Running Head: COMMUNITY ASSESSMENT

Community Assessment: Behavioral Dimension

Alyssa Cardinal, LeAnna Ceglia, Ikneet Kandola, and Andrea Valdez
California State University, Stanislaus

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Community Assessment: Behavioral Dimension

There are many factors that influence the health of a community. Health disparities and
differences between populations within a community are some of these contributing factors. The
ability to have safe places to exercise, to eat a balanced diet, participate in recreational activities,
have a safe sexual life, live in safe housing, are but some of the areas in which health disparities
exist. By evaluating pre-existing research as well as conducting our own survey, we will address
Merced residents behavioral considerations and any health disparities that exist.
Exercise
Exercise is an important component in health promotion and wellness. Exercise
combined with proper nutrition can make significant changes in an individuals life. In Merced
County, 29.9 percent of individuals have no time for either leisure or physical activity
(Professional Research Consultant, 2012). To gain a better understanding of Merced residents
exercise accessibility and frequency, the survey asked questions to gain insight on where
individuals from the community exercised, how often, the type of exercise performed and the
affordability of a gym membership. A total of six surveys were completed by individuals
ranging from upper to lower class. Individuals were given the option to either state their name or
remain anonymous. The survey that was conducted in the city of Merced indicated that 50
percent of residents exercised 1 to 2 times a week, 33 percent exercised 3 to 5 times a week, and
17 percent exercised 6 or more times a week (personal communication, October 1, 2014). Upper
income residents have the freedom to exercise at the gym and in their neighborhoods, while low
income residents are restricted to exercising in their homes. Middle class residents expressed a
variety of different exercise environments. This separation of opportunities between the

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different socioeconomic levels showcases a health disparity for the lower income families,
thereby affecting their overall well-being.
Leisure Activities & Recreational Facilities
To assess the typical leisure activities of Merced city residents, statistical information
was drawn from personal interviews, a self-conducted survey, and published research. To gain a
better understanding of the populations leisure activities, the survey asked residents about what
they do in their spare time and what facilities they feel are accessible to them. According to the
survey, it was discovered that upper income residents of Merced prefer walking for leisure and
utilized recreational facilities such as gyms, malls, dine-in restaurants, and movie theatres.
Middle income residents prefer watching TV and movies, shopping, playing video games, and
going to the park. It was also found that they use similar facilities as upper class residents, in
addition to bowling alleys, bars, and nightclubs. According to a low income resident from south
Merced, residents from this area enjoy playing video games, watching TV, and drinking alcohol
in their spare time. Due to lack of accessibility, low-income residents gravitate toward facilities
such as movie theatres, bars, and nightclubs (anonymous, personal communication, October 1,
2014).
To gain a better understanding of facility accessibility, an interview was conducted with
the manager of a local gym. Fitness Evolution Gym, a newly constructed facility located in the
center of Merced, is available for use seven days a week with long operating hours to
accommodate its members schedules (anonymous, personal communication, October 1, 2014).
The facility is extremely affordable with a monthly cost of only ten dollars per month. Because
of its affordability, the gym is occupied by all social classes, with most being of the middle
socioeconomic class.

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

communication, September 25, 2014). It was discovered that the City of Merced offers any array
of affordable leisure activities to its residents. The classes consist of yoga, Zumba, karate,
jujitsu, Sunday dances, social dances, hunter safety, indoor youth soccer, and summer outdoor
youth soccer. The classes occur in a variety of locations such as local parks, sports facilities, and
the Senior Community Center. The city of Merced offers a wide variety of recreational and
leisure activities for its residents, which some still may find inaccessible due to its cost. Aside
from cost, safety of parks is also a large concern for this population. Parks appear littered with
trash and heavily populated with homeless people. Parks are also a common ground for drug
paraphernalia, in which a resident states that they worry about stepping on dirty needles or
coming in to contact with illegal substances (anonymous, personal communication, October 1,
2014).

