Community Health Problem Identification - Research Paper Example

Community Health Assessment Affiliation Community health assessment Introduction United States continue to battle the increasing rates of teenage smoking amidst growing health concerns. Everyday in the United States, approximately 4,000 kids under the age of 18 are involved in cigarette smoking (Kitara et al., 2012). Notably, the majority of these young consumers is largely unaware of the existing health problems, besides majority of them ends up becoming addicted after repeated experimental exposure. Moreover, statistics indicate that early exposure to cigarette at teenage predisposes to other drugs such as marijuana and alcohol.sadly the habit is prevalent among the black community in New Jersey. Today, 86% of lung cancer mortality are caused by cigarette smoking, it is, therefore, a community health concern in New Jersey and the entire country (Sussex 2004). Community Health Problem Identification The prevalence of teenage smoking in New Jersey is an increasing local and national health concern. Notably, according to a 2011 health survey in New Jersey, it identified that 18.7% of the middle and senior high school teenagers were involved in active smoking (Kitara et al., 2012). Besides, it identified that over 80% of the adult smokers are involved in smoking that teenage age. Besides, there has been an increasing trend of experimental smoking due to teenage peer pressure that has increased significantly within the Bergen county in New Jersey white community. Sadly, over 60% of the teenage expose to smoking are from the black community (Chen et al., 2012). In the wake of increased community health awareness, the demographics of the study cohort significantly determine program intervention. Demographic Description In Bergenfield community health systems continue to be baffled by the rising cases of senior and middle high school teenage cigarette smoking. Furthermore, according to the American Community Survey showed that by 2010 the median household income was at $82.446 with a marginal error of +/- $ 6.568. In addition, the survey indicated that there was approximately 3.9-5.7% of the families were below the poverty line (Chen et al., 2012). Although the population census did not identify the health problems that exist in this locality, health care surveys have highlighted teenage cigarette smoking as a serious health care concern. Chen et al., (2012) states that 2010 census indicated a dynamic population in New Jersey, it noted that 17.1% of the population in the New Jersey state came from Bergen. In addition, there were 8852 households within this community in which 35.5% of the household had children under the age of 18, the majority of whom are high school. Besides, the study area covers 9,306.5per square mile which is approximately (3,593.3km2). Furthermore, the racial composition indicated that the majority of the population is whites at 52.42% with black community coming third at at 0.31%. In addition, the findings indicated hat 23.9% of the total population were under the age of 18 years (Chen et al., 2012). In light of identifying community health problem, there is a relative high level of teenage smoking that has become a health care challenge and the need to unrest it has been to increase. The increasing national rate of teenage smoking continues to be a national concern. In 2009, it was estimated that 46.6 million of the United States population were identified as addict smokers that need intervention (Chen et al., 012). Sadly, 19.5% of the smokers were teenagers and the rates were on the increase. Surprisingly, both male and female were significantly involved in smoking. Evidently, 17.9% of the smokers were female while 23.5% of the male population was smokers (Kitara et al., 2012). At Bergenfield, the statistics were relatively reflective of the national statistics. According to the findings, the most prevalent racial group was the whites, with white females more prone to cigarette smoking at the high school level. Leading Causes of Morbidity and Mortality in Bergenfield The most prevalent diseases in New Jersey include mainly chronic diseases that largely link with the high number of deaths caused by these diseases. According to Burden of Chronic Disease study, it revealed that 39% of adults in New Jersey reported having hypertension (Kitara et al., 2012). Diabetes comes second at 28% other leading diseases includes arthritis at 27%, respiratory tract diseases and cardiovascular-related diseases crowns the top most prevalent diseases (Underwood 2012). According to 2008 Center of Disease Control (CDC) Burden of Chronic Disease Report, it indicated that cardiovascular diseases are leading causes of death. A survey conducted by CDC in 2005 in New Jersey revealed 29% people died of heart-related diseases (Underwood 2012). Notably cancer was recorded to be the second killer at 24% that translate to 49,370 deaths. In addition, the American Cancer Society identified that lung cancer contributed 6080 of the total cancer deaths which are second after breast cancer (Tobacco control state highlights 2010). Other leading causes of deaths includes stroke, chronic respiratory diseases, and the fifth cause was unintentional injuries. Environmental Analysis of Teenagers Smokers in Bergenfield While so many theories exist on the reasons of increasing