Post Secondary Nutrition Education Needs in Alaska: A Statewide Needs Assessment

Post Secondary Nutrition Education Needs in Alaska:
A Statewide Needs Assessment
Prepared for the University of Alaska
June 29, 2005
Report Preparation:
Elizabeth D. Nobmann, PhD, MPH, RD
Licensed Nutritionist
EDN Nutrition Consulting
Anchorage, AK
Contract Administrator:
Timothy Doebler, Director
Culinary Arts and Hospitality/Dietetics and Nutrition Program
University of Alaska Anchorage
2
Acknowledgments
This project was made possible by funding from the University of Alaska. Karen Perdue,
Vice President for Health, University of Alaska, is acknowledged and thanked for her
initiative and support for this effort. The individuals who agreed to be interviewed are
thanked for their thoughtful insights and opinions. To everyone who responded to the
survey, thank you. The support of three individuals was especially helpful in encouraging
participation in the survey; Rod Betit, Executive Director, Alaska State Hospital and
Nursing Home Association, Paul Sherry, President, Alaska Native Tribal Health
Consortium, and Richard Mandsager, MD, Director Public Health, Alaska Department of
Health and Social Services. Several leaders/coordinators of organizations are thanked for
generously helping to distribute the survey to their members: Joan Gone, Anthony
Nakazawa, Meera A. Ramesh, Maria Vandenbos, Kathleen Wayne, Carol White and
school district administrators. Members of the Statewide Advisory Committee were
helpful in many ways and are acknowledged and thanked for their contributions.
Table of Contents
Statewide Nutrition Advisory Committee............................................................................ 3
Executive Summary ............................................................................................................. 4
Introduction and Background ............................................................................................... 5
Methods .............................................................................................................................. 10
Survey Results.................................................................................................................... 11
Employment needs ..................................................................................................... 11
Training needs ............................................................................................................ 12
Barriers and Solutions ................................................................................................ 12
Strengths of Alaskan Training.................................................................................... 13
Additional Comments................................................................................................. 14
Key Interviews ................................................................................................................... 16
Discussion .......................................................................................................................... 17
Conclusion.......................................................................................................................... 19
References .......................................................................................................................... 20
List of Tables...................................................................................................................... 21
List of Figures .................................................................................................................... 21
List of Appendices.............................................................................................................. 21
TABLES............................................................................................................................. 22
FIGURES ........................................................................................................................... 30
APPENDICES.................................................................................................................... 31
3
Statewide Nutrition Advisory Committee
Teresa
NAME
Altenburg, RD, LD
Marcia
Angela
Anderson
Bateman, MPH, RD, LD
Carrie
Benton, MS, RD, LD
Sandy
Wendy
Burnham, MPH, RD, LD
Christianson, MPH, RD,
LD, CDE
Dinstel
Roxie
TITLE
Community Outreach
Coordinator
CVD Project Coordinator
Dietetic Internship
Coordinator
Executive Director
Nutrition Manager
ORGANIZATION
Alaska Area Diabetes Program, ANMC /
UAA Dietetic Intern Graduate
Southcentral Foundation, Anchorage
Yukon-Kuskokwim Delta Regional
Hospital
University of Alaska Anchorage
Alaska Health Fair, Inc.
Maniilaq Association, Kotzebue
Extension Home Economist Fairbanks, Cooperative Extension Service
Samantha Maloney, RD, LD
University of Alaska Anchorage
Director, Culinary
Arts/Hospitality/Dietetics &
Nutrition
Program Manager
Family Nutrition & Health Services,
Municipality of Anchorage
Dean, College of Health & University of Alaska Anchorage
Social Welfare
Division Director, Allied
University of Alaska Anchorage
Health Sciences
Nutrition Specialist
Cooperative Extension Service, UAF
College of Rural Alaska
Chief Clinical Dietitian
Alaska Native Medical Center
Dick
Director, Pediatrician
Timothy Doebler, MS, CCE
Margaret Duggan, MS, RD, LD
Cheryl
Easley
Tammy
Green, MPH
Bret
Luick, PhD
Mandsager, MD
Anthony Nakazawa
Pat
Owens, RD, LD
Public Health, Alaska Department of
Health & Social Services
Director, Alaska Cooperative UAF College of Rural Alaska
Extension Service
Dietitian
Karen
Perdue
Erin
Peterson
Elizabeth Ruppert
Vice President for Health
Manager
Researcher
Lisa
Community & Employee
Coordinator
Consulting Dietitian
Cindy
Sadlier-Hart, MPH, RD,
CHES
Salmon, RD, LD
Elizabeth Watanabe, MBA, RD, LD
“Libby”
Kathleen Wayne, MS RD
Chief Dietitian
Health Program Manager
Norton Sound Regional Health
Corporation, Nome
University of Alaska
Obesity Program, ADHSS
(formerly) Center for Alaska Native Health
Research
SEARHC/Sitka
Fairbanks/UAA Dietetic Intern Graduate
SEARHC/Sitka/UAA Dietetic Intern
Graduate
Family Nutrition Programs, ADHSS
4
Executive Summary
Alaskans face growing nutrition-related problems. Sixty-four percent of Alaskans are
overweight or obese. With increases in obesity come increasing health risks. Alaska
Natives are experiencing the greatest increase in the prevalence of diabetes in all of North
America. The cost of medical treatment for nutrition related conditions is high. One of
every eight dollars in Medicaid spending now goes to care for people with diabetes.
Kidney dialysis, a potential result of uncontrolled blood sugar or high blood pressure costs
$250,000/yr/patient.The reasons for these problems are not the purview of any one
segment of society. They are the result of interacting factors. In order to turn these trends
around we need a multifaceted, multidisciplinary approach.
Trained manpower is only one part of the equation, however an important one. By
recruiting students and exposing them to the latest research on chronic diseases and
appropriate interventions, we are taking steps toward resolving problems that impact our
culturally-diverse Alaskan society.
To determine what are the nutrition education and manpower needs in Alaska, we
surveyed Alaskans who work in health care, preventive services, and education. Three key
groups who either hire these occupations (hospitals & nursing homes, and Alaska Native
health corporations) or advise potential students (large high schools) were targeted
resulting in response rates of 64-74%. There were 164 responses. In addition, 27 key
informant interviews were conducted to determine current and future needs, and ways to
address barriers to make training feasible.
•
Among the 13 nutrition-related occupations surveyed, cooks and bakers comprise
the largest number of people employed (380) followed by registered dietitians
(104). Vacancies currently exist in eight of the 13 occupations.
•
Ninety-nine percent of respondents stated that in the next 3-5 years student interest
in nutrition education will increase (59%) or remain the same (40%).
•
There are four major needs in post-secondary nutrition education; training for 1.
registered dietitians, 2. cooks and bakers, 3. paraprofessionals and 4. other
professions.
•
Respondents rated the need for additional training highest for registered dietitians,
the need for cooks and bakers next. There is widespread need at the village level
for paraprofessionals. There is need for individuals trained at the bachelor’s level
with a dietetic internship (dietitians and nutritionists) to work with
paraprofessionals. Increased attention is needed for certificate/associate level
training for cooks & bakers in schools and institutions, certified dietary managers,
community wellness advocates, and WIC certified professional authorities.
•
The demand for trained dietitians exceeds the supply of 4-5 graduated annually
from the one internship in Alaska. Employers must recruit outside the state. YKHC
is offering each applicant a hiring/retention bonus of $30,000.
5
•
Dietitian vacancies and demand may vary within the state. Rural Alaska has
ongoing needs, as does Anchorage. Jobs in Southeast Alaska have slower turnover
with the exception of state jobs.
•
Some training exists for some of these positions but not for all. There is no 4 year
degree in nutrition in Alaska. A bachelor’s degree (BS) in nutrition would fulfill
the degree qualifications for over 170 positions and 18 vacancies reported in the
survey. An undergraduate degree program in nutrition would be the training
foundation for dietitians, nutrition educators (4 year degree), public health
nutritionists, extension home economists, researchers and university faculty.
•
Training to become a registered dietitian requires both academic preparation (a 4
year degree) and supervised experience (internship). Although there is a dietetic
internship program at UAA, Alaska is the only state that has no institution offering
a bachelor’s degree in nutrition. This degree is required before entering the
supervised experience known as the internship.
•
Key informants supported the need for a four-year degree in nutrition by 15 to 1.
•
Establishment of additional training in nutrition by the University of Alaska is
justifiable on the basis of the overall needs of Alaskans for improved nutritional
status and the expanding need for nutrition-related occupations and opportunities
for employment. The University will contribute to the health of Alaskans statewide
by offering this training.
Introduction and Background
The purpose of this report is to document the current needs for nutrition training at the
post-secondary level in Alaska and to assess the feasibility of offering a four-year
academic degree statewide. In order to understand nutrition training needs it is helpful to
review briefly the nutritional needs of Alaskans and the current educational offerings.
Health Needs of Alaskans
Health Goals for the year 2010 have been established by and for Alaskans based on
documented health needs (Alaska Department of Health and Social Services 2002). Goals
specific to nutrition include reducing the prevalence of overweight and obesity, growth
retardation among Alaskan children, and anemia, and increasing consumption of fruit and
vegetables, and increasing food security thus reducing hunger. In addition, nutrition
impacts other goal areas including diabetes, cancer, heart disease and stroke, respiratory
disease, osteoporosis, maternal and child health and food safety.
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Major emphasis is placed on overweight and obesity as the rates have steadily risen
among Alaskans. Thirty-nine percent of adults are overweight and another 24% are obese
(Alaska Department of Health and Social Services BRFSS, 2004). (Appendix A) Among
Alaska Natives the rate of diabetes is increasing faster than in any other group in North
America (Diabetes Program Data, Alaska Native Tribal Health Consortium).
There are 350 patients on kidney dialysis in Alaska. The number of patients has doubled
in the last 10 years. Sixty-five percent of patients receive dialysis as a result of diabetes.
Renal dialysis for one patient costs $18,000/month ($250,000/year with some drugs).
Depending on the patient’s eligibility, this may be paid by Medicare, Medicaid or private
insurance - until the patient’s $1 million cap is reached.
Another health goal for the year 2010 is to ensure that state local, and tribal health
agencies have the infrastructure to provide essential public health services effectively.
This includes: 1. Assure access to public health information for communities, policy
makers, and the general public. 2. Assure a well-trained, competent public health
workforce. 3. Engage communities to solve local health problems. 4. Increase personal
responsibility for individual health (Alaska Department of Health and Social Services,
2002).
Research Needs
Research is a growing focus in Alaska that is attracting increasing amounts of money. In
response to the Alaska State Legislature’s call for a state research and development plan, a
statewide task force identified critical future research needs (University of Alaska, 2004).
Human nutrition plays a significant role in the identified areas of chronic disease
(diabetes, heart disease, high blood pressure, cancers), environmental health and
toxicology, environmental contamination, health aspects of living in an arctic and subarctic climate, shortage of health professionals, complementary medicine integration,
disabilities, aging of disabled population, effect of disabilities on children, services for
children with disabilities in foster care, gerontology, maternal, child & family health
including adolescent health, pediatric anemia, prenatal care, longitudinal study of children
and obesity prevention. The need for nutrition research is pervasive throughout the Report
as illustrated by the following excerpts.
”Limited samples of Alaskan fish have not found levels of contaminants that cause
concern “(p 44), however risk-benefit analysis of eating Native foods which are
exceptionally nutritious should continue. This is an area of interest and concern for many
rural Alaskans.
“Research is needed on the impact on Alaska Native seniors having their culturally related
activities, foods, traditional healing, and opportunities for spiritual expression absent in
health care settings.” P 141. “Alaska needs more researchers to study all the unique
situations here and to work on challenges the state faces. As with personnel shortages in
other fields, the best way to get more researchers for Alaska is to train Alaskans. In order
to begin to do this, Alaska needs additional doctoral education opportunities” P 164.
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“Rural employers are increasingly focused on spending money to train and educate local
residents for the health care jobs in rural Alaska” P 166. “It is critical for Alaskans that we
have an in-state capacity to educate and train our citizens for health research and health
delivery” P 17.
Nutrition-Related Occupational Needs
In 1997 a nutrition and chronic disease assessment found that the demand for trained
nutrition professionals within Alaska far exceeded the supply. As a result, out-of-state
recruitment must be done in order to fill positions, especially for remote communities
(Alaska Department of Health and Social Services, 1997)
The 1997 assessment described 19 different organizations or programs that address food
and nutrition needs for Alaskans, from government funded programs such as the WIC
Program, to non-profit organizations such as the American Diabetes Association.
Hospitals are major recruiters of dietitians. Nutrition education needs of children, the
general public through grocery stores, restaurants and the mass media are other entities
where personnel with nutrition expertise are needed.
Surveys by the US Department of Labor are conducted periodically to assess the national
labor force. They assess three relevant occupations in the health care core: 1. Cooks,
Institution and Cafeteria, 2. Dietitians and Nutritionists, and 3. Food Service Managers.
From 2002 to 2012 in the US, the percentage of dietitians and nutritionists will increase by
17.8% in contrast to all occupations which will increase by 14.8% (US Department of
Labor, 2005). The Alaska Department of Labor predicts increases in each occupation
listed below. The greatest increase is for dietitians and nutritionists, significantly more
than the all-occupations average in Alaska (Alaska Department of Labor, 2005).
