Effects of Leadership on Smoking Cessation

Running head: Leadership influence on childhood obesity prevention 1 Literature Review and Problem Statement on Effect of Leadership on Childhood Obesity Prevention Walden University Instructor: Shawn Munford Public Health Leadership and Systems Thinking Running head: Leadership influence on childhood obesity prevention 2 Introduction There have been global and local increase in the prevalence of overweight and obesity over the past 30 years, with about 170 millions of children less than 18 years of age affected (Karnik, & Kanekar, 2012; World Health Organization (WHO), 2012). In the United States of America, overweight and obesity prevalence increased from about 6% in 1972 to almost 18% in 2008; the trends are similar in all the states, with those in the minority and lower socioeconomic groups disproportionately affected (Kanekar, 2012). It is a risk factor for adulthood obesity and some other chronic illnesses both in childhood and later on in adulthood, and there are associated substantial financial and social burdens. Childhood obesity is due to imbalance between caloric intake and usage that results in positive energy balance (Karnik, & Kanekar, 2012; Wang, Gortmaker, Sobol, & Kuntz, 2006). The positive energy balance is influenced by complicated interactions between genetic and behavioral factors determined by obesogenic environments, which are influenced by leadership all levels (Latzer and Stein, 2013). A literature review was conducted to acquire evidence-based knowledge on leadership role on childhood obesity prevention. Methods A broad range search of English language literature on leadership role in childhood obesity prevention was conducted. Academic search engines utilized include but were not limited to Walden university library search catalogue, PubMed, Medline, and google scholar. Inclusion criteria for the search are peer-reviewed or scholarly resources on leadership role and childhood obesity prevention polices, must be in English language, and not older than 10 years. 10 out of all the articles that qualified were selected. Running head: Leadership influence on childhood obesity prevention 3 The literature review is separated into leadership roles, barriers to policy implementation, and policies against the obesogenic environment. Data was based on the Walden university literature review matrix as applicable. Review of papers Leadership roles In light of the global public health importance of obesity, and with scientific evidence of cost-effective population-based childhood obesity prevention interventions, the World Health Organization (WHO) in 2012 as part of its commitment to providing technical advice in implementing the global strategy on diet, physical activity, and health that is vital to addressing increasing prevalences of noncommunicable diseases, with specific emphasis on childhood obesity, advised governments through a journal titled “Population-based approaches to childhood obesity prevention” that there are population-level behavioral interventions actions that can be taken by them to prevent the public health threat of childhood obesity, but the success of these intervention depend on effective leadership at all levels of government (WHO, 2012). Effects of Leadership on Smoking Cessation

Leadership roles include structures at the government that support childhood obesity prevention policies and interventions such as leadership, policies that support healthy living, funding that are committed to health promotion, systems to monitor noncommunicable disease monitoring, workforce capacity, and networks and partnerships developed to support and improve the effectiveness of the direct policy initiatives and population-based interventions, and the direct policy actions that are helpful in creating healthy-living environments, which support physical activity and healthy eating (WHO, 2012). Running head: Leadership influence on childhood obesity prevention 4 The influence of the commercial sector on the obesity epidemic cannot be underrated with consumers purchasing more unhealthy food and more cars to move around; this trend is expected to continue, so concerted government action is required to counter the effects of the commercial drivers that are contributing to the obesity epidemic (Swinburn, 2008). According to Swinburn, actions needed from the government are provision of leadership in setting the agenda and providing direction; advocating for a multi-sectorial response and establishing the system for all sectors to engage and enhance action; developing and implementing policies that include laws and regulations to creation of healthier food and physical activity environments; and funding that are secure and can be increased to reduce the obesogenic environments and promote healthy lifestyle (Swinburn, 2008). Ben-Sefer, Ben-Natan, and Ehrenfeld conducted a literature review in a study “Childhood obesity: current literature, policy and implications for practice.” (Ben-Sefer, E., Ben-Natan, M., & Ehrenfeld, 2009). They concluded that any country that is experiencing increasing prevalence of childhood overweight and obesity should consider the core factors that contribute to the increasing prevalence such as social factors, physical activity, advertising targeting children, public policy and the relevance of partnerships in policy; and that, public policy and community partnerships are important in the prevention of childhood obesity (Ben-Sefer, Ben-Natan, & Ehrenfeld, 2009). Effects of Leadership on Smoking Cessation

