disease, diabetes, or cancer Perceived severity of the disease state, such as to what degree the disease will impact his/her life, physically, socially, and emotionally Perceived benefits and barriers to adopting a lifestyle that would lessen the impact of the disease Self-efficacy, or the belief that one can make the necessary change to lessen health risk

98. Apply the theory of planned behavior to a pregnant mother deciding on whether or not to breastfeed her newborn infant.

ANSWER: The theory of planned behavior predicts a person's intention to perform a behavior in a well-defined setting. According to this theory, behavior is determined directly by a person's intention to perform the behavior as well as the thoughts of significant others in his/her life. If the pregnant mother views breastfeeding as positive for her and/or her child, the significant others in her life (child's father, grandparents, close friends and family) view breastfeeding positively, and she believes that she can successfully breastfeed her child, then the intention, and the chance that she will breastfeed, are higher.

Conversely, if the pregnant mother and/or her significant others view breastfeeding negatively and/or she doesn't believe that she can breastfeed successfully, then her decision might be to bottle feed her infant.

99. Intentions and subjective norms help to define the theory of planned behavior. What are intentions and subjective norms? Provide an example of how they might be used to predict a future nutritional behavior.

ANSWER: Intentions are the instructions people give to themselves to behave in certain ways. They are scripts for future behaviors. Subjective norms are the perceived social pressures to perform or not perform a behavior. Examples will vary greatly, but should point out that an individual's intentions are strengthened when the subjective norms originating from the person's significant others agree with those intentions.

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Chapter 04: Understanding and Achieving Behavior Change 100. List and explain four techniques to use during a public speaking presentation to ensure you give an effective presentation.

ANSWER: Answers should include four of the six techniques listed here: Smile. A smile will go a long way toward helping you relax and making you appear accessible to your audience. This is especially important when dealing with the general public.

Use eye contact. Regardless of the size of the audience, select one person with whom to establish eye contact. Let your eyes dwell on this one individual a few moments, and then move on to another person. This gives the appearance of a one-on-one interactive discussion, which engages the audience in your presentation and helps ensure that they are listening to you.

Use gestures. Gestures give energy to your presentation and provide additional emphasis for key points. Practice making them during your rehearsals. Exercise a little common sense here—wild arm movements and pirouettes will detract from your presentation.

Control the pace. Although maintaining a steady pace will ensure that you complete your speech on time, it may make your audience sleepy. Vary the pace to keep the audience interested in what you are saying.

Use pauses. Pauses, like gestures, can be used for emphasis. A well-timed pause keeps your audience engaged and allows them a moment to process what you've just said.

Vary the volume and pitch. Changing the volume and pitch of your voice has more auditory appeal for the audience than speaking in a monotone.

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Chapter 05: Community Needs Assessment True / False 1. Nutrition status is defined as the condition of a population's or individual's health as affected by the intake and utilization of nutrients and nonnutrients. a. True b. False ANSWER: True 2. Health risk appraisals are often used by worksites, universities, and other institutions as a health education or screening tool. a. True b. False ANSWER: True 3. A target population is always a relatively small group of individuals with common needs. a. True b. False ANSWER: False 4. If a needs assessment has been undertaken, it is not necessary for the community nutritionist to seek input from community members prior to developing a program. a. True b. False ANSWER: False 5. Collecting data is the last step in conducting a community needs assessment. a. True b. False ANSWER: False 6. In conducting a community needs assessment, setting priorities immediately precedes choosing a plan of action. a. True b. False ANSWER: True 7. A community needs assessment objective might be "to identify attitudes of teenagers regarding their knowledge of nutritional content of fast food." a. True b. False ANSWER: True Page 1

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Chapter 05: Community Needs Assessment 8. Community data for needs assessments are primarily qualitative in nature, focusing on opinions and insights from community members. a. True b. False ANSWER: False 9. Key informants are the people and organizations with a vested interest in promoting and achieving optimal nutrition status. a. True b. False ANSWER: False 10. Vital statistics are qualitative data. a. True b. False ANSWER: False 11. Labor force characteristics, language preferences, and educational levels are examples of sociocultural data. a. True b. False ANSWER: True 12. Demographic data include factors such as sex, age, race/ethnicity, education level, marital status, employment and socioeconomic and household characteristics. a. True b. False ANSWER: True 13. Analysis of target population needs includes both qualitative and quantitative data. a. True b. False ANSWER: True 14. As used in community needs assessment, a survey is a systematic study of a cross-section of individuals who represent the target population. a. True b. False ANSWER: True

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Chapter 05: Community Needs Assessment 15. Important considerations for survey development include the reading level of the target population, survey length, and delivery method. a. True b. False ANSWER: True Multiple Choice 16. Which process documents existing assets and resources to address community improvement and problem-solving? a. Defining the community b. Assessing health status c. Asset mapping d. Measuring nutrition status ANSWER: c 17. What is the focus of a community needs assessment? a. Key informants b. Nutritional status c. Objective creation d. Target population ANSWER: d 18. Which term refers to a collection of broad statements that outline the needs assessment’s expected accomplishments? a. Goals b. Objectives c. Measurements d. Parameters of assessment ANSWER: a 19. Which term refers to the integrated pattern of human knowledge, beliefs, and behaviors that are learned and transmitted to succeeding generations? a. Social factors b. Community values c. Society d. Culture ANSWER: d

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Chapter 05: Community Needs Assessment 20. Which tool was designed to reverse, slow, or halt a disease's progress by detecting it as soon as possible? a. Survey b. Focus groups c. Screening d. Assessment ANSWER: c 21. When are focus groups conducted? a. After program planning b. Before, during, and after program planning c. Before and after program planning d. Before program planning ANSWER: b 22. What is considered the "gold standard" of diet assessment methods? a. Food records b. Interviews c. Surveys d. Needs assessment ANSWER: a 23. What method is used to assess the body's physical dimensions and composition to detect degrees of malnutrition? a. Clinical assessment b. Anthropometrics c. Laboratory method d. Diet recall ANSWER: b 24. Which term refers to the proportion of subjects without the disease or condition who accurately receive a negative test for the disease? a. Reliability b. Validity c. Specificity d. Sensitivity ANSWER: c

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Chapter 05: Community Needs Assessment 25. In data collection, which term refers to the ability of a measurement tool to measure what it is intended to measure? a. Reproducibility b. Specificity c. Reliability d. Validity ANSWER: d 26. When does a cultural assessment occur? a. At the time of dietary recall b. Before laboratory data c. Before data collection begins d. End of data collection ANSWER: c 27. Which term refers to the effect of an intervention on the health and well-being of an individual or population? a. Health outcome b. Lifestyle factors c. Nutrition status d. Nutrition intervention ANSWER: a 28. Who ranks existing health and nutrition needs and makes recommendations about where the community's resources should be directed? a. Stakeholders b. Key informants c. Community nutritionists d. Members of an assessment team ANSWER: d 29. Which term refers to the condition of a population's or individual's health, including estimates of quality of life and physical and psychosocial functioning? a. health status b. nutrition status c. community needs assessment d. asset map ANSWER: a

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Chapter 05: Community Needs Assessment 30. A(n) is the process of evaluating the health and nutrition status of a population to determine the population’s health and nutrition requirements. a. epidemiologic investigation b. functional activity assessment c. community needs assessment d. asset mapping ANSWER: c 31. What is the first step in conducting a community needs assessment? a. developing a data collection plan b. setting the parameters of the assessment c. setting priorities d. choosing a plan of action ANSWER: b 32. The of a needs assessment set the direction for the assessment. a. objectives b. scope c. parameters d. limitations ANSWER: c 33. Which activity is undertaken when setting an assessment parameter? a. reviewing the purpose, goal, and objectives of the needs assessment b. determining the purpose of the needs assessment c. collecting community data d. determining data collection procedures ANSWER: b 34. Which term refers to statements of outcomes and activities needed to reach the goal of a needs assessment? a. Objectives b. Intentions c. Aims d. Purposes ANSWER: a

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Chapter 05: Community Needs Assessment 35. Which phrase would be part of a statement of an objective? a. "understand information" b. "assess practices" c. "learn about attitudes" d. "contemplate services" ANSWER: b 36. In a community needs assessment, there are three basic categories of data to collect. In addition to community environment and background conditions, what is the third category?. a. working conditions b. focal data c. individual condition d. community data ANSWER: d 37. Which set of parameters is considered part of background conditions? a. target population’s nutrition status b. environmental characteristics c. lifestyle factors d. food preferences and attitudes ANSWER: b 38.

are those with a vested interest in addressing the nutrition status of a target population. a. Key informants b. Community leaders c. Stakeholders d. Public officials ANSWER: c

39. Under what category of community data do unemployment statistics fall? a. community health b. economic data and trends c. sociocultural data d. demographic data and trends ANSWER: b

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Chapter 05: Community Needs Assessment 40. Secondary data archive services include the a. Department of Agriculture

.

b. U.S. Bureau of Census c. Odum Institute for Research in Social Science d. Department of Health and Human Services ANSWER: c 41. Learning about the social and cultural climate of the community may help a community nutritionist to a. determine new governmental regulations b. perform quantitative data analysis

.

c. measure vital statistics important to the community d. work within the area’s value system ANSWER: d 42.

is the integrated pattern of human knowledge, beliefs, and behaviors that are learned and transmitted to succeeding generations. a. Demography b. Society c. Climate d. Culture ANSWER: d

43. The finding that "women who become pregnant unexpectedly are less likely to breastfeed their infants than women whose pregnancies are planned" illustrates how factors influence health and wellness. a. motivational b. cultural c. lifestyle d. social ANSWER: c 44. What does the National Nutrition Monitoring and Related Research Program (NNMRRP) provide? a. general information on a target population data b. standard nutritional recommendations for populations c. resources for funding nutrition programs for at-risk groups d. expertise in setting up and implementing needs assessments ANSWER: a

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Chapter 05: Community Needs Assessment 45. The systematic study of a cross-section of individuals who represent the target population is a a. survey

.

b. health risk appraisal c. screening d. focus group ANSWER: a 46. Which method of obtaining data is used to alert individuals about potentially risky health behaviors? a. survey b. health risk appraisal c. screening d. focus group ANSWER: b 47. Which component is one of the three components of a health risk appraisal? a. focus group b. 24-hour food diary c. medical history d. educational message ANSWER: d 48. Surveys are most likely to be . a. relatively inexpensive to conduct b. used to reverse disease progression c. analyzed on an individual level d. qualitative in nature ANSWER: a 49. A decreased level of a nutrient in body fluids is best identified using a. dietary b. biochemical

analysis.

c. behavioral d. clinical ANSWER: b

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Chapter 05: Community Needs Assessment 50. Focus groups usually consist of how many participants? a. 2-5 b. 5-12 c. 12-22 d. 22-35 ANSWER: b 51. Which quality is characteristic of an effective survey? a. The response scales contain many options. b. The survey can cover multiple target populations. c. The survey is comprehensive but brief. d. The questions imply value judgments.

ANSWER: c 52. If the target population of a study is teenagers with a high risk of pregnancy, who are the key informants? a. teenagers having unprotected sex b. adults of the community c. teenagers who work in peer education programs d. school administrators ANSWER: c 53. Why would a diet history interview be considered ineffective? a. relies on participant memory b. requires the participants to be literate c. is time-consuming d. may be culturally insensitive ANSWER: a 54. What is a strength of the 24-hour recall dietary assessment? a. is useful for screening subjects b. is quick and easy to administer c. not dependent on memory d. not affected by seasonal variations of food ANSWER: b

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Chapter 05: Community Needs Assessment 55. An instrument that accurately measures what it is intended to measure is described as which of the following? a. reliable b. dependable c. acute d. valid ANSWER: d 56. Which statement is true of anthropometric measurements? a. They are used to detect moderate to severe degrees of malnutrition. b. They can be used to measure stored nutrient reserves. c. They detect physical signs and symptoms associated with malnutrition. d. They are easily collected during focus group activities.

ANSWER: a 57. A measurement tool which correctly identifies the individuals in a sample without the disease or condition by returning negative results for them is said to have which quality? a. sensitivity b. reliability c. validity d. specificity ANSWER: d 58. Which factor is not considered during a cultural assessment? a. food rituals b. typical greeting c. literacy level d. eye contact ANSWER: c 59. The priority-setting process begins with a. reviewing the report summary

.

b. data collection c. objective writing d. hypothesis formation ANSWER: a

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Chapter 05: Community Needs Assessment 60. What is an example of entrepreneurship in community needs assessment? a. Healthy People 2030 campaign b. NHANES survey c. Healthy Communities Program d. MEDLINE program ANSWER: c 61. Which dietary assessment tool is self-administered, requires only 15-30 minutes, and is analyzed at a reasonable cost? a. diet history interview b. food diary c. 24-hour recall d. food frequency questionnaire ANSWER: d 62. Which dietary assessment tool is quick and easy to administer but relies on memory? a. 24-hour recall b. food diary c. diet history interview d. food frequency questionnaire ANSWER: d 63. Which dietary assessment tool does not depend on memory but requires literacy? a. food frequency questionnaire b. 24-hour recall c. food diary d. diet history interview ANSWER: c 64. Which dietary assessment tool furnishes an overall picture of the diet but requires the ability to judge portion sizes? a. 24-hour recall b. diet history interview c. food diary d. food frequency questionnaire ANSWER: d

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Chapter 05: Community Needs Assessment 65. Which dietary assessment tool clarifies issues but requires specific training? a. food frequency questionnaire b. diet history interview c. food diary d. historical data form ANSWER: b 66. Which dietary assessment tool isn't affected by season and doesn't include meal pattern data? a. food frequency questionnaire b. 24-hour recall c. food diary d. food record ANSWER: a 67. Which dietary assessment tool provides a preliminary nutritional assessment and clues to strengths and barriers but may seem invasive? a. client assessment questionnaire b. 24-hour recall c. food record d. food frequency questionnaire ANSWER: a 68. Which dietary assessment tool may not represent the usual diet due to over/under-reporting? a. food frequency questionnaire b. 24-hour recall c. client assessment questionnaire d. diet history interview ANSWER: b 69. Which dietary assessment tool provides accurate intake data and information about food habits, but requires a motivated client? a. 24-hour recall b. food frequency questionnaire c. food diary d. diet history interview ANSWER: c

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Chapter 05: Community Needs Assessment 70. Which dietary assessment tool is quick and tends not to influence the usual diet? a. 24-hour recall b. food frequency questionnaire c. food diary d. diet history interview ANSWER: a 71. Which assessment category of data would a population’s supplement use fall under? a. anthropometric b. laboratory c. community conditions d. dietary ANSWER: d 72. When obtaining information on community conditions, which method of collecting data is most appropriate? a. focus groups b. survey c. food frequency questionnaire d. clinical data ANSWER: b 73. What type of information can be collected when obtaining clinical data? a. medication use b. weight gain or weight loss c. supplement use d. serum albumin levels ANSWER: a 74. What tool is used to obtain skinfold measurements? a. scale b. phlebotomy c. calipers d. medical chart ANSWER: c

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Chapter 05: Community Needs Assessment 75. Clinical data, medical history, and physical exam data fall under which category of data collection? a. food preference and attitudes b. lifestyle factors c. nutrition status d. sociocultural factors ANSWER: c 76. What is the purpose of collecting community conditions data? a. to determine which community services are used by a population b. to assess the nutritional status of a population c. to assess the nutrition knowledge of a population d. to determine which population falls below the poverty line ANSWER: a 77. What does nutritional status data examine? a. attitudes toward food b. clinical data c. physical activity level d. motivations for food and health choices ANSWER: b 78. Which type of data is used to assess weight loss over time? a. anthropometrics b. clinical data c. survey d. diet recall ANSWER: a 79. Which type of data are used to assess a population’s functional status? a. community condition b. biochemical data c. clinical data d. anthropometrics ANSWER: c

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Chapter 05: Community Needs Assessment 80. Which of the following questions would be used to obtain data on community conditions?

Does the food intake of this audience meet nutrient needs? a. Does this population use any dietary supplements? b. Does this population use nutrition support? c. How many members of this population use home-delivered meals? d. Does the food intake of this audience meet nutrient needs?

ANSWER: c Subjective Short Answer 81. How is a community needs assessment similar to a patient's nutritional assessment in a hospital?

ANSWER: In a community needs assessment, the "patient" is the community, and this "patient's" nutritional status is investigated using multiple types and sources of data.

Use the following case scenario to answer short answer items 2-6.

Several health professionals in your city are interested in conducting a needs assessment to determine whether a substance abuse education program is necessary for older adults.

82. Draft a goal and objective for the needs assessment.

ANSWER: Answers will vary. An example follows: Goal: To determine whether a substance abuse education program for older adults within the identified community is necessary.

Objective: Draft a list of all existing services, complete with eligibility requirements and contact information for each service.

83. What community characteristics would be helpful to collect?

ANSWER: Answers will vary; however, a few could include the number of older adults by age, frequency by gender, marital status, living arrangements, and overall health status, including prescription drug use.

84. What environmental characteristics would be helpful to collect?

ANSWER: Answers will vary but could include food systems, geography and climate, health systems, housing, recreation, and transportation systems.

85. What socioeconomic characteristics would be helpful to collect?

ANSWER: Answers will vary but could include income level, the percentage receiving public assistance; education level; literacy rate; and employment status.

86. What sources might you use to collect community data?

ANSWER: Many demographic and socioeconomic data can be located in publications of the U.S. Bureau of the Census, Bureau of Labor Statistics, Department of Agriculture, and Department of Health and Human Services. The annual reports of local hospitals, clinics, and health centers provide information on the types of health problems within the community.

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Chapter 05: Community Needs Assessment Use the following case scenario to answer short answer items 7-10.

The local chapter of the American Heart Association has contacted you to assist in developing a focus group to determine if their services in your community have been positively received.

87. Is a focus group an appropriate data collection method for this purpose? Why or why not?

ANSWER: Yes; focus groups are informal groups of about 5 to 12 people who are asked to share their concerns, experiences, beliefs, opinions, or problems and can be used to obtain advice, insights, and opinions regarding services and products.

88. If a focus group were to be utilized, what questions might be asked?

ANSWER: A variety of questions could be asked. The questions would need to be open-ended and written to stimulate conversation. Here are sample questions: What are some of the AHA services that you have used in the past 6 months?

Of the services used, which ones did you find most helpful?

Of the services used, which ones did you find least helpful?

What services would you like to see offered?

89. Would it be appropriate to collect this information via a survey? Why or why not?

ANSWER: The survey method is a relatively inexpensive method of collecting information from a large group of people. A survey could be used in conjunction with a focus group to obtain qualitative and quantitative data.

90. If the survey method were to be used, what might affect the survey's validity?

ANSWER: Answers will vary but could include the following concepts: The respondent's knowledge of the services, literacy level, education level, conscientiousness in completing the instrument, and ability to follow instructions The questionnaire design including the difficulty of instructions, ease of recording the answer, and the number and types of questions asked Adequacy of reference data, depending on questions asked Accuracy of data input and management Essay 91. Differentiate between qualitative and quantitative data and list examples of each type of data.

ANSWER: Both qualitative and quantitative data help describe the community and its values, health problems, and needs. Qualitative data such as opinions and insights may be derived from interviews or focus groups with key informants, stakeholders, and members of the target population. Quantitative data may be derived from a variety of databases, including registries of vital statistics, published research studies, hospital records, and local health surveys.

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Chapter 05: Community Needs Assessment 92. Differentiate among the three types of data about the community that can be collected and identify where these data may be found.

ANSWER: The three types of data include community, environmental, and socioeconomic characteristics. Information regarding the characteristics of the community is needed to determine how the community operates, how its population is distributed, and how healthy it is. Community characteristics include information on the following: community organizational power and structures; demographic data and trends; community health statistics; and existing community services and programs. Environmental characteristics focus on how each target population lives and works within a particular physical environment. Access to medical clinics and ambulatory care services and food availability are two examples of environmental characteristics. Socioeconomic characteristics provide insight about the income of families and the number of families receiving public assistance.

93. Define culture. How does one's culture influence his/her food intake and nutritional status?

ANSWER: Culture is defined as the integrated pattern of human knowledge, beliefs, and behaviors that are learned and transmitted to succeeding generations. Many of our food habits, attitudes, and practices arise from the traditions, customs, belief systems, technologies, values, and norms of the culture in which we live.

94. Differentiate between a goal and an objective, and explain why both are important.

ANSWER: Goals are broad statements that indicate what the assessment is expected to accomplish, whereas objectives are statements of outcomes and activities needed to reach a goal. Both are important because they determine the types of data collected and how they will be used. Both provide a focus to the assessment.

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Chapter 05: Community Needs Assessment 95. Describe five methods for obtaining data about a target population.

ANSWER: Methods used for obtaining data include:

A survey is a systematic study of a cross-section of individuals who represent the target population.

It is a relatively inexpensive method of collecting information from a large group of people.

A health risk appraisal (HRA) is a type of nutrition survey used in community nutrition. The HRA is a kind of "health hazard chart" that asks questions about the lifestyle factors that influence disease risk, and it has been used successfully to improve health behaviors.

Screening is an important preventative health activity designed to reverse, slow, or halt a disease's progress by detecting it as soon as possible. Screening can be conducted in clinical and community settings by various health care professionals.

Focus groups are informal groups of 5 to 12 people who are asked to share their concerns, experiences, beliefs, opinions, or problems. Focus groups provide qualitative information that helps nutritionists understand how the nutritional problem developed and whether the target population perceives it to be a problem.

Interviews with key informants can be used to complete a cultural assessment of the target population or provide insights about whether the target population perceives a nutritional problem and which actions to address the problem are culturally appropriate.

Direct assessments of nutritional status are used to determine an individual's or a population's usual dietary intake and to identify potential dietary inadequacies. Direct assessment methods use dietary, laboratory, anthropometric, and clinical measurements of individuals to identify those with malnutrition or a nutrient deficiency.

96. Describe the three components of a health risk appraisal (HRA), and discuss the usefulness and limitations of this type of survey instrument.

ANSWER: The three components of the HRA are the questionnaire, certain calculations that predict the risk of disease, and an educational message or report. HRAs are used to alert individuals to any risky health behaviors they engage in and inform them how such behaviors might be modified, usually through a lifestyle modification program. A significant limitation of the HRA is that it provides a "brief intervention" and should not be used as the sole source of nutrition education. The HRA is best used as a screening tool that provides an opportunity for more nutrition education.

97. Define and describe focus groups, including their uses and how they are planned and conducted.

ANSWER: Focus groups usually consist of 5 to 12 people who meet in sessions lasting about 1 to 3 hours. The group's members are brought together to talk about their concerns, experiences, beliefs, or problems.

They are used to obtain advice and insights about new products and services; research data and information about key variables used in quantitative studies; and opinions about products or creative concepts, such as advertising campaigns or program logos. A trained moderator who is skilled at putting people at ease and promoting group interaction leads focus group sessions. Open-ended questions are prepared, since they allow participants to take any direction they want and to reconstruct particular experiences.

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Chapter 05: Community Needs Assessment 98. As a WIC nutritionist seeking to evaluate the nutrition status of children whose mothers are participating in the WIC program, what nutrition status indicators might include in your evaluation?

ANSWER:

Hemoglobin to assess iron stores with reference to the most recent NHANES survey for children of the same age & sex.

Height and weight plotted on NCHS growth charts for evaluating physical growth

99. Differentiate between sensitivity and specificity, using an example to illustrate the differences.

ANSWER: Sensitivity is the proportion of subjects with the disease or condition with a positive test result. A sensitive test rarely misses people with the disease or condition. It is often used in screening situations to detect a disease or condition in people who appear to be asymptomatic. Specificity is the proportion of subjects without the disease or condition with a negative test. Specific tests are used to confirm a diagnosis. The oral glucose test is a highly specific test for diagnosing diabetes mellitus, whereas a blood draw to check cholesterol is more sensitive.

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Chapter 06: Program Planning for Success True / False 1. The decision to develop a nutrition program or modify an existing program is always dictated by the enactment of new laws or regulations. a. True b. False ANSWER: False 2. New research findings might trigger the revision of existing or the development of new community nutrition programs. a. True b. False ANSWER: True 3. Regardless of external factors, a community nutritionist should consider developing a program when there is a nutritional or health problem in the community that has not been resolved adequately. a. True b. False ANSWER: True 4. Before developing or modifying a program, a community nutritionist should first review the organization’s mission statement. a. True b. False ANSWER: True 5. When developing a new program, program goals and objectives are not defined until after funding sources have been identified. a. True b. False ANSWER: False 6. A needs assessment might include a survey, the results of which indicate a low level of awareness of heart disease risk factors among Hispanic women. a. True b. False ANSWER: True

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Chapter 06: Program Planning for Success 7. New program goals and objectives should be achievable, not necessarily measurable, events. a. True b. False ANSWER: False 8. The “A” in SMART objectives for planning new programming refers to the availability of resources for new programming. a. True b. False ANSWER: False 9. Structural objectives are measurable activities surrounding the budget, staffing, organizational resources, and coordination of program activities. a. True b. False ANSWER: True 10. Program planning is the process of designing a program to meet nutritional needs or fill gaps in service. a. True b. False ANSWER: True 11. A logic model is a framework for planning, implementing, and evaluating programs. a. True b. False ANSWER: True 12. Outcome evaluation is used to determine whether and to what extent a program or an intervention accomplished its stated goals. a. True b. False ANSWER: False 13. The use of the problem, etiology, and signs and symptoms (PES) statement occurs in the monitoring and evaluation step of the nutrition care process. a. True b. False ANSWER: False

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Chapter 06: Program Planning for Success 14. The first step in the nutrition care process is nutrition diagnosis. a. True b. False ANSWER: False Multiple Choice 15. Which of the following can trigger the planning process? a. Management systems b. A process objective c. A mission statement d. Research findings ANSWER: d 16. Which of these is most likely to trigger program planning? a. A community group devises an intervention strategy. b. An organization reviews the goals and objectives of a program. c. A community activist calls attention to unmet nutritional needs in a community. d. A local activist group develops a marketing plan for its new outreach program.

ANSWER: c 17. Which step follows a needs assessment? a. Set goals and objectives. b. Develop a program plan. c. Identify funding sources. d. Develop a management system.

ANSWER: a 18. Before developing a program plan, it is important to do which of the following? a. Evaluate program elements and effectiveness. b. Calculate the management costs of the program. c. Collect information about the target population. d. Secure funding from nonprofit or government agencies.

ANSWER: c

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Chapter 06: Program Planning for Success 19. Which of the following describes process objectives? a. They are measurable activities surrounding budget, staffing, management systems, and use of resources. b. They are measurable activities carried out by the community nutritionist and other team members in implementing the program. c. They are measurable activities that evaluate the value or degree of success in achieving specific objectives. d. They are measurable activities to assess a program’s effectiveness in changing one or more aspects of nutritional or health status.

ANSWER: b 20. Which of the following describes a formative evaluation? a. It determines whether the program’s methods and activities resulted in the desired immediate changes in the client. b. It measures a program’s effectiveness in changing one or more aspects of nutritional and health status. c. It determines a program’s benefits relative to cost. d. It tests and assesses certain elements of a program before it is implemented fully.

ANSWER: d 21. Which of these is an example of an appropriately stated outcome objective? a. Reduce death rate from breast cancer among women. b. Increase community awareness of depression and early detection. c. Promote fruit and vegetable consumption among adolescents. d. By the year 2030, decrease saturated fat consumption among 85% of adolescents to decrease risk of obesity.

ANSWER: d 22. Which of the following activities is part of developing a nutrition education plan? a. Pilot test program plan. b. Set goals and objectives. c. Secure funding. d. Achieve attitude change.

ANSWER: b 23. Which statement is true about the logic model? a. It does not require regular updating. b. It helps enhance the experience for program participants. c. It provides a roadmap for evaluating community nutrition needs. d. It ensures transparency of the program.

ANSWER: c

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Chapter 06: Program Planning for Success 24. Which factor is not likely to be part of the decision to modify or develop a new community nutrition program? a. Results of a needs assessment b. Anecdotal, word-of-mouth evidence c. Research findings d. Government policy changes ANSWER: b 25. Which factor is likely to trigger a decision to create a new community nutrition program rather than modify an existing one? a. Staffing changes b. An op-ed in a local newspaper c. Decreases in funding d. Federal mandate ANSWER: d 26. Which is a broad statement of an organization’s purpose and a guideline for future decisions? a. Portfolio b. Needs assessment c. Mission statement d. Business plan ANSWER: c 27. Which is the first step in program planning? a. Developing a management system b. Defining program goals c. Reviewing a community needs assessment d. Identifying funding sources ANSWER: c 28. Which is the last step in program planning? a. Developing a management system b. Evaluating a program c. Reviewing a community needs assessment d. Identifying funding sources ANSWER: b

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Chapter 06: Program Planning for Success 29. During the implementation of an urban community nutrition program, it was discovered that items packaged into food baskets could not be eaten by many of those receiving the donations because of religious practices. Which step in the program planning process should have noted this fact? a. Developing a management system b. Evaluating a program c. Reviewing a community needs assessment d. Identifying funding sources ANSWER: c 30. In the context of program planning, which is one of four components of an objective? a. An indication of how success will be measured or evaluated b. An educational program for managers and supervisors c. The funding source d. The total cost of the project ANSWER: a 31. In terms of SMART objectives for programming planning, what does the “M” stands? a. Money b. Measurable c. Management d. Member ANSWER: b 32. What does the “T” in SMART objectives for planning new programs refer to? a. Target population b. Time frame c. Task achievement d. Training needs ANSWER: b 33. Which statement describes an intervention strategy? a. It is a set of activities directed toward putting a program into effect. b. It is a broad statement of desired changes or outcomes and provides a general direction for the program. c. It is an approach developed for achieving the program’s goals and objectives. d. It is an assessment of the target population’s nutritional problem or need.

ANSWER: c

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Chapter 06: Program Planning for Success 34. Counseling sessions, fitness programs, and community-based wellness programs are examples of which level of intervention? a. Level I interventions b. Level II interventions c. Level III interventions d. Level IV interventions ANSWER: b 35. One of the objectives of a program is for the participants to be able to interpret food labels to identify low-calorie foods. What type of change is this? a. Skill change b. Knowledge change c. Motivational change d. Attitude change ANSWER: a 36. One of the objectives of a program is for the participants to write daily goals and keep track of progress towards ultimate goals of losing weight. What type of change is this? a. Skill change b. Knowledge change c. Motivational change d. Attitude change ANSWER: c 37. In program management, indirect costs include which of the following? a. Marketing campaigns b. Labor costs c. Raw material d. Equipment ANSWER: a 38. In the context of program planning, the question “how will we know that change has occurred” corresponds to which SMART objective? a. Specific b. Measurable c. Achievable d. Relevant ANSWER: b

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Chapter 06: Program Planning for Success 39. In the context of program planning, the fact that grant money is available to fund the project corresponds to which SMART objective? a. Specific b. Measurable c. Achievable d. Relevant ANSWER: c 40. Which verb is used when constructing process objectives for program planning? a. Understand b. Know c. Instruct d. Learn ANSWER: c 41. Which of the following is an appropriately phrased process objective? a. Recognize environmental factors. b. Know health risks. c. Understand warning signs. d. Screen for risk factors.

ANSWER: d 42. Measurable activities carried out by team members in implementing a program are part of which type of objective? a. Structure b. Instruction c. Activity d. Process ANSWER: d 43. Measurable activities related to budgeting, staffing, and management of program activities are part of which type of objective? a. Process b. Activity c. Instruction d. Structure ANSWER: d

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Chapter 06: Program Planning for Success 44. The first step in designing a community nutritional intervention is to review which? a. Program’s goals and objectives b. Budget and financial data c. Marketing and social media presence d. Time frame for implementation ANSWER: a 45. An intervention strategy addresses which question? a. Why is the program being implemented? b. What facilities will be utilized? c. When will the program start and end? d. How will the program be implemented?

ANSWER: d 46. Level I interventions are designed to do what? a. To promote lifestyle changes b. To create supportive environments c. To build awareness d. To change health care policy or laws ANSWER: c 47. Which describes a Level II community intervention? a. Providing a health fair b. Creating a fitness program in a school c. Providing tax incentives for companies with wellness programs d. Creating Internet websites ANSWER: b 48. Which describes a Level III system intervention? a. Small group counseling b. School policy restricting sugar intake during lunch c. Peer leadership programs d. Improved restaurant menu labeling ANSWER: b

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Chapter 06: Program Planning for Success 49. A company providing incentives for employees to join local fitness clubs is an example of which intervention? a. Level I b. Level II c. Level III d. Level IV ANSWER: b 50. A brochure on the dangers of smoking during pregnancy is an example of a which intervention? a. Level I b. Level II c. Level III d. Level IV ANSWER: a 51. “Heart Healthy, Heart Happy” is an example of which? a. Marketing plan b. Service announcement c. Tag line d. Headline ANSWER: c 52. Which activity is a way to control costs and increase the reach of community nutritional programs? a. Developing a marketing plan b. Creating websites for advertising c. Forming partnerships with local businesses d. Hiring publicists and marketing specialists ANSWER: c 53. Which expense is an indirect program cost? a. Office space rental b. Salaries of program personnel c. Travel expenses d. Equipment costs ANSWER: a

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Chapter 06: Program Planning for Success 54. In a logic model, outputs include which? a. Workshops, counseling, and other services b. Budgets, marketing plans, and salaries c. Grants, funding steams, and cost-analysis d. Technology, materials, and money ANSWER: a 55. In a logic model, expected outcomes for short-term results might include which? a. Social changes b. Environmental impact c. Attitude and opinion changes d. New policies ANSWER: c 56. In a logic model, which include media, economic and political circumstances, and participants’ demographics? a. Priorities b. Assumptions c. Situations d. External factors ANSWER: d 57. For group education sessions offered on a voluntary basis and without incentives, the participation rate will likely be which? a. Less than 5% b. 5% to 35% c. 35% to 50% d. 50% to 75% ANSWER: b 58. According to the text, the first step in improving participation rates is to do what? a. Put more effort into making the activities fun and easy for participants. b. Understand the target population and its needs and interests. c. Switch to a newer, better supported intervention. d. Focus funding on advertising in local radio, television, and print media.

ANSWER: b

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Chapter 06: Program Planning for Success 59. Program evaluations do which? a. Take place only when issues arise b. Are never taken to measure cost effectiveness c. Can be used to test innovative approaches to nutrition and public health d. Are carried out only by agency staff, never by outside consultants ANSWER: c 60. An evaluation of which focuses on activities rather than outcomes? a. Process b. Impact c. Fiscal d. Structure ANSWER: a 61. An evaluation of which is used to determine whether a program or intervention accomplished its stated goals? a. Process b. Impact c. Fiscal d. Structure ANSWER: b 62. An evaluation of which is used to determine the adequacy and effectiveness of the internal resources needed to deliver the program? a. Process b. Impact c. Fiscal d. Structure ANSWER: d 63. The stated goal of which type of evaluation might be “to determine whether the nutrition and smoking messages delivered through the intervention resulted in a behavior change in the target population”? a. Process b. Impact c. Outcome d. Structure ANSWER: c

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Chapter 06: Program Planning for Success 64. An intervention evaluation determined that “for every one dollar required to produce the program, there is a $4 savings in medical costs.” This is an example of which type of evaluation? a. Outcomes b. Cost-benefit c. Cost-effectiveness d. Indirect cost ANSWER: b 65. Which statement describes the process of program evaluation? a. It is the process of testing and assessing certain elements of a program before it is implemented fully. b. It is a useful tool for helping program implementers to achieve structure objectives. c. It is usually undertaken immediately after reviewing existing programs and talking to colleagues and other professionals who have worked with similar programs or with the target population. d. It is the use of scientific methods to judge and improve the planning, monitoring, effectiveness, and efficiency of health, nutrition, and other human service programs.

ANSWER: d 66. Evaluation of programming should always be what? a. Comprehensive, assessing all aspects of programming from development through implementation b. Carried out by outside consultants to avoid internal bias c. Tailored to the organization in which it is conducted d. The first step in designing an intervention ANSWER: c 67. Which of the following is a reason to conduct a program evaluation to document a program in general? a. To assess the adequacy of program goals b. To identify weaknesses in the program content c. To measure effectiveness of resources d. To record data on clients who drop out ANSWER: d 68. Which of the following is a reason to conduct a program evaluation to justify a program? a. To compare program outcomes against program standards b. To assess the adequacy of program goals c. To describe the content of the treatment setting d. To measure staff effectiveness ANSWER: a

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Chapter 06: Program Planning for Success 69. A community nutritionist writes an evaluation report of a program that fell short of its goals. The nutritionist wants to identify potential weaknesses of the program. For which purpose is this evaluation being undertaken? a. To justify a program b. To improve a program c. To show accountability d. To document the program ANSWER: b 70. In response to a request for more funds for a community wellness program, the sponsoring organization requests an evaluation report with an itemized list of expenditures. For which purpose is this evaluation being undertaken? a. To justify a program b. To improve a program c. To identify weaknesses d. To document the program ANSWER: a 71. A program aimed at reducing obesity in a community is deemed successful, and other communities request a report on it so that they can understand the basics, including client attendance and progress. For which purpose is this evaluation being undertaken? a. To justify a program b. To improve a program c. To identify weaknesses d. To document the program ANSWER: d 72. Which of the following is a tool for program evaluation? a. BOLD Healthy Living Program b. RE-AIM Framework c. SMART Objectives d. NHANES ANSWER: b 73. What is a program summary? a. A broad declaration of the organization’s purpose and a guideline for future decisions b. A brief review of a program’s evaluation, not to exceed one to two pages c. The influential part of the report d. The findings that are interpreted to see if the program caused the achievement of the objectives ANSWER: b

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Chapter 06: Program Planning for Success 74. What would be found in the results section of a program report? a. A presentation of the findings of the evaluation b. Identification of weakness and strengths of the program implementation c. A detailed explanation of the target population’s characteristics d. The specific, measurable actions that are intended to be taken ANSWER: a 75. What function does the background information collected serve? a. It places the program in context. b. It gives an outline for planning a program. c. It summarizes information about previously successful interventions. d. It includes information about the participants’ personal data.

ANSWER: a 76. What does the front cover of a program evaluation report include? a. The origin and goals of the program b. Charts, graphs, and tables c. The title of the program and the location d. Suggestions for the course of action ANSWER: c 77. Which findings are interpreted to see whether the program caused the achievement of the objectives? a. Conclusions, recommendations, and options b. Summary c. Discussion of results d. Results ANSWER: c 78. Which section of the final evaluation report includes the origin and goals of the program, target population, and characteristics of program material? a. Fiscal evaluation b. Background information c. Description of the evaluation d. Overview of the evaluation ANSWER: b

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Chapter 06: Program Planning for Success 79. Which type of evaluation determines whether the program’s methods and activities resulted in the desired immediate changes in the client? a. Impact b. Outcome c. Process d. Formative ANSWER: a 80. Within the nutrition care process and model, passing out food vouchers and meals or snacks would fall into which category of nutrition intervention? a. Nutrition counseling b. Food and/or nutrient delivery c. Coordination of nutrition care d. Nutrition education ANSWER: b 81. A nutrition for individuals enrolled in an osteoporosis prevention class might state “an intake of 1,200 milligrams of calcium per day from food and supplement sources.” a. care plan b. output c. benefit d. prescription ANSWER: d Essay 82. Describe the six factors that can trigger program planning.

ANSWER: Factors that can trigger program planning include the following: Results of the community needs assessment Mandate from an organization’s national office or from a federal agency Research findings Community leader or coalition Availability of funding for new programs Government policy One or more of these might prompt the planning. For example, recent research findings and results of a community needs assessment might indicate the same need, and thus funding might become available for programs to alleviate that need.

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Chapter 06: Program Planning for Success 83. What are the four components of a well-written objective? Why is each component important?

ANSWER: An objective has four components: (1) the action or activity to be undertaken, (2) the target population, (3) an indication of how success will be measured or evaluated, and (4) the time frame in which the objective will be met. Each component is important because each further clarifies the program goal and ultimately leads to a successful intervention. Well-written objectives aid in conducting the components of the program’s evaluation plan.

84. The goal of your program is to “improve the fitness level and eating habits of employees in participating worksites.”

Define outcome and process objectives and write both an outcome and a process objective relevant to your program goal.

ANSWER: Outcome objectives are measurable changes in a health or nutritional outcome. For this example, an outcome objective might focus on improvement of the fitness level or eating habits. A process objective is one that is carried out by the community nutritionist in the implementation of the program. Examples of process objectives for this example could include what the nutritionist is going to do to assist the learner in achieving the outcome objectives.

85. Describe three levels of community intervention and provide an example of each.

ANSWER: Level I interventions focus on increasing awareness of a health or nutritional topic or problem. Examples of Level I interventions include health fairs, health screenings, flyers, posters, table tents, Internet websites, special events, media announcements, health claims on food labels, and legislation.

Level II interventions are designed to help participants make lifestyle changes. Examples of Level II interventions include one-on-one counseling, small-group sessions, fitness programs in schools, health promotion programs for city employees, company incentives for employees who join local fitness clubs, and the formation of a community-based wellness committee.

Level III interventions work toward creating environments that support the behavior changes made by individuals. Examples of Level III interventions include worksite cafeteria programs, peer leadership, municipal policy that supports food gleaning, point-of-purchase labeling, tax incentives for companies with health promotion programs, Medicare coverage of medical nutrition therapy, school policy, and legislation.

86. Discuss the purpose of evaluating programs.

ANSWER: The purpose of program evaluation is to gather information for making decisions about redistributing resources, changing program delivery, or continuing a program. It takes the guesswork out of planning and implementing programs. Ultimately, the purpose of program evaluation is to enhance the quality of the program.

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Chapter 06: Program Planning for Success 87. Discuss the differences among the varying types of evaluation.

ANSWER: Formative evaluation helps pinpoint and eliminate any kinks in the proposed delivery system or intervention before the program is fully implemented. For example, formative evaluation can be used to assess educational materials.

Process evaluation involves examining program activities in terms of the demographic variables of the target population; the program’s organizations, funding, and staffing; and its location and timing. Process evaluation focuses on program activities rather than on outcomes, and it occurs throughout the planning and implementation phases.

Impact evaluation is used to determine whether and to what extent a program or an intervention accomplished its stated goals. It describes the specific effect of program activities on the target population and on immediate indicators of a program’s success.

Outcome, or summative, evaluation determines whether the program or intervention influenced the target population’s health status, food intake, morbidity, mortality, or other outcomes. Outcome evaluation tends to occur at the end of the program or intervention.

Structure evaluation includes assessing the personnel and environmental factors related to program delivery.

Fiscal evaluation determines how program outcomes compare with their costs either through a costbenefit analysis or a cost-effectiveness analysis.

88. How might outcome (summative) evaluation data be used in a formative way?

ANSWER: Summative evaluation data can be used in a formative way by utilizing the data completed at the summation of a previous intervention in a manner that will improve the intervention the next time it is given.

89. Discuss three major principles to consider when preparing an evaluation report and describe how you would distribute it.

ANSWER: Three principles to keep in mind include the following: a. Communicate the information to the appropriate potential users. b. Ensure that the report addresses the issues that the users perceive to be important. c. Be sure that the report is delivered in time to be useful and in a form that the intended users can easily understand.

The results of the evaluation can be distributed informally through a short memorandum or more formally, such as in a full report. You may send the full report to your immediate supervisor, division director, and board of directors and provide a copy of the executive summary to interested community groups. You may inform the media and general public by distributing a press release and posting key findings on the organization’s website.

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Chapter 06: Program Planning for Success 90. Describe how an evaluator must consider multiculturalism when conducting an evaluation.

ANSWER: Conducting a fair and democratic evaluation in a multicultural environment requires striking a balance between the rights of the minority culture groups and the rights of the larger culture.

Here are some challenges: a. The evaluator must strive to remain neutral in the face of competing minority interests. b. The evaluator must search out and define the views and interests of the minority groups to ensure that their needs are being met. c. The evaluator must be sensitive to the cultural differences that make implementing the evaluation difficult.

91. How might a community nutritionist utilize the nutrition care process (NCP)?

ANSWER: A community nutritionist may utilize the NCP to design and deliver nutrition care, use the standardized language as part of a community assessment, or use outcome data to advocate for new policy development.

92. List the seven steps of program planning in order.

ANSWER: The seven steps include: 1. Review the results of the community needs assessment.

2. Define program goals and objectives.

3. Develop a program plan.

4. Develop a management system.

5. Implement the program.

6. Evaluate program elements and effectiveness.

93. What is a SMART objective?

ANSWER: A SMART objective is one that is specific, measurable, achievable, relevant, and able to be completed within a given time frame.

