communitypp

Community of

Menifee, CA

Introduction

 _{As part of a community health assessment study, a thorough investigation was performed}

in the area of Menifee, California as one student’s public health objective.

 _{Through this study, several categories of data were systematically collected and applied}

to the results of the assessment.

 _{This paper will shed light on some of those findings to provide the reader with a}

generalized idea of the given population’s most vulnerable groups; how community nursing can assist in health enhancement of the community; some of the communities geographical landmarks; availability of housing, resources, and public transportation; as well as the major causes of morbidity and mortality.

 _{Once the reader completes this community assessment, the reader will have a more}

Windshield Survey

 _{A windshield survey of Menifee California was conducted by means of a privately owned}

vehicle around mid-afternoon on Friday March 21st, 2014.

 _{The physical boundaries of the area include highway 215 as well as the 15 freeway.}

 _{The area surrounding this particular community, contained newer higher income homes}

recently built from the year 2002 to presently.

 _{However, deeper within the community, there were more 55 years of age plus}

neighborhoods with lower income homes built in the early 1980’s as well as lower income housing developments built in the late 1970’s.

 While driving through the community, there was a collective mixture of residents walking the

streets.

 In the higher income housing developments, younger families were outside playing and more middle

aged women were noticed walking with friends. It appeared to be more active.

 _{Residents either dressed in professional attire, school uniforms or casual attire.}

 _{Neighborhoods contained more of the younger population with a combination of Caucasian as well as} Mexican-American residents.

 _{Homes were newer two story homes that appeared to be well maintenance, possibly related to home owner’s} associations.

 _{Neighborhoods appeared to have a combination of Catholic, as well as Christian churches integrated} throughout.

 _{In the lower income housing developments, there was a homeless man noted on the corner asking for}

spare change and more elderly residents were seen outside gardening or walking into their homes.

 _{The lower income neighborhoods contained fewer residents seen on the streets in comparison to the families} witnessed playing or walking the streets of the higher income neighborhoods.

 _{Residents appeared more disheveled and lacked that zest and spirit.}

 _{The residents were mixed with Caucasian elderly residents as well as younger generation African Americans.}

 _{The streets were in relatively good condition throughout and the homes in the lower income areas were older} single story homes that appeared to be in need of maintenance.



There were numerous grocery stores, pharmacies, and gas stations throughout as

well as several public transportation stops scattered within the community.



This community is close to Loma Linda Hospital which was recently built and

opened in 2010.



30 minutes down the other freeway is an alternative hospital that has a trauma

center and offers many other specializations to the public.



However, given the complexity of the neighborhoods containing many lower

income elderly residents as well as younger lower income families, a clinic should

be established to better assist in public health and disease prevention.



The overall “feel” for this community was sedentary, casual and potential for

Statistics in Riverside County:

By Ethnic Group:

 _{Hispanic or Latino (45.5%)}

 _{White Non-Hispanic Alone (39.7%)}

 _{Black Non-Hispanic Alone (6.0%)}

 _{Asian alone (5.8%)}

 _{Two or more races (2.2%)}

 American Indian and Alaska Native

alone (0.5%) (Riverside County California, 2012).

By Gender:

 _{Males: 1,089,576 (35.1%)}

 _{Females: 1,100,065 (64.9%)}

Riverside County:

 _{The highest morbidity rates include chlamydia and gonorrhea.}

 _{Median household income is $42,104}

 _{Median contract rent: $1,413}

 _{Population 6,704}

 _{Households: 2,942}

 _{Unemployment: 2.8%}

 _{Residents below the poverty level: 16.8%}

 _{Median resident age: 46.7}

 _{Average household size: 3 people (Riverside County California, 2012).}

 _{Crime in 2011 (reported by the sheriff's office or county police, not the county total):}

 _{Murders: 39}

 _{Rapes: 115}

 _{Robberies: 416}

 _{Assaults: 1577}

 _{Burglaries: 3829}

 _{Thefts: 8215}

Death Rates Riverside County by Age

Group & Etiology in 2010:

By Age:

 _{Total> 13,638}  _{Under 5> 188}  _{5-14> 44}

 _{15-24> 196}  _{25-34> 256}  _{35-44> 514}  _{45-54> 1,011}  _{55-64> 1,452}  _{65-74> 2,326}

 _{85 & over> 3,479 (Riverside County}

California, 2012).