rates of teenage smokers, the environmental factors remain the critical elements that identify the underlying causes. According to Center of Disease Control (CDC) Smoking Report 2010, it identified that the leading influence of teenage smoking is the environmental background (Tobacco control state highlights 2010). In line with this theoretical fundamental, notably children raised in families of smokers have 2.4 times likely to smoke as compared with the those raised by non-smokers. Evidently, the New Jersey statistics indicates that majority of households have at least one smoker (Tobacco control state highlights 2010). In addition, teenage environment is two-tired, firstly is the household. The parents’ role and guidance is a critical element that would determine the teenage behavioral pattern. Smoking status in any family is largely determined by the smoking status of the parents. With increased adult smoking at 21.3% in New Jersey, it creates an encouraging environment that children can engage in experimental smoking (Corey 2013). While parents remain aware of the effects of indoor smoking, the majority of whom continue to expose their children to the harmful effects of indoor smoking. The greatest health challenge is the ability to create parental awareness on the importance of promoting safe smoking. Several researches show that parental habits are the greatest determinants of the child’s behavior (Etter 2013). Smoking within the household and high prevalence in Bergenfield is a key determinant that has led to a substantial rise in cases of teenage smoking in this community. According to social learning theory, it identifies that children have high tendencies to copy the parents’ habit. The school environment presents one of the greatest challenges to teenage behavioral pattern. Windshield Community Survey Model Using a moving vehicle around the community survey, it will show a Bergenfield community structure that identifies the region demographics and health concern of discussion. With this methodology, the community participatory approach enables the problem identification obtained from the basic knowledge of the community. It allows the healthcare experts to understand the specific nature of the health concern and through actual walking across the streets, it will offer an opportunity to spot teenage smoking. Besides, this study method is important in giving an insight to the community demographics and fostering health care and the target group partnership. Teenage smoking in New Jersey can be best understood if the health care team takes a visit to the Bergenfield community. As noted by the statistics, the menace continues to rise daily as the eventuality of severe effects of cigarette smoking remains largely known. Part Two Proposed Interventions As earlier noted, one of the immediate environment of the teenagers that bears greater responsibility towards the rising cases of teenage smokers in Bergenfield County is school environment. In order to respond to the teenage peer pressure and behavioral patter challenges, a school-based program is desirable. As a community based health program, school health interventions are central to the promotion of the teenage health care needs. With 17.9% cases of middle and senior high school smoking, the fear of the future health gives a substantive reason to design a program that seek to arrest the increase in numbers of the teenage smokers and at the same time rehabilitate teenage addicts (Etter 2004). Premises Underlying School-Based Intervention Programs Firstly, it is true that the school environment is crucial in shaping child’s habit and cigarette smoking has been recorded to be one of those negative habits. Besides, children spend more time in school and thus it is a fundamental contributor to life habits. Adolescent stage occurs during the school lifetime and has been noted to be one of the high risk groups in cigarette smoking. According to community health survey conducted in Bergenfield, the adolescent group was found to be the highest risk group and majority of who are in school. Secondly, the school environment is one of the best platforms where community-based health interventions can be substantively integrated. By designing a school-health program that takes into account the versatility and the high risk group, the fight against teenage smoking will be substantially succeed. Nursing Process Application in Bergenfield School Health Program Assessment The community living in Bergenfield has one of the highest cases of teenage smoking. According to the New Jersey Health Report 2010, it identified the vice as a health concern due to the rising number of high school teenagers and young adults engage in smoking (Corey 2013). Following this revelation, the community health program design is the most desirable health intervention. In designing the nursing intervention, the program shifts the location of intervention to school because of the high numbers of the target population. Nursing Diagnosis In teenage cigarette smoking, the critical nursing care concerns are risks-based. Firstly, the risk of lung cancer and respiratory tract diseases is the primary nursing diagnosis. This is a proactive risk diagnosis because the effects of cigarette smoking is overt. Today, in the U.S, over 85% of the lung cancer is primarily caused by cigarette smoking, according