94. Explain how evaluation could be used to justify your program or to show accountability.

ANSWER: Evaluation can be used to justify the budget or expenditures or to show the need for increased funds. It can be used to justify staff, resources, and facilities, as well as to justify program goals and procedures.

Evaluation can be used to account for certain program practices and to compare program outcomes against program standards.

95. Differentiate between cost-benefit analysis and a cost-effectiveness analysis.

ANSWER: A cost-benefit analysis estimates both the tangible and intangible benefits of a program and the direct and indirect costs of implementing the program. Unlike a cost-benefit analysis, which reduces a program’s benefits and costs to a common monetary unit, a cost-effectiveness analysis relates the effectiveness of reaching the program’s goals to the monetary value of the resources going into the program.

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Chapter 06: Program Planning for Success 96. List the four steps of the nutrition care process.

ANSWER: The four steps include: 1. Nutrition assessment 2. Nutrition diagnosis 3. Nutrition intervention 4. Monitoring and evaluation 97. Who might be possible partners for a community nutrition program aimed at 6- to 8-year-old girls?

ANSWER: Possible partners could include local businesses, cooperative extension offices, fitness and recreational facilities, food companies, local health departments, girl scouts, the university, other civic organizations, and parent and church groups.

98. State one overall program goal and two learning objectives for a community nutrition program aimed at 6- to 8-yearold girls.

ANSWER: Answers will vary but should focus on nutritional issues of 6- to 8-year-old girls. The goal should be a broad statement of desired changes or outcomes, whereas the objectives should be specific and measurable.

99. Write a structure objective and a process objective for a community nutrition program aimed at 6- to 8-year-old girls.

ANSWER: Answers will vary. However, a process objective is a measurable activity carried out by the community nutritionist in implementing the program while the structure objective helps achieve the process objective (and is related to budget, staffing patterns, management systems, resource use, or coordination).

100. Write a tag line for a community nutrition program aimed at 6- to 8-year-old girls.

ANSWER: Answers will vary but will need to be a short, simple message that conveys a key theme of the program.

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Chapter 07: The Art and Science of Policymaking True / False 1. Before a problem can be addressed, a majority of people must be convinced that it is a public, as opposed to a private, issue. a. True b. False ANSWER: True 2. Evaluation of a public policy should occur only after the policy has been terminated a. True b. False ANSWER: False 3. A community nutritionist will enforce policy decisions in his or her practice. a. True b. False ANSWER: True 4. In the United States, the steps followed by a bill that originates in the House are significantly different from those of a bill that originates in the Senate. a. True b. False ANSWER: False 5. Although Congress sets the policy, the enforcing agencies, such as the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (DHHS), are responsible for interpreting the law and providing detailed rules that put the policy into place. a. True b. False ANSWER: True 6. For entitlement programs, Congress provides whatever money is required from year to year to maintain benefits for eligible people. a. True b. False ANSWER: True 7. Medical nutrition therapy is a service provided by a registered dietitian that includes counseling, nutrition support, and nutrition assessment, and screening to improve people’s health and quality of life. a. True b. False ANSWER: True Page 1

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Chapter 07: The Art and Science of Policymaking 8. Licensure is a state regulatory action that establishes and enforces minimum competency standards for individuals working in regulated professions, such as dietetics. a. True b. False ANSWER: True 9. All states have state licensure laws for practicing dietitians. a. True b. False ANSWER: False 10. Currently, food safety efforts are consolidated into one independent agency. a. True b. False ANSWER: False 11. In the grassroots pyramid, there are more power players than fence sitters. a. True b. False ANSWER: False 12. The Academy of Nutrition and Dietetics has a political action committee (PAC) that has the legal authority to raise funds to support a given presidential candidate. a. True b. False ANSWER: True 13. Bread for the World is an example of a trade association interest group. a. True b. False ANSWER: False 14. Emailing your legislators can be an effective way to communicate with them. a. True b. False ANSWER: True

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Chapter 07: The Art and Science of Policymaking 15. As a community nutritionist, you will find that only national policy issues directly affect your work and the services you deliver. a. True b. False ANSWER: False Multiple Choice 16. Which is an appropriate method of building community awareness of an issue? a. Use the internet and other media sources. b. Write letters to congressional representatives. c. Join a professional organization, such as the Academy of Nutrition and Dietetics. d. Lobby elected government officials.

ANSWER: a 17. What is the purpose of policy evaluation? a. To identify potential problems that require policy to solve b. To gain support for the policy agenda c. To determine whether a program achieved its stated goals and reached its intended audience d. To brainstorm the best way to implement the policy ANSWER: c 18. What must happen before money can be released to a program? a. The program must submit receipts for reimbursement. b. An appropriation bill must be passed. c. The program must submit a budget of how the funds will be spent. d. The agency must be audited.

ANSWER: b 19. Which is a functional food? a. A dietary supplement b. A food that is fortified with essential nutrients c. A food that may provide health benefits beyond basic nutrition d. Foods that can be purchased only at farmers markets ANSWER: c

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Chapter 07: The Art and Science of Policymaking 20. Which is an effective method for communicating with elected officials? a. Hold a town hall meeting. b. Define a problem. c. Call the official’s office. d. Campaign on issues of community importance.

ANSWER: c 21. Which is the first step in the policy cycle? a. The formulation of alternatives b. Policy implementation c. The problem definition and agenda setting d. Policy adoption ANSWER: c 22. Which is the process by which people concerned about an issue work bring the issue to the attention of government officials? a. Agenda setting b. Formulation of alternatives c. Policy making d. Policy adoption ANSWER: a 23. Which is typically the most creative phase of the policy-making process? a. Formulation of alternatives b. Policy adoption c. Policy termination d. Problem definition and agenda setting ANSWER: a 24. In the United States, an issue must win support from whom to get onto the institutional agenda? a. Executive branch b. Judicial branch c. Senate d. Iron triangles ANSWER: d

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Chapter 07: The Art and Science of Policymaking 25. In which phase of the policy-making process are tools/instruments for dealing with the problem typically chosen? a. Formulation of alternatives b. Policy adoption c. Policy termination d. Problem definition and agenda setting ANSWER: b 26. Which two agencies are responsible for most nutrition programs at the federal level? a. U.S. Department of Agriculture (USDA) and the U.S. Food and Drug Administration (FDA) b. U.S. Department of Health and Human Services (DHHS) and USDA c. DHHS and National Institutes of Health (NIH) d. NIH and FDA ANSWER: b 27. Which is the overall mission of the Department of Health and Human Services? a. To reduce hunger in America and in other parts of the world b. To support the production of agriculture c. To ensure a safe, affordable, nutritious, and accessible food supply d. To protect the health of all Americans and provide essential human services ANSWER: d 28. The Food and Drug Administration is an agency of the which organization? a. National Institutes of Health b. Food and Nutrition Service c. Department of Health and Human Services d. Department of Agriculture ANSWER: c 29. Which agency houses 27 separate institutes and centers? a. Centers for Disease Control and Prevention b. Food and Drug Administration c. National Institutes of Health d. Food and Nutrition Service ANSWER: c

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Chapter 07: The Art and Science of Policymaking 30. Which U.S. Department of Agriculture (USDA) agency is responsible for administering the Supplemental Nutrition Assistance Program? a. Food Safety and Inspection Service b. Health Resources and Services Administration c. National Institutes of Health d. Food and Nutrition Service ANSWER: d 31. The houses the , the agency that oversees research related to nutrient needs, food trends, composition of the diet, nutrient interactions, and bioavailability of nutrients. a. Department of Health and Human Services; Center for Nutrition Policy and Promotion b. U.S. Department of Agriculture; Agricultural Research Service c. National Academy of Sciences; National Institute of Food and Agriculture d. Food and Drug Administration; Animal and Plant Health Inspection Service ANSWER: b 32. Which street-level bureaucrat makes daily policy decisions by interpreting government laws and regulating citizens? a. Federal congressperson b. Schoolteacher c. Food inspector d. State senator ANSWER: b 33. Which are rules for day-to-day operation that are established so that laws can be carried out? a. Legislation b. Bills c. Appropriations d. Regulations ANSWER: d 34. In which publication are the new rules of day-to-day operations necessary to carry out laws published? a. Federal Register b. Catalog of Federal Assistance c. Congressional Journal d. Congressional Record ANSWER: a

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Chapter 07: The Art and Science of Policymaking 35. After a bill is introduced in either body of Congress, where is the bill sent? a. To the President b. From the House to the Senate or vice versa c. To a committee d. To the systemic agenda ANSWER: c 36. After a bill has been introduced in Congress, where is the bill published? a. Federal Register b. Code of Federal Regulations c. White House Journal d. Congressional Record ANSWER: d 37. Once a bill has been sent from the Congress to the President, the President may do what? a. Sign it into law, at which point it becomes an act b. Veto it, which means it cannot become law c. Send it back with changes to conference committee d. Edit it, at which point it becomes a federal mandate ANSWER: a 38. The bill authorizing the women, infants, and children (WIC) supplemental feeding program became Public Law 92433. What do the numbers 92-433 stand for? a. Bill number 433, approved by a margin of 92 b. Bill number 92, enacted by the 433rd Congress c. Bill number 433, enacted by the 92nd Congress d. Bill number 92, approved by 433 votes ANSWER: c 39. The Affordable Care Act of 2010 authorized Medicare reimbursement for Registered Dietitians (working with primary care providers) to treat risk factors for obesity and what other condition? a. Osteoporosis b. Cardiovascular disease c. Diabetes d. Prediabetes ANSWER: c

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Chapter 07: The Art and Science of Policymaking 40. Which is the most important time for constituent involvement in the legislative process? a. Bill introduction b. Committee stage c. Floor stage d. Subcommittee stage ANSWER: d 41. In the federal budget process, the amounts of money that government agencies are allowed to spend in implementing their programs are called what? a. Budget revenue b. Budget outlays c. Budget authority d. Entitlements ANSWER: c 42. When does the President submits a budget proposal to Congress? a. Late January or early February b. March or April c. Mid to late June d. September or October ANSWER: a 43. Which program is an example of discretionary spending within the federal budget? a. Social Security benefits b. Medicare benefits c. Agricultural subsidies d. Funding for elderly nutrition programs ANSWER: d 44. Which defines the scope of a program and sets a maximum or ceiling on how much money can be spent on it? a. Appropriation b. Authorization c. Budget overlay d. Budget authority ANSWER: b

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Chapter 07: The Art and Science of Policymaking 45. In the House of Representatives, which committee has jurisdiction over revenue bills? a. Executive Committee b. Economic Development Committee c. Ways and Means Committee d. Economic Stimulus Committee ANSWER: c 46. What is one of the three priority public policy areas for the Academy of Nutrition and Dietetics? a. State licensure requirements b. Food and nutrition safety and security c. Repeal of the Medical Nutrition Therapy (MNT) Act of 1997 d. Insurance reimbursements ANSWER: b 47. Which federal agency is responsible for regulating all pesticide products? a. Environmental Protection Agency b. Centers for Disease Control and Prevention c. Federal Trade Commission d. Food and Nutrition Service ANSWER: a 48. Which involves talking to public officials and legislators to persuade them to consider information you provide on an issue you believe is important? a. Policy making b. Lobbying c. Political action committees (PACs) d. Coalition building ANSWER: b 49. Which approach to communicating with elected officials is most likely to be effective? a. Writing a multi-page letter referencing global examples for a local problem b. Sending an e-mail outlining your position with factual support c. Calling their offices and insisting on speaking directly to them d. Sending a letter addressed “To Whom It May Concern” ANSWER: b

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Chapter 07: The Art and Science of Policymaking 50. When issuing a press release to the media, it is best to do what? a. Speak off the cuff about the issue. b. Keep the content of the release brief. c. Begin with a vague call for action. d. Require the press to do its own fact-checking.

ANSWER: b 51. The gives the power to require that supplement makers follow “good manufacturing practices.” a. Dietary Supplemental Health and Education Act (DSHEA); U.S. Department of Agriculture (USDA) b. Medical Nutrition Therapy (MNT); USDA c. DSHEA; U.S. Food and Drug Administration (FDA) d. MNT; Centers for Disease Control and Prevention (CDC) ANSWER: c 52. Which are an effective tool for nutrition practitioners to become involved at the state and local level in policies that advance public health? a. Advertising campaigns b. Political action committees c. Trade associations d. Food policy councils ANSWER: d 53. Which resolves differences in the appropriations bills passed by the two houses of Congress? a. Compromise agreement b. Reconciliation bill c. Caucus bill d. Continuing resolution ANSWER: b 54. United Nations International Children’s Emergency Fund (UNICEF) has decried the ‘silent emergency’ of which ongoing issue within developed and developing countries? a. Adult malnutrition b. Contaminated health supplements c. Child malnutrition d. Obesity ANSWER: c

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Chapter 07: The Art and Science of Policymaking 55. The process of putting a policy into action is called what? a. Problem setting b. Adoption c. Implementation d. Termination ANSWER: c 56. Which individuals are “in the know” and understand the political system? a. Banner carriers b. Fence sitters c. Power players d. Willing workers ANSWER: c 57. Which term refers to people who have strong allegiance to their political group and who know their group members? a. Banner carriers b. Party people c. Power players d. Willing workers ANSWER: b 58. Which term refers to a person who endeavors diligently to get a task completed? a. Willing worker b. Banner carrier c. Critic d. Fence sitter ANSWER: a 59. Which term refers to someone who feels strongly about an issue but prefers to talk rather than do anything about it? a. Power player b. Fence sitter c. Critic d. Banner carrier ANSWER: d

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Chapter 07: The Art and Science of Policymaking 60. Dakota is not happy with the way things are but is not willing to do anything about it. Which term best describes Dakota? a. Fence sitter b. Critic c. Party person d. Banner carrier ANSWER: b 61. Although Riley seldom gets involved, she can be motivated on a specific issue. What would Riley be considered? a. Banner carrier b. Willing worker c. Fence sitter d. Power player ANSWER: c 62. Which term describes a significant gap between current reality (the way things are) and the desired state of affairs? a. Problem b. Appropriation c. Policy agenda d. Institutional agenda ANSWER: a 63. Which term describes the set of problems to which policy makers give their attention? a. Budget outlay b. Institutional agenda c. Appropriation d. Policy agenda ANSWER: d 64. Which term refers to the issues that are the subject of public policy? a. Budget authority b. Appropriation c. Outlay d. Institutional agenda ANSWER: d

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Chapter 07: The Art and Science of Policymaking 65. Meena is calculating the amount that government agencies are allowed to spend in implementing their programs.

What is Meena working on? a. Appropriation b. Budget authority c. Institutional agendas d. Budget outlays ANSWER: b 66. Which term refers to the amounts actually paid out by government agencies? a. Policy agendas b. Problems c. Appropriations d. Budget outlays ANSWER: d 67. Which term refers to having the authority to spend money? a. Institutional agenda b. Budget outlays c. Budget appropriation d. Policy agenda ANSWER: c 68. Which agency is part of the Department of Health and Human Services (DHHS)? a. Food Safety and Inspection Service b. Food and Nutrition Service c. Centers for Medicare and Medicaid Services d. Center for Nutrition Policy and Promotion ANSWER: c 69. Which agency coordinates nutrition policy within the U.S. Department of Agriculture (USDA) and works with the Department of Health and Human Services (DHHS) to revise the Dietary Guidelines for Americans? a. Centers for Disease Control and Prevention b. Food and Nutrition Service c. National Institutes of Health d. Center for Nutrition Policy and Promotion ANSWER: d

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Chapter 07: The Art and Science of Policymaking 70. Which agency supports research projects worldwide? a. National Institutes of Health b. Centers for Disease Control and Prevention c. Association on Aging d. Center for Nutrition Policy and Promotion ANSWER: a 71. What is the name of the operating division of the Department of Health and Human Services (DHHS) that oversees agencies such as the National Institutes of Health and the Centers for Disease Control and Prevention? a. Food, Nutrition, and Consumer Services b. Public Health Service c. Food Safety and Inspection Service d. Research, Education, and Economics ANSWER: b 72. Which agency is covered under the human resources operating division of the Department of Health and Human Services (DHHS)? a. National Institutes of Health b. Administration on Aging c. Food and Drug Administration d. Centers for Disease Control and Prevention ANSWER: b 73. Which Department of Health and Human Services (DHHS) agency collects national health data to prevent the spread of disease? a. Center for Nutrition Policy and Promotion b. National Institute of Food and Agriculture c. Centers for Disease Control and Prevention d. National Institutes of Health ANSWER: c 74. Which agency oversees food and nutrition assistance programs such as the Supplemental Nutrition Assistance Program and the National School Lunch Program? a. Food and Nutrition Service b. Center for Nutrition Policy and Promotion c. Administration for Children and Families d. Administration on Aging ANSWER: a

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Chapter 07: The Art and Science of Policymaking 75. Which agency ensures that meat and poultry are cleared for consumption and properly labeled? a. Agriculture Research Service b. National Institute of Food and Agriculture c. Public Health Service d. Food Safety and Inspection Service ANSWER: d 76. What is the goal of state licensure laws? a. To set safety standards for dietary and herbal supplements b. To ensure that individuals disseminating nutrition advice have the appropriate education and experience c. To monitor the development process of new food products d. To improve the nutritional quality and harvest yield of food crops ANSWER: b 77. What best describes complementary and alternative medicine? a. Adjunct to Western medicine b. Invasive form of preventive medicine c. Nontraditional use of Western medicines d. Management of health through diet alone ANSWER: a 78. Which term describes food products created by new scientific developments? a. Nutraceuticals b. Herbal supplements c. Dietary supplements d. Functional ANSWER: a 79. What is the goal of biotechnology? a. To monitor the diets of the public and track dietary trends b. To monitor the safety of herbal and dietary supplements c. To ensure that individuals disseminating nutrition advice have the appropriate education and experience d. To improve the nutritional quality and harvest yield of food crops ANSWER: d

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Chapter 07: The Art and Science of Policymaking 80. Which statement about dietary and herbal supplements is true? a. They are not required to meet any standards of effectiveness or safety. b. They are required to be approved by the Food and Drug Administration (FDA) prior to being placed on the market. c. Their packages may claim that the product “treats” or “prevents” common health problems. d. They are rigorously tested for safety and purity.

ANSWER: a Essay 81. Describe the process through which issues are placed on the policy agenda.

ANSWER: The first step is to build widespread public interest in the issue that deserves government attention. One of the most effective ways to build public interest and support for an issue is to work through the media (e.g., radio, television, newspapers, Internet). From there, the issue must get onto the institutional agenda as defined by each legislative body of the government. This is accomplished by winning support for the issue among interest groups, congressional committees or subcommittees, and administrative agencies.

82. Describe the policy-making process.

ANSWER: The policy-making process is illustrated in Figure 7-1. The major steps in this process are (1) problem definition and agenda setting, (2) formulation of alternatives, (3) policy adoption, (4) policy implementation, (5) policy evaluation, and (6) policy termination.

83. Explain the importance of legitimacy for successful public policies, citing an example.

ANSWER: Legitimacy is the belief on the part of citizens that the current government represents a proper form of government and a willingness on the part of those citizens to accept the decrees of that government as legal and authoritative. Essentially, legitimacy of public policy means that the citizens give the government the right to govern.

Examples will vary. One example shared in the chapter regarded the Food and Drug Administration’s (FDA’s) health claim policy. This stated that the appearance of health claims on food labels indicates that consumers and food companies accept the FDA’s authority to allow this action.

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Chapter 07: The Art and Science of Policymaking 84. A state dietetic association was interested in introducing a dietetic licensure bill during the state legislative session.

After three years, a dietetic licensure bill was signed into law. Describe the probable sequence of events for such a bill from the time the local dietetic association first raised licensure as a policy issue to the day the governor signed the bill into law.

ANSWER: The process by which a bill becomes a law is summarized in Figure 7-4. Probably, the dietetic association began the process by approaching one or more state legislature representatives, who had a dietetic licensure bill drafted. This bill would have been considered by committees and subcommittees and perhaps would have been revised during markup sessions before its presentation to the whole legislative body for a vote. A version of the bill would go through the same process in each part of the legislature (House and Senate). If the versions passed by each body were identical, the bill would have been sent to the governor to be signed into law; if not, a House–Senate conference committee would have been formed to develop a compromise bill that would be sent to the governor. Because it took three years for this bill to become law, it may have failed to pass originally and been reintroduced in a subsequent legislative session, or the dietetic association may have had to lobby for an extended period of time to have a bill introduced.

85. Why has the federal budget process been described as “fractured, contentious, and chaotic”?

ANSWER: The federal budget process has been described as “fractured, contentious, and chaotic” mainly because it forces the President and Congress to negotiate and agree on the problems that deserve top priority.

There is a limited amount of money, yet so many valid and important causes that need federal financial support. The budget is initially prepared by the Office of Management and Budget, then revised by the President, then submitted to Congress, where the two houses must reconcile any modifications they make before passing budget resolutions.

86. List the Academy of Nutrition and Dietetics’ three policy priority areas. Select one, and briefly share the Academy’s focus on this topic.

ANSWER: The three priority areas include prevention and well-being, health care and health systems, and food and nutrition safety and security.

Prevention and Well-Being: Develop appropriate and effective policies that support prevention and well-being initiatives to reduce the risk for chronic disease.

Health Care and Health Systems: Elevate the role of nutrition status in quality health care across the lifecycle; identify and treat all forms of malnutrition; use data to demonstrate the effectiveness of nutrition interventions; and improve health equity by increasing access to medical nutrition therapy services.

Food and Nutrition Safety and Security: Address food insecurity throughout the lifecycle with policies and culturally appropriate programs that increase equitable access to and utilization of affordable, healthy foods and safe water. Advance sustainable nutrition practices, and leverage innovations to reduce food waste.

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Chapter 07: The Art and Science of Policymaking 87. Identify three ways in which the community nutritionist can influence policy making.

ANSWER:

Contribute to a political action committee (PAC).

Lobby.

Join interest groups.

Build coalitions.

Communicate with your elected officials.

88. What is a political action committee (PAC)? Describe the purpose of PACs. ANSWER: A political action committee is the political arm of an interest group. It has the legal authority to raise funds from its members or employees to support candidates or political parties. The purpose of a PAC is to help elect candidates whose views are favorably aligned with the group’s mission or goals.

89. A personal letter to an elected official from a constituent can be a powerful tool for change. What points should you keep in mind to write an effective letter to your elected official?

ANSWER:

Get your elected official’s name right!

Limit your letter to one page.

Write about a single issue.

Refer to the legislation by bill number and name.

Explain how a legislative issue will affect your work, your organization, and your community.

Use logical rather than emotional arguments in support of your position.

Ask direct questions and request a reply.

Be cooperative and offer to provide further information.

Follow up with the elected official.

Whenever possible, use an example from your local community to draw attention to the issue.

Write as an individual rather than as a member of the Academy of Nutrition and Dietetics.

90. Draw the grassroots pyramid and describe your current level of involvement when it comes to nutrition policy.

ANSWER: The grassroots pyramid has a base of fence sitters. The next layer is comprised of banner carriers and critics. The third level includes willing workers; the fourth is party people; power players are in the peak level.

The student’s current level of involvement will vary.

91. What is the purpose of public policy?

ANSWER: The purpose of public policy is to fashion strategies for solving public problems.

92. What is the difference between an authorization and an appropriation?

ANSWER: An authorization defines the scope of a program, sets a ceiling on how much money can be spent on it, and provides the agency and departments with the legal ability to operate. Before money can be released to a program, an appropriation bill must be passed. This gives the program the authority to spend the money.

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Chapter 07: The Art and Science of Policymaking 93. What is the Human Genome Project?

ANSWER: The Human Genome Project was an international effort to locate and identify the sequencing of all the human genes, together known as the human genome.

94. Identify three methods that you would consider using when communicating with one of your elected officials. Why did you choose these?

ANSWER: Answers may include lobbying, writing letters, telephone calls, and e-mail.

95. Reflect on this statement: “If dietetics is your profession, politics is your business.”

ANSWER: Answers will vary, but students should be able to connect the strong relationship between dietetics and the role of public policy.

96. Define a problem. Does this question illustrate a problem, and more specifically, a public problem?

ANSWER: A problem is defined as a substantial discrepancy between what is and what should be. This is a problem, and a public problem for a variety reasons (which might vary). Possible reasons could include the monetary incentive to purchase more nutrient-dense foods and provide a “nudge” for fast-food restaurants to provide more healthful choices.

97. Draft a clear statement of the problem.

ANSWER: Statements will vary but will need to address the following components: • Who is experiencing the problem?

• Why or how did this problem develop?

• What actions have been taken in the past to address the problem?

• What is the history of the problem?

• What resources exist to help alleviate the problem?

98. What are some possible solutions to the problem? What phase of the policy-making process is this?

ANSWER: This is the policy-formulation phase of the process. Possible solutions will vary greatly.

99. What are some tips for working with the media?

ANSWER: Answers will vary but could include being connected in student and professional organization, making yourself available to media professionals and occasionally sending out short newsworthy articles or tips, being clear and using approachable language, being relevant and interesting, and being professional.

100. What are some general strategies for professional social media?

ANSWER: Answers will vary but could include developing a brand, posting frequently, checking for accuracy, responding to readers, and cultivating professional relationships with others.

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy True / False 1. A body mass index (BMI) of 30 translates into about 30 extra pounds for an adult. a. True b. False ANSWER: True 2. Extreme obesity refers to the same condition as having obesity. a. True b. False ANSWER: False 3. Excessive body weight in children is associated with increased morbidity and mortality, just as in adults. a. True b. False ANSWER: True 4. Body mass index may be an inaccurate measure for average-height adults. a. True b. False ANSWER: False 5. People with obesity spend at least a third more on health care costs than people without obesity. a. True b. False ANSWER: True 6. An obesogenic environment is one that promotes excessive weight gain. a. True b. False ANSWER: True 7. Consumption of energy-dense nuts is associated with weight gain. a. True b. False ANSWER: False

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 8. Food portion sizes have remained steady over the past 50 years. a. True b. False ANSWER: False 9. Obesity prevalence is higher within low-income neighborhoods, states, and legislative districts. a. True b. False ANSWER: True 10. Public health interventions for obesity target lifestyle approaches, such as dietary changes and physical activity. a. True b. False ANSWER: True 11. The role of the family is important in obesity prevention interventions targeting young children. a. True b. False ANSWER: True 12. One of the major components of the We Can! campaign initiated by the National Heart, Lung, and Blood Institute

is to increase physical activity and decrease screen time. a. True b. False ANSWER: True 13. A low Healthy Eating Index (HEI) score is associated with overweight and obesity. a. True b. False ANSWER: True 14. The United States Department of Agriculture (USDA) oversees deceptive marketing of foods and food-related

products. a. True b. False ANSWER: False

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 15. The Patient Protection and Affordable Care Act of 2010 requires certain restaurants to list calorie content

information for standard menu items on menu boards. a. True b. False ANSWER: True Multiple Choice 16. Why can we assume that the actual prevalence of overweight and obesity is somewhat higher than that ascertained

from Behavioral Risk Factor Surveillance System (BRFSS) data? a. Height is often underreported in self-report surveys. b. Weight is often underreported in self-report surveys. c. BRFSS data is obtained from those with a landline telephone. d. BRFSS data accounts for higher muscle mass levels.

ANSWER: b 17. Which childhood condition is associated with an increased body mass index (BMI) in adulthood? a. Food allergies b. Constipation c. Depression d. Arm fracture ANSWER: c 18. Which campaign is run by the National Heart, Lung, and Blood Institute (NHLBI) and targets ways to combat childhood obesity? a. We Can! b. MyPlate c. Action for Healthy Kids d. Voices for Healthy Kids ANSWER: a 19. The most accurate way to assess muscle mass and fat mass is through which method? a. Weight b. Body composition c. Waist circumference d. Body mass index (BMI) ANSWER: b

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 20. Body mass index (BMI) would be most accurate in identifying excess adiposity in which of the following individuals? a. 32-year-old male bodybuilder b. 65-year-old woman with low muscle mass c. 24-year-old male professional football player d. 40-year-old woman who eats a vegetarian diet ANSWER: d 21. Which body mass index (BMI) defines obesity in adults? a. Less than 24 b. Between 25 and 29.9 c. Greater than 30 d. Between 25 and 35 ANSWER: c 22. Which body mass index (BMI) defines overweight in adults? a. Less than 24 b. Between 25 and 29.9 c. Greater than 30 d. Between 25 and 35 ANSWER: b 23. Obesity for adults is divided into how many classes based on the degree of obesity? a. Two b. Three c. Four d. Five ANSWER: b 24. Which term describing body fat distributed around the abdomen is more highly associated with metabolic disturbances and health problems. a. Subcutaneous fat b. Android obesity c. Gynoid fat d. Peripheral obesity ANSWER: b

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 25. Excessive fat is indicated by a waist circumference of a. < 30 inches, < 25 inches b. > 30 inches, > 25 inches

for men and

for women.

c. > 40 inches, > 35 inches d. > 35 inches, > 40 inches ANSWER: c 26. Which body mass index (BMI) describes obesity in children? a. Below the 50th percentile on the Centers for Disease Control and Prevention (CDC) growth chart b. Between the 85th and 95th percentile on the CDC growth chart c. At or above the 75th percentile on the CDC growth chart d. At or above the 95th percentile on the CDC growth chart ANSWER: d 27. Which body mass index (BMI) describes overweight in children? a. Below the 50th percentile on the Centers for Disease Control and Prevention (CDC) growth chart b. Between the 85th and 95th percentile on the CDC growth chart c. At or above the 75th percentile on the CDC growth chart d. At or above the 95th percentile on the CDC growth chart ANSWER: b 28. For whom may the use of the body mass index (BMI) calculation be inaccurate? a. Those who are underweight b. Those who live in developing countries c. Children d. Those with large muscle mass ANSWER: d 29. Which national data are used most frequently to assess obesity data for Americans? a. Behavioral Risk Factor Surveillance System (BRFSS) b. Continuing Survey of Food Intakes by Individuals (CSFII) c. National Health and Examination Survey (NHANES) d. NHANES and BRFSS ANSWER: d

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 30. In the last two decades, which has been prevalent for U.S. adults? a. Both overweight and obesity increased. b. Obesity increased while the prevalence of overweight remained stable. c. Obesity increased while the prevalence of overweight decreased. d. Obesity remained stable while the prevalence of overweight increased.

ANSWER: b 31. According to the 2017–2018 National Health and Examination Survey (NHANES) data, the prevalence of obesity is highest among which ethnic population? a. Non-Hispanic whites b. Hispanics c. Non-Hispanic Asians d. Non-Hispanic Blacks ANSWER: d 32. Self-reported weight and height are considered somewhat unreliable because they are what kind of measures? a. Objective b. Outcome c. Subjective d. Desirable ANSWER: c 33. Which state has over 10 years of data indicating relatively stable rates of obese and overweight school-age children? a. Arkansas b. Tennessee c. Indiana d. Texas ANSWER: a 34. Which statement about the Youth Risk Behavior Surveillance System is most accurate? a. Data are self-reported. b. Data are limited to junior high and high school students. c. Data provide prevalence of obesity in all school age groups. d. Data are collected by school nurses.

ANSWER: a

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 35. Which of the following is one of the reasons for the costs associated with obesity? a. Higher supplement use b. Higher medical costs c. Increased use of alternative medicine d. Increased employment ANSWER: b 36. Of the increased cost of health care for individuals with obesity, which is the largest single contributor to associated death? a. Diabetes b. Cardiovascular disease c. Renal disease d. Hypertension ANSWER: b 37. Which individual has one of the contributing factors to metabolic syndrome? a. Woman with a waist circumference of 38 inches b. Man with a serum triglyceride level of 110 mg/dL c. Man with a serum HDL level of 43 mg/dL d. Woman with blood pressure of 128/80 mm Hg ANSWER: a 38. Which is the largest influence on energy expenditure? a. Basal metabolic rate b. Body mass index c. Thermal effect of food d. Volitionalphysicalactivity ANSWER: a 39. Which individual is at the greatest risk for significant weight gain over time? a. Individual with a basal metabolic rate (BMR) that does not change much b. Individual who starts drinking a 16 oz sugary coffee drink every day c. Individual who changes exercise routines every six months d. Individual who moves to a warmer climate after retirement ANSWER: b

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 40. Which describes the amount of energy able to be metabolized per unit weight or volume of food? a. Nutrient density b. Food weight c. Energy density d. Energy expenditure ANSWER: c 41. Increased consumption of which accounts for the greatest proportion of the overall increase in U.S. energy intake? a. Alcohol b. Sugar-sweetened beverages c. Fatty fast-food dishes d. Red meat ANSWER: b 42. Which behavior is most likely to contribute to the onset of obesity through epigenetics? a. Eating fruits and vegetables b. Consuming high-fiber foods c. Walking daily for at least 30 minutes d. Eating fast-food meals most days of the week ANSWER: d 43. Which environmental factor has been linked to more physical activity in children? a. Poverty b. Television c. Urban sprawl d. Friendship dynamics ANSWER: d 44. Based on recent research, what is a significant contributing factor of short sleep duration and the onset of obesity? a. Decrease in the satiety hormone leptin b. Decrease in the hunger hormone ghrelin c. 24-hour calorie intake d. Eating earlier in the day ANSWER: a

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 45. Which is an environmental strategy for a worksite weight-loss program? a. An educational dietary intervention offered to all employees b. A seminar about personal goal setting with mandatory attendance c. Encouraging physical activity during off-work hours d. Organizational practices that change the worksite physical environment ANSWER: d 46. Recent research indicates that breastfed babies are

likely to be overweight as compared with formula-fed

babies. a. somewhat more b. less c. equally d. muchmore ANSWER: b 47. More effective worksite-based interventions include which? a. Imposing financial penalties for not participating b. Linking salary to health status c. Implementing behavioral modification strategies d. Providing catered meals for those who wish to lose weight ANSWER: c 48. Many of the policy initiatives related to obesity address which? a. Overweight pregnant women b. Middle-aged to older adults with hypertension c. Children rather than adults d. Hispanics and African-American families ANSWER: c 49. What happened when Mexico passed a soda tax that was equivalent to a 10% price increase? a. There was a paradoxical increase in soda consumption across the nation. b. Only relatively wealthy households had a decrease in soda consumption. c. Only households in which wage-earners were relatively well educated decreased soda consumption. d. The greatest decrease in consumption occurred in the most vulnerable, low-income households.

ANSWER: d

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 50. Which of the following is one of the major goals established by the Institute of Medicine (IOM) in the report Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation? a. Make churches a national focal point for obesity prevention. b. Urge citizens to eat food prepared outside of the house. c. Encourage availability of fast food restaurants and casual dining. d. Transform messages about physical activity and nutrition.

ANSWER: d 51. Research indicates that targeted marketing and education may reduce obesity among Latino children through which types of strategies? a. Lists on foods to eat and foods to avoid b. Menu labeling and guided grocery store tours c. Playground signs and posters in school d. Community gardens and handouts on healthy foods ANSWER: b 52. Which organization developed the Healthy Eating Index? a. Food and Drug Administration b. Federal Trade Commission c. Center for Nutrition Policy and Promotion d. Centers for Disease Control and Prevention ANSWER: c 53. The built environment could be regulated to enhance physical activity and increase access to fresh, nutritious food through what kind of zoning? a. Mixed-use b. Subsidized c. Residential d. Exclusionary ANSWER: a 54. What is one potential problem with taxes on less nutritious foods? a. They may not appreciably alter food consumption patterns. b. They might disproportionately affect high-income people. c. They target manufacturers of food instead of consumers. d. Public opinion uniformly opposes these measures.

ANSWER: a

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 55. The United Nations addresses which the following through its Decade of Action on Nutrition? a. Complementary medicine b. Chronic diseases c. Childhood physical fitness d. Food insecurity ANSWER: d 56. Which are environmental and social trends that have been identified as possible contributors to the global obesity

epidemic? a. Fewer opportunities for recreational physical activity b. Increased safety measures to protect walkers and cyclists c. Replacement of contaminated water with soft drinks d. Expansion of the organic food market ANSWER: a 57. If public health approaches to address obesity are implemented, the obesity epidemic can be expected to follow a

pattern similar to smoking rates, which did what? a. Dropped sharply b. Rose sharply, then dropped gradually c. Reached a plateau, then started to drop d. Dropped and then rose again repeatedly ANSWER: c 58. Building awareness of what is the first step for the community nutritionist interested in addressing the obesity

epidemic? a. The societal cost of obesity reducing programs b. Association of obesity with chronic diseases c. Immediate financial costs of obesity to the taxpayer d. Role the media plays in the portrayal of overweight individuals ANSWER: b 59. Which is an immediate step that a community nutritionist may take to reduce obesity rates? a. Discouraging health care professionals from measuring and tracking (BMI) of their patients b. Writing to state legislators or members of Congress regarding upcoming obesity-related legislation c. Decreasing farm-to-school and farm-to-work programs d. Implementing taxation policies at the locally owned grocery store ANSWER: b

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 60. Which of the following strategies is most likely to have a positive impact on the community in improving factors

associated with obesity? a. Organize a fundraiser to create a safe walking trail. b. Post links to academic research papers online. c. Post educational flyers at local food banks. d. Campaign to shut down local fast food restaurants.

ANSWER: a 61. Which individual is most likely to experience a decrease in their basal metabolic rate (BMR)? a. A woman who adds eight lb of lean body mass b. A man who starts following a vegan diet c. A man who starts an exercise program d. A woman who loses 20 lb of weight ANSWER: d 62. Which act provides grants and technical assistance to schools, state and local agencies, Indian tribal organizations,

agricultural producers, and nonprofit entities to improve access to local foods in schools? a. Treat and Reduce Obesity Act of 2017 b. Expanding Nutrition’s Role in Curricula and Healthcare Act c. Farm to School Act of 2017 d. Sugar-Sweetened Beverages Tax Act of 2018 ANSWER: c 63. What is the effect of the Expanding Nutrition’s Role in Curricula and Healthcare Act? a. It establishes a program of three-year competitive grants to accredited medical schools for the development or expansion of an integrated physical activity curriculum. b. It imposes an excise tax on sugar-sweetened beverages and dedicates the revenues to the prevention,

treatment, and research of diet-related health conditions in priority populations, and for other purposes. c. It amends Title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. d. It provides grants and technical assistance to schools, state and local agencies, Indian tribal organizations, agricultural producers, and nonprofit entities to improve access to local foods in schools.

ANSWER: a

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 64. Which of the following situations is likely to be the biggest contributor to a child’s overweight status? a. Drinking 16 oz low-fat milk daily b. Drinking 20 oz sparkling water daily c. Drinking 20 oz orange juice daily d. Drinking 12 oz diet lemonade daily ANSWER: c 65. Which piece of legislation imposed an excise tax on sugar-sweetened beverages, with the revenues used to fund the prevention, treatment, and research of diet-related health conditions? a. Sugar-Sweetened Beverages Tax Act of 2018 b. Treat and Reduce Obesity Act of 2017 c. Farm to School Act of 2017 d. Expanding Nutrition’s Role in Curricula and Healthcare Act ANSWER: a 66. What is the effect of the Treat and Reduce Obesity Act of 2017? a. It provides grants and technical assistance to schools, state and local agencies, Indian tribal organizations,

agricultural producers, and nonprofit entities to improve access to local foods in schools. b. It imposes an excise tax on sugar-sweetened beverages and dedicates the revenues to the prevention, treatment, and research of diet-related health conditions in priority populations, and for other purposes. c. It amends Title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. d. It establishes a program of three-year competitive grants to accredited medical schools for the development or expansion of an integrated physical activity curriculum.

ANSWER: c 67. Which situation is likely to promote an obesogenic environment? a. A decrease of supermarket prices on fruits and vegetables b. A decrease of supermarket prices on energy-dense foods c. An increase of supermarket prices on carbonated sodas d. An increase of supermarket prices on packaged snack foods ANSWER: b 68. Which organization is the government sponsor of the School Health Index for Physical Activity and Healthy Eating? a. Division of Adolescent and School Health b. Centers for Disease Control c. Division of Nutrition, Physical Activity, and Obesity d. White House Task Force on Childhood Obesity ANSWER: a Page 13

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 69. Which governmental organization sponsors Spectrum of Opportunities? a. U.S. Department of Agriculture b. Division of Adolescent and School Health c. Centers for Disease Control d. Division of Nutrition, Physical Activity, and Obesity ANSWER: c 70. Mark is a 37-year-old man who is 5’9” tall and weighs 211 lb. How would you classify Mark’s weight status? a. Normal weight b. Overweight c. Obese I d. Obese III ANSWER: c 71. Increasing the number of sidewalks and playgrounds is an example of what type of strategy? a. Primary prevention b. Secondary prevention c. Health promotion d. Suburban sprawl ANSWER: a 72. Which organization sponsors the National School Lunch program? a. U.S. Department of Agriculture b. White House Task Force on Childhood Obesity c. Division of Nutrition, Physical Activity, and Obesity d. Division of Adolescent and School Health ANSWER: a 73. Which governmental organization sponsors State Public Health Actions? a. Division of Adolescent and School Health b. Centers for Disease Control and Prevention c. White House Task Force on Childhood Obesity d. Division of Nutrition, Physical Activity, and Obesity ANSWER: d

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 74. Which organization sponsors Safe Routes to School? a. White House Task Force on Childhood Obesity b. Centers for Disease Control and Prevention c. Department of Transportation d. Division of Adolescent and School Health ANSWER: c 75. Which of the following intervention methods for childhood obesity is most flawed? a. Refer the child to a dietitian for individual intervention. b. Give the child and parents a handout on healthy eating. c. Refer the child to a low-cost family education program offered at the doctor’s office. d. Give the child and family access to a physical fitness center.

ANSWER: b 76. Which individual would be most appropriate for pharmacotherapy weight loss intervention? a. Body mass index (BMI) 28.3 and diagnosis of type 2 diabetes b. BMI 26.5 and a diagnosis of type 2 diabetes c. BMI 29.5 with no comorbidities d. BMI 29.5 and a diagnosis of asthma ANSWER: a 77. How many minutes of exercise, six times a week, may be necessary to prevent weight gain? a. Up to 30 b. Up to 60 c. Up to 90 d. Up to 120 ANSWER: b 78. Among the many popular fad diets and weight loss programs available, what is the one thing they all have in common that makes them effective for weight loss intervention? a. They are followed for a specific amount of time. b. They provide food lists to follow. c. They promote healthy eating. d. They create a calorie deficit.

ANSWER: d

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 79. Which governmental organization sponsors the Whole School, Whole Community, Whole Child model? a. Division of Adolescent and School Health b. Centers for Disease Control and Prevention c. Department of Transportation d. Division of Nutrition, Physical Activity, and Obesity ANSWER: a 80. Which of the following statements is most accurate about the impact of marketing to children? a. Children do not respond to food marketing messages. b. Food marketers do not aim their messages to children under the age of 14. c. Marketing message improvements do not affect Black or Hispanic children. d. Marketing messages with candy using familiar media characters are effective.

ANSWER: d Essay 81. Define overweight and obesity for adults.

ANSWER: The terms obesity and overweight both refer to the accumulation of excess adipose tissues; obesity

is the more severe form. Adults with a body mass index (BMI) between 25.0 and 29.9 are defined as overweight, whereas those individuals with a BMI of 30.0 or greater are defined as obese.

82. Define overweight and obesity for children.

ANSWER: For children, obesity is defined as a body mass index (BMI) at or above the Centers for Disease

Control and Prevention (CDC) growth chart criterion of 95th percentile based on gender and age standards. Overweight reflects a BMI at or above the CDC growth criterion of 85th percentile but lower than the 95th percentile based on sex and age standards.

83. The National Health and Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) are two surveys used to collect data on individuals to assess overweight and obesity on a population level.

Identify the benefits and limitations to both surveys.

ANSWER: The NHANES is conducted by the National Center for Health Statistics and involves a nationally representative sample. Annually, NHANES staff members gather objective data such as anthropometric measures and biochemical measures, complete a dietary recall for intake data, collect physical activity information, and report demographic data. Dietary recalls may be inaccurate.

For the BRFSS, self-reported data are collected from individual states through a random-digit dial telephone interview with adults aged 18 and older. Because the data collected are representative at the state level, trends in overweight and obesity among adults can be obtained for each of the states. This data is subjective, which may lead to inaccuracies. With the increased use of cellular phones and decreased use of landlines, certain segments of the population may not be included.

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 84. Discuss the social ramifications of obesity and overweight for children.

