Professional Portfolio_Final (1)

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Running head: PROFESSIONAL PORTFOLIO

Professional Portfolio

Ariana Ochoa

ALH495

Clinical Practicum

Dr. Kim

California Baptist University

April 11, 2016

PROFESSIONAL PORTFOLIO 2

Table of Contents

Practicum Experience Plan and Evaluation.....………………Pg. 3-4

Practicum Information……………………………………….Pg. 5

Philosophy of Health and Professional Goals………………..Pg. 6-7

Resume…………………………………………………….....Pg. 8-9

Certifications………………………………………………....Pg. 10

References…………………………………………………....Pg. 11

Honors/Awards………………………………………………Pg. 12-13

Summary of Student Learning Outcomes……………………Pg. 14-15

Health Insurance Analysis……………………………………Pg. 16-19

Prevalence, Causes, Coping Strategies of Stress amongst Junior and

Senior Female College Students……………………………..Pg. 20-41

Violence Prevention for Gang Affiliated Youth……………..Pg. 42-54

Hoarding: A Community Health Problem………………...…Pg. 55-61


Practicum Experience Plan and Evaluation

Health Science Major Student Learning Outcomes (SLOs)

Student

Learning

Outcomes

(SLOs)

Write specific student

learning outcomes

below

Activities (Reports, projects, or

assignments) that address the

SLOs.

SLO #1 Understand the U.S.

healthcare system.

Conduct an interview with a

healthcare professional asking

questions regarding health

insurance policies, ethical issues,

quality of healthcare, and the

impact of their role in healthcare.

SLO #2 Display effective

communication skills

By interacting with healthcare

professionals, patients, and

various individuals, I will have

the opportunity to improve my

communication skills in several

settings. For example, I may

conduct a research survey design

for individuals to assess their

experience after interacting with

me. This will serve to keep a

record of my ability to effectively

communicate.

SLO #3 Demonstrate

competence in applied

statistical analysis.

With a sample size of more than

50 participants from the surveys

listed above, I will analyze and

SLO #4 Demonstrate a

thorough

understanding of the

relationship between

disease prevention and

health promotion.

Interpret this data

using the SPSS

Statistics software.

Based on learning of health

promotion and disease prevention

in previous courses, I will

practically apply that information

to a real healthcare setting. I

would do this by developing a

case study from observation and

presenting possible improvements


SLO #5 Demonstrate the

ability to evaluate the

scientific literature,

understand and

synthesize relevant

information from it,

and be able convey

that information both

orally and in writing.

or solutions stemming

from evidence-based

research.

Assess an article related to a

common health issue among

patients in a clinical setting, write

a summarized report, and briefly

present to the preceptor as if

explaining the information to a

patient. This will serve to

evaluate my understanding of the

issue and the language used in the

article.


Student Name: Ariana Ochoa

Agency and Department/Division: SoCal Emergency Medicine Urgent Care Centers

Preceptor Name: Julie Bearie

Dates of Practicum Plan: 2/15/2016 – 4/15/2016

I have met with practicum supervisor (preceptors) to discuss activities (projects, reports, and

assignments) that enable me to attain the student learning outcomes in this practicum experience.

Student’ signature

Preceptor’s signature


Philosophy of Health and Professional Goals

Ariana Ochoa

Clinical Practicum

ALH495

February 8, 2016


Philosophy of Health and Professional Goals

Health is a broad term that literally means being free from illness or injury, not only in

the physical aspect. This encompasses mental, emotional, spiritual, and social health along with

physical health. An area of healthcare that addresses all of these is public health, which deals

with health promotion and disease prevention. This does not only refer to the health of

individuals, but whole communities.

Soon, I will be working alongside other phenomenal healthcare professionals as a

physician assistant, who collectively are working towards the same goal; to improve the overall

health of the community. The motive behind my goal is based on my faith, which is to be of

service to others through the knowledge and skills I gain throughout. A verse in the Bible from 1

Peter 4:10 states “Each of you should use whatever gift you have received to serve others, as

faithful stewards of God’s grace in its various forms”. Serving as a physician assistant is only

one manner in which I can reflect the grace given to me and impact at least on area of health in

the lives of many.

As I continue my educational journey, I must first apply this concept to my own health in

order to serve as an example to others. My personal goal as a healthcare professional is to strive

to always better every aspect of my state of health. Along with this, I will work towards

educating myself on new strategies and technology to be an even more effective provider. In

terms of relationships with co-workers, I will be of service to them as well in order to create an

environment that is pleasing to employees and patients alike.


Ariana Ochoa

22880 Bay Avenue #A, Moreno Valley, CA 92553 | [email protected] | 951-3998376

Education

California Baptist University Riverside, California

Bachelor of Science: Health Science | Concentration: Pre-Physician Assistant Studies

Expected Graduation

April 2016

Provost’s List

Spring 2014

CBU Allied Health Scholarship Fall

2014 - Present

CBU Women’s Choir Scholarship Fall

2013 - Present

Relevant Coursework

Medical Terminology, Anatomy and Physiology I & II, Survey of U.S. Health Care Delivery, Public

Health Promotion and Disease Prevention, Microbiology, Ethics in Health Care, Research Methods,

Health Communication, Health Care Policy, Clinical Practicum, and Health Behavior Change

Experience

Moreno Beach Urgent Care Moreno

Valley, California

Clinical Practicum Student

February 2016 – Present

• Obtained medical history, chief complaint, and partial SOAP notes with supervision of a PA

• Conducted research using survey sampling and used SPSS to demonstrate applied statistical

analysis

• Understood the U.S. Health Care system through interviews with health care professionals

• Assessed scientific literature, wrote a summarized report, and presented information to a

preceptor

Additional Experience



Riverside, California

Women’s Choir Section leader September

2015 – Present

• Led the Soprano II section in reading and singing a wide array of music

• Organized sectionals with the Soprano II section



International Service Projects

• Thailand: Community Engagement

Summer 2016

Student Leader o Organized various

fundraising events

o Taught English in various schools ranging from elementary to high school

Skills

• Computer: SPSS, Microsoft Word, Microsoft Excel, Microsoft PowerPoint

• Language: Spanish – Conversational Proficiency

• Medical : CPR, First Aid, and Emergency Medical Services

• West Coast EMT


Emergency Medical Technician Certificate

Summer 2015


Certifications

CPR/First Aid (Medical)

The purpose of this certification is to have an individual prepared in cases of

general medical emergencies, especially those pertaining to the field of healthcare.

Some situations may include cardiopulmonary resuscitation, proper use of an AED,

broken bones, etc.

Emergency Medical Technician Certificate

The purpose of this certificate is to educate those who will be working under an

emergency ambulatory service. Those who receive this certificate have

demonstrated a basic understanding of human anatomy and physiology, healthcare,

precautions, and emergency medical care.

National Institute of Health Certificate

The purpose of this certificate is to train individuals on the principles used to define

ethical research using humans and the regulations, policies, and guidance that

describe the implementation of those principles.


References

Pennee Robertson

RN, MSN, CCRN

Assistant Professor Nursing


8432 Magnolia Ave, Riverside, CA 92504

Work phone: (951)552-8305

Email: [email protected]

Relationship: International Service Project: China, Leader

Julie Bearie

RN, BSN

Vice President

SoCal Emergency Medicine: Urgent Care Centers

27640 Eucalyptus Ave, Moreno Valley, CA 92555

Work phone: (909)797-8900


Relationship: Clinical Practicum Proctor

Ruben Elias

Pastor

Iglesia Pentecostal: Fuente de Vida

12125 Day St Suite G301, Moreno Valley, CA 92557

Work Phone: (951)777-8203


Relationship: Pastor


Honors/Awards

Provost’s List - GPA 3.88 Fall 2014

CBU Allied Health Scholarship Fall 2014 – Present

CBU Women’s Choir Scholarship Fall 2013 – Present

Private Organization Scholarship Fall 2012

Attachments



Summary of Student Learning Outcomes

Ariana Ochoa

ALH 495

Clinical Practicum

Dr. Kim

March 7, 2016


Summary of Student Learning Outcomes

1. Understand the U.S. health care system

The U.S. health care system is comprised of many aspects. For example, the clinical

setting (i.e. medical knowledge and treatment), Health Insurance, Ethics, etc.