to the CDC 2012 Smoking Reports (Underwood 2012). In relation with the Bergenfield community program, the focus is to eradicate the smoking habit in an effort to reverse this soaring levels of deaths as shown by the national surveys. As a critical step of conducting risk-based analysis, the program will use school-based interventions. Planning of the Nursing Intervention Goals of Intervention The school-based community health program identifies a number of short-term and long-term goals as critical pillars upon which the health program will be based. The program aims at building knowledge among the teenagers on the effect of early cigarette use. Secondly, the program envisions a substantial eradication of teenager smokers to less than 5% from the current rate of 17.7% in Bergenfield locality. The success of the program goal achievement will be summative at the end of the community health program. The short-term goal is to create awareness through school health care program on the harmful effects of cigarette smoking. Nursing Interventions After assessing the demographics and the health care problem, teenage smoking, the nursing team in collaboration with other key stakeholders embarks on two primary interventions. Firstly, they should draw the objective-based intervention. The following are relevant objectives of this intervention program: 1. To promote health education on the harmful effects of cigarette to the teenagers and beyond. 2. To foster an enabling environment in Bergenfield that would discourage teenage smoking. 3. To determine rehabilitate teenage smokers using multi-disciplinary approach 4.To create a working team work between school and local heath care system that would foster mutual partnership towards eradication of teenage smoking. 5. To eliminate teenage cigarette smoking from 17.7% to less than 5% through the community health care program 6. To foster a sustainable anti-smoking campaign among the teenagers that are culturally competent, accessible and sustainable. Nursing Evaluation A successful community health program would achieve numerous positive health outcomes. Firstly, in a repeated health survey, the number of teenagers smoking cigarette should have declined by over 10% within the first six months of the program. In achieving this, the health program would have attained the Health People 2020 MCH-11.3 that identifies that community health outcomes should increase abstinence from harmful drugs and cigarette smoking (Wand 2012). In addition, the use of cigarette among the women of reproductive age 15-49 years has been implicated to cause low birth weight and poor maternal outcome which are main concern of Health People 2020. Environmental Assessment Report Schools also provide a prime access point to the majority of young people, including the high risk and disadvantaged group. For any progress to be achieved in eradicating the teenage smoking menace, a community health program must integrate school-based interventions. In addition, schools provide an important community access to the stakeholders whose contributions are needed in eradicating the menace. Parents, families, teachers and local administration are key players in Bergenfield cigarette smoking eradication interventions. Collaborative Nursing Intervention Identification Bergenfield School-Based Cigarette Smoking Interventions Program should include a number of deliberate steps; firstly, they should incorporate health education programs in schools’ curricula. As a matter of concern, 17.7% of middle and senior high school teenagers are smokers, according to the CDC 2010 Smoking Survey (Tobacco control state highlights 2010). In recognizing smoking as a serious health concern and incorporation of health education that vividly highlight the negative health effects of cigarette smoking; it will establish a concrete foundation towards eradicating the vice. Notably, the major step that is most appropriate in enhancing positive health behaviors is built on the basis of ability to create an internal willingness to quit smoking. As a number one nursing role, establishing knowledge based on scientific findings coupled with statistical support will be effective in ensuring success of the program. Secondly, they should be school and community mentorship programs that aim at ensuring positive health habits among the youth. According to the social learning theory by Banduras, it identifies the power of positive social influence as a crucial element in shaping a child’s behavior towards desired the direction. Besides, social influence theory identifies positive traits can be identified and nurtured among individuals and groups. By initiating mentorship programs in schools and community, community interventionists would strive to identify teenage smoking as a major health concern. Both theoretical foundations and social scientists agree that social learning theory is a crucial theoretical foundation of eradicating the undesirable social vices. In addition, adoption of multi-modal programs is an important milestone that can help stem out teenage smoking in this region especially among the whites community. A multi-modal approach refers to health care intervention programs that combine curricula approach, inclusion of key stakeholders that incorporate parents, local administration, health care team and community opinion leaders. In addition, this