Health Hazards
There are many health hazards in Merced, making the community more susceptible to
disease processes and decreased quantity and quality of life for its residents. Research has
shown that a major part of the Merced population is employed by the company Foster Farms.
Many employees that work for this company stand or sit in the same position for hours with two
breaks within an eight hour shift. Approximately 43.5 percent of jobs entail mostly sitting or
standing, thus leading to stiff joints and back problems (Professional Research Consultant,
2012).
The high incidence of underage drinking among all socioeconomic income levels is
another health hazard that this community faces with 47.9 percent of the population being
current drinkers (Professional Research Consultant, 2012). According to a registered nurse from
Mercy Hospital, overconsumption of alcohol leads to a high admission rate in the emergency

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

hazard, putting Merced residents at risk for pulmonary conditions including chronic obstructive
pulmonary disease and various cancers involved with smoking tobacco. According to the
survey, which asked residents about the percentage of tobacco use in their neighborhood, it was
found that tobacco use is 0 to 24 percent in the upper socioeconomic class, 25 to 50 percent in
the middle socioeconomic class, and 75 to 100 percent in the lower socioeconomic class
(anonymous, personal communication, October 1, 2014). Of the Merced population, 13.1 percent
of residents are current smokers (Professional Research Consultant, 2012).
Alcohol
According to some residents, alcohol consumption is an escape route for many of Merced
Countys poor community. They claim that many residents become alcoholics due to depression
for lack of resources and the simple fact of being poor (anonymous, personal communication,
September 10, 2014). Unfortunately, alcoholism often masks depression and or mental illnesses
leading to other health problems such as liver failure, accidental deaths, violence, as well many
other negative effects and health outcomes. The Centers for Disease Control and Prevention
(CDC), in junction with the local health departments, has been working very hard to decrease
alcohol intake along with its mortality not only in Merced County, but all across the country.
According to the Merced County health needs assessment report, alcohol intake is more
prevalent among men, residents under 65, higher income adults and Caucasians (Professional
Research Consultant, 2012 pg. 151). The effects of alcohol have great impact not only at ones
home, but the community as a whole. Society pays millions of dollars in taxes to provide mental
health programs, hospitalizations and public health programs. According to a registered nurse at
Mercy Hospital in Merced, many individuals are transported by ambulance and admitted to the

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

October 1, 2014). The nurse reported at least two patients per shift admitted to the emergency
department due to overconsumption of alcohol. These individuals are of all different ages,
genders, and social classes. The Merced County Health Needs Assessment report states social
attitudes and political and legal responses to the consumption of alcohol and illicit drugs make
substance abuse one of the most complex public health issues (Professional Research
Consultant, 2012 pg. 148).
Fortunately, Merced County offers several programs for treatment and recovery from
drug use and alcoholism, including Adolescent Treatment, CalWORKS, The Center, Judicial
Treatment Services, Perinatal Recovery Program, and various prevention programs (Alcohol &
Drugs, 2014). Information was also gathered from the survey conducted regarding resources that
are available to help residents quit the use of tobacco. According an upper socioeconomic
resident, the resources that are available include doctor prescribed medications, nicotine patches,
nicotine gum, group therapy/support groups, as well as individual therapy (M.R., personal
communication, October 1, 2014). According to a couple of middle class residents, the resources
they find available to quit tobacco use includes the same as the upper class with an addition of
electronic cigarettes that monitor nicotine levels (anonymous, personal communication, October
1, 2014). The lower class, however, according to a resident, does not have as many resources
they find available. The few resources that seem accessible include nicotine gum and a few
group therapy/support groups (anonymous, personal communication, October 1, 2014).

With

that being said, emphasis on better education tools, assessment techniques and care to certain
individuals/populations will help benefit the county in decreasing mortality rates, suffering, and
expenses associated with alcoholism.