Industry Staffing Patterns, Core Healthcare in Alaska
Projected
Employment Employment Change
(2012)
(%)
(2002)
Occupation
Cooks, Institution and
Cafeteria
143
165
15.4
Dietitians and
Nutritionists
92
124
34.8
Food Service Managers
19
24
21.1
Adapted from Alaska Department of Labor, 2005
In 2001 the Allied Health Workforce Assessment surveyed health care organizations,
school districts and other health care businesses about their manpower need (Alaska
Center for Rural Health). The 27 organizations that responded about registered dietitians
reported 52 positions and 2/3rd of them rated the occupation as “somewhat” to “very
difficult” to recruit. Only 7 Dietetic Technicians were employed by the six organizations
reporting.
8
Medicare
Medicare is the federal health insurance program for people who are 65 or older, people
less than 65 with certain disabilities, and people with end-stage renal disease. Diet
counseling or medical nutrition therapy services are reimbursed by Medicare, however
they must be provided by a Registered Dietitian or Nutrition Professional licensed by the
state of Alaska. Only two conditions are eligible for reimbursed medical nutrition therapy
currently. Services are covered now for people who have diabetes or kidney disease
(unless the person is on dialysis) with a doctor’s referral. Medical nutrition therapy
services are covered for three years after a kidney transplant. Kidney dialysis, and services
and supplies, either in a facility or at home are covered (US Department of Health and
Human Services, 2004). Coverage for medical nutrition therapy for weight control, heart
disease, and pediatric needs is currently under consideration.
Nutrition Related Career Opportunities
There are a variety of occupations that can be considered nutrition related post-secondary
education or training (Appendix B). This report refers to three general categories of
nutrition-related careers; the food service track, the nutrition/dietetic practitioner track,
and the academic track. Within the food service track are three occupations; cooks &
bakers, certified dietary managers (two-year certificate level) and hospitality and
restaurant managers (four-year BS level). They work in institutions and other food service
settings in either food production or management.
The nutrition/dietetic practitioner track includes community wellness advocates (CWAs),
WIC competent professional authorities, dietetic technicians, nutrition educators (BS
level), dietitians and nutritionists (BS minimum plus a dietetic internship), and
Cooperative Extension home economists. Functions of the occupations in this track range
from serving as lay health educators in villages (CWAs), to providing basic services for
WIC clients (CPAs), to assisting registered dietitians by providing nutrition screening and
education (Dietetic Technicians, Registered, DTRs), to providing counseling for low risk
clients as health educators in the community or worksite (BS level), to providing medical
nutrition therapy and supervising service of nutritionally adequate meals in institutions
(Registered Dietitians, RDs), to assessing needs and implementing nutrition programs on a
community-wide basis (Public Health Nutritionists), to providing nutrition and food
education in the community (Extension Home Economists).
The academic track includes nutrition researchers at both the master’s and doctoral degree
levels, and university faculty. Nutrition researchers work on epidemiological studies
determining the role of diet in disease prevention and intervention, in intervention studies,
and in determining the nutrient composition of foods. University faculty (doctoral degree
level) teach undergraduate and graduate students, conduct and secure funding for research,
provide community service and hold administrative positions such as Director of a
Nutrition Department or Dean.
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Dietitians and nutritionists are professions licensed by the State of Alaska. The credentials
of Registered Dietitian (RD), Dietetic Technician, Registered (DTR), and Certified
Dietary Manager (CDM) are earned by successfully completing a national examination.
Current Nutrition Education Offerings in Alaska
Several training programs for nutrition related careers exist in Alaska (Appendix C).
Training for the food-service track occupations is currently conducted by the University of
Alaska Anchorage, University of Alaska Fairbanks through Tanana Valley Community
College and The Alaska Vocational and Technical Center, Seward.
Within the nutrition/dietetic track, WIC CPA training is conducted by the Alaska WIC
Program through UAA. The CWA program is offered through University of Alaska
Southeast in partnership with the Southeast Alaska Regional Health Consortium.
In principal, there are two program options that candidates may pursue to become eligible
to take the RD examination (Commission on Accreditation for Dietetics Education,
American Dietetic Association, 2005) (CADE) . One is through a coordinated program
that combines the bachelor’s or graduate level coursework for dietitians with the
supervised practice (known as the combined program). The second program option is the
bachelor’s or graduate level coursework which must be completed before the dietetic
internship, plus the post-bachelor’s supervised practice known as the dietetic internship.
(The candidate must complete the didactic program in dietetics and at least a bachelor’s
degree before entry to the supervised practice.) In Alaska an 1100-hour dietetic internship
is offered at UAA. Each year the program graduates students in the five slots allotted by
the CADE. In the past 2 years there have been 20 applicants for the five slots.
UAF offers a special program in food science and nutrition (12-15 credits) for students in
natural science, engineering, northern agriculture or management with emphasis area in
food science and nutrition. UAA offers a Master’s degree in Public Health, the primary
professional degree in public health with coursework aimed at population-based, culturally
appropriate and innovative approaches concerning current and emerging public health
problems. Although relevant to the training of public health nutritionists, this degree does
not provide the nutrition specialty coursework.
There are gaps in the nutrition education offerings in Alaska. Neither the coordinated
undergraduate program nor the bachelor’s or graduate degree coursework necessary for
training dietitians is offered in Alaska. There are no nutrition degree programs for the
associate degree-level dietary technicians, or the bachelor’s level nutrition educators, or
the master’s level researchers or the doctoral level candidates.
Currently students wishing to complete the didactic program in dietetics and obtain a
bachelor’s degree must go to one of the 228 programs located in every other state but
Alaska (Commission on Accreditation for Dietetics Education, 2005). Non-resident tuition
per year for these programs generally exceeds $10,000 and is as much as $32,450 at
Drexel University. Only two schools posted non-resident tuitions that were less than the
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estimated annual resident tuition of $3,165 at UAA (UAA, 2005). They were College of
the Ozarks, MO (a work college where students work on-campus for their tuition) and
University of Puerto Rico.
With this background information, we proceeded to document the current needs for
manpower in nutrition-related occupations and the perceptions of need for in-state
training.
Methods
In early 2005 the University of Alaska initiated a statewide nutrition education needs
feasibility study to determine if a four-year degree in nutrition is needed in Alaska. An
advisory committee was created and a consultant was hired to conduct the survey. During
the next three months information was solicited from key leaders in healthcare,
government and education via an online survey, phone calls, e-mails, and in some
instances by traveling through the state of Alaska and meeting with relevant individuals
and groups. The findings are compiled in this report.
The definition of “nutrition education needs” was refined to “the need for nutrition
education at the post-secondary level”. This expanded the assessment to all levels of
training from the certificate to the doctoral level. Occupations with different focus and
different training requirements were grouped into three categories based on general
functions: food related practitioners, nutrition/dietetic practitioners, and an academic track.
The advisory committee recommended that the survey be administered online and
SurveyMonkey.com was the software selected. The committee identified 37 potential
groups of employers of nutrition or health care-related food service workers to contact and
also suggested key individuals who should be interviewed.
Electronic Survey
The survey was drafted using a format similar to the earlier allied health manpower
assessment survey (Alaska Center for Rural Health, 2001), plus questions to estimate the
extent of student interest in nutrition training. It was pilot-test with advisory committee
members and modified. It was distributed to organizations likely to hire individuals with
nutrition training, individuals employed in the field, heads of school districts and high
schools where students might be counseled to pursue such training.
The survey was emailed with a cover letter co-signed by the consultant and a key person
known to the addressees (Appendix D). Cover letters were personalized for each group.
(Appendix E) A second email was sent as a reminder to respond. Follow-up telephone
calls were placed to administrators of three key groups; Alaska State Hospital and Nursing
Home Association, Alaska Native Health Corporations and larger high schools in Alaska.
The objective of the follow-up calls was to obtain a 70% response rate.
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The manpower results were compiled and analyzed based on the organizational unit, e.g.
one response from an organization, unless a distinct program such as WIC were located in
an organization, in which case that program was also counted. Responses from food
service managers were used to estimate the food related occupations. Responses from
administrators or dietitians were used to estimate the nutrition/dietetic occupations and the
academic track occupations. All respondents were included for analysis of questions about
training needs, career counseling and opinions.
Key Interviews
Key informants were selected to obtain a variety of perspectives. Interviews were
conducted to ascertain open-ended responses about current and future nutrition education
needs, the need for a four year degree in Alaska, and factors to address concerning
feasibility of offering a BS degree given the geographical distances and small population
of Alaska. (Appendix F) Twenty-seven people were interviewed by the consultant inperson in Fairbanks, Anchorage and Juneau. Several key individuals in other locations
were interviewed by telephone. (Appendix G)
Survey Results
Surveys were received from 164 individuals. Response rates from the three key groups
were 64-74% (Table 1). Most respondents described themselves as administrators, “other”
(including food service administrators, researchers, nurses, career counselors) or dietitians
(Figure 1) The main categories of organizations represented were “other” (including tribal
organizations, elder programs, WIC and private industry), school districts and hospitals
(Figure 2). Twenty-six percent of respondents were from Alaska Native organizations.
Employment needs
Information on current employment and projected needs is presented in Tables 2a, 2b, 2c.
The largest numbers of current employees are cooks & bakers, followed by registered
dietitians. Total numbers of employees projected in the next five and ten years were
extremely varied with some occupations showing fewer numbers needed. Rate of change
for the next five years ranged from minus 75% to plus 200%. Projected numbers may be
under-reported as at least one respondent interpreted the question as, “How many
additional employees are needed,” instead of “How many total employees are needed”. It
should also be noted that the number of respondents who reported current employment
was different than the number who projected future needs.
Nonetheless there was a projected increase in the next five years of 22 positions (13%)
over current employment (170 positions) among nutrition/dietetic and academic track
positions that require a bachelor’s degree. In the next ten years, there was an increase of
14 positions (8%) over the current employment, however there were only 60 responders
willing to project needs in ten years, compared with 77 who reported current employment.
Overall turnover rate for these positions was 24 /year.
Among the food-related track positions, there were fewer cooks and bakers projected for
the next five and ten years, but more dietary managers. There were fewer responders who
12
projected need than reported current numbers of cooks and bakers. In contrast there were
more responders projecting dietary manager needs than reporting the current numbers of
dietary managers.
Table 3 ranks occupations on the basis of need for additional training. Training for
registered dietitians, cooks & bakers and nutrition educators (4 year degree) were ranked
highest. Training for every occupation was rated as “needed” or “highly needed” by at
least half of the respondents.
Table 4 ranks personal interest in further training in each occupation. Numerous
responders mentioned interest in more than one training level. Some identified all training
programs from cooks through registered dietitian training.
Training needs
We looked at the potential for high school students pursuing careers in nutrition related
occupations. Both large and small schools were represented. Of the 50 respondents
working in high schools, 58% worked in schools with less than 500 students, 42% were
from schools with 500-2000 or more students.
Table 5 describes the number of counselors who counsel students to consider careers in
food or nutrition/dietetics, and the number of students who pursue training. Based on
responses from these counselors, 475-600 students are encouraged to consider a career in
food service; 325-450 are encouraged to consider a career in nutrition or dietetics
annually. Of those counseled, 150-300 pursue such training. It is unknown how many
receive training from existing training programs in-state and how many leave Alaska for
training. If there were a nutrition or dietetics program in Alaska some students who now
leave might stay in-state, and others who received counseling but are not pursuing the
training might decide to pursue it.
Ninety-nine percent of respondents stated that in the next 3-5 years student interest in
nutrition education will increase or remain the same (59%, 40% respectively).
Barriers and Solutions
Table 6 rates the importance of selected barriers to Alaska-based nutrition training.
Reasons rated as “very important” most often were lack of program, cost, and leaving
home community for training. Student interest was rated most often as “important”.
Additional barriers to Alaska-based nutrition training mentioned by more than one
respondent were: adequate positions [for graduates] (5), adequate pay (4), no degree
programs (4), lack of knowledge, understanding or interest in nutrition due to not being
exposed to the field (3), nutrition expertise not recognized/valued (2), and weather
conditions (2).
There were 81 respondents who offered a variety of ways in which the barriers to Alaskabased nutrition training could be addressed. The variety of solutions reflected the variety
of interpretations of post-secondary nutrition training. Distance education was most
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commonly mentioned (13 responses). The need to advertise, market or increase awareness
of the specialty among potential students was frequently mentioned. Student assistance
(through loans, grants, sponsorship, scholarships and financial incentives to work in
Alaska once trained) was another common theme. More programmatic funding to provide
local internships was mentioned. All who answered supported additional training in some
form.
Respondents suggested different combinations of delivery: distance learning; having
programs in Anchorage, Bethel, Fairbanks; in communities through local community
colleges; a university on-line dietary managers program; combination classroom and
distance learning; developing a four-year nutrition degree program; or an undergraduate
dietetic program preparing students for the internship program; vocational training
beginning in high school and working with the school food service department;
collaborating with existing programs to share resources and reduce costs; mentoring of
village students during their first year or two at the University; offer training in one central
location like Anchorage and then offer same program via distance education to smaller
UAA/UAS campuses; program for dietitians offered at UAF or UA; offering degrees in
nutrition, preferably both BS and MS degrees; and the doctoral level; collaborate with
non-university faculty but the university has to add FTE faculty; seeing any program as a
UA program would help so that UAF faculty…and UAA or UAS faculty could jointly
develop a program…may want to start with allied health programs to create a UA
pipeline; student internship opportunities; set up training programs “family style” in small
settings with dorms in the larger cities for village students; training that encompasses
experience and previous training; clinical and community based education; start training in
grade school.
