Running head: COMMUNITY HEALTH AND POPULATION

Community Health and Population­Focused Nursing (C228)

June 29, 2016

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Running head: COMMUNITY HEALTH AND POPULATION

A. Identification of Community

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Running head: COMMUNITY HEALTH AND POPULATION

The community that I will be presenting a health assessment status of for this task is
Collierville, TN. Collierville is a small active suburban community located in Shelby County,
TN near the Memphis Metropolitan area. It is approximately 25 square miles large, located
89.39W longitude and 35.2N latitude with an elevation of 387ft (WorldAtlas.com, 2016).
B. Assessment of Needs and Risks
I will assess the health needs and risks of Collierville, TN by discussing various epidemiological and demographic data and providing some vital statistics that I found during my research. I will also provide a description of my visual assessment of the community and my own personal knowledge of this community. My experiences with the community of
Collierville, TN include living here as a resident for the past 13 years and working as an EMT with EMS prior to living here.
During my research, I was able to find the following data to describe the Population and
Economic Status Assessment for Collierville, TN. The population is approximately 48,655 for the year 2014 census according to CityData.com There was a large population growth during the years of 1995 and 2005 of approximately 52%. The average household income is $98,764 which is much higher than the state average of $44,297. The Cost of Living Index Score is 87.7 which is lower than the national score of 100. The percentage of households below poverty level is approximately 5.4%, with approximately 7.7% of children living in poverty in the year 2013.
There is a higher percentage of african americans living in poverty with a rate of 9% compared to caucasian americans at 3.4%. Although the absolute numbers show that there are twice as many caucasians living below poverty as 1187 while the number for african americans is 511.
This is due to the fact that the percentage of caucasians in Collierville, TN is 75.2% with only

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Running head: COMMUNITY HEALTH AND POPULATION

12.1% of the populations being african american. The rest of the population is made up of asians, hispanics, and other races. The unemployment rate in 2015 was 4.9%. The average cost of a house in Collierville, TN in 2014 was just over $250K, increasing from just over $200K in
2009. The average cost of rent is approx $1100/month. 96% of Collierville residents over the age of 25 are high school graduates and 54% have obtained a bachelor’s degree or higher. I was unable to find any specific information on the proportion of families in Collierville that receive public assistance (City Data, Collierville, TN, 2016), (City Data, Collierville, TN Poverty rate data, 2016)
B1. Interpretation of Collected Data
Neighborhood/Community Safety Inventory
My Neighborhood/Community Safety Inventory assessment includes data on water, air, natural environment, and fire safety. The air quality index is measured daily for the area of
Memphis/Shelby County. In 2013, the AQI was 77.6, slightly higher than the national average of
74.7. There is an observable relationship between the AQI and temperatures, with higher temps creating a higher AQI. There is a link on http://www.airnow.gov to sign up to receive daily alerts on the AQI when it is moderate or above. The water quality is excellent. The water is state inspected every 2 years and the latest report shows a score of 99 out of 100 in the sanitation survey performed in 2013. There is a wellhead protection plan on file with the state of TN to evaluate and prevent contamination near it’s aquifers. Other natural environmental hazards include lakes and ponds for which people can drown. Snakes and untamed animals are also present near water areas. Collierville used to be a primarily rural area with many fishing and hunting areas full of trees. You can often see deer crossing the road at any hour of the day or

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Running head: COMMUNITY HEALTH AND POPULATION

