Improving Cancer Risk Awareness Including Obesity as a Risk Factor for Cancer in a Small U.S. Community.

Obesity is a risk for certain types of cancer; however, awareness of obesity as a risk factor for cancer is low. This study evaluated increases in cancer risk awareness, including obesity as a risk factor for cancer, from a quasi-experimental intervention that provided educational materials and community reinforcement for healthy living. The study uses data on participant's awareness of cancer risk factors along with sociodemographic variables collected from in-person surveys (N = 863) at baseline (June 2011) and post intervention (June 2012). The average awareness that overweight and obesity are risk factors for cancer was low (35 %) compared to chewing tobacco (92 %), using tanning bed (73 %), and sunburn (97 %) at baseline. The intervention significantly increased participants' awareness that overweight and obesity are risk factors for cancer. Based on regression analysis, the unadjusted intervention effect on cancer risk awareness was significant: 0.392 ± 0.165 (p value = 0.020) for matched participants and 0.282 ± 0.125 (p value = 0.024) for community participants. The adjusted intervention effect was significant in the matched participants (0.528 ± 0.189, p value = 0.006). Education, income, gender, and age had a significant impact on cancer risk awareness for the community participants. The results show that community intervention that incorporates community reinforcement can have the desired effect regardless of differences at participant level. Such interventions could be used to prevent cancer risk in communities that are at high risk.

Reducing cancer risk in rural communities through supermarket interventions.

Cancer risk is high, and prevention efforts are often minimal in rural communities. Feasible means of encouraging lifestyles that will reduce cancer risk for residents of rural communities are needed. This project developed and tested a model that could be feasibly adopted by rural communities to reduce cancer risk. This model focuses on incorporating multi-faceted cancer risk education in the local supermarket. As the supermarket functions both as the primary food source and an information source in small rural communities, the supermarket focus encourages the development of a community environment supportive of lifestyles that should reduce residents' risk for cancer. The actions taken to implement the model and the challenges that communities would have in implementing the model are identified.

Registered dietitians' coding practices and patterns of code use.

Coding, coverage, and reimbursement are vital to the clinical segment of our profession. The objective of this study was to assess understanding and use of the medical nutrition therapy (MNT) procedure codes. Its design was a targeted, cross-sectional, Internet survey. Participants were registered dietitians (RDs) preselected based on Medicare Part B provider status, randomly selected RDs from the American Dietetic Association database based on clinical practice designation, and self-selected RDs. Parameters assessed were knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use/compensation, need for additional codes for existing/emerging services, and practice demographics. Results suggest that MNT is being reimbursed for a variety of diseases and conditions. Many RDs working in clinic settings are undereducated about code use of any kind, reporting that code selection frequently is determined not by the RD providing the service, but by "someone else." Self-employed RDs are less likely to rely on others to administrate paperwork required for reimbursement, including selection of procedure codes for billable nutrition services. Self-employed RDs are more likely to be reimbursed by private or commercial payers and RDs working in clinic settings are more likely to be reimbursed by Medicare; however, the proportion of Medicare providers in both groups is high. RDs must be knowledgeable and accountable for both the business and clinical side of their nutrition practices; using correct codes and following payers' claims processing policies and procedures. This survey and analysis is a first step in understanding the complex web of relationships between clinical practice, MNT code use, and reimbursement.

The elderly nutrition program: an effective national framework for preventive nutrition interventions.

OBJECTIVE: To guide national policy, Congress mandated the 1992 research evaluation of the Elderly Nutrition Program (ENP), the nation's oldest framework for providing community- and home-based preventive nutrition and health-related services to older persons. This article summarizes key findings on the program's influence on nutritional health, the targeting and costs of its nutrition services, and the study's policy implications. DESIGN: The research included a nationally representative sample of ambulatory and homebound ENP participants And a matched sample of nonparticipants drawn from the US Health Care Financing Administration's Medicare beneficiary listings. Interviews conducted in respondents' homes considered demographic and health characteristics and assessed anthropometry and physical functioning, nutrient intake and socialization patterns, and utilization of ENP program services (participants only). Administrative and service delivery data were gathered from all levels of the ENP infrastructure. RESULTS: The ENP program currently provides congregate and home-delivered meals and other nutrition- and health-related services to about 7% of the older population overall, including an estimated 20% of the nation's poor elders. Compared with nonparticipants, ambulatory and homebound ENP participants are better nourished (4% to 31% higher mean daily nutrient intakes; P<.001) and achieve higher levels of socialization (17% higher average monthly social contacts; P<.001). Federal spending on ENP nutrition services is efficiently leveraged by funding from other public and private sources, allowing ENP to more than double the nutrition services it provides to program participants. CONCLUSIONS: ENP is a well-targeted, effective, and efficient federal program available to dietetics and other professionals for providing elderly persons with community-based and home-delivered nutrition and related services. The ENP infrastructure offers a potential model for preventive nutrition intervention programs in ambulatory and homebound at-risk older populations.

Dietary intake and nutritional status of older adult homeless women: a pilot study.

A pilot study was conducted to identify eating patterns, food sources, and nutritional problems among a limited population of older homeless women located in a large urban area. Most of these women's food came from shelter meals, and their food intake was inadequate for most nutrients. The availability of fruits, vegetables, dairy products, and whole grains was very limited. Foods high in saturated fats and simple carbohydrates provided most of their caloric intake. Although some women were obese, most were found to have low BMI and mid-arm muscle mass area measurements indicating low body fat stores and potential muscle wasting.