Other suggestions included: having different levels (AA, BA, and MA) will address the
question of access. Stepwise programs: high school health/nutrition certificate, CWA,
two-year AA degree, bachelor’s, and master’s degree with internship.
Continuing education through tele-health upgrades; regular training for WIC CPA
positions; distance education classes for updating previous education in preparation for the
internship or master’ degree.
Alaska has many “hard to fill” sites; “homegrown” dietetic professionals will help fill
these positions.
Strengths of Alaskan Training
When asked what strengths are there in having training in Alaska, 104 people responded.
Here are some of their comments.
“People who train in Alaska stay in Alaska. We have a high transient population (military
mostly) and the costs of recruiting/training/turnover in professional fields is an enormous
industry burden.”
14
Having home-grown professionals to provide services within Alaska was a recurring
theme. The likely outcomes would be people are likely to take jobs where they trained,
and training could be specific to Alaskan needs, cultures, and foods.
Economically, additional research and funding would be brought to the state as nutrition
programs are developed. Alaskan trained students are more likely to stay and support our
local economy. Costs to the student would be less to live at home, reduced cost to travel,
retain permanent fund dividend, in-state tuition would likely be less than many other
schools Outside, decrease relocation expense. Other benefits would be reduced travel
time; increased likelihood of success if the student was closer to home and support
system; able to get subsistence foods. Training could be specific to Alaskan needs;
training with emphasis on instate cultures will require a lower learning curve when
entering the workforce in Alaska. Additional knowledge base will help support a healthy
state. Will help stop the “brain drain” that is occurring in this state. One person can see
linkages with Western Canada.
The minority opinion stated I don’t think this is an issue. Kids like to leave and check out
the rest of the country…those who do not can usually find what they need on line.
Additional Comments
Fifty-one respondents had additional comments. Some of them follow.
• After waiting many years to finish my internship, I was so grateful to have an
Alaskan internship. I don't know if I would have ever done it if I had to leave my
family behind. But I had to take my update classes at the University of Alabama and
BYU because none were available locally. I don't know if I could have taken classes
on campus because I was working prior to the internship. As I have talked to others
in my situation, they also have expressed interest in updating their education and
entering the internship.
•
Alaska-based nutrition training is paramount in ensuring that appropriate nutrition
education and Medical Nutrition Therapy are provided to residents of rural Alaska.
Thank you!
•
Clients often ask if nutrition training for WIC jobs is available here. I have helped
proctor students for several related fields (RD's, WIC CPA's, Dietary Managers), as a
proctor it is very hard to find time and to make sure students are learning adequately
so when released it is a positive image for the community.
•
With the new Department of Environmental Conservation changes that are slated
to happen soon more education is essential for food safety, sanitation and nutrition.
•
Getting proper nutrition training is a big deal. We would have to put together a
significant group of faculty to create a credible program.
15
•
I am a genetics researcher, but interested in the role of nutrition as a covariate for
genetic risk. It would be great to have more of a nutrition emphasis in Alaska.
•
I completely support professional education and development within Alaska.
•
I don't think there is enough interest or jobs to justify the expense of having a
program at UAA.
•
I have been employed in the nutrition field for over 15 years. During this time I
pursued a degree in Dietetics. One cause leading to not accomplishing this goal was
the difficulty of having to leave the state for the education. It is extremely costly to
leave your home state to get a degree. It became too difficult a task and I was unable
to complete the task.
•
I know several dietitians, myself included, who have advanced into non-nutritionrelated management positions because of our ability to apply our knowledge expertise
and training in fields which go beyond nutrition and dietetics. While we bring our
skills wherever we go, this is just one of the reasons that contributes to the need to
have more dietitians trained, ideally in state. Dietitians will continue to be pulled into
other fields and there will be a need to replace them. Also, I think that having more
paraprofessionals and non-RDs trained to do basic nutrition counseling under the
supervision of an RD will be cost-effective, especially in light of the possibility that
all future RDs will be required to have a master's degree. Some people won't want to
invest the time and money into a program like that, but will want to have nutrition
training. In addition, public health programs may not be able to afford to pay master's
level RDs.
•
I think we need trained people who can offer training in positive life styles and not
just nutrition. In other words, a holistic approach to healthy living (physically,
intellectually, emotionally, socially, and spiritually).
•
need to add to high school/junior curriculum - with the demise of home economics,
fast food and all, lots of kids don't get training at home about nutrition, etc.
•
The federal government has mandated wellness policies for schools by June 2006.
University could provide training for managers in how to meet these policies.
•
This plan should get started as soon as possible.
•
This would be a very worthwhile program if you can get some place in state to begin
offering this type of training - students have talked about being cooks/food service
employees at this site especially due to the proximity to Prudhoe Bay and how
important these jobs are to the oilfield industry - and how lucrative these jobs are.
16
•
Training is highly needed if jobs are available. We still have to import RDs from the
lower 48 states. We have trouble hiring RDs for WIC in Anchorage. I already have a
Master's degree but am interested in continuing education in infant, child and
women's nutrition; also in business aspects including accounting, grant writing, and
dealing with Unions; and marketing skills since we are constantly 'selling' the WIC
program describing how it helps out and is not a welfare program.
•
Until we expand the bed capacity of our hospital I don't foresee a need for more
dietitians. In the event expansion occurs outside of the hospital there might be a need
for one fte.
Key Interviews
Responses to the interview questions are listed in Appendix H. Common themes are
summarized here.
There are broad nutrition education needs among Alaskans that deal with recognizing the
importance of good nutrition, obesity, chronic disease, diabetes and inadequate fitness.
Early diet counseling to control blood sugar and high blood pressure at comparatively low
cost, can delay later high-cost treatment for patients with end-stage renal disease.
Education should begin in elementary school. All university students should be offered a
course in nutrition. Skills aimed at community-wide guidance in making healthy choices,
as well as providing medical nutrition therapy are needed. The role of schools in
improving nutritional status is significant with school health policies being mandated.
There is general interest in nutrition from the citizenry and nutrition courses that are
offered around the state are filled quickly. Respondents recognize that these needs will
require multifaceted solutions and new approaches in schools, public health and the
environment to change current trends.
Integrating the different levels of skilled workers was identified as important. Have more
trained paraprofessionals in the villages/communities working together with professionals;
a ratio of 50:3 at least was suggested. Local nutrition workers could be CWAs, CPAs or
school food service workers. Additional professional/academic personnel are needed to
provide coordination, supervision and training for paraprofessionals with an increase in
the paraprofessional workforce. Registered dietitians will have increased demands as more
complex medical nutrition therapy is needed e.g. patients needing total parenteral
nutrition, and medical nutrition therapy with gastric by-pass surgery or renal dialysis.
When describing training needs, several interviewees mentioned career ladders in school
food service, for managers and for dietitians. Also, integrating nutrition into other
programs such as health promotion, nursing, health sciences and teaching was mentioned
and the idea of a minor in nutrition was supported. Continuing education needs were
17
mentioned by many. Losing potential employees because they must go Outside for
training was mentioned by several.
Future trends that will impact the needs for people trained in nutrition include: increases in
the population, in the average age, in the numbers of providers retiring, in the chronic
disease rates including diabetes and kidney disease, and in obesity. New federal
regulations require health policies in schools; school lunch menu evaluations based on
nutrient composition rather than on food groups; teacher training; and increased rigor in
ADEC standards for food sanitation and safety. Funding may decrease from some sources
(bloc grants, diabetes) but may increase from others (research grants).
Recruiting dietitians is a challenge in rural Alaska but also in Anchorage. One staffing
ratio calls for one nutritionist or dietitian for every 3-4 primary care providers, and the
need is growing with in-migration to Anchorage from rural Alaska. Students frequently
work where they train, so offer training in accessible locations to help recruitment.
Solutions offered to meet societal needs included: a systems approach that works with
food suppliers; do more partnering; link health efforts with the schools, the school lunch
person could be the nutrition focus in the village.
Solutions to the training needs start with being flexible in the course-work e.g. for the
four-year program, once basic core courses are met, emphasizing either skills and
knowledge to effect behavior change, or to provide medical nutrition therapy, or to
manage large foods systems. There is also the need to offer courses to meet eligibility for
dietetic internships. Various modes of delivery were proposed, many included distance
delivery. Describe how teams of paraprofessionals and professionals work together.
Recognize the student’s needs- the young student seeking a career path and the continuing
education student seeking to increase immediate skills. Use existing distance programs as
models.
Interviewees supported the need for a four year academic nutrition degree in Alaska by 15
to 1 with 4 people who said they don’t know. The four who didn’t know would be
influenced by whether or not this survey demonstrates a need.
Factors that need to be addressed to make a nutrition degree feasible include: public
interest, numbers of students, numbers of jobs, mechanics of offering distance learning,
administrative support for students and for implementing programs once people are
trained and employed, good planning, sufficient faculty, program promotion and student
recruitment, funds, physical space and acknowledgment of Alaskan issues (foods, culture,
environment).
Discussion
Despite coinciding with the end of the school year and the legislative session, survey
response rates met the 70% goal for two of three targeted groups. Based on this
assessment there are four major needs in post-secondary nutrition education.
18
1. Training for registered dietitians. A baccalaureate degree plus 6 months of supervised
practice (internship), is considered as the training level required for entry-level
practitioners and for those seeking an academic track career according to the Commission
on Accreditation for Dietetics Education (Skipper and Lewis, 2005). Alaska lacks the
bachelor’s level training.
2. Training for cooks and bakers. Several programs exist in Alaska but respondents ranked
this training need as second in importance. The large number of employees and high turnover rates contribute to this need.
3. Training for paraprofessionals. To increase the number of trained workers in all
communities, training programs for CWAs, WIC Competent Professional Authorities and
school cooks are needed to complete nutrition teams. Training may need to be offered at
additional sites.
4. Training for other professions. Courses in nutrition are needed by nurses, teachers,
community wellness providers, restaurant managers, health science and allied health
graduates. Offering a nutrition course for all university graduates has merit on the basis of
improving the knowledge level and health of Alaskans.
An undergraduate degree program in nutrition would be the training foundation for
dietitians, nutrition educators (4 year degree), public health nutritionists, extension home
economists, researchers and university faculty. There were 170 positions and 18 vacancies
reported in the survey that require a bachelor’s degree as a minimum.
The need for career ladders was mentioned by many respondents. However, caution is
advised when assuming that certificate-level training can be the prerequisite to a
bachelor’s degree. At least one person pointed out that such an expectation has to be
identified by students and faculty at the outset and the training rigor built into the program
that will meet academic and professional standards
Although survey respondents and key informants described nutrition education needs
among all occupations listed, some respondents said additional training was not needed.
The few key informants expressing reservations about the need for a four-year degree in
nutrition questioned if the numbers of potential students could sustain an ongoing degree
program.
The need for training many students in basic nutrition and the need to train fewer students
more in depth can be balanced and complementary. One solution could be offering a
variety of basic nutrition courses or sections to meet the needs of community interest,
entry level training, and other disciplines (considered service courses to other disciplines).
This would sustain a program that trains bachelor’s level students where enrollment would
be lower.
19
Conclusion
What factors drive the decisions about providing nutrition-related training? Several
questions can be posed and answered. First, how does this program help the people of
Alaska?
The well-being of Alaskans will be positively impacted. Obesity is a driving factor.
Obesity contributes to diabetes. Diabetes contributes to end stage renal disease. The
numbers of all are increasing. Medical care is costly. A workforce with knowledge and
expertise is a vital part of solving these complex societal problems. Determining more
successful intervention strategies through research is also part of the solution. Training
local residents who are already knowledgeable about Alaskan cultures will improve the
services provided to the diverse residents of the state. The need for nutrition training at the
certificate level is broad – many students. However, needs exist at each level, the
baccalaureate, masters and doctorate. Each level reinforces the other in creating nutritional
change in our communities. Establishment of additional training in nutrition by the
University of Alaska is justifiable on the basis of the overall needs of Alaskans for
improved nutritional status.
Is there a demand for the jobs? What are the needs of the workforce? This assessment
enumerates jobs in thirteen nutrition-related occupations. Vacancies exist in eight of these
occupations. Some occupations experience high turnover rates (cooks and bakers). Some
are considered “hard to fill” (dietitians). Based on major trends and survey responses, the
needed number of workers will increase in the next 5-10 years.
This assessment has shown the number of positions in various nutrition-related
occupations and the forecasts for additional needs. The greatest number of positions is
among cooks & bakers; the greatest need for additional training is for registered dietitians.
The most glaring void is at the baccalaureate level. Increased attention is also needed for
nutrition training at the certificate/associate level for cooks and community workers.
How does offering nutrition training in-state impact careers of Alaskans? Students can
obtain training in a familiar environment, closer to their families and support structure.
