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Community Health Nursing-C228-Task 1
Western Governors University
Teresa McDonald
SI# 000460708
12/29/15

Identification of Community
In Southeast Tennessee, you will find most of Hamilton County between the Appalachian and the Cumberland mountain ranges. It is the fourth most populous county in the state of Tennessee (Wikipedia, ND). Within Hamilton County, there are many different towns. The most populous city is Chattanooga that is also the county seat (Wikipedia, ND). Hamilton County is unique because it boarders ten other counties. According to the 2010, U.S. Census Bureau the population of Hamilton County is 336,463 (Memorial Health Care Systems, 2013) . The leading cause of death for Hamilton County is heart disease, cancer, chronic lower respiratory disease, and diabetes (Memorial Health Care Systems, 2013). According to the 2012 healthy ranking of the county, Hamilton County was higher than the National Benchmark in all of the Health Behavior categories (Memorial Health Care Systems, 2013). The Health Behavior categories include Adult smoking, Adult obesity, Physical inactivity, and Excessive drinking (Memorial Health Care Systems, 2013). According to Picture of Health 2015, 66% of Hamilton County is in the overweight or obese and 75% of the adolescents are not participating in sufficient aerobic activities daily (Chattanooga-Hamilton County Health Department, 2015).

Assessment of Needs and Risks

Population Economic Status Assessment
The population economic status assessment was used to determine the following. The estimated 2010 population for Hamilton County is 336,463 (USA.com, Hamilton County Population and Races, 2015). Of these, cultural demographics 73.9% were white and 20.2% were African American (Memorial Health Care Systems, 2013). In 2013 Hamilton county reported 5.2% of the total births and 5.4% of the deaths in the state of Tennessee (Tennessee Department of Health, 2015). Of the 5.4% of deaths recorded in Hamilton county 23.3% of those were related to cardiovascular disease and 22.2% related to cancer (Tennessee Department of Health, 2015). There are various employment opportunities including manufacturing, medical, retail, and service industries. The average income in Hamilton County is 46,544 with 12% of families being at or below poverty level (USA.com, Hamilton County Income and Careers, 2015). Approximately 35% of Hamilton County’s population receives either Medicare or Medicaid benefits (Chattanooga-Hamilton County Health Department, 2015). Hamilton County reported an 8% unemployment rate in 2012, although this is below the 10% unemployment rate reported for the state of Tennessee.

Neighborhood/Community Safety Inventory The Neighborhood/Community Safety Inventory tool was used to determine the following. Some of Hamilton County’s Environmental safety hazards include air pollution, drowning, and climate. In 1969, Chattanooga held the title for the most Polluted City in the US (Bureau, 2015). Throughout the years, Hamilton County has drastically improved the air quality. Some of the ways this has happened is by requiring county wide yearly emission testing and controlling seasonal burning (Bureau, 2015). Due to the many creeks that run off the surrounding mountains into lakes and eventually to the Tennessee River, drowning is also a hazard in this community. Hamilton County has typically hot and humid summers with mild winters. The average rainfall is 56.08 inches per year and snow being minimal with an average of 1.8 days with greater than one inch of snow (USA.com, 2015) .

Cultural Assessment Tool
The Cultural Assessment Tools was used to determine the primary cultural group of Hamilton County is whites, making up 73.9% of the population with a strong Irish ancestry (USA.com, Hamilton County Population and Races, 2015) . The Majority of the population is 45-54 years old with 51% female and 48% male (USA.com, Hamilton County Population and Races, 2015). Approximately one third of the population has some college or an Associate’s degree (USA.com, Hamilton County Population and Races, 2015). English is the primary language spoken (USA.com, Hamilton County Population and Races, 2015). Hamilton County is primarily conservative voting Democratic for many years (Wikipedia, ND). In 2015, Chattanooga was named by Outside magazine as the Best Town Ever (Morrison, 2015). Being named the Best Town ever was probably because of the multiple historic site, public art displays, and many outdoor activities. Hamilton County is part of the Bible Belt and for the most part has a religious community.

