Community Assessment Paper

COMMUNITY ASSESSMENT 1

Community Assessment: Behavioral Dimension

Alyssa Cardinal, LeAnna Ceglia, Ikneet Kandola, and Andrea Valdez

California State University, Stanislaus


Community Assessment: Behavioral Dimension

There are many factors that influence the health of a community. Health disparities and

differences between populations within a community are some of these contributing factors. The

ability to have safe places to exercise, to eat a balanced diet, participate in recreational activities,

have a safe sexual life, live in safe housing, are but some of the areas in which health disparities

exist. By evaluating pre-existing research as well as conducting our own survey, we will address

Merced residents’ behavioral considerations and any health disparities that exist.

Exercise

Exercise is an important component in health promotion and wellness. Exercise

combined with proper nutrition can make significant changes in an individual’s life. In Merced

County, 29.9 percent of individuals have no time for either leisure or physical activity

(Professional Research Consultant, 2012). To gain a better understanding of Merced residents’

exercise accessibility and frequency, the survey asked questions to gain insight on where

individuals from the community exercised, how often, the type of exercise performed and the

affordability of a gym membership. A total of six surveys were completed by individuals

ranging from upper to lower class. Individuals were given the option to either state their name or

remain anonymous. The survey that was conducted in the city of Merced indicated that 50

percent of residents exercised 1 to 2 times a week, 33 percent exercised 3 to 5 times a week, and

17 percent exercised 6 or more times a week (personal communication, October 1, 2014). Upper

income residents have the freedom to exercise at the gym and in their neighborhoods, while low

income residents are restricted to exercising in their homes. Middle class residents expressed a

variety of different exercise environments. This separation of opportunities between the


different socioeconomic levels showcases a health disparity for the lower income families,

thereby affecting their overall well-being.

Leisure Activities & Recreational Facilities

To assess the typical leisure activities of Merced city residents, statistical information

was drawn from personal interviews, a self-conducted survey, and published research. To gain a

better understanding of the population’s leisure activities, the survey asked residents about what

they do in their spare time and what facilities they feel are accessible to them. According to the

survey, it was discovered that upper income residents of Merced prefer walking for leisure and

utilized recreational facilities such as gyms, malls, dine-in restaurants, and movie theatres.

Middle income residents prefer watching TV and movies, shopping, playing video games, and

going to the park. It was also found that they use similar facilities as upper class residents, in

addition to bowling alleys, bars, and nightclubs. According to a low income resident from south

Merced, residents from this area enjoy playing video games, watching TV, and drinking alcohol

in their spare time. Due to lack of accessibility, low-income residents gravitate toward facilities

such as movie theatres, bars, and nightclubs (anonymous, personal communication, October 1,

2014).

To gain a better understanding of facility accessibility, an interview was conducted with

the manager of a local gym. Fitness Evolution Gym, a newly constructed facility located in the

center of Merced, is available for use seven days a week with long operating hours to

accommodate its members’ schedules (anonymous, personal communication, October 1, 2014).

The facility is extremely affordable with a monthly cost of only ten dollars per month. Because

of its affordability, the gym is occupied by all social classes, with most being of the middle

socioeconomic class.


The receptionist at the Merced Department of Recreation was interviewed (personal

communication, September 25, 2014). It was discovered that the City of Merced offers any array

of affordable leisure activities to its residents. The classes consist of yoga, Zumba, karate,

jujitsu, Sunday dances, social dances, hunter safety, indoor youth soccer, and summer outdoor

youth soccer. The classes occur in a variety of locations such as local parks, sports facilities, and

the Senior Community Center. The city of Merced offers a wide variety of recreational and

leisure activities for its residents, which some still may find inaccessible due to its cost. Aside

from cost, safety of parks is also a large concern for this population. Parks appear littered with

trash and heavily populated with homeless people. Parks are also a common ground for drug

paraphernalia, in which a resident states that they worry about stepping on dirty needles or

coming in to contact with illegal substances (anonymous, personal communication, October 1,

2014).

Health Hazards

There are many health hazards in Merced, making the community more susceptible to

disease processes and decreased quantity and quality of life for its residents. Research has

shown that a major part of the Merced population is employed by the company Foster Farms.

Many employees that work for this company stand or sit in the same position for hours with two

breaks within an eight hour shift. Approximately 43.5 percent of jobs entail mostly sitting or

standing, thus leading to stiff joints and back problems (Professional Research Consultant,

2012).