The cost to the student is less than out-of-state training. Students will have increased job
opportunities and a wider range of degree/certificate offerings. Higher paying positions
are available once credentials are earned.
Do we have to rely on importing skilled workers? For dietitian positions, we have relied
on this technique in the past. It has resulted in recruitment challenges, steep learning
curves for newly hired employees from outside of Alaska, and turnover rates that are
counter-productive. We need opportunities for Alaskans to obtain quality training to fill
the positions opening today and those in the future.
What happens if we don’t develop in-state training? We will be under-prepared for today’s
needs as well as the coming needs. We will continue to recruit from out-of-state or we will
do without trained individuals whose skills will be vital for the future needs of Alaskans.
20
References
Alaska Center for Rural Health. Alaska’s Allied Health Workforce: A Statewide
Assessment. University of Alaska Anchorage, Anchorage, AK, 2001.
Alaska Department of Health and Social Services. 2004 Behavioral Risk Factor
Surveillance System http://www.epi.hss.state.ak.us/hp/brfss/risks/obesity.htm accessed
May, 2005.
Alaska Department of Health and Social Services. Healthy Alaskans 2010. Volume 1:
Targets for Improved Health. Data and Evaluation Unit, Juneau, AK, April 2002.
Alaska Department of Health and Social Services. Eat Smart Alaska! Nutrition-Related
Chronic Disease in Alaska 1997 Needs Assessment, Anchorage, AK, 1997.
Alaska Department of Labor, Research & Analysis Section. Industry Staffing Patterns—
Core Healthcare: Hospitals, Outpatient, Physician & Dentist Offices and Healthcare and
Social Assistance Residual, Prepared for the AWIB Healthcare Industry Workforce
Readiness Meeting, February 2005. Juneau, AK.
American Dietetic Association. 2002 Dietetics Compensation & Benefits Survey,
American Dietetic Association, Chicago, IL, 2003.
Commission on Accreditation for Dietetics Education. American Dietetic Association,
Chicago, IL; http://www.eatright.org accessed June 23, 2005.
Skipper A, Lewis NM. A Look at the Educational Preparation of the Health-Diagnosing
and Treating Professions: Do Dietitians Measure Up? J. Am Diet Assoc. 2005;105:420427.
US Department of Health and Human Services Centers for Medicare & Medicaid
Services. Medicare & You 2005. Publication No. CMS-10050, Baltimore, MD, September
2004.
US Department of Labor http://data.bls.gov accessed April 9, 2005.
University of Alaska Anchorage. http://www.uaa.alaska.edu/prospective/tuition.cfm
accessed June 21, 2005.
University of Alaska. Health Research in Alaska: A report in Response to SJR 44,
Fairbanks, AK, August 2004.
21
List of Tables
Table 1 Survey Response to Alaska Nutrition Education Needs Assessment by
Organization
Tables 2 Employment and Projected Needs
2a Employment and Projected Needs: Food-Related Track
2b Employment and Projected Needs: Nutrition/Dietetic Track
2c Employment and Projected Needs: Academic Track
Table 3 Need for Additional Training by Occupation Rated
Table 4 Personal Interest in Further Training
Table 5 Number who Counsel High School Students to Consider Careers in Food or
Nutrition/Dietetics
Table 6 Importance of Barriers to Alaska-based Nutrition Training
List of Figures
Figure 1. Which of the following best describes you?
Figure 2. Which of the following best describes your organization?
List of Appendices
A. Prevalence of Obesity and Overweight among Alaskans, 2003
B. Nutrition-Related Career Opportunities for Graduates by Level of Training
C. Post-Secondary Nutrition Education Offerings in Alaska
D. Survey Form
E. Cover Letter
F. Interview Form
G. Key Informant List
H. Interview Responses from Key Informants, Post-Secondary Nutrition Education Needs
Assessment and Feasibility Project
22
TABLES
TABLE 1
Survey Response to Alaska Nutrition Education Needs
Assessment by Organization
Organizational List
Alaska Dietetic Association
Alaska State Hospital &
Nursing Home Association
Alaska Native Health
Corporations
National School Lunch
Program Contacts
Alaska Dietary Managers
Association
Cooperative Extension Home
Economists
Researchers
School Districts
High Schools
Larger High Schools
Senior Meals Programs
Take Heart Alaska Coalition
organizational members
WIC Program Directors
Pioneer Homes
Total Number of Recipients
Number of
Recipients*
117
Number of
Responses*
50
Response
Rate (%)
43
31
23
74
23
16
70
71
27
38
26
9
35
7
16
54
302
22
32
5
11
23
27
14
13
71
69
43
9
64
41
61
20
5
787
22
11
5
36
55
100
*Some people appear on more than one list.
23
TABLE 2a
Employment and Projected Needs:
Food-Related Track
Cooks & Bakers
(1600 hr training)
vacant positions
turnover rate
(persons/year)
Dietary
Managers,
Certified (2 yr
degree)
vacant positions
turnover rate
(persons/year)
Hospitality and
Restaurant
Managers (4 yr
degree)
vacant positions
turnover rate
(persons/year)
Number
Currently
employed
Number of
Organizational
Units
Responding
380
24
68
9
129
29
48
1
27
1
6
6
8
0
7
0
0
0
Total
Number
projected
next 5
years
Number of
Organizational
Units
Responding
Total
Number
projected
next 10
years
Number of
Organizational
Units
Responding
304
56
306
50
55
30
55
21
7
6
7
4
24
TABLE 2b
Employment and Projected Needs:
Nutrition/Dietetic Track
Number of
Organizational
Number
currently Units
employed Responding
Total
projected
staff in the
next 5
years
Number of
Organizational
Units
Responding
Total
projected
staff in the
next 10
years
Number of
Organizational
Units
Responding
Community Wellness
Advocates (CWA 1 yr
certificate)
vacant positions
turnover rate (persons/year)
13
0
0
6
0
0
31
11
24
5
WIC Competent
Professional Authorities
(CPA 18 months ojt)
vacant positions
turnover rate
35
4
7
16
1
5
47
14
73
10
Dietary Technicians,
Registered ( AA degree)
vacant positions
turnover rate
6
1
0
6
1
0
10
7
14
7
Nutrition Educators (4 yr
degree)
vacant positions
turnover rate
23
4
2
11
3
2
26
13
23
9
Dietitians, Registered (4 yr
degree + internship)
vacant positions
turnover rate
104
8
19
48
7
9
111
45
111
34
Cooperative Extension
Agents (Master's degree)
vacant positions
turnover rate
8
3
1
2
1
1
2
1
4
1
Public Health Nutritionists
(Master's degree + internship)
vacant positions
turnover rate
12
0
0
6
0
0
9
8
26
8
25
TABLE 2c
Employment and Projected Needs:
Academic Track
Nutrition
Researchers
(Master's
degree)
vacant
positions
turnover rate
(persons/year)
Nutrition
Researchers
(Doctoral
degree)
vacant
positions
turnover rate
(persons/year)
University
Faculty
(Doctoral
degree)
vacant
positions
turnover rate
(persons/year)
Number
Currently
employed
Number of
Organizational
Units
Responding
Total
projected
staff in
the next
5 years
Number of
Organizational
Units
Responding
Total
projected
staff in
the next
10 years
Number of
Organizational
Units
Responding
5
4
15
5
4
3
0
0
0
0
9
6
14
7
3
2
0
0
0
0
9
6
15
5
13
3
3
4
2
1
26
TABLE 3
Need for Additional Training by Occupation Rated
Dietitians Registered 4 yr degree* + internship
Cooks & Bakers 1600 hr training
Nutrition Educators 4 yr degree*
Public Health Nutritionists Master's degree* +
internship
Dietary Managers Certified 2 yr degree
Community Wellness Advocates (CWA) 1 yr
certificate
WIC Competent Professional Authorities (CPA)
18 months on the job training
Dietary Technicians Registered AA degree*
Nutrition Researchers Master's degree*
Cooperative Extension Agents Master's degree*
Hospitality and Restaurant Managers 4 yr degree
University Faculty Doctoral degree*
Nutrition Researchers Doctoral degree*
Not
needed
N
reporting
20
20
28
Needed
N
reporting
50
64
47
Highly
needed
N
reporting
45
25
31
Response
Average**
29
26
44
49
27
20
1.98
1.94
31
39
24
1.93
31
30
40
38
35
40
46
48
44
35
31
34
33
25
22
11
18
14
11
13
16
1.91
1.78
1.76
1.71
1.7
1.69
1.66
Total Respondents
149
(skipped this question)
14
* No in-state training exists.
** Based on 1=not needed, 2=needed, 3=highly needed
2.22
2.05
2.03
27
TABLE 4
Personal Interest in further Training
"Are you interested in taking further training? Check all that apply."
Cooks & Bakers 1600 hr training
Dietary Managers Certified 2 yr degree
Dietitians Registered 4 yr degree* + internship
Community Wellness Advocates (CWA) 1 yr certificate
Dietary Technicians Registered AA degree*
Nutrition Researchers Doctoral degree*
Public Health Nutritionists Master's degree* + internship
University Faculty Doctoral degree*
Nutrition Educators 4 yr degree*
WIC Competent Professional Authorities (CPA) 18
months on the job training
Nutrition Researchers Master's degree*
Hospitality and Restaurant Managers 4 yr degree
Cooperative Extension Agents Master's degree*
Total Respondents
(skipped this question)
Yes
(N)
35
17
17
16
16
17
15
13
12
11
11
6
4
132
31
Percent
interested by
occupation
Response (N)
(%)
101
35
80
21
82
21
80
20
80
20
87
20
84
18
82
16
77
16
77
80
76
75
14
14
8
5
28
TABLE 5
Number who Counsel High School Students to Consider Careers in Food
or Nutrition/Dietetics
Number of
students
counseled
0
1 to 5
6 to 10
11 to 15
16-20
21-25
more than 25
Total
Respondents
(skipped this
question)
How many
students do you
encourage to
consider a
career in food
service?
How many
students do you
encourage to
consider a career
in nutrition or
dietetics each
year?
How many of those
you counsel pursue
such training?
Number of
counselors
reporting
9
20
3
6
1
1
13
Number of
counselors
reporting
13
26
4
2
1
0
9
Number of
counselors reporting
20
28
3
0
2
0
3
53
55
56
111
109
108
29
TABLE 6
Importance of Barriers to Alaska-based Nutrition Training
Lack of program
Not important
3% (5)
Important
37% (55)
Very
important
59% (88)
Student interest
6% (8)
62% (87)
33% (47)
142
Leaving home community
for training
9% (13)
44% (67)
47% (72)
152
Cost
5% (8)
45% (68)
50% (75)
151
Other
32% (9)
29% (8)
39% (11)
Total Respondents
(skipped this question)
Respondent Total
148
28
153
11
30
FIGURES
FIGURE 1
Which of the following best describes you?
Response
Percent
39%
6%
16%
3%
Administrator
Dietary Manager
Dietitian
Educator, K-12
Educator, health
field
Nutritionist
Student
University faculty
Other *
Response
Total
64
10
27
5
4%
2%
1%
5%
23%
Total Respondents
(skipped this question)
7
4
1
8
38
164
0
* Other includes food service supervisors or managers, lunch lady (8); researchers (6), nurses (3),
high school career resource advisors (2), and administrative assistants (2)
FIGURE 2
Which of the following best describes your organization?
Childcare, family or
senior services
Government Agency
Health Department
Hospital
Health Department &
Hospital
Nursing Home
School District
Private Industry
University
Research
Other *
Response
Percent
Response
Total
6%
5%
6%
15%
9
8
9
24
3%
3%
24%
1%
9%
1%
29%
Total Respondents
(skipped this question)
5
5
38
2
14
1
46
161
2
*Other included respondents with tribal organizations (10), elder care or senior meals
programs (6), WIC (4), and private industry (4).
31
APPENDICES
APPENDIX A
Prevalence of Obesity and Overweight among Alaskans
Behavioral Risk Factor Surveillance System, Alaska Department of Health and Social
Services
Obesity increases the risk for heart disease, diabetes and for certain types of cancer.
Definition for this survey: Respondents with Body Mass Index >= 25.0 and < 30.0
Overweight (2004)
Alaska Population Weighted
95% Confidence
Sample Size
(18+)
Prevalence
Interval
Male
46%
42.0 - 50.3
1,209
Female
31%
27.2 - 34.3
1,326
Native*
43%
36.6 - 48.7
570
Non-Native
38%
34.9 - 41.1
1,949
Total
39%
36.1 - 41.7
2,535
* Native was defined as those respondents who said they were Alaska Native alone or in
combination with other races.
Definition for this survey: Respondents with Body Mass Index >= 30.0 and <= 99.8
Obesity (2004)
Alaska Population Weighted
95% Confidence
Sample Size
(18+)
Prevalence
Interval
Male
22%
18.9 - 25.6
1,209
Female
25%
22.4 - 28.8
1,326
Native*
25%
20.8 - 30.2
570
Non-Native
24%
21.0 - 26.3
1,949
Total
24%
21.4 - 26.1
2,535
* Native was defined as those respondents who said they were Alaska Native alone or in
combination with other races.