night. Caution signs are posted where many of them are seen regularly seen. Sometimes they are even seen coming into the neighborhoods looking for food in the trash cans late at night.
Most structures are in good condition without any major hazards or disrepair noted. In 2014 there were over 1700 code compliance inspections and 1100 business inspection surveys conducted. Sidewalk repair is the responsibility of the homeowner and while most concrete is seen intact, there are areas where broken sidewalks need repair. These are seen in mostly older neighborhoods. The liability of injuries occurring on sidewalks falls on the homeowner or business owner.
The Collierville Fire Department puts out an annual report regarding the nature of calls to
911. In 2014 the fire department took in 3069 emergency calls. 91 of them, or almost 3% were related to an actual fire (grass, brush, structure, vehicle, etc…). 121 or near 4% were related to actual hazards such as chemical spills, downed power lines, etc… Less than 1% was related to severe weather. 67% were medical incidents. Other calls included false alarms and service calls.
Collierville’s fire protection rating is a class 3, which is scored on a 1­10 range with 1 being the highest rating you can achieve. There were 4 fire related injuries and 0 deaths for 2014. Total residential fires for 2014 was 25 and a total of 11 other building structures. There is a total of 5 fire stations which are staffed 24/7. Their average response time is 4.5 minutes with 93% of response times in 8 minutes or less. I was unable to find any published data on national average response times, nor is there any national standard required for response times. A great deal of time is spent on education of fire risks/hazards with the citizens of the community. In 2014 there were over 14000 education contacts with citizens in the community. The majority of fire safety education and prevention is aimed at children.

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The Collierville sanitation department runs Monday through Friday with weekly residential curbside pick up. If a holiday occurs then they will post the alternate pick up date on their website if necessary. Any household hazardous waste materials should be brought by the homeowner to the Memphis and Shelby County Hazardous Waste Facility. This service is free to Shelby County residents. There is a list of acceptable materials and their operating hours on their website. I was not able to find a plan of action for citizens that are unable to take their hazardous materials to this waste facility. Nor did I find any information as to the disposal of items that are not accepted by either the Collierville Sanitation Department or the Hazardous
Waste facility. This creates a dilemma on how to dispose of such materials. For example, CFL bulbs contain mercury which is toxic to the environment. If a citizen were unwilling or unable to bring them to the hazardous waste facility, would they just throw them into their trash can?
(Collierville fire department, 2014), Town of Collierville, Solid waste/recycling, 2016), (City
Data, Collierville, TN, 2016), Environmental Protection Agency, n.d.), (Town of Collierville,
Water quality report, 2013).
Cultural Assessment Tool
My cultural assessment of Collierville includes data on various religions, ethnicities, and the typical family structure in the community. The majority of Collierville is made up of white and black americans, totaling 89% of the population. The remaining 11% is made up of Asians,
Hispanics, Mixed, and other ethnicities. It is not unusual to see Indian or Muslim citizens within the community. The shipping company FedEx, relocated its headquarters from Memphis TN to
Collierville, TN in the early to mid 1990s. This created a major growth in the city, which transformed this once small quiet rural area into modern suburbia. FedEx is known for its

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Running head: COMMUNITY HEALTH AND POPULATION

international shipping and many different countries are represented by the employees within this company. Many of them choose to live in the same community that they work in. However, there aren’t many different ethnic shops for clothing items and groceries seen around town.
What you will see are mainly American shopping stores but there are several different cuisine restaurants located throughout the town. The primary language is English, with a total of less than 10% of households speaking other languages such as spanish, chinese, arabic, etc… The majority of citizens work in the management, sales, administrative, and business occupations, over 50%. The rest is mixed between healthcare, education, transportation, and manual labor professional jobs. The family unit in households with children are on average 85% married with
11.6% single moms and almost 2% single dads. According to Citydata.com, the majority religion in Collierville is Protestant with almost 54% of the population identifying with this religion in 2010. There is 36.6% no religious affiliation and the remaining 10% are of other religions (Statistical Atlas, 2015), (City Date, Collierville, TN, 2016).
Disaster Assessment and Planning Guide
I am unable to find direct data on any recent disasters for the city of Collierville, TN but was able to find some information on natural disasters in Shelby County, TN. The main threat for disaster is weather related such as strong winds, storms, tornados, and flooding. There is also a threat of chemical or hazardous material spill/exposure as Memphis is a major hub for the transportation industry including truck carriers and railroad carriers. The Shelby County
Emergency Management Agency works closely with FEMA to provide emergency aid in the event of a disaster. Our fire department has staff specially trained in Hazmat as well as a hazmat specialty response team located at the Dupont Facility nearby. All local hospitals and EMS run

