Running head: CAP REPORT CT 39.

03

Community-as-Partner Report: Census Tract 39.03

Alejandro Domnguez, Jacob Early, Erin Krening, Rachel Naftulin

University of Arizona
CAP REPORT TRACT 39.03

Community as Partner Report: Census Tract 39.03

The Community-as-Partner report will focus on Census Tract (CT) 39.03, located in

South Tucson, Arizona. The boundaries for the assigned CT include Valencia Road, 12th

Avenue, Los Reales Road, and a wash running alongside Interstate 19. Our group of four

nursing students assessed the assigned CTs population demographics and community strengths

and stressors using the Community as Partner model windshield surveys, key informant

interviews, community participation, and online research. We then used this information to

evaluate the needs of the community to determine and implement an appropriate intervention

based on the populations strengths and stressors. The project took place over a one-month

period in the fall.

Community Nursing Assessment

The CT is 0.888 square miles with a population density of 3640.1299 people per square

mile all within Tucson city limits. The communitys core is comprised primarily of those that

identify as Hispanic or Latino, which make up 91.2% of the CT compared to 35.7% of Pima

County. Likewise, 70% of CT 39.03 speaks Spanish with 22.3% speaking English less than very

well. Thirty percent of the CT speaks English in comparison to 71.4% of Pima County (Pima

County Health Department Public Health Nursing Community Profile Census Tract 39.03, 2017)

The median household income in Pima County is $46,162, which is higher than those

living in the CT whose median income is $40,764. However, the CTs poverty rate is lower at

13.6% when compared to Pima County at 19.3%. There is a higher amount of single female

householders with a child under 18 within the CT: 10.6% compared to Pima County at 7.0%.

There are no bars, restaurants, banks, malls, laundromats or dry cleaners, thrift stores, and

supermarkets within the CT. There is one convenience store, discount store, gas station and

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neighborhood market within the CT. There are two check cashing locations and three fast food

restaurants inside the CT with four fast food restaurants directly outside. There are four

supermarkets outside the CT, the closest being Food City on Valencia and 12th St. (Pima County

Health Department Public Health Nursing Community Profile Census Tract 39.03, 2017).

The vast majority of the housing is built before 1979; 42.9% of the houses in the census

tract are built before 1959 and about 44.4% of the houses are built between 1960 and 1979.

Ninety-six percent of the housing are single-family homes and 4% are mobile homes. There are

no duplex or multiplex homes. A windshield survey of the neighborhood revealed one vacant

church, more than six vacant lots, and three areas of graffiti. There was no indication of new

construction going on. Regarding education, 70.8% of the residents living in the census tract

graduated high school and pursued higher education. However, 6.1% of residents obtained a

Bachelors degree or higher, compared to the 30.3% of Pima County. The neighborhood falls in

the Sunnyside School District. Santa Clara Elementary School resides within the tract and serves

as the communitys source for elementary education. Challenger Middle School and Desert

View High School, both outside the CT, provide public education to the community for grades 7-

12. A childcare center right next to the church named Guadalupana Pre-K and Kinder Child

Care (Pima County Health Department Public Health Nursing Community Profile Census Tract

39.03, 2017).

The CT does not have its own newspaper, but the local Valencia library (located within 1

mile of the CT) carries various newspapers and flyers, offers pamphlets, leaflets, and information

about community resources, and provides free Wi-Fi. This library serves as a central meeting

location for families, children, and older adults. The neighborhood within the tract contains

signs advertising the presence of garage sales, lost pets, and Wi-Fi sales. However, most

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information is communicated via word of mouth. Recreation sources within the CT include

Psychosomatic Transformation Center, neighborhood centers, and monthly community events at

the New Hope Methodist Church (NHMC). Two parks are located outside tract boundaries:

Santa Cruz River Park, and Mission Manor Park (Pima County Health Department Public Health

Nursing Community Profile Census Tract 39.03, 2017).

The CT is covered by Tucson Fire Department Station 14, residing two miles north of the

center of the CT The Tucson Police Department has jurisdiction in this area. Between Oct.

4, 2017 and Oct. 18, 2017, eight crimes occurred varying from assaults and thefts to drug arrests.

Five sex offenders live in the community. According to a local police officer, drug use and

violent activities are recurring issues in the community (personal communication, October 13,

2017). Safety concerns in the neighborhood include a ravine running through the CT, flood

areas in the neighborhood, lack of streetlights in alleyways, and narrow roads with potholes and

faded streets lines. Transportation proves efficient in the community as 65% of households have

one or two vehicles and 32% have three or more vehicles. In addition, ten bus routes line the CT

border, and sidewalks lined with streetlights exist in and outside the CT (Pima County Health

Department Public Health Nursing Community Profile Census Tract 39.03, 2017).

The CT lies within City Ward 1 represented by City Councilor Regina Romero and its

democratic council members Laura Dent, Alvira Gallego, Nathalia Untiveros and Steve

Arnquist. The tract also lies in District 5, represented by democrat Richard Elas. Lisa Atondo

serves the census tract as the democratic senator of State Legislative District 4. Charlene

Fernandez and Geraldine Peten serve as their democratic state representatives. The CT is located

within Congressional District 2 and is represented by republican senators John McCain and Jeff

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Flake and republican congressional representative Martha McSally (Pima County Health

Department Public Health Nursing Community Profile Census Tract 39.03, 2017).

