Test Bank For Community Nutrition in Action An Entrepreneurial Approach 6th Edition by Marie A. Boyle

Test Bank1 for Community Nutrition in Action 6e Chapter 3 – Assessing the Target Population’s Nutritional Status Learning Objectives 3.1 Describe the types of data that might be collected about the target population specified in the community needs assessment. 3.2 Describe a minimum of eight methods for obtaining data about the target population. 3.3 Discuss the issues of validity and reliability as they apply to data collection. 3.4 Discuss cultural issues that are considered when choosing a method for obtaining data about the target population. True/False2 1. One of the purposes of studying the target population is to understand their values and beliefs. a. true b. false ANS: a REF: 69 OBJ: 3.1 2. The social-ecological framework emphasizes connections between people and their environment. a. true b. false ANS: a REF: 71 OBJ: 3.1 3. Low socioeconomic status is linked with high prevalence rates of chronic conditions, reduced access to medical care, high stress levels, and poor outcomes following treatment. a. true b. false ANS: a REF: 75 OBJ: 3.1 4. A low literacy level is not a predictor of poor health. a. true b. false ANS: b REF: 75 OBJ: 3.1 5. A nutrition survey needs to be complex and detailed to be meaningful. a. true b. false ANS: b REF: 77 OBJ: 3.2 1 By Melanie Tracy Burns of Eastern Illinois University 2 ANS = correct answer; REF = page reference; OBJ = learning objective © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-1 3-2 6. Health risk appraisals are used to diagnose disease states. a. true b. false ANS: b REF: 77-78 OBJ: 3.2 7. Nutrition screening is designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible. a. true b. false ANS: a REF: 80 OBJ: 3.2 8. Nutrition screening can occur in both the clinical and community environments. a. true b. false ANS: a REF: 80 OBJ: 3.2 9. Nutrition screening programs are an adequate substitute for routine medical visits. a. true b. false ANS: b REF: 80 OBJ: 3.2 10. Questions regarding family interaction around food and food acquisition are important to ask during a nutrition assessment. a. true b. false ANS: a REF: 86 OBJ: 3.2 11. Ideally, it is desirable to have an assessment method that is both highly sensitive and highly specific, but in reality, this is improbable. a. true b. false ANS: a REF: 88 OBJ: 3.3 12. Validity refers to the repeatability or precision of an instrument. a. true b. false ANS: b REF: 88|89 OBJ: 3.3 13. Nonverbal communication skills are critical when conducting a nutrition assessment in a culturally diverse setting. a. true b. false ANS: a REF: 90 OBJ: 3.4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 14. A cultural assessment of the target population is needed before data collection begins. a. true b. false ANS: a REF: 90 OBJ: 3.4 15. Nutrition status indicators are qualitative measures that serve as guides to screen, diagnose, and evaluate interventions in individuals. a. true b. false ANS: b REF: 91 OBJ: 3.1 Multiple Choice 1. Lifestyle factors include all of the following except: a. physical activity level. b. ability to handle stress. c. genetic predispositions. d. use of alcohol. ANS: c REF: 69 OBJ: 3.1 2. As illustrated by the social-ecological framework, our belief systems, heritage, religion, and lifestyle are all examples of a. environmental settings. b. individual factors. c. sectors of influence. d. social and cultural norms and values. ANS: d REF: 71 OBJ: 3.1 3. As illustrated by the social-ecological framework, food intake is influenced by a. governmental policies and programs. b. our attitudes and cognitions. c. our cultural norms and values. d. All of these influence our food intake. ANS: d REF: 71 OBJ: 3.1 4. Which of the following can affect nutrient utilization? a. Alcohol use b. Genetic factors c. Gender and race d. All of these ANS: d REF: 72 OBJ: 3.1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-3 3-4 5. A _____ is a group of people who are interdependent and share a set of norms, beliefs, values, or behaviors. a. sample b. social group c. focus group d. population ANS: b REF: 73 OBJ: 3.1 6. Which of the following exerts the most influence on health and nutrition status? a. Friends b. Family c. Co-workers d. Neighbors ANS: b REF: 73 OBJ: 3.1 7. Which of the following has the strongest association with health among children? a. Poverty b. Race c. Family structure d. Education level of parents ANS: a REF: 75 OBJ: 3.1 8. Which of the following is the greatest predictor of health status? a. Literacy level b. Poverty c. Race or ethnicity d. Single parent households ANS: b REF: 75 OBJ: 3.1 9. A group of individuals whose beliefs, biological characteristics, or other features represent a larger population is called a a. subset. b. case. c. sample. d. survey. ANS: c REF: 76 OBJ: 3.2 10. A systematic study of a cross-section of individuals who represent the target population is called a a. sample. b. survey. c. subset. d. case. ANS: b REF: 77 OBJ: 3.2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 11. Which of the following statements is false? a. Surveys are an expensive method of collecting information. b. Surveys can be used to collect qualitative and quantitative data. c. Surveys can be used with both individuals and groups. d. Surveys can be self-administered or administered by a trained interviewer. ANS: a REF: 77 OBJ: 3.2 12. The first step in planning a survey is to determine a. who will design the survey. b. who will conduct the