RWJF Scholar Tackles Childhood Obesity

New Jersey Nursing Scholar explores effects of neighborhood safety, family, and acculturation on Latina adolescent health.

    • February 28, 2013

Problem: The rate of childhood obesity is dangerously high and putting kids at risk for health problems normally associated with adults, such as diabetes, hypertension, and high cholesterol. Minority and low-income youth face particular barriers to achieving healthy weights for cultural and environmental reasons.

Background: When Shanda Johnson was a young girl, she watched in awe as nurses helped her family members survive a number of health problems including strokes, diabetes, and hypertension. She knew then that she wanted to grow up to be a nurse, and was given a strong blessing by her grandmother, who had wanted one of her six  daughters to join a profession she believed was well-suited to women. None had done so, but Johnson wanted to fulfill her grandmother’s wish—and that she did.

“I told my grandma I’ll be her nurse,” Johnson says. “She didn’t live to see me finish, but she knew I was on my way and that was good enough for me.”

At age 21, Johnson, MS, RN, APN-C, FNP, became an orthopedic nurse in the medical-surgical department at a hospital in New Jersey and soon after decided to earn her master’s degree to become a family nurse practitioner. The position appealed to her because it enabled her to work with patients of all ages and backgrounds.

Johnson planned to earn her doctorate degree immediately after her master’s, but she became pregnant and had a son and decided to put plans to advance her education on hold while he was young.

When her son was in kindergarten, Johnson applied to the school of nursing at Rutgers, the State University of New Jersey, and to the Robert Wood Johnson Foundation (RWJF) New Jersey Nursing Initiative Scholar Program, which runs a Faculty Preparation Program that supports masters and doctoral degree scholars in New Jersey who are interested in becoming nurse faculty. The goal is to ensure that the state has the well prepared, diverse nursing faculty it needs to educate nurses to meet the demand for health care in the 21st century. Each scholar receives a scholarship covering tuition and fees, a $50,000-per-year living stipend, and a laptop.

Now in her fourth and final year of the program, Johnson plans to complete her research and earn her doctoral degree this spring and become a professor of nursing at a New Jersey college or university.

During her studies, Johnson has been working part-time as a nurse practitioner at a pediatrician’s office serving an urban, minority community in Plainfield, N.J. that has a high number of patients—including children—who are overweight or obese. Last December, for example, a 14-year-old girl came to the office and weighed in at 232 pounds—far above the healthy body weight for girls her age. The girl had high blood pressure and high cholesterol, two problems normally associated with adults but increasingly common in overweight children.

Johnson was saddened, but not surprised; ever since she started working there, she’s treated a number of overweight and obese teenage girls who are experiencing hypertension and high cholesterol as well as other health problems such as diabetes, depression, and social problems.

“A lot of the kids are being bullied because of their weight,” Johnson says. “And they don’t want to take physical education courses—the very kinds of courses they need to lose weight—because they don’t want to be bullied or made fun of. They’re dealing with that too.”

Curbing obesity rates, however, is notoriously difficult to do, especially in low-income communities like the one in which Johnson works. Kids are inclined to stay indoors—and sedentary—because they don’t live in safe neighborhoods; because many live with migrant parents who are working multiple jobs and are not home to cook healthy meals; and because nearby grocery and convenience stores do not offer healthy items.

“These kids walk to school and eat Doritos and Pepsi, and that’s their breakfast,” Johnson says. “After school, a lot of them go out for fast food. Near one of the middle schools in our community, there’s a Wendy’s, a McDonalds, a White Castle, a Burger King, and Italian and Chinese restaurants—all within walking distance of the school. These places wait for school to get out to serve them those high-calorie fast foods.”

Solution: There’s no silver bullet to a problem as complex as the nation’s high rate of childhood obesity, so Johnson is tackling the problem one step at a time. For her doctoral research, she’s exploring how neighborhood safety, the family, and acculturation—the process by which the patient or patient’s family has assimilated into American culture—affect the weights of adolescent Latinas.

For the study, Johnson will ask girls between the ages of 14 and 18 to fill out surveys about crime in their neighborhoods and whether it deters them from taking part in outdoor exercise. She will also ask about family relationships and about assimilation into the U.S. culture. And she will gauge the respondents’ allostatic loads—a person’s physiological response to stress—by measuring waist circumference, blood pressure, height, and weight.

The results aren’t in yet, but she hypothesizes that unsafe neighborhoods, family relationships, and acculturation into American society are linked to higher rates of stress and, consequently, obesity among teenage Hispanic girls. Johnson hopes her dissertation will form the basis of a research portfolio in adolescent health. She plans to develop the portfolio as a professor of nursing in New Jersey after she graduates this spring.

In addition to being a full-time student, Johnson is also maintaining her clinical practice as a nurse practitioner, and is the main caregiver for her 8-year-old son—so her life is more than full. Of her very busy life, she says: “I want to show my son that whatever he chooses to do, it can be done.”

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Shanda Johnson, MS, RN, APN-C, FNP

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