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Running head: COMMUNITY HEALTH AND POPULATION

mock incidents on a regular basis in order to train in responding and treating large amounts of people during a mass casualty or emergency incident. Each hospital works closely with EMS to develop protocols on HazMat emergencies that include decontamination, large volume victim scenarios, and other local emergency issues. Resources in addition to local hospitals, hazmat responders, and EMS include The American Red Cross, local tornado shelters, flood shelters, federal agencies like FEMA and state agencies like TEMA. Many of the programs in place today are funded by federal grants
(Tennessee Emergency Management Agency, n.d.), (Shelby
County Emergency Management, 2013
Windshield Survey
During my Windshield Survey, I was able to make visual assessments of the community.
Collierville is a thriving suburban community. The majority of residential homes are built from the year 1995 and later. They are primarily single detached brick homes in good repair. The average lot size is around a quarter of an acre with privacy fences in most yards. Lawns are mostly manicured, with sidewalks edged and flower beds cleaned. There is about half of the community that uses weed control on their lawns. I did not see many window air conditioning units, mostly central A/C. Most neighborhoods have boundary markers visible by brick wall entrances with the name of the neighborhood visible. Many neighborhoods have community parks. Some are large public parks, while others are smaller common areas. All of these parks and common areas are kept clean and manicured. There are 4 major public parks, which are maintained nicely and attract residents who live outside the city. 2 of the parks have several baseball fields, soccer fields, tennis courts, handicapped accessible playgrounds, and spray parks.
All 4 parks have walking/bike/hiking trails present. There are ponds with fish and ducks visible.

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Running head: COMMUNITY HEALTH AND POPULATION

There is no visible evidence of disease with the animals in these ponds. Trees are kept trimmed away from power lines. There is a railroad track that runs through the city. All streets that intersect with the railroad have lights and safety guards at them. There are 5 public elementary schools, 2 middle schools, and 1 high school located in Collierville. All have manicured lawns, brick buildings, and adequate parking. School zones are clearly marked by speed signs and you will see crossing guards during school start and dismissal times. There is one major outdoor mall and several smaller strip malls. They are all in good repair and landscaping is maintained.
There are several types of cuisine ranging from fast food to high dollar restaurants. There is one motel. People are visibly active in the recreational areas in the community. There are several churches in Collierville. They range from very small to very large congregations. The landscaping is well maintained and the buildings are in great shape. During election times, you will see many political campaign posters at voting sites only. There are not many yard sale signs posted. There are no billboards. All business signs are low to the ground to reduce clutter. Cell phone towers are not visible as they are decorated to blend in with the landscaping of the community. Collierville has a square that has many very old buildings. They are all updated but maintained to keep their old fashioned look, made of old brick and wood. There are wooden decks and stairs around these buildings. There is even an old gas station from the 1950s that has kept the pumps visible although they are no longer in service. The gas station is used as an auto repair shop. The Collierville landfill is well hidden away from neighborhoods and is located away from the center of town where businesses are. The town hall and library are brick buildings with columns out front and marble floors inside. These buildings are moved away

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Running head: COMMUNITY HEALTH AND POPULATION

from the center of the city and are surrounded by a nice quiet park with a large pond and walking trails. There are no playgrounds to attract children in this park.
Population Health Scavenger Hunt
My Community and Population Health Scavenger Hunt consisted of visits to the following places: YMCA, Collierville Community Center, Collierville Fire Department,
Domestic Violence Center, Shelby County Health Department, and Collierville Food Pantry.
The local YMCA is located in Collierville, TN and they are open to the public. They provide services such as health/wellness meetings with a wellness assessment. They have an exercise room with 2 hours of childcare provided for members, group exercise classes, nutrition counseling, and summer camps. Their target group population is the entire community from all ethnic backgrounds and of all ages from children to the elderly. Membership rates are reasonable and they offer assistance to single parents and those with limited incomes. There is an application that must be filled out. Staff members are polite and the place is clean. They have pamphlets and information online advertising the services available along with membership fees. There are indoor/outdoor swimming pools with lifeguards on duty. There are also swimming lessons available (YMCA of Memphis, n.d.). The Collierville Community Center is located at the entrance of a nice public park inside the city and is operated by the Parks and Recreation Department. There is a theater for local plays and a fitness center (DeSoto Athletic Center) inside the facility. They promote community sports and athletics such as baseball, football, tennis, and many other community recreational activities for children and adults (Town of Collierville, Recreation & sports home, 2016).