The high incidence of underage drinking among all socioeconomic income levels is

another health hazard that this community faces with 47.9 percent of the population being

current drinkers (Professional Research Consultant, 2012). According to a registered nurse from


Mercy Hospital, overconsumption of alcohol leads to a high admission rate in the emergency

department (anonymous, personal communication, October 1, 2014). Tobacco is another health

hazard, putting Merced residents at risk for pulmonary conditions including chronic obstructive

pulmonary disease and various cancers involved with smoking tobacco. According to the

survey, which asked residents about the percentage of tobacco use in their neighborhood, it was

found that tobacco use is 0 to 24 percent in the upper socioeconomic class, 25 to 50 percent in

the middle socioeconomic class, and 75 to 100 percent in the lower socioeconomic class

(anonymous, personal communication, October 1, 2014). Of the Merced population, 13.1 percent

of residents are current smokers (Professional Research Consultant, 2012).

Alcohol

According to some residents, alcohol consumption is an escape route for many of Merced

County’s poor community. They claim that many residents become alcoholics due to depression

for lack of resources and the simple fact of being poor (anonymous, personal communication,

September 10, 2014). Unfortunately, alcoholism often masks depression and or mental illnesses

leading to other health problems such as liver failure, accidental deaths, violence, as well many

other negative effects and health outcomes. The Centers for Disease Control and Prevention

(CDC), in junction with the local health departments, has been working very hard to decrease

alcohol intake along with its mortality not only in Merced County, but all across the country.

According to the Merced County health needs assessment report, alcohol intake is more

prevalent among men, residents under 65, higher income adults and Caucasians (Professional

Research Consultant, 2012 pg. 151). The effects of alcohol have great impact not only at one’s

home, but the community as a whole. Society pays millions of dollars in taxes to provide mental

health programs, hospitalizations and public health programs. According to a registered nurse at


Mercy Hospital in Merced, many individuals are transported by ambulance and admitted to the

emergency department due to alcohol consumption (anonymous, personal communication,

October 1, 2014). The nurse reported at least two patients per shift admitted to the emergency

department due to overconsumption of alcohol. These individuals are of all different ages,

genders, and social classes. The Merced County Health Needs Assessment report states “social

attitudes and political and legal responses to the consumption of alcohol and illicit drugs make

substance abuse one of the most complex public health issues” (Professional Research

Consultant, 2012 pg. 148).

Fortunately, Merced County offers several programs for treatment and recovery from

drug use and alcoholism, including Adolescent Treatment, CalWORKS, The Center, Judicial

Treatment Services, Perinatal Recovery Program, and various prevention programs (Alcohol &

Drugs, 2014). Information was also gathered from the survey conducted regarding resources that

are available to help residents quit the use of tobacco. According an upper socioeconomic

resident, the resources that are available include doctor prescribed medications, nicotine patches,

nicotine gum, group therapy/support groups, as well as individual therapy (M.R., personal

communication, October 1, 2014). According to a couple of middle class residents, the resources

they find available to quit tobacco use includes the same as the upper class with an addition of

electronic cigarettes that monitor nicotine levels (anonymous, personal communication, October

1, 2014). The lower class, however, according to a resident, does not have as many resources

they find available. The few resources that seem accessible include nicotine gum and a few

group therapy/support groups (anonymous, personal communication, October 1, 2014). With

that being said, emphasis on better education tools, assessment techniques and care to certain


individuals/populations will help benefit the county in decreasing mortality rates, suffering, and

expenses associated with alcoholism.

Drug Use

Drug use is another big issue in Merced County. Similar to alcoholism, drug abuse is a

complex disease in which depression and mental illness are major factors. Just like alcohol, drug

use also has many negative effects on the individual as well as the society in general. According

to community indicators of alcohol and drug abuse for Merced County, 67 percent of hospital

discharges are related to drug and alcohol use, 12.9 percent of arrests are due to drug violations,

and about 28.1 percent of deaths are caused by drug and alcohol abuse (Community Indicators of

alcohol and drug abuse Merced County, 2004).

Tobacco Use

Tobacco use is another substance that is hard on the body. It affects every organ system

leading to diseases such as strokes, vascular damages, visual changes, renal damage and failure,

high blood pressure, lung problems and many types of cancers. It has been fifty years since the

release of the first Surgeon General report that warned the American citizens of the hazards

associated with smoking. Since that report, Americans have changed their attitudes about

smoking greatly, however much work still needs to be done to completely eradicate its

use/abuse. According to the Merced County Health Needs Assessment Report of 2012, “tobacco

use is the single most preventable cause of death and disease in the United States. Each year,

approximately 443,000 Americans die from tobacco related illnesses. For every person who dies

from tobacco use, 20 more people suffer with at least one serious tobacco related illness” (2012).