Disaster Assessment & Planning Guide
The Disaster Assessment & Planning Guide was used to determine the following. Hamilton County’s LEPC (Local Emergency Planning Committee) assists with disaster planning and preparation (General Government of Hamilton County, 2015). Hamilton County is at risk for many disasters including natural to acts of terrorism. The most typical disasters in this area are floods, thunderstorms, tornados, and winter storms. With these specific disasters the most likely, to vulnerable is the younger and older populations. The community has many agencies including the Red Cross, Erlanger Hospital, Salvation Army, and the Health Department able to offer resources as needed during a crisis. With approximately 6.8% of the Hamilton County population speaking some language other than English at home this may cause an ethnicity issue during a disaster due to language barriers (USA.com, Hamilton County Population and Races, 2015).

Windshield Survey
The Windshield Survey tool was used during this assessment. Hamilton County is a mixture of urban and rural areas. It has an area of 576 square miles, 542 of that being land (Wikipedia, ND). Within Hamilton County, there are 20 parks & recreational areas (General Government of Hamilton County, 2015). One of those being the Tennessee River Park, which runs ten miles from the Chickamauga Dam along the riverside to downtown Chattanooga (General Government of Hamilton County, 2015). This includes a lighted and landscaped concrete trail perfect for walking, running, or riding your bike. There is also a play area for children making it a great use of beautiful outdoor space. In Soddy Daisy, TN located in the northwest area of Hamilton County most of the homes are well maintained with a mixture of landscaping including trees, shrubs, flowers, gentle rolling hill with an occasional farm with animals. A portion of Soddy Daisy, TN is located on top of a mountain. There are creeks that run off the mountain and several hiking trails all over creating beautiful scenery. The lot sizes range from very small in downtown Chattanooga to large farms in the rural areas. There is a mixture of older and newer homes throughout the county. Most of the older homes are in the Chattanooga area. There are many historical sites in the downtown Chattanooga area. Most of the Chattanooga area has sidewalks with streetlights and public transportation; the more rural areas such as Soddy Daisy do not. Soddy Daisy does have multiple subdivisions that do have streetlights and sidewalks within them. Throughout Hamilton County there are various restaurants ranging from fast food to elegant table service. There are numerous elementary, middle, high, and private schools in the county. There are a total of five colleges and Universities to choose from including a community college. Three hospitals serve the area with multiple branches of each surrounding the county. Erlanger is the only level 1 trauma center in the southeastern region and has the only level 3 neonatal intensive care unit. Two large shopping malls, several shopping centers, and small businesses are scattered thought the county. The majority of the community is Caucasian or African American.

Population Health Scavenger Hunt
The scavenger hunt tool was to determine the following. Hamilton County’s Health Departments serve the residents of the county. The Health Department offers family planning, dental checkups, immunizations, also WIC (Women, Infant, and Children) programs. They offer interpreters as needed to non-English speaking patients. Payments for services depend on the family’s income to attempt to allow everyone to receive the medical care they need. The Health Department has three satellite offices besides the main downtown office for greater accessibility. Soddy Daisy’s Chamber of Commerce has information on their website that promotes area businesses, recreational activities, and new resident information. The chamber of commerce through signage, newspaper, and social media also promotes town activities. A fire and police station are also located within the Soddy Daisy city limits. The fire department is strictly volunteer, but still finds time to educate the elementary kids on fire safety along with making sure we stay safe. Five homeless shelters are located in Chattanooga providing a warm place to sleep, food, and often showers at no cost. Some of the shelters are specific for women and children.

B1. Interpretation of Data
The collected data shows the percentage of births versus deaths within Hamilton County in 2013 they were pretty even. The leading cause of death within this area is heart disease followed by cancer. An interpretation could be made from the above data. half of the population in Hamilton County is considered obese. I believe many of the contributing factors to heart disease is the sedentary lifestyle and obesity within the community. I believe with the proper health education and promotion for adults and children within the community these percentages could be reduced.