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Drug Use
Drug use is another big issue in Merced County. Similar to alcoholism, drug abuse is a
complex disease in which depression and mental illness are major factors. Just like alcohol, drug
use also has many negative effects on the individual as well as the society in general. According
to community indicators of alcohol and drug abuse for Merced County, 67 percent of hospital
discharges are related to drug and alcohol use, 12.9 percent of arrests are due to drug violations,
and about 28.1 percent of deaths are caused by drug and alcohol abuse (Community Indicators of
alcohol and drug abuse Merced County, 2004).
Tobacco Use
Tobacco use is another substance that is hard on the body. It affects every organ system
leading to diseases such as strokes, vascular damages, visual changes, renal damage and failure,
high blood pressure, lung problems and many types of cancers. It has been fifty years since the
release of the first Surgeon General report that warned the American citizens of the hazards
associated with smoking. Since that report, Americans have changed their attitudes about
smoking greatly, however much work still needs to be done to completely eradicate its
use/abuse. According to the Merced County Health Needs Assessment Report of 2012, tobacco
use is the single most preventable cause of death and disease in the United States. Each year,
approximately 443,000 Americans die from tobacco related illnesses. For every person who dies
from tobacco use, 20 more people suffer with at least one serious tobacco related illness (2012).
In Merced County a total of 13.1 percent of Merced County adults currently smoke cigarettes,
either regularly (8.5 percent every day) or occasionally (4.6 percent on some days (Professional
Research Consultant, 2012, p. 157). There are an array of smoking cessation programs, most of

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which are provided by the state, however the University of California, Merced offers cessation
resources available on its website.
Sexual Practices
In continuing with the results of the survey conducted on Merced residents, many
questions were asked concerning sexual practices and family planning. These questions included
gaining knowledge on what type of contraceptives are available in their neighborhood, where
people in the neighborhood mainly get their contraceptives, average age that minors become
sexually active, how common is teenage pregnancy, and the availability of sex education for
minors. The upper class resident reported a wide variety of available contraceptives purchased at
doctors offices, clinics and pharmacies. The average age that sexual activity begins is claimed to
be 18 or older (R., M., personal communication, October 1, 2014). There was also a denial of
teenage pregnancies and sex education is provided in the home as well as at school. Middle class
residents also reported having multiple forms of contraceptives including the Depo Provera shot.
These methods of birth control are obtained from stores, doctors offices, Planned Parenthood
Clinics, pharmacies, and family members and friends (anonymous, personal communication,
October 1, 2014). The average age of sexual activity begins between ages 16 and 17 years old.
Middle class residents admit to a common occurrence of teen pregnancies and sex education
being received in the home and at school. Low socioeconomic class residents reported the main
source of contraceptives are condoms, which are most commonly purchased at convenience
stores. The average age of sexual activity for this class has a wider range being 15 to 18 years of
age with sex education provided primarily in the school. There was also a report of teen
pregnancy being a common occurrence (anonymous, personal communication, October 1, 2014).
Although there appears to be a discrepancy between the socioeconomic classes on how common

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teen pregnancy is, according to kidsdata.org, an average of 39.4 out of 1,000 teens are pregnant
in Merced County (2014).
An interview was conducted at the local Planned Parenthood (PPH) clinic to assess the
programs and resources available to its community members (anonymous, personal
communication, October 1, 2014). It was noted that PPH offers a wide variety of available
contraceptives to prevent pregnancy with the most commonly used contraceptive being the birth
control pill. The average age of patients ranges from 12 to 65 years of age with most coming
from the middle socioeconomic class. This agency provides treatment, resources, and referrals
for family planning, prenatal care, pregnancy terminations, sexually transmitted infection
treatment and counseling.
Housing
A survey about housing was conducted with the residents of the North, Central, and
South parts of Merced (personal communication, October 1, 2014). It was revealed through
observation and survey that North Merced has larger well kept homes on larger plots that house 5
to 6 members per household, have security alarm systems, and are associated with the high
socioeconomic income level. Central Merced has average sized homes on smaller plots that
house anywhere from 3 to 8 per household, have security alarms, bars, and screens. Some of
these homes were better kept than others and are linked with the middle socioeconomic class.
South Merced has small, run down homes or apartments with a majority that house 4 to 5 per
household. These homes typically have bars and metal screens on the doors and windows for
added security, and are affiliated with the lower socioeconomic class.
Sources of Stress
Through survey, we assessed the major sources of stress for Merced residents of all
socioeconomic classes. According to many south Merced residents, one of the major sources of