survey. c. how the survey will be carried out. d. the purpose of the survey. ANS: d REF: 77 OBJ: 3.2 13. Which of the following is not an acceptable method of assessing the readability of surveys? a. FOG Index b. SMOG formula c. Readability function within a word processing program d. MOP formula ANS: d REF: 77 OBJ: 3.2 14. Which of the following is characteristic of the health risk appraisal? a. Formal interview used to determine the population’s general health status b. Used widely in worksites, government agencies, and universities c. Has been unsuccessful in improving health behaviors d. All of these are characteristic of the health risk appraisal. ANS: b REF: 77-78 OBJ: 3.2 15. How might a community nutritionist determine an individual’s attitude towards the health care services available in her community? a. Individual interview b. Phone survey c. Focus group d. Any of these might be appropriate. ANS: d REF: 77|80-82 OBJ: 3.2 16. Which of the following is not a component of a health risk appraisal? a. A questionnaire b. A report to the participant c. Nutrition screening d. Calculations that predict risk of disease ANS: c REF: 78 OBJ: 3.2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-5 3-6 17. Which of the following is not a characteristic of screening efforts? a. Screens tend to be safe, simple, and inexpensive to administer. b. Screens can only be administered by medical doctors or nurses. c. Screens occur in both the clinical and community settings. d. There are many acceptable screening tools available for use. ANS: b REF: 80 OBJ: 3.2 18. _____ is an important preventive health activity designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible. a. Screening b. Analysis c. Assessment d. Evaluation ANS: a REF: 80 OBJ: 3.2 19 Which of these screening methods is commonly used in a community setting? a. Conducting a medical history b. Tuberculin testing c. Health risk appraisal d. All of these ANS: c REF: 80 OBJ: 3.2 20. Which of the following is an informal, qualitative research tool in which attitudinal information is drawn from a group discussion? a. Health risk appraisal b. Focus group c. Interview with key informants d. Screening ANS: b REF: 81 OBJ: 3.2 21. Which of the following is most characteristic of an effective focus group facilitator? a. A good listener b. Biased c. Controlling d. Aggressive ANS: a REF: 81 OBJ: 3.2 22. Focus group data is usually _____ in nature. a. qualitative b. quantitative c. both qualitative and quantitative d. neither qualitative nor quantitative ANS: a REF: 81 OBJ: 3.2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 23. Which of the following issues should be considered when selecting a dietary intake determination method? a. Age, literacy level, and language skill b. Cost of analysis, training of interviewers, and intake forms c. Sample size needed and type of intake data needed d. All of these should be considered. ANS: d REF: 82-83 OBJ: 3.2 24. Food records and inventory methods are used at which level to estimate food consumption? a. Individual b. Household c. Community d. National ANS: b REF: 82 OBJ: 3.2 25. Based on some of practical aspects of dietary intake information, which of the following methods would be the most appropriate for a low-income female immigrant living in public housing? a. Food diary b. Food frequency c. Diet history d. Twenty-four hour recall ANS: d REF: 84-85 OBJ: 3.2 26. The _____ method is considered the “gold standard” of diet assessment methods. a. diet record b. food frequency c. twenty-four-hour recall d. diet history ANS: a REF: 85 OBJ: 3.2 27. Jane has a decreased level of albumin in her blood. Which method of nutrition assessment was most likely used to determine this indicator of nutritional status? a. Anthropometric b. Biochemical c. Clinical d. Dietary ANS: b REF: 87 OBJ: 3.2 28. Anthropometric measurements include: a. skinfold measures. b. waist circumference. c. capillary fragility. d. a and b e. b and c ANS: d REF: 87 OBJ: 3.2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-7 3-8 29. _____ methods of assessment can detect subclinical deficiencies of nutrients. a. Anthropometric b. Clinical c. Laboratory d. Diet record ANS: c REF: 87 OBJ: 3.2 30. Validity refers to: a. the ability of a diet assessment instrument to measure what it is intended to measure. b. the ability of a diet assessment instrument to produce the same estimate of dietary intake on two separate occasions. c. accuracy. d. a and c e. b and c ANS: d REF: 88 OBJ: 3.3 31. The proportion of individuals in the sample with the disease or condition who have a positive test for the disease or condition is referred to as a. reliability. b. sensitivity. c. specificity. d. validity. ANS: b REF: 88 OBJ: 3.3 32. The proportion of subjects without the disease or condition who have a negative test is referred to as a. specificity. b. sensitivity. c. reliability. d. validity. ANS: a REF: 88 OBJ: 3.3 33. Which of the following would not affect an instrument’s validity? a. The participant’s reading level b. A large number of different varieties of apples included on the food frequency questionnaire component c. Questions regarding MyPlate d. Several questions assessing the same concept ANS: d REF: 88-89 34. Other terms for reliability include a. precision. b. reproducibility. c. accuracy. d. a and b e. b and c ANS: d REF: 89 OBJ: 3.3 OBJ: 3.3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 35. Which of the following is not an example of non-verbal communication? a. Facial expressions b. Food rituals