The American Heart association (AHA, date) released a statement in a journal titled “Population-based prevention of obesity – The need for comprehensive promotion of healthful eating, physical activity, and energy balance – A scientific statement from American heart association council on epidemiology and prevention, interdisciplinary committee for prevention Running head: Leadership influence on childhood obesity prevention 5 (formerly the expert panel on population and prevention science)” (Kumanyika et al, 2008). The statement is in realization of obesity being a major risk factor in the development and course of cardiovascular diseases with the socioeconomic burdens; the importance of the effectiveness of public health interventions to reduce obesity and other risks that have increased in recent years due to the epidemic proportions of childhood and adulthood obesity rates; interventions to prevent obesity throughout the life-course are population-based approaches and clinical preventive strategies that complimentary; so there is need for development and implementation of policies for environments that support healthy lifestyle (Kumanyika et al, 2008). According to the acting Surgeon-General of the United States (U.S.), there is a renewed focus on childhood overweight and obesity prevention; the Secretary of Health and Human Services, has demonstrated a proactive leadership style in asking the acting Surgeon-General to chair a council of senior leaders across the Department of Health and Human Services (DHHS) with the main purpose of identifying and assessing evidence-based community-based programs that have been proven to be effective in combating this serious obesity health crisis (Galson, 2008). The council will focus on harmonizing the various DHHS programs to engage in an effective collaborative effort (Galson, 2008). Research literature is suggestive of childhood obesity being a health-threat to the public because of its association with health problems in childhood and adulthood, and the risk factors are behavioral that can be prevented by interventions directed at the various levels of the socioecological model (Berkowitz & Borchard, 2009). The results of a literature review by Berkowitz and Borchard to identify the roles of nursing in childhood obesity prevention are in support of a family-focused approach in influencing dietary habits of very young children; early Running head: Leadership influence on childhood obesity prevention 6 childhood interventions before poor dietary patterns are established; and the importance of community support (Berkowitz & Borchard, 2009). Effects of Leadership on Smoking Cessation

They concluded that given the roles of nurses in public health prevention interventions, nurses are urged to develop skills that include emotional intelligence especially empathy, collaborative leadership, advocacy, and social marketing skills that will make meaningful contribution to childhood obesity prevention; and there is need for a systematic consideration of how to ascertain that nurses are provided with the leadership, policy, and intervention skills for behavioral change that include emotional intelligence, collaborative leadership, advocacy, and social marketing skills, that are crucial for preventing childhood overweight and obesity (Berkowitz & Borchard, 2009). Policies Childhood obesity is as a result of positive energy balance because many children take in more calories than burnt (Wang et al. 2006). Physical activities are being discouraged in schools; children are inactive at home; those living in low-income neighborhoods are prevented from outdoor activities due to safety concerns; and there are no opportunities for children to walk around or ride their bikes due to lack of sidewalks in new housing areas (Friedman, & Schwartz, 2008). Effects of Leadership on Smoking Cessation