ANSWER: Overall quality of life is often worse with increasing obesity, and people with obesity experience

prejudice and discrimination. Children who are overweight are often seen as lazy and unmotivated and may have lower self-esteem and experience depression. Recent research has found that children who are overweight tend to have fewer friends and social networks.

85. Discuss the postulated relationship between sleep duration and obesity.

ANSWER: Epidemiological studies in both children and adults have found a positive association between short

sleep duration and obesity. The association is believed to be linked to low lepton and high gherkin levels (two hormones that control appetite).

86. List and discuss four of the environmental risk factors for obesity and overweight.

ANSWER: a. Food Production and Transportation. Some researchers suggest the mass production and preparation of ready-to-eat meals factor into the increase in obesity. b. Other Technological Changes. Technological change may lead to an expanding food supply, putting downward pressure on the price of food, which in turn stimulates consumption at the consumer level. c. Portion Sizes. The increase in portion size parallels the rising rate of obesity. d. Food Available at Restaurants. A recent study found that fast-food and table service meals at restaurants are larger and have more calories than meals prepared at home. e. Social Environment. Examples of factors in the social environment that may influence the risk of childhood overweight include parental overweight; maternal smoking during pregnancy; cumulative stress experienced by a child’s mother; parental depression, which is a stressor on parenting behavior;, and low rates of breastfeeding. f. Urban Sprawl and the Built Environment. The walkability of a residential area is thought to be an important predictor of body weight, with lower rates of overweight and obesity in more walk able neighborhoods.

g. Poverty. Obesity rates are higher in lower-income neighborhoods, states, and legislative districts.

87. Discuss public health intervention strategies for the treatment of obesity and overweight among adults.

ANSWER: In public health applications, interventions that address body weight are often preventive, rather than treatment oriented. For an effective intervention in the public health setting, the program has to have significant effectiveness in clinical settings, broad reach in the population of interest, and consistent implementation in real-life settings. Interventions may also be grouped by age. Public health interventions tend to focus on lifestyle approaches, such as dietary changes and physical activity, and are implemented in community or worksite settings.

88. Many of the policy initiatives address children rather than adults. Why? ANSWER: First, because obesity is so intractable, it is preferable and more cost-effective to focus on

prevention. Second, food habits are still fairly malleable for children, so it makes sense to target policies and programs at this age group. Finally, it is easy to reach children through the school environment.

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 89. Discuss how regulating food, school, and built environments could lessen the impact and prevalence of obesity.

ANSWER: It is logical to conclude that regulation of environmental factors, such as food availability and

opportunities for physical activity, can influence diet and exercise habits, which in turn leads to the decrease or increase of obesity rates in a population. From an economic perspective, increased rates of obesity lead to higher costs to society in a number of ways, including direct health care costs or work productivity losses. Systematic change of environments has greater potential than education alone to affect overall diet and physical activity patterns in populations.

90. Discuss the tax-related pricing policies that have been proposed to address obesity.

ANSWER: Tax incentives could be used to encourage more healthful dietary and physical activity behaviors, by (1) encouraging employers to promote worksite wellness programs, and (2) encouraging real estate developers to convert unused or abandoned spaces into physical activity-oriented facilities or to include green space and accessible sidewalks in their plans for residential development. An additional recommendation is to tax less nutritious foods, similar to the taxation of alcohol and tobacco products.

The tax revenue could then be used on nutrition education campaigns.

91. Why is body mass index (BMI) used most frequently as a measure of obesity?

ANSWER: The use of the BMI calculation is inexpensive and more practical in large population-based studies.

92. List five problems associated with obesity in children and five for adults.

ANSWER: See Table 8-3 for a complete listing.

93. What is the Youth Risk Behavior Surveillance System (YRBSS)?

ANSWER: The YRBSS provides self-reported data from high school students on risky behaviors, including

obesity.

94. Based on the research using data from a variety of sources, including census data and the Behavioral Risk Factor

Surveillance System (BRFS), discuss the relationship between fast-food restaurants and weight status.

ANSWER: Researchers found that fast-food density and a higher ratio of fast-food to full-service restaurants

were associated with higher individual-level weight status. The prevalence of fast-food restaurants in the United States was associated with obesity on a statewide basis. Fast-food restaurant concentration was also associated with increased preschool-aged childhood obesity and with eating fewer fruits and vegetables in middle school and high school students.

95. In the research, parents are reported as “gatekeepers” for children’s eating and physical activity behaviors. What

does this mean?

ANSWER: A gatekeeper is one who controls the types of foods in the house, the access to and availability of

those foods, opportunities for activity or inactivity, and meal patterns.

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Chapter 08: Addressing the Obesity Epidemic: An Issue for Public Health Policy 96. List two specific community interventions or programs that you could create to address overweight and obesity. In

each example, include the reasoning for the intervention or program, the target audience, the objective of the program, and possible professional collaboration for implementation.

ANSWER: Answers will vary greatly. Examples may include programs that attempt to promote healthful food

products; campaigns aimed at regulation of media and advertising, especially those aimed at children; helping to formulate new nutrition standards for school meals and food sold on campuses; helping to establish farmers’ markets and farm-to-work programs; and setting up walking programs or walking routes around the cities and neighborhoods.

97. Reflecting on your years in high school, what are some areas in which health and wellness were not promoted?

ANSWER: Answers will vary but could include the presence of vending machines filled with nutrient-poor

snacks, lack of physical education courses, limited nutrition information presented in health courses, and/or unhealthful food options available for lunch.

98. Of these areas of improvement, which one area would you prioritize first and why?

ANSWER: Answers will vary.

99. Outline a brief plan of action to improve this identified weaker area.

ANSWER: Answers will vary.

100. Of these areas of improvement, which one area do you believe would be hardest to address?

ANSWER: Answers will vary.

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Chapter 09: Health-Care Systems and Policy True / False 1. Paradoxically, U.S. health care treats preventable illness rather than investing in prevention. a. True b. False ANSWER: True 2. In the United States, there are two general categories of health insurance: private insurance and managed care plans. a. True b. False ANSWER: False 3. Traditional fee-for-service plans are provided by the Centers for Medicare and Medicaid Services (CMS). a. True b. False ANSWER: False 4. Consumer-directed health plans define employer contributions while asking employees to be more responsible for

health care decisions and cost-sharing. a. True b. False ANSWER: True 5. Medicare pays qualified dietitians and nutrition professionals who enroll in the Medicare program as providers,

regardless of where they provide medical nutrition therapy (MNT) services. a. True b. False ANSWER: True 6. As currently used, the term health care reform refers to the efforts undertaken to ensure that everyone in the

United States has access to affordable, quality health care. a. True b. False ANSWER: True 7. Use of generic drugs is one method that has been utilized to help contain the costs of health care. a. True b. False ANSWER: True Page 1

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Chapter 09: Health-Care Systems and Policy 8. Over two-thirds of national health care expenditures are from hospital care, physician and clinical services, and

prescription drugs. a. True b. False ANSWER: True 9. A self-insured health plan describes a plan where the risk for medical costs is assumed by the patient rather than

by an insurance company. a. True b. False ANSWER: False 10. A prospective payment system involves hospitals being paid a fixed sum per case according to a schedule of

diagnosis-related groups. a. True b. False ANSWER: True 11. Relative weight reflects the cost of caring for a patient in a particular category with a diagnosis-related group

(DRG). a. True b. False ANSWER: True 12. The Affordable Care Act (ACA) includes regulations on private market health plans that allow employers to

insure participants based on current health status. a. True b. False ANSWER: False 13. The cost effectiveness of nutrition services is uncertain. a. True b. False ANSWER: False 14. The challenge for the next decade is to change the U.S. approach to health care from a system based on disease

prevention and health promotion to one based on treatment of acute conditions. a. True b. False ANSWER: False Page 2

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Chapter 09: Health-Care Systems and Policy 15. The International Classification of Diseases was written to guide decision making in areas of moral conflict and

to outline the obligations of the practitioner to self, client, society, and the profession. a. True b. False ANSWER: False Multiple Choice 16. What is the leading cause of death in the United States? a. Hospital visits b. Chronic diseases c. Accidents d. Smoking ANSWER: b 17. What type of insurance plan is provided through an employer or union? a. Medicare and Medicaid b. Direct purchase private insurance c. Employment-based private insurance d. Government health insurance plans ANSWER: c 18. What is a disadvantage of traditional fee-for-service insurance? a. It is not as common and hard to obtain. b. There is too much flexibility to obtain services. c. There is limited access to physicians. d. It encourages physicians to provide more services than may be necessary.

ANSWER: d 19. In some health maintenance organization (HMO) programs, the provider receives a specific amount per enrollee per month to provide a defined group of health care services. What is this amount called? a. Capitation payment b. Fee for service c. Provider payment d. Discounted fee ANSWER: a

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Chapter 09: Health-Care Systems and Policy 20. Who defines eligibility for Medicaid? a. The federal government b. Individual states c. Local governments d. Hospital systems ANSWER: b 21. What was the purpose of the Children’s Health Insurance Program initiative? a. To help more children become insured by employer-sponsored programs b. To insure children whose families were not working and did not know about Medicaid c. To reach children whose families’ incomes were too high for Medicaid but too low to afford private health insurance d. To educate families about insurance options for their children ANSWER: c 22. Which group makes up the highest percentage of those who are uninsured? a. Families with at least four members b. The very poor c. Older adults d. Employees of small businesses ANSWER: d 23. Which of the following is an important factor shaping the future of medical care costs? a. Aging population b. Race c. Number of babies born annually d. Geographical demographics ANSWER: a 24. What is one issue that Healthy People 2020 will monitor over the next decade? a. Access to care for diverse populations b. Effectiveness of prenatal care c. Protection from chronic diseases d. Health care access by geographical location ANSWER: a

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Chapter 09: Health-Care Systems and Policy 25. Over two-thirds of national health care expenditures are related to hospital care, physician and clinical services, and which other factor? a. Workers’ compensation b. Outpatient services c. School health d. Prescription drugs ANSWER: d 26. Which of the following statements is a reason to include nutrition in reimbursable services for health promotion and

disease prevention? a. Patient buy-in is easy to achieve in lifestyle changes like improving nutrition. b. Nutrition services are an important intervention to those with chronic disease. c. Nutrition services can reduce the need for more expensive therapies. d. Patients readily adapt to nutrition interventions.

ANSWER: c 27. Which of the following statements is most accurate about the shifting focus of health care to one of health promotion? a. Community nutritionists will have to make ethical decisions to provide optimal nutritional care for individuals. b. Community nutritionists can work with clients only after a referral from a physician. c. Community nutritionists can support reform to health care by advocating for change to local politicians. d. Community nutritionists should work with only the clients who have an underlying condition requiring nutritional intervention.

ANSWER: c 28. Which best describes an overarching goal of the health agenda Healthy People 2020? a. Supporting financial incentives for chronic disease treatment b. Creating physical environments that promote good health for all c. Assigning a treatment role to the health care model d. Increasing per capita spending on managing functional health impairments ANSWER: b 29. Public policy is now attempting to direct the medical system toward which? a. Disease prevention b. Illness treatment c. Chronic disease management d. Complementary and alternative therapies ANSWER: a

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Chapter 09: Health-Care Systems and Policy 30. Which option for health care insurance is considered the most cost-effective way of practicing medicine? a. Health maintenance organization (HMO) b. Preferred provider organization (PPO) c. Point of service (POS) d. Exclusive provider organization (EPO) ANSWER: a 31. Which best describes how a preferred provider organization (PPO) differs from a health maintenance organization

(HMO)? a. Only PPOs enter into agreements with health care providers. b. A member of a PPO is not required to select a primary care provider. c. A PPO limits coverage to care only from specialists. d. A PPO requires higher deductibles than HMOs. ANSWER: b 32. Health maintenance organizations are designed to make money by doing what? a. Charging fees for each service rendered b. Keeping people healthy c. Limiting coverage to chronic disease and disabilities d. Avoiding public health models of care ANSWER: b 33. Which type of health insurance is available as either traditional plans or group contract insurance? a. Private insurance b. Preferred provider plans c. Health maintenance organizations d. Public health plans ANSWER: a 34. Using specified codes, enrolled Medicare medical nutrition therapy (MNT) providers are able to bill Medicare for

MNT services provided to Medicare beneficiaries with what condition? a. Rheumatoid arthritis b. Type 1 diabetes c. Gastroesophageal reflux d. Dementia ANSWER: b

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Chapter 09: Health-Care Systems and Policy 35. Which best describes a benefit of a point-of-service (POS) plan? a. Plan members can get medical care from both in- and out-of-network providers. b. Plan members receive a tax-advantaged health reimbursement arrangement. c. Plan members can use specialty services without requiring a referral. d. Plan members are always enrolled in a health savings account.

ANSWER: a 36. To be able to receive benefits through a Medicare Advantage Plan (Part C), an individual must have what? a. Medicare parts A and B b. Evidence of a disability c. At least one minor dependent d. An income that is at or above the federal poverty line ANSWER: a 37. Which status would qualify an individual for Medicare benefits? a. Living on an income below the poverty line b. Retired fromfulltime employment c. Eligible for Social Security disability programs for 24 months d. Living in a state that has health insurance benefits ANSWER: c 38. Under the Children’s Health Insurance Program (CHIP), states may target eligible uninsured children by what

means? a. Setting maximum allowable amounts for medical assets b. Offering enrollment at designated times c. Expanding Medicaid programs d. Increasing parameters for disability diagnoses ANSWER: c 39. Benefits provided by Medicare Part A include which? a. Inpatient hospital care b. Diagnostic x-rays c. Ambulance services d. Medical nutrition therapy services ANSWER: a

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Chapter 09: Health-Care Systems and Policy 40. When those without health insurance get sick and need care, which service do they often wind up using? a. Primary care providers b. Publichealth clinics c. Hospital emergency rooms d. Home health services ANSWER: c 41. Which are the two most notable gaps in Medicare coverage? a. Rehabilitation services and in-hospital care b. Skilled nursing care and prescription drug coverage c. Primary care physician services and durable medical equipment costs d. Home health care and palliative or hospice care ANSWER: b 42. The Medicare Modernization Act provides which benefit as part of optional coverage for Medicare recipients? a. Inpatient hospital care b. Psychiatric and mental health services c. Long-term institutional care d. Cardiovascular disease blood screening ANSWER: d 43. For whom does Medicaid provides assistance with medical care? a. Medicare-covered government employees b. People with end-stage renal disease c. People eligible for Social Security benefits d. Blind persons ANSWER: d 44. Who are most often included among the uninsured? a. Older adults b. Self-employed business persons c. Those with end-stage renal disease d. Pregnant women ANSWER: b

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Chapter 09: Health-Care Systems and Policy 45. In 2018, approximately which percent of the U.S. population was uninsured? a. 9 b. 17 c. 68 d. 91 ANSWER: a 46. By 2030, approximately which percent of the population will be over 65 years of age? a. 13 b. 17 c. 21 d. 26 ANSWER: c 47. What best describes one of the challenges to health care reform? a. Making health care accessible only to those with disabilities b. Understanding why some individuals are qualified for health care coverage c. Gaining access to federal funds for health expenditures d. Providing nursing home care to those who need it ANSWER: d 48. To determine the rating of a particular health care system, one must examine three crucial variables: cost, quality,

and what? a. Property b. Access c. Budgets d. Injuries ANSWER: b 49. Which term describes a health insurance contract that is made with an employer or other entity and covers several

people by reference to their relationship to the entity? a. Group contract b. Managed care system c. Point-of-service plan d. Exclusive provider contract ANSWER: a

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Chapter 09: Health-Care Systems and Policy 50. Which is a factor in the increasing level of health care activity? a. Expanded guidelines for diagnosing chronic health problems b. Increased health disparities between racial and ethnic minorities c. Growth of infant mortality rates d. Continuing advances in medicine ANSWER: d 51. Which trend characterizes the cost-containment efforts of third-party payers to control their own costs? a. Avoiding corporate management of health care costs of employees b. Moving away from managed care to fee-for-service models c. Moving toward cost shifting in order to avoid self-insured health plans d. Setting reimbursement restrictions and limitations ANSWER: d 52. Which is a consequence of the prospective payment system? a. The elimination of palliative care services b. A restriction for dietitians to provide inpatient services c. An increased focus on outpatient as opposed to inpatient care d. The replacement of allied health services with nursing care ANSWER: c 53. Which best describes the concept of the prospective payment system? a. Patients pay a specific portion of their own medical care. b. Insurers are given discounts to cover the costs of charity care. c. Insurance plan members pay certain amounts to preferred providers within a network. d. Hospitals are paid a fixed sum according to diagnosis related groups.

ANSWER: d 54. Which is the largest component of national health care expenditures? a. Hospital care b. Physician and clinical services c. Prescription drug coverage d. Long-term care ANSWER: a

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Chapter 09: Health-Care Systems and Policy 55. Which best describes how medical nutrition therapy can reduce health costs? a. It reduces out-of-pocket costs for acute illnesses. b. It improves patient outcomes and reduces recovery times. c. It has unlimited financial holdings on health coverage. d. It is easier to implement when compared to most medical treatments.

ANSWER: b 56. To enhance the quality and effectiveness of nutrition programs and intervention, what are policy makers urging

dietitians to do? a. Educate clients. b. Collaborate with other professionals. c. Make these services cheaper. d. Develop practice guidelines.

ANSWER: d 57. Which element is a component of the Affordable Care Act to reform health care? a. Medicaid eligibility is available for people who live at up to 55% of the national poverty level. b. Preexisting conditions have been eliminated from care considerations. c. Young adults can be covered by their parents’ insurance until they reach age 18. d. Individuals and small businesses can buy health insurance through insurance exchanges.

ANSWER: d 58. When nutrition services are integrated into health care and diet and nutritional status change, what outcome is most

likely to occur? a. Blood pressure in hypertensive patients is lowered. b. The prevalence of hemophilia is reduced. c. Instances of premature infant delivery is reduced. d. Patients report greater satisfaction in their personal relationships.

ANSWER: a 59. What challenge is the United States facing over the next decade as it relates to health care reform? a. It is a prevention model that needs to reduce the number of uninsured. b. It is an activity model that needs to reduce chronic disease. c. It is a wellness model that needs to shift health care focus to disease prevention and health promotion. d. It is a medical model that needs to get more professionals interested in education of individuals.

ANSWER: c

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Chapter 09: Health-Care Systems and Policy 60. Dietetics practitioners have voluntarily adopted the Code of Ethics to set forth obligations of the dietetics

practitioner to the self, clients, society, and what? a. The government b. Insurance companies c. The profession d. Third-party payers ANSWER: c 61. Which health maintenance organization (HMO) model owns and operates its own facility, is equipped for laboratory, pharmacy, and x-ray services, and hires its own physicians and other health care providers? a. Group model b. Independent practice association c. Network model d. Staff model ANSWER: d 62. Which health maintenance organization (HMO) model contracts with one or more multispecialty group practices that contract to provide health care services to its members? a. Group model b. Independent practice association c. Network model d. Staff model ANSWER: a 63. Which health maintenance organization (HMO) model contracts with multiple group practices, hospitals, and other providers to provide services to its members in a nonexclusive arrangement? a. Group model b. Independent practice association c. Network model d. Staff model ANSWER: c 64. Which health maintenance organization (HMO) model is decentralized? a. Group model b. Independent practice association c. Network model d. Staff model ANSWER: b

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Chapter 09: Health-Care Systems and Policy 65. Which term describes an expense that must be incurred by an insured person before an insurer will assume any liability for the covered services? a. Capitation b. Coinsurance c. Copayment d. Deductible ANSWER: d 66. Which term describes a health insurance contract that is made with an employer and covers employees? a. Group contract b. Health maintenance organization (HMO) c. Managed-care system d. Preferred provider organization (PPO) ANSWER: a 67. Which term describes an approach to paying for health care in which insurers try to limit the use of health services, reduce costs, or both? a. Health maintenance organization (HMO) b. Managed-care system c. Preferred provider organization (PPO) d. Prospective payment system ANSWER: b 68. Which term describes a prepaid plan that both finances and delivers health care? a. Group contract b. Health maintenance organization (HMO) c. Managed-care system d. Preferred provider organization (PPO) ANSWER: b 69. Which term describes a group of providers who contract with fee-for-service insurance companies to provide medical care for a discounted fee? a. Group contract b. Health maintenance organization (HMO) c. Managed-care system d. Preferred provider organization (PPO) ANSWER: d

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Chapter 09: Health-Care Systems and Policy 70. Which term describes a predetermined fee paid per enrollee per month to the participating health care provider? a. Capitation b. Coinsurance c. Copayment d. Deductible ANSWER: a 71. Which term describes a cost-sharing requirement in which the insured assumes a portion of the costs of covered expenses? a. Capitation b. Coinsurance c. Copayment d. Deductible ANSWER: b 72. Which term describes the portion of the charge for medical services that the patient must pay? a. Copayment b. Deductible c. Reimbursement d. Coinsurance ANSWER: a 73. Which term describes a payment made by a third party? a. Copayment b. Deductible c. Reimbursement d. Coinsurance ANSWER: c 74. Which term describes a payment system under which hospitals are paid a fixed sum per case? a. Preferred provider organization (PPO) b. Prospective payment system c. Managed-care system d. Copayment ANSWER: b

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Chapter 09: Health-Care Systems and Policy 75. Which of the following describes Medicare? a. It serves certain pregnant women and infants with family incomes below 133% of the poverty level. b. It assists individuals with end-stage renal disease. c. It is financed by taxes from federal, state, and local sources. d. It is a federal-state partnership.

ANSWER: b 76. Social security handles enrollment for which of the following programs? a. Medicaid b. Point of service (POS) c. Self-insured health plan d. Medicare ANSWER: d 77. Which of these is a federal-state partnership assistance program? a. Exclusive provider organization (EPO) b. Medical nutrition therapy c. Medicare d. Medicaid ANSWER: d 78. Which program is financed by taxes from federal, state, and local sources? a. Exclusive provider organization (EPO) b. Medicaid c. Medicare d. Point of service (POS) ANSWER: b 79. Which program consists of Part A and Part B? a. Children’s Health Insurance Program (CHIP) b. Medicare c. Self-insured health plan d. Preferred provider organization (PPO) ANSWER: b

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Chapter 09: Health-Care Systems and Policy 80. Which describes Medicaid? a. It assists individuals with end-stage renal disease. b. It consists of Part A and Part B. c. It serves certain pregnant women and infants with family incomes below 133% of the poverty level. d. It is financed by trust funds from Social Security.

ANSWER: c 81. Which of these is financed by trust funds from Social Security? a. Point of service (POS) b. Medicare c. Coinsurance d. Medicaid ANSWER: b 82. Which of these excludes most prescription drugs, regular dental care, and nursing home care (except skilled nursing care)? a. Health maintenance organization (HMO) b. Self-insured health plan c. Medicare d. Preferred provider organization (PPO) ANSWER: c Essay 83. Explain why health maintenance organizations (HMOs) are viewed as a more cost-effective way of practicing

medicine than the traditional fee-for-service systems.

ANSWER: The HMO idea is viewed as a fixed cost to the consumer with the health care insurer and health care

provider as one and the same. This model is viewed as a more cost-effective way of practicing medicine compared to the traditional fee-for-service plan. Prepaid group health plans emphasize health promotion because they provide health care services at a preset cost. By keeping people healthy, HMOs avoid the need for lengthy hospitalizations and costly services. Because HMOs make money by keeping you healthy, they have a greater stake in your wellness.

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Chapter 09: Health-Care Systems and Policy 84. Differentiate between traditional systems of health care and managed forms of health care.

ANSWER: Traditional systems of health care include a billing system in which the provider of care charges a fee

for each service rendered. While this type of insurance has become relatively uncommon, proponents of fee-for-service systems prefer the greater flexibility and unrestricted access to physicians, tests, hospitals, and treatments. The managed care system is an approach to paying for health care in which insurers try to limit the use of health services, reduce cost, or both. A utilization review aims to prevent unnecessary treatment by requiring enrollees to obtain approval for nonemergency hospital care, denying payment for wasteful treatment, and monitoring severely ill patients to ensure that they get cost-effective care. Managed forms of health care include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans. The presumed goal of managed care is improved quality of care with decreased costs.

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Chapter 09: Health-Care Systems and Policy 85. Describe eligibility requirements for and services provided to recipients of Medicare and Medicaid.

ANSWER: Eligibility requirements for Medicare include:

People 65 years of age and older People of any age with end-stage renal disease People eligible for Social Security/Railroad Retirement Board disability programs for 24 months Medicare-covered government employees Eligibility requirements for Medicaid include: Individuals with low incomes People 65 or older The blind Persons with disabilities All pregnant women and infants with family incomes below 133% of poverty level Members of families with dependent children in which one parent is absent, incapacitated, or unemployed Those eligible for Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI) Recipients of adoption or foster care assistance Services provided to Medicare recipients include: Hospital insurance (Part A), including inpatient hospital care, care at a skilled nursing facility, and some home health care Medical insurance (Part B), including physician services, outpatient hospital services, certain home health services, and durable medical equipment Services provided to Medicaid recipients include: Inpatient and outpatient hospital services Physician, pediatric/family nurse practitioner, and nurse-midwife services Selected health center and rural health clinic services Prenatal care and family planning services/supplies Vaccines for children Laboratory and x-ray services Skilled nursing home and home health services

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Chapter 09: Health-Care Systems and Policy 86. Summarize the demographic characteristics of those without health insurance.

ANSWER:

The largest non-white racial/ethnic group is Hispanics (32%), then Blacks (15%), and then Asians (5%).

Eight million are children.

More than half are in families with incomes below 200% of the poverty guidelines.

They include the self-employed, those who work part-time, seasonal workers, the unemployed, full-time workers whose employers offer unaffordable insurance or none at all, and early retirees aged 55 to 64 who retired from companies that either offered no health insurance or have since dropped it.

87. Discuss some of the current trends and issues that will shape the future of health care.

ANSWER: By the year 2030, 21% of the population will be over the age of 65. Not only will the elderly be

greater in number, but they may require care for a greater number of years, placing a heavier burden on the long-term care system. Because older Americans consume a disproportionate amount of medical care, the demand for such care, including pharmaceutical products and services, can be expected to rise. There is an expected increase in the Hispanic population, which represents the largest single racial group without health insurance. A population shift from the Northeast to the Southwest and the Sun Belt continues.

88. Given the current statistics of Americans with a chronic disease, such as diabetes, hypercholesterolemia, and

obesity, how can we shift our focus to health promotion when so many resources need to go towards the care of these individuals?

ANSWER: Answers will vary. While resources such as a staff hours and funding must go towards managing

those with a chronic condition, outcomes can be improved and costs reduced with interventions designed to reduce the severity of such conditions. This includes education to these individuals on how to best take care of themselves every day once they leave the physician’s office. Resources can be allocated, and programs can be implemented to educate those who are healthy as a preventative measure.

89. What are some of the major contributors to health care expenditures in the United States?

ANSWER: The major contributors to health care expenditures include hospital care, physician and clinical

services, other spending (dental services, home health care, durable medical products, over-thecounter medications, and research), prescription drugs, nursing home care, and program administration and net cost. Other contributors include administrative cost of the insurance process itself, professional liability costs, continuing advances in medicine, and malpractice lawsuits.

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Chapter 09: Health-Care Systems and Policy 90. List and describe several current health care cost containment measures.

ANSWER: Efforts to curb soaring health care costs cover a broad spectrum: slowing hospital construction,

modifying hospital and physician reimbursement mechanisms, reducing the length of hospital stays, increasing copayments and deductibles for insured employees and Medicare recipients, changing eligibility requirements for Medicaid, reducing unnecessary surgery by requiring patients to obtain second opinions, restricting access to new technology, encouraging alternative delivery systems, emphasizing prevention, and using generic drugs.

91. List six activities that promote health reform that are included within the scope of dietetics practice.

ANSWER:

Nutrition assessment for the purpose of determining individual and community needs and recommendations of appropriate nutrient intake to maintain, recover, or improve health Nutrition counseling and education of individuals, families, community groups, and health professionals Research, development, and evaluation of appropriate nutrition practice guidelines Administration through management of time, finances, personnel, protocols, and programs Consultation with patients, clients, and other health professionals Evaluation of the effectiveness of nutrition counseling/education and community nutrition programs

92. You have been asked to present arguments in favor of reimbursable nutrition services to a health maintenance

organization (HMO) benefits coordinator. What benefits of nutrition intervention would you highlight in your discussion?

ANSWER: Effective nutrition therapy can produce economic benefits as a result of altered food habits and risk

factors. Nutrition intervention activities can lead to an increase in knowledge, skills, and motivation, thus leading to changes in food habits and altering risk factors. The positive outcomes include improved health and well-being with an overall decreased health cost to the company.

A few other points to highlight include: Nutrition services are attractive, progressive health benefits that are relatively inexpensive compared with other types of benefits.

Nutrition services benefits enhance the insurance product.

Nutrition services have a preventive component.

Nutrition services benefits attract healthy subscribers.

Nutrition services are manageable; they can be easily documented.

Nutrition services help patients become more self-reliant by helping them fight disease, avoid hospitalization, and reduce the use of other, more expensive medical therapies.

Nutrition care speeds recovery.

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Chapter 09: Health-Care Systems and Policy 93. Explain why health promotion is a major component of health care reform at the national level.

ANSWER: It is ultimately less expensive to prevent disease than to treat disease.

94. What is a consumer-directed health plan? What are its benefits and limitations?

ANSWER: A consumer-directed health plan combines a high-deductible health plan with a tax-advantaged

health reimbursement arrangement or health savings account that enrollees use to pay for a portion of their health expenses. Due to the high deductibles, the premiums are typically low. Proponents of these plans contend that enrollees seek lower-cost health care services and seek care only when necessary. Critics contend that only healthier individuals are attracted to these plans. In addition, employers may use these plans to shift the cost of coverage to employees.

95. What is the Children’s Health Insurance Program (CHIP)?

ANSWER: The CHIP was created under Title XXI of the Social Security Act in 1997 to expand the health

coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage.

96. Discuss three cost containment efforts.

ANSWER: Three cost containment efforts include (1) a movement away from traditional fee-for-service health

care to managed care; (2) a movement to self-insured health plans to avoid cost shifting; and (3) the development of reimbursement restrictions and limitations.

97. List three of the major provisions of the Affordable Care Act of 2010.

ANSWER: Major provisions include the following:

Requiring that most U.S. citizens and legal residents have health insurance by 2014 The creation of state-based health benefit (insurance) exchanges through which individuals can purchase coverage, with subsidies available to lower-income individuals A major expansion of the Medicaid program Requiring employers to cover their employees or pay penalties New regulations on health plans in the private market requiring them to cover all individuals, regardless of health status Greater support for prevention, wellness, and public health activities

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Chapter 09: Health-Care Systems and Policy 98. Why is proper and thorough documentation of medical nutrition therapy provided by registered dietitians

necessary?

ANSWER: The Academy of Nutrition and Dietetics has developed practice guidelines for medical nutrition

therapy for specific conditions, such as diabetes and hypercholesterolemia. These guidelines define the number of office visits and activities for successful nutrition intervention and expected outcomes.

Thorough documentation provides proof of this intervention, which is critical for payment of nutrition services and expansion of third-party reimbursement.

99. You are writing a proposal to a local agency for a nutrition program designed to educate individuals within the

community. Pick the population or disease state and thoroughly explain why nutrition education to this particular group of individuals will be cost-effective in the long run.

ANSWER: Answers will vary. Nutrition programs could target high-risk pregnant mothers, iron-deficiency

anemia, those with obesity, patients in a cardiology practice with dyslipidemia or hypertension, or patients with diabetes. Answers should explain the connection between nutrition intervention and optimal health, and what issues may be prevented that could be costly.

100. Consider the scope of practice for a registered dietitian. Identify and explain three areas within this scope of

practice that have a significant role in reducing health care costs.

ANSWER: Nutrition assessment: identifies specific nutrient requirements for individuals to optimize their health

and reduce chronic disease. Nutrition counseling and education: provides intervention and knowledge to individuals on how to best optimize their health. Research, development and evaluation of optimal and appropriate nutrition guidelines for individuals. Administration through management of time, budget, and resources for nutrition programs. Consultation: communicate with individuals, groups, and other health care professionals about optimal nutritional intervention and education.

Evaluation: on the effectiveness of nutrition intervention and community-based programs.

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Chapter 10: Food Insecurity and the Food Assistance Programs True / False 1. People who live with chronic hunger might have food available to them, but they are lacking in nutrients. a. True b. False ANSWER: True 2. Government aid programs such as the Supplemental Nutrition Assistance Program (SNAP) are required to use the official federal poverty measure as their eligibility criterion. a. True b. False ANSWER: False 3. Food security is one of several conditions necessary for a population to be healthy and well nourished. a. True b. False ANSWER: True 4. Food insecurity rates are higher than average in households with children that are headed by a single mom. a. True b. False ANSWER: True 5. Since 2000, there has been a gradual downward trend in the percentage of Americans living in poverty. a. True b. False ANSWER: False 6. Ultimately, the goal of food assistance programs is to improve the food security, nutritional status, and health of Americans by providing free food to the masses. a. True b. False ANSWER: False 7. The Nutrition Services Incentive Program (NSIP) provides incentives for efficient delivery of nutritious meals specifically to older adults. a. True b. False ANSWER: True

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Chapter 10: Food Insecurity and the Food Assistance Programs 8. Currently, the benefit allotments for those participating in the Supplemental Nutrition Assistance Program (SNAP) are sufficient to meet the nutritional needs of the family. a. True b. False ANSWER: False 9. Private food assistance programs exist to supplement the federal programs. a. True b. False ANSWER: True 10. Generally, food pantries and soup kitchens are federally funded programs. a. True b. False ANSWER: False 11. The elimination of food insecurity and the reduction of poverty are within our nation’s reach. a. True b. False ANSWER: True 12. Food insecurity can lead to physical, social, and mental health problems, including overweight and obesity. a. True b. False ANSWER: True 13. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves both a remedial and a preventive role. a. True b. False ANSWER: True 14. Building community food security requires understanding how communities interact with resources in their physical and social environments over extended periods of time. a. True b. False ANSWER: True

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Chapter 10: Food Insecurity and the Food Assistance Programs 15. Inadequate fruit and vegetable consumption is not a common problem among women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). a. True b. False ANSWER: False Multiple Choice 16. Those living below the poverty threshold experience food insecurity and hunger at nearly what fraction of the national average? a. 1/4 b. 1/2 c. 1/3 d. 1/5 e. 1/8 ANSWER: c 17. A job that pays the minimum wage affects a family income by a. rising above b. remaining at c. dropping below d. a and c e. b and c

the federal poverty threshold.

ANSWER: b 18. What do households with children experience at a greater rate than households without children? a. Poverty and hunger b. Food security and poverty c. Food insecurity and poverty d. Food insecurity and hunger ANSWER: d 19. Typically, which states have rates for food insecurity and hunger that are lower than the national average? a. Northeastern b. Southern c. Midwest d. Western e. Southeastern ANSWER: a

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Chapter 10: Food Insecurity and the Food Assistance Programs 20. Which is the most compelling single reason for food insecurity? a. Health b. Income c. Poverty d. Location e. a and c ANSWER: d 21. Meals on Wheels is the nation’s largest supplier of surplus food to whom? a. Families b. Schools c. Food banks d. Community centers e. Churches ANSWER: c 22. Which entity is concerned with food insecurity? a. Federal government b. State government c. Local government d. a and b e. a, b, and c ANSWER: d 23. Which is defined as having too little money to meet minimum needs for food, clothing, and shelter? a. Food Insecurity b. Food Security c. Hunger d. Food Assistance e. Poverty ANSWER: e 24. As of 2015, the U.S. Department of Health and Human Services defined a poverty-level income for a family of four as how much annually? a. $42,000 b. $45,000 c. $52,000 d. $55,000 e. $62,000 ANSWER: c Page 4

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Chapter 10: Food Insecurity and the Food Assistance Programs 25. For whom is food insecurity a problem? a. Homeless b. Unemployed c. Poor d. a and b e. a, b, and c ANSWER: e 26. When did welfare reform legislation change the welfare system from a work-based system to an income-supportbased system? a. Early 1900s b. Mid 1990s c. Early 2000s d. Mid 2000s e. Late 2000s ANSWER: c 27. The Commodity Supplemental Food Program was formerly referred to as which? a. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) b. FDPIR c. The Emergency Food Assistance Program (TEFAP) d. Supplemental Nutrition Assistance Program (SNAP) e. None of the above ANSWER: e 28. Which was designed for disaster relief purposes? a. The Emergency Food Assistance Program b. Food Distribution Disaster Assistance c. Commodity Supplemental Food Program d. Supplemental Nutrition Assistance Program e. None of the above ANSWER: b

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Chapter 10: Food Insecurity and the Food Assistance Programs 29. The proportion of income spent on what by economically stressed families is used as the basis for the current poverty thresholds? a. Housing b. Utilities c. Food d. Education e. Transportation ANSWER: c 30. Households with no problems or anxiety about consistently accessing adequate foods are experiencing what kind of food security? a. High b. Marginal c. Low d. Very low e. Very high ANSWER: a 31. Households in which a child’s meal size is reduced or one or more of the household members does not eat regularly are categorized as having what kind of food security? a. High b. Marginal c. Low d. Very low e. Very high ANSWER: d 32. The most compelling single reason for food insecurity is which? a. Mental illness b. Health problems of old age c. Alcoholism d. Poverty e. Educational level ANSWER: d

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Chapter 10: Food Insecurity and the Food Assistance Programs 33. The harvesting of excess food from farms, orchards, and packing houses to feed the hungry is referred to as what? a. Skimming b. Gleaning c. Poaching d. Purloining e. None of the above ANSWER: b 34. Which community food security strategy helps families save money by pooling their resources, such as money and labor, to buy food in bulk quantities at reduced costs? a. Food-Buying Cooperatives b. Directory of Supply and Demand for Community Food Surplus c. Community-Supported Agriculture Programs d. Farm-to-Cafeteria Initiatives ANSWER: a 35. In 2013, approximately what percentage of all Americans age 65 and over were living below the poverty threshold? a. 5% b. 7.5% c. 9% d. 10.2% e. 12.5% ANSWER: c 36. States in which region of the United States generally have higher-than-average rates of food insecurity? a. Northeast b. Midwest c. West d. South e. Northwest ANSWER: d 37. What is the number one contributor to homelessness? a. Addiction to alcohol or drugs b. Unemployment c. Mental illness d. Physical disability e. All of the above ANSWER: b

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Chapter 10: Food Insecurity and the Food Assistance Programs 38. Approximately how many Americans participate in a U.S. Department of Agriculture (USDA) food assistance program annually? a. 1 in 20 b. 1 in 10 c. 1 in 7 d. 1 in 4 e. 1 in 2 ANSWER: d 39. Congress first established the federal government’s authority to buy and distribute excess food commodities during which decade? a. 1930s b. 1940s c. 1950s d. 1960s e. 1970s ANSWER: a 40. Hunger diminished as a serious problem in this country during which decade as a result of the efforts of the food assistance programs? a. 1960s b. 1970s c. 1980s d. 1990s e. 2000s ANSWER: b 41. In 2013, what percentage of the people in the United States lived in poverty? a. 5% b. 7.5% c. 14.5% d. 15.1% e. 18.2% ANSWER: c

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Chapter 10: Food Insecurity and the Food Assistance Programs 42. Under the Temporary Assistance for Needy Families Program, who determines the eligibility of needy families and the benefits and services those families will receive? a. Federal government b. Local government c. County d. School board e. State ANSWER: e 43. As a result of the welfare reform law initiated in the mid-1990s, which people make up the major target group for job placement and training? a. Single women with children b. Single young adults just out of college c. Elderly adult men d. Married men facing foreclosure e. Married with children ANSWER: a 44. Which demographic group makes up 45% of the participants in the Supplemental Nutrition Assistance Program (SNAP)? a. Children b. Elderly c. Women d. Homeless e. Men ANSWER: a 45. What items can be purchased with benefits from the Supplemental Nutrition Assistance Program (SNAP)? a. Ready-to-eat hot foods b. Vitamins c. Garden seeds d. Cleaning supplies e. Steamed seafood ANSWER: c

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Chapter 10: Food Insecurity and the Food Assistance Programs 46. The Supplemental Nutrition Assistance Program (SNAP) was formerly referred to as what? a. Emergency Food Assistance Program b. Nutrition Services Incentive Program c. Expanded Food and Nutrition Education Program d. Food Stamp Program e. Food Distribution Disaster Assistance ANSWER: d 47. What is the largest single ethnic group participating in the Supplemental Nutrition Assistance Program (SNAP)? a. African Americans b. Hispanics c. Asians d. Whites e. a and b ANSWER: d 48. In what way are the Supplemental Nutrition Assistance Program (SNAP) benefits dispersed to participants? a. Paper coupons known as “stamps” b. Electronic benefits transfer cards c. Cash reimbursements for groceries d. Direct cash subsidies e. None of the above ANSWER: b 49. Which concept serves as the food guide for a nutritious diet at a minimal cost and is used as the basis for the Supplemental Nutrition Assistance Program (SNAP) allotments? a. Safety Net Programs b. Team Nutrition c. Expanded Food and Nutrition Education Program d. Thrifty Food Plan e. Afterschool Snack Program ANSWER: d

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Chapter 10: Food Insecurity and the Food Assistance Programs 50. Which program was designed to reduce the level of government-held surplus commodities while supplementing the diets of low-income needy persons, including elderly people, through provision of commodity foods to food banks? a. Summer Food Service Program for Children b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. WIC Farmers’ Market Nutrition Program e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Farmers’ Market Nutrition Program ANSWER: c 51. Children over five years of age whose families participate in the Supplemental Nutrition Assistance Program (SNAP) are automatically eligible to receive free meals in which program? a. Fresh Fruit and Vegetable Program b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Expanded Food and Nutrition Education Program d. Afterschool Snack Program e. National School Lunch Program ANSWER: e 52. Which program is administered by the Federal Emergency Management Agency (FEMA)? a. Temporary Assistance for Needy Families b. The Emergency Food Assistance Program c. The Nutrition Services Incentive Program d. Food Distribution Disaster Assistance e. None of the Above ANSWER: d 53. Of those children participating in the National School Lunch Program, approximately what percentage receive their meal for free? a. 29% b. 37% c. 56% d. 69% e. 42% ANSWER: c

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Chapter 10: Food Insecurity and the Food Assistance Programs 54. The Summer Food Service Program for Children is offered in what kinds of communities? a. All communities that participate in the National School Lunch Program b. Communities where 50% or more of the children are from households with incomes at or below 185% of the poverty guidelines c. Communities where 75% or more of children are from households with incomes at or above 130% of the poverty guidelines d. Communities that apply for and receive special federal grant funds ANSWER: b 55. What action is recommended for improving the Supplemental Nutrition Assistance Program’s (SNAP’s) ability to meet the needs of low-income households? a. Provide nutrition education materials to households that are not eligible to participate. b. Improve and expand outreach about the program. c. Decrease allotments to facilitate thrifty shopping and job seeking. d. Increase administrative requirements to participate in the program. e. All of the above ANSWER: b 56. Financial eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is determined by what? a. Income at or below 185% of the poverty guidelines b. Income at or below 100% of the poverty guidelines c. Participation in the Nutrition Services Incentive Program d. Participation in the Commodity Supplemental Food Program e. Income at or below 150% of the poverty guidelines ANSWER: a 57. A nonprofit program that helps feed people in need by linking sources of unused, unsaved cooked and fresh food with social service agencies that serve meals to people who would otherwise go hungry is referred to as what? a. Food bank b. Food pantry c. Soup kitchen d. Prepared and perishable food program e. Afterschool meal program ANSWER: d

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Chapter 10: Food Insecurity and the Food Assistance Programs 58. The community food security strategies that help local farmers sell fresh fruits and vegetables directly to school meal programs, hospitals, and worksites are called what? a. Farm-to-Cafeteria Initiatives b. Community-Supported Agriculture Programs c. Food-Buying Cooperatives d. Farmers’ Markets e. Farm-to-Home Initiatives ANSWER: a 59. It is estimated that on average, what percentage of requests for emergency food assistance go unmet? a. 8% b. 12% c. 14% d. 27% e. 32% ANSWER: d 60. Purchasing locally produced foods protects the environment by reducing the use of what? a. Fossil fuel b. Marketing c. Packaging material d. Food spoilage e. Fossil fuel and packaging materials ANSWER: e 61. When was the Older Americans Act Nutrition Program passed? a. 1935 b. 1945 c. 1955 d. 1965 e. 1975 ANSWER: d 62. When was the Head Start Program started? a. 1965/1994 b. 1965/1884 c. 1955/1994 d. 1970/1984 e. 1970/1994 ANSWER: a Page 13

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Chapter 10: Food Insecurity and the Food Assistance Programs 63. When was the Special Supplemental Nutrition Program for Women, Infants, and Children started? a. 1965 b. 1968 c. 1972 d. 1975 e. 1978 ANSWER: c 64. When was the Fresh Fruit and Vegetable Program started? a. 2002 b. 1998 c. 1981 d. 1978 e. 1975 ANSWER: a 65. When was the Special Milk Program started? a. 1946 b. 1949 c. 1955 d. 1966 e. 1969 ANSWER: c 66. When was the After-School Snack Program started? a. 1968 b. 1972 c. 1977 d. 1998 e. 2002 ANSWER: d 67. When was the Commodity Foods Program started? a. 1955 b. 1958 c. 1961 d. 1964 e. 1969 ANSWER: e

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Chapter 10: Food Insecurity and the Food Assistance Programs 68. When was the National School Lunch Program started? a. 1946 b. 1955 c. 1961 d. 1965 e. 1966 ANSWER: a 69. When was the Supplemental Nutrition Assistance Program started? a. 1946 b. 1955 c. 1961 d. 1966 e. 1969 ANSWER: c 70. When was the Supplemental Nutrition Assistance Program Nutrition Education started? a. 1972 b. 1977 c. 1981 d. 1986 e. 1998 ANSWER: d 71. When was the Team Nutrition Program started? a. 1980 b. 1985 c. 1995 d. 1996 e. 2002 ANSWER: c 72. When was the Emergency Food Assistance Program started? a. 1965 b. 1972 c. 1975 d. 1981 e. 1986 ANSWER: d

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Chapter 10: Food Insecurity and the Food Assistance Programs 73. When was the School Breakfast Program started? a. 1960 b. 1966 c. 1970 d. 1972 e. 1980 ANSWER: b 74. When was the Food Distribution Disaster Assistance Program started? a. 1972 b. 1977 c. 1981 d. 1986 e. 1998 ANSWER: b 75. Which program provides supplemental nutritious foods, nutrition education, and referrals to health care to low-income pregnant, breastfeeding, and postpartum women, infants, and children up to five years determined to be at nutritional risk? a. Child and Adult Care Food Program (CACFP) b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Older Americans Act (OAA) Nutrition Program d. The Expanded Food and Nutrition Education Program (EFNEP) e. Team Nutrition Program ANSWER: b 76. Which program improves the diets of low-income households by increasing their food purchasing ability? a. Supplemental Nutrition Assistance Program (SNAP) b. National School Lunch Program (NSLP) c. Summer Food Service Program (SFSP) d. Child and Adult Care Food Program (CACFP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: a

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Chapter 10: Food Insecurity and the Food Assistance Programs 77. Which program provides congregate and home-delivered meals and related nutrition services to older adults? a. Child and Adult Care Food Program (CACFP) b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Older Americans Act (OAA) Nutrition Program d. The Expanded Food and Nutrition Education Program (EFNEP) e. Team Nutrition Program ANSWER: c 78. Which program provides federal funds and United States Department of Agriculture (USDA)-donated foods to nonresidential child care and adult day care facilities and to family day care homes for children? a. Supplemental Nutrition Assistance Program (SNAP) b. National School Lunch Program (NSLP) c. Summer Food Service Program (SFSP) d. Child and Adult Care Food Program (CACFP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: d 79. Which program ensures that children in lower-income areas continue to receive nutritious meals when school is not in session? a. Supplemental Nutrition Assistance Program (SNAP) b. National School Lunch Program (NSLP) c. Summer Food Service Program (SFSP) d. Child and Adult Care Food Program (CACFP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: c 80. Which program assists adults and youth with limited resources in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets? a. Child and Adult Care Food Program (CACFP) b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Older Americans Act (OAA) Nutrition Program d. The Expanded Food and Nutrition Education Program (EFNEP) e. Team Nutrition Program ANSWER: d

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Chapter 10: Food Insecurity and the Food Assistance Programs 81. Which program assists states in providing nutritious free or reduced-price lunches to eligible children? a. Supplemental Nutrition Assistance Program (SNAP) b. National School Lunch Program (NSLP) c. Summer Food Service Program (SFSP) d. Child and Adult Care Food Program (CACFP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: b 82. Which program improves the health of children by having school meals reflect federal dietary guidelines? a. Child and Adult Care Food Program (CACFP) b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Older Americans Act (OAA) Nutrition Program d. The Expanded Food and Nutrition Education Program (EFNEP) e. Team Nutrition Program ANSWER: e 83. Which program’s allotments are based on household size, income, assets, housing costs, work requirements, and other factors? a. Supplemental Nutrition Assistance Program (SNAP) b. National School Lunch Program (NSLP) c. Summer Food Service Program (SFSP) d. Child and Adult Care Food Program (CACFP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: a 84. Which program’s eligible individuals include all persons 60 years or older and their spouses? a. Child and Adult Care Food Program (CACFP) b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) c. Older Americans Act (OAA) Nutrition Program d. The Expanded Food and Nutrition Education Program (EFNEP) e. Team Nutrition Program ANSWER: c

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Chapter 10: Food Insecurity and the Food Assistance Programs Essay 85. List and describe the five components of the concept of food security.