32
APPENDIX B
Nutrition-Related Career Opportunities For Graduates by Level of Training
Program / Training Level
Non-degree Programs
Career Opportunities
Professional Cooking & Baking
Program: 1470 hours plus a 200
hour externship
Graduates can become cooks and bakers for the hospitality
industry; Move on to the UAA Culinary Arts Associate's or
Bachelor's Degree.
Community Wellness Advocate
(CWA). Option of receiving a
certificate upon completion of the
30-credit university's year-long
basic health-promotion training
program.
CWA is a lay health educator who works in health promotion at
health fairs, healthy food demonstrations, physical activity
programs, school health presentations, exercise classes, health
screenings, and develops community profiles.
WIC Competent Professional
Authority; 18 months on-the-job
training
CPA is employed by WIC Clinics (Women Infants and Children
Special Supplemental Food Program). Graduates provide WIC
services for clients including record keeping, basic nutrition
education, community referrals, breast-feeding promotion, vendor
monitoring, and referral of high-risk clients to a dietitian.
Two year Certificates
Certified Dietary Managers
complete High School Degree and
19 credits or 2-4 semesters of
schooling + national exam, or
Associate's Degree in Culinary Arts.
Training varies.
Dietetic Technicians complete at
least a two year associate's degree
and at least 450 hours of
supervised practice. A national
exam exists.
Bachelor’s Degrees
BS in Hospitality and Restaurant
Management
BS in Dietetics, foods and nutrition
or related degree, such as food
science, food service management
or clinical nutrition or relevant
nutrition/health field
Dietary managers work in institutions and other food service
settings and direct the food production operations.
The majority of Dietetic Technicians, Registered (DTRs) work with
Registered Dietitians (RDs) in a variety of health care settings
assisting RDs in providing medical nutrition therapy in hospitals,
HMOs, clinics or other facilities. DTRs conduct nutrition
screening, routine nutrition assessment, provide individualized or
group nutrition education and monitor food served to patients. In
addition, DTRs can work in community and public health settings
such as school or day care centers, correctional facilities, weight
management clinics and WIC programs as nutrition counselors.
Approximately 26% hold a bachelor’s degree or higher.
Graduates work in the hospitality and restaurant industry and in
institutions where food is served.
Graduates may work in positions providing nutrition counseling
and education, such as in a health department with the WIC
program, as nutritionists or dietetic technicians counseling lowrisk children, at gyms, employee wellness programs, as health
educators not clinically based but community based.
33
Nutrition Related Career Opportunities, cont.
Program
Dietetic Internship. After bachelor's
degree, minimum 900 hour
supervised practice program for
individuals whose educational
background meets the American
Dietetic Association's requirements.
A national exam exists to become a
registered dietitian. Dietitians are
licensed by the State of Alaska.
Master’s Degree in family and
consumer sciences, public health,
foods and nutrition, nutrition
science, food science, food
management or related area.
Candidates with acceptable work
experience and academic
preparation (master's degree or
doctorate with a major in human
nutrition, public health nutrition,
clinical nutrition, nutrition education,
community nutrition, or food and
nutrition) can be licensed by the
State of Alaska.
The majority of RDs works in the treatment and prevention of
disease administering medical nutrition therapy, and are often
part of medical teams in hospitals, HMOs, private practice or
other health-care facilities. Depending on job descriptions, they
provide nutritional services for individuals such as developing and
implementing enteral or parenteral nutrition plans, counseling outpatients, families and groups, addressing the special needs of
pediatric, renal and dialysis patients. RDs plan regular and
therapeutic diets, oversee food service staff, supervise the
preparation and service of nutritionally adequate meals for jail
inmates, hospital patients and others in institutional settings. RDs
work in community and public health settings and academia and
research. A growing number of RDs work in the food and nutrition
industry, in business, journalism, sports nutrition, and corporate
wellness programs.
Graduates plan, develop and implement nutrition and healthrelated programs through Cooperative Extension Service or
health departments. Public Health Nutritionists assess community
nutrition needs, develop and implement community events and
programs, plan and deliver in-service training and education for
public health personnel, provide nutrition services and medical
nutrition therapy to individuals and groups, design or oversee
research on products, recipes, nutrient labeling, and
epidemiological issues. Directors of Nutrition Departments play a
lead role in developing and executing the nutritional strategy of
companies/organizations, serve as a resource on nutrition issues,
plan and monitor financial aspects of nutrition programs and
services, and direct dietetic internships or didactic programs. 45%
of RDs hold master’s degrees that increase the depth of their
practice.
34
Nutrition-Related Career Opportunities, cont.
Program
Doctoral Degree in
nutrition/dietetics or related field.
Candidates with acceptable work
experience and academic
preparation (master's degree or
doctorate with a major in human
nutrition, public health nutrition,
clinical nutrition, nutrition education,
community nutrition, or food and
nutrition) can be licensed by the
State of Alaska.
Doctoral degree is preferred for Directors of Nutrition
Departments. Graduates play a lead role in developing and
executing the nutritional strategy of companies/organizations,
serve as the resource on nutrition issues, plan and monitor
financial aspects of nutrition programs and services. Graduates
teach undergraduate and graduate courses, plan, conduct and
secure funding for research, provide community service, chair
Nutrition and Food Science Departments, serve as deans of
colleges providing leadership in developing and evaluating
academic curricula, activities and programs. Three percent of
RDs hold doctoral degrees and the majority work in academia.
Special Training Program in Food
Science and Nutrition, UAF (nondegree, additional credits)
Job openings exist for people trained as food technologists.
35
APPENDIX C
Post-Secondary Nutrition Education Offerings in Alaska
Existing Programs
Alaskan Sponsoring Agent
UA Anchorage, UA Fairbanks
Non-degree Programs
WIC Competent Professional Authority, non-accredited
certificate
Professional Cooking & Baking Program
One year certificate
Community Wellness Advocate (CWA)
Two year certificate
Dietary Manager, Certified
Associate Degree Culinary Arts
Alaska WIC Program through UAA
Alaska Vocational Technical Center,
Seward
UA Southeast in partnership with
Seatheast Alaska Regional Health
Consortium
UAA - closing May 2006.
UAA , Tanana Valley Community College
None
Dietary Technicians, Associate Degree
Bachelor’s Degree in
UAA
Hospitality and Restaurant Management
None
Dietetics, foods and nutrition or related field
Dietetic Internship
University of Alaska Anchorage
Dietetic Internship: 1100 hours of supervised-practice
program for individuals whose educational background
(bachelor's degree minimum) meets the American Dietetic
Association's requirements.
None
Master’s Degree
None
Doctoral Degree
Special Program : Food Science and Nutrition, (12-15 UAF School of Fisheries and Ocean
credits provides students in natural science, engineering, Sciences and School of Natural Resources
and Agriculutral Sciences
northern agriculture or management with emphasis area
in food science and nutrition)
36
APPENDIX D
Survey Form
Post-High School Nutrition Education Needs Assessment Exit this survey >>
1. Nutrition Education Needs Assessment
Welcome!
The results of this survey will be used by the University of Alaska to develop nutrition
training following high school. Your responses will help identify Alaska's current
needs.
Thank you for your time and thoughtful answers!
* 1. Name of Organization
2. Location
3. Zip code
4. Your name
37
5. Your title
6. Which of the following best describes you?
Administrator
Dietary Manager
Dietitian
Educator, K-12
Educator, health field
Nutritionist
Human Resources recruiter
Student
University faculty
Other (please specify)
7. Which of the following best describes your organization?
Childcare, family or senior services
Government Agency
Health Department
Hospital
Health Department & Hospital
38
Nursing Home
School District
Private Industry
University
Research
Other (please specify)
8. Is your organization an Alaska Native organization?
yes
no
9. List the current number of personnel in each of the following occupations in your organization. (If
you do not have employees, go to question 11.)
Currently
employed
Cooks & Bakers (1600 hr training)
Dietary Managers, Certified (2 yr degree)
Hospitality and Restaurant Managers (4 yr degree)
Community Wellness Advocates (CWA 1 yr certificate)
WIC Competent Professional Authorities (CPA 18 months ojt)
Dietary Technicians, Registered ( AA degree)
Nutrition Educators (4 yr degree)
Dietitians, Registered (4 yr degree + internship)
Cooperative Extension Agents (Master's degree)
Public Health Nutritionists (Master's degree + internship)
Nutrition Researchers (Master's degree)
Nutrition Researchers (Doctoral degree)
vacant positions
turnover rate
(persons/year)
39
University Faculty (Doctoral degree)
10. Project your organization's future personnel needs for each of the following
occupations.
Total projected Total number of
staff in the next staff in the next
5 years
10 years
Cooks & Bakers (1600 hr training)
Dietary Managers, Certified (2 yr degree)
Hospitality and Restaurant Managers (4 yr degree)
Community Wellness Advocates (CWA 1 yr certificate)
WIC Competent Professional Authorities (CPA 18 months ojt)
Dietary Technicians, Registered ( AA degree)
Nutrition Educators (4 yr degree)
Dietitians, Registered (4 yr degree + internship)
Cooperative Extension Agents (Master's degree)
Public Health Nutritionists (Master's degree + internship)
Nutrition Researchers (Master's degree)
Nutrition Researchers (Doctoral degree)
University Faculty (Doctoral degree)
11. Nutrition-related training programs exist in Alaska for some but not all occupations
listed. Existing training opportunities may be insufficient. (* = No in-state training
exists) Rate the need for additional training for each occupation.
Not needed
Cooks & Bakers, 1600 hr training
Dietary Managers, Certified, 2 yr degree
Needed Highly needed
40
Hospitality and Restaurant Managers, 4 yr
degree
Community Wellness Advocates (CWA), 1 yr
certificate
WIC Competent Professional Authorities
(CPA), 18 months on the job training
Dietary Technicians, Registered, AA
degree*
Nutrition Educators, 4 yr degree*
Dietitians, Registered, 4 yr degree* +
internship
Cooperative Extension Agents, Master's
degree*
Public Health Nutritionists, Master's degree*
+ internship
Nutrition Researchers, Master's degree*
Nutrition Researchers, Doctoral degree*
University Faculty, Doctoral degree*
12. Are you interested in taking further training? Check all that apply.
Yes
No
41
Cooks & Bakers, 1600 hr training
Dietary Managers, Certified, 2 yr degree
Hospitality and Restaurant Managers, 4 yr degree
Community Wellness Advocates (CWA), 1 yr
certificate
WIC Competent Professional Authorities (CPA), 18
months on the job training
Dietary Technicians, Registered, AA degree*
Nutrition Educators, 4 yr degree*
Dietitians, Registered, 4 yr degree* + internship
Cooperative Extension Agents, Master's degree*
Public Health Nutritionists, Master's degree* +
internship
Nutrition Researchers, Master's degree*
Nutrition Researchers, Doctoral degree*
University Faculty, Doctoral degree*
13. If you work with high school students, please answer the following questions. (If
not, go to question 17.)
How many students are enrolled in your school?
42
Less than 50
50-99
100-499
500-999
1000-1499
1500-2000
More than 2000
14. How many students do you encourage to consider a career in food service?
0
1-5
6-10
11-15
16-20
21-25
more than 25
15. How many students do you encourage to consider a career in nutrition or
dietetics each year?
0
43
1-5
6-10
11-15
16-20
21-25
more than 25
16. How many of those you counsel pursue such training?
0
1-5
6-10
11-15
16-20
21-25
more than 25
17. Do you predict that student interest in nutrition-related training in the next 3-5
years will increase, decrease or remain the same?
Increase
Decrease
44
Remain the same
18. How important are these barriers to Alaska-based nutrition training?
Not important
Important
Lack of program
Student interest
Leaving home community for
training
Cost
Other
19. If there are other important reasons, please describe them.
20. How can these barriers be addressed?
Very important
45
21. What strengths are there in having training in Alaska?
22. Do you have other comments?
Next >>
Thank you very much!
46
23. If you would like a copy of the final report, please write your
preferred address. The report may be emailed or sent to a postal
address.
<< Prev
Done >>
47
APPENDIX E
Survey Cover Letter
April 25, 2005
Greetings!
Health problems such as obesity and diabetes are increasing in Alaska at an alarming rate.
The need for additional nutrition education in Alaska has been identified (1, 2). The goal
of this survey is to identify the post-secondary nutrition education needs within the state.
Your information will be used by the University of Alaska in developing appropriate
nutrition training. This training will benefit students, potential employees, employers and
the people of Alaska.
Please take a few minutes (about 10 minutes) to complete the survey regarding the
training needs and potential for employment. Your responses will be combined with
those of others, and your name will not be used in any reports without your permission.
If you have any questions about this survey you may contact Betsy Nobmann, at EDN
Nutrition Consulting or:
Contract Administrator
Timothy Doebler, Director, University of Alaska Anchorage Culinary Arts &
Hospitality, Dietetics & Nutrition
(907) 786-4728 or by email: [email protected].
Please complete your survey online by clicking on the following address:
https://www.surveymonkey.com/s.asp?u=715451031880
If you need a hard copy, request it from Betsy at [email protected] and return
your survey to fax number (907) 333-4963, or by mail. Please respond by Friday May 13.
Thank you very much for your time and insights! Ultimately your feedback will help to
address the pressing nutrition-related health concerns of Alaskans.