2. (2 & 5) Demonstrate understanding of research methodology and the scientific

method.

Demonstrate competence in applied statistical analysis.

This involves statistical analysis collected from a large sample size and analyzing this

data.

3. Demonstrate a thorough understanding of the relationship between disease prevention

and health promotion.

4. (4 & 6) Display effective communication skills. Demonstrate the ability to evaluate the

scientific literature, understand and synthesize relevant information from it, and be able

to convey that information both orally and in writing.


Health Insurance Analysis:

United Healthcare Insurance Company

HSC 104

Ariana Ochoa

Professor Fletcher

November 11, 2013


United Healthcare Insurance Company

Brief Background

I am currently enrolled in the health insurance plan that the school provides, due to the

fact that neither me nor my family have medical anymore. I would still have coverage; however I

was required to have a job while I was in school. So, because of circumstances I temporarily am

under the United Healthcare Insurance Company. This company provides a variety of different

plans for a vast group of people. It strives to make healthcare affordable and accessible to all.

Some of their goals include; “improving the quality and effectiveness of healthcare for all

Americans, enhance access to health benefits, create and products and services that make

healthcare more affordable, and use technology to make the healthcare system easier to

navigate”. (2013). Some of their plans include copay, health savings account, high deductible,

short term medical, and student coverage. This company provides services to approximately 70

million Americans, and their pharmaceutical management programs provide more availability

and affordability of prescription drugs to over 13 million people. In seeking improvements in all

areas of healthcare, United Healthcare has made several investments in research and

development, technology, and business process improvements.

My Health Insurance Plan

The plan that I am on is a PPO network. I do not pay a monthly premium. The overall

cost of the insurance is $770 and is included with the cost of my tuition. Included with my health

insurance coverage is access to the Collegiate Assistance Program. This allows me to speak with

either a registered nurse or student assistant specialist any time of the day and week. I can speak

with them if I have questions regarding any symptoms I may be experiencing, taking care of a

certain illness, information on medications, and many other things. I also have global emergency

services included on my plan. This is a comprehensive program providing 24/7 medical and


travel assistance service. The last thing included on my health insurance plan and coverage is the

United Health Allies Discount Plan. This allows me to save 10% to 20% on a variety of health

services such as; annual eye exams, active apparels books and other media, dental checkups, and

so many more things. From what I have learned about my insurance provider and plan, I do not

see any restrictions placed on any physicians or hospitals. I also do not see any incentives to use

any certain health care providers. It seems that this insurance plan mostly just provides discounts

on any services I might use. Since I have just received this kind of insurance, I have not had the

need or opportunity to use their services yet. Personally, I do not like the fact that this insurance

is so expensive and does not necessarily cover much health expenses, but rather gives me a

discounted price. However, it does seem like a reliable insurance company. I am aware of the

fact that there many insurance companies, not only health insurances, that do a poor job of

helping you find the best plan for you and sometimes you end up spending more than what the

insurance plan covers.


References

"Health Insurance Plans for Individuals | UnitedHealthcare." Health Insurance Plans for

Individuals | UnitedHealthcare. N.p., n.d. Web. 11 Nov. 2013.


Prevalence, Causes, and Coping Strategies of Stress amongst Junior and Senior Female

College Students


Abstract

In this survey research 50 females of the junior and senior class in California Baptist

University were asked various questions regarding lifestyle behaviors from major work load,

grade point average (GPA), sleeping, eating, and exercise habits, and relationship status. The

purpose of this study was to identify the causes, management, and perceived levels of stress

among female college students. The survey was organized with questions pertaining to

demographics, descriptive research questions, and perceived levels of stress scales. Four scales

measured stress relating to school, work, relationships, and other sources. Descriptive analysis

was conducted to find the relationship between lifestyle behavior and stress levels. It was

expected that there is a proportional relationship between level of physical exercise, healthy

eating patterns, and sleep. Those who sleep within 6-9 hours should have lower stress levels and

they should increase if sleep is inadequate below 6 hours of sleep or above 9 hours. Also those

who have healthy eating patterns, eating 3 full meals, should have lower stress levels. Routine

exercise has previously demonstrated to decrease stress levels. This research helped determine

whether a load of responsibilities increase level of perceived stress such as unit load,

extracurricular activities, relationships, and jobs.


Table of Contents

CHAPTER 1: INTRODUCTION 5

Purpose of this Study 5

Research Question 5

Significance 5

Limitations of the Study 6

Delimitations of the Study 6

CHAPTER 2: LITERATURE REVIEW 7

CHAPTER 3: RESEARCH METHODOLOGY 11

Design 12

Participants 12

Measures 13

Procedures 14

Data Analysis 15

CHAPTER 4: RESULTS 15

Demographics 15

CHAPTER 5: DISCUSSION 19


Conclusion 19

Discussion 20

Recommendations 21

REFERENCES 23


CHAPTER ONE

INTRODUCTION

The purpose of this research was to analyze the prevalence, causes, and coping strategies

amongst junior and senior female college students. There is lack of research demonstrating how

lifestyle behaviors and stress from different sources affects female students. The correlations that

caused stress were identified through the lifestyle of 50 female college students, which included

work, school, relationship, and lifestyle behavior. The American Journal of Health Studies

states, “Emotional and Cognitive reactions to stressors occurred more frequently, and behavioral

and physiological reactions to stressors were reported less often” (Misra & McKean, 2000). It

also concluded that there was greater correlation between stressors and reactions to stressors

with time management behaviors than with leisure satisfaction. Strategies that reduced

behavioral reactions to stressors and increased cognitive reaction were through goal setting and

prioritization of time.

Research Questions

1. How does social support affect stress form work, school, relationship, and other factors?

2. How does stress from one source affect another? (i.e. stress from school, association to

stress from work)

3. How do student lifestyle behaviors such as amount of sleep, activity level, and eating

patterns, unit load, and GPA affect perceived levels of stress?

Significance

In previous research there is evidence by The American College Health Association that 42.8%

of college students have reported more than average stress (ACHA, 2013). According to ACHA

the overall stress levels have increased amongst female college students with a total of 56.8%,

reporting more than average stress and tremendous stress within the last twelve months. A


significant amount of the student population reported that stress affects academic performance.

Some of the correlations that were investigated in this study that played a role in the

development of stress were, relationships, employment, school, and social support. Given the

impact on academic performance college administrators should assess the factors among female

college students. This research can provide affective resources that help mitigate stress

symptoms and is helpful for coping techniques.

Limitations of the Study

It was expected that participants in this study were to answer the questions honestly,

completely, and to the best of their knowledge. There may be misunderstandings on the

interpretation of the questions. The time when the surveys were administered to the participants

was during the middle of the course semester. Stress levels vary from those of the beginning of

the semester and those at the end of the semester. This was a convenience sampling, which

indicate that some of the participants come from different college departments and it’s expected

that certain schools are excluded such as engineers.

Delimitations

In one study it demonstrated that first and second year students have added stress from

transitions to new environment and more rigorous courses than their upper classman peers (Ford

et al., 2014). Based on this, the study was conducted to junior and senior female college students

to eliminate stress from transitions. Women tend to perceive situations as being more stressful

than men (Eaton & Bradley, 2008). It was beneficial to focus on the female population to get a

better understanding of their correlations associated with stress from different sources.

CHAPTER TWO

LITERATURE REVIEW


In previous research there is various evidence that demonstrates perceived level of stress

is affected by a multitude of different stimuli. Stress is a stimulus response interaction between

the subject and internal and external factors. There is research that has shown that there is

correlation between lifestyle decisions that result with different levels of perceived stress.