intervention seek to design a mutual policy stand that declares teenage smoking as a health care problem and a mutual agreement to discourage the habit in the community, school and all levels. As a critical duty of a school nurse, the health education approach is one of the main tools that would hopefully lead the positive behavioral change. Third intervention is lobbying of the policy makers to identify teenage smoking as a recipe to poor health outcome and enact legislation that illegalizes the habit. Like alcohol legislations that hold a club or a pub responsible for selling alcohol to minors, policy makers should ensure that those retailers who sells cigarette to teenagers can be punished by laws. There has been policies that have seen cigarette taxation go high, however, the legislation should further recognize that increasing taxes on cigarette products alone will not discourage teenage smoking. The new legislation should incorporate banning of cigarette outlets from selling cigarettes to the teenagers. `In addition, the policy makers should recognize the knowledge and skills of existing health care system by incorporating them in making cigarette policies. The campaign against teenage smoking should be another pillar in stemming out the minors cigarette smoking. Sadly, minors begin to smoke because of negative parental, teachers or community influence, majority of them ends up becoming addicts before they get a chance of quitting. Today, there are over 60% of teenage smokers who have come out to seek health advice on quitting smoking. It is, therefore, important to embark on health care promotion whose approach is preventive since curative and rehabilitative programs are expensive to be met by the community health care system. In addition, there are a number of strategies that can drive the campaign towards success. Firstly, the strategy can adopt “TOBACCO-the truth is out there” that was successfully used in Australia and New South Wales. In this strategy, it targets primary and lower secondary school children. The primary goal is to map the Bergenfield community and conduct a walking or driving-around campaign that promotes fact sharing strategies. It incorporates the health belief model; under this theoretical framework it uses health interviews and health surveys to unmask teenage personal beliefs and health habits. As used in Australia, the program successfully built a fundamental knowledge to the teenagers on the negative effects of cigarette smoking. Drug education K-12 and teacher support package programs, under this strategy the anti-cigarette smoking campaign is designed within school programs and uses teachers as sole disseminators of the messages. The intervention programs should recognize teachers as the greatest resource in building adolescent positive health habits. The strategy has been successful in South Australia; it built anti-cigarette campaigns through mentorship programs. In addition, it covers critical topics such as recognizing the negative effects of smoking, peer pressure influence, exposure to secondary smoking and rehabilitation of cigarette addicts. The objective is to pass the ant-cigarette message through various media and using multiple persons. In so doing, the teenagers will be brought up in an environment that recognizes smoking as both the immoral and unhealthy. Another intervention is school drug education and road awareness campaign, the focus of this intervention should be an intensive anti-teenage cigarette smoking. In addition, the strategy works effectively with all programs. It incorporates the initial suggestion of incorporating health education in school curricula. Through the school drug education program, the Canadian health department has successfully reduced teenage smokers in Ontario by almost 34% according to Canadian Health Department. In addition the program takes into consideration support from parents and school administration in enacting necessary school laws that would ensure that the habit is discouraged and the rehabilitation program is designed. Creation of awareness through road shows is not a new strategy; the approach was used successfully in Australia anti-smoking nationwide campaign in 2010 (Wand 2012). The nurse duty in this case is both the management and hands-on. For instance, the nursing team is required to mobilize the community through community health workers, draw budget, coordinate activities and communicate the information to the relevant parties. Certainly, this is a critical health promotion strategy that interlaces well with the health education program. Under both strategies, this program will borrow heavily from a once successful anti-cigarette smoking in Australia that has continued to shape teenage community programs on smoking. Additionally, by using Health-Risk model, a center dubbed “Cigarette smoke is Poison” should be established in Bergenfield community. As a center of anti-smoking campaign and rehabilitation center, it will encourage positive teenage behavior from the onset. The approach that would discourage smoking uptake by the young people and focus on creating a negative image on smoke use. Furthermore, it is an integral center that would integrate cigarette smoking and school health program. Important Resources in Intervention The teachers, school nurses and local administration are the greatest human