Sincerely,
Betsy Nobmann
Elizabeth D. Nobmann, PhD, MPH, RD,
Licensed Nutritionist
and Project Consultant for
Nutrition Education Advisory Committee
Richard Mandsager, MD
Director of Public Health
Alaska Department of Health
Social Services
48
APPENDIX F
Interview Form
Post-Secondary Nutrition Education Needs Assessment and Feasibility Project
Interview questions
Hello______ My name is Betsy Nobmann. I am conducting a survey for the University of Alaska about the
post-secondary (after high school) nutrition education needs in Alaska. You may have seen a request to
complete an online survey. You have been recommended as a key leader by my advisory committee. I would
like your opinions regarding the nutrition education needs of our statewide population. I would also like
your opinions on the feasibility of an academic degree (4 yr or greater) in nutrition for Alaska. Is this a
convenient time? If not, when would be convenient? It may take about 10 minutes, depending on your
answers.
Name__________________________
Title_____________________________
Organization_________________________ Phone _______________________
1. What do you believe are the nutrition education needs in Alaska at the post-secondary
(after high school) level?
2. How might these needs change in the next 5-10 years?
3. How can we best address these needs given the large geographic distance and the
relatively small population?
4. Does there need to be an academic degree in nutrition in Alaska? (That is, a four year
degree?) Yes______ No___________
5. What factors need to be addressed to make an academic degree in nutrition feasible?
Thank you!
May I use your name as a key contact in the final report? Yes _____ No______
Would you like a copy of the final report? Yes _____ No______
If yes, give preferred mailing address: ________________________
_______________________
________________________
Or, email address: ______________________
Again thank you for your input!
49
APPENDIX G
Key Informant List
Name
Teresa
Altenburg
Title
Organization
Community Outreach Coordinator Alaska Area Diabetes Program, ANMC
Jayne
Andreen
Manager Health Promotion
Brian
Nancy
Barnes*
Barros*
Director
Project Coordinator
Todd
Brocious
Education Specialist
Bill
Tammy
Denkinger
Green
Superintendent
Director
Jan
Harris
Senior Health Systems Analyst
Section of Epidemiology, Alaska Department of
Health & Social Services
Institute for Arctic Biology, Fairbanks
Office of the Commissioner, Health Planning &
Systems Development, State of Alaska
Alaska Department of Education & Early
Childhood
Mt. Edgecumbe Schools
Division of Allied Health Sciences, University of
Alaska Anchorage
School of Nursing, University of Alaska
Anchorage
Alaska Renal Care Group, Anchorage
M. Alison Hull
Dietitian
Brynn
Keith*
Economist
Joseph
Bret
Klejka, MD
Luick
Dick
Gerald
Dennis
Mandsager,
MD
Mohat*
Murray
Julien
Patty
Naylor, MD
Owen
Karen
Ruth
Purdue*
Vice President for Health
Riley-Elvsaas Program Director
University of Alaska
Food Bank of Alaska
Cindy
Salmon*
Consulting Dietitian
Karen
Schmitt
Dean
Robert
Sewell
Kathy
Kathleen
Walker
Wayne
Health Sciences Coordinator
Staff members
Nutrition Services Supervisor
Health Program Manager
Carol
White
Jammin' Salmons' Physical & Nutritional
Therapies
Career Education, Business, University of
Alaska Southeast
University of Alaska Southeast
Southcentral Foundation
Mat-Su School District Nutrition Program
WIC Alaska Department of Health & Social
Services
Alaska Department of Health & Social Services
Alaska Department of Labor & Workforce
Development
Corporate Medical Director
Yukon Kuskokwim Health Corporation
Nutrition Specialist, Associate
Cooperative Extension, University of Alaska
Professor
Fairbanks
Director
Division of Public Health, Alaska Department of
Health & Social Services
Director
Center for Alaska Native Health Research
Administrator
Heritage Place, Extended Care Facility,
Soldotna
Director
Alaska Area Diabetes Program, ANMC
Health Program Manager, Youth Epidemiology Section, Div. of Public Health,
Risk Behavior Survey Coordinator ADHSS
Cardiovascular Health Program
Manager
Ann
Willert
Recruitment Manager
*Interviewed without interview form.
Yukon Kuskokwim Health Corporation
50
APPENDIX H Interview Responses from Key Informants
Post-Secondary Nutrition Education Needs Assessment and Feasibility Project
1. What do you believe are the nutrition education needs in Alaska at the post-secondary
(after high school) level?
General needs
•
Inadequate fitness, overweight, chronic disease
•
An adequate work force is only part of the solution. We don’t know how to change
families and communities.
•
Begin nutrition education in elementary school.
•
We need people looking at normal nutrition (without the need for clinical
knowledge) in a way people hear it and integrate it into their lives. Communicate
effectively with restaurants and groceries and vendors. The environment and
policies of good nutrition have been engineered out of society. Have
knowledgeable people lead us back to status where healthy choices are easy to
make. This mind-shift back needs guidance based on good science. Focus around
public health and work with policy making and supply systems, not necessarily a
clinical emphasis. There is a tremendous need for clinical emphasis but still have a
behavioral change emphasis.
•
Absolutely enthusiastic on something being developed…I’m looking at possible
school reforms on collecting BMI (body mass index used to define overweight and
obesity)… and on state legislation requiring vending machine profits to be
reported.
•
We’re missing nutrition in chronic disease and how to help people.
•
School Health Programs are being promoted based on the CDC School Health
Index. Nutrition is in health education, but Alaska is not funded to do this program.
There is emphasis on No Child Left Behind and one conference/year. It is hard to
get food service persons or nurses into the classroom due to emphasis on academic
strengths. Districts and teachers need to take more responsibility in contrast to
volunteers coming in where quality control is not assured. CWAs could teach but
districts are turning away.
•
According to the 2003 Behavioral Risk Factor Survey (BRFSS), 62% of NonNative Alaskans and 68% of Alaska Natives are overweight or obese.
51
•
Although Alaska is divided into rural and city, there is great need for education in
both settings. It is easier to do in the city- to attend community schools, short
courses; tougher in rural Alaska where the health aide is the trainer. There is more
awareness (more diabetes and heart issues) but there is a long way to go.
Hospitalized patients have problems with foods. There is no way to follow the
Food Guide Pyramid if you can’t buy the foods – either no money or foods such as
fresh fruits, vegetables and meats might not be available in rural Alaska. It’s easier
to buy junk food. People will eat canned foods but these are high in sodium. Even
with food stamps it’s hard to make it. Some elders can no longer hunt and sharing
with elders is gone. ANTHC is trying to come up with a Native Foods Pyramid.
•
People in general need a better understanding of nutrition and special dietary needs
such as those for diabetes, vegetarianism, lactose intolerance and food allergies.
Food service such as school cafeterias should adjust the meals to the student’s or
staff member’s need and advertise what they offer.
•
We need to do outreach to the villages. Stress importance of proper diet. Get
young people hooked on education…importance of getting Alaska Natives to see
importance of nutrition education and pursuing some certification and higher
education in nutrition arena.
•
Chronic disease throughout the country is increasing. The relationship between
obesity and asthma in children is pretty clear. Cardiovascular disease is increasing
around the state. So the need for nutritionists is also increasing.
•
There is a need for nutritionists in the Bush. The perception is not there in some
locations that there is a need. Some Bush positions are difficult to fill…would it be
easier to fill with Alaskans?
•
The population is increasing. The state population is urbanizing and with that
adopting poor living habits.
•
The prevalence of obesity is equal to all other states and not decreasing. The
answer is not meeting with a nutritionist, but looking at the role of the built
environment (how we’ve created our environment) and other things. The epidemic
of obesity and diabetes goes far beyond the clinic. Clinical care is like putting a
finger in a hole in the dam. Issues involving policy, advocacy, and initiatives based
on family and community need to be addressed. Head Start tries to influence kids
but the workers and the parents are overweight. People with high BMIs see
themselves as “not fat “.
•
There is a huge misunderstanding on people’s parts about what is healthy. In 2000,
only 3% of American adults met all four healthy lifestyle characteristics
(nonsmoking, healthy weight, eating 5 fruits and vegetables per day, and regular
physical activity) according to the Behavioral Risk Factor Surveillance System.
(Arch Intern Med 2005; 165:854-857)
52
•
Renal dialysis for one patient costs $18,000/month. This is paid by Medicare,
Medicaid or private insurance (until the patient’s $1 million cap is reached). There
are 350 dialysis patients in Alaska, double the number 10 years ago. Sixty-five
percent of dialysis patients are there as a result of diabetes. Reimbursement for
therapeutic services to dialysis patients is inadequate.
Training needs
•
We are suffering from inadequate training at multiple levels. There is a need for a
continuing education system to keep work force adaptable. Do we have enough
jobs to support the training? Build it into other educational tracks, e.g. elementary
teachers.
•
Students in health sciences need training in nutrition...ambivalent on need for a 4
year program… Could see a career ladder building up from 200 level courses.
•
Have one course in nutritional science as a service course to other curricula. There
is a market for the service course level. UAS is trying to do this.
•
Turnover for professional nutrition jobs in SE is glacial in speed…not a growth
area. Should it be? Yes. Do we need a 4 year degree? Maybe not. Support and
expand MPH but don’t think there’s a need for an MS in nutrition. The issue is
what jobs graduates will do. Don’t think UA should put lots of money into it.
•
BS in Nutrition. Having an itinerating dietitian would be wonderful so that every
kid in every school has contact with a dietitian. This could be a specialty at the
district level similar to the physical education, counselor or extended learning
specialists for gifted and talented children.
•
Yes, there is a need for post-secondary nutrition education. The need for more
nutritionists definitely came up through the Alaska Obesity Summit, 2003. It is
difficult to find Registered Dietitians for state positions such as WIC. During the
Obesity Summit Joanne Ikeda, nationally known education specialist, emphasized
the need for nutrition education at the community level. There is a need to
communicate good messages to the community and to kids on physical activity
and good nutrition.
•
Advocate for medical and advanced health care degrees in Alaska.
•
Alaska is focusing on obesity. Prevention, screening and chronic care management
and counseling are targeted. We need a systems approach to managing chronic
care; primary, secondary, tertiary care and prevention.
53
•
Develop a system for obesity treatment and prevention that identifies uses and
integrates partnerships across all disciplines (i.e. health care, physical fitness,
nutrition, etc.)
•
Certification or associate degree and bachelor’s degree.
•
Federal regulations call for cooks in Child Nutrition Programs to meet certification
but there is no recognition. It is needed from the University. Financial reward and
recognition are needed (although some cooks are highest paid employees in a
school.). The title cook can apply to those in the school nutrition program who are
baking bread from scratch to those who are food handlers who warm up food but
don’t cook it. There is no career ladder in school food service or for managers.
•
WIC requires Competent Professional Authorities to certify WIC recipients. This
can be done by a 4yr degree graduate in nutrition, a nurse, a doctor, or in Alaska, a
paraprofessional in the absence of others. WIC staff members have similar desires
to those working in schools – raise the standard of knowledge base and
acknowledge their progression along the way.
•
The WIC CPA program works well. By training local staff WIC can maintain a
person in the position. Constant turnover is a problem when hiring Outsiders. Even
with turnover local employees, trained staff members, take their knowledge with
them and continue to advocate for WIC. The biggest challenge now is providing
continuing education; 24 hrs/yr are required. A consulting dietitian is still required
to counsel high-risk patients. This is being done by distance also.
•
Need to make career ladders. Help people get higher salary. The CWA training
may be a pre-nutrition track. There is a value judgment in deciding what is more
important a 1yr or a 4 yr. program. Collaboration has improved between
Anchorage and outlying communities.
•
The course “Science of Nutrition” fills every time it’s offered at UAS. It’s also
offered through distance delivery from UAF and onsite in Anchorage. The
Anchorage course enrollment filled within 24 hours during a recent registration.
•
Train RDs and link with the MPH program.
•
I’m not very knowledgeable in this area, my information is anecdotal. There is a
problem with importing nutrition specialists/RDs. The need is acute. It’s an area
needing more practitioners than recognized. A steady flow of graduates would
meet the needs.
•
I don’t know what’s currently available. That a person can’t get to be an RD in
Alaska is a real gap. There are gaps in health education and health promotion and
nutrition is a big piece. Nutrition needs to be integrated into other programs such
as health promotion and nursing.
54
•
Nutrition and health research expertise. People willing to publish more research
papers so everything is not based on American Indians (in contrast to Alaska
Natives). We need research expertise – both masters and doctoral level.
•
Certified Diabetes Educators are trained through on-the-job experience and general
interest.
•
Definitely, formal education is needed.
•
Not real familiar with training needs. But there is a need for more nutritionists and
dietitians in Alaska. We had to recruit Outside. It’s more costly to advertise and we
can’t pay to move people to the state.
•
Dietitians need more information about diet pre- and post-gastric by-pass surgery,
more information about alternative medicine and supplements. More research.
•
On-the-job training. If I’ve hired someone how can I send them away for training?
People aren’t showing up at your desk with training. They need to work while
doing training. It should be distance approach with lots of hands on. I’ve used the
University Of North Dakota for correspondence course which makes sense.
•
Needs are high. We need more training for cooks – currently nothing. Need classes
in safety and sanitation, classes specifically for schools.
