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Community-Based Respiratory and Nutritional Health Education Duwamish Valley Youth Corps

Carmen Martinez

Maria Gorodyuk Julie Trang

Ellie Marsh MN, RN Clinical Instructor

Fall Quarter 2017 NCLIN 409

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Abstract:

This fall quarter University of Washington nursing students Maria Gorodyuk and Julie

Trang were partnered with South Park community leader and Duwamish Valley Youth Corps

(DVYC) program coordinator Carmen Martinez to work in collaboration with adolescent youths

participating in the DVYC. We spent time developing lesson plans about respiratory health and

nutrition and providing education to the DVYC youths. We supported community projects

including Duwamish Alive! and the DVYC Youth Forum. We worked together using the

Community-Based Participatory Research (CBPR) approach that integrates a collaborative,

equitable relationship amongst researchers and community partners to create and implement

interventions within the South Park community.

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Introduction:

This fall quarter we worked with the Duwamish Valley Youth Corps (DVYC) to serve

and learn from the individuals of the South Park community. We collaborated with Carmen

Martinez to assess and determine what the DVYC would like us to focus on. We created a

respiratory health presentation that would address the concerns of the community including high

asthma rates in South Park and marijuana use among youths. For our next project we discussed

nutrition. Given that South Park is a food desert, we talked about healthy food options and the

impact it has on the future of each individual (USDA, 2015; Smith, 2011). We raised questions

like “How could we improve access to healthy and affordable foods to South Park?” that can be

passed onto the next group of nursing students. We also contributed to help DVYC with

addressing social determinants of health by planting trees, educating the community through the

DVYC Youth Forum, helping at meetings, and sharing our nursing expertise.

Assessment: Geography and Demographics

South Park is a small neighborhood located in the southwest end of Seattle, Washington.

Annexed into Seattle in 1907, South Park is surrounded by numerous commercial and industrial

businesses, highways, and is proximate to the Lower Duwamish Waterway Superfund site

(Lange, 2001; WA Department of Ecology, 2017; EPA, 2017). It also has a rich history of

community activism and a strong presence of locally owned businesses. South Park is home to

approximately 3,991 people and of these people, 42.3% identify as being Hispanic or Latino,

30.6% identified as White, 9.9% as Asian, 4.4% as Black, 5% as Mixed, and 5.6% as Other (U.S.

Census Bureau, 2015). In terms of citizenship and national origin, 61.5% are American born

citizens while 21.6% are not (U.S. Census Bureau, 2015). Non-English languages spoken at

South Park include Spanish (35.5%), the Pacific Island language (5.7%), Vietnamese (4.3%),

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Cambodian (2.7%), and Chinese (2.5%) (U.S. Census Bureau, 2015). South Park is also

disproportionately poorer than the greater Seattle metropolitan area; the median household

income in South Park is $43.9k in comparison to Seattle’s median income of $67.7k (U.S.

Census Bureau, 2015). In terms of education, 28.5% of South Park’s population has completed

less than a high school graduate education compared to 8.5% of Seattle’s total population (U.S.

Census Bureau, 2015).

Community Assets and Challenges

A windshield survey was conducted in South Park to assess for community assets and

challenges. Guided by the CBPR principle that recognizes community members as equitable

partners, interviews of South Park residents were also conducted (Israel et al., 2005). Community

assets include the strong sense of community; respect for the Duwamish River and environment

as evidenced by the establishment of the Duwamish River Cleanup Coalition/Technical Advisory

Group (DRCC/TAG) and annual Duwamish Alive!; public recreational areas such as Cesar

Chavez Park, South Park Community Center, and Duwamish Waterway Park; Marra Farm,

private residential gardens, and Providence Regina House; painted murals and public art

sculptures; cultural diversity; and community-based programs such as the DVYC.

Challenges include South Park residents have a lower life expectancy of 8 years

compared to King County (73.3 years vs. 81.5 years) (Cummings & Gould, 2013); South Park

residents have a higher rate of hospitalization for asthma compared to King County (240.4 vs.