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stress is the lack of jobs and income (anonymous, personal communication, October 1, 2014).
According to a resident from north Merced, the largest stressor is declining health among aging
individuals (anonymous, personal communication, October 1, 2014). Middle class residents
reported that their major stressors consist of job availability, financial security, poor family
relations, safety of their neighborhoods, affordable housing and affordable medical care
(anonymous, personal communication, October 1, 2014). Due to the majority of residents in this
area being low income, non-English speaking, and uneducated, they have a tough time finding
year round work. According to the United States Census Bureau, 2013 there are 24.6 percent of
individuals living below poverty levels in Merced. Lack of knowledge and access to resources
leads to other disparities such as depression, drug and alcohol use, and teenage pregnancy. Many
young people find escape venues such as joining gangs or committing crimes. Merced residents
also reported high gang activity is a major cause of stress for the community as well as unsafe
city parks and neighborhoods that harbor the potential for violence (personal communication,
September 10, 2014).
Nutrition
It has been well documented that good nutrition leads to good health outcomes.
However, in the same manner poor nutrition coupled with inactivity can lead to chronic life-long
diseases and obesity. Unfortunately, the communitys lack of nearby resources can worsen the
outcomes for some of its residents. Lack of supermarkets that offer fresh fruit and vegetables is
a significant issue within Merceds County poorest communities. According to the Centers for
Disease Control and Prevention, the risk of dying from cardiovascular disease, cancer, diabetes,
and stroke are greatly decreased by maintaining a healthy diet and increased physical activity
(2009). Current statistics show that 17 percent of Merced county residents are dying prematurely

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due to poor diet and inactivity with 207 percent of residents dying from heart disease and 25.8
percent dying from diabetes mellitus. In relation to Merceds residents, 70.7 percent are
overweight and 35.9 percent are obese (Professional Research Consultant, 2012). In the survey
conducted, there were three pictures that depicted three different types of meals ranging from
healthy to unhealthy. The upper and middle class residents chose the middle plate, stating that
the majority of their meals consist of half healthy and half unhealthy foods. Alternatively, one
low income resident felt that the majority of his neighborhood ate similar to the unhealthy plate
(anonymous, personal communication, October 1, 2014). Most of the population in south Merced
is Hispanic. Their diets consist of high fat, and carbohydrate meals due to the preparation of food
with lard, which is a cheaper alternative to cooking with oil. After conducting the survey and
personal interviews, it appears that the south Merced population needs education on how to
prepare healthy meals and how to gain access to healthier food resources.
Nursing Diagnosis
Altered nutrition: more than body requirements related to: an excessive intake in relation
to metabolic needs; the lack of knowledge of nutritional needs, food intake, and/or
appropriate food preparation; poor dietary habits; a sedentary lifestyle as evidenced by
the high rates of overweight and obese residents.

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

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

Researchable Question
Will the implementation of maternal and child health education for pregnant teen mothers
prevent complications and reduce risks of maternal and child health?
Program Activities: Interventions, Planning, and Support Activities