•
There is a role for positions in schools and hospitals. I don’t know if there are
careers out in the villages but they are needed. Paraprofessionals are an option but
must be knowledgeable about cardiovascular disease, seal oil and soda pop.
•
Career pathways for adults and kids.
•
UA should offer a 4 year degree at a minimum, especially if you’re trying to train
nutritionists to stay in Alaska. Is there enough exposure in high school for students
to think about it as a career choice?
•
I adamantly promote that nutrition should be taught at every main campus (UAF,
UAS, UAA) and offered to all students at the 100 level. It is a real disservice not to
offer a proper course in nutrition. Young women may become pregnant and need
nutrition information.
•
I see needs at the graduate level. About two people/yr ask about setting up a
doctoral program, but the resources are not there to meet their requests. Supportive
of some kind of graduate degree in nutrition; a master’s degree is more achievable
than a doctorate. I would be happy to teach at UAA/UAF, just need to work out a
way to do it.
55
What demand is there for a minor in nutrition? (not asked of all respondents)
•
Good idea as a build out strategy…far less hassle to establish than a four-year
program. A nutrition course is required for nursing and health science degrees.
When offered in Ketchikan, the nutrition course filled with 19 students. There is
interest from the general citizenry.
•
Supports.
•
Great. School districts and teachers’ training (No Child Left Behind) in the future.
•
We need to get a health promotion program with a minor in nutrition.
•
Continuing education and credentialing are needed. If you have a program, then
keep practitioners up-to-date.
•
It would be nice to have nutrition in the education department so existing teachers
could have health and physical education in the curriculum.
2. How might these needs change in the next 5-10 years?
•
Today’s problems of overweight will remain. Nutritional problems of children,
older adults, men and women will continue.
•
Community members need to have expertise to drive change. Diabetes and
programs to combat it will influence the skills needed.
•
Schools need school health plans, a new requirement of federal funding. Districts
are understaffed but will need to assess the plan, make changes and evaluate the
changes. Changes will need to be repetitive to result in change which will be
gradual. Vending machines in schools is an example of potential change –
decreasing portion sizes dispensed.
•
There is more community recognition of the need for nutrition education and
programs that can make a difference (Tuntutuliak School has a dog team providing
students opportunities for physical activity, responsibility and other learning
experiences.)
•
There is a statewide Chronic Disease Academy originating from the National
Governor’s Association. The Policy Academy is concerned about fiscal impact of
nutrition-related problems, e.g. $1 of every $8 in the Alaska Medicaid budget is
spent on care for patients with diabetes. Among the priorities in Alaska this year
56
are: increase physical fitness, reduce tobacco use, change the norms about body
weight and improve medical care for persons suffering from resulting chronic
diseases.
•
A minor in nutrition and an MPH in nutrition are targets in the coming years.
•
We will evolve into the needs described above (school nutrition education, public
health policy and environmental changes emphasizing behavioral change).
•
A PhD program is a long shot and far fetched in the next 5-10 years.
•
There is a greater emphasis on obesity and health issues. Health care is still
growing.
•
There is concern about prevention… no state financial support. Federal Block
grant funds are being redirected to anthrax vaccine stockpiling, etc. In the past
these funds have supported prevention activities. Small grants of $10,000-50,000
made to CWA graduates to implement programs from the Block Grant are being
discontinued as the Block Grant funding is eroding.
•
Following the process of compacting health care functions, the Native Health
Corporations are recommitting to prevention activities (e.g. SEARHC, Bristol Bay
Health Corporation, Alaska Native Tribal Health Consortium).
•
Looking at integration (The Policy Academy) could support more professionals at
the community level. See potential for hiring CWAs (Community Wellness
Advocates) in the STEPS Project (a coordinated community approach to physical
education, nutrition and smoking funded at SEARHC)
•
There are huge changes ahead. With retirements there is a “Brain drain”. The State
Child Nutrition Program is losing key long-time employees. Schools are losing
food service workers.
•
Both at the national and state level, No Child Left Behind emphasizes reading,
writing and math and doesn’t allow child to be a top performing learner or a
holistic child. That teachers will be more qualified is good.
•
The needs won’t change. We’re now highlighting and understanding our need –
obesity and nutrition are coming to the forefront. We are on the cusp of reform
with policy changes in the next couple of years. Then the need for trained
professionals, public and legislative endorsement will have to come together.
•
Based on the nursing model, students will want to increase their level of training.
Have ladders in place and a strategy to grow positions. The needs will weight the
development budget and where to put the level of training.
57
•
Baby Boomers will influence needs. There will also be a mass exodus from public
health, nutrition, and health education as workforce ages.
•
Need to have basic people prepared. There will be increased needs for masters and
doctoral trained individuals. There needs to be opportunities for advanced level
training here, if people leave for training they may not come back.
•
The need will grow. If industry opens to the skills, clearly the need is going to be
greater – an older population with chronic conditions with a nutrition component.
Finding reliable sources is not always easy in small communities (or in large ones).
•
There is quite a need in school food service. Lots of programs are run by the
school business office and it’s hard to keep up with USDA requirements.
•
Obesity is the big driver that is pushing change. Nutrition policies in classrooms
integrated with child nutrition programs may change. Health teachers are another
driver, but there are fewer now. Maybe private industry, clinics and weight
management programs will have more emphasis on nutrition and physical
education.
•
Given the small population, I vote for community health at the undergraduate level
with physical education and nutrition strength.
•
USDA has mandated as part of the WIC reauthorization that all schools will have a
wellness policy in one year. ADHSS will help build. Ninety percent of Alaskan
schools receive federal funds for school lunch and will be affected by this
mandate.
•
There will only be more need for them (nutrition researchers). There are emerging
and changing health issues. There is a big shift to chronic disease – its nutrition
related. Diabetes is exploding – an emerging problem. Alaska Natives have the
highest rate of increasing prevalence of diabetes in all of North America.
•
The federal budget is in deficit in contrast to the surplus available when major
funding was available to fight diabetes in Indian Country. We probably won’t see
this continue when this funding cycle ends in three years.
•
We always need dietitians in the Bush. One Native Health Corporation is offering
$30,000 signing bonuses to attract qualified dietitians. If you are working in rural
Alaska you’ll be working with diabetes.
•
I hope there will be more outreach to the community and more awareness.
Everyone needs to know.
•
The need for nutritionists will increase. There is a need for more 1-2 yr degreed
people who are more in touch with the public, therefore also 4 year degreed people
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to work together as a team. For every 50 people at the lower level at least 3 people
are needed at the higher level. A certificate and associates degree would be the
greatest need. All are needed. One year, 2 year and 18 month training will produce
the most effect at the village level.
•
As our service population continues to grow, the staffing need will continue to get
worse. More Native people are moving to Anchorage. There are more elderly. We
have a staffing ratio of 1 nutritionist or dietitian for every 3-4 primary care
providers. With increasing numbers of primary care providers, our need will
increase by 2 dietitians/yr. Health Education has 7 full-time dietitians and 3
vacancies. The entire campus has 15 dietitians including the hospital and research.
Future growth may also depend on grants that come in. There will probably be a
couple more in the next 5-10 years.
•
There will be more scrutiny of food service.
•
The needs change and yet they don’t. We’ll need to do more with less, be creative.
•
There will be more need for higher end nourishment – TPN (total parenteral
nutrition) and feeding tubes.
•
The Alaska Department of Environmental Conservation is passing policy requiring
all employees to take food handlers courses. If preparing food from scratch, have
one person in each kitchen knowledgeable about regulations. This would mean
training 13 people for the 29 schools in our district. Companies are offering
different forms of this training but it will be expensive to meet the expected
standard in money and time.
•
We need more people in dietetics with the obesity problems we face, just more
people, and a need for more professional knowledge about healthy eating. By
2008-2009, Federal Regulations will require School Food Service Personnel to do
nutrient analyses on their menus. In another School District where I worked food
service personnel went into the classroom to teach. I taught middle school children
about the harm of anorexia, bulimia and making weight inappropriately for sports
teams.
•
The epidemic of obesity and skyrocketing insurance costs may produce the first
generation in the US that has a shorter life-span than their parents.
•
More Natives are living in Anchorage, more rural people are moving to urban
settings. So people will take training offered in urban settings.
•
The population continues to grow and to age. With age we’ll see more
cardiovascular disease, more diabetes and its effects.
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•
The needs (for attracting young people into education and nutrition) probably
won’t change. Proper diet is ongoing. New people/generations are coming along so
the need will be around forever.
•
Numerous corporations now have nutritionists/dietitians. The number has
increased in the last five years due to specific diabetes grants. During the time of
federal budget surplus, $150 million/year was appropriated to diabetes treatment
and prevention in Indian Country nationwide (Alaska Native Medical Center is
included). Reauthorization determinations will occur in 2008. Deficit federal
budgets, an election year, the level of lobbying, whether funds are compacted
directly to tribes or dispersed through Indian Health Service are all factors that
may influence funding levels. I predict that diabetes funding will continue but it
may be at lesser amounts.
•
Having someone proactively advocating at UA and with professional organizations
will change the needs. Show that people have to go Outside for training. You have
dietetic training and food science programs in place. A four year degree would be a
reasonable step.
•
The number of kidney dialysis patients in Alaska doubled in the last ten years. The
Alaska Renal Care Group currently has four sites (Anchorage, Fairbanks, Juneau
and Mat-Su Valley) and they plan to open another on the Kenai Peninsula.
Otherwise patients are flown in at least quarterly for care. The caseload for each
full-time dietitian has recently been increased from 100 to 130 patients/dietitian,
which is not optimal. A pediatric renal care program is developing with 12 patients
in the wings.
•
The need will grow as the population of the state grows.
•
What are the requirements for positions – is an RD required?
3. How can we best address these needs given the large geographic distance and the
relatively small population?
•
General needs: improve food quality, model cooking and eating behaviors.
•
There is some need for professional people who know how to build skills, but also
non-degree people. Health aides are slowly getting involved at the village level
whereas teachers are short term. Other village based work force people may be
employed in senior centers or schools.
•
Provide incentives to schools to keep school lunch programs good.
•
Raise the recognition of the obesity and diabetes situation with policy makers.
Increase funding to address obesity.
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•
Practitioners in public health don’t need biochemistry to impact people in living
environments. This is a very different challenge.
•
Build on the MPH and interdisciplinary approach. 400 and 600 level courses in
nutrition with staff to teach. Upper division biochemistry with lab classes would be
tricky. For survey course, distance education works well. Web based is an option.
Consider instructors co-located. Three examples: 1. cohorts of UAA students using
video conferencing in Juneau, Ketchikan, or Sitka. 2. the UAA Nursing recruiter
works in Juneau; 3. the BSW social work professor employed at UAF and the
radiology technicians in hospitals use live video conferencing.
•
Determine the type of student – returning or first time; part-time or full time.
Figure how to provide instruction to them where they are. There are models. Parttime students may be seeking career improvement with shorter time-frames in
contrast to students seeking a bachelor’s degree or higher with rigorous science
requirements.
•
Addressing general needs: One problem is small grocery stores statewide. We need
a systems approach, work with suppliers and on the demand side through
education and awareness. Collaborate with unusual partners. Support continuation
of traditions. Take Heart Alaska is a group of 150 people representing 65
organizations working towards better heart-health for Alaskans. In partnership they
support people’s ability to make healthy choices; Community Health Aides know
where the message needs to come from to make a difference.
•
Regarding training: have a 4 year program with the basics and then specialize in
therapeutics, public health policy or industrial emphasis (i.e. restaurants, school
districts, or feeding a large population focus). Have internships with people in
these areas, e.g. food distributors. Redefine who can supervise for the internship to
be a supervisor who may have the vision while the student may have the content.
Place interns with the state obesity program or Eat Smart Alaska.
•
Train with distance learning, with two week intensive courses at a site; two weeks
every quarter is done. Exercise physiology labs are an example.
•
Offer paraprofessional, bachelors and advanced degrees. Build on the
paraprofessionals as the front line in small communities. The University of Alaska
should award bachelors and masters degrees and ideally provide training at the
doctoral level. The CWA is a well developed distance program. Nurse training is
done in communities. ILINK is web-based and audio-conferencing learning.
•
There is nothing inherently unique about training for nutrition. Build on what’s
established. The Child Nutrition Services should be instrumentally involved.
Revitalize the expertise of Child Nutrition Services.
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•
The distance model used in nursing is good. The intensity of clinical training is an
issue. They have had good luck with students at three campuses. Some campuses
are providers, others are distributors of programs. UAS works well with both UAA
and UAF. There are 12 extended sites and Sitka; two sites, and Ketchikan.
Examples of ways to reach out include computer labs, web-based instruction, and
phone connections. Delivery system options included serving at home, at
Anchorage only or at the Juneau campus. All are feasible.
•
Decide where the jobs are and train where you want to employ the students.
Students frequently work where they train. The more programs with access, the
easier it is to fill positions.
•
We need to create the opportunity for continuing education (for WIC) – this has to
be distance delivery – 1 credit nutrition – web-based, simple modules with
PowerPoint presentations- student driven in one location, manageable and simple.
•
Consider partnerships e.g. APU and Boston University. However, there are
constraints around partnerships such as WUE (Western Undergraduate Exchange)
e.g. a certain grade point average to enter.