The socio-ecological model of behavior makes provision for a framework that includes policy development and implementation for childhood obesity prevention, but these public policies need to be enforceable and efficient (Friedman, & Schwartz, 2008). Leadership support for the obesity prevention programs include development and implementation of policies that facilitate the various public health obesity prevention programs, funding for overweight and obesity research, and furnishing support and encouragement for healthcare workers in the engagement of parents about their childrens’ weight (Friedman, & Running head: Leadership influence on childhood obesity prevention 7 Schwartz, 2008). Childhood obesity prevention policies include federal, state, and local legislation and regulation; policies and position statements from the World Health Organization and American medical association; and self-regulatory policies by food and soft drinks manufacturers. The policies are aimed at changing the obesogenic family, social, economic, and physical environments (Friedman, & Schwartz, 2008). There are policies at the federal, state, local and organizational levels that deal with physical education activity, school nutrition and education, general policies, and advertising to children. These policies can be initiated at any level of the community, organization, institution, or the society. According to Friedman and Schwartz, the World Health organization, and the Institute of Medicine issued policy statements requesting for a ban on food and beverage advertisements targeting children, especially those less than 12 years (Friedman, & Schwartz, 2008). Some of the major food chains made proclamations about self-regulation of their advertisement to children (Friedman, & Schwartz, 2008). Effects of Leadership on Smoking Cessation

Barriers to policy implementation Effective strategies for reversing childhood obesity rates include increased levels of physical activity and healthy eating, and in an effort to increase physical activity levels and encourage healthy eating, several policies have been developed at district, state, and federal levels. Different policies have been written, some have been enacted, but not all have been implemented. The barriers to implementation include obstacle created by politicians and legislative problems, for example, the effect of federal testing requirements in the “No Child Left Behind Act of 2001”, which resulted in decrease in physical education classes and activities in many districts to satisfy the testing requirements (Friedman, & Schwartz, 2008); the policy Running head: Leadership influence on childhood obesity prevention 8 contents and their introduction without pretesting (Wake, Canterford, Hardy, & Ukoumunne, 2011); lack of implementation at school level (Amis, Wright, Dyson, Vardaman, and Ferry, 2012); and resistance by the food and beverage companies (Friedman, & Schwartz, 2008). Majority of these policies have been directed at schools because the school setting has been identified as the ideal place for implementing this type of intervention. But there is strong evidence that there was no widespread adoption of these policies especially at the high- and middle- school levels (Amis, Wright, Dyson, Vardaman, & Ferry, 2012). Amis, Wright, Dyson, Vardaman, and Ferry, examined the adoption of New South Wales state policy for child obesity prevention by analyzing policy implementation in 8 high schools in Mississippi and Tennessee; data were collected between 2006 and 2009 through interviews with administrators, policymakers, students, and teachers, and by observing school based activities, and documents (Amis et al. 2012). They found that there were significant barriers to effective implementation of policies aimed at addressing health and social problems in high school settings in Mississippi and Tennessee (Amis et al., 2012). The most notable barriers are a value system that gives priorities to performances in standardized tests over physical education (PE), a university sport system that impact negatively on opportunities for PE, resource constraints, and the school administrators being overloaded with new policies (Amis et al., 2012). Amis et al. suggested that for the childhood obesity prevention policies to be effective, it is necessary that they have to be tied to the current educational strategies that provide incentives, and the school leaders responsible for their implementation should be held responsible (Amis et al., 2012). Possible limitation is the potential of selection bias that may affect the generalizability of study findings due to purposeful sampling method that was utilized (Amis et al., 2012). Running head: Leadership influence on childhood obesity prevention 9 Wake, Canterford, Hardy, and Ukoumunne conducted a longitudinal study on parents of 4,983 children aged 4-5 years, in Australia in 2004 to determine what body mass index (BMI) cut-off point activates parental concern (Wake, Canterford, Hardy, & Ukoumunne, 2011). They found that the concern of pre-schoolers ’ parents about their child’s weight was not activated by any determined BMI threshold, but was related mildly to body mass; they concluded that this may explain why some of the current childhood obesity policies are ineffective, because they focus only on individual concerns (Wake et al., 2011). In an article “Prevention of Overweight and Obesity: How Effective is the Current Public Health Approach” by Chan and Woo, low self-efficacy in managing patients with overweight by doctors that are supposed to be the leaders of patient management teams was identified as one of the barriers to an effective management thus rendering ineffective, the current public health approach to childhood obesity preventing (Chan, & Woo, 2010). Effects of Leadership on Smoking Cessation Theoretical gaps in the research area This literature review looked at many leadership aspects of childhood obesity prevention programs through policies that promote health living research on the most effective and generalizable strategies to combat childhood obesity was not carried out. There are some theoretical gaps. There was little or no information on the policy-making processes; pathways from policy to desired behavioral environmental changes; characteristics that can affect policy efficacy; contextual conditions; measures of policy and changes in the obesogenic environment; and likelihood of policy sustainability (Brennan, Castro, Brownson, Claus, & Orleans, 2011) Conclusion Running head: Leadership influence on childhood obesity prevention 10 The global epidemic of childhood obesity and its complications need to be controlled. This can only be achieved though community-based prevention programs that need leadership support in terms of provision of policies, sustained funding, collaboration between the different stakeholders; leadership at the level of the program implementation that includes helping the public health workers to acquire the necessary leadership skills needed at the operation level. Problem Statement There has been a global and local increase in the prevalence of overweight and obesity over the past 30 years with about 170 millions of children than 18 years of age affected (Karnik, & Kanekar, 2012; World Health Organization (WHO), 2012). In the United States of America, overweight and obesity prevalence increased from about 6% in 1972 to almost 18% in 2008; the trends are similar in all the states, with those in the minority and lower socioeconomic groups disproportionately affected (Kanekar, 2012). It is a risk factor for adulthood obesity and some other chronic illnesses including cancers and psychological problems. There are associated substantial financial and social burdens. Childhood obesity is due to imbalance between caloric intake and usage that results in positive energy balance (Karnik, & Kanekar, 2012; Wang, Gortmaker, Sobol, & Kuntz, 2006).