143.4 people under age 18 years old per 100,000 people) (Cummings & Gould, 2013); South

Park residents have a higher rate of mortality related to lung cancer compared to King County

(52.3 vs. 41.4 people per 100,000 people); “South Park has one of the highest obesity rates in

Washington” (Lopez, interview, 2017); and South Park qualifies as a food desert and poor

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nutrition related to limited access to healthy foods increases the risk of cardiovascular disease,

stroke, cancer, and diabetes (Smith, 2011; Schroeder & Smaldone, 2015). Also, industrial and

commercial pollution is a significant problem in South Park (Cummings & Gould, 2013).

Duwamish Valley Youth Corps

DVYC is a community-based program that supports adolescents from the Duwamish

Valley neighborhoods of South Park and Georgetown by engaging them in environmental and

health improvement projects, helping them gain job and leadership skills, and providing them

opportunities for civic engagement. Carmen Martinez is the Program Coordinator of DVYC and

describes the youth as “ages 13-19 years old and ~80% speak Spanish fluently” (Martinez,

interview, 2017). This program was established in 2014 by the DRCC/TAG and DVYC

members have made significant contributions to their community (DRCC/TAG, 2017).

Planning: Respiratory Health Lesson

The goals of the Respiratory Health Lesson included educating the youth about the

prevalence of asthma in South Park, the pathophysiology of asthma, and the health impact of

living in a polluted environment (see appendix for complete learning objectives). We wanted to

present the statistics that were stacking against the community to bring awareness of the social

determinant of their ecological location. Our planning process consisted of a few weeks of

corresponding with Carmen Martinez and researching. During the planning process, we used

community-based participatory research (CBPR) and the core Public Health Nurse competencies

which aim to increase knowledge of the community and then integrate it into interventions

within the community. The CBPR principle we used “focuses on the local relevance of public

health problems and ecologic perspectives that recognize and attend to the multiple determinants

of health” (Israel, 2005, p. 1464). For example, we collaborated with Carmen Martinez to

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identify asthma and weed smoking as an important health concern related to South Park’s

ecological determinant of health because “South Park residents have up to a 13-year shorter life

expectancy [at birth] than wealthier parts of Seattle” and higher rates of asthma compared to

King County (Cummings, 2013, p. 2).

Nutrition Lesson

Planning the Nutrition Lesson involved assessing the challenges and assets of South Park.

Due to South Park’s limited access to affordable and nutritious foods, our learning goals aimed at

helping the youth gain knowledge about nutrition, make healthier shifts in eating, and

strengthening their community assets (see appendix for complete list of goals and objectives).

We presented a discussion about the sugar content in soft beverages and its impact on health in

the long term. The healthy food plate activity allowed participants to explore healthy eating

within their cultural context. Youth could think about the ingredients in their cultural foods and

ways to modify it to adopt a healthier eating pattern (e.g. using brown rice or quinoa for burrito,

using romaine lettuce leaves in place of tortillas for fajitas, adjusting the portion size of chorizo).

The US Department of Health and Human Services (HHS) and of Agriculture (USDA)’s healthy

food plate recommendation was provided in Spanish. Using the CBPR principle that “builds on

strengths and resources within the community” (Israel, 2005, p.1464), which means that as

partners of South Park, we wanted to conclude with assets in the community that can be used to

support healthy eating.

Implementation:

Respiratory Health Lesson

The CBPR principle used to implement this lesson was “promoting collaborative and

equitable partnerships in all research phases and involves an empowering and power-sharing

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process” (Israel, 2005, p. 1464). We collaborated with Carmen Martinez to make an authentic,

equitable presentation that included ideas from the DVYC and the UW nursing students. The

lesson began with a conversation with the DVYC about the negative impact of weed on school

performance and health. A picture that compared a healthy lung and a smoker's lung was shared

and the youth identified the differences between the lungs. We engaged in the CBPR principle of

facilitating “co-learning and capacity building among all partners,” (Israel, 2005, p. 1464) when

we learned from Carmen Martinez that South Park’s asthma rates are highest in Seattle area. We

validated her knowledge by providing current statistical data about hospitalization rates for

asthma and average lifespan in South Park in comparison to King County. The youth

underscored that respiratory health is a significant concern in their community when almost

every hand was raised in response to a live-poll that asked “who here has asthma or knows

someone with asthma?” We shared information about the pathophysiology of asthma, engaged

the youth in the bent straw activity so they can develop empathy for individuals with asthma,

engaged the youth in identifying different asthma triggers, and had the youth share how they can

support a friend with asthma. We created a safe and inclusive atmosphere, allowing current