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It has been well established that teen pregnancy and childbearing leads to huge amounts of
costs, not only to the teen and their families, but also to the cities, counties, states, and the
country as a whole. Schaffer, Goodhue, Stennes, and Lanigan (2012), found on the life
trajectory of teen mothers and their children, poor outcomes in educational attainment,
socioeconomic status, marital status, and school progress (p. 218). The CDC has teen
pregnancy prevention as the sixth priority in order to improve health and quality of life of our
youth. The CDC is also partnering with state agencies to develop and promote evidence-based
programs to educate youth on pregnancy prevention, sexually transmitted disease prevention,
values, communication skills between teens and parents or caregivers, as well as other programs
(CDC, 2013). Schaffer et al. (2012), stated literature on adolescent parenting featured relevant
theories including mentorship, social support, social competence, and resiliency that guided
program development (p. 219). For Merced County, a teaching project for local schools was
developed to reduce maternal and child health risks and decrease teen pregnancy and births to
adolescent women.
Goals
Reduce teen pregnancy rates.
Provide culturally competent education to adolescents on the need of open
communication about sexual practices and prevention. This effort should be a top
priority.
Increase access to early prevention programs, i.e. Planned Parenthood.
Support and promote teen moms to remain in school and graduate.
In order for this teaching project to be successful, certain things needed to be in place for the
program activities to happen. This included:

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

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

support (projector, screen, computer, and flash drive), visual aids, handouts, and
pamphlets needed to be in place beforehand.

School addresses, phone numbers, directions, and the number of students needed to be
known to formulate the proper teaching plan.

Pre-intervention start-up activities included:

The clinical instructor had an idea about teaching teens about teen pregnancy and
maternal and child care. This idea was turned into a project to test the effectiveness of
this teaching plan on the adolescent population.

Meetings between the clinical instructor and the teachers occurred to arrange the schedule
and build a trusting relationship.

The clinical instructor and the teachers followed up via email over the summer and this
semester.
The stakeholders in the teaching project are the teachers, teenagers, and the community

health student nurses conducting the teachings. The needs of the teachers are that they would
like to see a decreased rate of teen pregnancies in their schools. The needs of the teenagers
are that they need the proper education to care for themselves and their children and to
prevent future teen pregnancies. The needs of the student nurses are that they must be
educated about evidence-based and evidence-informed strategies to reduce teen pregnancy
and maternal-child risks, as well as data of needs and resources needed in the community to
accomplish the stated goals. This project did not include partner/stakeholder workshops.

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Activities that led to developing capacity of partners included education and lecture (like
the lecture by the clinical instructor) about increased rates of high risk teen pregnancies and
how teaching this population can help in the decrease of teen pregnancies and high maternalchild risks associated with it.
One of the most important goals is to prevent pregnancy, however once the teen is
pregnant, the second most important goal, is to have a healthy pregnancy and infant. It is also
important to keep these girls from dropping out of school. Lee SmithBattle (2006) found that
teen mothers continue to lag behind their non-parenting peers in education (p. 130). Providing
these teens with emotional support is crucial in ensuring a better outcome for their own and their
childrens future. A case manager or school nurse could work closely with these teens to assist
in motivation and goal achievement, SmithBattle explains that many of these girls commonly
report desires of continuing their education, but lack of support from their teachers, parents, and
society in general undermine their goals, she stated teens with the least tangible family and
community support had the greatest difficulty attending school and becoming successful
students (2006, p.132).
In preventing teen pregnancy, it is the responsibility of parents/guardians, adults, and
community members to develop ways of educating and communicating with or our youth on
pregnancy prevention. Unfortunately, many cultures avoid providing their children with safe sex
conversations since in many cultures, sex before marriage is considered against the religious
practices and norms. The assumption is that teens are to practice abstinence until marriage,
which in this day and age is considered unrealistic, neglectful, and ignorant. Parents must be
educated on how to engage in such conversations, which could be very uncomfortable and
awkward, but it builds a trusting relationship with their children. This would also allow the

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parents to have a positive impact on the childs coping mechanisms, attitudes, and behaviors
related to sexuality. In a study by Murray, Berne, Lammers, and Strack (1999), it was found that
educating parents was one of the recommendations to help reduce teen pregnancy, they stated in
the context of teaching healthy parenting, it is important to teach the rights and responsibilities of
parents for being the primary sexuality educators of their children (p.148). Knowing at what age
to approach children is also an important aspect, therefore parents should be provided with the
tools needed to educate their teens.
This study also focused on educating religious communities/organizations with their
recommendations; they felt that if these organizations are aboard with safe teen sexual education
the outcomes would be better. Murray et al. (1999), stated if the religious institutions in the
community are viewed as leaders on moral issues, leadership that supports comprehensive
sexuality education within these institutions has to be developed and supported in their efforts
(p. 148). All in all, the community as a whole should provide and support such programs for
reduced teen pregnancy rates and risks of maternal-child health. Such programs are very
expensive, but in the long run would be a cheaper way to prevent teen pregnancy and all
expenses that arise from supporting teen parents and their children.