The positive energy balance is influenced by complicated interactions between genetic and behavioral factors that are determined by obesogenic environments, which are influenced by leadership all levels (Latzer and Stein, 2013). Childhood obesity result from multiple interactions between genetics, unhealthy eating habits, the obesogenic food environment, effects of advertisement, lack of physical activity, and environmental contexts(Friedman, & Schwartz, 2008). Physical activities are being discouraged in schools, at home children are not active, sedentary activities; walking and biking to school are Running head: Leadership influence on childhood obesity prevention 11 being discouraged due to lack of sidewalks in some development arears, the need to cross busy streets, long distances to schools; and children living in low-income neighborhoods are discouraged from playing outdoors out of safety concerns (Friedman, & Schwartz, 2008).

Fast food commercials influence children’s eating habits; there are heavy advertisement on television and internet by many fast food outlets, and television cartoons are inserted with fast food commercials with resultant increase in fast food and beverages consumption advertised on television (Caroli, 2006). These behaviors can be controlled by evidence-based interventions that target the various influences of behavior according to the socioecological model of behavior. This framework includes policy development and implementation, as part of public health role in the fight against childhood obesity, they must be enforceable and proven to be effective (Friedman, & Schwartz, 2008). Effects of Leadership on Smoking Cessation

Leadership support for the obesity prevention programs include development and implementation of policies that facilitate the various public health obesity prevention programs, funding for overweight and obesity research, and furnishing support and encouragement for healthcare workers in the engagement of parents about their children’ weight (Friedman, & Schwartz, 2008). Different stakeholders and public health leaders have lent their support for the policies which exist at various levels. However there are some barriers to the implementation of the policies which include….(mention them here). Implications for social change Social change as described by Walden University is an intentional course of action that creates and applies ideas, strategies, and activities aimed at promoting the worth, dignity, and improving individuals, communities, organizations, institutions, cultures, and societies (Yob, Running head: Leadership influence on childhood obesity prevention 12 2012). Research contributes to the body of knowledge, which includes knowledge of humans, culture, and society; this stock of knowledge is u …