c. Gestures d. Touch ANS: b REF: 90 OBJ: 3.4 36. Which of the following should be considered during a cultural assessment? a. The appropriateness of certain hand gestures b. The typical greeting used c. Whether or not to look the client in the eye d. All of these should be considered. ANS: d REF: 90 OBJ: 3.4 37. A quantitative measure used as a guide to screen, diagnose, and evaluate interventions in individuals is a a. focus group. b. mini nutrition assessment. c. nutrition survey. d. nutritional status indicator. ANS: d REF: 91 OBJ: 3.1 Matching Match the description on the left with the most appropriate dietary assessment tool on the right. The same letter may be used more than once. a. client assessment questionnaire b. diet history interview c. food diary d. food frequency e. twenty-four-hour recall Match the questions asked during a needs assessment of independent elderly persons in the left column with the type of data in the right column. The same letter may be used more than once. 11. Does this population use any supplements? a. anthropometric © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-9 1. Self-administered, requires only 15-30 minutes, analyzed at a reasonable cost 2. Quick and easy to administer, but relies on memory 3. Does not depend on memory, but requires literacy 4. Furnishes an overall picture of the diet, but requires ability to judge portion sizes 5. Provides clarification on issues, but requires interview training 6. Isn't affected by season, but doesn't include meal pattern data 7. Provides a preliminary nutritional assessment and clues to strengths and barriers, but may seem invasive 8. Literacy not required, but may not be representative of usual diet due to over/under reporting 9. Provides accurate intake data and information about food habits, but requires a motivated client 10. No burden for respondent and tends not to influence usual diet 3-10 12. How many members of the population use the services provided by dietitians? 13. What kinds of medications does this population take? 14. Has the population experienced a change in skinfold measurement? 15. Does this population have nutrition-related disorders like arthritis? 16. How many members of this population use home health care? 17. Has this population experienced a significant reduction in serum albumin? 18. Has this population experienced a significant weight loss over time? 19. What is the functional status of this population? b. laboratory c. clinical d. dietary e. community conditions 20. How many members of this population use home delivered meals? OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 OBJ: 3.2 Matching key: 1. ANS: d 2. ANS: e 3. ANS: c 4. ANS: d 5. ANS: b 6. ANS: d 7. ANS: a 8. ANS: e 9. ANS: c 10. ANS: e 11. ANS: d 12. ANS: e 13. ANS: c 14. ANS: a 15. ANS: c 16. ANS: e 17. ANS: b 18. ANS: a 19. ANS: c 20. ANS: e REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 84 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 REF: 92 Essay Questions 1. Describe the types of data that might be collected about the target population specified by the community needs assessment. ANS: The types of data that might be collected include information on individual lifestyle factors, including physical activity and diet habits; food choices; food supply and food availability; income and food prices; sociocultural factors; food preferences, cognitions, and attitudes; health beliefs and practices; and living and working conditions. REF: 69-75 OBJ: 3.1 2. Using the social-ecological framework, illustrate the key factors that influence food intake. ANS: See Figure 3-1 on page 74. REF: 70 OBJ: 3.1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3. Describe five methods for obtaining data about a target population. ANS: Five 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 is one type of nutrition survey used in community nutrition.  Screening is an important preventative health activity designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible. Screening can be conducted in the clinical and community settings by a variety of 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 to provide insights about whether the target population perceives a nutritional problem and which actions for addressing 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. REF: 77-87 OBJ: 3.2 4. As a community nutritionist, what questions would you ask about the design of a survey in order to ensure that it is carefully designed and carried out so that it will provide valid and reliable information for your nutritional needs assessment? ANS: See Table 3-2 for more information. Questions to ask include:  Is the survey valid and reliable, i.e., one that measures what it is intended to measure and one that will yield similar results each time it is used?  Are norms that you can compare your data to, such as reference data or population standards, available?  Is the survey suitable for the target population?  Are the survey questions easy to read and understand and written at the appropriate level of literacy, reading comprehension, and fluency in the primary language?  Is the format of the questionnaire clear?  Are the responses clear with a variety of scales and responses utilized?  Is the survey comprehensive, but brief?  