However, there is a majority of research that demonstrates that students typically experience

moderate to high levels of perceived stress. In a 2013 Research on Dietary Patterns studying

relationship with perceived level of stress among college students showed that perceived level of

stress among college students tend to be moderate with the majority, 68.3% of students within

the moderate level. They also found that there was no association with income, gender, BMI,

perceived level of stress, and perceived course load. However, it did find that course load was

significantly correlated to perceived levels of stress (Fabian et al., 2013). A study done on

pharmaceutical students also found that there was a significant direct association between

academic workload and perceived academic stress (Ford et al., 2014). In fall of 2009 National

college health assessment reported that 20% of college students in a nationwide survey reported

sleep difficulties as a factor for that contributes to academic performance ranking 2nd after stress.

In addition poor quality sleep has shown to make students tenser, irritable, anxious, depressed,

angry, and confused. It was also interesting to find that there is disconnect between how students

perceive their sleep quality and their day-to-day motivation to getting things done. Other studies

demonstrated poorer sleeping patterns and more suffering of consequences from college female

students than men. This leads to poor academic performance, and more physical, social and

emotional problems (Orzech, Salafky, & Hamilton 2011).

When referring to how women and their coping strategies, one study found that women

tend to perceive situations as more stressful and they cope by using emotionally focused

techniques (Eaton & Bradley, 2008). When looking at social connectedness, which is a construct


of a sense of belonging, social inclusion and exclusion, and loneliness, it was significantly

correlated with perceived level of stress among women and men. It demonstrated strong

correlation of perceived level of stress by measuring social connectedness through social

appraisal. With negative appraisals there was a direct negative effect of social connectedness.

However, there was only a 9% variance between perceived level of stress and social appraisal,

which suggests that there are other personal and social factors contributing to stress. This study

had a subject pool size of 214, with 111 men and 103 women participating. It showed that

women have more interdependent self-construal. So when measuring social connectedness there

was a 21% total variance. In other words, women who gave more positive appraisal have more

social connectedness. The article suggests that women who feel more socially connected tend to

also be able to cope with stress more effectively (Lee, Keough, & Sexton, 2002). Another study

also suggests female students engaged in talking twice as often as either attending class or

studying which indicates a high degree of social connectedness. However, at times it was also a

source of stress in college women school activities such as out of class assignments, class

attendance, class projects have accounted for largest amount of stress. Also communicating,

mobility, and work were rated as highly stressful (Larson, 2006). Indicative of coping

mechanisms studies show that individuals who make behavioral attributions to chance have

higher perceived levels of stress and poorer wellbeing than those with high demand and high

control (Carvahlo et al., 2009) and (Larson, 2006).

Another article presents information on psychological distress among female college

students. It states that, “College presents a number of potential stressors that may lead to

psychopathology, such as academic overload, continual pressure to succeed, competition against

peers, financial hardship, and worries about the future (Vázquez, Otero, & Díaz, 2012). These

stressors increase the probability of developing personality disorders, depression, work


difficulties, anxiety, and social problems. A sample that was done within Spanish college

students, 60% displayed psychological distress and 33% had elevated depressive

symptomatology, which means individuals have a high risk of developing depression. None of

the studies in this article compared relations between mental health problems with their area of

study or year of study. Studies that were done on women only, mainly amongst developed

countries, females were more likely to present higher rates for mental disorders such as anxiety

and depression. The methods used for this study were first term of academic year from 2008-09’;

a population of 42,138 female college students registered in three universities of Galicia located

in a region of Spain. Random sampling was used for 1,054 women who were 1st-3rd year, or

4th6th year. Via postal study or telephone were applied to this study to inform the participants

about the study, its risks, and benefits. The results of the study were that females under 20 years

of age showed more distress than older women, for example, younger females revealed greater

sensitivity. Students with financial difficulties and working while studying have poorer mental

health. The limitations of this study included random sampling, cross-sectional design; it did not

analyze origin or etiology of emotional distress; it focused mainly on psychological distress.

In the article, The Influence of Perceived Stress, Loneliness, and Learning Burnout on

University Students’ Educational Experience, explains that stressors such as loneliness and

burnout are encountered during student’s educational career. Loneliness is experienced through

social network and relationships. The authors also state, “Essentially, several factors can initiate

the feeling of loneliness, including a lack of satisfaction with one’s social relationships,

expectations not meeting the reality of social status, or a deficit in emotional connectivity”

(Stoliker & Lafreniere, 2015). According to this article, these types of stressors may develop

poor physical health, depression, and psychological distress. “Burnout” develops through

academic pressure, homework overload, psychological factors, emotional exhaustion, etc.


University students develop stress because one deals with homework, exams, work, clubs,

volunteer positions, and family problems. There were 150 undergraduate students at a medium

sized university located in Ontario, Canada that played a role in this study. A multi ethic

population was used in this study and in order to participate in the study students had to be

registered in at least one psychology class and be registered in the Psychology Participant Pool.

Throughout the study, “it was concluded that feelings of perceived stress were associated with

poor physical and psychological symptomology, such as depression, high blood pressure, greater

susceptibility to infection, as well as social (Cohen et al., 1983). The feeling of loneliness and

learning burnout would negatively influence individual’s academic experience, which was

assessed by educational engagement and academic performance, and perceptions of stress

(Stoliker & Lafreniere, 2015). In an article by Ranjita Misra and Michelle McKean it states,

“Stressors affecting students can be categorized as academic, financial, time or health related,

and self-imposed” (Goodman, 1993; LeRoy, 1988). It is reported that females experienced

higher self-imposed stress and more physiological reactions to stressors than males. Males show

lower anxiety levels and experience satisfaction through leisure activities. Females are able to

manage their time wisely, plan for their future, and approach tasks and workplace better than

males.

CHAPTER THREE

METHODOLOGY

Taking into consideration previous research studies a hypothesis was formed to study the causes,

management, and perceived levels of stress in female college juniors and seniors. A survey study

was designed to observe relationships between behaviors and perceived levels of stress. This

could contribute with identifying behaviors that can exacerbate stress for female college juniors


and seniors, and find solutions to decrease unnecessary stressors. The research can also help in

improving attitudes towards stimuli that cause stress. Using a randomized survey study from

participants of different college departments allowed a generalized understanding of stresses that

affect upper-classmen females.

Design

This research design was a cross-sectional non-experimental administrative survey study. These

surveys were distributed to female students on the California Baptist University campus at

different points during a five day period. Female students were informed of their contribution to

the research study also noting that this questionnaire was completely anonymous. The survey

provided self-reported estimations.

There were various independent variables measuring four categories of sources of stress. These

four sources were school, work, relationships, and other. The variables influencing the perceived

levels of stress were physical activity, unit load, social support, amount of relaxation and sleep,

activity involvement, and residential status. The dependent variables are the self-reported

perceived levels of stress.

Knowing that stress has various factors contributing to it, a few questions were designed to

measure behaviors and attitudes of their daily living. A few examples of these types of questions

are knowledge based questions such as “Do you think social support is important to your

wellbeing?” Questions were also used to assess certain behaviors such as those pertaining to

amount of sleep, relaxation, unit load, and number of meals per day.

General demographic data was also collected. The data collected involved college of major,

class, GPA, residential status, and age. No medical histories were collected, nor were any

samples from participants collected for testing.


Participants

The target data collected were from female juniors and seniors attending California Baptist

University. Disqualifying factors for participants was based on sex and age of students. This

group was chosen to eliminate factors due to home sickness and resistance to change and

adaption to social environment.

In total, 50 participants were necessary to provide statistically significant findings. The selection

of these participants was completely random to exclude any possibility of bias.

Measures

The total amount of survey questions were 17 used to examine the selected population. The

questions and reporting scales that were used were based on standardized tests.