In Merced County “a total of 13.1 percent of Merced County adults currently smoke cigarettes,

either regularly (8.5 percent every day) or occasionally (4.6 percent on some days” (Professional


Research Consultant, 2012, p. 157). There are an array of smoking cessation programs, most of

which are provided by the state, however the University of California, Merced offers cessation

resources available on its website.

Sexual Practices

In continuing with the results of the survey conducted on Merced residents, many

questions were asked concerning sexual practices and family planning. These questions included

gaining knowledge on what type of contraceptives are available in their neighborhood, where

people in the neighborhood mainly get their contraceptives, average age that minors become

sexually active, how common is teenage pregnancy, and the availability of sex education for

minors. The upper class resident reported a wide variety of available contraceptives purchased at

doctor’s offices, clinics and pharmacies. The average age that sexual activity begins is claimed to

be 18 or older (R., M., personal communication, October 1, 2014). There was also a denial of

teenage pregnancies and sex education is provided in the home as well as at school. Middle class

residents also reported having multiple forms of contraceptives including the Depo Provera shot.

These methods of birth control are obtained from stores, doctor’s offices, Planned Parenthood

Clinics, pharmacies, and family members and friends (anonymous, personal communication,

October 1, 2014). The average age of sexual activity begins between ages 16 and 17 years old.

Middle class residents admit to a common occurrence of teen pregnancies and sex education

being received in the home and at school. Low socioeconomic class residents reported the main

source of contraceptives is condoms, which are most commonly purchased at convenience stores.

The average age of sexual activity for this class has a wider range being 15 to 18 years of age

with sex education provided primarily in the school. There was also a report of teen pregnancy

being a common occurrence (anonymous, personal communication, October 1, 2014). Although


there appears to be a discrepancy between the socioeconomic classes on how common teen

pregnancy is, according to kidsdata.org, an average of 39.4 out of 1,000 teens are pregnant in

Merced County (2014).

An interview was conducted at the local Planned Parenthood (PPH) clinic to assess the

programs and resources available to its community members (anonymous, personal

communication, October 1, 2014). It was noted that PPH offers a wide variety of available

contraceptives to prevent pregnancy with the most commonly used contraceptive being the birth

control pill. The average age of patients ranges from 12 to 65 years of age with most coming

from the middle socioeconomic class. This agency provides treatment, resources, and referrals

for family planning, prenatal care, pregnancy terminations, sexually transmitted infection

treatment and counseling.

Housing

A survey about housing was conducted with the residents of the North, Central, and

South parts of Merced (personal communication, October 1, 2014). It was revealed through

observation and survey that North Merced has larger well kept homes on larger plots that house 5

to 6 members per household, have security alarm systems, and are associated with the high

socioeconomic income level. Central Merced has average sized homes on smaller plots that

house anywhere from 3 to 8 per household, have security alarms, bars, and screens. Some of

these homes were better kept than others and are linked with the middle socioeconomic class.

South Merced has small, run down homes or apartments with a majority that house 4 to 5 per

household. These homes typically have bars and metal screens on the doors and windows for

added security, and are affiliated with the lower socioeconomic class.

Sources of Stress


Through survey, we assessed the major sources of stress for Merced residents of all

socioeconomic classes. According to many south Merced residents, one of the major sources of

stress is the lack of jobs and income (anonymous, personal communication, October 1, 2014).

According to a resident from north Merced, the largest stressor is declining health among aging

individuals (anonymous, personal communication, October 1, 2014). Middle class residents

reported that their major stressors consist of job availability, financial security, poor family

relations, safety of their neighborhoods, affordable housing and affordable medical care

(anonymous, personal communication, October 1, 2014). Due to the majority of residents in this

area being low income, non-English speaking, and uneducated, they have a tough time finding

year round work. According to the United States Census Bureau, 2013 there are 24.6 percent of

individuals living below poverty levels in Merced. Lack of knowledge and access to resources

leads to other disparities such as depression, drug and alcohol use, and teenage pregnancy. Many

young people find escape venues such as joining gangs or committing crimes. Merced residents

also reported high gang activity is a major cause of stress for the community as well as unsafe

city parks and neighborhoods that harbor the potential for violence (personal communication,

September 10, 2014).

Nutrition

It has been well documented that good nutrition leads to good health outcomes.