Does the survey ask “socially loaded” questions? REF: 78 OBJ: 3.2 5. Describe the three components of a health risk appraisal, and discuss the usefulness and limitations of this type of survey instrument. © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-11 3-12 ANS: The three components of the HRA are the questionnaire, certain calculations that predict risk of disease, and an educational message or report. HRAs are used to alert individuals to any risky health behaviors that they engage in and to inform them how such behaviors might be modified, usually through a lifestyle modification program. A major 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 when used as a screening tool that provides an opportunity for more nutrition education. REF: 78 OBJ: 3.2 6. Define and describe focus groups, including their uses and how they are planned and conducted. ANS: 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. REF: 80-81 OBJ: 3.2 7. Compare and contrast three direct assessments of nutritional status. ANS: See Table 3-6 for a summary of the methods, strengths, and limitations of selected dietary assessment tools. REF: 84 OBJ: 3.2 8. Differentiate between sensitivity and specificity, using an example to illustrate the differences. ANS: Sensitivity is the proportion of subjects with the disease or condition who have a positive test result. A sensitive test rarely misses people with the disease or condition, and 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 who have 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. REF: 88 OBJ: 3.3 9. Discuss the factors to consider when conducting a cultural assessment of the target population. ANS: Factors to consider when conducting a cultural assessment include:  Religion, including individuals’ belief systems and food rituals.  Etiquette and social customs, including typical greeting and direct and indirect communication methods. © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.  Nonverbal communications, including eye contact, tone of voice, facial expressions, gestures, amount of personal space, and appropriate touch. REF: 90-91 OBJ: 3.4 10. As a WIC nutritionist seeking to evaluate the nutrition status of children whose mothers are participating in the WIC program, list three nutrition status indicators you might include in your evaluation. ANS:  Hemoglobin and hematocrit levels to assess iron stores.  Serum albumin levels to assess protein stores.  Food intake to assess appropriateness for age.  Growth as plotted on growth charts by age and gender. REF: 91 OBJ: 3.1 Short Answer 1. Differentiate between attitudes and cognitions and explain how they both influence food intake. ANS: Attitudes are an individual’s positive or negative evaluations of performing a behavior or engaging in an activity. Cognitions include people’s knowledge and awareness of the environment and the judgments they make related to it. We use our attitudes and cognitions to make decisions about purchasing and consuming foods. REF: 71 OBJ: 3.1 2. What primary social group has the most influence on health and nutritional status and why? ANS: The family exerts the most influence over an individual’s health as it is the first social group to which an individual belongs. REF: 73 OBJ: 3.1 3. What are three factors that affect nutrient utilization? ANS: Answers may vary, but could include activity level, smoking status, dietary supplement usage, drug-nutrient interactions, variety and quantity of food consumed, nutritional status, and physiological status (e.g., childhood or pregnancy). REF: 72 OBJ: 3.1 4. What are three issues to consider when selecting a method to assess dietary intake? ANS: • Program objectives (the degree of accuracy and type of data needed) • Study population (sample size needed, ability of respondents, willingness to cooperate, and time constraints) © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. 3-13 3-14 • Financial issues (cost of analysis software, training, and intake forms) • Implementation requirements (time required to complete form, ease of completion of form, training and skill level of interviewer) • Analysis requirements (quality of nutrient database, quality of analysis software, and training and skill level of food coder) REF: 82-83 OBJ: 3.2 5. List three threats to the validity of a survey designed to measure food intake. ANS: Answers will vary, but they all should focus on the accuracy of the survey. Ultimately, the survey should be able to measure food intake. REF: 88-89 OBJ: 3.3 Use the following case scenario to answer short answer items 6-9. The local chapter of the American Heart Association has contacted you to assist in the development of a focus group to determine if their services in your community have been positively received. 6. Is a focus group an appropriate data collection method for this purpose? Why or why not? ANS: 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. REF: 80-81 OBJ: 3.2 7. If a focus group were to be utilized, what questions might be asked? ANS: A variety of questions could be asked. The questions would need to be open-ended and written to stimulate conversation. Sample questions might include: • What are some of the services offered by the AHA 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? REF: 81 OBJ: 3.2 8. Would it be appropriate to collect this information via a survey? Why or why not? ANS: 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 in order to obtain both qualitative and quantitative data. REF: 77 OBJ: 3.2 9. If the survey method were to be used, what might affect the survey’s validity? ANS: Answers will vary, but could include the following concepts: © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. • 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 REF: 88-89