Demographics

At the beginning of our questionnaire were self-reported demographic questions meant to provide

general information of the participant. Participants were provided the option of choosing the school in

which their major was classified under. The options listed were College of Allied Health, College of

Architecture, Visual Arts, and Design, College of Arts and Sciences, College of Engineering, School of

Behavioral Sciences, School of Business, School of Christian ministries, School of Education, School of

Music, School of Nursing, and Online and

Professional Studies (OPS). There was also the option of choosing under which category classes

fall under such as in during the day, night, OPS, or other. Residency questions were asked in the

form of checking either living off campus within an hour away, off campus (1hr or more away),

or on campus. Information on the participant’s class status was asked as junior or senior. GPA

information was divided into 5 clusters: 2.0 - 2.49, 2.5 - 2.99, 3.0 - 3.49 or 4.0 - above.


Participants were asked to fill in their age. Finally, was marking whether participants had a

parttime job, full-time job, more than one job, or no job.

The rest of the questions focused on the causes, management, and perceived levels of

stress.

Part A

Part A of the survey focused on research dedicated to collect information of causes,

management, and attitudes and behaviors in terms of social support. Three questions of Part A

focused on possible causes of stress. Two questions were dedicated to attitudes and behaviors

towards social support. The last four questions of Part A were aimed to determine management

habits of stress.

The portion of the questionnaire based on causes of stress asked students’ involvement in

different activities, relationship status, and the amount of units taken in the spring 2015 semester.

The questions relating to attitudes and behaviors of social support used a likert scale. Participants

were given options of circling 1-5; one being strongly disagree and 5 being strongly agree. The

remainder of the questions consisted of amounts of exercise, relaxation, sleep, and meals. These

questions are force response.

Part B

Part B of this survey was dedicated to researching perceived levels of stress in various

areas of their life. This portion of the survey asked participants to circle their perceived level of

stress using a likert scale ranging from 1-5 in the areas of school, work, relationship, and other;

one being no stress to minimal stress and 5 being very stressed.


Procedures

Participants were chosen randomly from the California Baptist University Campus within

a five day period. The selection of these participants was done in person, and all surveys were

completed via hard-copy. Each participant was informed on the purpose of the study and all

information provided in the survey was completely anonymous and was not traceable.

The majority of the questionnaires were completed within ten minutes. Each survey was marked

with a random number to identify the case prior to being handed out. Once all surveys were

completed and collected, they were filed randomly for future analysis.

Data Analysis

Provided by the university, we used the software program, Statistical package for the

Social Sciences (SPSS). This program was used to enter data and relate findings under

supervision and counseling. Every case was based on the identification number given to each

survey.

CHAPTER FOUR

RESULTS

Demographics

Of the 50female participants of the junior and senior class, 24% (n=12) are Behavioral Science

majors, 22% (n=11) are College of Allied Health majors, 14% (n=7) are College of Arts and

Sciences majors, and 12% (n=6) are School of Nursing majors. Of the 50 participants of the

junior and senior class, 90% (n=45) are enrolled in day classes and 10% (n=5) are enrolled in

night/Online Professional Studies (OPS). Of the 50 participants of the junior and senior class

56% (n=28) reside on campus and 32% (n=16) reside off campus within an hour away, and12%

(n=6) reside off campus more than an hour away. Of the 50female participants of the junior and


senior class, 68% (n=34) are juniors and 32% (n=16) are seniors. Of the 50 participants of the

junior and senior class, 36% (n=18) have a grade point average (GPA) of 3.5 and above, 36%

(n=18) have a GPA of 3.0-3.49, 18% (n=9) have a GPA of 2.5-2.99, and 10% (n=5) have a GPA

of 2.0-2.49. Of the 50 participants of the junior and senior class, 37% (n=19) are 21 years of age,

18% (n=9) are 23 years of age, 18% (n=9) are 22 years of age, and 12% (n=6) are 20 years of

age. Of the 50 participants of the junior and senior class, 66% (n=33) have a part time job, 20%

(n=10) have no job, and 10% (n=5) have a full time job.

Major Findings

Research question #1: How many units are you taking this semester?

Analysis: Of the 50 female participants of the junior and senior class, 56% (n=28) are taking

1518 units, 40% (n=20) are taking 12-14 units, and 4% (n=2) are taking more than 18 units.

Research question #2: Are you in a relationship?

Analysis: Of the 50 female participants of the junior and senior class 64% (n=32) are single, and

36% (n=18) are in a relationship.

Research question #3: Do you feel like you have a strong social support

Analysis: Of the 50 female participant of the junior and senior class 40% (n=20) strongly agree

that they have strong social support, 36% (n=18) agree that they have strong social support, 12%

(n=6) neither agree nor disagree, 6% (n=3) disagree that they have strong social support, and 6%

(n=3) strongly disagree that they have strong social support.

Research question #4: Do you think social support is important to your well-being? Analysis:

Of the 50 female participant of the junior and senior class 46% (n=23) agree that social


support is important to their wellbeing, 42% (n=21) strongly agree that social support is

important, 8% (n=4) strongly disagree that social support is important to their well-being, 4%

(n=2) neither agree nor disagree.

Research question #5: How many hours per week do you exercise?

Analysis: Of the 50 female participants of the junior and senior class, 46% (n=23) exercise 1-2

hours per week, 20% (n=10) does not exercise, 20% (n=10) exercises 3-4 hours a week, 14%

(n=7) exercises 5 or more hours per week.

Research question #6: Generally sleep about how many hours per night?

Analysis: Of the 50 female participants of the junior and senior class 60% (n=39) sleep about 6

to 9 hours per night, 36% (n=18) sleep less than 6 hours per night, and 4% (n=2) sleep more than

9 hours.

Research question #7: Normally eat how many meals per day?

Analysis: Of the 50 females participants of the junior and senior class 50% (n=25) normally eat 2

meals per day, 40% (n=20) normally eat 3 meals per day, 6% (n=3) normally eat 4 meals per

day, and 4% (n=2) normally eat 1 meals per day.

Research question #8: Circle perceived level of stress from school

Analysis: Of the 50 female participants of the junior and senior class 56% (n=28) have a

perceived level of stress of 4, 24% (n=12) have a perceived level of stress of 5, 14% (n=7) have

a perceived level of stress of 3, and 6% (n=3) have a perceived level of stress at 2.


Research question #9: Circle perceived level of stress from work

Analysis: Of the 50 females from the junior and senior class 30% (n=15) have a perceived level

of stress from work of 1, 32% (n=32) have a perceived level of stress from work of 2, 22%

(n=11) have a perceived level of stress from work of 4, 12% (n=6) have a perceived level of

stress of 3, and 4% (n=2) reported no stress from work.

Research question #10: Circle perceived level of stress from relationships

Analysis: Of the 50 females from the junior and senior class 42% (n=21) reported they have a

perceived level of stress from relationships of 1, 16% (n=8) reported they have a perceived level

of stress of 2 from relationships, 20% (n=10) have a perceived level of stress of 3 from

relationships, 16% (n=8) have a perceived level of stress of 4 from relationships, and 6% (n=3)

have a perceived level of stress of 5 from relationships.

Data Interpretation

In order to interpret the data in SPSS, Spearman correlation was used. Statistically significant

findings included the following: stress from school and social support, stress from work and

social support, and stress from other sources and social support. Other findings included

relationships between one stress and another such as: stress from school and work, stress from

school and other, and stress from other and relationships. Other correlations were between other

and social support being important to well-being, amount of relaxation and stress from school,

and amount of relaxation and stress from other.

It was found that as stress increases from work so does stress from school. There was also a

direct relationship as stress from school arises so did stress from other factors and vice versa.

Subjects who agreed that social support was important to their well-being tended to have lower


perceived levels of stress than those who disagreed with the claim. Those who agreed with the

claim “Do you think that social support is important to your well-being?” also had felt they had a

strong social support. Also, high levels of stress correlated to less time to relax.