•
If a bachelor’s degree in nutrition were offered, the MPH would be a next step.
Students would come to Anchorage as the hub. Increase distance education.
•
A fair amount of people are working in something related – to get different or
advanced degrees.
•
There are two groups – young students seeing a career path, and those seeking
general nutrition education to increase skills. The issue of recognizing the rigor of
coursework needed for the former will require good advising and hard work to set
students on the path and not require them to take many extra credits to advance to
the bachelor’s degree.
•
We need to fit the training pieces together. The Medical Technology Bachelors
Degree is a good model. They have articulated different skills for each level of
training.
•
Describe how levels work as a team: paraprofessional people are needed. They
need training, supervision and technical input from the professional team member
(bachelor’s level/RD)
•
Lab courses are the challenge. There are constraints of physical space. There is lab
space for 13 students [in Anchorage].
•
Intense courses aren’t a traditional learning style. Younger students may not have a
problem with this.
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•
There is an issue with reimbursement for nutrition services.
•
I am biased to stretching the envelope to make distance education available. Online
courses can take massive efforts to get them developed or improved. Have faculty
in other locations. Have employers willing to provide mentors.
•
Piecing together money to design distance development may be complicated but
possible.
•
Time and money for faculty to develop and pay designers is needed for all courses.
(Nursing at UAA uses designers and multimedia specialists for 40 courses needing
distance upgrade. Fairbanks relies on faculty to develop courses.) Offer
prerequisites by distance. The process would be available to nutrition courses as
it’s an allied health program.
•
Start growing from the beginning. Offer something at the bachelor’s level, even
with a minor. Anything would be good.
•
The CWA program is starting to meet statewide needs. It uses a combination of
distance (not high tech) audio conferencing and one week-long intensives. This
works as students get to know each other. It’s more personal and is an argument
for students coming together for training.
•
Provide advanced education at UAA. Alaska is right for research- we seem so far
behind.
•
Offer large incentives for people to move here; advertise out-of-state. Have people
move here, not just come to do some work and leave.
•
Cooperative Extension is trying to do nutrition education with nutritionists, a
kitchen and cameras- a college without walls. Public Television is a tool to bring
education.
•
Seward Skill Center is a controlled type of environment for rural students.
Anchorage and Fairbanks are not good options as rural students may not be
prepared academically or emotionally. Math and reading skills may need attention.
Good choices include Sipy Indian College where kids are tested; Ilasavik College
in Barrow; Patrick Anderson, Chugachmiut (computers, skills for tribes);
Extension Service could be a key player; Alaska Honors Program brings students
in for summer through UAF. Taylor training after this model.
•
Generate awareness of nutrition among students at the high school and middle
levels (home economics students).
•
Have students attend three months at a time during a year, in a controlled setting.
Incorporate physical activity.
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•
Utilize and train health aides – they are key person in the bush.
•
Offer short-term courses in changes in dietary standards, how to prepare meals for
special diets. There are huge expectations from the state for skilled nursing homes
and they don’t get a lot of money.
•
I enjoyed taking long distance courses on the internet. All districts have computers
in the schools that could be used even if a student didn’t have a computer at home.
On-site classes could be offered in Anchorage and the Mat-Su Borough.
•
I developed a BS specifically for school food service that emphasized both
business and nutrition and graduated from the program at Viterbo University, La
Crosse, WI.
•
Try to get health career exploration class in High Schools. I would have a class of
25-30 students but I can’t get an instructor – they are all working in their fields.
Many of our graduates announce they will go into the health field. [When asked
how many mention nutrition the response was only 1 in the last 5 years. Asked
why? Because of lack of information about the field among both students and their
parents.]
•
A resource that we’ve (in health care) missed is that we don’t partner enough with
the school districts. Schools are so much a part of the community. So many elders
get lunches at the schools. In Mekoryak one person walks a couple of miles in the
gym each day. Dietitians from YKHC can teach. Every school has someone in the
kitchen who could be a health focus for the community. Despite many federal
regulations with the School Nutrition Programs we could do better. There is too
much dichotomy. We need to be on the same page. The school health program in
the classroom and what schools do should not be disassociated. We need to focus
on one school district and prove that it works.
•
Offer courses through extended campuses, e.g. Kuskokwim. Offer distance
delivery, and audio conferencing. Need to campaign the program. There is no
bachelor’s degree in nutrition. UA needs to develop an associate degree or BS. Do
a mock run to see interest in the schools. There is need for good nutrition or diet
trained people in each of the villages to manage the cafeteria program in the
schools.
•
Address needs as other programs do – telemedicine, long distance learning.
Distance and small population shouldn’t matter. People are prepared to come to
Fairbanks or Anchorage for a four year degree. Students should be willing to come
in for a four year program. Students need to be made aware of the opportunities.
•
Assess how many students go out of state to get a four year program and would
they have stayed if a program were offered in state.
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•
We are missing getting pre-dialysis diet counseling for people which could delay
the development of end-stage renal dialysis. By controlling blood glucose and
blood pressure we can delay dialysis for years.
4. Does there need to be an academic degree in nutrition in Alaska? (That is, a four
year degree?) Yes 15 N o 1 Don’t know 4
•
A yes response qualified by cost and number of students. No doubt we will be
better off if we can afford it. It needs to be a series of steps along the way. With
chronic disease and obesity, I don’t see that we have the work force to meet
today’s needs let alone tomorrows needs.
•
No, Maybe, Not necessarily (from one person and counted as one “don’t know”)…
wait and see what we learn about the market and job potential, and options used to
develop a curriculum. A BS in nutrition is only one option.
•
Yes, Definitely. I’m amazed there wasn’t one.
•
Yes. A tremendous asset….clearly see bonified need for nutrition expertise in the
school setting.
•
Seems to me obviously a good idea. The more the population ages, there will be
more need. It’s an established profession. The food service training can be a
byproduct serving the tourism industry.
•
Don’t know if there’s a demand, therefore don’t need to create a program.
•
Would like to see it. With a degree in nutrition a person might not want to go on to
be an RD, but would still use the training.
•
Good to have available. Seems like it’s feasible to do in-state. A number of
professions can’t legitimately be offered in AK such as pharmacists, dentists,
physical therapists. Numbers are small and investment is huge so they look at
outside schools and develop pre-professional track with courses here.
•
It’s a luxury. I’d rather have more general training with a strong nutrition
component. It would be wonderful but we need other things first such as a fouryear degree in community health with emphasis in nutrition. I would love to see
the nutrition degree if there were not other priorities.
•
A four year degree would be beneficial. Nutrition is such a big problem. Diabetes
and obesity are growing at an outrageous rate. Nutritionists have knowledge and
partner with our exercise physiologists and case managers and primary care
managers to address these problems.
65
•
No. Spend more money on nurses, or occupational therapy or physical therapy
assistants.
•
Yes, it would be very beneficial. I don’t know how many would sign up but the
more trained professional people the better. Nutrition is the way to go. Lots of
districts say they need an RD but in my position I need to know business to keep
the program in the black. However, I don’t know if classes would fill with a school
food service emphasis. Students would definitely need chemistry in their training if
graduates were going into hospital positions.
•
Are there jobs that require a four year degree? [Answer: Yes. A Registered
Dietitian must have a 4 year degree to become Registered {and licensed} and to
work in settings such as hospitals.] Yes, if there are jobs. When we send students
out-of-state for training, few come back to Alaska.
•
Don’t know. We don’t know the implications and what this means – what it takes
away from.
•
Why not?
•
Technically we could get along without it, but it’s better if training were offered.
•
Depends on results from this survey.
•
Build it and they will come. People enroll in one program and switch to another.
Nutrition is hard. Demand for BS in food science is far higher than for nutrition.
Could UAA generate four-year graduates who are competitive to be selected for
the limited number of slots available in the Anchorage dietetic internship?
5. What factors need to be addressed to make an academic degree in nutrition feasible?
•
General interest in nutrition will sustain an academic degree. There is interest from
the public. Charisma of instructor can result in continued enrollment from the
general public.
•
We may need more internship slots, or extern experiences.
•
Determine if numbers of students and are the numbers of jobs realistic.
•
Explore alternatives to BS in nutrition.
•
Alaska Natives are under-represented in the field.
•
Consider distance learning.
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•
Take advantage of existing programs and tie in with CWA.
•
Are there industry scholarships?
•
Don’t know enough to answer.
•
Financial challenge of providing fresh fruits and vegetables is a gigantic hurdle.
•
Administrative support at all levels not just school district.
•
Assuming trained people are available, then funding to take ideas and make them a
reality.
•
Looking at other states may be helpful. Texas looked at vending machines.
•
Establish policy to enforce. Then having the four-year degree could be powerful.
Get people with nutrition expertise for kids. Issue of do people have the knowledge
of how to do this with a 2 year training program. Don’t get discouraged with
school response to the survey…this is crunch time.
•
Good planning. A needs assessment, and then bring in the strategy from the
University.
Initiative to attract funds – solid funding
A number of faculty (4-6 people) to develop a bachelor’s degree
What impact is there on the school curriculum? 120 credits for a degree (1/3
general education. 1/3 prerequisites, 1/3 technical and electives). Full-time faculty
members teach 24 credits/yr. Adjunct faculty members teach up to 15 credits/yr.
Determine target audience – full time or part-time students. Will employers pay?
Are there scholarships or aid?
Offering courses using distance delivery can expand student enrollment and
revenues. Funding ratio varies by program, based on demand for the program
(general funding varies from 40-80% with the remainder from tuition.) Do some
modeling to determine numbers who start a program and how many remain at the
senior year.
•
•
•
•
•
Build the demand with government, e.g. Department of Education. Decision
makers and policy setters need to see the need. I don’t know how to do this. Of 52
school districts with child nutrition programs in Alaska, only 4 or 5 have or had a
nutrition specialist or dietitian on staff or contracted. In ADHSS dietitians may be
titled Public Health Specialists. [Dietitians may not show up in manpower surveys
using the occupational title “dietitian” although they are employed and using
dietetic skills. Many dietitians are now in management positions, an area of
growth according to the Alaska Department of Labor.]
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•
•
1.
2.
3.
4.
The Alaska Dietetic Association could get the word out about working with a
nutrition expert.
One person listed four factors:
Cost – personal and financial – Cost to run the program, develop the curriculum,
administration to support.
University system commitment. Need to know that resources are there and long
term.
Physical space – classroom availability. The Cuddy Center at UAA has cooking
facilities. Share resources.
Recruiting students. Have the program in one place and expand. House it in
Anchorage and distance deliver. It is costly to have it in three different places.
•
Really strong recruitment…actively researching into health careers, using focus
groups. Recruiting in-state would be great.
•
Not to be too negative, but need to grow an audience….need a ladder in health and
public health… a BS degree in science. I see more generalists in community health
and more academic stepping stones for going into sciences.
•
Money to develop program at the University and to support students.
•
Develop a program in Alaska that should be more Alaska-friendly. Nutrition
values of Alaskan Foods are important for Native and Non-Native students alike.
Education should be for all economic classes, for food stamp recipients and nonrecipients, include differences and cross nutritional training. Teach students how to
preserve foods- process peaches when they are cheap, dry fish.
•
Recruiting. We don’t often get Native candidates for jobs. We have summer and
winter programs for kids (RAISE) where each hospital department has 1-2 students
to encourage careers in health care fields. We target schools with high Native
enrollment.
•
We can’t just throw money at the problem. More people trained won’t necessarily
help. We need more parents taking responsibility. Do a better job in high schools.
Huge amounts of money go into institutional kitchens in schools and the staff is
just heating pizzas and JoJos. This (editor’s note: unclear if it’s the kitchen or the
staff) is an underused resource. Home Economics is not celebrated. In Food
Service employees are food warmers, not cooks. There is nothing to teach young
people and excite them.
•
Get information out to students while they are in high school or younger, i.e. in
elementary school. Help them onto the career path early. Work with parents to
encourage kids. Parents need to know what careers exist.
•
Get people interested in the high schools and grade schools. Be sure they have a
good background in science.
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•
An example of student work placements is UAF placing students in Health
Corporation hospital labs for learning and providing stipends. They may be hired
locally then. This may be a good model for nutrition training.
•
Assess existing faculty, core components, missing courses and teachers and
finances. Does program need to be credentialed? Determine if program is
sustainable based on number of students/year. Is it cost effective? If not, students
might need to go out-of-state. The program would need to attract Alaskan students
who may want to go Outside for training.
•
First survey the schools to find if schools have registered dietitians or registered
nutritionists operating the school lunch program. Find from them whether to
operate a healthy program, does the person need the credentials. It would be
interesting to compile information on type 2 diabetes and obesity to stress the
importance of diet and nutrition.
Other comments
•
YKHC has the best diabetes program in the state.
•
The Lower Kuskokwim School District, Bethel-based schools did away with the
school lunch program. Students either go home for lunch or buy food locally.
•
Yukon Kuskokwim Health Corporation recently filled a clinical dietitian position
but they are still recruiting for two clinical diabetes educators (may be filled by a
dietitian or other provider with the qualifications). Dietitians and Diabetes
Educators are considered critical or hard to fill positions and therefore candidates
are offered a $30,000 retention bonus.
•
I’m glad the University is looking at this!