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Running head: COMMUNITY HEALTH AND POPULATION

The Collierville Fire Department is dedicated to serving and protecting the entire community regardless of age, race, or ethnicity. They provide many services such as medical care for 911 emergencies, transportation to an emergency room, fire emergencies, smoke detector evaluations, search and rescue, and general public education. They are actively seen in the community engaging with the public. They host tours of the fire stations and go into all the public schools to provide education on fire safety and prevention. They also respond to assistance calls if an elderly has fallen and needs assistance getting up. Collierville has 5 fire stations that are staffed 24 hours a day, 365 days a year. The grounds are kept well maintained by fire department staff. They maintain a website with tips and education to the public. Their goal is to save lives, reduce injury, and save property (Collierville Fire & Rescue, 2016).
Collierville has a Family Violence Outreach Center in Collierville, TN. Although their location is not published for safety reasons, they do have a facilities located within the community. Their services are mainly for victims of domestic violence. While their primary target is women and children, they do serve men as well. They have emergency apartments that are set up in undisclosed locations to allow citizens of domestic violence stay in emergencies.
These apartments are equipped with towels, dishes, bed linens, furniture, running water, and electricity. They do not charge a fee to stay as a temporary resident. They also provide counseling and other information to victims to help them transition into an independent lifestyle away from their abuser. They work closely with the Collierville Police Department to help educate, protect, and provide resources for victims of family violence (Collierville Community
Fund, 2016), (Town of Collierville, Domestic violence, 2012).

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Running head: COMMUNITY HEALTH AND POPULATION

The Shelby County Health Department is one of the largest community health resources around. They serve the entire community of all citizens of Shelby County. They provide many services such as epidemiology, environmental health such as water and air quality, maternity health checkups, well child care and vaccinations, treatment for community acquired diseases, and nutrition education. There are many more services listed on their website. The SCHD has 8 different locations and 3 separate locations for specific diseases such as a STD/HIV clinic and a
Tb clinic. I visited the clinic located in Collierville. It was a small building, not as attractive as many other buildings inside the city. Although it was clean and the lawn was maintained, there was not much landscaping around the area. The staff wore uniforms, they were polite but seemed a little rushed. They referred me to their website which holds a huge amount of information regarding their services. They have many pamphlets and brochures that they keep in office and also distribute to many local hospitals, clinics, and doctor’s offices. They serve citizens of all genders, ages, ethnics, and race. They will even serve undocumented immigrants.
The Collierville location is only open on Tuesday and Thursday every week. They are closed for holidays (Shelby County, Health Department, n.d.).
I also visited the Collierville Food Pantry which is located inside the city. They are part of a non­profit group The Mid­South Food Bank and are only open on Thursday mornings. I was unable to visit during their open hours but I did talk to them on the telephone. This group serves primarily citizens in the community that are at or below poverty level that rely on additional resources besides food stamps to receive nutrition as well as those living just above poverty and still can not afford adequate food. They also assist homeless citizens and shelters.
Their age group is children, adults, and the elderly. They rely primarily on donations from