ANSWER: The concept of food security includes five components: a. Quantity: Is there access to a sufficient quantity of food? b. Quality: Is food nutritionally adequate? c. Suitability: Is food culturally acceptable and the capacity for storage and preparation appropriate? d. Psychological: Do the type and quantity of food alleviate anxiety, lack of choice, and feelings of deprivation? e. Social: Are the methods of acquiring food socially acceptable?

86. State the major cause of food insecurity in the United States and discuss other factors that contribute to the U.S. hunger problem.

ANSWER: Poverty is the major cause of food insecurity. As identified by the U.S. Conference of MayorsSodexho Hunger and Homelessness Survey 2014, there are many causes of hunger and food insecurity that are often interrelated. The factor most frequently identified by the survey cities was unemployment, followed by poverty, low wages, and high housing and health care costs. Other factors may include utility costs, lack of education, transportation costs, mental health problems, and substance abuse.

87. Explain how food insecurity can lead to overweight and obesity.

ANSWER: Although the coexistence of obesity and food insecurity sounds contradictory, they sometimes coexist in the same families and the same individuals. There are three primary explanations for this paradox.

1. The need to maximize caloric intake: The need within households with food insecurity is to maximize caloric intake. Without adequate resources for food, families must make decisions to stretch their food money as far as possible and maximize the number of calories they can buy so that their members do not suffer from frequent hunger. Low-income families therefore may consume lower-cost foods with relatively higher levels of calories per dollar to stave off hunger when they lack the money or other resources to purchase a more healthful balance of more nutritious foods.

2. The trade-off between food quantity and quality: Along the continuum of typical coping strategies, food quality is generally affected before the quantity of intake. Households reduce food spending by changing the quality or variety of food consumed before they reduce the quantity of food eaten. As a result, although families may get enough food to avoid feeling hungry, they also may be poorly nourished because they cannot afford a consistently adequate diet that promotes health and averts obesity.

3. Overeating when food is available: Chronic ups and downs in food availability can cause people to eat more when food is available than they normally would. When money or Supplemental Nutrition Assistance Program (SNAP) benefits are not available for food purchases during part of the month, for example, people may overeat on the days that food is available. Over time, this cycle can result in weight gain. Research among food-insecure families also shows that low-income mothers first sacrifice their own nutrition by restricting their food intake during periods of food insufficiency to protect their children from hunger. This practice may result in eating more than is desirable when food is available, thereby contributing to obesity among poor women.

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Chapter 10: Food Insecurity and the Food Assistance Programs 88. Describe three of the government’s five largest food assistance programs, including eligibility requirements and services provided.

ANSWER: The five largest food assistance programs, accounting for 96% of all federal dollars spent for food assistance in 2014, are as follows: 1. Supplemental Nutrition Assistance Program (SNAP): Household eligibility and allotments are based on household size, income, assets, housing costs, work requirements, and other factors.

Assistance is provided through direct payments in the form of electronic benefits transfer (EBT) redeemable at most retail food stores. The purpose is to improve diets of low-income households by increasing access to food.

2. National School Lunch Program (NSLP): Public or nonprofit private schools of high school grade or under and public or nonprofit private residential childcare institutions may participate. Eligibility standards for children: All students attending schools where the programs provided may participate.

Children from households with incomes at or below 130% of poverty guidelines are eligible for free meals. Children from households with incomes between 130% and 185% of the poverty guidelines are eligible for reduced-price meals. Children from households with incomes over 185% of the poverty guidelines pay full price, a price set by the school. Schools receive cash subsidies and United States Department of Agriculture (USDA) commodities for each meal served. The purpose is to assist states in providing nutritious, free, or reduced-price lunches to eligible children.

3. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Pregnant, breastfeeding, and postpartum women, infants up to one year of age, and children up to five years of age are eligible if they are individually determined by a qualified health professional to be in need of the special supplemental foods provided by the program because they are nutritionally at risk (having a medical-based or dietary-based condition), and if they meet an income standard (gross income at or below 185% of the poverty guidelines). Provides nutritious foods to supplement diets, nutrition education and counseling, and screening/referrals to other health, welfare, and social services.

The purpose is to safeguard the health of low-income women, infants, and children up to age five who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.

4. School Breakfast Program: Public and nonprofit private schools and residential childcare institutions may participate. Operates in the same manner as NSLP. Schools and institutions receive cash subsidies for each meal served. The purpose is to assist states in providing nutritious breakfasts to children. Free and reduced-price meals must be offered to eligible children.

5. Child and Adult Care Food Program (CACFP): Eligible institutions include public or private nonprofit childcare centers; outside-school hours care centers; Head Start programs; some daycare homes; community-based programs that offer enrichment activities for at-risk children and teenagers after the regular school day ends; public or private nonprofit emergency shelters that provide residential and food services to homeless families; and public or private nonprofit adult daycare facilities that provide structured, comprehensive services to nonresidential adults who are functionally impaired or age 60 and older. Participant eligibility standards for free and reduced-price meals are the same as the NSLP. Assistance is provided through cash reimbursement for meals served that meet federal nutritional guidelines and reimbursement of associated administrative costs. The purpose is to improve the quality and affordability of daycare for low-income families by providing nutritious meals and snacks to children and to adults who receive are in nonresidential adult daycare centers, providing meals to children residing in homeless shelters, and providing snacks and suppers to youths participating in eligible after-school care programs.

See Table 10-4 for more specifics of the various programs.

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Chapter 10: Food Insecurity and the Food Assistance Programs 89. Of the different hunger policy initiatives, which one do you believe is the most beneficial and why?

ANSWER: Answers will vary based on the students’ selection of initiatives.

90. What improvements to the Supplemental Nutrition Assistance Program (SNAP) would you recommend to enhance its ability to meet the needs of low-income households?

ANSWER: Answers will vary, but could include the following: Increase the monthly allotments and benefits to better meet the needs of the households.

Increase the awareness of the program.

Improve the participation rate.

Streamline the application process.

Provide nutrition education materials to households that receive SNAP. 91. Discuss the background and goals of the Community Food Security Initiative.

ANSWER: To reduce hunger, the United States Department of Agriculture (USDA) partnered with states, local municipalities, nonprofit groups, and the public sector to create this initiative. The goals of the Community Food Security Initiative include the following: Building and enhancing local infrastructures to reduce hunger and food insecurity in communities Increasing economic and job security for low-income people by helping people locate livingwage jobs and achieve self-sufficiency Strengthening the federal food and nutrition assistance safety net Bolstering supplemental food provided by nonprofit groups by assisting or developing local food recovery, gleaning, and donation efforts Improving community food production and marketing by aiding community projects that grow, process, and distribute food locally Boosting education and raising awareness about nutrition, food safety, and food security among community residents Improving research, monitoring, and evaluation efforts to help communities assess and strengthen food security 92. Identify ways that you can become involved in ending hunger in the United States.

ANSWER: Answers will vary, but could include some of following: Assist in food assistance programs as a volunteer.

Help develop the means of informing low-income people about food-related federal and local services and programs for which they are eligible.

Help increase the accessibility of existing programs and services.

Document the hunger-related needs that exist in your own community.

As a food and nutrition practitioner, monitor the household food security of the clients you serve.

Support local food production.

Conduct or participate in research to document the effectiveness of food assistance programs.

Follow food security legislation; call and write legislators about food insecurity issues.

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Chapter 10: Food Insecurity and the Food Assistance Programs 93. Differentiate between the housing wage and the hourly wage.

ANSWER: The housing wage is the hourly wage that must be earned for a 40-hour work week to afford a twobedroom housing unit. The hourly wage is the employee compensation for the work done. As of 2014, the housing wage is $18.92/hour, while the federal minimum wage is $7.25/hour.

94. What are some of the problems that arise when children are hungry?

ANSWER: Research shows that children living in food-insufficient households have poorer health, even after controlling for poverty. A child’s growth, cognitive development, academic achievement, and physical and emotional health are negatively affected by living in a family that does not have enough food to eat.

95. Describe the demographic and economic circumstances of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits.

ANSWER:

45% of all participants are children (age 18 or younger).

46% of all participants are adults (age 60 or younger).

9% of all participants are older adults (age 60 or over).

75% of all benefits go to households that include a child, a disabled person, or an older adult.

33% of households with children are headed by a single parent, the overwhelming majority of which are headed by women.

40% of participants are white; 26% are African American, non-Hispanic; 10% are Hispanic; 2% are Asian; and 1% are Native American.

Eligibility is based on income, household size, assets, housing costs, work requirements, and other factors

96. Describe the eligibility requirements to participate in the Older Americans Act Nutrition Program.

ANSWER: Participants (or their spouse) must be 60 years or older, regardless of income level; however, priority is given to those who are economically and socially needy.

97. Explain the concept of the Thrifty Food Plan.

ANSWER: The Thrifty Food Plan serves as a food guide for a nutritious diet at a minimal cost, is used as the basis for SNAP allotments, and is maintained by the United States Department of Agriculture’s (USDA’s) Center for Nutrition Policy and Promotion.

98. When grocery shopping, Sally purchases energy-dense foods instead of nutrient-dense foods and bypasses the legumes and fresh vegetables and fruits. Why might she make these choices?

ANSWER: Sally might make these choices for a number of reasons. Possible reasons could include lack of food preparation knowledge, lack of basic kitchen equipment, lack of nutritional knowledge, and the need to provide as many calories for as little money as possible.

99. How would Sally’s choices at the grocery store affect her children’s nutritional intake over time?

ANSWER: If the choices were to continue as they are, the children might gain weight, and their diets may lack fiber and several key vitamins and minerals. Malnutrition, in terms of over- and undernutrition, might become evident. In time, these might also become the purchasing selections of the children.

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Chapter 10: Food Insecurity and the Food Assistance Programs 100. What is the food insecurity and obesity paradox? Are Sally’s behaviors indicative of someone who exhibits the food insecurity and obesity paradox?

ANSWER: The food insecurity and obesity paradox are seen when low-income, food-insecure people are overweight. Reasons for this paradox include the need to maximize caloric intake, the tradeoff between food quantity and quality, and overeating when food is available. Because we do not know Sally’s weight, it is difficult to determine whether Sally is representative of this paradox. However, we do know that Sally experiences times of hunger towards the end of the month and that she purchases the energy-dense foods instead of the nutrient-dense foods.

101. List two other non–public-assistance programs that might be appropriate for Sally to consider.

ANSWER: Answers will vary but may include the following: Farmers’ markets Community-supported agriculture programs Community gardens Food recovery and gleaning programs Food-buying cooperatives Directory of supply and demand for community food surplus

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs True / False 1. One of the best indicators of a nation’s health is the infant mortality rate. a. True b. False ANSWER: True 2. The La Leche League International is a peer-counseling organization that promotes abstinence before marriage. a. True b. False ANSWER: False 3. If a woman gains more than the recommended amount of weight early in the pregnancy, she should diet for weight loss in the last few weeks. a. True b. False ANSWER: False 4. Maternal age can be a risk factor during pregnancy. a. True b. False ANSWER: True 5. Babies should be weaned from breast milk to whole cow’s milk at 6 months. a. True b. False ANSWER: False 6. The Special Supplemental Nutrition Program for Women, Infants, and Children was authorized in 1972 as an amendment to the Child Nutrition Act of 1966. a. True b. False ANSWER: True 7. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an entitlement program and can therefore serve all individuals requesting services. a. True b. False ANSWER: False

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 8. Results from several cost-benefit analyses have shown that money spent on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services is well spent. a. True b. False ANSWER: True 9. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) is a mandatory Medicaid service administered by the Centers for Medicare & Medicaid Services (CMS) and is a widespread and well utilized program because it is available to many participants. a. True b. False ANSWER: False 10. All commercially available infant formulas are based on milk proteins and therefore contain lactose. a. True b. False ANSWER: False 11. Breast milk contains the antibacterial agent lactoferrin,which helps protect the infant against infection. a. True b. False ANSWER: True 12. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is federally funded but is administered by the states. a. True b. False ANSWER: True 13. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has made only a minor contribution to reducing fetal deaths, accounting for a reduction of less than 5% in fetal mortality rates. a. True b. False ANSWER: False 14. The aim of Congress in passing the Title V legislation was to improve the health of mothers, infants, and children in areas where the need was greatest. a. True b. False ANSWER: True

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 15. Many of the existing health care programs frequently refer their clients to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) for nutrition services. a. True b. False ANSWER: True 16. If a woman gains more than the recommended amount of weight early in the pregnancy, she should diet for weight loss in the last few weeks. a. True b. False ANSWER: False Multiple Choice 17. Which nation has the lowest infant mortality rate among industrialized countries? a. Japan b. China c. Germany d. United States e. New Zealand ANSWER: c 18. The amount of weight a woman should gain during pregnancy depends on her . a. prepregnancy body mass index (BMI) b. number of children she is carrying

and

c. current weight d. A and C e. A and B ANSWER: e 19. Recipients may not participate in both and . a. Commodity Supplemental Food Program (CSFP) b. La Leche League c. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) d. Expanded Food and Nutrition Education Program (EFNEP) e. A and C ANSWER: e

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 20. Which does the Healthy Start Program specializes in to help women receive prenatal care as early as possible? a. Education and school activities b. Home visit and school activities c. School activities and church programs d. Outreach and home activities e. Church programs and education ANSWER: d 21. Over what percent of all Healthy Start families are African American, Hispanic, or Native Americans? a. 50 b. 60 c. 70 d. 80 e. 90 ANSWER: e 22. Which remains a prevalent nutritional problem in infancy, although it has declined in recent years. a. Iron deficiency b. Folate deficiency c. Vitamin D deficiency d. B12 deficiency e. None of the above ANSWER: a 23. If a woman gains more than the recommended amount of weight early in the pregnancy, what should she do? a. Diet for three weeks to decrease intake b. Diet for the remainder of the pregnancy or until her weight gain meets the recommendation c. No dieting or adjustment d. No dieting, but watch intakes of sugars and fats e. None of the above ANSWER: d 24. Introducing a variety of flavors and foods before the age of variety of flavors and foods in later childhood. a. 6 months, increase b. 12 months, decrease c. 18 months, increase

may

acceptance of a wider

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 25. Which is probably the most significant factor affecting an infant’s susceptibility to food allergies? a. Diet b. Genetics c. Body mass index (BMI) status d. Health conditions e. None of the above ANSWER: a 26. The infant mortality rate (IMR) is expressed as the number of infant deaths under 1 year of age per how many live births? a. 10 b. 100 c. 1,000 d. 10,000 e. 100,000 ANSWER: c 27. What are the two primary indicators of an infant’s future health status? a. Length of gestation and birth weight of infant b. Mother’s weight and age before pregnancy c. Birth weight of the infant and mother’s age d. Type of prenatal care and birth weight of infant e. Length of gestation and mother’s weight ANSWER: a 28. Of the following countries, which one has the highest infant mortality rate (IMR)? a. Switzerland b. Japan c. Czech Republic d. United States e. China ANSWER: d 29. The failure to further improve the infant mortality rate (IMR) in the United States has been attributed to which? a. The increased prevalence of neural tube defects b. Iron deficiencies in pregnant women c. The number of infants born with low birth weights d. The number of infants born to obese mothers e. Infants born to mothers with drug addictions ANSWER: c Page 5

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 30. The Healthy People 2020 objective for maternal mortality seeks a target of how many maternal deaths per 100,000 live births? a. 2.5 b. 5.6 c. 11.4 d. 17.2 e. 15.1 ANSWER: c 31. The Healthy People 2020 objective for abstinence from alcohol among pregnant women seeks which target? a. 98.3% b. 100% c. 77.9% d. 89.4% e. 92% ANSWER: a 32. Which group has the highest infant mortality rates in the United States? a. Black, non-Hispanic b. American Indian c. White, non-Hispanic d. Hispanic ANSWER: a 33. What is the leading cause of post neonatal mortality in the United States? a. Low birth weight b. Sudden infant death syndrome (SIDS) c. Very low birth weight d. Neglect e. Heart disease ANSWER: b

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 34. What is one of the key areas for improving the health of mothers and infants, as identified by an interagency workgroup and the surgeon general? a. Seek to reform eligibility requirements for maternal and infant programs so as to decrease participation. b. Direct additional research toward determining the cause of Asian-American women’s increased risk of dying from maternal complications. c. Increase research on genetic, environmental and behavioral factors that have an influence on pregnancy outcomes for mother and child. d. Develop new interventions to reduce caffeine consumption during pregnancy. e. None of the above ANSWER: c 35. Which group of women tend to gain less than the recommended level of weight during pregnancy? a. African American women b. Older moms c. Hispanic young women d. Moms with other children e. Moms with babies less than 2 years ANSWER: a 36. What is the recommended weight gain range for women who begin pregnancy at a healthful weight? a. 15 to 20 pounds b. 15 to 25 pounds c. 20 to 25 pounds d. 25 to 35 pounds e. 20 to 30 pounds ANSWER: d 37. Following the first trimester, how many pounds per week of weight gain is normal and recommended? a. 0.5 b. 1.0 c. 1.5 d. 2.0 e. 2.5 ANSWER: b

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 38. During the first two or three days of lactation, the breasts produce a premilk substance containing antibodies and white cells from the mother’s blood called what? a. Colostrum b. Bifidus c. Lactoferrin d. Meconium ANSWER: a 39. By what age have most infants tripled their birth weight? a. 6 months b. 10 months c. 12 months d. 16 months ANSWER: c 40. The goal of which program is to specifically identify and develop community-based approaches to reducing infant mortality and improve the health of low-income families? a. Title V Maternal and Child Health Program b. Healthy Start Program c. Health Center Program d. Commodity Supplemental Food Program e. Community Supplement Program ANSWER: b 41. Congress enacted which program in 1965 through Title XIX of the Social Security Act to ensure financial access to health care for economically disadvantaged people? a. Title V b. Medicaid c. Healthy Start Program d. Health Center Program e. Farm to School ANSWER: b

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 42. Which measurement can best confirm that growth is proceeding normally and/or help detect protein-energy malnutrition in infants? a. Body mass index (BMI) b. Head circumference c. Height d. Weight e. A and B ANSWER: b 43. Failure to thrive is diagnosed in infants who fall below the which percentile on the growth chart for weight-forlength. a. 5th b. 10th c. 15th d. 25th e. 50th ANSWER: a 44. Although iron deficiency remains a prevalent nutritional problem in infancy, it has declined in recent years, largely because which has increased? a. Use of iron-fortified formulas b. Supplementation of folate during pregnancy c. Awareness of the benefits of breastfeeding d. Use of cow’s milk in place of breast milk e. All infants being required to take iron supplements ANSWER: a 45. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was authorized in what year? a. 1952 b. 1966 c. 1972 d. 1985 e. 1981 ANSWER: c

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 46. In the United States, which demographic group breastfeeds its infants most frequently? a. Asian, non-Hispanic b. Black, non-Hispanic c. Hispanic d. White, non-Hispanic e. Black, Hispanic ANSWER: a 47. If the infant is not breastfed, then what should be given to the newborn? a. Nonfat milk b. Whole cow’s milk c. Low-iron formula d. Iron-fortified formula e. Powdered milk ANSWER: d 48. Which of these is the most prevalent nutritional problem in infancy? a. Vitamin B12 deficiency b. Iron deficiency c. Vitamin A deficiency d. Food aversions e. Vitamin D deficiency ANSWER: b 49. Why should foods be introduced to an infant one at a time because? a. To prevent overfeeding b. Because the swallowing reflex is not under voluntary control c. Because immunological protection has not been developed d. Because any allergic reactions can be detected e. To reduce obesity in the infant ANSWER: d 50. How is financial eligibility for Special Supplemental Nutrition Program (SNAP) for Women, Infants, and Children (WIC) participation determined? a. Anyone with income at or below 138% of poverty guidelines b. Income at or below 185% of poverty guidelines or participation in SNAP or Medicaid c. Income at or below 125% of poverty guidelines for persons who have children under 19 d. All infants, children, and adolescents up to18 years of age e. Income at or below 100% of poverty guidelines ANSWER: b Page 10

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 51. By October 2020, all Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies will transition to using what to distribute financial allotments to participants? a. Direct food distribution b. Vouchers or coupons c. Electronic benefit transfer d. Cash or checks e. All of the above ANSWER: c 52. Which individual will receive priority care within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program? a. Victor, a four-year-old boy who is at the 50th percentile for weight b. Mary Ann, a mom of four children aged one, three, four, and six c. Candice, a breastfeeding mom d. Emily, a pregnant woman with iron-deficiency anemia e. Laverne, a pregnant woman with normal weight gain ANSWER: d 53. Because of the caps placed on allocated federal funds, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) currently reaches only about what percent of eligible persons? a. 20% b. 50% c. 80% d. 95% e. 150% ANSWER: c 54. Which program is funded by the U.S. Department of Agriculture (USDA)? a. Title V Maternal and Child Health Program b. Commodity Supplemental Food Program c. The Health Center Program d. The Healthy Start Program ANSWER: b

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 55. Which program is administered by the U.S. Department of Health and Human Services (DHHS)? a. Health Center Program b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Farmers’ Market Nutrition Program c. Supplemental Nutrition Assistance Program d. Expanded Food and Nutrition Education Program e. Team Nutrition ANSWER: a 56. Which program is a mandatory Medicaid service that aims to improve the health status of children from low-income families by providing health services as outlined by Congress? a. Supplemental Nutrition Assistance Program b. Expanded Food and Nutrition Education Program c. Early Periodic Screening, Diagnosis, and Treatment Program d. Commodity Supplemental Food Program e. Farm to School Program ANSWER: c 57. Which trait of a successful leader means adhering to a high standard of honesty and has been described as the most important leadership principle? a. Sociability b. Accountability c. Intelligence d. Integrity e. Flexibility ANSWER: d 58. Which program increases the ability to purchase food for anyone with an income < 130% of the poverty level? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Supplemental Nutrition Assistance Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: d

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 59. Which program gives checks or vouchers to purchase healthful foods and provides nutrition education and referral to health services? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) ANSWER: e 60. Which program increases fruit and vegetable consumption for persons eligible for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: e 61. Which program provides monthly food package of fruits, vegetables, meats, infant formula, beans and other available foods? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: a 62. Which program provides nutrition education for persons with incomes at or below 125% of poverty level who have children under 19 years of age? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: b

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 63. Which program provides complete health care for anyone with an income < 138% of poverty level? a. Medicaid b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: a 64. Which program provides prenatal and postpartum care for pregnant women with incomes < 185% of poverty level? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Healthy Start e. Farmers Market Nutrition Program (FMNP) ANSWER: d 65. Which program provides health screenings, dental checks, health education, and hearing and vision test for children up to 18 years of age? a. Commodity Supplemental Food Program (CSFP) b. Expanded Food and Nutrition Education Program (EFNEP) c. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) d. Special Supplemental Nutrition Program (SNAP) e. Farmers Market Nutrition Program (FMNP) ANSWER: c 66. Which prevents neural tube defects? a. Folate supplementation b. Small for age c. Obese d. Iron deficiency e. Failure to thrive ANSWER: a 67. Which risks for infants are higher among pregnant adolescents? a. Large for age b. Small for age c. Obese d. Iron deficiency e. Failure to thrive ANSWER: d Page 14

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 68. Which program provides peer counseling for breastfeeding promotion? a. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) b. Expanded Food and Nutrition Education Program (EFNEP) c. La Leche League d. Federal Supplement Program e. Title V ANSWER: c 69. Which is the only federal program concerned exclusively with the health of mothers, infants, and children? a. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) b. Expanded Food and Nutrition Education Program (EFNEP) c. La Leche League d. Federal Supplement Program e. Title V ANSWER: e 70. Which nutrition education program is for low-income families? a. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) b. Expanded Food and Nutrition Education Program (EFNEP) c. La Leche League d. Federal Supplement Program e. Title V ANSWER: b 71. Which program provides a mandatory Medicaid service to improve the health status of children from low-income families? a. Early and Periodic Screen, Diagnostic and Treatment (EPSDT) b. Expanded Food and Nutrition Education Program (EFNEP) c. La Leche League d. Federal Supplement Program e. Title V ANSWER: a 72. Which risk is found in infants whose weight-for-length falls below the 5th percentile? a. Large for age b. Small for age c. Obese d. Iron deficiency e. Failure to thrive ANSWER: e Page 15

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 73. Which risk is found in infants whose weight-for-length falls above the 95th percentile? a. Large for age b. Small for age c. Obese d. Iron deficiency e. Failure to thrive ANSWER: c 74. Which is present in both breast milk and premilk and favors the growth of the “friendly” bacteria in the infant’s digestive tract so that harmful bacteria cannot grow there? a. Colostrum b. Bifidus factor c. Lactoferrin d. Infant formula e. Cow’s milk ANSWER: b 75. To which is an infant transitioned if the infant is weaned from breast milk within first year of life? a. Colostrum b. Bifidus factor c. Lactoferrin d. Infant formula e. Cow’s milk ANSWER: d 76. Which is a premilk substance produced during the first two or three days of lactation containing antibodies and white blood cells from the mother’s blood? a. Colostrum b. Bifidus factor c. Lactoferrin d. Infant formula e. Cow’s milk ANSWER: a

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 77. Which may be introduced to an infant’s diet after the infant is one-year-old? a. Colostrum b. Bifidus factor c. Lactoferrin d. Infant formula e. Cow’s milk ANSWER: e 78. Which is a powerful antibacterial agent in breast milk the helps protect the infant against infection? a. Colostrum b. Bifidus factor c. Lactoferrin d. Infant formula e. Cow’s milk ANSWER: c 79. At which age may iron-fortified rice cereal and pureed fruits and vegetables be introduced to an infant? a. 2 to 4 months b. 4 to 6 months c. 6 to 8 months d. 8 to 10 months e. 10 to 12 months ANSWER: b 80. At which age may protein foods, such as yogurt, chopped meats, egg yolks, and toast and teething crackers be introduced to an infant? a. 2 to 4 months b. 4 to 6 months c. 6 to 8 months d. 8 to 10 months e. 10 to 12 months ANSWER: d 81. At which age may whole eggs be introduced to an infant because allergies are less likely? a. 2 to 4 months b. 4 to 6 months c. 6 to 8 months d. 8 to 10 months e. 10 to 12 months ANSWER: e Page 17

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 82. At which age may mashed fruits and vegetables, and infant bread and crackers be introduced to an infant? a. 2 to 4 months b. 4 to 6 months c. 6 to 8 months d. 8 to 10 months e. 10 to 12 months ANSWER: c Essay 83. Explain the relationship of maternal weight gain to infant birth weight.

ANSWER: Normal weight gain and adequate nutrition support the health of the mother and the development of the fetus. Low weight gain in pregnancy is associated with increased risk of delivering a low birth weight (LBW) infant; these infants have high mortality rates. Excessive weight gain in pregnancy increases the risk of complications during labor and delivery, as well as postpartum obesity.

84. Identify the measures that are commonly taken to assess the nutrition status of pregnant women.

ANSWER: a. Dietary measures: diet history, including food habits, attitudes, and folklore; allergies; use of vitamin and mineral supplements; and lifestyles (e.g., substance use or existence of pica). b. Clinical measures: obstetric history, including outcome of previous pregnancies, interval between pregnancies, and history of problems during the course of previous pregnancies (e.g., pregnancy-induced hypertension (PIH), gestational diabetes, iron-deficiency anemia, or pattern of inadequate or excessive weight gain). c. Anthropometric measures: measurement of weight-for-height or body mass index (BMI).Laboratory values: screening for anemia by hematocrit and/or hemoglobin and a urine analysis for ketones, glucose, and protein spillage.

85. What issues must specifically be addressed with a pregnant teenager?

ANSWER: The complex social, emotional, and physical factors involved make teen pregnancy one of the most challenging situations for nutrition counseling. Medical and nutritional risks are particularly high when the teenager is within two years of menarche. Risks include higher rates of pregnancy-induced hypertension (PIH), iron-deficiency anemia, premature birth, stillbirths, low birth weight (LBW) infants, and prolonged labor in pregnant teens. The increased energy and nutrient demands of pregnancy place adolescent girls, who are already at risk for nutritional problems, at even greater risk. Those who gain between 30 and 35 pounds during pregnancy have lower risks of delivering LBW infants. Adequate nutrition can substantially improve the course and outcome of adolescent pregnancy.

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 86. Discuss infant nutrient needs in relation to adult nutrient needs.

ANSWER: Because of their small size, infants need smaller total amounts of nutrients than adults do, but, relative to body weight, infants need over twice as much of many of the nutrients. After six months, energy needs increase less rapidly because the baby’s growth rate begins to slow down, but some of the energy saved by slower growth is spent on increased activity.

87. Describe current infant feeding recommendations.

ANSWER: Exclusive breast milk is recommended for the first year. Cow’s milk should not be introduced until one year of age, and then whole milk should be given. Solid foods can be introduced at six months, but this really depends on the developmental readiness of the infant. Iron-fortified cereal is recommended as the first food. New foods should be introduced one at a time to note possible allergies.

88. Discuss two of the most significant nutrition-related problems of infants and describe possible solutions.

ANSWER: Iron deficiency and food allergies are the two most significant nutrition-related problems of infants.

Possible solutions to lessen the risk of iron deficiency include supplementing breastfed infants with ironfortified cereal at six months or using iron-fortified formulas for the bottle-fed infant. Possible solutions to lessen the risk of food allergies include introducing new foods one at a time, with at least two days elapsing before another new food is introduced. For infants with a strong family history of food allergies, solid foods should not be given before six months of age, with potential food allergens not introduced until one year.

89. What improvements would you recommend to enhance the effectiveness of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in meeting the needs of those who are eligible to participate?

ANSWER: Overall, research evaluating the WIC’s effectiveness finds positive outcomes for WIC participants compared to nonparticipants. The following measures would help lower the barriers to program participation: a. Increase the congressional funding for the program to enable more eligible women, infants, and children to receive WIC benefits. b. Improve the coordination between WIC and programs providing or financing maternal and child health care services. c. Implement outreach activities to increase access to WIC program benefits by all who are eligible.

90. Why do you think that the farmers’ markets are not used as much as they could be?

ANSWER: Answers will vary but could include lack of knowledge of how to prepare the fresh produce and limited knowledge of the local farmers’ market.

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 91. What are the unique features of the Expanded Food and Nutrition Education Program (EFNEP)?

ANSWER: The EFNEP is a federally funded program designed specifically for nutrition education and is administered by the USDA National Institute of Food and Agriculture. It was authorized in 1968 and is designed to assist limited-resource audiences in acquiring knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet. The program is implemented by trained paraprofessionals (peer educators) and volunteers from the local community under the supervision of county extension family and consumer science professionals.

92. What factors contribute to maternal and infant health?

ANSWER: Genetic, environmental, and behavioral factors all affect risk and the outcome of pregnancy.

93. What are the weight gain recommendations for pregnant women based on body mass index (BMI)?

ANSWER: BMI < 18.5, 28 to 40 pounds BMI 18.5 to 24.9, 25 to 35 pounds BMI 25.0 to 29.9, 15 to 25 pounds BMI > 30.0, 11 to 20 pounds 94. List six nutritional risks in pregnancy.

ANSWER: The nutritional risks in pregnancy include age 15 or under; unwanted pregnancy; many pregnancies close together; history of poor pregnancy outcome; poverty; lack of access to health care; low education level; inadequate diet; iron-deficiency anemia early in pregnancy; cigarette smoking; alcohol or other substance abuse; chronic disease requiring a special diet; underweight or overweight; insufficient or excessive weight gain; and carrying twins or triplets.

95. List four potential barriers to achieving the nation’s health objective of increasing the incidence of breastfeeding.

ANSWER: They include a lack of experience or understanding among family members of how best to support mothers and babies, insufficient opportunities to communicate with other breastfeeding mothers, lack of up-to-date instruction and information from health care professionals, hospital practices that make it hard to get started with successful breastfeeding, and lack of accommodation to breastfeed or express milk at the workplace.

96. List three potential barriers to participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

ANSWER: Barriers to participation in WIC include limited government funding, lack of transportation, insufficient time or money to travel to the clinic, insufficient outreach to potential WIC recipients, the absence or expense of childcare, inconvenient clinic hours, and understaffing of WIC facilities

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Chapter 11: Mothers and Infants: Nutrition Assessment, Services, and Programs 97. Describe three anthropometric measurements routinely taken on infants.

ANSWER: Anthropometric measurements routinely obtained in the examination of infants include length, weight, and head circumference. Length should be measured in the recumbent position on a measuring board that has a fixed headboard and a movable footboard attached at right angles to the surface. Infants should be weighed nude, using a table model beam scale that allows the infant to lie or sit. To measure head circumference, a nonstretchable tape is placed around the largest part of the infant’s head, and the measurement is read.

98. What is the relative value of these anthropometric measurements? How are the values to be interpreted?

ANSWER: Although all values of are great importance, the head circumference measures can confirm that growth is proceeding normally or that it helps detect protein-energy malnutrition and evaluates the extent of its impact on brain size. Exceeding the 95th percentile for weight-for-length is considered obese. Falling below the 5th percentile for weight-for-length is categorized as failure to thrive, while falling at or below the 10th percentile for weight-for-length is classified as suspect for failure to thrive. All of the values are plotted on the appropriate growth chart with trends to be noted over time. An infant’s growth rate should be fairly consistent, and wide variations are cause for further evaluation.

99. One of your very first infants is diagnosed with failure to thrive. What is this?

ANSWER: Failure to thrive is inadequate weight gain of infants and is diagnosed when an infant’s weight-forlength falls below the 5th percentile.

100. A few weeks later, you meet a young mother and her two-month-old boy who are both new to the community.

Based on the services offered in your community, what referrals and/or helpful pieces of information might you share with her?

ANSWER: Answers will vary but could include information on the nutrition assistance programs available.

Information on the food pantries and soup kitchens might be appropriate, as well as addresses and/or phone numbers of various agencies of assistance, possible places of employment, and childcare options.