However, in the same manner poor nutrition coupled with inactivity can lead to chronic life-long

diseases and obesity. Unfortunately, the community’s lack of nearby resources can worsen the

outcomes for some of its residents. Lack of supermarkets that offer fresh fruit and vegetables is

a significant issue within Merced’s County poorest communities. According to the Centers for

Disease Control and Prevention, the risk of dying from cardiovascular disease, cancer, diabetes,


and stroke are greatly decreased by maintaining a healthy diet and increased physical activity

(2009). Current statistics show that 17 percent of Merced county residents are dying prematurely

due to poor diet and inactivity with 207 percent of residents dying from heart disease and 25.8

percent dying from diabetes mellitus. In relation to Merced’s residents, 70.7 percent are

overweight and 35.9 percent are obese (Professional Research Consultant, 2012). In the survey

conducted, there were three pictures that depicted three different types of meals ranging from

healthy to unhealthy. The upper and middle class residents chose the middle plate, stating that

the majority of their meals consist of half healthy and half unhealthy foods. Alternatively, one

low income resident felt that the majority of his neighborhood ate similar to the unhealthy plate

(anonymous, personal communication, October 1, 2014). Most of the population in south Merced

is Hispanic. Their diets consist of high fat, and carbohydrate meals due to the preparation of food

with lard, which is a cheaper alternative to cooking with oil. After conducting the survey and

personal interviews, it appears that the south Merced population needs education on how to

prepare healthy meals and how to gain access to healthier food resources.

Nursing Diagnosis

● Altered nutrition: more than body requirements related to: an excessive intake in relation

to metabolic needs; the lack of knowledge of nutritional needs, food intake, and/or

appropriate food preparation; poor dietary habits; a sedentary lifestyle as evidenced by

the high rates of overweight and obese residents.

● Knowledge deficit in sexually active adolescents related to sex education, contraceptive

use, and available resources as evidenced by the high rates of teen pregnancies.

Researchable Question


Will the implementation of maternal and child health education for pregnant teen mothers

prevent complications and reduce risks of maternal and child health?

Program Activities: Interventions, Planning, and Support Activities

It has been well established that teen pregnancy and childbearing leads to huge amounts of

costs, not only to the teen and their families, but also to the cities, counties, states, and the

country as a whole. Schaffer, Goodhue, Stennes, and Lanigan (2012), found “on the life

trajectory of teen mothers and their children, poor outcomes in educational attainment,

socioeconomic status, marital status, and school progress” (p. 218). The CDC has teen

pregnancy prevention as the sixth priority in order to improve health and quality of life of our

youth. The CDC is also partnering with state agencies to develop and promote evidence-based

programs to educate youth on pregnancy prevention, sexually transmitted disease prevention,

values, communication skills between teens and parents or caregivers, as well as other programs

(CDC, 2013). Schaffer et al. (2012), stated “literature on adolescent parenting featured relevant

theories including mentorship, social support, social competence, and resiliency that guided

program development” (p. 219). For Merced County, a teaching project for local schools was

developed to reduce maternal and child health risks and decrease teen pregnancy and births to

adolescent women.

Goals

● Reduce teen pregnancy rates.

● Provide culturally competent education to adolescents on the need of open

communication about sexual practices and prevention. This effort should be a top

priority.

● Increase access to early prevention programs, i.e. Planned Parenthood.


● Support and promote teen moms to remain in school and graduate.

In order for this teaching project to be successful, certain things needed to be in place for the

program activities to happen. This included:

• Schedules with the schools and the teachers had to be set to arrange meeting times.

• An age-appropriate presentation, teaching plan, meeting place (classroom), technological

support (projector, screen, computer, and flash drive), visual aids, handouts, and

pamphlets needed to be in place beforehand.

• School addresses, phone numbers, directions, and the number of students needed to be

known to formulate the proper teaching plan.

Pre-intervention start-up activities included:

• The clinical instructor had an “idea” about teaching teens about teen pregnancy and

maternal and child care. This idea was turned into a project to test the effectiveness of

this teaching plan on the adolescent population.

• Meetings between the clinical instructor and the teachers occurred to arrange the schedule

and build a trusting relationship.

• The clinical instructor and the teachers followed up via email over the summer and this

semester.

The stakeholders in the teaching project are the school administration, teachers,

teenagers, and the community health student nurses conducting the teachings. The needs of

the teachers are that they would like to see a decreased rate of teen pregnancies in their

schools and be informed of the various topics being taught. The needs of the teenagers are

that they need the proper education to care for themselves and their children and to prevent

future teen pregnancies. The needs of the student nurses are that they must be educated


about evidence-based and evidence-informed strategies to reduce teen pregnancy and

maternal-child risks, as well as data of needs and resources needed in the community to

accomplish the stated goals. This project did not include partner/stakeholder workshops.