Etiology:

 _{Heart disease}

 _Stroke

 _{Accidental death (overdose)}

 _Pneumonia

 Cirrhosis

 _{Diabetes (Riverside County}

Death Rates Riverside County 2010:

 _{13,678> deaths total}  _{7,123 >male}

 _{6,515 >female}  _{1,994> Hispanic}

 _{49> 2 or more race groups}  _{65 >American Indian}

 _{289 >Asian}  _{689> Black}

 _{18 >Pacific Islander}

Health of residents in Riverside County based on CDC

Behavioral Risk Factor Surveillance System Survey

Questionnaires from 2006 to 2012:

 _{General health status score of residents in this county from 1 (poor) to 5}

(excellent) is 3.5. This is about average. 

 _{56.6% of residents exercised in the past month. This is about less than average.} 

 _{52.4% of residents smoked 100+ cigarettes in their lives. This is slightly above}

average. 

 _{99.8% of adult residents drank alcohol in the past 30 days. This is more than}

average. 

 _{70.7% of residents visited a dentist within the past year. This is about average.} 

 _{Average weight of males is 194 pounds. This is about average.} 

 _{Average weight of females is 168 pounds. This is slightly above average}

Two Key Informant Interviews:

 _{Interviewed a local police officer who}

has been employed with the city for 22 years. When asked him his interpretation of the high crime rates and poverty

level, he stated he thinks it’s related to the lack of college preparation that is being implemented in high schools

stating he feels “kids aren’t prepared for college.” He also voiced his concerns with the available colleges in the area, stating the city needs more options for community colleges that are affordable. He says a lot of the crime comes from the younger generation. He says he often thinks if the kids were more involved in after school activities, then the crime rates would lessen as a result. He says many of the teenagers from the Hispanic culture are being raised by sick elderly grandparents and lack the guidance that other children are getting from their parents. He believes this too contributes to the crime rates in this city.

 _{Public health nurse:}

 _{Interviewed a public health nurse who}

voiced her concerns regarding the

community’s lack of available resources stating this area is in need of additional low income health care information since a large percentage of the population is living below poverty levels. She also states there is a need for more self-help support groups to help those struggling with

addiction, such as cigarette smoking since hypertension, CVA, and heart disease is so prevalent in the country, as well as within the community. She voiced her concerns with the amount of reported sexually transmitted diseases within the female population ranging from 13 years of age to 21 years of age. When asked what her recommendation is for improvement, she stated she thinks the community lacks the educational programs needed within high schools for STD prevention and

Leading Causes of Death 2000:

California

1. Heart disease

2. Malignant neoplasms

3. Cerobrovascular disease

4. Chronic lower respiratory disease

5. Accidents

6. Alzheimer’s disease

7. Diabetes

8. Influenza & pneumonia

9. Chronic liver disease & cirrhosis

10. Suicide

United States

1. Heart disease

2. Malignant neoplasms

3. Cerobrovascular disease

4. Chronic lower respiratory disease

5. Accidents

6. Diabetes

7. Alzeihmer’s disease

California Leading Causes of Death In

2006:

1. Heart disease

2. cancer (malignant neoplasms) accounted for over half

3. Cerebrovascular disease

4. chronic lower respiratory disease

5. Accidents (unintentional injuries) accounted for 17.3 percent of deaths in 2006

California Leading Causes of Death for

Males & Females in 2010:

Males

1. Heart disease 2. Cancer

3. Accidents 4. Stroke

5. Lung disease 6. Diabetes

7. Influenza & pneumonia 8. Suicide

9. Cirrhosis

10. Alzheimer's disease

Females

1. Heart disease 2. Cancer

3. Stroke

4. Lung disease

5. Alzheimer’s disease 6. Influenza & pneumonia 7. Diabetes

Regional Leading Causes of Death for

Males & Females in 2010:

Males

1. Heart disease

2. Cancer

3. Lung disease

4. Stroke

5. Accidents

6. Influenza & pneumonia

7. Diabetes

8. Suicide

9. Alzheimer’s

10. Cirrhosis (Kochanek, K., & Murphey, S, 2013.)

Females

1. Heart disease

2. Cancer

3. Stroke

4. Lung disease

5. Alzheimer's

6. Influenza & pneumonia

7. Accidents

8. Diabetes

9. Hypertension

Death Rates By Ethnic Groups 2010:

California:

1. Hispanic

2. Non-Hispanic with 2 or more race groups

3. American Indian

4. Asian

5. Black

6. Pacific Islanders

7. White/Other/Unknown

Regional:

1. Black

2. Hispanic

3. Non-Hispanic with 2 or more race groups

4. American Indian

5. Pacific Islanders

6. Asian

Clostridium Difficile Outbreak Statewide

 _{Enterocolitis due to Clostridium difficile (C. difficile)—a predomi nantly}

antibiotic-associated inflammation of the intestines caused by C. difficile, is of growing concern.

 _{The disease is often acquired in hospitals or other health-care facilities with long-term}

patients or residents, and accounted for an increasing number of deaths each year from 1999 through 2008.

 _{In 1999, 793 deaths were due to C. difficile, compared with 7,476 deaths in 2008.}

 Dropping slightly in recent years, the number of deaths was 7,251 in 2009 and 7,298 in

2010.

 _{In 2010, the age-adjusted death rate for this cause was 2.2 deaths per 100,000 standard}

population, unchanged from the rate in 2009 but lower than the peak rate of 2.4 observed in 2008.

 In 2010, C. difficile ranked as the 18th leading cause of death for the population aged

65 and over.

Regional Statistical Findings

 _{The 15 leading causes of death in 2010 were:}  _{1. Diseases of heart (heart disease)}

 _{2. Malignant neoplasms (cancer)}  _{3. Chronic lower respiratory diseases}  _{4. Cerebrovascular diseases (stroke)}  _{5. Accidents (unintentional injuries)}  _{6. Alzheimer’s disease}

 _{7. Diabetes mellitus (diabetes)}

 _{8. Nephritis, nephrotic syndrome and nephrosis (kidney}  _disease)

 _{9. Influenza and pneumonia}

 _{10. Intentional self-harm (suicide)}  _{11. Septicemia}

 _{12. Chronic liver disease and cirrhosis}

 _{13. Essential hypertension and hypertensive renal dis}  _{ease (hypertension)}

 _{14. Parkinson’s disease}

2010 Regional Trends:

 The age-adjusted death rate declined to a record low in 2010.

 _{Life expectancy was 78.7 years, continuing a long-term rising trend. Life}

expectancy increased for the total population, as well as for the black and white populations. Both white and black male and female populations experienced an increase in life expec tancy in 2010 compared with 2009

 Assault (homicide) dropped from among the 15 leading causes of death for the

first time since 1965.

 _{Rates for the two leading causes—heart disease and cancer— continued their}

long-term decreasing trends. Significant decreases also occurred for Chronic lower respiratory diseases, stroke, Influenza and pneumonia, and Septicemia.

 In 2010, the age-adjusted death rate for the black population was 1.2 times that

for the white population.

 _{In 2010, the age-adjusted death rate for drug-induced causes for the U.S.}

State & Regional Trends

California Life Expectancy

 _{Life expectancy for a child born in}

2006 was 77.8 years for males and 82.5 years for females.

 _{This is a gain of 4.1 years of}

expected life from the 1996 level for males and a gain of 2.4 years for females.

Regional Life Expectancy

 _{Life expectancy was 78.7 years,}

continuing a long-term rising trend.

 _{Life expectancy increased for the}

total population, as well as for the black and white populations.