DVYC members to share their personal health stories related to respiratory health. For example,

a DVYC youth shared that his dad has asthma and manages it by recognizing the symptoms of

asthma and knowing his asthma triggers. We discussed the positive impact that DVYC has made

to promote the health of their community. We concluded the presentation with a fun activity that

measured the youths’ lung capacities using incentive spirometers. We encouraged the youth to

keep exercising as it increasing lung volume and benefit their health. We brought in an electronic

mannequin for the youth to listen to healthy and unhealthy lung sounds.

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Nutrition Lesson

The Nutrition Lesson took about two weeks to plan and create. We created a drink board

which consisted of a poster board with empty beverage containers and the correlating sugar

amount hanging below (see appendix). This visual tool showed how much sugar was in each

drink and was compared to the daily amount of added sugar recommended by HHS & USDA.

We used white paper plates and markers for the next activity where each member created their

own healthy plate. The youth had the opportunity to think about the meaning of eating healthy

and compared their ideas with the recommended dietary guidelines provided by the HHS &

USDA. We emphasized that HHS & USDA’s recommended plate model was not a prescription

but a guide that can be adjusted based on one’s personal, cultural, and traditional preference. The

nutrition presentation was discussion-based and discussion topics covered chronic disease in

association with bad eating choices, the prevalence of the diseases, why healthy eating is

important, and how South Park can support healthy eating (e.g. smart snacking in school,

Georgetown’s Urban Farm and Forest, Mara Farms, food bank, etc.). The CBPR principle used

was focusing on the local relevance of public health problems, which is South Park’s high

obesity rates. The ecological perspective in this lesson that related to the social determinants of

health was the lack of resources to healthy foods. We discussed what the community can do like

voice and advocate for a grocery store at South Park that sells affordable and nutritious foods.

Evaluation:

The Respiratory Health Lesson was successful because we achieved all our learning

objectives based on the survey responses and received positive feedback from Carmen Martinez.

There were ~23-35 attendees at the event. The cost of the project was ~$25. The healthy snacks,

healthy vs. unhealthy lung image, asthma trigger images, and surveys were the items distributed.

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Most participants were attentive, engaged in the activities, and asked questions throughout the

lesson (e.g. What kind of cancer does marijuana cause?). Relevant health-related stories were

shared by South Park residents which enhanced the lesson. The lesson was ~55 minutes long and

Carmen Martinez played an integral role in helping with our success. Due to time constraints, not

all participants were able to listen to different lung sounds via the heart/lung mannequin.

The Nutrition Lesson was successful because we achieved most of our learning

objectives based on the survey responses and received positive feedback from our community

partners. There were ~25 attendees at the event. DVYC covered the cost of healthy snacks which

was prepared by Jennifer Lynn. Materials for the healthy food plate activity, images of the

USDA & HHS healthy food plate recommendation which was available in Spanish, a drink

board, and surveys were the items distributed. This lesson took ~40 minutes in total and Paulina

Lopez, an Outreach Specialist and Community Based Participatory Research expert of South

Park, contributed her insights which enhanced the outcome of our lesson. If more time was

permitted, we would be able to practice reading nutrition labels and discuss more in depth about

making healthier shifts in eating. A theme from the surveys include the youth expressing how

they will make a healthier change in their diet. We used the CBPR principle by assessing the

strengths and challenges related to eating a nutritious diet in South Park. The community lacks a

supermarket that sell affordable nutritious foods, so our lesson focused on empowering the youth

to make healthier food choices within their cultural context as well as identifying individual and

community resources to support healthy eating.

Recommendation:

According to Paulina Lopez, South Park currently has one of the highest obesity rates in

Washington and a contributing factor to this problem is not having a supermarket that sells

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affordable healthy foods in South Park. The Hunger Vital Sign Survey that we conducted

revealed that some participants rated “sometimes true” to the statement “Within the past 12

months, your family worried that your food would run out before you got money to buy more.”