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs True / False 1. The final review for the Healthy People 2020 initiative shows that overall progress was mixed regarding the objectives for children and adolescents. a. True b. False ANSWER: True 2. Children’s eating habits have changed little over the past 20 years. a. True b. False ANSWER: False 3. The Healthy Eating Index is used as an indicator of diet quality because it provides an overall picture of the types of foods people choose to eat and of their adherence to the Dietary Guidelines for Americans. a. True b. False ANSWER: True 4. The National Football League (NFL) helped establish the Fuel Up to Play 60 program focused on fighting childhood obesity. a. True b. False ANSWER: True 5. Despite advances in clinical and preventive medicine, children and adolescents in the United States have significant nutritional concerns. a. True b. False ANSWER: True 6. As children grow into teenagers, their diets typically improve. a. True b. False ANSWER: False 7. Nearly half of family food expenditures are spent on food and beverages outside the home. a. True b. False ANSWER: True

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 8. Body mass index (BMI) values for children and adolescents are age-specific but not gender-specific. a. True b. False ANSWER: False 9. Iron deficiency is common throughout the world but not in the United States. a. True b. False ANSWER: False 10. Adolescent boys and girls have the same iron needs. a. True b. False ANSWER: False 11. Legislation is being sought to eliminate the reduced-price category within the National School Lunch Program. a. True b. False ANSWER: True 12. All schools that offer the National School Lunch Program (NSLP) are also required to offer the breakfast program. a. True b. False ANSWER: False 13. More students participate in the School Breakfast Program than the National School Lunch Program. a. True b. False ANSWER: False 14. Improving child nutrition is the focal point of the Healthy, Hunger-Free Kids Act of 2010. a. True b. False ANSWER: True 15. Most schools prohibit competitive foods from being sold on school grounds. a. True b. False ANSWER: False

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs Multiple Choice 16. How many strategies does Team Nutrition use to change behaviors? a. 1 b. 2 c. 3 d. 4 e. 5 ANSWER: c 17. The average number of daily servings of which foods consumed by children still falls short of the recommendations? a. Fruits b. Vegetables c. Proteins d. a and b e. b and c ANSWER: d 18. Which is the number one most chronic disease of childhood? a. Food allergy b. Dental caries c. Iron-deficiency anemia d. Blood lead level e. High blood cholesterol ANSWER: b 19. Nearly 60% of overweight children have been shown to have at least one risk factor for which disease? a. Cardiovascular b. Hypercholesterolemia c. Diabetic d. None of the above e. All of the above ANSWER: a

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 20. Which describes the widespread practice of dieting among adolescent girls that places them at risk for undernutrition? a. Eating disorder b. Diabetes c. Obesity d. Cardiovascular diseases e. Undernutrition ANSWER: e 21. Children with special health care needs are at increased nutritional risk due to potential , and _. a. feeding problems b. drug nutrient interactions

,

c. decreased mobility d. a and b e. a, b, and c ANSWER: e 22. Which extreme weight-loss behavior is a potential cause of undernutrition in adolescent girls? a. Vomiting b. Taking laxatives c. Taking diet pills d. None of the above e. a, b, and c ANSWER: e 23. What percentage of children and adolescents enrolled in school eat at least one of three meals at school? a. 10% b. 20% c. 30% d. 40% e. 50% ANSWER: e

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 24.

children tend to be taller and to mature earlier than children who are not . a. Underweight, underweight b. Overweight, underweight c. Underweight, overweight d. Overweight, overweight ANSWER: d

25. Which is the primary feeding goal of a child with special needs? a. Parent feeding b. Self-feeding c. Adequate intakes d. Reduced waste e. None of the above ANSWER: b 26. Which kind of messaging in the media about products and values leads to successful, effective nutrition programs for children and youth? a. Clear messaging b. Concise messaging c. Avoiding mixed messaging d. None of the above e. All of the above ANSWER: c 27. In 2010, what percentage of children and adolescents aged 6 to 19 years were overweight? a. 5% b. 11% c. 18% d. 21% e. 23% ANSWER: c

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 28. Healthy People 2020 aims to increase the proportion of adolescents who meet current federal physical activity guidelines for aerobic physical activity to what percentage? a. 9.3% b. 17.9% c. 28.7% d. 31.6% e. 34.3% ANSWER: d 29. As measured by the Healthy Eating Index (HEI) for adolescents ages 2 to 17, the consumption of which dietary components were closest to the standards? a. Dairy products and protein foods b. Total fruits and vegetables c. Green vegetables and beans d. Whole grains e. Protein foods ANSWER: a 30. As measured by the Healthy Eating Index (HEI) for adolescents ages 2 to 17, the consumption of which dietary components were farthest from recommendations? a. Dairy products and protein foods b. Total fruits and vegetables c. Green vegetables and beans d. Whole grains e. Protein foods ANSWER: c 31. What is the primary reason that dietary quality tends to decline from childhood to adolescence? a. Decreased intake of sodium b. Decreased intake of fruits c. Increased intake of vegetables d. Increased intake of whole grains e. Increased intake of proteins ANSWER: b

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 32. Over the past 20 years, which has increased in commonly consumed foods? a. Fiber content b. Portion sizes c. Nutrient density d. Cholesterol content e. All of the above ANSWER: b 33. Which social influence is associated with improved diet quality in children? a. Eating family meals at home b. Dining out with friends c. Eating take-out meals alone d. Dining at fast food restaurants with family e. Dining out multiple times a week ANSWER: a 34. Which two United States Department of Agriculture (USDA) nutrition education programs specifically target the improvement of children’s health? a. Expanded Food and Nutrition Education Program and Team Nutrition b. Action for Healthy Kids, Title V Maternal, and Child Health Program c. Medicaid and the Early and Periodic Screening, Diagnosis, and Treatment program d. Head Start and Early Head Start programs e. None of the above ANSWER: a 35. Childhood obesity is associated with which health factors? a. Hyperinsulinemia, hypertriglyceridemia, and reduced high-density lipoprotein (HDL)-cholesterol b. Hyperinsulinemia, hypertriglyceridemia, and elevated HDL-cholesterol c. Hypoinsulinemia, hypotriglyceridemia, and reduced HDL-cholesterol d. Hypoinsulinemia, hypotriglyceridemia, and elevated HDL-cholesterol ANSWER: a 36. How is overweight in children defined in terms of body mass index (BMI) on the Centers for Disease Control and Prevention (CDC) growth chart? a. Above the 15th but below the 25th percentile b. Above the 50th but below the 60th percentile c. Above the 85th but below the 95th percentile d. At or above the 95th percentile e. Above 100th percentile ANSWER: c Page 7

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 37. How is obesity in children defined with respect to body mass index (BMI) and percentile on the Centers for Disease Control and Prevention (CDC) growth chart. a. above the 25th b. above the 50th c. above the 75th d. above the 85th e. above the 95th ANSWER: e 38. Which of the following is a clear risk factor for type 2 diabetes in children? a. Younger than 10 years of age b. Strong family history of hypoglycemia c. Overweight d. Asian ancestry e. All of the above ANSWER: c 39. How many pounds do children typically gain per year between one year of age and adolescence? a. 2 b. 3 c. 5 d. 7 e. 10 ANSWER: c 40. How many inches do children typically grow per year between one year of age and adolescence? a. One to two b. Two to three c. Four to five d. Five to six e. More than six ANSWER: b 41. Which statement best describes, in general, the nutritional health status of U.S. children? a. It is worse today than ever before. b. It is better today than ever before. c. It is the same today as it has been for a decade. d. It is much worse today than it was a decade ago. e. It is slightly better than a decade ago ANSWER: b Page 8

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 42. How is more than one-third of the dollars spent on food away from home? a. On fast foods b. At fine-dining establishments c. On produce from farmer’s markets d. At convenience stores e. On candies and fatty foods ANSWER: a 43. Low calcium intakes during the peak bone-building years increase the risk for what in later life, especially among females? a. Hypertension b. Type 2 diabetes c. Heart disease d. Anemia e. Osteoporosis ANSWER: e 44. Which of the following children is most likely to be iron deficient? a. A white boy who plays soccer b. A Mexican-American boy living above the poverty threshold c. A Native-American girl from a middle-class family d. An African-American girl living below the poverty threshold e. A white teenaged girl ANSWER: d 45. How many times higher is the prevalence of hunger in children is in single-mother households than in two-parent households? a. Two b. Four c. Six d. Eight e. Ten ANSWER: c

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 46. How many times higher is the prevalence of hunger in children among racial and ethnic minorities than among the white majority? a. Two b. Three c. Four d. Five e. Six ANSWER: b 47. Which negotiation method’s main precept is that a decision about an issue should be based on its merits, not on what each side says it will or will not do? a. Principled negotiation b. Hard negotiation c. Soft negotiation d. Business negotiation e. Nonbusiness negotiation ANSWER: a 48. The link between high blood lead levels and what in children led to a large-scale public health effort and legislation to eliminate or reduce lead from certain products? a. Increased iron deficiency b. Decreased bone health c. Lowered intelligence d. Stunted growth e. Mental health issues ANSWER: c 49. Which of the following is credited with the substantial decline in dental caries in children? a. Decreased sugar consumption b. Fluoridation of public drinking water c. Elimination of lead-based house paint d. Increased availability of bottled water e. None of the above ANSWER: b

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 50. Which is the most common chronic disease in children aged 5 to 17 years? a. Diabetes b. Chronic obstructive pulmonary disease (COPD) c. Hypertension d. Dental caries e. Asthma ANSWER: d 51. Approximately which percentage of people with eating disorders are women? a. 90% b. 75% c. 50% d. 25% e. 10% ANSWER: a 52. The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents classifies a total blood cholesterol level of mg/dL or an LDL-cholesterol level of mg/dL as high. a. 300; 150 b. 240; 160 c. 200; 130 d. 160; 53 e. 150; 100 ANSWER: c 53. Which mandates the provision of comprehensive nutrition services to special needs children three to five years of age, using a community-based approach that focuses on the family. a. American Disabilities Act b. Developmental Disabilities Assistance and Bill of Rights Act c. Education of the Handicapped Act Amendments d. Healthy, Hunger-Free Kids Act e. Title V ANSWER: c

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 54. Which initiative was implemented first? a. After School Snack Program b. National School Lunch Program c. School Breakfast Program d. Summer Food Service Program for Children e. School Milk program ANSWER: b 55. A serious commitment to which sport may especially predispose some female athletes to develop eating disorders? a. Soccer b. Tennis c. Gymnastics d. Basketball e. Swimming ANSWER: c 56. The Free to Be Me program, which helped young girls feel good about their bodies, worked within the framework of which established, widely accepted community program? a. Young Women’s Christian Association (YWCA) b. Young Men’s Christian Association (YMCA) c. Boys and Girls Club d. Girl Scouts e. a and b ANSWER: d 57. The School Breakfast Program serves breakfast for free or at a reduced price of no more than from households with incomes at or below the income eligibility guidelines. a. $0.30 b. $0.40 c. $0.50

to students

d. $0.60 e. $0.70 ANSWER: a

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 58. Not eating enough fruits and vegetables, eating too much fat, and not engaging in regular vigorous physical activity are contributing factors to the fact that more than what percentage of young people are considered overweight or obese? a. 5% b. 12% c. 17% d. 23% e. 35% ANSWER: c 59. Which act aims to improve child nutrition by authorizing funding and allows the United States Department of Agriculture (USDA) to reform the nutrition standards of the school lunch and breakfast programs? a. Child Nutrition Act of 1966 b. Economic Opportunity and Community Partnership Act of 1967 c. National School Lunch Act of 1946 d. Healthy, Hunger-Free Kids Act of 2010 e. Title V ANSWER: d 60. Which program of Feeding America is one of the nation’s largest free-meal service programs for children? a. Team Nutrition b. Kids Café c. The National School Lunch Program d. The Summer Food Service Program e. WIC ANSWER: b 61. Which trait is characteristic of a hard negotiator? a. Their goal is agreement among the parties. b. They think of the participants as friends. c. They perceive the process as a contest of wills. d. They make concessions to maintain the relationship. e. they do not work to seek mutual agreements ANSWER: c

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 62. Which program improves the diets of low-income households by increasing their ability to purchase foods? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: e 63. Which program provides fresh fruits and vegetables to low-income individuals while supporting local farmers? a. Emergency Food Assistance Program b. Food Distribution Program c. Supplemental Nutrition Assistance Program d. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) e. WIC Farmers’ Market Nutrition Program ANSWER: e 64. Which program improves the diets of school and preschool children by using government surplus foods? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: d 65. Which program makes food commodities available to the states for distribution to the needy? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: a 66. Which program assists states in initiating, maintaining, and expanding nonprofit food service programs for children and elderly or impaired adults in nonresidential day care facilities? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: a Page 14

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 67. Which program improves the health and nutritional status of low-income women, infants, children, and the elderly through donation of supplemental foods? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: b 68. Which program provides, at no cost, supplemental nutritious food, nutrition education, and referrals to health care to low-income pregnant women, infants, and children to age five who are at nutritional risk? a. Child and Adult Care Food Program b. Commodity Supplemental Food Program c. Emergency Food Assistance Program d. Food Distribution Program e. Supplemental Nutrition Assistance Program ANSWER: d 69. Select the administering department for the Head Start Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: a 70. Select the administering department for the School Breakfast Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: b

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 71. Select the administering department for the Summer Food Service Program for Children. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: b 72. Select the administering department for the National School Lunch Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: b 73. Select the administering department for the Special Milk Program for Children. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: b 74. Select the administering department for the Title V Maternal and Child Health Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: a 75. Select the administering department for the Early and Periodic Screening, Diagnosis, and Treatment Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. Food and Drug Administration (FDA) d. National Institute of Food and Agriculture (NIFA) e. None of the above ANSWER: a

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 76. Which program of Feeding America has the primary goal to provide free prepared food and nutrition education to hungry children? a. Fuel Up to Play 60 b. Farm-to-School c. Best Bones Forever d. Kids Café Program e. Eat Smart. Play Hard.

ANSWER: d 77. Which program helps students gain access to healthy, local foods and experiential learning opportunities? a. Fuel Up to Play 60 b. Farm-to-School c. Best Bones Forever d. Kids Café Program e. Eat Smart. Play Hard.

ANSWER: b 78. Uses a mascot, Power Panther, as the primary communication vehicle for delivering messages about nutrition and physical activity to children and their caregivers. a. Fuel Up to Play 60 b. Farm-to-School c. Best Bones Forever d. Kids Café Program e. Eat Smart. Play Hard.

ANSWER: e 79. Which in-school program encourages the availability and consumption of nutrient-rich foods and at least an hour of daily physical activity? a. Fuel Up to Play 60 b. Farm-to-School c. Best Bones Forever d. Kids Café Program e. Eat Smart. Play Hard.

ANSWER: a

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 80. Which program’s goal is to encourage calcium consumption and physical activity to reduce the risk of osteoporosis later in life? a. Fuel Up to Play 60 b. Farm-to-School c. Best Bones Forever d. Kids Café Program e. Eat Smart. Play Hard.

ANSWER: c Essay 81. Discuss the progress made in reaching the Healthy People 2010 objectives for children.

ANSWER: The most recent progress review shows that, overall, the weight status of children reflects a trend for the worse with 18% of children and adolescents ages 6 to 19 years being overweight. The prevalence of overweight among children and adolescents of all ethnic groups increased substantially with the proportion of students in grades 9 through 12 participating in daily physical activity increasing slightly.

The incidence and prevalence of diabetes increased for the population as a whole. Progress was made in moving toward some of the objectives for the year 2010. The prevalence of growth retardation among low-income children decreased for all races combined and for some Hispanics and Asians/Pacific Islanders. No progress was made in reducing the prevalence of iron deficiency among young children overall, although the prevalence did decline for low-income children. The three objectives for fruit, vegetable, and grain consumption have shown little or no progress in this decade.

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 82. List and explain four of the eight recommended steps for achieving the Healthy People 2020 objectives that promote healthful weights and food choices in children and adolescents.

ANSWER: Answers will vary but should include four of the following eight steps: Because most post pubertal children regain any lost weight within a year, promote the initiation of behavioral therapy for overweight children before the onset of puberty. Such therapy should include the teaching of social skills to counter taunting and to maintain and develop friendships.

Educate children and their families about the health benefits of being physically active and the possible added benefit of thereby attaining modest weight reduction.

Encourage schools to find ways to offset potential revenues lost from removal of competitive foods that do not meet United States Department of Agriculture (USDA) Food and Nutrition Service nutrition standards. Recommendations include offering healthier competitive food choices and substituting nonfood sales and fundraising activities.

Promote partnerships among schools, families, and community members to increase resources that support a health-promoting environment.

Demonstrate to schools that setting aside regularly scheduled periods for physical education during the school day can boost students’ academic achievement.

Develop and implement strategies to increase physical activity among children with disabilities.

This step should include the use of media that feature disabled adults who can serve as role models of physical fitness for youth who have disabilities.

Advocate for public health policies that address not only individual behaviors but also the environmental context and conditions in which people live and make choices.

Implement strategies to make healthful food choices available, identifiable, and affordable to people of all races and income levels and in all types of geographic locations (e.g., urban, suburban, rural).

83. What is the Healthy Eating Index (HEI)? What do the results for children indicate? Please provide examples to justify to your conclusions.

ANSWER: The HEI is a summary measure of the quality of one’s diet. The HEI provides an overall picture of how well one’s diet conforms to the nutrition recommendations contained in the Dietary Guidelines for Americans. The index factors in such dietary practices as consumption of calories from solid fats and added sugars, saturated fat, sodium, and the variety of foods in the diet. The results indicate that most children and adolescents aged 2 to 17 have less-than-optimal diets. Children who live in poor families, compared to those who do not live in poverty, are more likely to have a diet rated as poor or needing improvement. Dietary quality continues to decline from childhood to adolescence, especially with the decreased consumption of fruits and the increased intake of sodium and empty calories from solid fats and added sugars. Children aged seven to nine have a lower-quality diet than younger children, and the lower quality is associated with a decline in their fruit and sodium HEI scores, perhaps because as children get older, they consume more fast food and salty snacks.

84. What are three reasons for the decline in healthful eating patterns and behaviors as children and adolescents age?

ANSWER: The reasons for the decline in good eating habits can be correlated with growing independence from parents, eating away from home, concern with physical appearance and body weight, the need for peer acceptance, the multiple roles media plays, and busy schedules.

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 85. Discuss why undernutrition is a problem for some adolescent girls in the United States.

ANSWER: The widespread practice of dieting among adolescent girls places them at risk for undernutrition. The results of the National Youth Risk Behavior Survey found adolescent girls engaging in extreme weightloss behaviors, such as vomiting, using laxatives, or taking diet pills. Some 47% of high school students reported that they were trying to lose weight.

86. Describe the components of an interdisciplinary assessment of children with special health care needs.

ANSWER: Children with special health care needs are at increased nutritional risk because of feeding problems, metabolic aberrations, drug/nutrient interactions, decreased mobility, and alterations in growth patterns; thus, an interdisciplinary approach is recommended. The interdisciplinary team may include a physician, nurse, psychologist, dentist, dietitian, school administrator, food service director, special education staff, and occupational, physical, and speech therapists. The interdisciplinary team evaluation of the health and nutritional status of children with special needs includes the dietary history, medical history, anthropometric measurements, clinical assessment, and feeding assessment.

87. What improvements would you recommend to enhance the ability of the National School Lunch Program to meet the nutritional needs of its participants?

ANSWER: Answers will vary but could include the following: Greater variety of low-fat, whole foods served More/stronger legislation on the sale and availability of competitive foods More appealing foods for children Nutrition education focus Greater confidentiality of level of payment plan 88. Discuss three United States Department of Agriculture (USDA) nutrition assistance programs aimed at improving the health and nutritional status of children, including their purpose, types of assistance offered to clients, and eligibility requirements.

ANSWER: Answers provided will vary but should include three of the following programs: National School Lunch Program, School Breakfast Program, After School Snack Program, Special Milk Program for Children, and the Summer Food Service Program for Children. See Table 12-3 for specific information on types of assistance offered and eligibility requirements.

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 89. List the new K-12 food requirements that a school breakfast must meet in order to be reimbursable by the federal government.

ANSWER:

Milk: one cup of fat-free (flavored/unflavored) or 1% unflavored; and Fruit: one cupper day (vegetable substitution allowed); and Grains: one oz equivalent minimum daily; weekly ranges differ among age groups: Grades K-5: 7 to 10 oz weekly Grades 6-8: 8 to 10 oz weekly Grades 9-12: 9 to 10 oz weekly All grains must be whole grain-rich There is no separate meat/meat alternate component in the new standards. Schools may substitute one oz equivalent of meat/meat alternate for one oz equivalent of grains after the minimum daily grains requirement is met.

90. What are three suggestions for building a more healthful school environment?

ANSWER: Answers will vary, but some possible suggestions include the following: Providing age-appropriate nutrition and health education to help students develop life-long healthful lifestyle habits Ensuring that meals offered through school breakfast and lunch programs meet healthful standards Adopting policies that require all foods and beverages available on school campuses and at school events to contribute toward eating patterns that are consistent with the 2010 Dietary Guidelines for Americans Providing food options that are low in fat, calories, and added sugars Ensuring that healthful snacks and foods are provided in vending machines, school stores, and other venues Prohibiting access to vending machines that compete with healthful school meals in elementary schools, and restricting access in middle, junior, and high schools Providing adequate time for students to eat school meals, and scheduling lunch periods at reasonable hours around midday 91. What are some factors that contribute to overweight and obesity in children?

ANSWER: Genetic susceptibility to obesity, lifestyle choices, family eating patterns, and lack of access to neighborhood environments that support physical activity all contribute.

92. Briefly state the main impetus for the initiation of the National School Lunch Program.

ANSWER: As a result of testimony from the surgeon general that “70 percent of the boys who had poor nutrition 10 to 12 years ago were rejected by the draft,” legislation was introduced to give the school lunch program permanent status.

93. What is an “open site” as defined in the Summer Food Service Program for Children?

ANSWER: “Open sites” are located in areas where 50% or more of the children come from families whose household income is below 185% of the federal poverty guidelines.

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Chapter 12: Children and Adolescents: Nutrition Issues, Services, and Programs 94. What role does the Food Distribution Program play in the National School Lunch Program (NSLP)?

ANSWER: School districts are given an entitlement dollar value based on the number of lunches served. The amounts of entitlement commodities provided are based on this calculated value.

95. Define competitive foods. What is the impact of the sale of these foods during lunch times?

ANSWER: Competitive foods are foods sold in competition with United States Department of Agriculture (USDA) school meals through cafeteria á la carte sales, vending machines, school stores, or snack bars. For many schools, the sale of competitive foods represents additional income.

96. Physiologically, how do overweight and obesity affect the growth and maturation of children?

ANSWER: Overweight and obesity can lead to early maturation in children. Early maturation is associated with increased fatness in adulthood and an increase in abdominal fat. Overweight children tend to be taller and to have advanced bone ages.

97. What might be some features that you would examine?

ANSWER: Answers will vary, but could include the following: Menu appeal Nutritional compliance Participation Barriers to participation Cost Value for cost 98. Describe the outcomes and indicators you would select to determine whether the program meets the needs of its clients. Why did you select these particular outcomes and indicators?

ANSWER: Answers will vary but could include feedback from students, parents, and school personnel on the following: Participation rates Time breakfast is served Menu choices Location where breakfast is served 99. Let’s assume that your community’s School Breakfast Program is not meeting the needs of its participants or the target population. What steps would you take to correct the situation?

ANSWER: Answers will vary greatly but could include responses in the areas of program delivery (time breakfast is served), menu choices available, and other barriers to participation noted.

100. Describe one marketing strategy that you would undertake to enhance program participation.

ANSWER: Answers will vary greatly but could include involvement of parents, students, and school personnel. A class competition might be a fun way to develop a creative marketing strategy.

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs True / False 1. Older adults in Okinawa, Japan, have among the lowest mortality rates from a multitude of chronic diseases of aging in the world. a. True b. False ANSWER: True 2. By 2030, minority groups will represent 26.4% of the population of older adults. a. True b. False ANSWER: True 3. One of the goals of the Healthy People 2020 initiative is to increase the number of older persons who receive pneumonia and influenza vaccinations. a. True b. False ANSWER: True 4. One general characteristic of baby boomers is that they are nostalgic and are not necessarily concerned with eating food that is healthy and convenient. a. True b. False ANSWER: False 5. There has been a dramatic improvement in the past decade in the status of most objectives for physical activity and fitness among adults. a. True b. False ANSWER: False 6. The health effects of aging in the endocrine system of older adults are most commonly manifested as decreased absorption of minerals. a. True b. False ANSWER: False 7. Polypharmacy, which is the tendency to purchase drugs at more than three stores, is problematic for many older adults. a. True b. False ANSWER: False Page 1

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 8. Providing entreat nutrition for older adults at nutritional risk is the most important first step in maintaining quality of life and functional status. a. True b. False ANSWER: False 9. The Mini Nutritional Assessment is a basic evaluation that assesses an older adult’s cognitive status, memory, and affect. a. True b. False ANSWER: False 10. Many instrumental activities of daily living, such as shopping and paying bills, are closely related to adequate nutrition status. a. True b. False ANSWER: True 11. Title III nutrition program efforts are usually limited to home-delivered meal sites. a. True b. False ANSWER: False 12. A food bank project buys irregular foods that are damaged or expired and would be thrown away, and sells the food to older adults at a reduced price. a. True b. False ANSWER: False 13. The Meals on Wheels Association of America helps reach older adults in communities who are also fully serviced by the Older Americans Nutrition Program. a. True b. False ANSWER: False 14. Seniors interviewed in focus groups have shown no interest in changing their eating behaviors. a. True b. False ANSWER: False

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 15. Older adults often avoid feeling the loss of future by using their present time for leisure and enjoyment. a. True b. False ANSWER: False Multiple Choice 16. For whom was the Supplemental Nutrition Assistance Program designed specifically to assist? a. Older population b. Mothers with small children c. Working middle class d. School-aged children e. Low-income households ANSWER: e 17. What does the Older Americans Nutrition Program provide to meet the needs of homebound older adults? a. Information b. Referrals c. Attention d. A, B, and C e. a and b ANSWER: d 18. To age successfully, how should one prepare for old age early in life? a. Psychologically and nutritionally b. Physically c. Medically d. Socially e. None of the above ANSWER: a 19. Which is designed to reach people in many different contexts of their daily lives? a. Medical Nutrition Therapy b. Nutrition consultation c. Nutritional screening d. Community Nutrition Intervention e. Nutritional assessments ANSWER: c

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 20. Which characteristic describes the older population in terms of their progression through the aging process? a. Homogeneous b. Heterogenous c. Neutral d. Both a and b e. None of the above ANSWER: b 21. Which is the Eat Smart, Live Strong program designed to improve among older adults eligible for nutrition assistance programs? a. Fruit consumption b. Vegetable consumption c. Fruit and vegetable consumption d. Physical activity e. Both c and d ANSWER: e 22. For adults over which age do health promotion efforts seek to preserve independence, productivity, and personal fulfillment? a. 40 b. 45 c. 50 d. 55 e. 60 ANSWER: c 23. Nationwide, about what portion of all seniors live in rural areas? a. One eighth b. One quarter c. One third d. One forth e. One half ANSWER: e

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 24. A child born in 2013 can expect to live a. 65, 40 b. 69.2, 45 c. 72.8, 50

years, about

years longer than a child born in 1900.

d. 75.2, 50 e. 78.2, 55 ANSWER: c 25. Because of what kind of care and improved means of combating disease in older adults has led, in part, to increased life expectancy? a. Prenatal care b. Postnatal care c. Elderly care d. a and b e. a and c ANSWER: d 26. Though optimal nutrition contributes to healthy aging, approximately of all hospitalized older adults may suffer from malnutrition. a. One quarter, one quarter b. One quarter, one half c. One half, one quarter d. One half, one half e. One third, one half

of all older adults and

ANSWER: b 27. The average age at which a person dies is known as which? a. Maximum age b. Centenarians c. Life expectancy d. Chronologic period e. Expiration date ANSWER: c

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 28. By 2040, the number of adults aged 65 and over in the United States is expected to be about what percent of the population? a. 14% b. 22% c. 38% d. 54% e. 60% ANSWER: b 29. The baby boom generation consists of people born between which years? a. 1900 and 1920 b. 1922 and 1936 c. 1940 and 1980 d. 1946 and 1964 e. 1946 and 1980 ANSWER: d 30. Which describes a topic area relevant to older adults as part of the Healthy People 2030 initiative? a. Controlling alcohol intake b. Eliminating instances of mental illness c. Providing increased funding for nutrition services d. Reducing the arthritis e. Reducing the rate of hospital admissions for diabetes among older adults ANSWER: e 31. The Centers for Disease Control and Prevention has urged public health efforts to increase consumer intakes of fruits and vegetables through which? a. Improved guidelines for organic products b. Competitive pricing of foods c. Increased financial backing for farmers d. Development of mobile food units e. Increasing food trucks ANSWER: b

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 32. What describes a general characteristic of baby boomers in terms of health promotion programs and services? a. They will not age gracefully. b. They are not concerned with convenience. c. They have more time for leisure activities. d. They become less thrifty with age. e. They just want to have fun.

ANSWER: a 33. What best describes the purpose of the U.S. Department of Agriculture’s Super Tracker tool? a. To provide education for families with limited resources b. To monitor amounts of insurance premiums associated with preventive care c. To educate older adults about the dangers of hypertension d. To provide weekly meal plans e. To help consumers decide what and how much to eat ANSWER: d 34. In what way does the Farm to Work initiative support obesity prevention? a. By increasing financial support for obesity prevention programs b. By using farmers to educate older adults about obesity c. By encouraging older adults to plant gardens d. By providing baskets of healthy foods to worksites e. By offering prepared foods on worksites ANSWER: d 35. What percent of older adults currently live in nursing homes? a. 3.4% b. 7.5% c. 11.2% d. 17.7% e. 18.1% ANSWER: a 36. Reduced stomach acidity associated with advancing age most likely impairs the absorption of what nutrient? a. Magnesium b. Sodium c. Vitamin B12 d. Vitamin C e. Zinc ANSWER: c Page 7

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 37. What condition is a major contributor to disability and placement in nursing homes for those over age 75 and is often accompanied by food intake changes? a. Diabetes b. Hypertension c. Dementia d. Osteoporosis e. Hypercholesterolemia ANSWER: c 38. What best describes how osteoarthritis impacts nutritional status in older adults? a. Difficulties in regulating fluid balances b. Altered cognitive abilities related to eating c. Increased risk of nutrient malabsorption d. Difficulties in communicating needs e. Difficulties with movement and meal preparation ANSWER: e 39. More than what percentage of older Americans have multiple chronic conditions that can benefit from nutrition intervention by food and nutrition practitioners? a. 25% b. 35% c. 55% d. 66% e. 70% ANSWER: d 40. Which type of drugs are most commonly used by older adults? a. antacid medications b. antidepressants c. seizure medications d. cardiac drugs e. Asthma ANSWER: d

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 41. Nutrition helps promote health and affects the quality of life in older adults as a form of what kind of prevention? a. Primary b. Secondary c. Tertiary d. Essential e. Necessary ANSWER: a 42. To promote healthful aging, improve care, and broaden access to food and nutrition programs and services for older adults, the Academy of Nutrition and Dietetics supports which strategy? a. Calculating the numbers of community-dwelling adults with dehydration b. Expanding funding for home-based nutrition services c. Training only professional caregivers of homebound older adults d. Providing culturally appropriate foods in health care centers e. Working with nurses so they can provide nutritional care ANSWER: b 43. Which best describes an example of tertiary prevention? a. A health fair b. A grocery store tour c. Medical nutrition therapy d. Cholesterol screenings e. Church health screening ANSWER: c 44. Which tasks best represent activities of daily living (ADLs)? a. Bathing, dressing, and food preparation b. Housekeeping, managing money, and shopping c. Going to grocery store d. Grooming, dressing, and using the phone e. Eating, bathing, and getting out of bed ANSWER: e 45. An example of a physiologic risk factor that would affect nutrition status in older adults would be which? a. Inadequate housing b. Alcohol or drug abuse c. Lack of transportation d. Limited education ANSWER: b

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 46. The word DETERMINE is used as a mnemonic device with the self-assessment checklist of the Nutrition Screening Initiative. What does the D in DETERMINE stands for? a. Drinks b. Drugs c. Disease d. Diet e. None of the above ANSWER: c 47. The functional assessment component for a nutritional status assessment of older adult’s measures which? a. Activities of daily living b. Cardiac output c. Adverse health risk d. Risk of malnutrition e. Liver function ANSWER: a 48. Which nutrition program would most likely be implemented as part of care for institutionalized older adults? a. Cooperative extensions b. Home-delivered meal programs c. Hospice d. Local community gardens e. Hospice ANSWER: e 49. The Older Americans Nutrition Program is funded by the which? a. Department of Health and Human Services b. U.S. Department of Agriculture c. Centers for Medicare and Medicaid Services d. Social Security Administration e. Food and Nutrition Services ANSWER: a

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 50. The current Older Americans Nutrition Program legislation makes meals available to seniors at least how many days a week? a. Three b. Four c. Five d. Six e. Seven ANSWER: c 51. A luncheon club, initiated by some states to reduce the cost of providing meals, would most likely take place where? a. Neighbor’s home b. Senior center c. Outpatient clinic d. Adult day care center e. Community center ANSWER: a 52. Which describes an example of a nutritional risk factor that is diagnostic for the need for nutritional assistance among older adults? a. Short periods of the day without food or beverages b. Consumption of fewer than 15 main meals per week c. Depression or loneliness d. Presence of acute illness e. Poor mobility ANSWER: c 53. Which describes a role of the Meals on Wheels Association of America (MOWAA)? a. Developing health and wellness centers for older adults b. Offering grant opportunities to members c. Providing store tours for people on special diets d. Selling irregular food products to low-income consumers e. Developing elderly program ANSWER: b

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 54. Which describes a benefit of using a supermarket program to educate older adults about nutrition services? a. Lowered cholesterol levels among consumers b. Improved food security in the community c. Decreased alcohol intake among older adults d. Increased product sales for the market e. Positive interactions ANSWER: d 55. The Go4Life campaign is designed to do what? a. To decrease diagnoses of depression b. To encourage medication compliance in older adults c. To decrease shopping difficulties among older adults d. To increase numbers of older adults who are active and healthy e. To increase activity among older people ANSWER: d 56. Which best describes a “life advantage” that seems to contribute to good physical and mental health in later years? a. Consuming milk alternatives instead of milk b. Adhering to a nutritious diet with excess food energy c. Achieving financial independence d. Avoiding new knowledge and new experiences e. Avoiding negative people ANSWER: c 57. Identify the funding source for the Adult Day Care Food Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: b 58. Identify the funding source for the Older Americans Nutrition Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: a

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 59. Identify the funding source for the Supplemental Nutrition Assistance Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: b 60. Identify the funding source for the Seniors Farmers’ Market Nutrition Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: b 61. Identify the funding source for Medicare. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: a 62. Identify the funding source for the Supplemental Nutrition Assistance Program (SNAP) Nutrition Education Program. a. Department of Health and Human Services (DHHS) b. United States Department of Agriculture (USDA) c. National Institute of Food and Agriculture (NIFA) d. Food and Drug Administration (FDA) e. None of the above ANSWER: b 63. Which is the third-party payment system that covers medical expenses for seniors? a. Adult Care Food Program b. Older Americans Nutrition Program c. Supplemental Nutrition Assistance Program (SNAP) d. SNAP Nutrition Education Program e. Medicare ANSWER: e Page 13

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 64. Which is an income subsidy that provides low-income seniors with coupons that can be used to purchase fresh fruits and vegetables? a. b. c. d. e. f.

ANSWER: f 65. Which program provides congregate and home-delivered meals? a. b. c. d.

ANSWER: b 66. Which program provides electronic benefits transfer for food purchases? a. b. c. d.

ANSWER: c 67. Which program provides low-income individuals with nutrition education? a. b. c. d.

ANSWER: d 68. Which program provides meals and snacks to participating daycare programs for older Americans? a. b. c. d.

ANSWER: a

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 69. Which describes the average age of death? a. Older Americans Act Older Americans Act b. Instrumental activities of daily living c. Life expectancy d. Disability e. Baby Boom ANSWER: c 70. Which describes the period between 1946 and 1964? a. Older Americans Act Older Americans Act b. Instrumental activities of daily living c. Life expectancy d. Disability e. Baby Boom ANSWER: e 71. Which describes any restriction on or impairment in performing an activity in the manner considered normal? a. Older Americans Act Older Americans Act b. Instrumental activities of daily living c. Life expectancy d. Disability e. Baby Boom ANSWER: d 72. Which describes the act of taking three or more medications regularly? a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living ANSWER: a 73. Which describes bathing, dressing, grooming, and feeding oneself? a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living ANSWER: c

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 74. Which describes food preparation, housekeeping, managing money, and shopping? a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living ANSWER: e 75. Which established the federal Older Americans Nutrition Program? a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living ANSWER: d 76. Which is a government-sponsored program that includes congregate and home-delivered meals? a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living ANSWER: b 77. Dryness, loss of elasticity, dilation of capillaries a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous ANSWER: b 78. Macular degeneration, hearing loss a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous ANSWER: c

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 79. Altered circulating hormone levels a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous ANSWER: a 80. Degeneration of joints a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous ANSWER: d 81. Decreased sensory perception, loss of brain cells a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous ANSWER: e Matching Match the definitions in the left column with the appropriate term in the right column. Options will be used only once. a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living f. Life expectancy g. Disability h. Baby boom 82. The average age of death ANSWER: f

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs Match the definitions in the left column with the appropriate term in the right column. Options will be used only once. a. Polypharmacy b. Older Americans Nutrition Program c. Activities of daily living d. Older Americans Act Older Americans Act e. Instrumental activities of daily living f. Life expectancy g. Disability h. Baby boom 83. The period of time between 1946 and 1964 ANSWER: h Match the aging effect(s) in the left column with the organ system in the right column. Options will be used only once. a. Endocrine b. Skin c. Head and neck d. Musculoskeletal e. Nervous 84. Dryness, loss of elasticity, dilation of capillaries ANSWER: b Essay 85. Why do Okinawans enjoy one of the longest lifespans of anyone on Earth?

ANSWER: Okinawan elders have one of the longest lifespans for the following reasons: Okinawan elders have an average body mass index (BMI) of 18 to 22.

Okinawan elders never smoke.

They consume a diet that is 80% plant-based and naturally high in unrefined whole grains, soy, vegetables, and fruit.

They consume higher intakes of good fats from omega-3 rich fish and monounsaturated fats, and they have rather low amounts of saturated and trans fats in their diet.

They are active every day.

Okinawans put family first and possess a strong sense of purpose.

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 86. Describe the demographic trends of Baby Boomers in America and their contribution to the growing older adult population.

ANSWER: The Baby Boom that took place between 1946 and 1964 and improved life expectancy are important contributors to the growing older adult population in the United States. Baby Boomers increased the numbers of the older middle-aged (ages 46 to 63) people until 2011 when they began to swell the ranks of the retired population. The growth rate of the older population is expected to slow after 2030 when the last Baby Boomers turn 65 years old.

87. List three examples of objectives set by the Healthy People 2020 initiative related to nutrition and weight status.

ANSWER: Primary Healthy People 2020 topic areas for adults include reducing the prevalence of and the overall number of people who suffer from diseases such as arthritis, osteoporosis, cancer, heart disease, diabetes, and kidney disease. Other age-specific goals include increasing the number of older persons receiving pneumonia and influenza vaccinations and colorectal cancer screenings, along with increasing daily physical activity and cardio- vascular health. Examples of areas related to nutrition and weight status include increasing the proportion of physician office visits made by patients with a diagnosis of heart disease, diabetes, or hyperlipidemia that include counseling or education related to diet and nutrition; increasing the proportion of work sites that offer nutrition or weight-management classes or counseling; increasing the proportion of adults who are at a healthy weight; and reducing household food insecurity and in so doing reducing hunger.

88. Identify some of the characteristics of Baby Boomers and describe how they could be incorporated into a nutritioneducation program for this target group.

ANSWER: Characteristics of baby boomers include the following: a. They can change the marketplace due to their numbers and affluence. b. They make decisions based on personal beliefs and they desire to be empowered. c. They are pressed for time. d. They look for value and quality in their investments and are thrifty. e. They will not age gracefully. f. They like nostalgia.

These characteristics could be incorporated in a variety of ways: a. Providing quick, easy, and healthy recipes b. Keeping current on hot trends and topics in nutrition c. Modifying favorite recipes to be more healthful d. Incorporating activities that promote autonomy

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 89. Describe the classifications of worksite health promotion efforts designed to improve health and prevent disease.

ANSWER: Many employers now provide worksite health promotion programs offering classes and activities for smoking cessation, weight management, and stress reduction. These programs vary widely. Some are simple and inexpensive whereas others are more complex. In general, worksite health promotion efforts can be classified under four main areas: Policies. Smoking and alcohol and other drugs.

Screenings. Health risk/health status, cancer, high blood pressure, glucose, and cholesterol.

Information or activities. Individual counseling, group classes, workshops, lectures, special events, and resource materials such as posters, brochures, pamphlets, videos, podcasts, pedometers, and interactive online tools. Topics typically covered include cancer, high blood pressure, cholesterol, smoking, physical activity and fitness, nutrition, weight management, and stress reduction.

Facilities or services. Nutrition, physical fitness, alcohol and other drugs, and stress reduction.

90. Describe four specific risk factors and four major indicators of poor nutrition status in older adults as identified by the Nutrition Screening Initiative.

ANSWER: Specific risk factors include the following: a. Inappropriate food intake b. Poverty c. Social isolation d. Dependence/disability e. Acute/chronic diseases or conditions f. Chronic medication use g. Advanced age (80+) Major indicators of poor nutrition status: a. Weight loss of 10 or more pounds b. Underweight, overweight c. Serum albumin below 3.5 g/dL d. Change in functional status e. Inappropriate food intake f. Mid-arm muscle circumference < 10th percentile g. Triceps skin fold < 10th percentile or > 95th percentile h. Obesity i. Nutrition-related disorders such as osteoporosis, osteo malacia, foliate deficiency, and vitamin B12 deficiency

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 91. Discuss the various components of a thorough nutrition assessment for older adults.

ANSWER: A thorough nutrition assessment includes four major areas: physical assessment, functional ability, psychological health, and socio environmental factors.

The specific components are as follows: a. Anthropometric measures include height, weight, and skin fold measures that are affected by aging. b. Clinical assessment evaluates the condition of the hair, skin, nails, and other physical attributes. c. Biochemical assessment may include serum albumin because low serum albumin levels are associated with increased morbidity and mortality in older adults. d. Dietary assessment detects persons who avoid certain food groups, adhere to unusual dietary practices, or consume excessive or insufficient amounts of essential nutrients. e. Functional assessment measures changes in basic functions necessary to maintain independent living. f. Medication assessment notes the types and doses of prescription and over-the-counter drugs and evaluates possible nutrient-drug interactions. g. Social assessment examines financial resources, living arrangements, and social support.

92. List four examples of major nutritional policy recommendations from the Academy of Nutrition and Dietetics to better help older adults manage their health.

ANSWER: Several major nutrition policy recommendations for promoting the health of older adults are related to the value of nutrition services: Good nutrition is essential to the health, independence, and quality of life of older adults and one of the major determinants of successful aging.

Nutrition services are needed in the wide variety of settings in which older adults live, dine, and receive health care. These include rehabilitation, community health, congregant feeding, home care, adult daycare, assisted living, and nursing facilities.

More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions (e.g., cardiovascular disease, diabetes mellitus, kidney disease, hypertension, obesity, and osteoporosis) that can benefit from nutrition intervention by food and nutrition practitioners.

Most homebound older adults rely on informal caregivers, most of whom are untrained and unprepared for care management.

A broad array of culturally appropriate food and nutrition services, and physical activities and supportive care are vital for maintaining the health of this growing segment of the U.S. population.

Enjoyment of food, along with its social and nurturing aspects, contributes to quality of life for older adults. Evidence shows that services that improve nutrition among older adults produce positive health outcomes and reduce their health care costs.

Adults with poor nutritional status, especially those consuming inadequate food and fluids, are more likely to have serious complications.

93. What is the main difference between the home-delivered meals offered by the Older Americans Nutrition Program and the Meals on Wheels Association of America program?

ANSWER: The major difference is the funding source. The Older Americans Nutrition Program is a federally funded program (public) whereas the Meals on Wheels Association of America is privately funded.

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 94. What improvements would you recommend to enhance the ability of the Older Americans Nutrition Program to meet the needs of those who are eligible to receive its benefits?

ANSWER: Answers will vary, but could include the following: a. Ease in paperwork completion b. Case manager process c. Benefits become part of Social Security check d. Promotion of luncheon clubs 95. What is the difference between life expectancy and maximum lifespan?

ANSWER: Life expectancy is the lifespan from birth to death, whereas the maximum lifespan is the maximum age to which a person can live.

96. How do the food intake and body mass index (BMI) of Okinawan elders differ from average Americans?

ANSWER: Okinawan elders have an average BMI that ranges from 18 to 22. The Okinawans stay lean by eating a low-calorie diet, practicing calorie control in a cultural habit known as hara hachi Bu (only eating until they are 80% full), and keeping physically active every day.

97. List five examples of leading causes of death among adults over age 65.

ANSWER: Heart disease, cancer, chronic low respiratory disease, cerebrovascular disease, Alzheimer’s disease, diabetes, unintentional injury, influenza and pneumonia, nephritis, and septicemia.

98. List three environmental and three socio economic factors that specifically influence the nutrition status of older adults.

ANSWER: Environmental factors include inadequate housing, inadequate cooking facilities, and lack of transportation. Socioeconomic factors include cultural beliefs, poverty, limited education, literacy level, limited access to health care, and institutionalization.

99. What elements would be included in the clinical component of the nutrition assessment?

ANSWER: The clinical assessment should evaluate the condition of hair, skin, nails, musculature, eyes, mucosa, and other physical attributes. An oral examination is useful for determining the condition of the mouth and teeth, the need for dentures or the condition of existing dentures, and oral lesions. An assessment of the client’s ability to chew, swallow, and self-feed is recommended.

100. What types of services are most often included as part of this program?

ANSWER: Services include meals, transportation, shopping assistance; limited nutrition education; information; referral; and attention to the needs of home-bound older adults.

101. How might the nutrition information be shared?

ANSWER: The information could be shared in a face-to-face session or series of sessions or in non–face-to-face sessions. Face-to-face activities could include a lecture format, question-answer format, supermarket tour, and individual counseling. Non–face-to-face activities could include newsletters, bulletin boards, handouts, and pamphlets.

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Chapter 13: Healthy Aging: Nutrition Assessment, Services, and Programs 102. Describe specific goals of the Older Americans Nutrition Program.

ANSWER: To reduce hunger and food insecurity by providing low-cost, nutritious meals; to provide opportunities for social interaction among older individuals; to promote the health and well-being of older individuals; and to delay adverse health conditions through access to nutrition and other disease prevention and health promotion services.

103. Explain several elements associated with the Congregate Meals program.

ANSWER: The congregate meal sites are often community centers, senior centers, faith-based facilities, schools, adult daycare facilities, or older adult housing complexes. Administrators try to select sites for congregate meals that will be accessible to as many of the eligible older adults as possible.