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corporations and citizens in the community. They ask for monetary donations as well as food donations. Anyone needing assistance can apply for help. They hold several fundraisers throughout the year to obtain donations. They have several locations in the Memphis area and one location in Collierville, TN. They maintain an informational website as well (MId­South
Food Bank, 2016).
C1. Problems in the Selected County
The top three problems that I have selected for the community of Collierville, TN is diabetes, obesity, and sleep deprivation. All three are preventable contributors to physical health decline, mental health problems, and premature death. Diabetes, sleep deprivation, and obesity can be all be related each other. So preventing one may also prevent another.
The adult diabetes rate is 11.3% compared to a TN average of 11.4%.
HealthyPeople2020 goal is 7.2% new diagnoses annually (Office of Disease Prevention and
Health Promotion, Diabetes, 2016). The adult obesity rate is 32.8% which is higher than the state average of 30.2%. HealthyPeople2020 goal is 30.5% (Office of Disease Prevention and Health
Promotion, Nutrition and weight status, 2016). The average adult Collierville citizen gets 6.8 hours of sleep each night. I was unable to find published data with percentages on how many adults are sleep deprived, but the HealthyPeople2020 goal is for 70.8% of adults to get 8 or more hours of sleep/24hr period )Office of Disease Prevention and Health Promotion, Sleep health,
2016).
C3. Primary Prevention Topic
I am going to discuss obesity in further detail as it pertains to the overall health of the community and provide some community and primary prevention resources. Obesity has been

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increasing globally for decades. According to CityData.com, the average adult BMI in collierville is 28.8, which is overweight. There are 37.2% which are obese (BMI 30 or higher) and the people trying to lose weight currently are 39.9%. The average person eats 4 meals/week not home prepared and only 52% of people consider their diet healthy (Memphis & Shelby
County HEalth Department, 2010).
Research has shown time and time again that diet and physical activity are directly related. I personally feel that education is one of the most important aspects of prevention. Most people know that if they eat bad foods and have a sedentary lifestyle that they will become overweight. Most people are not educated properly on how to eat nutritiously or even how much exercise is required weekly to maintain a healthy weight. Motivation and self esteem are also issues contributing to lack of exercise.
Obesity and a healthy diet are directly related. Dietary guidelines from the USDA are revised and published every 5 years for their current recommendations. These guidelines are based on scientific research on how nutrients are used, metabolized, and stored in the body. Age, physical health, activity, and gender are all integrated into forming dietary caloric recommendations for the general public. I feel while this may work for a large percentage of the population, there are still many people who need specific attention to coming up with a specific dietary plan instead of general guidelines. However for the community as a whole, education on eating healthy and access to fresh wholesome foods is a primary prevention tactic that will benefit the most people (United States Department of Agriculture, 2016).

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C2a. Availability of Community Resources
Some great resources for the community are ChooseMyPlate.gov, community health centers, doctor’s offices, weight management clinics, and hospital based dieticians.
ChooseMyPlate.gov is online for anyone to learn the basics of healthy eating. There is information available in 20 different languages. The Shelby County Health Department is promoting a program called “Let’s CHANGE” which is an acronym for Let’s Commit to Healthy
Activity and Nutrition Goals Every Day. This program is made up of community leaders and community organizations who have pledged to help reverse the numbers of obesity in the area.
With the new healthcare laws that have taken effect, everyone should be able to get an annual physical screening exam with their primary care doctor that shouldn’t cost anything out of pocket. These physical exams are necessary for measuring BMI and overall health status of an individual. Education start with primary care and resources should be available in these offices.
There are several weight management clinics and groups such as Weight Watcher’s in the
Collierville area, but they do cost money. Also many of the activity centers and gyms such as
Lifetime Fitness, YMCA, and CrossFit Collierville hold nutrition education classes, but they are usually not free. Baptist Memorial Hospital Collierville holds a monthly class on diabetes management, which includes diet and exercise education Memphis & Shelby County Health
Department, 2010), (United States Department of Agriculture, 2016).
There are many gym/exercise facilities which are open 24hrs a day in Collierville and many others which are open during daytime hours. Some provide child care while others do not.
The YMCA is a resource for those with limited income. There are special rates for those who meet certain income requirements. Also in Collierville, there are many parks with walking