C1. Problems in the Selected Community and C1a. Problem in relation to Goals
When the Healthy People 2020 goals are taken into consideration for the Hamilton County area, topics of Heart Disease and Stroke, Nutrition and Weight Status, and Cancer are found to be the top three problems. According to Centers for Disease Control and Prevention (CDC) Heart disease is the leading cause of death in America (U.S. Department of Health & Human Services, 2013). Prevention of most of these events can be fairly easy with maintaining a healthy diet, weight, and increased physical activity (U.S. Department of Health & Human Services, 2015). Also, resisting the use of tobacco and alcohol can reduce the risk of heart disease and stroke (U.S. Department of Health & Human Services, 2015). After identifying the health needs within the community determining what is the priority is the next step. The top priority health concerns for Hamilton County according to the Healthy People 2020 goals is reducing risk of heart disease and cancer by improving nutrition and weight status. Addressing the needs of the individuals within the community should improve the community. By improving one’s diet, weight, nutrition, and physical activity not only is it decreasing the risk of heart disease, but also others such as cancer, obesity, or diabetes. Healthy People 2020 goal of Nutrition and Weight Status promotes healthy diets and weight, but also eliminating hunger (U.S. Department of Health and Human Services, 2014). These goals would be beneficial to this community and with the involvement of the community should be met. C2a. Availability of Community Resources Various resources are scattered throughout the Hamilton County community to aid in promoting improved nutrition and weight status. Downtown Chattanooga has a Farmer’s market open to the public every weekend in the spring, summer, and fall. This not only promotes local fresh produces, but also encourages a positive social gathering for the community. Community members and tourists are encouraged to take advantage of the Bicycle Transit System located downtown which provides an efficient way to travel while promoting exercise. Scattered throughout the community are outdoors opportunities for the entire family including hiking, paddle board, 5k marathons. Hamilton county also developed the STEP1 program that’s mission is “To create a culture of health in Hamilton County where residents choose to eat healthy and be physically active.” (HC STEP ONE, 2016)

C3. Primary Prevention Topic The primary prevention topic is decreasing the overweight and obese population by encouraging and promoting healthy nutrition and physical activity. By reducing the populations overweight and obese population the risk of heart disease, stroke, cancer, and diabetes should also decrease.

References
Bureau, C. C. (2015). History. Retrieved from http://apcb.org/index.php/about-us/history
Chattanooga-Hamilton County Health Department, O. o. (2015, November). Picture of Our Health, Hamilton County, Tennessee. Retrieved from http://health.hamiltontn.org/Portals/14/CommunityHealth/AssessmentPlanning/Docs/Picture%20of%20Our%20Health%202015%20Final.pdf
General Government of Hamilton County. (2015). Hamilton COunty Parks & Recration Department. Retrieved from Approximately 6.8% of the Hamilton County population speak some langue other than English at home.
General Government of Hamilton County. (2015). Tennessee River Park. Retrieved from http://www.hamiltontn.gov/tnriverpark/
General Government of Hamilton County. (2015). What is the LEPC? Retrieved from http://www.hamiltontn.gov/lepc/
HC STEP ONE. (2016). Welcome to Hamilton County Step ONE. Retrieved from http://hcstep1.org/
Memorial Health Care Systems. (2013, 03). Community Health Needs Assessment. Retrieved from http://www.memorial.org/assets/pdf/MHCSCHNA_Report_0313.pdf
Morrison, C. (2015, June 5). Chattanooga: Outside magazine's Best Town Ever. Retrieved from http://nooga.com/170152/chattanooga-outside-magazines-best-town-ever/
Tennessee Department of Health. (2015, 4). Tennessee Vital Statistics Summary Resident Data 2013. Retrieved from https://tn.gov/assets/entities/health/attachments/VSSum13.pdf
U.S. Department of Health & Human Services. (2013). Leading Cause of Death. Retrieved from http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
U.S. Department of Health & Human Services. (2015, Aug). Preventing Heart Disease: Healthy Living Habits. Retrieved from http://www.cdc.gov/heartdisease/healthy_living.htm
U.S. Department of Health and Human Services. (2014). Nutrition and Weight Status. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status
USA.com. (2015). Hamilton County Income and Careers. Retrieved from http://www.usa.com/hamilton-county-tn-income-and-careers.htm
USA.com. (2015). Hamilton County Population and Races. Retrieved from http://www.usa.com/hamilton-county-tn-population-and-races.htm
USA.com. (2015). Hamilton County Weather. Retrieved from http://www.usa.com/hamilton-county-tn-weather.htm#HistoricalSnow
Wikipedia. (ND). Hamilton County, Tennessee. Retrieved from https://en.wikipedia.org/wiki/Hamilton_County,_Tennessee

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