Activities that led to developing capacity of partners included education and lecture (like

the lecture by the clinical instructor) about increased rates of high risk teen pregnancies and

how teaching this population can help in the decrease of teen pregnancies and high maternal-

child risks associated with it.

One of the most important goals is to prevent pregnancy, however once the teen is

pregnant, the second most important goal, is to have a healthy pregnancy and infant. It is also

important to keep these girls from dropping out of school. Lee SmithBattle (2006) found that

“teen mothers continue to lag behind their non-parenting peers in education” (p. 130). Providing

these teens with emotional support is crucial in ensuring a better outcome for their own and their

children’s future. A case manager or school nurse could work closely with these teens to assist

in motivation and goal achievement, SmithBattle explains that many of these girls commonly

report desires of continuing their education, but lack of support from their teachers, parents, and

society in general undermine their goals, she stated “teens with the least tangible family and

community support had the greatest difficulty attending school and becoming successful

students” (2006, p.132).

In preventing teen pregnancy, it is the responsibility of parents/guardians, adults, and

community members to develop ways of educating and communicating with or our youth on

pregnancy prevention. Unfortunately, many cultures avoid providing their children with safe sex

conversations since in many cultures, sex before marriage is considered against the religious

practices and norms. The assumption is that teens are to practice abstinence until marriage,


which in this day and age is considered unrealistic, neglectful, and ignorant. Parents must be

educated on how to engage in such conversations, which could be very uncomfortable and

awkward, but it builds a trusting relationship with their children. This would also allow the

parents to have a positive impact on the child’s coping mechanisms, attitudes, and behaviors

related to sexuality. In a study by Murray, Berne, Lammers, and Strack (1999), it was found that

educating parents was one of the recommendations to help reduce teen pregnancy, they stated “in

the context of teaching healthy parenting, it is important to teach the rights and responsibilities of

parents for being the primary sexuality educators of their children” (p.148). Knowing at what age

to approach children is also an important aspect, therefore parents should be provided with the

tools needed to educate their teens.

This study also focused on educating religious communities/organizations with their

recommendations; they felt that if these organizations are aboard with safe teen sexual education

the outcomes would be better. Murray et al. (1999), stated “if the religious institutions in the

community are viewed as leaders on moral issues, leadership that supports comprehensive

sexuality education within these institutions has to be developed and supported in their efforts”

(p. 148). All in all, the community as a whole should provide and support such programs for

reduced teen pregnancy rates and risks of maternal-child health. Such programs are very

expensive, but in the long run would be a cheaper way to prevent teen pregnancy and all

expenses that arise from supporting teen parents and their children.

Summary of Evidence Based Research Article

Teaching Adolescents with Age and Culture Appropriate Methods

In the article Teaching Strategies for the Net Generation, Berk addresses the relationship

between generations from the years 1982 to 2007 (2009). He describes what each generation is


known for by providing a brief description of their habits and tendencies. However, while each

generation varies from one another, they have one main thing in common - becoming easily

disengaged with school and finding the material boring. The high level of disengagement is due

to poor instructional strategies in which the students have a difficult time relating to. For

example, many teachers use text books, bombard the students with words versus visual aids and

provide little to no time for interaction. However, the author has alternative teaching methods to

help engage adolescents in the class room setting.

Berk addresses twenty different teaching implications to consider while interacting with

adolescents. These implications include remaining aware that this generation is technologically

savvy, relies on search engines to gather information, is interested in multimedia, prefers

everything at a quick speed, learns best by doing and not being told what to do, learns through

trial and error, is great at multitasking, has a short attention span, and learns best with visual aids.

Other considerations to keep in mind when teaching adolescents include their craving for social

face-to-face interaction; they thrive on constant feedback and immediate gratification.

The next step in reaching out to adolescent students is to became better acquainted with

their “characteristics, behaviors, and habits to design and custom tailor your teaching strategies

for them. Consider each characteristic and how one or more teaching techniques can draw on

their specific interests, intelligences, and learning styles. “You should be sensitive to their

individual strengths and weaknesses and try to build on the former before helping them to

compensate for the latter” (Berk, 2009, p. 14). In other words, each student should be

individually assessed and teaching should be specific to their needs.


References

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Documents

Community Assessment Paper