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities True / False 1. In developing countries, mothers are advised to continue breastfeeding for up to two years. a. True b. False ANSWER: True 2. The weaning period is one of the most dangerous times for children in developing countries because newly weaned infants often receive nutrient-poor, diluted cereals or starchy root crops. a. True b. False ANSWER: True 3. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) is a child survival plan set forth by the United States Department of Agriculture (USDA). a. True b. False ANSWER: False 4. One of the 17 Sustainable Development Goals set at the United Nations 2015 Sustainable Development Summit is to end poverty in all its forms everywhere. a. True b. False ANSWER: True 5. The most widespread form of malnutrition in the world today is protein-energy malnutrition (PEM). a. True b. False ANSWER: True 6. Our choices have an impact on the way the rest of the world’s people live and die. a. True b. False ANSWER: True 7. The global prevalence of iodine deficiency has been halved because of a sustained effort to add iodine to the world’s household salt. a. True b. False ANSWER: True

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 8. Birth weight is a potent indicator of an infant’s future health status. a. True b. False ANSWER: True 9. The direct costs of hunger include the loss of productivity and income because of problems associated with chronic hunger. a. True b. False ANSWER: False 10. Food insecurity is a product of poverty resulting from the ways in which governments and businesses manage national and international economies. a. True b. False ANSWER: True 11. Debt and trade are closely related to the progress a country can make toward achieving adequate diets for its people. a. True b. False ANSWER: True 12. Fertile farmlands are often controlled by multinational corporations that hire indigenous people for below-subsistence wages to grow crops to be exported for profit, leaving little fertile land on which the local farmers can grow food. a. True b. False ANSWER: True 13. The green revolution describes giving people a meaningful opportunity to produce food for local consumption. a. True b. False ANSWER: False 14. International nutrition programs can include both large-scale and small-scale operations. a. True b. False ANSWER: True

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 15. A potential risk of using genetically modified crops is that they are often tolerant of poor environmental conditions. a. True b. False ANSWER: False Multiple Choice 16. Which condition is known as kwashiorkor, or starvation? a. Severe emaciation b. Energy deficiency c. Chronic wasting of fat d. Wasting of muscle and other tissues e. All of the above ANSWER: e 17. Along with clean water, health care services, and education, what other basic human needs need to be met to achieve sustainable development? a. Food b. Medicines c. Shelter d. Clothes e. a and c ANSWER: e 18. Which involves the administration of a solution that mothers can access for a small fee after its components are sent to their local area? a. Rebounding b. Hydration c. Medical nutrition therapy d. Oral rehydration therapy e. None of the above ANSWER: d 19. Nutrition security requires that all people have access to a variety of which? a. Nutritious foods and potable drinking water. b. Snacks and fruits c. Fruits and vegetables d. Balance meal plans e. Proteins and vegetables ANSWER: a Page 3

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 20. Which was once viewed as a problem of overpopulation and inadequate food production but which now many people recognize as a problem of poverty? a. Nutritional intakes b. Food security c. Food insecurity d. a and b e. b and c ANSWER: c 21. Approximately 3 billion people live in extreme poverty, or on less than how much per day? a. $1.00 b. $1.25 c. $1.30 d. $1.75 e. $2.00 ANSWER: b 22. Which region has the highest prevalence of hunger, where one in four people are undernourished? a. Eastern America b. Western America c. Northern America d. Southern America e. Central America ANSWER: e 23. For the poor, the struggle for what leaves no energy or resources for other concerns? a. Safe water b. Adequate nutrition c. Access to basic health care d. a and b e. a, b, and c ANSWER: e

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 24. According to estimates, most of the increase in the world’s population between which years will occur in rural areas? a. 1995 and 2000 b. 2000 and 2030 c. 2000 and 2020 d. 2010 and 2030 e. 2000 and 2040 ANSWER: d 25. According to the United Nations, what is the world population projected to be by 2050? a. 11 billion b. 12 billion c. 15 billion d. 16 billion e. 18 billion ANSWER: a 26. Which deficiency manifests a range of symptoms, from mild night blindness to dryness of the conjunctiva and cornea and, in severe cases, to melting of the cornea and blindness? a. Vitamin D b. Vitamin C c. Vitamin A d. B12 e. None of the above ANSWER: c 27. Fortifying food is generally a fortified product for free. a. large-scale

undertaking and is effective only if the target groups can get the

b. medium-scale c. small-scale d. minor e. None of the above ANSWER: a

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 28. One obstacle to the success of policymakers of the critical nature of a. biotin, biotin b. vitamin C, vitamin C

supplementation programs is a lack of awareness among nutritional status.

c. vitamin A, vitamin A d. vitamin D, vitamin D e. itamin A, vitamin D ANSWER: c 29. Which is the biggest risk factor for illness worldwide? a. Overpopulation b. Malnutrition c. Poverty d. Lack of education e. Homelessness ANSWER: b 30. According to the World Health Organization, deficiencies of iron, vitamin A, and what rank among the top ten leading causes of death through disease in developing countries? a. Vitamin B12 b. Vitamin D c. Thiamin d. Zinc e. Vitamin C ANSWER: d 31. What condition causes the highest rate of child mortality among children ages one month to five years? a. Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) b. Pneumonia c. Malaria d. Measles e. Hypertension ANSWER: b

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 32. Iodine deficiency is one of the major preventable cause of which condition worldwide? a. Protein-energy malnutrition b. Diarrhea c. Mental retardation d. Prematurity e. Sudden infant death syndrome (SIDS) ANSWER: c 33. Which percentage of deaths of children under five years of age is associated with low birth weight? a. 15% b. 25% c. 30% d. 40% e. 50% ANSWER: d 34. Which is an example of a direct health-related expense associated with maternal complications in pregnancy? a. Lost productivity from complications of pneumonia b. Reduced occupational opportunities due to illness c. Cost of food during pregnancy d. Lost income from an inability to work e. Oral rehydration to treat diarrhea ANSWER: e 35. Which is the most widespread form of malnutrition in the world today? a. Kwashiorkor b. Miasmas c. Protein deficiency d. Protein-energy malnutrition e. Calorie deficiency ANSWER: d 36. What best describes an example of a cause of global food insecurity at the household level? a. Limited status of women b. Inadequate environmental resources c. Poor access to clean water d. Limited support from political leaders e. No university community engagement programs ANSWER: c

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 37. Which best describes the role of multinational corporations? a. Hiring indigenous people for below-subsistence wages to grow crops to be exported for profit b. Working with other lenders to provide financial stability to certain areas within developing countries c. Arranging for food and supplements to be delivered free of charge to the poorest areas of developing countries d. Lending money to low-income individuals who cannot afford to buy food e. None of the above ANSWER: a 38. Three major factors affect population growth are birth rates, death rates, and which? a. Standards of living b. Educational status c. Social class d. Health care availability e. Income levels ANSWER: a 39. In developing countries, access to which has been shown to lead to better job opportunities? a. Education b. Credit c. Health care d. a and b e. a, b, and c ANSWER: d 40. Which system is an example of labor-intensive technology that could benefit those in developing countries? a. Manual grinder b. Center pivot irrigation c. Mechanized solid-waste disposal systems d. Combine harvester e. None of the above ANSWER: a 41. Which best describes a benefit of using genetically modified food? a. Increased environmental impact b. Transfer of allergens c. Increased nutrient absorption by livestock d. Greater predictability e. Improve food textures ANSWER: c Page 8

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 42. The successful management of agricultural resources to satisfy changing human needs while maintaining the natural resource base and avoiding environmental degradation is known as which? a. Sustainable development b. Genetic engineering c. The green revolution d. Industrialization e. None of the above ANSWER: a 43. Golden rice has the potential to lessen which deficiency? a. Calcium b. Iron c. Iodine d. Vitamin A e. Vitamin E ANSWER: d 44. Achieving improved nutritional well-being worldwide requires broad action on many issues, including which? a. Cultivating cash crops for others b. Borrowing money to maintain healthy living c. Creating a governing infrastructure to move indigenous materials d. Preventing chronic disease e. Promoting healthful diets and lifestyles ANSWER: e 45. During the initial World Summit for Children, one of the United Nations International Children’s Emergency Fund’s (UNICEF’s) goals for nutrition and food security included which? a. Increase in breastfeeding to a rate of 75% b. 40% increase in market production of cash crops c. 50% reduction in the levels of low-birth weight infants d. Global immunization program that reaches all children under age five e. Underweight rates of less than 20% ANSWER: c

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 46. What does the G stand for in GOBI, a child survival plan set forth by United Nations International Children’s Emergency Fund (UNICEF)? a. Gaining weight b. Growth charts c. Generating opportunities d. Goals of nutrition e. Green and clean ANSWER: b 47. Oral rehydration therapy is a solution that includes which? a. Fruit juice b. Formula c. Salt d. Magnesium e. Iodine ANSWER: c 48. Oral rehydration therapy (ORT) is used in the treatment of which? a. Protein-calorie malnutrition b. Diarrhea and/or dehydration c. Goiter d. Whooping cough e. Pneumonia ANSWER: b 49. The global recommendation for infant feeding is for exclusive breastfeeding for the first a. 6 b. 12 c. 18 d. 24

months of life.

e. 25 ANSWER: a 50. Which best describes the International Code of Marketing of Breast milk Substitutes? a. All new mothers in the hospital should have access to the infant nursery. b. Formula and pacifiers should only be offered when breastfeeding is impossible. c. It does not ensure the proper use of breast-milk substitutes. d. Women have a right to choose between formula-feeding and breastfeeding. e. Free formula samples should not be provided to new mothers.

ANSWER: e Page 10

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 51. Which describes why the breastfeeding weaning period is a dangerous time for infants? a. Their new food is often prepared with contaminated water. b. They no longer get enough vitamin D in their diets. c. Their risk for exposure to the human immunodeficiency virus (HIV) increases. d. They no longer have exclusive bonding periods with their mothers. e. They experience withdrawal from the breast.

ANSWER: a 52. When giving immunizations to children, why must adequate protein be available for the vaccines to be effective? a. The needle from the vaccine will cause too much tissue damage. b. The body may use the vaccine as a source of protein. c. The vaccine will replicate within the body. d. A child’s immune system is otherwise too weak to respond. e. It reduces the pain of the vaccination.

ANSWER: b 53. Any solution to the problems of poverty and hunger is incomplete and hopeless if it fails to address which role in developing countries? a. Multinationals b. Religious leaders c. Political leaders d. Women e. Children ANSWER: d 54. International public health nutrition employment opportunities are most likely found in such organizations as which? a. Pharmaceutical companies b. Private universities c. Health insurance companies d. Humanitarian organizations e. Hospitals and community health centers ANSWER: d

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 55. Worldwide, more than how many children have lost one or both parents to acquired immunodeficiency syndrome (AIDS)? a. 5 million b. 13 million c. 17 million d. 21 million e. 29 million ANSWER: b 56. Which describes a global factor affected by urbanization? a. Poor adherence to immunization schedules b. Increased incidences of kwashiorkor c. decline in breastfeeding d. Increased spread of HIV/AIDS e. All of the Above ANSWER: c 57. Which group of people is projected to grow to almost 1.5 billion by the year 2050? a. Older adults b. Pregnant women c. Middle-aged men d. Children under five e. Middle-aged women ANSWER: a 58. Which is an example of a step anyone can take that would reduce the ecological footprint? a. Monitor weight gain and fat intake. b. Increase water intake to 14 cups per day. c. Eat local foods in season. d. Receive regularly scheduled immunizations. e. None of the Above ANSWER: c 59. How does reducing the amount of goods and products used impact the rest of the world? a. By improving accessibility of safe drinking water b. By transferring money to families in developing nations c. By increasing the lifespan of a product d. By increasing jobs in environmental improvements e. By decreasing the amount that ends up in landfills ANSWER: e Page 12

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 60. Which nutrient is deficient in victims of the disease exophthalmia? a. Vitamin C b. Vitamin A c. Vitamin E d. Iodine e. Iron ANSWER: b 61. Which is the most common factor contributing to the magnitude of vitamin A deficiency worldwide? a. Contaminated drinking water b. Chronic inadequate dietary intake c. Poor immune system functioning d. Lack of access to sunlight e. Overeating ANSWER: b 62. Vitamin A has been added to which product in several regions of Central America as part of food fortification to combat vitamin A deficiency? a. Cereal b. Flour c. Rice d. Milk e. Sugar ANSWER: e 63. Which describes long-term food deprivation? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: a 64. Which describes recent and extreme food deprivation? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: b Page 13

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 65. Which describes stunting? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: a 66. Which contributes to children being short for their age? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: a 67. Which describes wasting? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: b 68. Which contributes to children being thin for their height? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: b 69. Which leads to apathy? a. Chronic malnutrition b. Severe acute malnutrition c. Acute malnutrition d. a and c e. None of the above ANSWER: c Page 14

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 70. Which is associated with minimal resistance to disease? a. Multinational corporations b. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) c. Poverty d. Chronic protein-energy malnutrition (PEM) e. Oral rehydration therapy (ORT) ANSWER: c 71. Which is associated with the presence of nutritional anemia and severe lack of food? a. Multinational corporations b. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) c. Poverty d. Chronic protein-energy malnutrition (PEM) e. Oral rehydration therapy (ORT) ANSWER: b 72. With which is anemia common? a. Multinational corporations b. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) c. Poverty d. Chronic protein-energy malnutrition (PEM) e. Oral rehydration therapy (ORT) ANSWER: c 73. Which is the most important cause of food insecurity? a. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) b. Poverty c. Chronic protein-energy malnutrition (PEM) d. Oral rehydration therapy (ORT) e. Acute PEM ANSWER: b 74. Which describes transnational companies with direct investments and/or operative facilities in more than one country? a. Kwashiorkor b. Pulses c. Green revolution d. Miasmas e. Multinational corporations ANSWER: e Page 15

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 75. Which is characterized by short height for age in children? a. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) b. Poverty c. Chronic protein-energy malnutrition (PEM) d. Oral rehydration therapy (ORT) e. Acute PEM ANSWER: c 76. Which is characterized by thin for height in children? a. Multinational corporations b. Growth monitoring, oral rehydration therapy, breast milk, and immunization (GOBI) c. Poverty d. Chronic protein-energy malnutrition (PEM) e. Acute PEM ANSWER: e 77. Which describes severe malnutrition caused by inadequate protein and calories leading to apathy, anemia, loss of body proteins, and poor growth? a. Kwashiorkor b. Pulses c. Green revolution d. Miasmas e. Multinational corporations ANSWER: a 78. Which describes severe emaciation from energy deficiency with chronic wasting of fat, muscle, and other tissues? a. Kwashiorkor b. Pulses c. Green revolution d. Miasmas e. Multinational corporations ANSWER: d 79. Which describes a package of modern agricultural technology delivered to developing countries? a. Kwashiorkor b. Pulses c. Green revolution d. Miasmas e. Multinational corporations ANSWER: c Page 16

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities Matching Match the definitions/descriptions in the left column with the appropriate term in the right column. Options will only be used once. a. kwashiorkor b. pulses c. green revolution d. miasmas e. multinational corporations f. GOBI g. poverty h. chronic PEM i. ORT j. acute PEM 80. Acronym for elements of UNICEF’S child survival campaign ANSWER: f 81. Legumes ANSWER: b 82. Treatment for dehydration ANSWER: i Essay 83. Define nutrition security and explain what happens when nutrition security is not present for people worldwide.

ANSWER: Nutrition security requires that all people have access to a variety of nutritious foods and potable drinking water; knowledge, resources, and skills for healthy living; prevention, treatment, and care for diseases affecting nutrition status; and safety-net systems during crisis situations such as natural disasters or deleterious social and political systems. Regardless of race, religion, sex, or nationality, our bodies experience similarly the effects of hunger and its companion, malnutrition: listlessness, weakness, failure to thrive, stunted growth, mental retardation, muscle wastage, scurvy, anemia, rickets, osteoporosis, goiter, tooth decay, blindness, and a host of other effects, including death. Apathy and shortened attention span are two of a number of behavioral symptoms that are often mistaken for laziness, lack of intelligence, or mental illness in undernourished people. Malnutrition is the biggest risk factor for illness worldwide. Some 2 billion people, mostly women and children, are deficient in one or more of four essential micronutrients: iron, zinc, iodine, and vitamin A. 84. Which four micronutrient deficiencies are of most concern when discussing world food insecurity? For one of these four micronutrients, discuss the implications and the progress made toward lessening these implications.

ANSWER: The four micronutrient deficiencies of particular concern are vitamin A deficiency, iron-deficiency anemia, iodine deficiency, and zinc deficiency.

Vitamin A deficiency Page 17

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities An estimated 500,000 children become partially or totally blind as a result of insufficient vitamin A. Vitamin A deficiency compromises the immune systems of approximately 40% of the developing world’s children under five years old, leading to early death of an estimated one million children each year.

More than 40 developing countries are now reaching 70% or more of their young children with at least one vitamin A supplement capsule every year.

Efforts to date are estimated to be saving the lives of more than 300,000 young children annually and preventing many hundreds of thousands of cases of irreversible blindness.

Iron-deficiency anemia Iron-deficiency anemia in infancy and early childhood is associated with decreased cognitive abilities and resistance to disease.

Iron deficiency in the 6- to 24-month age group impairs the mental development of 40% to 60% of the developing world’s children.

Severe cases cause the deaths of an estimated 50,000 young women a year during pregnancy and childbirth.

Iron-deficiency anemia is so widespread in adults that it lowers the productivity of workforces.

An international movement to fortify all wheat flour with iron and folic acid is beginning to gain momentum.

Iodine deficiency Iodine deficiency is the major preventable cause of mental retardation worldwide.

Worldwide, 700 million people—especially in mountainous regions—are estimated to have goiter, while over 16 million suffer overt cretinism.

Iodine deficiency in pregnancy causes as many as 20 million babies a year to be born mentally impaired.

Iodine deficiency has been halved from 30% to 15% because of sustained efforts to add iodine to the world’s household salt.

Zinc deficiency Zinc deficiency contributes to growth failure and weakened immunity in young children.

Zinc deficiency results in some 800,000 child deaths per year from diarrhea, pneumonia, and malaria.

Research demonstrates the usefulness of zinc supplements in treating diarrhea and reducing diarrheal mortality by 50%. The World Health Organization (WHO), along with the United Nations International Children’s Emergency Fund (UNICEF), has issued a statement recommending use of zinc for 10 to 14 days for all episodes of diarrhea among children under age five; however, the recommendation has not yet been widely adopted.

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 85. Describe kwashiorkor and miasmas and explain how malnutrition is currently classified.

ANSWER: Historically, severe child malnutrition was characterized as either protein deficiency called kwashiorkor, the disease of the weaned child, or miasmas, the emaciation caused by energy deficiency. Today, child malnutrition is described in terms of chronic malnutrition—evidenced by stunting from long-term under nutrition and severe acute malnutrition—characterized by rapid weight loss, wasting, and nutritional edema from recent or sudden food deprivation.

86. Why do some observers say that the multinational companies have done more harm than good with regards to solving the hunger problem?

ANSWER: Multinational corporations that hire indigenous people for below-subsistence wages to grow crops to be exported for profit leave little fertile land on which local farmers can grow food. Export-oriented agriculture consumes the labor, land, capital, and technology that are needed to help local families produce their own food. Besides diverting acreage from the traditional staples of the local diet, some multinational corporations also contribute to hunger through their marketing techniques, which lead consumers with limited incomes to associate products such as cola beverages, cigarettes, infant formulas, and snack foods with Western culture and prosperity.

87. Describe the interrelatedness of birth rates, death rates, and standards of living.

ANSWER: Low-income countries have high birth rates, high death rates, and low standards of living. When people’s standard of living rises—giving them better access to health care, family planning, and education—the death rate falls. In time, the birth rate also falls. As the standard of living continues to improve, the family earns sufficient income to risk having smaller numbers of children. The relationships between the infant mortality rate and the population growth rate reveal that hunger and poverty reflect both the level of national development and the people’s sense of security.

88. Explain why people in developing countries choose to have many children.

ANSWER: A family depends on its children to cultivate the land, secure food and water, and provide for the adults in their old age. Under conditions of ongoing poverty, parents will choose to have many children to ensure that some will survive to adulthood.

89. Discuss the GOBI intervention.

ANSWER: GOBI is the United Nations International Children’s Emergency Fund’s (UNICEF’s) “Child Survival” campaign and includes four components: growth monitoring, oral rehydration therapy, breast milk, and immunization. GOBI has made outstanding progress in cutting the number of hunger-related child deaths.

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 90. Discuss the benefits of breastfeeding in developing countries compared to formula feeding.

ANSWER: Replacing breast milk with infant formula in environments and economic circumstances that make it impossible to feed formula safely may lead to infant undernutrition. Breast milk, the recommended food for infants, is sterile and contains antibodies that enhance an infant’s resistance to disease. In the absence of sterilization and refrigeration, formula in bottles is an ideal breeding ground for bacteria. In countries where poor sanitation is prevalent, breastfeeding should take priority over feeding formula.

Studies indicate that a bottle-fed infant living in poverty is up to 14 times more likely to die from diarrhea-related causes and four times more likely to die of pneumonia than an exclusively breastfed baby. The promotion of breastfeeding among mothers in developing countries has many benefits.

Breast milk is hygienic, readily available, and nutritionally sound, and it provides infants with immunologic protection specific to their environment. In the developing world, its advantages over formula feeding can mean the difference between life and death.

91. Describe how the trend toward urbanization in developing countries is a health challenge of the 21st century.

ANSWER: According to Food and Agriculture Organization (FAO) estimates, most of the increase in the world’s population between 2000 and 2030 will occur in urban areas. Urbanization has been a factor in the worldwide decline in breastfeeding; the increased consumption of fats, sugars, meat, and wheat; and the outbreak of cholera in several countries due to contamination of the urban water supply. As nations continue the rural-to-urban transition, the incidence of chronic diarrhea from polluted water and food borne contamination remains a major public health problem in urban slums.

92. Explain some of the more common factors that contribute to vitamin A deficiency in developing countries.

ANSWER: The most common factor contributing to the magnitude of vitamin A deficiency worldwide is the chronic inadequate dietary intake of vitamin A. Other contributors include poor nutritional status of mothers during pregnancy and lactation, low prevalence of breastfeeding, delayed or inappropriate introduction of complementary foods, high incidence of infection (such as diarrhea, acute respiratory infection, and measles), low levels of maternal education, drought, civil strife, poverty, and ecological deprivation in some regions resulting in limited availability of vitamin A–rich foods. For example, the production and consumption of vitamin A–rich foods in Africa (dark green, leafy vegetables; orangecolored fruits and tubers; and red palm oil) are influenced strongly by seasonal trends and cultural practices.

93. What are the indicators of child malnutrition?

ANSWER: Stunting (short-for-age), wasting (thin-for-height), underweight, and overweight.

94. Explain the relationship between birth weight and mortality risk.

ANSWER: A low–birth-weight baby is more likely to experience complications during delivery than a baby of normal weight and has a statistically greater-than-normal chance of exhibiting stunted physical and cognitive growth during childhood, contracting diseases, and dying early in life.

95. What is the relationship between biotechnology and genetic engineering?

ANSWER: Biotechnology is the use of biological systems or living organisms to make or modify products, whereas genetic engineering is a form of biotechnology in which a plant’s genes are altered in an effort to create a new plant with different traits.

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Chapter 14: Global Food and Nutrition Security: Challenges and Opportunities 96. What are the Millennium Development Goals?

ANSWER: The Millennium Development Goals were set at the Millennium Summit of the United Nations for achievement by 2015. The Goals set targets for progress in eight areas: poverty and hunger, primary education, women’s equality, child mortality, maternal health, disease, environment, and a global partnership for development.

97. Knowing that every six seconds, one child dies from malnutrition and related causes, list three things that you can do to combat world hunger.

ANSWER: Answers will vary. Examples include supporting organizations that are helping combat hunger; contacting political representatives to express concerns about hunger-related issues/legislation; supporting efforts of one’s religious organization to feed the hungry; and making personal choices to conserve resources and use only what one needs so as to leave more for others.

98. Explain how oral rehydration therapy (ORT) can combat some of the diarrhea experienced by these children.

ANSWER: ORT involves the administration of a simple solution that mothers can make themselves, using locally available ingredients; the solution increases a body’s ability to absorb fluids 25-fold. International development groups also provide mothers with packets of premeasured salt and sugar to be mixed with boiled water in rural and urban areas.

99. What feeding guidelines are recommended for the newborn baby?

ANSWER: For the best nutrition, the newborn infant should be exclusively breastfed until six months old.

100. What would be a benefit of teaching a family about growth monitoring of their children?

ANSWER: A mother can learn to weigh her child every month and chart the child’s growth on specially designed paper. She can learn to detect the early stages of hidden malnutrition that can leave a child irreparably impaired in mind and body. Then at least she will know she needs to take steps to remedy the malnutrition, if she can.

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Chapter 15: Gaining Cultural Competence in Community Nutrition True / False 1. Culture has a minimal impact on food behavior. a. True b. False ANSWER: False 2. The term ethnocentric describes people who think their own culture is best. a. True b. False ANSWER: True 3. Empathy and sympathy are synonymous. a. True b. False ANSWER: False 4. Minorities constitute a large proportion of the health care workforce. a. True b. False ANSWER: False 5. Rural Americans have lower rates of chronic illness and enjoy better overall health than those living in urban areas. a. True b. False ANSWER: False 6. Because most of our life experiences occur within the same cultural context, our worldviews are repeatedly reinforced. a. True b. False ANSWER: True 7. Learning useful generalizations about a cultural group is not recommended as a starting point because it leads to developing too many stereotypes about the group. a. True b. False ANSWER: False

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Chapter 15: Gaining Cultural Competence in Community Nutrition 8. The degree of acculturation among immigrants and the length of time in the United States have been shown to negatively influence food practices and health, especially among men. a. True b. False ANSWER: True 9. Research has shown that many minority populations are less likely to receive routine medical checkups. a. True b. False ANSWER: True 10. In general, rural communities have adequate numbers of physicians and dentists to meet health care needs. a. True b. False ANSWER: False 11. Two individuals who speak the same language always give the same meaning to a specific word. a. True b. False ANSWER: False 12. Smiling, showing warmth, and being friendly seldom enhance cross-cultural communication. a. True b. False ANSWER: False 13. A study by Kittler et al. found that behavioral stereotypes hold true for 50% of the individuals in a cultural group. a. True b. False ANSWER: False 14. An overarching objective of Healthy People 2030 is to improve the linguistic and cultural competency of public health professionals. a. True b. False ANSWER: True

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Chapter 15: Gaining Cultural Competence in Community Nutrition 15. A dynamic conceptual model of cultural competence developed by Campinha-Bacote for health care professional’s views cultural competence as a process rather than an end result. a. True b. False ANSWER: True 16. Those in the cultural precompetence phase of the cultural competence continuum believe that culture makes no difference and that everyone is treated the same. a. True b. False ANSWER: False 17. Health disparities can exist regarding access to health care; delivery of quality, competent health care services; and health outcomes. a. True b. False ANSWER: True 18. In the Campinha-Baccote Model, cultural encounters are believed to have the greatest impact on the other four cultural constructs. a. True b. False ANSWER: True 19. Both Westerners and non-Westerners tend to use scientific reasoning to identify the causes of illnesses. a. True b. False ANSWER: False 20. Many nonverbal gestures can be universally translated across all cultural groups. a. True b. False ANSWER: False 21. Avoiding eye contact is often considered proper behavior among Hispanics, Native Americans, and Asian Americans. a. True b. False ANSWER: True

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Chapter 15: Gaining Cultural Competence in Community Nutrition 22. Minority health care professionals are more likely to work in medically underserved communities. a. True b. False ANSWER: True 23. A translator works with written information, while an interpreter explains spoken words. a. True b. False ANSWER: True 24. A nonprofessional interpreter is often sufficient for use in health care settings. a. True b. False ANSWER: False 25. The LEARN (listen, explain, acknowledge, recommend, negotiate) guidelines are useful in developing a culturally sensitive treatment plan. a. True b. False ANSWER: True 26. Both the rate and duration of breastfeeding are low in the United States. a. True b. False ANSWER: True 27. According to the National Standards for Culturally and Linguistically Appropriate Services (CLAS), health care organizations must offer language assistance to individuals who have limited English proficiency. a. True b. False ANSWER: True 28. Acculturation is the process of adopting the beliefs, values, and behaviors of another culture. a. True b. False ANSWER: True

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Chapter 15: Gaining Cultural Competence in Community Nutrition 29. Since the 1970s, the United States has been moving toward a cultural plurality, where no single ethnic or racial group is a majority. a. True b. False ANSWER: True 30. African American infants are twice as likely to die from issues related to low birth weight than white American infants. a. True b. False ANSWER: False Multiple Choice 31. What do cultural beliefs influence? a. Behavior only b. Conscious thoughts only c. Conscious and unconscious thoughts only d. Behavior and conscious and unconscious thoughts ANSWER: d 32. Which is true of cultural values? a. They are genetically determined. b. They provide a set of rules by which to govern life. c. They vary greatly within a culture. d. They change frequently.

ANSWER: b 33. Through which means are cultural characteristics and beliefs developed? a. Life experiences only b. Education only c. Life experiences and education d. Genetic traits and education ANSWER: c 34. Which term describes principles or standards that members of a cultural group share in common? a. Mindsets b. Attitudes c. Guidelines d. Values ANSWER: d Page 5

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Chapter 15: Gaining Cultural Competence in Community Nutrition 35. As of 2014, which demographic was the largest minority group in the United States, accounting for nearly 16% of the population? a. Hispanics b. Pacific Islanders c. Asians d. African Americans ANSWER: a 36. Which is a form of diversity that may not be visible or obvious? a. Socioeconomic status b. Language c. Disability d. Physical traitS ANSWER: a 37. Which example best demonstrates cross-cultural communication? a. A doctor discussing high blood pressure medications with a schoolteacher b. A mother talking with her son c. An Asian woman speaking with an American nurse practitioner d. A businessman from New York speaking with a surfer from California ANSWER: c 38. Ethnocentric individuals do what? a. Value all cultures equally b. Are generally accepting of cultural differences c. Consider their beliefs, values, and customs to be the best d. Value other cultures more than their own ANSWER: c 39. Which group has a high prevalence of diabetes and a high death rate from cirrhosis? a. Hispanics b. American Indians/Alaska Natives c. African Americans d. Asian Americans/Pacific Islanders ANSWER: b

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Chapter 15: Gaining Cultural Competence in Community Nutrition 40. Generational analyses of Asian Americans show significant generation residents of the United States. a. Decreases in height b. Increases in height

in succeeding generations as compared to first-

c. Decreases in body mass index (BMI) d. Increases in BMI ANSWER: d 41. An evaluation of Hispanic health beliefs and practices indicates a greater emphasis on the power of on preventive health care. a. medication

and less

b. God c. surgery d. exercise ANSWER: b 42. Which term describes a highly personal and unreasoned distortion of judgment? a. Disparity b. Stereotyping c. Bias d. Distortion ANSWER: c 43. Minorities and the poor are more likely to live in polluted environments and to work in hazardous occupations that increase the likelihood of exposure to what? a. Toxins b. Minerals c. Fluoride d. Viruses ANSWER: a 44. The Affordable Health Care Act aims to bring an end to health care disparities caused by what? a. Lack of physicians b. Lack of insurance c. Discrimination d. Acculturation ANSWER: b

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Chapter 15: Gaining Cultural Competence in Community Nutrition 45. The health care work force is expected to a. remain the same

in the coming years.

b. diversify c. become less diversified d. decrease ANSWER: b 46. Which organization established national standards for culturally and linguistically appropriate services in health care? a. Centers for Disease Control and Prevention b. Academy of Nutrition and Dietetics c. World Health Organization d. U.S. Department of Health and Human Services ANSWER: d 47. Which government entity is responsible for the most recent government initiative dealing with health care disparities? a. Centers for Disease Control and Prevention b. Food and Drug Administration c. Patient Protection and Affordable Care Act of 2010 d. Title VI of the Civil Rights Act ANSWER: c 48. In which cultural construct of the Campinha-Bacote model do health care workers engage in cross-cultural interactions? a. Awareness b. Desire c. Encounters d. Skill ANSWER: c 49. Which behavior is best associated with the desire construct of the Campinha-Bacote model? a. Initiating an in-depth exploration of one’s own cultural background b. Developing a sound foundation of worldviews c. Learning to perform culturally sensitive assessments and interventions d. Having a feeling of wanting to engage in the process of becoming culturally competent ANSWER: d

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Chapter 15: Gaining Cultural Competence in Community Nutrition 50. During which stage of the cultural competence continuum model do individuals hold paternalistic attitudes towards “unfortunate” minorities? a. Cultural incapacity b. Cultural blindness c. Cultural precompetence d. Cultural competence ANSWER: a 51. Which are characteristics of the majority American culture? a. Action, task oriented, group welfare, and formality b. Informality, control over fate, and family decision-making c. Materialism, directness, and practicality d. Spiritualism, cooperation, and formality ANSWER: c 52. The notion that too much food can block “ki” (energy) is a traditional belief of which culture? a. Chinese b. Italian c. Korean d. Mexican ANSWER: c 53. High intakes of carbonated beverages and limited dental care are dietary concerns/issues of which Americans? a. Asian/Pacific Island b. European c. Mexican d. Native ANSWER: c 54. Which cultural group(s) believe(s) that a healthy diet should consist of a balance of yin and yang foods? a. Chinese only b. Italian only c. Mexican only d. Korean and Chinese ANSWER: d

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Chapter 15: Gaining Cultural Competence in Community Nutrition 55. Which communication approach is advised to improve cross-cultural communications? a. Make judgments rather than observations about behaviors. b. Refrain from using “you.” c. Repeat questions in the same way if they are not understood the first time. d. Avoid use of visual aids and use only spoken language.

ANSWER: b 56. As of 2011, about what percentage of American households speak a language other than English at home? a. 7% b. 14% c. 21% d. 28% ANSWER: c 57. Advising a Mexican woman who wishes to lose weight to try increasing her level of exercise, decreasing her intake of cheese, or increasing her intake of lean protein is an example of which LEARN guideline? a. Listen b. Explain c. Recommend d. Negotiate ANSWER: c 58. Racial and Ethnical Approaches to Community Health (REACH) U.S. is a program established by the Centers for Disease Control and Prevention (CDC) that aims to do what? a. To eradicate all infectious diseases b. To lower birth rates among low-income minorities c. To increase doctor visits by male patients d. To eliminate racial and ethnic health disparities ANSWER: d 59. The Northside Breastfeeding Campaign aimed to raise awareness and increase knowledge of breastfeeding in which American population? a. African b. Hispanic c. Chinese d. Native ANSWER: a

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Chapter 15: Gaining Cultural Competence in Community Nutrition 60. Both increasing around the world and work with varied cultural groups. a. globalization; isolationism b. globalization; diversity

in the United States require health professionals to acquire skills to

c. isolationism; diversity d. travel; isolationism ANSWER: b 61. To provide guidance for instituting elements of organizational cultural competence, the Office of Minority Health of the United States Department of Health and Human Services (DHHS) has issued National Standards for which? a. Foreign Language Learning b. Minority-only Health Services c. Culturally and Linguistically Appropriate Services d. Doctors without Borders ANSWER: c 62. Which advice would best serve a nutrition counselor asked to speak with a non–English-speaking Muslim community? a. Use a pictorial guide to illustrate nutrition options. b. Speak slowly in plain English. c. Use advanced medical terms because these are the same in all cultures. d. Use a nonprofessional translator.

ANSWER: a 63. According to the cross-cultural nutrition counseling algorithm, community nutrition practitioners should do what during the Involving phase? a. Arrange a follow-up. b. Tailor an intervention approach. c. Establish comfort. d. Assess readiness to change.

ANSWER: c 64. During the closing phase of a nutrition counseling session, a. new goals should be established

.

b. nutritional issues should be discussed c. goals should be restated, and a follow-up session should be discussed d. goals should be restated so that a follow-up session is not required ANSWER: c

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Chapter 15: Gaining Cultural Competence in Community Nutrition 65. For clients who are ready to make dietary changes, goals should be worked out a. solely by the client

.

b. jointly between client and counselor c. jointly between the client’s family and the counselor d. jointly between the client and his/her family ANSWER: b 66. Which stage of cultural competence describes attitudes, practices, and policies that are destructive to other cultures? a. Cultural blindness b. Cultural competence c. Cultural destructiveness d. Cultural incapacity e. Cultural precompetence ANSWER: c 67. Which stage of cultural competence describes a paternalistic attitude toward the “unfortunates”? a. Cultural blindness b. Cultural competence c. Cultural destructiveness d. Cultural incapacity e. Cultural precompetence ANSWER: d 68. Which stage of cultural competence describes a belief that culture makes no difference? a. Cultural blindness b. Cultural competence c. Cultural destructiveness d. Cultural precompetence ANSWER: a 69. Which stage of cultural competence describes when weaknesses in serving culturally diverse populations are realized, with some attempts to make accommodations? a. Cultural blindness b. Cultural competence c. Cultural destructiveness d. Cultural incapacity e. Cultural precompetence ANSWER: e

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Chapter 15: Gaining Cultural Competence in Community Nutrition 70. Which stage of cultural competence describes when differences are accepted and respected with continuous selfevaluation? a. Cultural blindness b. Cultural competence c. Cultural destructiveness d. Cultural incapacity e. Cultural precompetence ANSWER: b 71. Which stage of cultural competence describes when a society works to improve cultural relations? a. Cultural blindness b. Cultural precompetence c. Cultural destructiveness d. Cultural incapacity e. Cultural proficiency ANSWER: b 72. A select subgroup of which ethic group has the highest incidence of diabetes in the world? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: d 73. In 2012, tuberculosis was 24 times more common for which group? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: b 74. In which group is infant mortality rate more than double that of white Americans? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: a Page 13

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Chapter 15: Gaining Cultural Competence in Community Nutrition 75. In which group are women 1.4 times more likely to die from cervical cancer than white women? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: c 76. In 2010, which individuals had a 30% higher chance of dying from heart disease than white individuals? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: a 77. Which group is twice as likely to develop and die from diabetes than whites? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: d 78. Overall incidence of AIDS has increased in which population in the past five years? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: b 79. From which group are adults 1.2 times as likely to be obese and children 1.6 times as likely to be overweight compared to white counterparts? a. African Americans b. Asian Americans c. Hispanics d. American Indians e. None of the above ANSWER: c Page 14

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Chapter 15: Gaining Cultural Competence in Community Nutrition 80. Which is a collection of beliefs that includes an evaluative aspect? a. Attitude b. Bias c. Ethnicity d. Ethnocentrism e. Value ANSWER: a 81. Which is an assumption that information about a cultural group applies to all individuals who appear to represent that group? a. Health disparities b. Multiculturalism c. Diversity d. Minorities e. Stereotypes ANSWER: e 82. Which is a property of a group that consists of sharing cultural traditions, common linguistic heritage, and land of origin? a. Attitude b. Bias c. Ethnicity d. Ethnocentrism e. Values ANSWER: c 83. Which exists when a segment of the population bears a disproportionate incidence of a health condition or illness? a. Health disparities b. Multicultural c. Diversity d. Minorities e. Stereotypes ANSWER: a

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Chapter 15: Gaining Cultural Competence in Community Nutrition 84. Which is a mental slant or leaning to one side, a distortion of judgment? a. Attitude b. Bias c. Ethnicity d. Ethnocentrism e. Values ANSWER: b 85. Which describes considering one’s own beliefs and viewpoints to be the best? a. Attitude b. Bias c. Ethnicity d. Ethnocentrism e. Values ANSWER: d 86. Which describes any belief or quality that is important, desirable, or prized? a. Bias b. Ethnicity c. Ethnocentrism d. Values e. Immigrants ANSWER: d 87. Which describes a property of groups wherein several cultures are represented? a. Health disparities b. Multiculturalism c. Diversity d. Minorities e. Stereotypes ANSWER: b 88. Which describes individuals who move to a new country seeking permanent residence? a. Bias b. Ethnicity c. Ethnocentrism d. Values e. Immigrants ANSWER: e

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Chapter 15: Gaining Cultural Competence in Community Nutrition 89. Which describes differences among groups of people? a. Health disparities b. Multiculturalism c. Diversity d. Minorities e. Stereotypes ANSWER: c 90. In the United States, which term describes American Indians and Alaska Natives, Asian Americans, Native Hawaiians and Other Pacific Islanders, blacks or African Americans, or Hispanics or Latinos? a. Health disparities b. Multiculturalism c. Diversity d. Minorities e. Stereotypes ANSWER: d Essay 91. Differentiate between visible and invisible diversity.

ANSWER: Physical differences, abilities and disabilities, and language differences are visible forms of diversity.

Forms of diversity that may not be visible include sexual orientation, gender identification, socioeconomic status, and age.

92. List six possible causes of health disparities.

ANSWER: Among the interrelated factors that contribute to health disparities are the following: a. Socioeconomic status. Minorities often have lower levels of income and education, reside in poorer housing, live in unsafe neighborhoods, and have fewer opportunities to engage in healthpromoting behaviors. b. Insurance issues. Lack of insurance has frequently been identified as a cause of health disparities. c. Culture. Some cultural beliefs and health practices of minorities may contribute to health risks, with the degree of acculturation contributing to decreased health advantages. d. Access to and utilization of quality health care services. Many minorities do not have access to and/or use quality health care services. e. Discrimination/racism/stereotyping. Some minorities may experience discrimination or racism and experience psychological distress, depressive symptoms, substance use, and physical health problems as a result. f. Environment. Minorities are more likely to live in polluted environments and work in hazardous occupations.

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Chapter 15: Gaining Cultural Competence in Community Nutrition 93. What is acculturation? How is it important when providing nutrition education?

ANSWER: Acculturation is the process of adopting the beliefs, values, and behaviors of another culture. The degree of acculturation among immigrants and their length of time in the United States have been shown to negatively influence food practices and health, especially among men.

94. Explain the statement “culture is fluid.”

ANSWER: The statement “culture is fluid” refers to the tendency to migrate to and away from various cultures throughout a lifetime. For example, an individual may change religious membership, residence, career, or recreational pursuits, resulting in the loss or acquisition of cultural attributes. Thus, culture can change over time.

95. According to the Campinha-Bacote model, what is the pivotal construct in the process of becoming culturally competent? Describe characteristics of this construct.

ANSWER: The cultural encounter is the pivotal construct in the process of becoming culturally competent. In this construct, individuals seek and engage in cross-cultural encounters and reflect on experiences allowing integration of cultural competence constructs.

96. Define cultural competency for community nutrition professionals.

ANSWER: A food and nutrition practitioner needs to approach cross-cultural interactions with a nonjudgmental attitude and a willingness to explore and understand different values, beliefs, and behaviors. Working successfully with individuals from different cultures and/or developing cross-cultural programming requires culturally sensitive communication, negotiation, and education skills.

97. Identify reasons why healthy professionals need to gain cultural and linguistic expertise.

ANSWER: The reasons include demographic diversity and projected population shifts, disparities in health status, increased utilization of traditional therapies, and legislative, regulatory, and accreditation mandates.

98. Explain the importance of recognizing one’s own cultural values and biases.

ANSWER: The foundation of cultural competence is an awareness of your own beliefs, values, and attitudes and an understanding that these attributes reflect your own biases and are really just one point of view among many. Without cultural self-awareness, there is a tendency to be ethnocentric, devalue alternative cultural practices, blindly impose one’s own cultural procedures, and not seeing opportunities for successful interventions.

99. Describe some strategies for learning about different cultural practices.

ANSWER: Strategies for learning about different cultural practices include eating at ethnic restaurants, exploring stories about other cultures in the media, establishing focus groups to gain insight into a target population’s culture, reading about cultural customs and etiquette, reading local newspapers, traveling, taking language lessons, familiarizing yourself with diverse neighborhoods, and attending professional development and training classes.

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Chapter 15: Gaining Cultural Competence in Community Nutrition 100. Give examples of some guidelines for creating a comfortable cross-cultural interaction.

ANSWER: The following suggestions can enhance cross-cultural communication: Smile, show warmth, and be friendly.

Attempt to learn and use key words, especially greetings and titles of respect.

Thank clients for trying to communicate in English.

Suggest that clients choose their own seat.

Articulate clearly; speak in a normal volume.

Paying attention to children appeals to women in most cultures; however, some believe that accepting a compliment about a child is not appropriate, especially in front of the child.

When interacting with individuals who have limited English proficiency, always keep in mind that limitations in English proficiency do not reflect their level of intellectual functioning.

Explain to clients that you have some questions to ask and that there is no intention to offend.

If you are not sure how to interpret a particular behavior, ask for clarification.

Follow your intuition if you believe something you are doing is causing a problem.

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Chapter 16: Principles of Nutrition Education True / False 1. For many people, simply learning about health benefits or harms of a behaviour results in lasting behaviour change. a. True b. False ANSWER: False 2. The Heart Works for Women program embraces non-specific objectives in hopes of increasing women’s awareness of dietary factors that raise the risk for heart disease. a. True b. False ANSWER: False 3. For adults, learning is an intentional, purposeful activity. a. True b. False ANSWER: True 4. Children and adults approach learning in the same manner. a. True b. False ANSWER: False 5. Adults are more likely to stick with lifestyle changes if they set broad, non-specific goals. a. True b. False ANSWER: False 6. Asking adult learners open-ended questions should facilitate their learning. a. True b. False ANSWER: True 7. Most food and nutrition practitioners have extensive training in educating individuals. a. True b. False ANSWER: False

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Chapter 16: Principles of Nutrition Education 8. Nutrition education plans for individuals and communities are identical in that the same activities are appropriate for either audience. a. True b. False ANSWER: True 9. After two weeks, we remember 70% of what we read. a. True b. False ANSWER: False 10. Learning experiences/activities and materials needed are two critical components of a nutrition education lesson plan. a. True b. False ANSWER: True 11. Effective specific instructional objectives should be stated in terms of the learning outcomes and not in terms of the process of learning. a. True b. False ANSWER: True 12. Effective objectives in nutrition education plans contain words such as increase, gain, improve, add, and develop. a. True b. False ANSWER: False 13. Learning objectives can be improved by using multiple active verbs to state a single objective. a. True b. False ANSWER: False 14. A nutrition education lesson plan should contain an introduction, body, and conclusion. a. True b. False ANSWER: True

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Chapter 16: Principles of Nutrition Education 15. A United States Department of Agriculture (USDA) study showed that approximately half of all elementary school students consume inadequate amounts of calcium. a. True b. False ANSWER: True 16. 16.