Food security is an important social determinant of health and we recommend future nursing

students to work on improving access to affordable and healthy foods at South Park. Without

access to affordable health fruits and vegetables within South Park’s built environment, these

residents are at greater risk for developing negative health outcomes such as cardiovascular

disease, diabetes, stroke, and cancer (Schroeder & Smaldone, 2015). Residents of South Park

deserve to have the resources they need to adopt and sustain a healthy eating pattern.

Conclusion:

We collaborated with the DVYC to improve the health and wellbeing of South Park and

the Greater Duwamish Valley neighborhood. Carmen Martinez identified respiratory illness and

inadequate nutrition as the top health priorities in the South Park community. We used education

as our primary prevention strategy. We served as nurse educators for the youth and engaged in a

power-sharing and co-learning process; we shared evidence-based research, gained knowledge

about community resources and experiences, and actively exchanged ideas with South Park’s

community leaders. The respiratory health and nutrition lessons were provided in partnership

with a South Park community leader and the strengths of South Park were highlighted in order to

positively reinforce community-identified interventions that promote health and prevent or

alleviate illness and injury. In order to empower and build the capacity of the DVYC youth, we

supported efforts made by the youth to disseminate their acquired knowledge and experiences to

other South Park community members through the DVYC Youth Forum.

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Appendices: Duwamish Alive!: This is when we collaborated with Dirt Corps Duwamish Alive! to restore a piece of wetland that the Hamm Creek runs right through. We planted 300+ trees, shrubs, and various plants. We are hoping to see salmon swim through the creek this year.

Respiratory Health Lesson: heart and lung mannequin with an electronic stethoscope, healthy vs. unhealthy lung image handout, incentive spirometers, powerpoint presentation, audio clip (http://www.seattleglobalist.com/2016/03/30/49490/49490), videoclip (https://www.youtube.com/watch?v=TVJSmfYtXyw), asthma trigger image handout.

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Nutrition Lesson: visual board of sugar content in beverages, healthy food plate activity, US HHS & USDA healthy food plate guideline image,

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Duwamish Valley Youth Corps Youth Forum: program advertisement, planning, and implementation

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Surveys: ● Respiratory+Health+Survey+

○ What+is+one+thing+that+you+learned+today?+○ What+is+one+positive+thing+you+can+do+to+reduce+asthma+rates+in+your+

community?+○ How+many+people+do+you+know+have+asthma+in+the+South+Park+community?+○ What+is+your+resource+when+you+have+a+health=related+concern?+○ Do+you+have+any+questions+or+feedback?+

● Nutrition Survey ○ Why is it important to eat a healthy diet? ○ What does “eating healthy” mean to you? ○ What healthy foods are already in your diet? ○ Based on what you learned today, will you make any changes to your diet (if yes,

please specify the changes. If no, please specify your reason.) ○ Where do you get your source of healthy foods? ○ Do you have any questions or feedback?

● Hunger Vital Sign ○ Within the past 12 months, your family worried that your food would run out

before you got money to buy more. ■ Often True ■ Sometimes True ■ Never True

○ Within the past 12 months, the food your family bought didn’t just last and you didn’t have money to get more. ■ Often True ■ Sometimes True ■ Never True

Lesson Plan Learning Objectives: ● Respiratory Health Learning Objectives:

○ Describe the negative health and academic impacts of smoking marijuana among adolescents

○ Identify asthma and mortality rates in South Park in comparison to King County ○ Describe the pathophysiology of asthma ○ Describe the signs and symptoms of asthma ○ Identify asthma triggers and ways to manage them ○ Describe an asthma attack and how to appropriately respond ○ Identify ways to reduce the rates of asthma in the South Park community ○ Describe how to maintain a healthy lung capacity

● Nutrition Learning Objectives:

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○ Describe the importance of healthy eating ○ Define a healthy eating pattern ○ Describe the dietary guidelines provided by the USDA and HHS ○ Describe the importance of reading nutrition labels ○ Demonstrate how to read nutrition labels ○ Identify ways to make healthier food choices ○ Identify the barriers to healthy eating ○ Identify ways to promote healthy eating

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