resources whose efforts are critical in promoting health habits among school-going teenagers. Other important resources include “Keeping Ahead of the Pack, “which is a drug guide book that offers a scientific approach to the teenage smoking cessation. The focus of resources should be available, accessible and sustainable. In addition, the community should own the program; external support has not been effective because it encourages dependence on the health care systems. For successful Bergenfield smoking cessation community health intervention, a team of fifteen nurses and two teacher representatives are important. The main location of carrying out the program is in school because of travelling costs and logistics of carrying out house-to-house health promotion. The cost of the program would fluctuate heavily due to the unpredictable costs of transport and logistics. In addition, the cost would likely reduce drastically because the program borrows heavily from community own resources as one of the pillars of the Primary Health Care package. The availability of Bergenfield community Health care workers is a critical resource that will revamp the health care team into schools identification and authorization identification. Monitoring and Evaluation The success of anti-cigarette programs in New Jersey should be founded on ability to continuously monitor and evaluated periodically in order to streamline the activities towards the desired results. Notably, the Australian School Health Care has successfully designed a health sensitive school and the rates of teenage cigarette smoking have reduced by 14.1% according to Australian Smoking Survey 2011. The report identifies the multiplicity of anti-smoking campaigns and the diligence monitoring and evaluation. However, in the United States, the evaluation reporting is patchy and the information available is hardly published. In contrast, in Australia, randomized studies are consistently carried out to indicate success rates of every program. Behavioral Change Evaluation The most recent program in Australia was conducted in 2012 and the survey focused on Smoking Cessation for Youth and Teenage Project (Corey 2013). The findings indicated that the program was successful in reducing the number of the target group smoking by 13.5% and the frequency of smoking for five days a week to less than three (Corey 2013). In Bergenfield, the criteria of success of the health care intervention will be evaluated based on three main considerations. Firstly, just like the Australian model, the ability to record a decrease in the number of teenage smokers will be a fundamental measure of success. The evaluation under this criteria will be based on summative evaluation, this means after a year the survey will be conducted to identify whether there has been a decrease in smoking habit or not, besides failure to have the numbers decline will be a useful feedback that would inform on the necessary adjustment in the subsequent health program. The Australian teenage smoking reporting and monitoring provides an ideal approach that the Bergenfield Health Care system ought to copy. Not only has the program succeeded in reducing teenage smoking, but also has made a landmark in other countries. New Zealand, France and Germany anti-cigarette campaigns has been heavily borrowed from this, model (Sussex 2004). As an intervention program, the need to ensure that the Bergenfield community health program builds on a successful model elsewhere is an important success criterion. This is in line with the goal of nursing intervention of creating a desirable program that would form an important theoretical knowledge contribution to the profession. This will ensure that the program has not only succeeded in New Jersey but also create a desirable community nursing model that would inform the health care system at national and even shape the global healthcare delivery system. Knowledge Evaluation In addition, the program would be considered successful if periodic evaluation indicates an increase in the number of teenagers who are aware of the health related effects of cigarette smoking. During the nursing health education program which is one of the primary interventions of creating awareness, the effects of smoking would be dealt with comprehensively. Firstly, the statistics n lung cancer, other forms of malignancies and upper respiratory tract infections forms the basis of education. In evaluating the effectiveness and the success rate of the program, the students should be able to relate the smoking and the possible health woes and fatality statistics. It is the cornerstone that informs the health belief theory, use in the above intervention program. Conclusion In order to achieve positive health outcomes among teenagers, there should be a deliberate community health nursing program that identifies a healthcare concern and use available resources to address it. Teenage smoking remains a big challenge in the majority of states in U.S; Bergenfield case study represents a minute portion of the actual menace. The health care systems in collaboration with school health programs should address this menace through a mutual partnership. References Chen, X., Ren, Y., Lin, F., Macdonell, K., & Jiang, Y. (2012). Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000–08. 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