In the interest of cost, use of preexisting educational materials is acceptable for nutrition education programs. a. True b. False ANSWER: True Multiple Choice 17. Which campaign was developed to address two separate issues: calcium consumption and a lack of interest in drinking milk at lunchtime? a. Drink Milk b. Milk Matters c. Calcium Matters d. Three a Day e. None of the above ANSWER: b 18. The Heart Works for Women program embraces which goals? a. Increasing women’s awareness of dietary factors that raise risk for heart disease b. Educating individuals about the contribution of diet to coronary heart disease (CHD) risk c. Building skills related to heart healthy cooking and eating d. a and c e. b and c ANSWER: e 19. Group sessions should be a. avoided b. mandatory c. encouraged d. limited

in nutrition counseling.

e. optional ANSWER: e

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Chapter 16: Principles of Nutrition Education 20. Which is an instructional method that promotes healthful behaviors by imparting information that individuals can use to make informed decisions about food, dietary habits, and health? a. Nutrition education b. Nutrition facts c. Nutrition knowledge d. Nutrition understanding e. Nutrition literacy ANSWER: a 21. Most people have sufficient what? a. Learning disabilities b. Health literacy c. Knowledge gaps d. a and b e. a and c ANSWER: b 22. Differences in the ability to appear to contribute to health disparities. a. read b. understand c. access d. All of the above e. None of the above

materials related to personal nutrition and health

ANSWER: c 23. Among older adults, poor healthy literacy is associated with faster what? a. Physical decline b. Health knowledge c. Income d. Education e. Social status ANSWER: a

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Chapter 16: Principles of Nutrition Education 24. People with low a. education

are more likely to be hospitalized.

b. income c. health knowledge d. health literacy e. awareness ANSWER: d 25. Consumers process nutrition and health messages at different levels, depending on what? a. Interest b. Experiences c. Knowledge d. Experiences and knowledge e. Interest and experiences ANSWER: e 26. When conveying actionable messages, focus less on the information. a. details; accuracies b. accuracies; details c. details; charity d. charity; accuracies e. clarity; details

and more on the

of the

ANSWER: c 27. Developing and communicating what kind of messages is a key part of nutrition educations? a. Clear b. Strong c. Accurate d. Precise e. a, c, and d ANSWER: e 28. What kind of evaluation is designed in the planning stage but conducted at the end of the program? a. Formative b. Summative c. Direct d. Indirect e. None of the above ANSWER: e Page 5

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Chapter 16: Principles of Nutrition Education 29. Which levels of intervention can be applied to communities? a. build awareness b. change lifestyles c. create a supportive environment d. change lifestyles and build awareness e. build awareness, change lifestyles, and create supportive environments ANSWER: e 30. When writing for the general public, the most important sentence in any piece of writing which? a. First sentence b. Second sentence c. Last sentence d. All the above e. None of the above ANSWER: a 31. Knowledge plus can work together to promote lasting behavioral change. a. skill development only b. increased motivation only c. environmental supports only d. skill development, increased motivation, and environmental supports e. skill support ANSWER: d 32. Any set of learning experiences designed to facilitate the voluntary adoption of eating and other nutrition-related behaviors conducive to health and well-being is referred to as what? a. Nutrition support b. Nutrition education c. Nutrition advice d. Nutrition development e. Nutrition insight ANSWER: b 33. An effective nutrition intervention program integrates what? a. Good instructional design and uses media only b. Good instructional design and learning principles only c. Learning principles and uses media only d. Good instructional design and learning principles and uses media e. Learning principles, activities, and adequate instructional design ANSWER: d Page 6

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Chapter 16: Principles of Nutrition Education 34. What generic term refers to formal, informal, vocational, and continuing education for the purpose of learning? a. Adult education b. Adolescent education c. Primary education d. Secondary education e. Preschool education ANSWER: a 35. Which lifestyle change would an adult be most likely to implement? a. Eating one apple per day b. Lowering overall calorie intake c. Eliminating fat from the diet d. Eating more vegetables e. Increasing fiber ANSWER: a 36. Adequate heat and light are examples of a. sociological needs b. interactive designs c. interpretive requirements d. physical dimensions e. physical designs

of a supportive learning environment.

ANSWER: d 37. When teaching children, an educator should do what? a. Keep the message short, clear, and simple. b. Make negative statements because they are easier to understand. c. Explain the reasons for doing something. d. Make learning more fact-based than fun. e. Reduce activities.

ANSWER: a 38. System-level strategies do not require what? a. Formal lesson plans objectives b. Formal lesson goals c. Nutrition messages or marketing plans d. Marketing plans or goals/objectives e. Formal lesson plans or program identifiers ANSWER: e Page 7

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Chapter 16: Principles of Nutrition Education 39. The first step in developing a lesson plan is to do what? a. Develop and fine-tune your materials. b. Schedule a time, day, and location. c. Identify key concepts and questions. d. Know your target audience, the setting, and the content. e. Develop the plan.

ANSWER: d 40. Based on the “cone of experience,” after two weeks, people remember how much of what they see? a. 10% b. 20% c. 30% d. 50% e. 60% ANSWER: c 41. Based on the “cone of experience,” after two weeks, people remember what percentage of what they say and do? a. 10% b. 20% c. 50% d. 90% e. 100% ANSWER: d 42. Which activity is associated with the most memory retention? a. Role-playing b. Participating in a discussion c. Giving a talk d. Watching a demonstration e. Reading an activity ANSWER: a 43. Which activity is associated with the least memory retention? a. Watching a video b. Hearing a new report c. Listen to a presentation d. Attending an exhibit e. Reading an article ANSWER: e

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Chapter 16: Principles of Nutrition Education 44. What is the first component of writing a nutrition lesson? a. Identify the major concept you are communicating. b. Determine teaching strategies that will be used. c. Write well-stated objectives. d. Order does not matter because all are important components. e. Develop an implementation plan.

ANSWER: a 45. Developing a successful lesson plan is based on what? a. Applying experiences appropriately b. Using media to effectively transmit the message c. Writing effective objectives d. Choosing a good audience e. None of the above ANSWER: c 46. The Client-Centered Nutrition Education toolkit suggests developing objectives that affect participants in what three areas? a. The physical, mental, and emotional b. The individual, group, and community c. The oral, visual, and experiential d. The head, hands, and heart e. The physical, group, and visual ANSWER: d 47. Effective instructional objectives do what? a. Describe the teacher’s performance b. Are stated in terms of the expected learning outcomes c. Contain more than one active verb d. Contain terms such as grasp, believe, or realize e. Are long-terms goals for the program ANSWER: b 48. Which component of the lesson plan contains an introduction, body, and closure? a. Lesson goal b. Learning objectives c. Procedure d. Method of evaluation e. Results ANSWER: c Page 9

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Chapter 16: Principles of Nutrition Education 49. To reach students and catalyze change, education should be what? a. Amusing, aggregated, and fact-based b. Challenging, variegated, and results-oriented c. Integrated, challenging, amusing and fact-based d. Difficult, delegated, and detail-oriented e. Fun, integrated, and behaviorally based ANSWER: c 50. Why is a goal of the Milk Matters program to increase elementary school low-fat and fat-free milk consumption? a. Because students were at risk for obesity due to drinking too much whole milk b. To boost calcium intake since childhood is a critical time for bone development c. To increase overall fluid consumption by students d. Because milk consumption improves digestion e. To increase vitamin d consumptions ANSWER: b 51. Which term refers to the degree to which individuals have the capacity to obtain, process, and understand basic health information, tools, and services needed to make appropriate health decisions? a. Health learning b. Adult education c. Health literacy d. Health knowledge e. None of the above ANSWER: c 52. When should a formative evaluation be conducted? a. Before and after a program is fully implemented b. After the program is fully implemented c. Before the program design process d. Throughout the program design process e. Through the evaluation process ANSWER: d 53. The results of what kind of evaluation is used to change and improve program delivery? a. Formative b. Summative c. Outcome d. Structure e. Direct ANSWER: a Page 10

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Chapter 16: Principles of Nutrition Education 54. People with low health literacy are what? a. More likely to use preventative care b. Less likely to have poor disease outcomes c. Have greater quality health d. More likely to have slower physical decline e. More likely to be hospitalized ANSWER: e 55. Nutrition education messages should be ones that the a. general public

finds relevant and motivating.

b. educator c. target audience d. government e. family ANSWER: c 56. Insights to guide message development and testing are provided by what kind of research methods? a. Formative b. Health literacy c. Adult education d. Summative e. Direct ANSWER: a 57. It is important to direct nutrition messages to because they a. adults; comprehend messages better b. children and adolescents; have the potential for a lasting effect c. older adults; have more health concerns

.

d. adolescents; are more willing to change e. Toddlers; have greater health issues ANSWER: b 58. Actionable messages should do what? a. Contain passive verbs b. Be long and descriptive c. Use qualifiers such as perhaps, may, and maybe d. Be clear e. None of the above ANSWER: d Page 11

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Chapter 16: Principles of Nutrition Education 59. Which food-based recommendation message is likely to be most effective? a. Eat less sugar. b. Eat a diet reduced in trans fats. c. Eat fish and other seafood to increase intake of omega-3 fatty acids. d. Eliminate salt from the diet. e. Eat fewer carbohydrates ANSWER: c 60. What type of evaluation is conducted at the end of a program to provide information about program effectiveness? a. Process b. Summative c. Formative d. Output e. Input ANSWER: b 61. The first step in developing a nutrition education plan for older adults at congregate feeding sites is to do what? a. Interpret information b. Draw conclusions c. Identify relevant information and uncertainties d. Implement a program e. Specify the format ANSWER: c 62. Which statement regarding effective writing is false? a. Write for different purposes: to educate, to inform, or to persuade. b. Practice makes perfect. c. The first draft could be an effective final draft. d. Write for an intended audience. e. Know what you want to say.

ANSWER: c 63. Which author wrote On Writing Well? a. E. B. White b. H.W. Fowler c. M. Schertzer d. W. Zinsser e. D. George ANSWER: d

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Chapter 16: Principles of Nutrition Education 64. Which part of the writing process makes the writing stronger, tighter, and more concise? a. Brainstorming b. Formatting c. Editing d. Styling e. Editing ANSWER: c 65. When writing for the general public, which two elements of the material are more important? a. The introduction and body b. The body and the conclusion c. The title and the introduction d. The first sentence and the last e. The first sentence and the body ANSWER: d 66. A relevant principle considering that people learn at different times and rates a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: d 67. Degree to which communication is directed toward accomplishing the intended outcome a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: a 68. Degree of fit between the program and its objectives a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: a

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Chapter 16: Principles of Nutrition Education 69. Degree to which the intervention is geared to the clients a. Consonance b. Facilitation c. Feedback d. Individualization e. Relevance ANSWER: e 70. Allows clients to have personal questions answered a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: d 71. Helps clients learn by providing a measuring stick to determine how much progress they are making a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: c 72. Components of a program designed to reward the desired behavior a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: e 73. Measures taken to accomplish desired actions or eliminate obstacles a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: b

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Chapter 16: Principles of Nutrition Education 74. An example includes a weekly food diary sheet that is designed to increase a client’s ability to record actual food intake a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: b 75. Principle in which praise and congratulations are very effective methods a. Consonance b. Facilitation c. Feedback d. Individualization e. Reinforcement ANSWER: e 76. Consider the impact of peer pressure. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: b 77. Consider experiences with and knowledge of the subject discussed. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: c 78. Keep your message short, clear, and simple. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: a Page 15

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Chapter 16: Principles of Nutrition Education 79. Show how to, not why. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: a 80. Consider the impact of chronic diseases and conditions on the client’s ability to communicate and the client’s attention span. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: d 81. Tie concepts into concerns such as appearance and athletic ability. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: b 82. Consider the client’s rebelliousness and attitudes toward authority. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: b 83. Make practical, concrete suggestions. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: a Page 16

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Chapter 16: Principles of Nutrition Education 84. Acknowledge and relate to the client’s needs and concerns. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: c 85. Consider your recommendations in the context of the client’s quality of life. a. Children b. Adolescents c. Adults d. Older adults e. None of the above ANSWER: d Essay 86. What is adult education?

ANSWER: Adult education is a generic term that refers to formal, informal, vocational, and continuing education for the purpose of learning. It is the process whereby adults learn and achieve changes in knowledge, attitudes, values, or skills.

87. List three provisions that will enhance learner-centered educational experiences for adults.

ANSWER: Provisions include the following: Creating an environment (physically, psychologically, and socially) that supports learning, such as geographically convenient location; easy-to-locate classroom or meeting room; furniture of appropriate size; adequate heat and light; friendly, respectful instructor; appropriate location for topic being presented to audience; opportunities for learners to get to know each other are provided; and guidelines and procedures allow all learners equal opportunity to participate in learning.

Preparing the adult learners for the learning episode through the assessment of their learning needs, interests, and prior knowledge; and encouraging learner participation in establishing goals and content of the learning experience.

Providing instruction that encourages learner interaction, emphasizes material that learners perceive as relevant, uses repetition and plan time for learner practice, uses a variety of teaching methods, uses instructional resources that “fit” learners’ needs, plans audio-visuals that all can see and easily interpret, and provides frequent feedback.

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Chapter 16: Principles of Nutrition Education 88. What are the three basic principles guiding adult education?

ANSWER: The basic principles guiding adult education are that (1) adult roles, responsibilities, and previous experiences influence learning; (2) adult learning is constantly occurring; and (3) the role of the adult educator is to facilitate this continuous learning process.

89. What is included in a nutrition education plan?

ANSWER: A nutrition education plan is a written document that describes the needs of the target population, the goals and objectives for intervention activities, the program format, the lesson plans (including instructional materials such as handouts and videos), the nutrition messages to be imparted to the target population, the marketing plan, any partnerships that will support program development or delivery, and the evaluation instruments.

90. List three questions that educators should ask themselves before creating a lesson plan.

ANSWER: Three questions that educators should ask themselves before creating a lesson plan are (1) What is the telling question? Ask yourself: What am I trying to teach? Have I identified the major concept to be taught, and what do I need to know about it? (2) What are the key concepts? Once you have defined the telling questions, list the concepts you plan to define and teach about. (3) What teaching methods are best suited to your audience? Consider your audience.

91. Describe the difference between a lesson goal and learning objectives.

ANSWER: A lesson goal is the goal for the class, or a statement of what will be accomplished or learned. Learning objectives identify the expected learning outcomes using measurable statements.

92. List three purposes of key nutrition messages.

ANSWER: Three purposes of key nutrition messages are to promote change in consumer behavior, to educate or inform individuals, and to advocate for policy changes to support healthy eating.

93. How can environmental changes affect the educational process, specifically with regards to children?

ANSWER: Changes in the environment can enhance effectiveness of educational efforts. For example, environmental changes may change food access (such as by increasing access to fruits and vegetables). Environmental approaches may also endeavor to change social norms (e.g., by using marketing approaches to change attitudes and norms related to milk consumption). Students learn well when they are having fun, are actively participating in their education and are surrounded by healthy environments.

94. Why is integration of the three levels of intervention important in designing effective nutrition messages and programs?

ANSWER: Building awareness is important, but not enough. To change lifestyles, knowledge is not enough; it must be applied with skill-based practice and reinforced with motivational techniques. Lastly, considering physical and social environments will help you understand how to promote healthy lifestyles most effectively within the context of your audience’s lives.

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Chapter 16: Principles of Nutrition Education 95. List the three basic rules of writing.

ANSWER: The three basic rules of writing are (1) know what you want to say; (2) eliminate clutter; and (3) edit, edit, edit.

96. Discuss the elements of a nutrition education plan.

ANSWER: The nutrition education plan is a written document that describes the needs of the target population, the goals and objectives for intervention activities, the program format, the lesson plans (including instructional materials, such as handouts and videos), the nutrition messages to be imparted to the target population, the marketing plan, any partnerships that will support program development or delivery, and the evaluation instruments.

97. Differentiate among nutrition education plans written for the individual, community, and system levels.

ANSWER: Nutrition education plans for individuals and communities are identical, with the same activities being appropriate to both types of interventions. System-level interventions, or strategies, do not require formal lesson plans or program identifiers, such as logos or action figures, but they may draw on these program elements to reinforce key messages.

98. Briefly discuss three principles that should be considered when developing a lesson plan.

ANSWER:

The lesson plan should be centered on the learner’s interests, needs, and motivation.

When learning is related to real-life situations, learners can readily identify with the situation.

The examples provided need to be directly related to the learners’ lives and experiences.

Adults learn best when they are involved in the process. Ask them at the beginning of the class what they expect to learn. People learn by doing and by being involved in solving the problem at hand.

99. Briefly describe the guiding principles of a well-written instructional objective.

ANSWER: Effective instructional objectives should (1) concentrate on the learner and not the teacher; (2) clearly communicate a specific instructional intent; (3) be stated in terms of the end product (the learning outcomes) and not in terms of the process of learning; and (4) describe one type of learning outcome per objective that is specific in describing the learner’s performance.

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Chapter 16: Principles of Nutrition Education 100. List and briefly describe the components of a well-developed lesson plan.

ANSWER: A common format used to structure lesson plans follows: Materials needed. List all of the necessary materials for use by the educator and those needed by the learner.

Lesson title. Every lesson should have a catchy but clear title.

Target audience. Clearly identify the target audience and their grade or educational level.

Duration. Identify the duration of the lesson.

Lesson goal. This is the goal for the class, a statement of what will be accomplished or learned.

Learning objectives. Identify the expected learning outcomes using measurable statements.

Procedure. Describe in detail your plan for the lesson, such as how the goals and objectives will be accomplished. Your lesson plan should include an introduction, a body, and a conclusion.

Learning experiences or activities. List the different activities you expect the instructor and/or the learners to be involved with during the educational session.

Method of evaluation. Describe how the instructor will assess whether the expected outcomes have been achieved.

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Chapter 17: Marketing Nutrition and Health Promotion True / False 1. Social marketing is the same as commercial marketing. a. True b. False ANSWER: False 2. Social marketing is a strategy for changing consumer behavior. a. True b. False ANSWER: True 3. Social marketing promotes behaviors and products as “ideas.” a. True b. False ANSWER: False 4. The purpose of marketing is to sell a product. a. True b. False ANSWER: False 5. A weblog’s content is static. a. True b. False ANSWER: False 6. Market segmentation separates large groups of potential clients into more distinct and homogeneous subgroups. a. True b. False ANSWER: True 7. Secondary data are gathered by private market research companies as opposed to government agencies. a. True b. False ANSWER: False

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Chapter 17: Marketing Nutrition and Health Promotion 8. Information such as fertility rates and age distribution of the population are particularly important when developing public health nutrition programs and services. a. True b. False ANSWER: True 9. Social networking comprises a broad category of websites that allow users to interact and contribute content. a. True b. False ANSWER: False 10. Price includes only tangible costs. a. True b. False ANSWER: False 11. Social marketing aims to satisfy the needs and wants of targeted consumers. a. True b. False ANSWER: False 12. In community nutrition, the product often refers to a service to be delivered. a. True b. False ANSWER: True 13. Health care providers and school boards are important intermediaries for community nutritionists. a. True b. False ANSWER: True 14. Developing a budget and timeline is the first step in crafting a marketing plan. a. True b. False ANSWER: False 15. Online marketing is typically low cost and personal, but not always statistically representative. a. True b. False ANSWER: True

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Chapter 17: Marketing Nutrition and Health Promotion Multiple Choice 16. Which tool may include radio and television interviews? a. Place b. Product c. Promotion d. Price e. Publicity ANSWER: e 17. Which two terms refer to the same activities. a. Promotion and marketing b. Marketing and publicity c. Advertisement and publicity d. Advertisement and marketing e. Promotion and publicity ANSWER: d 18. Within social marketing, which is the most difficult to market? a. Value change b. Time c. Taste d. New product e. None of the above ANSWER: a 19. Successful marketers get the right product, service, or program a. to the right place

.

b. at the right time c. for the right price d. a and b e. a, b, and c ANSWER: e

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Chapter 17: Marketing Nutrition and Health Promotion 20. Which is the fifth P of social marketing? a. Product b. Price c. Positioning d. Performance e. Promotion ANSWER: c 21. Which needs to be examined when conducting a situational analysis? a. Internal environment b. External environment c. Social trends d. Internal environment and social trends e. External environment and social trends ANSWER: e 22. Which is a critical component of any marketing plan? a. Finishing b. Starting up c. Team planning d. Designing e. Evaluating ANSWER: e 23. The Pawtucket “Know Your Cholesterol” campaign was one of the earliest efforts. a. heart disease prevention b. cholesterol awareness c. diabetes prevention d. diabetes awareness

and screening

e. hypertension ANSWER: b 24. The main components of a social marketing plan include all of the following except which? a. Health issues b. Target audience c. Behavior d. Strategy for change e. How the community receives the message ANSWER: e Page 4

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Chapter 17: Marketing Nutrition and Health Promotion 25. Creating an effective public service announcement (PSA) consists of all but which? a. Announcing professional quality b. getting the audience involved c. Spending money d. Marketing the service offered e. Developing and nurturing a good rapport with the public service director ANSWER: e 26. Who is credited with demonstrating the benefits of marketing to business? a. Frank Gilbreth b. Peter Drucker c. Ralph Nader d. Douglas McGregor e. George Daniel ANSWER: b 27. In contrast to traditional marketing, social marketing aims to do what? a. Change the attitudes and/or behavior of targeted consumers b. Satisfy the needs of the targeted consumers c. Satisfy the wants of the target markets d. Explicitly target young adults e. Increase revenue ANSWER: a 28. What is the second step in developing a marketing plan? a. Determine the needs and wants of the target population. b. Conduct a situational analysis. c. Specify the benefits of the services to the target population. d. Develop a marketing strategy. e. Implement the marketing strategy.

ANSWER: c 29. The purpose of marketing is to what? a. Increase money. b. Sell a product or service. c. Change consumer’s actions. d. Increase distribution. e. Find a problem, need, or want and fashion a solution to it.

ANSWER: e Page 5

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Chapter 17: Marketing Nutrition and Health Promotion 30. Which describes the primary, distinct customer group for your product or service? a. Market mix b. Marketing plan c. Target market d. Market segmentation e. Market research ANSWER: c 31. Which is developed to ensure a good fit between the goals and resources available with the needs and wants of the target population? a. Marketing mix b. Marketing plan c. Target market d. Marketing strategy e. Market research ANSWER: d 32. Which step in establishing a marketing plan immediately follows developing a marketing strategy? a. Identify the benefits of the service to the target population. b. Determine the needs of the target population. c. Develop a budget and timetable. d. Conduct a situational analysis. e. Implementing the plan.

ANSWER: c 33. Who would referral sources most likely include? a. Spouses b. Parents c. Potential clients d. Teachers e. Past clients ANSWER: d 34. What does the O in SWOT stand for? a. Options b. Outcomes c. Opportunities d. Opinions e. Observation ANSWER: c Page 6

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Chapter 17: Marketing Nutrition and Health Promotion 35. Which is a detailed assessment of the environment, including an evaluation of the consumer, the competition, and any other factors that may affect the program or business? a. Marketing mix b. Situational analysis c. Needs assessment d. Target market e. Competitive analysis ANSWER: b 36. Which step in establishing a marketing plan immediately follows identifying the benefits of the services to the target population? a. Determine the needs and wants of the target population. b. Implement the marketing strategy. c. Develop a budget and timeline. d. Develop a marketing strategy. e. Conduct a situational analysis.

ANSWER: b 37. Which type of market segmentation groups individuals based on such variables as age, sex, income, occupation, education, family size, religion, race, marital status, and life-cycle stage? a. Behavioristic b. Demographic c. Geographic d. Psychographic e. Social ANSWER: b 38. Grouping individuals according to the location of their work or neighborhood is an example of what kind of segmentation? a. Behavioristic b. Demographic c. Geographic d. Psychographic e. Social ANSWER: c

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Chapter 17: Marketing Nutrition and Health Promotion 39. Which type of market segmentation groups individuals based on criteria such as purchase frequency and occasion, benefits sought, and attitude toward product? a. Behavioristic b. Demographic c. Geographic d. Psychographic e. Social ANSWER: a 40. Which type of market segmentation groups individuals based on criteria such as personal values, attitudes, opinions, personality, lifestyle, and level of readiness for behavior change? a. Behavioristic b. Demographic c. Social d. Psychographic e. Geographic ANSWER: d 41. A reliable source of secondary data most likely includes which? a. An Internet survey b. The U.S. Department of Agriculture c. A personal interview d. A mail survey e. The Food and Drug Administration ANSWER: b 42. Which serves as a communications bridge between the researcher and the people the researcher is trying to reach? a. Personal interview b. Mail survey c. Internet survey d. Consumer panel e. Focus group ANSWER: e

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Chapter 17: Marketing Nutrition and Health Promotion 43. Which data collection method is often used to test new products using the same individuals in several tests? a. Consumer panel b. Mail survey c. Personal interview d. Focus group e. Internet survey ANSWER: a 44. Which data collection method is recommended as a supplement to mail or telephone surveys?Which data collection method is recommended as a supplement to mail or telephone surveys? a. Consumer panel b. Focus group c. Internet survey d. Personal interview e. Blind survey ANSWER: d 45. What is the last P of the marketing mix? a. Persuade b. Publicity c. Plan d. Promotion e. Position ANSWER: d 46. Examples of which include area of expertise, professional image, size, location, and customer service? a. Competitive edges b. Competitor strengths c. Entrepreneurial advantages d. Niches e. Competition ANSWER: a

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Chapter 17: Marketing Nutrition and Health Promotion 47. Which element of the marketing mix includes the channels of distribution required to deliver the service or product to the consumer? a. Place b. Price c. Product d. Promotion e. Position ANSWER: a 48. Which element of the marketing mix encompasses the range of services offered? a. Place b. Price c. Product d. Promotion e. Position ANSWER: c 49. Which is an example of a fee for a service? a. Direct costs b. Intangible commodities c. Nonmonetary costs d. Tangible costs e. Indirect cost ANSWER: d 50. Time, effort, and inconvenience are examples of which? a. Direct costs b. Indirect cost c. Nonmonetary costs d. Tangible commodities e. Intangible commodities ANSWER: e

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Chapter 17: Marketing Nutrition and Health Promotion 51. Which term describes any paid form of nonpersonal presentation and promotion of ideas, goods, or services by an identified sponsor? a. Public relations b. Sales promotion c. Personal promotion d. Advertising e. Price ANSWER: d 52. Generally speaking, advertising does what? a. Reaches a small number of people b. Is always costly c. Can help build image d. Is limited to television and magazines e. Does not work ANSWER: c 53. Which promotional tools are considered media and public events? a. Advertising, contests, and direct mail b. Business cards, networking, and news conferences c. Letters, trade shows, and consulting d. Networking, public speaking, and writing e. Indirect mail and writing ANSWER: a 54. What is a limitation of using television for promotion? a. Low attention b. Creative limitations c. Low cost d. Low creativity e. Fleeting exposure ANSWER: e 55. Sales promotion generally consists of coupons, free samples, point-of-purchase materials, and which? a. Personal meetings b. Counseling sessions c. Trade catalogs d. Formal presentations to organizations e. New merchandise ANSWER: c Page 11

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Chapter 17: Marketing Nutrition and Health Promotion 56. The advantages of using newspapers for promotion include which? a. High reach and audience selectivity b. Flexibility and timeliness c. Low cost and long life d. High reach and personalization e. Personalization and low cost ANSWER: b 57. Personal promotion aids include which? a. Public speaking, seminars, and letters of reference b. Flyers, brochures, and banners c. YouTube ads, trade shows, and websites d. Blogs, cooking demonstrations, and classifieds e. Classifieds, YouTube ads, and banners ANSWER: a 58. Which type of change can be difficult to achieve because it costs the consumer more in terms of personal involvement on a continuing basis? a. Value b. Cognitive c. Behavior d. Action e. Plan ANSWER: c 59. Screening programs for hypertension, hypercholesterolemia, or breast cancer involve what kind of change? a. Value b. Cognitive c. Behavior d. Action e. Positive ANSWER: d 60. Which type of change is the easiest to market? a. Value b. Cognitive c. Behavior d. Action e. Positive ANSWER: b Page 12

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Chapter 17: Marketing Nutrition and Health Promotion 61. Which type of marketing has the potential for reaching the largest possible group of people at the least cost with the most effective, consumer-satisfying program? a. High-impact marketing b. Advanced marketing c. Health marketing d. One-to-one marketing e. Social marketing ANSWER: c 62. Which type of marketing is most appropriate when counter marketing is needed to offset the negative effects of a practice or the promotional efforts of companies for products that are potentially harmful? a. Commercial b. Social c. Traditional d. Business e. Nontraditional ANSWER: b 63. What is an advantage of using the radio for promotion? a. Low competition b. Flexibility c. High attention d. High geographical selectivity e. High geographical and demographic selectivity ANSWER: d 64. Which site was originally used for personal social networking but has increased in popularity among business and professionals? a. Facebook b. WordPress c. YouTube d. LinkedIn e. Instagram ANSWER: a

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Chapter 17: Marketing Nutrition and Health Promotion 65. The process of designing one’s blog or website and its content in such a way that allows search engines to find it easily is referred to as which? a. Social networking b. Niche marketing c. Really simple syndication d. Social engine optimization e. Social marketing ANSWER: d 66. Which term describes new data collected for the first time through various methods? a. Personal promotion/communication b. Primary data c. Public relations d. Public service announcement (PSA) e. Sales promotion ANSWER: b 67. Which term describes a situational analysis technique often used in market research? a. Sales promotion b. Secondary data c. Social marketing d. SWOT e. Target market ANSWER: d 68. Which term describes the particular area of service or the particular product suited to the specific clients to be reached? a. Market niche b. Market segmentation c. Marketing d. Marketing mix e. Personal promotion/communication ANSWER: a

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Chapter 17: Marketing Nutrition and Health Promotion 69. Which term describes data gathered by government agencies, private market research companies, and nonprofit organizations? a. Personal service announcement (PSA) b. Sales promotion c. Secondary data d. Social marketing e. SWOT ANSWER: c 70. Which term describes the separation of large groups of potential clients into smaller, distinct groups with similar characteristics and/or needs? a. Health marketing b. Market c. Market niche d. Market segmentation e. Marketing ANSWER: a 71. Which term describes an advantage over others who are in the business, gained through use of business strategies, market research, expert management, new product development, or other sound business techniques? a. Advertising b. Brand image c. Branding d. Cluster analysis e. Competitive edge ANSWER: e 72. Which term describes statistical method used to classify neighborhoods by their residents’ demographics, attitudes, media habits, and buying patterns? a. Advertising b. Brand image c. Branding d. Cluster analysis e. Competitive edge ANSWER: d

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Chapter 17: Marketing Nutrition and Health Promotion 73. Which term describes the oral presentation in a conversation with one or more prospective purchasers for the purpose of making sales or building goodwill? a. Personal promotion/communication b. Primary data c. Public relations d. Public service announcement (PSA) e. Sales promotion ANSWER: a 74. Which term describes short-term incentives to encourage purchases or sales of a product or service? a. Personal promotion/communication b. Primary data c. Public relations d. Public service announcement (PSA) e. Sales promotion ANSWER: e 75. Which term describes the four universal elements of marketing that are often called the “fours”? a. Market b. Market niche c. Market segmentation d. Marketing e. Marketing mix ANSWER: e 76. Which term describes any paid form of nonpersonal presentation and promotion of ideas, goods, or services by an identified sponsor? a. Advertising b. Brand image c. Branding d. Cluster analysis e. Competitive edge ANSWER: a

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Chapter 17: Marketing Nutrition and Health Promotion 77. Which term describes an organized effort to promote a favorable image of a person or product through news coverage or goodwill? a. Personal promotion/communication b. Primary data c. Public relations d. Public service announcement (PSA) e. Sales promotion ANSWER: c 78. Which term describes a mirror reflection of the brand personality or product being marketed; in other words, it is what people believe about a brand: their thoughts, feelings, and expectations? a. Advertising b. Brand image c. Branding d. Cluster analysis e. Competitive edge ANSWER: b 79. Which term describes a brief message used to promote programs, activities, and services of federal, state, or local governments and the activities of nonprofit organizations when they are regarded as serving a community interest a. Personal promotion/communication b. Primary data c. Public relations d. Public service announcement (PSA) e. Sales promotion ANSWER: d 80. Which term describes what a product or service stands for and is designed to do? a. Advertising b. Brand image c. Branding d. Cluster analysis e. Competitive edge ANSWER: c

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Chapter 17: Marketing Nutrition and Health Promotion 81. Which term describes one market segment pinpointed as a primary customer group? a. Sales promotion b. Secondary data c. Social marketing d. SWOT e. Target market ANSWER: e 82. Which term describes the process by which individuals and groups get what they need and want by creating and exchanging products and values with others? a. Health marketing b. Market c. Market niche d. Marketing e. Market segmentation ANSWER: d 83. Which term describes a method for changing consumer behavior; in other words, the design, implementation, and management of programs that seek to increase the acceptability of asocial idea or practice among a target group? a. Sales promotion b. Secondary data c. Social marketing d. SWOT e. Target market ANSWER: c 84. Which term describes potential customers for a product or service? a. Health marketing b. Market c. Market niche d. Market segmentation e. Marketing ANSWER: b

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Chapter 17: Marketing Nutrition and Health Promotion 85. Which term describes health promotion programs that are developed to satisfy consumer needs, are strategically planned to reach as broad an audience as is in need of the program, and thereby enhance the organization’s ability to effect population-wide changes in targeted risk behaviors? a. Health marketing b. Market c. Market niche d. Market segmentation e. Marketing ANSWER: a Essay 86. Define social marketing, provide an example, and state how the goals of social marketing differ from the aims of traditional marketing.

ANSWER: Social marketing is a strategy for changing consumer behavior by combining the best elements of consumer behavior theory with marketing tools and skills to help consumers change their beliefs, attitudes, values, actions, or behaviors. Traditional marketing seeks to satisfy the needs and wants of targeted consumers and social marketing aims to change their attitudes and/or behavior. Examples of successful social marketing campaigns include “Got Milk?” “Eat Fresh, Buy Local,” and “Fruits and Veggies—More Matters.”

87. Describe the steps a community nutritionist should take when developing a marketing plan.

ANSWER: The community nutritionist should first determine the needs and wants of the target population because marketing starts with the customer. Second, specify the benefits of the product or service to the target population. Third, conduct a situational analysis. Fourth, develop a marketing strategy for ensuring a good fit between the goals and resources of the organization and the needs and wants of the target population. Fifth, before the marketing plan can move forward, a budget and timetable must be developed. Sixth, after all aspects of the marketing plan have been decided, implement the plan according to the original design and then evaluate its effectiveness.

88. Describe the different types of consumers and provide an example of each type.

ANSWER: Consumers can be categorized as one of three types: users of services, referral sources, and other decision makers. The users of services are the clients themselves or potential clients. For example, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program identifies its users as low income, pregnant, or breastfeeding women and mothers of children under five years of age. Referral sources include anyone who refers clients or customers to you. They may include physicians, social workers, teachers, and former clients. Other decision makers are those who influence the client’s decision to use a service or join a program. Such people include family members (spouses, parents) and third-party payers, among others.

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Chapter 17: Marketing Nutrition and Health Promotion 89. Imagine you are a community nutritionist with a private practice. Identify a target market and describe an appropriate marketing strategy for your chosen audience.

ANSWER: (Answers will vary greatly.) Possible target markets include overweight women between 20 and 40 years of age; athletic men; people interested in sports nutrition; people seeking healthful lifestyles; individuals wanting basic nutrition information; and corporations planning to provide employee wellness workshops. The marketing strategy should include a product, place, promotion, and price to address the needs of the target market chosen.

90. What are the advantages of personal promotion?

ANSWER: Unlike the standardized message presented in advertising, the message presented in personal promotion can be tailored to fit the needs of the particular individual or group. Personal promotion also offers other advantages: 1. Direct contact provides positive feedback to the listener through both the verbal communications and the nonverbal gestures of the communicator.

2. The interpersonal contact facilitates the transfer of the message better than other methods.

3. The communicator can ensure comprehension by asking questions and monitoring responses.

4. The communicator has an opportunity to probe for resistance to change and then is able to address each issue.

5. The listener may believe that someone is now able to monitor behavior and thus hold the listener accountable for it.

91. List and discuss six methods frequently used to collect primary data.

ANSWER: Six methods used most often to collect primary data are as follows: 1. Mail survey: tips to improve reliability include using a homogeneous sample, keeping length reasonable, pretesting, and rewriting as necessary.

2. Telephone survey: can involve errors as in mail surveys. Helpful to ask: Is the true meaning of the question being reflected by the interviewer, or is it distorted? Is the wording of the question likely to elicit a biased response?

3. Internet survey: gathers data from people who have e-mail accounts or visit a particular website; can obtain highly specific information about people who use the Internet.

4. Personal interview: a recommended supplement to mail or telephone surveys; helpful in observing subtle feedback that would otherwise be unavailable.

5. Consumer panel: often used to test new products using the same persons in several tests; a problem is that panel members do not always represent the buying population and may not always give honest answers.

6. Focus group: frequently used to gather information from small, homogeneous groups; allows the researcher to see how people view a product, intervention, or other issue; serves as a communications bridge between the researcher and the people the researcher is trying to reach; not to be used to persuade, convince, or reach a consensus.

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Chapter 17: Marketing Nutrition and Health Promotion 92. What are the objectives of promotion?

ANSWER: The four general objectives of promotion are to Inform and educate consumers about the existence of a product or service and its capabilities (what the community program has to offer).

Remind present and former users of the product’s continuing existence (e.g., prenatal nutrition counseling).

Persuade prospective purchasers that the product is worth buying (improved health status, other benefits).

Inform consumers about where and how to obtain and use the product (accessibility, location, and time).

93. What is the purpose of market research for community nutritionists, and how is it helpful?

ANSWER: Market research enables community nutritionists to target specific groups for health promotion and disease prevention in terms of their geography, demography, and psychography. This type of analysis is helpful in many ways: (1) targeting those at risk; (2) carrying out strategic marketing planning; (3) developing marketing media strategies; (4) examining the feasibility of various promotional tools (e.g., direct mailing versus online distribution of nutrition education materials); and (5) determining the appropriate mix of nutrition programs and services to offer on the basis of demographics (such as concentration of women, infants, children, and older adults).

94. List five tips for creating effective public service announcements (PSAs).

ANSWER: Five tips for creating PSAs are 1. Produce announcements of professional quality. One professional PSA is better than several lowquality ones.

2. Get the audience involved. Sound effects, questions, repetition, and humor are sometimes more effective at grabbing the attention of the audience than the factual approach.

3. Market the service offered, not just the PSA topic. Offer a brochure, a toll-free information hotline, or a screening service.

4. Simplify the response action needed. Advertise a local phone number or an easy-to-remember post office box number or web address.

5. Develop and nurture a good rapport with the television and radio public service directors. They may be able to improve the PSA’s production quality and increase scheduled airtime.

95. List and describe the five Ps of social marketing.

ANSWER: The five Ps of social marketing are as follows: 1. Product: the behavior or health idea that the campaign planners would like the targeted individuals to adopt.

2. Price: the costs associated with “buying” the product (e.g., money, time [inconvenience]).

3. Place: the distribution channels used to make the product available to target audiences.

4. Promotion: the efforts taken to ensure that the target audience is aware of the campaign.

5. Positioning: the efforts to place the product to maximize benefits and minimize costs.

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Chapter 17: Marketing Nutrition and Health Promotion 96. What are the three situations in which social marketing is particularly appropriate?

ANSWER: The three situations conducive to social marketing occur when: 1. New research data and information on practices need to be disseminated to improve people’s lives.

Examples include campaigns for cancer prevention, breastfeeding promotion, and childhood immunization.

2. Counter marketing is needed to offset the negative effects of a practice or the promotional efforts of companies for products that are potentially harmful; for example, cigarettes, alcoholic beverages, or (in developing countries) infant formula.

3. Activation is needed to move people from intention to action; for example, motivating people to lose weight, be physically active, increase fruit and vegetable or calcium intakes, or floss their teeth. Without movement, there is no marketing.

97. Define market niche and summarize its underlying philosophy.

ANSWER: A market niche is the particular area of service or the particular product suited to the specific clients to be reached. The underlying philosophy is that you cannot be all things to all people, so you must find the spot that fits your objectives and goals and enables you to meet a particular unmet need.

98. What are some evaluation methods, and which questions should you be asking during the evaluation step of the marketing process?

ANSWER: Evaluation methods include tracking changes in volume or net profit, referral sources, and customer satisfaction. In this step of the marketing process, you need to ask the following questions: Are you accomplishing your goals? Who benefited from the service? What changes in knowledge, attitudes, and practices occurred? What are the actual costs of providing the service? What changes are warranted to make the service more effective in the future?

99. What are the six steps of social marketing?

ANSWER: The six steps of social marketing are as follows: 1. Planning and strategy 2. Selecting channels and materials 3. Developing materials and pretesting 4. Implementing the plan 5. Assessing effectiveness 6. Reviewing feedback to refine the program 100. What are the benefits of market segmentation?