CHAPTER FIVE

DISCUSSION

Conclusion

Using Spearman two-tailed analysis the research found significant associations between social

effect and perceived level of stress, and stress affecting another source of stress. Regarding the

former, female students that felt strong social support demonstrated to have lower levels of stress

than those who reported feeling weak social support. Regarding the latter, stress from one source

had direct relationship with another source of stress. The study found if perceived level of stress

from school increased then perceived level of stress from work also increased. The same

relationship was found for stress from other and stress from school and stress from relationships

and other. There was no significant association between any student lifestyle behaviors and

perceived level of stress. Student behaviors such as sleeping, eating patterns, and exercise did

not correlate with perceived level of stress.

Discussion

The study supports previous research on how social support effects perceived stress in college

females. Females who report strong social connectedness tend to cope more effectively with

stress than those who do not have a sense of support. As mentioned previously in other findings,


women have a more interdependent self-construal. There was also evidence of a direct

relationship between stress from one area and another. A previous study on financial stress

demonstrates that students who work more than twenty hours per week reported high stress

levels that impact academic progress (Trombitas, 2012). It was particularly interesting that the

study found no association between student lifestyle behaviors and stress. Previous studies

demonstrate that exercise can mitigate stress for individuals and lack of sleep has demonstrated

to increase mental health problems for female students. (Orzech, Salafsky, & Hamilton, 2009).

The lack of evidence of significance could be due to error in survey question design. Since the

answers were written in a nominal method, it could not be measured by SPSS means. An ordinal

design of the answers might have been more effective.

Recommendations

The research suggests that school administrators would benefit to assess stress among students

on campus so they may provide effective resources to cope with stress. With correlations

showing that there is evidence of stress rising, when work stress rises, administrators may

provide education to the student body about how to manage time wisely. Social connectedness

was shown to have an inverse relationship with perceived level of stress, which indicates that

community is important to the college environment. Knowing this, prospective female students

should account for sense of community and connectedness when making decisions on a college

to attend.

For future research the data found no correlations between students’ lifestyle behaviors and

stress levels. There may be error in the design of survey questions since there is a significant


amount of research that demonstrates that there is association between amount of sleep, activity

level, and workload. It is imperative that survey be designed with ordinal scales to assess degree

of association. Also ‘stress from other’ is a broad and general term which needs to be defined

since there is indication that stress from ‘other’ sources are affecting stress within the academic

spectrum. These other sources may be club involvement, outside commitments such as weddings

or community events, or financial stress. Since this study was focused on upper-classmen

students there is also an imposed stress from plans of future employment with no certainty. A

more focused population on a particular major would also help adapt stress coping resources for

students within a certain field.


References

American College Health Association. (2013). Reference Group Executive Summary. American

College Health Association.

de Carvalho, C. F., Gadzella, B. M., Henley, T. B., & Ball, S. E. (2009). Locus of Control:

Differences Among College Students' Stress Levels. Individual Differences Research,

7(3).

Eaton, R. J., & Bradley, G. (2008). The role of gender and negative affectivity in stressor

appraisal and coping selection. International Journal of Stress Management, 15(1), 94.

Fabián, C., Pagán, I., Ríos, J. L., Betancourt, J., Cruz, S. Y., González, A. M., ... & Rivera-Soto,

W. T. (2013). Dietary patterns and their association with sociodemographic

characteristics and perceived academic stress of college students in Puerto Rico. Puerto

Rico health sciences journal, 32(1).

Ford, K. C., Olotu, B. S., Thach, A. V., Roberts, R., & Davis, P. (2014). Factors Contributing to

Perceived Stress Among Doctor of Pharmacy (PharmD) Students. College Student

Journal, 48(2), 189-198.

Larson, E. A. (2006). Stress in the lives of college women:“Lots to do and not much time”.

Journal of Adolescent Research, 21(6), 579-606.

Lee, R. M., Keough, K. A., & Sexton, J. D. (2002). Social connectedness, social appraisal, and

perceived stress in college women and men. Journal of Counseling & Development,

80(3), 355-361.

Misra, R., & McKean, M. (2000). COLLEGE STUDENTS'ACADEMIC STRESS AND ITS

RELATION TO THEIR ANXIETY, TIME MANAGEMENT, AND LEISURE

SATISFACTION. American Journal of Health Studies, 16(1), 41-51.


Orzech, K. M., Salafsky, D. B., & Hamilton, L. A. (2011). The state of sleep among college

students at a large public university. Journal of American College Health, 59(7), 612619.

Stoliker, B. E., & Lafreniere, K. D. (2015). The Influence of Perceived Stress, Loneliness, and

Learning Burnout on University Students' Educational Experience. College Student

Journal, 49(1), 146-160.

Trombitas, K. (2012). Financial stress: An everyday reality for college students. Lincoln, NE:

Inceptia.

Vazquez, F. L., Otero, P., & Diaz, O. (2012). Psychological distress and related factors in female

college students. Journal of American College Health, 60(3), 219-225.


Violence Prevention for Gang Affiliated Youth

Ariana E. Ochoa


HSC310

Public Health Promotion and Disease Prevention

Dr. LaChausse

November 24, 2014


Violence Prevention for Gang Affiliated Youth

The issue of gangs has been one that has existed since the1500s, and began to receive a

significant amount of attention in the past 80 years, particularly the participation of delinquent

youth. Sheldon et al. (2004) acknowledge an early study by the Illinois state police, in it is

mentioned a gang called the Forty Thieves founded in New York around the 1820s. It is believed

to be the first youth gang formed in the United States. (p. 2). These gangs would typically

“mark” their names on walls, commit acts of murder and robbery, and had a high rate of racial

tensions. We can see that these are all characteristics of gangs that exist today. After the Great

Depression, public attention to gangs oscillated, and didn’t gain very much back until the 1950s.

The media raised much public concern for the growth of youth gang activities. There came a

“rapid deployment of technology, databases and the proliferation of gang experts…” (Sheldon,

Tracy, & Brown, 2004, p. 3). With the rise of this awareness, especially in schools, gang

awareness and resistance techniques were incorporated into lectures. Students were not allowed

to wear what was considered “gang-related” clothing. Teachers and educators were trained to be

able to identify gang members and any concealed weapons they might be carrying. The rise of

these gang affiliated youth are typically found in inner-cities, however are spreading to urban

areas and smaller communities. With the spread and growing commonality, it is extremely

difficult to find a region in the United States that is without youth gangs.

Now, public health promotion specialists are conducting research studies and

implementing programs to reduce the prevalence of these gangs, violence affecting their

communities and the population as a whole; even preventing the risk of personal victimization.

Factors being considered are delinquency, mental health, gender differences, school status, class

status, minority populations, and problem behaviors. Those working in the public health

department find that youth gangs is an important issue to address because it causes tensions


between people groups; upper class versus lower class, and tensions between specific races. The

violence that arises from involvement in gangs leads to the death of lives and incarceration of

minors. Involvements in these types of groups also demonstrate a threat or existing signs of

social and psychological consequences to the individual and future generations. In various

projects, researchers are attempting to find the root of the cause and the solution in reducing the

prevalence of youth gangs.

Every year, law enforcement in the National Youth Gang Survey (NYGS) reports gang

problems. It was found that there was a 15 percent increase in youth gang problems between

2002 and 2008. In different segments of the U.S., populations reported increases in gang

problems; in suburban counties a 22 percent increase, in rural counties a 16 percent increase, in

smaller cities a 15 percent increase, and in larger cities a 13 percent increase. In the mid-1990s,

the presence of gangs in schools was 28 percent. That statistic decreased to 17 percent in 1999,

however, began to increase again up to 23 percent in 2007. (Howell, 2010, p. 2). According to

Howell and Hawkins (1998), there seems to have been “a spread in adolescence-limited

offending rather than an increase in the prevalence of life course-persistent offenders in the

population.” (p. 273). As previously mentioned, there are consequences to certain behaviors to

being involved in a gang, and one of the major contributing factors is violence. Ellickson et al.