 _{Both white and black male and}

Riverside County vs Regional

 Based on the local results, several problems were identified to include:

 _{Increased numbers in STD’s}

 _{Community lacks STD prevention programs and reproductive health education to the youth.}

 _{16.8% of residents are living below poverty levels}

 _{Crime rates are on the rise}

 _{Residents have a reported sedentary lifestyle compared to regional.}

 _{Heart disease is the #1 cause of death in this community as well as regionally.}

 _{The community has a slightly above average amount of smokers compared to regional.}

 _{The community consists of a larger percentage of female residents and since females are at}

99.8% of adult residents drank alcohol in the past 30 days according to one survey in the community which is above the regional average.

 _{Liver failure and cirrhosis of the liver ranked in at #9 top causes of death in}

California alone in 2010.

 _{Possibly in need of further education to the community members, local support}

groups for alcoholics, and health promotion interventions geared towards disease prevention.

 _{Average weight of females within this community is 168 pounds, which is}

slightly higher than the regional.

 _{Obesity leads to several co-morbidities such as CVA, hypertension, diabetes, etc.}

 _{Female to male ratio is larger in this community.}

 _{Heart disease, diabetes, and CVA are the main causes of death within this}

community, as well as within the state of California and the region.

 _{Interventions are needed to improve physical activity, especially with the female}

Community Nursing Diagnosis:

 _{Risk of inadequate healthcare among the Menifee community related to}

residents living below poverty level, no available clinics, little public

Public Health Nursing Intervention Plan:

at different levels of evaluation, then changing behavior may require using social

influences such as family, social networks, organizations, and public policy as strategies for change (U.S. National Library of Medicine National Institutes of Health, 2003).

 _{Interventions may include:}

 _{Family support- Such as diet and physical activity interventions}

 _{Social network influences- Used in tobacco, physical activity, access to health care, and sexual}

activity interventions

 _{Organizational policies & practices}

 _{Community factors- Observed in physical activity, diet, and access to health care services.}  _{Public policy}

 _{Culture- Observed in some counter-advertising interventions (U.S. National Library of Medicine}

National Institutes of Health, 2003).

Public Health Nursing Intervention Plan:

 _{Introduce a cardiovascular disease prevention and control program to make available}

to the residents within this community.

 _{This recommended program reduces out-of-pocket costs for cardiovascular disease}

preventive services for patients with high blood pressure (The Guide to Community Preventative Services, 2013).

 An excellent nursing intervention geared towards disease prevention for this high risk

population.

 _{Reducing out-of-pocket costs (ROPC) for patients with high blood pressure to make}

cardiovascular disease preventive services more affordable. These proposed services provide assistance with:

 _Medications

 _{Behavioral counseling, such as nutritional counseling.}

 _{Behavioral support such as community-based weight management programs and assistance}

with gym memberships.

 _{The Community Preventative Services Task Force recommends reducing patient}

Public Health Nursing Intervention Plan:

to offer all schools the proper promotional tools to assist in the prevention of diabetes mellitus by educating the youth on proper nutrition and the importance of physical activity (National Diabetes Education Program,2014.)

 _{Such interventions can promote public education by:}

 _{Public service announcements}

 _{Presentations at schools}

 _{Webinars available to community members}

 _{School newsletter articles, projects, and flyers}

References:

_{California Department of Public Health, 2013. Riverside County’s Health Status Profile for 2013.}

http://www.cdph.ca.gov/search/results.aspx?k=morbidity%20and%20mortality%20rates%20riverside%2 0county

_{City-data.com. (2012). Riverside County California. Retrieved from:http} ://www.city-data.com/county/Riverside_County-CA.html

_{Kochanek, K., & Murphey, S. (2013). National Vital Statistics Report. Retrieved from:} http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf

_{National Diabetes Education Program. (2014). Partners & Community Organizations. Retrieved from:}

http://www.ndep.nih.gov/partners-community-organization/index.aspx

_{The Guide to Community Preventative Services. (2013). Cardiovascular Disease Prevention and}

Control: Reducing Out-of-Pocket Costs for Cardiovascular Disease Preventive Services for Patients with

High Blood Pressure and High Cholesterol. Retrieved from:

http://www.thecommunityguide.org/cvd/ROPC.html

_{U.S. National Library of Medicine National Institutes of Health. (2003). Community Based}