ANSWER: Market segmentation offers the following benefits: A more precise definition of consumer needs and behavior patterns Improved identification of ways to provide services to population groups More efficient utilization of nutrition and health education resources through a better fit among products, programs, services, and consumers

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Chapter 18: Managing Community Nutrition Programs True / False 1. Once a program is underway, planning is no longer a valued and needed management tool. a. True b. False ANSWER: False 2. Strategic planning is usually undertaken by the organization’s midlevel managers. a. True b. False ANSWER: False 3. Operational plans guide the development of a strategic plan. a. True b. False ANSWER: False 4. Organization charts help establish lines of communication and procedures, but they do not depict rigid systems. a. True b. False ANSWER: True 5. The ideal span of management has been identified as five to seven subordinates. a. True b. False ANSWER: False 6. Community nutritionists must have good management skills. a. True b. False ANSWER: True 7. The formal outcome of a job analysis is the preparation of a job design. a. True b. False ANSWER: False

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Chapter 18: Managing Community Nutrition Programs 8. The performance appraisal interview is a good time for reviewing and changing both organizational and personal goals. a. True b. False ANSWER: True 9. Underutilizing an employee’s skills can destroy motivation. a. True b. False ANSWER: True 10. Offering a pay raise is the single best way to motivate employees. a. True b. False ANSWER: False 11. Tone of voice refers to the way something is said. a. True b. False ANSWER: True 12. An income statement lists an organization’s assets and liabilities. a. True b. False ANSWER: False 13. Time spent working is automatically time spent valuably. a. True b. False ANSWER: False 14. Data, even when considered on their own, are always meaningful. a. True b. False ANSWER: False 15. As a management function, planning involves influencing others to carry out the work required to reach the organization’s goals. a. True b. False ANSWER: False Page 2

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Chapter 18: Managing Community Nutrition Programs Multiple Choice 16. What do strategic planning include? a. Assessing the past b. Assessing the present c. Assessing future conditions d. Trends and event e. All of the above ANSWER: e 17. Which type of organization chart, such as the “web” format, exhibits no strict hierarchy of authority? a. Nontraditional b. Traditional c. Conventional d. Nonconventional e. Formal ANSWER: b 18. Span of management is an important aspect of what? a. Departmentalization b. Compartmentalization c. Sectioning d. Staffing e. Grouping ANSWER: a 19. What must every organization file with the Department of Labor’s Office of Federal Contract Compliance Programs? a. Income b. Budget c. Affirmative action plan d. Hiring plan e. Labor plan ANSWER: c

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Chapter 18: Managing Community Nutrition Programs 20. What quality must information have to be useful? a. Relevant b. Accurate c. Timely d. Complete and concise e. All of the above ANSWER: e 21. Providing feedback to employees about what can occur informally at any time? a. Time b. Morals c. Performance d. Hiring e. Dismissal ANSWER: c 22. The first step in taking control of your things that are most important to you. a. goals b. budget c. hiring d. time e. income

is setting priorities, in other words, determining those

ANSWER: d 23. Managers who can justify their program’s projects and activities. a. income b. hiring c. budget requests

are more likely to be successful in appropriating funds for their

d. organization’s needs e. performance ANSWER: c

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Chapter 18: Managing Community Nutrition Programs 24. Communicating effectively with coworkers is a skill that can be acquired with what? a. Commitment and time b. Time and determination c. Time and commitment d. Practice and commitment e. Practice and determination ANSWER: e 25. Most programs and projects receive a a. yearly

budgetary review.

b. monthly c. biweekly d. weekly e. daily ANSWER: b 26. What kind of interview helps employees stay informed about what managers expect of them? a. Job description b. Performance appraisal c. Job analysis d. a and b e. b and c ANSWER: d 27. Which terms are sometimes used interchangeably but are not the same thing? a. Budgeting and accounting b. Accounting and income management c. Income management and organizing d. Organizing and accounting e. Budgeting and income management ANSWER: a 28. Which includes accounts payable and shareholders’ equity? a. Assets b. Liabilities c. Budgets d. Expenses e. Income ANSWER: b

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Chapter 18: Managing Community Nutrition Programs 29. Community nutritionists often have responsibility for what? a. Planning b. Program budget c. Departmental budgets d. Managing information e. b, c, and d ANSWER: e 30. The primary purpose of information is to help managers do what? a. Plan b. Organize c. Review d. Change e. Make decisions ANSWER: e 31. Which term is commonly used to refer to the groups of employees who work in a particular unit or department? a. Administration b. Line position c. Staff d. Management e. People ANSWER: c 32. Project management requires setting goals and objectives and outlining the project’s what? a. Budget b. Critical path c. Organization chart d. Balance sheet e. Income ANSWER: b 33. Which type of planning occurs over a period of several years and is usually undertaken by the organization’s senior managers? a. Operational b. Strategic c. Project management d. Structural e. Functional ANSWER: b Page 6

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Chapter 18: Managing Community Nutrition Programs 34. “Empowering members to be food and nutrition leaders” is the Academy of Nutrition and Dietetics’ a. goal

.

b. mission c. value d. vision e. objective ANSWER: b 35. Which type of planning involves coordinating a set of activities that are typically limited to one program or intervention? a. Critical path b. Strategic c. Project management d. Structural e. Intense ANSWER: c 36. The physical demands of a job are generally included in which component of a job description? a. Job duties b. Job specifications c. Job title d. Job summary e. Job description ANSWER: b 37. Which type of planning is typically done by midlevel managers and deals with specific actions, expenditures, controls, and the timing of these activities in a formal, structured process? a. Operational b. Functional c. Strategic d. Systems e. Functional ANSWER: a

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Chapter 18: Managing Community Nutrition Programs 38. An organization chart does what? a. Depicts rigid systems b. Works well only in large companies c. Gives employees information about relationships among departments d. Is a requirement for companies with more than 50 employees e. Defines the description of each employee ANSWER: c 39. Most management experts recommend that each manager directly supervise how many subordinates? a. 3 to 7 b. 8 to 12 c. 13 to 15 d. 16 to 20 e. 22 to 28 ANSWER: a 40. The way employees are clustered into units, units into departments, and departments into divisions or other larger categories is referred to as what? a. Sections b. Critical path c. Delegation d. Span of control e. Departmentalization ANSWER: e 41. The formal outcome of a job analysis is what? a. Determination of the span of control b. Monthly budgetary review c. Determination of work hours and pay scale d. Preparation of a job description e. Job guide ANSWER: d 42. Job descriptions serve as a basis for doing what? a. Determining the span of control b. Rating and classifying jobs c. Budgeting d. Creating an income statement e. Hiring ANSWER: b Page 8

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Chapter 18: Managing Community Nutrition Programs 43. What is the primary purpose of a staff position? a. To assist those in line positions b. To achieve the organization’s main goals and objectives c. To coordinate a limited set of activities around a single program d. To influence others to work toward goals e. To manage employment objectives ANSWER: a 44. Placing a “Help Wanted” ad on an online newspaper is considered what kind of recruiting strategy? a. Traditional b. Nontraditional c. Direct d. Indirect e. Specific ANSWER: c 45. Which component of a job description is a short statement of the purpose of the job and its major tasks and activities? a. Job duties b. Job specifications c. Job title d. Job summary e. Job description ANSWER: d 46. Which method is considered an indirect recruiting strategy used to attract applicants? a. Placing ads in newspapers b. Training sessions for professionals c. Sending personalized letters to potential applicants d. Participating in a job recruitment fairs e. Internet advertisement ANSWER: b

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Chapter 18: Managing Community Nutrition Programs 47. The set of human resources activities intended to recruit individuals to help meet the organization’s goals and objectives is referred to as what? a. Affirmative action b. Delegation c. Job analysis d. Job review e. Staffing ANSWER: e 48. Which type of communication reportedly accounts for between 65% and 93% of what gets communicated? a. Nonverbal b. Verbal c. Written d. Oral e. Online ANSWER: a 49. The best managers spend up to what percentage of their time in face-to-face interactions with their employees that allow time for performance feedback. a. 20% b. 30% c. 40% d. 50% e. 60% ANSWER: c 50. A performance appraisal is, in part, used to do what? a. Help assess the employee’s potential for advancement b. Deliver reprimands c. Influence the employee in a positive or negative manner d. Reinforce the bottom line e. Hire new employees ANSWER: a

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Chapter 18: Managing Community Nutrition Programs 51. The budgeting process usually begins with what? a. The development of a new budget b. The development of the operating budget c. A review of accounting procedures d. A review of the previous budget period e. Planning resources ANSWER: d 52. Liabilities include which? a. Cash b. Equipment c. Short-term loans d. Accounts receivable e. All of the above ANSWER: c 53. Assets include which? a. Shareholders’ equity b. Long-term loans c. Accounts payable d. Inventories e. Monies borrowed ANSWER: d 54. The goals of the Better Health Restaurant Challenge (BHRC) were to do what? a. To offer diabetes education classes and help those with diabetes lose weight b. To increase the quantity and availability of local produce c. To increase the availability of tasty, healthy menu items in restaurants and to increase restaurant patrons’ selection of healthy menu items d. To offer screenings and decrease the iron status of inner-city schoolchildren e. educate consumer about healthy behaviors ANSWER: c 55. A potential source of revenue is which? a. Advertising b. The printing of education materials c. Office rent d. Sales from merchandise e. Hiring new employees ANSWER: d Page 11

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Chapter 18: Managing Community Nutrition Programs 56. Which lists the organization’s assets and liabilities? a. Income statement b. Balance sheet c. Budget d. Strategic plan e. Revenue statement ANSWER: b 57. An unforeseen reduction in a public health department’s budget forced a manager to reallocate personnel and impose tighter spending controls. Which management function is the manager using? a. Controlling b. Leading c. Organizing d. Planning e. Reviewing ANSWER: a 58. Budgeting is intricately linked to which? a. Controlling b. Leading c. Planning d. Organizing e. Reviewing ANSWER: c 59. The difference between revenues and expenses is sometimes called what? a. Balance sheet b. Budget c. Income statement d. Bottom line e. Starting point ANSWER: d 60. The primary purpose of information is to help managers do what? a. Make decisions b. Motivate employees c. Develop strategic goals d. Develop a new budget e. To be aware of status ANSWER: a Page 12

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Chapter 18: Managing Community Nutrition Programs 61. Which describes the effective retrieval, organization, storage, and optimum use of information, data, and knowledge for food; and nutrition-related problem solving and decision making? a. Line position b. Management c. Nutrition informatics d. Operating budget e. Operational planning ANSWER: c 62. Which describes unanalyzed facts and figures? a. Controlling b. Critical path c. Data d. Delegation e. Income statement ANSWER: d 63. Which describes the process of stating, in quantitative terms, the planned organizational activities for a given period of time? a. Affirmative action b. Balance sheet c. Budgeting d. Controlling e. Critical path ANSWER: c 64. Which describes a financial statement that depicts, at given intervals, an organization’s assets and the claims against those assets at that time? a. Affirmative action b. Balance sheet c. Budgeting d. Controlling e. Critical path ANSWER: b

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Chapter 18: Managing Community Nutrition Programs 65. Which describes a financial statement that summarizes the organization’s financial position over a specified period, such as a quarter or a year? a. Controlling b. Critical path c. Data d. Delegation e. Income statement ANSWER: e 66. Which describes data that have been analyzed or processed into a form that is meaningful for decision makers? a. Information b. Job analysis c. Job design d. Leading e. Line position ANSWER: a 67. Which describes regulating organizational activities so that performance meets accepted organizational standards and goals? a. Affirmative action b. Balance sheet c. Budgeting d. Controlling e. Critical path ANSWER: d 68. Which describes the systematic collection and recording of information about a job’s purpose, its major duties, the conditions under which it is performed, and the knowledge, skills, and abilities needed to perform the job effectively? a. Information b. Job analysis c. Job design d. Leading e. Line position ANSWER: b

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Chapter 18: Managing Community Nutrition Programs 69. Which describes the assignment to others of part of a manager’s work, along with both the responsibility and the authority necessary to achieve the expected results? a. Data b. Delegation c. Income statement d. Information e. Job analysis ANSWER: b 70. Which describes the specification of tasks and activities associated with a particular job? a. Information b. Job analysis c. Job design d. Leading e. Line position ANSWER: c 71. Which describes the number of subordinates who report directly to a specific manager? a. Planning b. Project management c. Span of control d. Staff position e. Strategic planning ANSWER: c 72. Which describes the process of achieving organizational goals through engaging in the four major functions of planning, organizing, leading, and controlling? a. Job analysis b. Job design c. Leading d. Line position e. Management ANSWER: e

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Chapter 18: Managing Community Nutrition Programs 73. Which describes a line diagram that depicts the broad outlines of an organization’s structure and suggests the reporting relationships among employees? a. Nutrition informatics b. Operating budget c. Operational planning d. Organization charts e. Organizing ANSWER: d 74. Which describes a position with the authority and responsibility to achieve the organization’s main goals and objectives? a. Job analysis b. Job design c. Leading d. Line position e. Management ANSWER: d 75. Which describes a position whose primary purpose is to assist those in line positions? a. Planning b. Project management c. Span of control d. Staff position e. Strategic planning ANSWER: d 76. Which describes any activity undertaken by employers to increase equal employment opportunities for groups protected by federal equal employment opportunity laws and regulations? a. Affirmative action b. Balance sheet c. Budgeting d. Controlling e. Critical path ANSWER: a

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Chapter 18: Managing Community Nutrition Programs 77. Which describes a manager’s formal review of an employee’s performance on the job? a. Organizing b. Performance appraisal c. Planning d. Project management e. Span of control ANSWER: b 78. Which describes the process by which carefully formulated plans are carried out? a. Nutrition informatics b. Operating budget c. Operational planning d. Organization charts e. Organizing ANSWER: e 79. Which describes deciding what to do and when, where, and how? a. Planning b. Project management c. Span of control d. Staff position e. Strategic planning ANSWER: a 80. Which describes long-term planning that addresses an organization’s overall goals? a. Planning b. Project management c. Span of control d. Staff position e. Strategic planning ANSWER: e 81. Which describes short-term planning that focuses on the activities and actions required to meet the organization’s goals? a. Nutrition informatics b. Operating budget c. Operational planning d. Organization charts e. Organizing ANSWER: c Page 17

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Chapter 18: Managing Community Nutrition Programs 82. Which describes a plan that coordinates a limited set of activities around a single program or intervention? a. Planning b. Project management c. Span of control d. Staff position e. Strategic planning ANSWER: b 83. In a complex project, which describes the series of tasks that takes the longest amount of time to complete? a. Affirmative action b. Balance sheet c. Budgeting d. Controlling e. Critical path ANSWER: e 84. Which describes the management function that involves influencing others to achieve the organization’s goals and objectives? a. Information b. Job analysis c. Job design d. Leading e. Line position ANSWER: e 85. Which describes a statement of the financial plan for a program that outlines the revenues and expenses related to the program’s operation? a. Operating budget b. Operational planning c. Organization charts d. Organizing e. Performance appraisal ANSWER: a

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Chapter 18: Managing Community Nutrition Programs Essay 86. Differentiate between strategic planning and operational planning.

ANSWER: Strategic planning is broad in scope and addresses the organization’s overall goals. Strategic planning occurs over a period of several years and is usually undertaken by the organization’s senior managers.

It focuses on formulating objectives; assessing past, current, and future conditions, trends, and events; evaluating the organization’s strengths and weaknesses; and making decisions about the appropriate course of action. The strategic plan guides the development of operational plans. Operational planning is short-term planning typically done by mid-level managers. It deals with specific actions, expenditures, and controls and with the timing of these activities in a formal, structured process.

87. What is a job description, how is it helpful, and what items are often included in a job description?

ANSWER: A job description helps employees understand what is expected of them and to whom they report.

Although there is no standard format, most job descriptions include job title, immediate supervisor, job summary, job duties, and job specifications. The job description serves as a basis for rating and classifying jobs, setting wages and salaries, and conducting performance appraisals. It helps organizations comply with the accrediting, contractual, legal, and regulatory directives of the government or other institutions; and it provides a basis for decisions about promotions and training. In addition, it can be adapted for use in recruiting and hiring prospective employees.

88. As a manager, what tips should you keep in mind when delegating some activities to employees?

ANSWER: • The first step to take when delegating your work to subordinates is to evaluate their skill levels and the difficulty of the task. The trick is to select the employee with the appropriate skills who will find the task challenging but not frustrating.

• Once you have chosen the best employee, give him or her all the information needed to do the job well. Be honest about the work; if it is drudgery, say so.

• Do these three things to ensure success: 1. Give the employee responsibility for completing the project or task.

2. Hold the employee accountable for the results.

3. Provide the employee with the authority to make needed decisions, direct others to help with the project, and carry out actions as required.

• Make sure the employee has the necessary materials, equipment, time, and funds to complete the project.

• Evaluate the employee’s progress periodically and be prepared to accept a less-than-perfect result.

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Chapter 18: Managing Community Nutrition Programs 89. As a manager, what are four things you can do to obtain peak performance from your employees?

ANSWER: Here are four things that you can do to obtain peak performance from your employees: 1. Set high standards and stick to them. Employees become demoralized when managers do not hold themselves to the same high standards set for other workers in the organization. Employees are stimulated to work hard with managers who expect a lot of themselves, believe in excellence, and set a good example.

2. Put the right person in the right job. Employees take pride in meeting a challenge and doing a job well. Their sense of accomplishment enhances their performance. Underutilizing employees’ skills destroys their motivation.

3. Keep employees informed about their performance. Employees should be able to control, measure, and evaluate their own performance. To do this, they need to know and understand the standard against which their performance is being compared. The job description and performance appraisal interview help keep employees informed about what managers expect of them. Keep in mind the unwritten rule of managing people: Put praise in writing. But when you must reprimand an employee, do so verbally and in private.

4. Allow employees to be a part of the process. One means of motivating employees is to give them a managerial vision, a sense of how their work contributes to the success of the project, program, or organization. In a sense, a manager cannot “give” his or her own vision to employees, but the manager can allow them to help mold and shape the vision, thereby making it theirs as well.

90. Describe which qualities information should have to be useful.

ANSWER: To be useful, information must be: 1. Relevant. Although it is sometimes difficult to know precisely what information is needed, managers should try to identify the information most likely to help in making decisions.

2. Accurate. If information is inaccurate or incorrect, the quality of the decision will certainly be questionable.

3. Timely. Information must be available when it is needed.

4. Complete. Information must cover all the areas important to the decision-making process.

5. Concise. Information should be concise, providing a summary of the items central to the decision.

91. What is a nontraditional organization structure, and when might it be appropriate?

ANSWER: In a nontraditional organization structure, employees have roughly the same rank, and there is no strict hierarchy of authority. This format has the advantage of promoting teamwork and consensual decision making, but it can create confusion about authority and responsibility. This design seems to work well in small companies and organizations.

92. Describe the four functions of management.

ANSWER: The main activities and responsibilities of managers can be grouped into four areas, or functions.

1. Planning is the forward-looking aspect of a manager’s job; it involves setting goals and objectives and deciding how best to achieve them.

2. Organizing focuses on distributing and arranging human and nonhuman resources so that plans can be carried out successfully.

3. Leading involves influencing others to carry out the work required to reach the organization’s goals.

4. Controlling consists of regulating certain organizational activities to ensure that they meet established standards and goals.

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Chapter 18: Managing Community Nutrition Programs 93. What is an organization chart and how is it helpful? Additionally, draw a sample traditional organization chart for a hypothetical local health department.

ANSWER: An organization chart is a line diagram that depicts the broad outlines of an organization’s structure and suggests the reporting relationships among employees. Organization charts give employees information about the major functions of departments, relationships among departments, channels of supervision, lines of authority, and certain position titles within units.

(Answers may vary as to drawing a chart for a local health department but should be based on Figure 18.4) 94. What is affirmative action and how is it reflected in Title VII of the Civil Rights Act of 1964?

ANSWER: Affirmative action is an important aspect of recruiting and includes all activities designed to ensure increased equal employment opportunities for groups protected by federal laws and regulations. A significant law in this area is Title VII of the Civil Rights Act of 1964, which forbids employment discrimination based on gender, race, color, religion, or national origin.

95. Explain the difference between line positions and staff positions. How are these designations helpful?

ANSWER: A person in a line position has direct responsibility for achieving the organization’s goals and objectives.

An employee in a staff position assists those in a line position. These terms can help employees to identify which individuals have the authority and responsibility to fulfill the organization’s mandates.

Line and staff relationships clarify an organization’s structure. The terms are still used today in many organizations to help employees identify individuals who have the authority and responsibility for fulfilling the organization’s mandate.

96. What is the key to conducting a good performance appraisal interview? As a manager, how can you reduce an employee’s discomfort during the performance appraisal interview?

ANSWER: The key to conducting a good performance appraisal interview is to start with clear objectives, focus on observable behavior, and avoid vague, subjective statements of a personal nature. Because employees are often uneasy about the review process, managers must take care to be objective in their rating of performance. One way to reduce employees’ discomfort is to let them know in advance how the process works and what to expect during the performance appraisal interview. Employees are most likely to have a favorable impression of the process when they are aware of the evaluation criteria used, have an opportunity to participate in the process, and are able to discuss their career development.

97. What are the four rules of the Merck face-to-face communication approach?

ANSWER: Here are the four rules of the Merck face-to-face communication approach: 1. Be candid. Any questions or comments that arise during the face-to-face interactions should be addressed truthfully.

2. Be prepared. Ask participants to submit questions or topics for discussion several weeks or days before the meeting is scheduled to occur.

3. Encourage participation. Conduct the face-to-face meeting in a relaxed and friendly atmosphere where people feel comfortable expressing their ideas.

4. Focus on listening, not judging. When sensitive topics arise, try not to appear upset or judgmental.

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Chapter 18: Managing Community Nutrition Programs 98. What is the key to managing time wasters? Give some specific examples of how you would manage time wasters.

ANSWER: The key to managing these time wasters is to take control of them. (Answers may vary as to examples.) Schedule your telephone calls for certain periods of the day, and do not accept interruptions during “quiet” times unless an emergency arises. Minimize interruptions from colleagues and visitors.

Attend only meetings that are related to your work.

99. As you move into the community with your ideas, products, and nutrition services, what are four strategies for success you should keep in mind?

ANSWER: The four strategies of success you should keep in mind are as follows: 1. Continually assess the competitive environment.

2. Continually assess your strengths.

3. Build organizational skills.

4. Build managerial (people and process) skills.

100. How do managers make decisions when presented with data?

ANSWER: Managers begin the decision-making process by organizing the data into usable information. Then they specify how the data are to be analyzed. This analysis usually involves sorting, formatting, extracting, and transforming the data via certain statistical methods. Finally, managers interpret the output and prepare reports that summarize the information. Decisions are then based on the figures in the reports.

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Chapter 19: Building Grantsmanship Skills True / False 1. Regardless of the length, the development of proposals can be divided into three main steps: laying the foundation, building the grant proposal, and assembling the final product. a. True b. False ANSWER: True 2. Grant proposal preparation begins with an idea. a. True b. False ANSWER: True 3. Once an idea for a grant is formulated, the next step is to review the literature available from the last six months to a year. a. True b. False ANSWER: False 4. The most successful grant writers keep up to date in their subject-matter area by reading key journals regularly and being well informed about current trends and activities. a. True b. False ANSWER: True 5. Community-based participatory research can help grant seekers and program developers create community nutrition interventions that address key needs of the community. a. True b. False ANSWER: True 6. Because there is an increasing need to demonstrate the impact of grant dollars, it is often helpful to begin by stating grant goals in broad terms. a. True b. False ANSWER: False 7. A request for proposals (RFP) is also called are request for applications (RFA). a. True b. False ANSWER: True Page 1

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Chapter 19: Building Grantsmanship Skills 8. In the United States, grant funding usually comes from government agencies, foundations and community trusts, and business and industrial organizations. a. True b. False ANSWER: True 9. Most grant sponsors prefer little or no contact with an applicant before a proposal is prepared. a. True b. False ANSWER: False 10. The most successful grant seekers jump from topic to topic to capture the latest stream of grant funding. a. True b. False ANSWER: False 11. The key to successful collaboration in grant writing is to select collaborators carefully and try to get them involved as early in the grant-writing process as possible. a. True b. False ANSWER: True 12. Grant sponsors often require grant seekers to submit a letter of intent prior to submitting a full proposal. a. True b. False ANSWER: True 13. The proposal abstract or summary restates the proposed project and appears on the last page of the proposal. a. True b. False ANSWER: False 14. The needs statement describes in detail the procedures for achieving the proposal’s objectives. a. True b. False ANSWER: False

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Chapter 19: Building Grantsmanship Skills 15. The Nuremberg Code became the prototype for many later codes designed to ensure that research involving human subjects would be conducted ethically. a. True b. False ANSWER: True Multiple Choice 16. Which describes the proposed project? a. Summary outline b. Abstract c. Introduction d. Literature review e. a or b ANSWER: e 17. Which section should explain how interested audiences will learn about the project and its outcomes? a. Dissemination b. Conclusion c. Methods d. Evaluation plan e. Future research needs ANSWER: a 18. Which is not an example of direct costs? a. Wages b. Consultant fees c. Fringe benefits d. Administrative costs e. Travel ANSWER: d 19. How are the most inviting and easy-to-read proposals written? a. With active voice b. With passive voice c. With active voice in sentences of no more than 30 words d. With passive voice in sentences between 10 and 20 words in length e. With sentences between 10 and 30 words.

ANSWER: c

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Chapter 19: Building Grantsmanship Skills 20. If a funding decision has not been provided within a few weeks of the expected decision date, it is acceptable to contact the individual designated on the call for proposals and do what? a. Ask if a decision has been made. b. Demand a decision date. c. Nothing; requests should never be made by phone. d. Requestion information on grant scoring and award. e. Politely ask when a funding decision is likely to be made.

ANSWER: c 21. To better increase the chances of acceptance, what kind of proposal should never be sent out to several grant sponsors? a. Exact b. Similar c. Generic d. All of the above e. None of the above ANSWER: d 22. Many funded grants are a. duplicates b. resubmissions c. variations d. similar e. None of the above

of previous work.

ANSWER: b 23. What do some grant sponsors require proposals to include? a. Logic model b. Planning model c. Stakeholders d. Inputs e. Planning description ANSWER: a

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Chapter 19: Building Grantsmanship Skills 24. Which often has a negative connotation and typically is viewed as a signal that something is wrong, but it is inevitable in any relationship? a. Agreement b. Collaborations c. Work groups d. Friendships e. Conflicts ANSWER: e 25. Which is the final stage of the grant proposal process? a. Assembling the final product b. Identifying potential collaborators c. Putting the proposal into action d. Reviewing pertinent literature e. Proof the project ANSWER: c 26. When reviewing the literature for supporting evidence, the review should consist of literature for at least the last years and preferably more. a. two b. three c. four d. five e. six ANSWER: d 27. Which statement best describes an advantage of investing time to survey the literature before starting a grant proposal? a. The grant seeker may be able to refine ideas for the grant. b. The final impact of the grant can be evaluated. c. The grant seeker can save time by simultaneously writing the proposal. d. The literature will reveal an expected budget for the proposal. e. The literature will educate the reader.

ANSWER: a

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Chapter 19: Building Grantsmanship Skills 28. When seeking grant funding from a specific organization, which step would best determine whether a goal is appropriate to pursue? a. Reading recent literature for ideas to support the proposal b. Determining whether outside funding sources are needed c. Surveying research participants to establish their credibility d. Reviewing the funding organization’s mission statement e. Describing whether the goal is based on the relevance to the current project ANSWER: d 29. Once appropriate goals have been selected, the next step is to do what? a. Generate a research question. b. Write clearly defined, specific objectives. c. Identify a learning theory. d. Review the literature. e. Write the abstract.

ANSWER: b 30. If those in need of the grant are interested, grant seekers should think about whether their organization is willing to work collaboratively with them using what kind of approach? a. Recipient-matching b. Community-based participatory research c. Requested assistance d. Organizational collaboration e. Establish teams ANSWER: b 31. When setting goals for a grant proposal, the grant seeker should consider whether the goal a. is broadly defined and covers multiple areas

.

b. can be broken down into short- and long-term components c. is a topic of importance to the grant seeker d. can be achieved in a timely manner e. are broad and manageable ANSWER: d

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Chapter 19: Building Grantsmanship Skills 32. The four broad goal statements in are good examples of how to state goals. a. the Dietary Guidelines for Americans b. the Supplemental Nutrition Assistance Program (SNAP) c. Healthy People 2020 d. Let’s Move! e. Healthy Heart Initiative ANSWER: c 33. Which phrase best describes a characteristic of a successful grant seeker? a. Choosing broad and far-reaching goals b. Dividing projects into manageable pieces before starting c. Addressing needs that can be met by any organization d. Using individual templates for writing grants e. Establishing inclusive and broad process for grant preparations ANSWER: b 34. A request for proposals . a. invites grant seekers to submit proposals b. is very specific regarding grant activities c. is also called a request for quotation d. requires a particular cost estimate for work e. contains general information about the granting process ANSWER: a 35. How do community nutritionists find out about grants that are available? a. They contact granting agencies for information about requests for proposals (RFPs). b. They review literature to determine what community needs are most prominent. c. They determine whether their goals align with those of the national health agenda. d. They focus their goals to bet met within a certain timeframe. e. None of the above ANSWER: a 36. Which funding agency is a nonprofit organization? a. International Nutrition Foundation b. March of Dimes c. American Cancer Society d. Spencer Foundation e. Alcorn State University ANSWER: c

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Chapter 19: Building Grantsmanship Skills 37. Universities and hospitals are examples of what kind of funding agencies? a. Federal b. Nonprofit c. Institutional d. Industry e. State ANSWER: c 38. A grant seeker is considering a project that involves providing more low-calorie, fiber-rich foods to low-income families. What potential grant sponsor would be most appropriate for seeking funding? a. A sporting goods manufacturer b. A pharmaceutical company c. A local school district d. A supermarket chain e. Community rehab center ANSWER: c 39. What phrase best describes the concept of “chasing” grants? a. Contacting more than one organization to find sources of funding b. Jumping from topic to topic to capture the latest stream of funding c. Networking with others who could become potential collaborators d. Submitting a grant proposal to more than one funder at a time e. Having exact views ANSWER: b 40. The best collaborators on grant seeking projects are . a. willing to follow through on all their responsibilities related to the project b. able to take over the primary duties of grant seeking c. affiliated with the grant sponsor in some way d. willing to provide a portion of the funds for the grant e. seeking to expand their research resumes ANSWER: a 41. What is the purpose of the letter of intent for a grant proposal? a. The letter of intent contains the project title, the grant program, and the start and end dates of the project. b. The letter of intent outlines the proposed project and appears at the beginning of the proposal. c. The letter of intent states that the grant seeker intends to submit a proposal for a specific grant. d. The letter of intent describes in detail the procedures for achieving the study’s objectives. e. The letter of intent is submitted with the final application.

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Chapter 19: Building Grantsmanship Skills 42. A brief, friendly communication addressed to the individual designated on the call for proposals is called what? a. A letter of intent b. A request for quotation c. An objectives statement d. A transmittal letter ANSWER: d 43. Which element should be included as part of the proposal abstract? a. The grant seeker’s contact information b. A needs statement c. A detailed description of study procedures d. Measurements of intervention outcomes e. Detailed results ANSWER: b 44. Grant reviewers form their initial impression of a project from what? a. Methodology b. Grant narrative c. Goals and objectives d. Writer’s credentials e. Abstract ANSWER: e 45. The grant narrative includes a needs statement, the goals and objectives, and what? a. The abstract b. Methods c. An evaluation plan d. A transmittal letter e. Results ANSWER: b 46. What information should be included in the introduction of the needs statement? a. An argument that the proposed project will help extend the current knowledge base b. Data regarding what will have been accomplished when the project is completed c. The procedures for achieving the study’s objectives and their justification d. A description of how data will be analyzed to determine the success of the project e. statement that the project will be successful ANSWER: a

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Chapter 19: Building Grantsmanship Skills 47. The background information needed to write a compelling needs statement for a grant proposal should come from where? a. Brainstorming sessions b. Collaborators c. Census data d. The grant sponsor e. A literature search ANSWER: e 48. In which portion of the grant must the grant seeker convince the sponsor that he or she knows how to achieve the project’s objectives? a. Abstract b. Grant narrative c. Methods section d. Evaluation plan e. Conclusion ANSWER: c 49. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research describes three ethical principles for acceptable conduct of research with human subjects: respect for persons, beneficence, and what? a. Autonomy b. Fairness c. Justice d. Relativism e. Ethical ANSWER: c 50. Which term refers to interventions designed solely to enhance the patient or client well-being and to have a reasonable expectation of success? a. Research b. Practice c. Study d. Design e. None of the above ANSWER: b

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Chapter 19: Building Grantsmanship Skills 51. Which type of evaluation occurs at the end of a program to document its success and the extent to which project objectives were achieved? a. Process b. Formative c. Summative d. Impact e. Final ANSWER: c 52. Which measurement choice gives similar results each time it is used? a. Reliable b. Valid c. Justifiable d. Precise e. Validity ANSWER: a 53. What phrase best describes the purpose of the dissemination section of the research study? a. To describe how data collected will be analyzed b. To generate needed information that outlines the scope of the study c. To explain how the grant seeker proposes to measure the outcomes of the project d. To describe how interested audiences will learn about the project and its outcomes e. share grant with stakeholders ANSWER: d 54. The section of the grant that establishes the credibility of the grant seeker is which section? a. Capability b. Methods c. Activity d. Budget e. Literature review ANSWER: a 55. What statement best describes the characteristics of a successful budget in a grant proposal? a. The budget includes prepaying for work that will be completed after the grant ends. b. The budget is always presented according to the individual template of the grant seeker. c. The budget is only included with proposals submitted to state or national organizations. d. The budget is totally consistent with the grant narrative. e. The budget allow two discrepancies.

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Chapter 19: Building Grantsmanship Skills 56. What is an example of an indirect cost that may occur as part of the grant development? a. Consultant fees for grant collaborators b. Utilities for the building where the research is taking place c. The project director’s salary d. The cost of travel to different states for training e. Consultant fees ANSWER: b 57. Which type of costs are least likely to be reported in the budget of a grant proposal? a. Administrative b. Equipment c. Supply d. Travel e. Fringe benefits ANSWER: a 58. Which item would most likely be included in the appendix of the grant proposal? a. A list of expected costs associated with the project b. A chart that breaks the project into manageable steps c. The calculated results of survey questionnaires from participants d. Letters of endorsement from grant supporters e. Budget ANSWER: d 59. The most inviting and easy-to-read proposals tend to have which characteristics? a. Professional vocabulary and appropriate jargon b. Little to no use of white space and single spacing c. Bold headings and subheadings for each section d. Justified (not ragged) right margins e. Very few headings and subheadings and single line spacing ANSWER: c 60. For grant proposal writers, the Logic Model . a. provides a framework for programs from start to finish b. is becoming outdated as a requirement of the grant proposal c. should only be used when the grant seeker does not receive a funding decision d. is a helpful though inflexible tool e. must be followed exactly as written ANSWER: a Page 12

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Chapter 19: Building Grantsmanship Skills 61. A strong team consists of people with a. different problem-solving styles

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b. the same educational backgrounds c. a common skill set d. more similarities than differences e. exact views ANSWER: a 62. National Institutes of Health; Food and Drug Administration a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: a 63. Arts council; school district a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: e 64. March of Dimes; International Life Sciences Institute a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: b 65. American Diabetes Association; civic groups a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: d

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Chapter 19: Building Grantsmanship Skills 66. Trade associations; supermarkets a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: c 67. Pharmaceutical companies; commodity groups a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: c 68. American Cancer Society; American Heart Association a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: d 69. Departments of education, health, and human services a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: e 70. National Heart, Lung, and Blood Institute; United States Department of Agriculture (USDA) a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: a

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Chapter 19: Building Grantsmanship Skills 71. National Institute on Aging; National Cancer Institute a. Federal b. Foundations c. Industry d. Nonprofit organizations e. State and local ANSWER: a 72. Which describes a block grant? a. A grant, usually of limited duration, made to establish the feasibility of a theory or an approach b. The most common form of grant, made to support a discrete project c. A grant that requires the recipient to match the money with cash or in-kind gifts from another source d. A grant from the federal government to states for broad purposes as authorized by legislation e. A grant from which funds must be expended within specific groups (e.g., maternal and childcare) ANSWER: c 73. Which describes a challenge grant? a. A grant, usually of limited duration, made to establish the feasibility of a theory or an approach b. The most common form of grant, made to support a discrete project c. A grant that requires the recipient to match the money with cash or in-kind gifts from another source d. A grant from the federal government to states for broad purposes as authorized by legislation e. A grant from which funds must be expended within specific groups (e.g., maternal and childcare) ANSWER: d 74. Which describes a demonstration grant? a. A grant that serves as a magnet to attract additional funding b. A grant that supports costs of organizing, establishing, funding, or expanding the delivery of health services to a specified community c. A grant awarded to support the cost of meetings or special seminars d. A grant in which funds are provided to specified grantees based on a specific equation, prescribed in legislation, rather than based on an individual project review e. A grant made to an institution to provide a dependable support base, usually for training purposes ANSWER: c

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Chapter 19: Building Grantsmanship Skills 75. Which describes a project grant? a. A grant, usually of limited duration, made to establish the feasibility of a theory or an approach b. The most common form of grant, made to support a discrete project c. A grant that requires the recipient to match the money with cash or in-kind gifts from another source d. A grant from the federal government to states for broad purposes as authorized by legislation e. A grant from which funds must be expended within specific groups (e.g., maternal and childcare) ANSWER: a 76. Which describes a capitation grant? a. A grant that serves as a magnet to attract additional funding b. A grant that supports costs of organizing, establishing, funding, or expanding the delivery of health services to a specified community c. A grant awarded to support the cost of meetings or special seminars d. A grant in which funds are provided to specified grantees based on a specific equation, prescribed in legislation, rather than based on an individual project review e. A grant made to an institution to provide a dependable support base, usually for training purposes ANSWER: e 77. Which describes a conference grant? a. A grant, usually of limited duration, made to establish the feasibility of a theory or an approach b. The most common form of grant, made to support a discrete project c. A grant that requires the recipient to match the money with cash or in-kind gifts from another source d. A grant from the federal government to states for broad purposes as authorized by legislation e. A grant from which funds must be expended within specific groups (e.g., maternal and childcare) ANSWER: b 78. Which describes a formula grant? a. A grant that serves as a magnet to attract additional funding b. A grant that supports costs of organizing, establishing, funding, or expanding the delivery of health services to a specified community c. A grant awarded to support the cost of meetings or special seminars d. A grant in which funds are provided to specified grantees based on a specific equation, prescribed in legislation, rather than based on an individual project review e. A grant made to an institution to provide a dependable support base, usually for training purposes ANSWER: d

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Chapter 19: Building Grantsmanship Skills 79. Which describes a matching grant? a. A grant that serves as a magnet to attract additional funding b. A grant that supports costs of organizing, establishing, funding, or expanding the delivery of health services to a specified community c. A grant awarded to support the cost of meetings or special seminars d. A grant in which funds are provided to specified grantees based on a specific equation, prescribed in legislation, rather than based on an individual project review e. A grant made to an institution to provide a dependable support base, usually for training purposes ANSWER: a 80. Which describes a service grant? a. A grant that serves as a magnet to attract additional funding b. A grant that supports costs of organizing, establishing, funding, or expanding the delivery of health services to a specified community c. A grant awarded to support the cost of meetings or special seminars d. A grant in which funds are provided to specified grantees based on a specific equation, prescribed in legislation, rather than based on an individual project review e. A grant made to an institution to provide a dependable support base, usually for training purposes ANSWER: b 81. Which describes a categorical grant? a. A grant, usually of limited duration, made to establish the feasibility of a theory or an approach b. The most common form of grant, made to support a discrete project c. A grant that requires the recipient to match the money with cash or in-kind gifts from another source d. A grant from the federal government to states for broad purposes as authorized by legislation e. A grant from which funds must be expended within specific groups (e.g., maternal and childcare) ANSWER: e Essay 82. What are the foundational steps in generating a grant proposal?

ANSWER: The four foundational steps in generating a grant proposal include generating ideas, describing goals, identifying funding sources, and identifying potential collaborators.

83. How does a literature review assist the grant seeker in generating ideas?

ANSWER: (Answers may vary.) The literature review can assist the grant seeker in generating ideas by (1) assessing the value of an idea and adjusting its focus to describe the goals more clearly, (2) identifying other professionals who could be sources of advice and/or potential collaborators, and (3) providing the background data needed to write a compelling needs statement for the proposal. At the conclusion of the literature search, grant seekers should be able to describe their idea, the uniqueness of the proposed project, and why it is likely to succeed.

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Chapter 19: Building Grantsmanship Skills 84. List several questions that can help grant seekers decide whether to compete for a grant from a particular grant sponsor and explain how these questions are relevant.

ANSWER: Among the questions that can help grant seekers decide whether to compete for a grant are as follows: Do the grant sponsor’s funding priorities include the project’s goals? There needs to be a definite match here to better position your proposal for funding.

Is it possible to contact the sponsor before preparing the proposal? This could save time and money and lead to a better written proposal.

Are sufficient grant funds available for the grant seeker’s organization to achieve the goals in a successful and timely manner? If grant funds combined with resources from the grant seeker’s organization and partners are insufficient, the likelihood of achieving the goals is exceptionally low.

What will this grant sponsor fund, and is that what is needed? If the grant sponsor is not able to support those needs, the grant objectives cannot be achieved.

Who is eligible to apply for the grant? If the grant seeker’s organization is not eligible, an alternative may be to collaborate with another organization that is.

Can the grant seeker’s organization meet any special requirements of the grant sponsor? If not, then, other funding sources will need to be considered.

When is the grant application due and can the grant seeking organization respond in time? Many times, grant proposals received after the due date are discarded and hastily, poorly completed proposals reflect negatively on the organization.

What are the guidelines for writing this proposal, including any specific forms or format required? For success, it is essential that the grant seekers follow all guidelines, forms, and formats exactly.

Is information available on the types of projects the sponsor has funded in the past? If so, review those to get an idea of what the funding agency values.

What are the credentials of the grant reviewers? Knowing the reviewers’ level of expertise can help grant seekers determine the level of detail and documentation to use in their proposal.

85. Explain the benefits of collaborating with others when developing a grant proposal.

ANSWER: It is possible to complete the work in some grant proposals alone, but one person usually does not have all the expertise or time needed to complete all the proposed tasks. Collaboration is the rule rather than the exception. Collaborators may come from within the grant seeker’s organization or from outside.

Collaboration with other organizations is important when one organization lacks expertise in an area vital to the proposal. Collaborating may be critical to success for novice grant seekers or those who are changing their focus. It can greatly improve a proposed project. A well-conceived and well-managed collaboration plan gives grant seekers the opportunity to assemble a team that can effectively and efficiently achieve the project goals. The best collaborators are those who know what is expected of them and when, are excited about and committed to the project, and are willing to follow through on all their responsibilities related to the project.

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Chapter 19: Building Grantsmanship Skills 86. Describe the letter of intent as used as part of the grant proposal.

ANSWER: Increasingly, grant sponsors are encouraging grant seekers to submit a letter of intent prior to submitting a full proposal. This type of letter of intent helps the grant sponsor determine how many proposals it will receive, estimate the time it will need to spend processing the proposals, and determine the number of grant reviewers it is likely to need. Grant sponsors often indicate that the letter of intent is a pre-proposal that includes a synopsis of most or all of the parts of a full proposal. This type of letter of intent should give the grant sponsor a clear picture of the type of proposal a grant seeker intends to submit. Using this type of letter of intent, the grant sponsor can get an idea about whether the proposal is suitable for its grant program. Most grant sponsors respond to this type of letter of intent and indicate to the grant seeker whether the grant seeker should submit a full proposal.

87. Describe the different components that are included in the methods section of a grant proposal.

ANSWER: The methods section describes in detail the procedures for achieving the study’s objectives, justifies those procedures, and explains why the plan is likely to work. A full account of how the objectives will be achieved usually includes the project design, how success will be measured (usually through an evaluation plan), the participants or sample, the sequence and time frame of activities, and the duties and capabilities of the project staff.

88. Differentiate between direct and indirect costs and give examples of each.

ANSWER: Direct costs are concrete project expenditures that are directly listed line by line in the budget and usually include personnel, equipment, supplies, and travel. Indirect costs—also called overhead, administrative costs, or administrative and facilities costs—usually are not specifically listed on budgets because they tend to be difficult to price individually. Examples include costs of administering the grant, facility and equipment usage, and utilities. Indirect costs typically are calculated as a percentage of the direct costs.

89. Describe cost sharing and how it is used as part of grant proposal development.

ANSWER: Cost sharing, which is also called matching or cost matching, occurs when the grant-seeking organization agrees to pay certain costs (by contributing cash or in-kind goods or services) of the project. For instance, an organization may agree to contribute the cost of office space, incentives, photocopying, a percentage of a worker’s time, and/or indirect costs. Grant seekers should check the grant guidelines or call the sponsor to determine whether cost sharing is required and, if so, how much of the grant costs must be matched. If cost sharing is required, the grant-seeking organization usually is required to contribute (or match) a percentage of the funds requested. For example, some grant sponsors require that the grant seeker contribute one dollar for every dollar they award (a 100% match). Others may require the grant seeker to contribute more or less than a dollar for every dollar they award.

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Chapter 19: Building Grantsmanship Skills 90. Describe the most common reasons that grant proposals are not funded.

ANSWER: The most common problems associated with grant proposals not being funded are as follows: There were problems with planning and time management.

The proposal did not follow the guidelines.

The deadline for submitting the application was missed.

The proposal lacked a well-conceived plan of action or idea.

The proposal had errors in the budget estimate.

The proposal did not match the grant sponsor’s funding priorities.

91. Describe how the Logic Model could be utilized in grant writing.

ANSWER: The Logic Model provides a framework for planning, implementing, managing, and evaluating community nutrition programs. Thus, it can be helpful for grant writers because it can graphically illustrate where you are and what you will need to get where you want to go. After a proposal is funded, the Logic Model will help you stay on track and achieve the goals that were proposed.

92. Explain why successful grant writers do not chase grants.

ANSWER: A grant writer who chases grants is one who is not focused on a given topic and jumps from topic to topic to capture the latest stream of grant money. Unfocused grant chasers usually feel frustrated because they are constantly changing gears and trying to develop expertise in many, often unrelated areas. Many times, this grant chasing has a negative impact on their success rate as a funded grant writer.

93. What is the relevance of The Belmont Report to community nutritionists?

ANSWER: The Belmont Report describes three fundamental ethical principles (respect for persons, beneficence, and justice) for acceptable conduct of research with human subjects. As community nutritionists work with people, they need to be sensitive to these ethical principles.

94. What are evaluation plans, and why do grant sponsors often require them?

ANSWER: Evaluation plans explain how the grant seeker proposes to measure the outcomes or impact of the project. Many grant sponsors require evaluation plans because they want to know whether the funds they provided are having the desired impact (i.e., are they getting their money’s worth?).

95. Explain why it is a good idea to include an evaluation plan in a proposal, even if it is not required.

ANSWER: Programs without an evaluation plan cannot demonstrate their impact and thus often have difficulty sustaining their funding, especially during an economic downturn. If grant seekers genuinely want to achieve the goals set, a well-designed evaluation plan will help them track the project’s progress.

96. Differentiate between feasible measures and justifiable measures that might be included in the grant proposal.

ANSWER: Feasible measures fit resource constraints, yield measurements that are suitably precise, are manageable, and are not overly burdensome to study participants. Justifiable measures are among the best choices available to measure a particular characteristic, are as safe and nonintrusive as possible, and are truly necessary and within the project’s scope.

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Chapter 19: Building Grantsmanship Skills 97. What might you search for in your literature review while researching information about this proposal?

ANSWER: (Answers will vary but could include the following.)

Statistics on fruit/vegetable consumption nationwide and within your identified community Benefits of fruit/vegetable consumption Recommendations for fruit/vegetable consumption Other potential collaborators Other successful interventions from the past 98. What are potential funding sources to consider as sponsors for this grant?

ANSWER: (Answers will vary but could include the following.)

A supermarket chain Produce association A non-profit that raises awareness about health issues A group that funds projects related to the health of children The local school district 99. You have decided to develop your proposal as a type of project grant. Describe this specific type of grant.

ANSWER: A project grant is the most common form of grant. Such a grant is made to support a discrete, specified project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies.

100. You decide to try to find a collaborator to work with you on your grant proposal. Describe how to identify collaborators for this project.

ANSWER: You can identify collaborators by networking with colleagues and corresponding with individuals— identified via a literature search—who are working on similar projects. You also can interview a few references to learn more about potential collaborators’ prior performance records.

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