(1997) conducted a research study in which a longitudinal database of over 4,500 high school

seniors and dropout from California and Oregon was used. Their measures include violent

behavior, substance use, school status, academic orientation, mental health, and delinquency.

What they found was that 54 percent of the participants had engaged in some sort of violence in

the past year, and 23 percent committed violent acts towards family members or acquaintances.

One in four had been involved in at least one type of predatory violence including carrying a

hidden weapon. Of those carrying a weapon, 25 percent had the intention of hurting or killing


a person. It was also found that males were up to five times more likely to be involved in most

types of violence than females. (Ellickson, Saner, & McGuigan, 1997, p. 985-987). In

various articles and studies conducted all over the United States it is found that members of

these gangs are typically male, of a minority group, live in certain geographic locations, and

typically have a low socioeconomic status. “According to the 2008 NYGS, half

(50%) of all gang members are Hispanic/Latino, 32% percent are African American/black, and

11 percent are Caucasian/white.” (Howell, 2010, p. 3). We can also see that larger and more

populated cities have the highest rates of gang activity.

As we can see from the data provided by dedicated public health departments, that there

is a huge issue with violence among youth, and that violence is amplified with the involvement

in gangs. Howell and Hawkins (1998) state “Current violence prevention approaches seek to

reduce or eliminate factors that predict a greater probability of violence in adolescence and

young adulthood and strengthen factors that mediate or moderate exposure to risk.” (p. 263).

Although there are certain factors that contribute to putting an adolescent at a high risk for

violence and delinquency cannot be changed, having the knowledge can help distinguish the

populations that need preventive interventions the most. In such interventions, the goals are to

decrease risk and increase protection.

As we were previously informed, there are several factors that that can determine and

explain the reasons that certain behaviors are present. The involvement of an adolescent in this

type of group can have serious long term effects, especially since they are in a stage of

adjustment and development. The initial consequences of their membership are violent behaviors

and serious delinquency. The longer an adolescent is involved in a youth gang, the probability of

arrest and conviction in adult life is greater. Dupere et al. (2007) tells us of the consequences this

can have; “In the longer term, joining a youth gang appears to be a key element in a process of


distancing oneself from conventional society, a process with consequences that persist well

beyond the actual period of gang involvement.” (p. 1035). Often times, these adolescents place

themselves in premature adult roles such as parenthood and school dropout. One of the reasons

that there are cities with higher rates of youth gangs is because of impoverished neighborhoods.

They typically have a “reduced capacity for effective social control over the behavior and

activities of youth groups.” (Dupere, LaCourse, Douglas Willms, Vitaro, & Tremblay, 2007, p.

1036).

It is true that youth gangs tend to accumulate in disadvantaged communities. This

increases the likelihood that a teen might join a youth gang, however there are many adolescents

that are predisposed and are more probable to join a youth gang despite their current

circumstances. In a study conducted in Montreal, Canada, it was found that those with high

levels of hyperactivity, low levels of pro-sociality, and anxiety in kindergarten were at a greater

risk to join a youth gang. According to Dupere et al. (2007), this type of profile in children could

indicate early psychopathic tendencies. (p. 1036). Blair et al. (2001) describe psychopathy as a

disorder of a combination of insensitiveness, incapability to feel guilt or regret, prone to

boredom, and poor behavioral controls. Criminals characterized by this disorder are known to

commit a large amount of crime, constantly go against societal obligations, appear to lack

loyalty, and not concerned when confronted with the destructive nature of their behavior. (Blair,

Colledge, Murray, & Mitchell, 2001, p. 491). Children that show psychopathic tendencies are

reinforced when adolescents select peer groups that seemed to accept them. This means that

teens with risks on neighborhood and family levels were in particular likely to affiliate with

anomalous peers and exhibit behavior problems.

While disadvantaged communities and psychosocial tendencies play major roles in

determining the probability an adolescent will join a youth gang, there are several other factors to


take into consideration. These factors can be traced back as early as life in the womb. “Early

predictors of childhood oppositional behaviors have been identified. These include prenatal and

perinatal difficulties…” (Howell & Hawkins, 1998, p. 269). Howell (1998) also has found some

evidence that prenatal distress and complications during pregnancy lead to violent children who

are raised in unstable home environments. (p. 269). Aggressive behavior may also be linked to

neuropsychological disorders that affect cognitive processes. The same goes for attention

problems such as ADHD. Another prominent factor is academic difficulty. It may be argued that

difficulty in this area is linked to antisocial behavior; having problems in learning, reading,

speech, writing, and memory. Youths who frequently change schools are often found to be more

violent later in life. Both antisocial behavior and academic difficulty are linked to violent

behavior in childhood leading up to adolescence.

We know that the majority of a child’s peers are from school. We also know that violence

spreads in social contexts. The interaction between peers can escalate to the spread of violence.

Those known as “instigators” are youth who tend to be older with a longer offense history;

“joiners” are youth that are less experienced, but gain experience through their “instigator” peers.

A large proportion of school-related victimizations, better known as bullying, come from peer

interaction in daily activity. The majority of this violence occurs mostly in areas that are not

supervised by teachers or school staff, and may even be provoked. Provocation can be in the

form of insults, rough play fighting, or verbal teasing. The violence in school settings is only the

beginning of the larger issue of youth gangs. (Howell & Hawkins, 1998, p. 274-275).

As children grow and develop, they take on characteristics of their environment; taking it

as a model for their behavior. The biggest influences on this are parents. When parents do not

clearly delineate the expectations for behavior from their child, are too harsh, or are inconsistent

in punishment, they place their child in a state that may increase their risk for aggressive


behavior. “Child-rearing practices such as poor supervision, poor communication, parent-child

conflict, and frequent physical punishment predict physical aggression…” (Howell & Hawkins,

1998, p. 271). It has been found that relations between parents and their children is the strongest

predictor of adolescent behavior. In order to prevent this, parents must realize that it is crucial to

be involved in their child’s life and provide opportunities to bond as a family.

When addressing the issue of violence in adolescence, there are two main groups to take

into consideration. First, are those who begin to demonstrate oppositional and aggressive

behavior from childhood; these continue on into adolescence and even adulthood with increased

intensity of violent acts. The proper term for these offenders is life-course-persistent offenders.

Second, are those that commit these violent behaviors in adolescence. These are referred to as

adolescent-limited offenders. Life-course-persistent offenders begin in childhood, where they

engage in troublesome behaviors and often times lack an ability to concentrate. These children

also demonstrate antisocial behavior in different environments and circumstances. At different

stages of their lives is when certain behaviors are more prevalent. For instance, “…biting and

hitting at age four, shoplifting and truancy at age ten, selling drugs and stealing cars at age

sixteen, robbery and rape at age twenty-two, and fraud and child abuse at age thirty.” (Howell &

Hawkins, 1998, p. 265). As opposed to a history of childhood antisocial behavior in life-

coursepersistent offenders, adolescent-limited offenders do not. This characteristic does not arise

until adolescence. Engaging in antisocial behavior can also depend on whether responses are

beneficial to them and vice versa. Behavior can also vary with different situations. A teenager

might shoplift with a group of friends, but abide by school and family rules. Both groups of

adolescents are at risk to being lead into a youth gang.

When adolescents are involved in or affiliated with a youth gang, there are several

consequences that accompany this sort of activity; such as monetary, social, and personal costs.


An issue that several scholars address is victimization. According to Miller (1998), because of

gender differences, women are more susceptible to be victimized. This is especially true in

sexual crimes. (p. 433). While some of the consequences are irreversible; such as teen

parenthood, homicide, or suicide, there are programs constantly being planned, implemented and

evaluated in order to prevent further advancement of the issue.

In Howell’s (2010) article, he addresses a few prevention programs; evaluating them

based on the clarity of the framework of the program, program fidelity, the strength of the

evaluation’s design, and evidence proving that the program prevents or reduces problem

behaviors. He has also categorized the programs to be as level 1, 2, or 3. Level having been

scientifically proven, have a high quality research design, contain a control group in the research

design, and may be considered exemplary or model programs. The other levels are based off of

whether they contain these elements and characteristics in their program. (Howell, 2010, p. 13).