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paths, bike and hiking trails that promote healthy exercise. The parks have walking tracks that list the length in miles so you can keep track of how far you are walking and the paths are well lit for nighttime exercise. The parks remain open until 11pm.
As a community nurse, I would have to consider those with limited resources which include income, time, child care, and transportation to be able to focus on a primary prevention plan that meets the needs of the most people in the entire community. I would form a committee which would be dedicated to the ongoing promotion of diet and exercise within the community.
I would like to establish a program that would help people establish yearly goals such as walking a certain amount of miles, establishing healthy eating habits, and losing weight or maintaining a healthy weight. We would search out corporate donors and government grants to be able to hold a monthly or bimonthly diet and exercise event. This event would be a family fun walk in a local park with the goal of walking between 1 to 3 miles at the event. After the walk, we could various education activities that can change up each time. For example, we could provide a cooking class with recipes for healthy meals. We could have a farmer’s market located at the walk, awards ceremony for anyone meeting nutrition or exercise goals, a fun nutrition education activity for children, education on how to grow a vegetable garden, etc… We could also form a team of volunteer mentors to help encourage those who might have problems with self esteem and those who have motivation or accountability needs. We could have volunteers to help with those who have transportation needs and disabilities. The program would focus on getting as many people possible in the community active and give them the resources needed to become educated on healthy eating. The committee would also set and track goals for the whole community and make adjustments based on research, participation, and feedback.

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Resources
Baptist Memorial Health Care Corporation. (2016). Diabetes self­management education classes:
Baptist golden triangle. Retrieved from http://www.baptistonline.org/event­search­form/results­detail/?eventId=bfe64020­6fb9­e511­80d 9­005056bb492a
City Data. (2016). Collierville, Tennessee. Retrieved from http://www.city­data.com/city/Collierville­Tennessee.html City Date. (2016). Collierville, TN Poverty tate data. Retrieved from http://www.city­data.com/poverty/poverty­Collierville­Tennessee.htm Collierville Community Fund. (n.d.). Family Violence Council of Collierville. Retrieved from http://www.ymcamemphis.org/find­a­y/schilling/health­wellness/ Collierville Fire & Rescue. (2016). Collierville Fire & Rescue. Retrieved from http://www.ymcamemphis.org/find­a­y/schilling/health­wellness/ Collierville Fire Department. (2014). Town of Collierville fire department: 2014 Annual response report Retrieved from http://www.colliervillefd.org/ckfindercontent/files/2014%20Annual%20Report.pdf Environmental Protection Agency. (n.d.). Memphis weather forecast. Retrieved from https://www.airnow.gov/index.cfm?action=airnow.local_city&zipcode=38017&submit=Go Memphis & Shelby County Health Department. (2010). The Let’s change initiative. Retrieved from https://www.shelbycountytn.gov/DocumentCenter/Home/View/1036

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Mid­South Food Bank. (2016). Hunger facts & findings. Retrieved from http://colliervillepolice.org/services/domestic­violence Shelby County Emergency Management. (2013). 911 provides Emergency Medical, &
Emergency Police Dispatching. Retrieved from http://www.shelbycountyema.com/
Shelby County. (n.d.). Health department. Retrieved from http://colliervillepolice.org/services/domestic­violence Statistical Atlas. (2015). Overview of Collierville, TN. Retrieved from http://statisticalatlas.com/place/Tennessee/Collierville/Overview Tennessee Emergency Management Agency. (n.d.). Hazardous Materials. Retrieved from http://www.tnema.org/public/hazmat.html Town of Collierville. (2012). Domestic violence. Retrieved from http://colliervillepolice.org/services/domestic­violence Town of Collierville. (2013). Water Quality Report. Retrieved from http://collierville.com/images/stories/public/TownofColliervilleWaterQualityReportforCY13.pdf Town of Collierville. (2016). Recreation & sports home. Retrieved from http://www.ymcamemphis.org/find­a­y/schilling/health­wellness/ Town of Collierville. (2016). Solid waste/recycling. Retrieved from http://collierville.com/departments/public­services/solid­waste­recycling#Hazardouswaste United States Department of Agriculture. (2016). Healthy eating style. Retrieved from http://www.choosemyplate.gov/healthy­eating­style World Atlas. (2016). Longitude and latitude finder. Retrieved from http://www.worldatlas.com/aatlas/findlatlong.htm 18

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YMCA of Memphis (n.d.). Health & wellness. Retrieved from http://www.ymcamemphis.org/find­a­y/schilling/health­wellness/ 19