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Teaching Adolescents with Age and Culture Appropriate Methods

In the article Teaching Strategies for the Net Generation, Berk addresses the relationship
between generations from the years 1982 to 2007 (2009). He describes what each generation is
known for by providing a brief description of their habits and tendencies. However, while each
generation varies from one another, they have one main thing in common - becoming easily
disengaged with school and finding the material boring. The high level of disengagement is due
to poor instructional strategies in which the students have a difficult time relating to. For
example, many teachers use text books, bombard the students with words versus visual aids and
provide little to no time for interaction. However, the author has alternative teaching methods to
help engage adolescents in the class room setting.
Berk addresses twenty different teaching implications to consider while interacting with
adolescents. These implications include remaining aware that this generation is technologically
savvy, relies on search engines to gather information, is interested in multimedia, prefers
everything at a quick speed, learns best by doing and not being told what to do, learns through
trial and error, is great at multitasking, has a short attention span, and learns best with visual aids.
Other considerations to keep in mind when teaching adolescents include their craving for social
face-to-face interaction, they thrive on constant feedback and immediate gratification.
The next step in reaching out to adolescent students is to became better acquainted with
their characteristics, behaviors, and habits to design and custom tailor your teaching strategies
for them. Consider each characteristic and how one or more teaching techniques can draw on
their specific interests, intelligences, and learning styles. You should be sensitive to their
individual strengths and weaknesses and try to build on the former before helping them to

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compensate for the latter (Berk, 2009, p. 14). In other words, each student should be
individually assessed and teaching should be specific to their needs.

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References

Alcohol & drug. (2014). Merced County California. Retrieved from

http://www.co.merced.ca.us/copyright.aspx
Berk, R. (2009). Teaching Strategies for the Net Generation. Retrieved from John Hopkins
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http://www.kpu.ca/sites/default/files/Teaching%20and%20Learning/TD.3.2_Berk_Teach
ing_Strategies_for_Net_Generation.pdf

Center for Applied Research. (2004). Community indicators of alcohol & drug abuse risk
in Merced. Retrieved from http://www.wonder.cdc.gov/wonder/sci_data.
Centers for Disease Control and Prevention (CDC). (2013). Teen pregnancy prevention 20102015. Retrieved from http://www.cdc.gov/teenpregnancy/preventteenpreg.htm.
Livermore, T. (2012). Health Status Profile. Retrieved from
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Lucile Packard Foundation. (2014). Teen birth. Retrieved from
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22,341,338,350,342,329,325,359,351,363,340,335&tf=67&sortColumnId=1&sortType=d
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Murray, L.V., Berne, L.A., Lammers, J.W., Strack, R. (1999). Pregnancy prevention, sexuality
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Professional Research Consultants, Inc. (2012). Community Health Needs Assessment Report.
Merced County, California. Mercy Medical Center Merced. Omaha, Nebraska. Retrieved

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from http://www.co.merced.ca.us/index.aspx?nid=82
Shaffer, M.A., Goodhue, A., Stennes, K., Lanigan, C. (2012). Evaluation of a public health
nurse visiting program for pregnant and parenting teens. Public Health Nursing, 29
(3), pg. 18-231. doi:10.1111/j.1525-1446.2011.01005.x
SmithBattle, L. (2006). Helping teen mothers succeed. Journal of School Nursing. ---(). Pg.
United States Census Bureau. (2013). Merced County California. Retrieved from
http://www.census.gov/

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