The first is a primary prevention program, Level 2. “The Gang Resistance Education and

Training (G.R.E.A.T) Program is a school-based gang-prevention curriculum that has

demonstrated evidence of effectiveness.” (Howell, 2010, p.13). The program lasts 13 weeks and

is offered by law enforcement officers. In these 13 weeks students are taught not only the

dangers of gang-involvement, but also emphasize cognitive-behavioral training, development in

social skills, refusal skills, and conflict resolution. This program is also available to elementary

schools and families, and has a summer program. Although this program is not based on any

theory, it has shown to have short-term effects on the intended goals. Those who evaluated the

program believe that these effects were due to the program and not outside sources because the

program was implemented with fidelity and the evaluation utilized a randomized experimental

design. (Esbensen, Peterson, Taylor, Freng, Osgood, & Matsuda, 2011, p.67).


A model program that provides an excellent example of an effective early intervention

program is the Preventive Treatment Program in Montreal; a secondary prevention program. It

has been successful in reducing gang involvement, although that was not the original purpose of

the program; it was to “prevent antisocial behavior among boys ages 7 to 9 with a low

socioeconomic status who had previously displayed disruptive behavior in kindergarten.”

(Howell, 2010, p. 13). The program had evidence that a combination of parent training and

childhood skill development is able to prevent children from joining gangs before they reach

mid-adolescence. They were able to improve school performance and reduce delinquency and

substance abuse. This program is based on the Social-Cognitive Theory.

A theory that is commonly used in interventions is the Social Cognitive Theory (SCT).

Fertman and Allensworth (2010) describe SCT as defining “human behavior as an interaction of

personal factors, behavior, and the environment.” (p.64). The constructs involved are reciprocal

determinism, behavioral capability, expectations, self-efficacy, observational learning, and

reinforcements. The best programs are based off of evidence of previous programs and theories;

such as the modeling of observational learning in the SCT. A logic model is the best approach to

begin to develop a program in order to address the goal, behaviors, determinants, and base it off

of successful programs. I would also suggest incorporating sessions to teach parents how to

intervene in the lives of their child in an effective and positive manner; also bettering the

community to promote a pro-social environment. These two components along with an in-school

based program. Below is a logic model displaying the major topics discussed previously.


Logic Model: Violence Prevention for Gang Affiliated Youth

Interventions

and Activities

Determinants Behaviors Health

Goal(s)

•

•

•

Gang

Resistance

Education and

Training

(G.R.E.A.T.).

Preventive

Treatment

Program

Aggression

Replacement

Training

(ART)

(Howell,

2010, p.13).

•

•

•

• •

• •

•

•

Family

Adversity

Violent youth

“models”

Spread of

violence across

adolescents in

the population

School Failure

Poor Social

Environments

(Dupere,

LaCourse,

Douglas

Willms, Vitaro,

& Tremblay,

2007, p. 1036).

Rejection/Anger

Attention

Problems and

hyperactivity

(ADHD).

(Howell &

Hawkins,

1998, p. 269).

Victimization

Lack of ability

to concentrate

•

•

•

Persistent

aggressive

behavior as

children

Selfdestructive

behaviors (i.e.

drug/alcohol

abuse)

(Howell &

Hawkins,

1998, p. 271).

Criminal

Activity

Involvement

(Howell &

Hawkins,

1998, p. 265).

Reduce

violence in

youth

affiliated

with a gang

• Antisocial Behavior

(Blair,

Colledge,

Murray, &

Mitchell, 2001,

p. 491).


In regard to future research and practice, I would recommend studying more geographic

locations and determining where to implementing programs. This would be effective in

determining the specific behaviors and determinants that are most prevalent in that population in

order to effectively address that area. The program would function in a much more orderly

fashion and would produce the best results. I would also separate groups by age, gender, and

economic class. This is because the being in a gang affects these groups differently; each has

their own experience as a member. Finally, I would research whether bullying and gangs are

relational and how they affect each other. Studies in this area can reduce violence in more

aspects in the lives of children.


References

Blair, R. J. R., Colledge, E., Murray, L., & Mitchell, D. G. V. (December 2001). A Selective

Impairment in the Processing of Sad and Fearful Expressions in Children With

Psychopathic Tendencies. Journal of Abnormal Child Psychology, 29(6).

Dupere, V., Lacourse, E., Willms, J. D., Vitaro, F., & Tremblay, R. E. (July 2006). Affiliation to

Youth Gangs During Adolescence: The Interaction Between Childhood Psychopathic

Tendencies and Neighborhood Disadvantage. Journal of Abnormal Child Psychology,

35(1035).

Ellickson, P., Saner, H., & McGuigan, K. A. (1997). Profiles of Violent Youth: Substance Use

and Other Concurrent Problems. American Journal Of Public Health, 87(6), 985-991.

Esbensen, F., Peterson, D., Taylor, T. J., Freng, A., Osgood, D. W., Carson, D. C., & Matsuda,

K. N. (2011). Evaluation and Evolution of the Gnag Resistance Education and Training

(G.R.E.A.T.) Program. Journal of School Violence, 10(53).

Esbensen, F., Winfree, L. T., Terrance, He, N., & Taylor, T. J. (2001). Youth Gangs and

Definitional Issues: When is a Gang a Gnag, and Why Does it Matter?. Crime and

Delinquency, 47(105).

Fertman, C. I. & Allensworth, D. D. (2010). Health Promotion Programs: From Theory to

Practice. San Francisco, CA: Society for Public Health Education.

Howell, J. C. (December 2010). Gang Prevention: An Overview of Research and Programs.

Howell, J. C., & Hawkins J. D. (1998). Prevention of Youth Violence. Crime and Justice, 24.

Miller, J. (1998). Gender and Victimization Risk Among Young Women in Gangs. Journal of

Research in Crime and Delinquency, 35(4).

Shelden, R. G., Tracy, S. K., & Brown, W. B. (2004). Youth Gangs in American Society.

Belmont, CA: Wadsworth Cengage Learning.


Peterson, D., Taylor, T., & Esbensen, F. (December 2004). Gang Membership and Violent

Victimization. Justice Quarterly, 21 (No. 4).


Hoarding: A Community Health Problem

Taylor Jenkins & Ariana Ochoa

HSC300 Health Communication

Dr. Parks

December 6, 2015



Hoarding

Overview of Disorder

Hoarding is the insistent difficulty to discard or part with possessions, regardless of their

actual value. This behavior usually has harmful effects emotionally, physically, socially,

financially, and even legally. These effects not only affect the hoarder but also close family

members and friends. People hoard because they believe that an item will be of use or obtain

high value at some point in the future. The items that tend to be kept around have sentimental

value, are irreplaceable, or cannot be decided to throw away. The hoarder may also consider an

item as a reminder that will spark their memory about a certain person or event that they are

scared to forget about. Mostly, they cannot bring themselves to making an executive decision of

where something belongs causing them to settle with keeping it. (Neziroglu, 2015) Hoarding

disorders are very challenging to treat because most people often don't see it as an issue or have

little awareness of how it's hurting their life. Many others are able to realize they have a problem

but are hesitant to seek help because they feel extremely ashamed, embarrassed, or guilty about

it. (National Health Service, 2015)

Importance of Health Issue

A lack of functional living space is a common threat amongst hoarders. Their living

conditions transform into an unhealthy and dangerous environment for any individual entering

the home. Homes affected by hoarding often are furnished with broken appliances, which leave

the homeowner without heat and other necessary comforts. They learn to cope with their

malfunctioning systems rather than opening their home to allow a qualified person in to fix the

problem. The rise of hoarding in America produces serious risk to those who are affected by this

psychiatric disorder. Such unhealthy conditions can drive people to separation or divorce,

eviction, or even loss of child custody. Along with devastating living conditions, hoarding also


brings about anger, resentment, and depression amongst family members, which can affect

relationships and the social development of young children. Hoarding may also lead to serious

financial problems. Homelessness can occur if the local Department of Public Health orders the

person out of the home if the landlord can prove that the level of hoarding seriously violates the

terms of the lease. Health problems range from falls or accidents to the inability of emergency

personnel to enter and remove an ill resident. Hoarded items not only include clutter but also

garbage and animal or human feces, which can result in mold or infestation in the house. In the

presence of mold, serious respiratory and cardiac issues can arise. A lack of sanitation can be

especially dangerous to individuals suffering from compromised immune systems. (Health and

Human Services, 2015)

Magnitude and Scope of Health Issue

Perfectionism, indecision, and procrastination are all unique and significant

characteristics commonly associated with hoarding cases. It is suspected that those who have

achieved a higher level of education are more likely to hoard insignificant objects. Hoarding

behavior usually begins in teen years of childhood or adolescence; however it often doesn't

become a burden until the later years of life. The issue has always been present but not relevant

enough that no one has noticed. People with a hoarding disorder have a tendency to be single or

become single due to their condition conflicting with their relationship. Hoarders often avoid any

social outings by choosing to isolate themselves from other people. Hoarding is not a very

common disorder but when it is present it may harm one’s self or affected loved ones. Based on

estimates retrieved from a study conducted by US college students, the prevalence rate of

compulsive hoarding disorder is between two and four percent. The number of those with

Obsessive Compulsive Disorder that also suffer from compulsive hoarding comes out to less

than 1 in 200 people or 0.5% of the population. OCD has a lifetime prevalence of one to two


percent of the population and around 25% to 30% of patients with OCD are also diagnosed as

compulsive hoarders. Compulsive hoarding, however, has not had any major epidemiological

studies conducted treating it as its own disorder. Researchers suspect that this is a very

conservative estimate and it is actually much higher nearing five percent of the population.

(Cluttergone, 2014)

Summary of Research on Biological and Social Determinants of the Health Issue

In the past 25 years, there has been a rising curiosity in hoarding among mental health

clinicians, academic researchers, and ultimately the population. It is estimated that approximately

2-5% of the American population are hoarders. There are still many questions regarding the

cause(s), however it has been found that this appears to impact men more often than women

(Bratiotis, C., 2013, p. 245). In recent studies it was also found that 20-30% of people suffering

from Obsessive Compulsive Disorder (OCD) are hoarders; similar findings was among

individuals with anorexia nervosa, psychotic disorders, depression, and organic mental disorders.

Comparative studies have taken place between non-OCD and OCD hoarding patients; “all

[OCD hoarding patients] have found greater functional disability and more severe

psychopathology in hoarders.” (Saxena, S. & Maidment, K.M., 2004, p. 1146). In this same

study, hoarders had more anxiety, depression, personality disorder symptoms, and family and

social disability. This indicates that compulsive hoarders behave in a unique manner and have

similar characteristic patterns of symptoms and disability. Genetic and family studies have

suggested that the hoarding factor of OCD is different than other OCD symptoms. The hoarding

symptom shows an autosomal recessive inheritance pattern and has been associated to certain

genetic markers. Furthermore, 84% of compulsive hoarders reported a family history of hoarding

behaviors. This may suggest a subgroup or some sort of variant of OCD (Saxena, S. &

Maidment, K.M., 2004, p. 1146).


Hoarding behavior typically begins a young age, however it isn’t as notable or severe until it

reaches the elderly population. The issue is that only 15% of elderly clients that exhibit

substantial problems with hoarding recognized it. In other words, most elderly hoarders do not

realize there is an issue. This lack of discernment may be due to memory-loss or the sense of

responsibility to avoid being wasteful. A characteristic that is typical to the hoarding population

is the strong belief about the necessity of saving possessions. Many even displaying violent

behavior towards friends or family who attempt to dispose of their things (Frost, R., Steketee, G.,

& Williams, L., 2000, p. 229-230).

Interventions towards the Target Audience

In attempts to reduce the progression of hoarding behaviors, there are several treatment

options for patients. These are used to treat the symptoms of the determinants, not necessarily

hoarding itself. A common factor among people with anxiety and depression is the inhibition of

Serotonin in the brain. An effective treatment falls under pharmacotherapy; Serotonin Reuptake

Inhibitor (SRI). The combination of the medication and cognitive- behavioral therapy (CBT) has

been proven to be effective. The basis of CBT model outlines four main problem areas:

information processing deficits, problems in forming emotional attachments, behavioral

avoidance, and incorrect beliefs about the nature of possessions. The goals of the use of the

treatments is to decrease clutter, improve decision making and organizational skills, and

strengthen urges to accumulate and save items (Saxena, S. & Maidment, K.M., 2004, p. 1146).

The most difficult part of approaching the issue of hoarding is receiving knowledge of those

hoarders. Currently, the only intervention there is against this is officials coming to that person’s

home in an attempt to coerce them into seeking treatment and discarding of those items.


Recommended Actions for Target Audience

A recommendation to begin intervention would have to be on any parents’ part. Since we

know that hoarding behaviors begin at an early age, parents would need to teach their children

skills and behaviors that involve beliefs about amounts of possessions and organizational skills.

In terms of addressing this issue in older generations, there would have be reports of hoarders in

communities to confront the issue. However, there may be another way of knowing, instead of

waiting for responses from the community. There could be the possibility of placing a policy in

action to inspect homes every 5-10 years. To be more cost efficient, possibly performing

inspections more frequently in areas where populations are more susceptible to have hoarders.

This would require more studies on individuals in communities, possibly through sample size

surveys. The surveys could focus on questions that would trace symptoms to anxiety, depression,

OCD, and others linked to hoarding. Once hoarders are located, then give a warning to the home

owner to seek treatment and discard of those items, otherwise a fine may be placed on them.

These recommended actions may have a greater impact on reducing hoarding and reduce the

depletion of necessary resources on what could have been addressed earlier.

Conclusion

Hoarding is a terrible condition that affects not only the individual, but can branch out to the

community, and ultimately an entire population. This can potentially threaten every aspect of a

person’s life; financially, legally, physically, emotionally, psychologically, and so on. The

measures taken to handle this issue take a toll on communities’ resources that could hinder

assistance in other areas. There are several steps that individuals and the government can take in

order to prevent it from ever happening or addressing it quickly. Of course, as any intervention,

the process will take time, planning, and funds. However, these goals are attainable with careful

consideration of all contributing factors.


References

Bratiotis, C. (2013). Community hoarding task forces: a comparative case study of five task

forces in the United States. Health & Social Care In the Community, 21(30, 245-253.

Cluttergone. (2014). Prevalence and Demographics. (Cluttergone, Producer) Retrieved from

Compulsive Hoarding: http://www.compulsive-hoarding.org/Prevalence.html

Frost, R., Steketee, G., & Williams, L. (2000). Hoarding: a community health problem. Health &

Social Care In The Community, 8(4), 229-234.

Health and Human Services. (2015). Risks Caused by Hoarding. (C. W. Massachusetts, Producer)

Retrieved from Mass.gov:

http://www.mass.gov/eohhs/consumer/behavioralhealth/hoarding/risks-caused-by-

hoarding.html

National Health Service. (2015). Hoarding Disorder. (N. H. Service, Producer) Retrieved from

NHS Choices: http://www.nhs.uk/Conditions/hoarding/Pages/Introduction.aspx

Neziroglu, F. (2015, July). Hoarding: The Basics. (A. a. America, Producer) Retrieved from Anxiety

and Depression Association of America:

http://www.adaa.org/understandinganxiety/obsessive-compulsive-disorder-

ocd/hoarding-basics

Saxena, S., & Maidment, K.M. (2004). Treatment of compulsive hoarding. Journal of Clinical

Psychology, 60(11), 1143-1154.


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