Within the CT, there is a higher percentage of individuals without health insurance at

22.1% compared to in Pima Countys 13.3%. There are no hospitals, long-term care centers,

mental health services, pharmacies or urgent cares within the CT. The closest hospital is Banner

University Medical Center South Campus, roughly seven miles away. There are two long-term

care facilities outside the CT, The Southern Arizona Veterans Affairs Health Care System is

approximately five miles north and Avalon Southwest Health and Rehabilitation is

approximately six miles away. Fast Med Urgent Care and Next Care Urgent Care are both less

than two miles from the CT. There is a Walgreens, Walmart, and CVS roughly two miles from

the CT. Mental health services such as CODAC Health, Recovery & Wellness Child & Family

services, La Frontera and Cope Behavioral Services are all within six miles. Within the CT,

there is an OpenCare Dental and a General Dentistry 4 Kids outside of the CT (Pima County

Health Department Public Health Nursing Community Profile Census Tract 39.03, 2017).

Community Nursing Diagnosis

After an extensive survey of the community and its residents, the top three strengths

identified were sufficient transportation, family unity, and proximity to resources. Sixty five

percent of the residents who live in the CT have at least one or two vehicles available for

transportation (U.S. Census Bureau, n.d.c.; Pima Maps). The abundance of bus routes and

vehicle availability provide sufficient transportation. Family unity was another strength

identified through key informant interviews. The pastor of NHMC described how the residents

that attend the church place their family first and support each other (personal communication,

Oct. 13, 2017). The last noted strength of the CT is the proximity to resources. The shopping

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center located within the census tract contains a variety of stores and businesses. The shopping

center has many businesses within it, which are listed in the above subsystems section.

Resources such as pharmacy, library, and grocery stores are located just outside the CT within

walking distance, making it relatively easy for the residents to reach these resources. Within the

heart of the neighborhood lies NHMC, Santa Clara Elementary School and Guadalupana Pre-K

and Kinder Child Care, all accessible resources for community members.

Three critical stressors observed in the CT that became our top priorities of care were

nutritional knowledge, substance abuse among teenagers, and a language barrier (see Appendix

A). A majority of key informants interviewed mentioned a lack of education knowledge about

healthy eating within the community. For example, the dietician, pastor, librarian, and gym

instructor all mentioned that those they served in the community lacked education on the basics

of nutrition (personal communications, October 14, 2017). According to various key informants,

the lack of nutritional knowledge was evident given recurring health conditions throughout the

community, such as obesity and diabetes. Substance abuse issues was identified by the pastor;

he explained that the community has been experiencing significant illegal drug use in young

adolescents (personal communication, Oct. 13, 2017). The pastor mentioned the lack of

programs available to the CT to address drug use. The last stressor identified was the language

barrier. The vast majority of the CT has listed Spanish as their primary language with roughly

one fourth of the tract speaking English less than very well. Thus, English-speaking business

owners of the area have difficulties communicating with the Spanish speaking population.

After considering these stressors, we created a nursing diagnosis stating risk for chronic

illnesses, such as obesity, high blood pressure, and diabetes, among school aged children in CT

39.03 related to imbalanced nutrition as evidenced by key informant statements verbalizing high

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rates of diabetes, obesity, and lack of nutrition education (Food City produce manager, dietician

& fitness director, personal communication, October 13, 2017; librarian & Open Care Dental

receptionist, personal communication, Oct 12, 2017).

Community Nursing Plan

A goal was formulated to address the diagnosis detailed above. We aimed to increase

healthy food choices of school-aged children in CT 39.03 to reduce risk factors for future chronic

illnesses. To achieve the above goal and address the nursing diagnosis, a health teaching

intervention was created to provide education to school aged children about healthy food

choices. The intervention took place at Valencia Library on Wednesday, November 1, 2017

during the childrens Create Club. The intervention attempted to target approximately 20 school-

aged children with an interactive presentation on how to choose the healthier option between two

food choices and understand the healthier options health benefit. This would increase the

childrens knowledge on healthy eating, promote a healthier lifestyle, and ideally decrease risk

for chronic disease.

A Level I systematic review conducted by Dudley, Cotton & Peralta (2015) aimed to

determine the effectiveness of various teaching interventions to teach healthy eating habits

(Dudley et al., 2015). The research looked at 49 peer-reviewed journals and found eight

dominant teaching strategies (Dudley et al., 2015). Out of the 49 peer reviewed journals, there

were a total of 39,600 grade school students included in the sample of this systematic review

(Dudley et al., 2015). The setting for these studies had to be in elementary schools or in the

community close to the schools. Studies done in homes, religious places, healthcare settings,

hospitals or weight loss clinics were excluded. This setting inclusion criterion directly applies to

the intervention we implemented, since our intervention was done in the community near CT

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39.03s elementary school. Our education project utilized three of the eight approaches

identified in the article. The strategies used included having a parental presence, utilizing a

contingent reinforcement approach (e.g. having snacks provided to reward the children for

participating) and using a games-based approach to engage the children in learning. By using

these evidence based teaching strategies, we ensured a greater understanding of the material.

The most pertinent overarching goal of Healthy People (HP) 2020 is to promote quality

of life, healthy development, and healthy behaviors across all life stages (U.S. Department of

Health and Human Services [HHS], n.d.a.). The most applicable topic area of HP 2020 is

Nutrition and Weight Status. The goal of this topic is to promote health and reduce chronic

disease risk through consumption of healthful diets and achievement of healthy body weights

(HHS, 2017a). The HP 2020 objectives supporting our project are NWS-14 and NWS-15 under

Food and Nutrient Consumption. The related full objective statements are to increase the

variety and contribution of vegetable to the diets of the population aged two years and older as

well as fruits (HSS, 2017b).

Two SMART objectives were formed to obtain the goal aiming to reduce the risk of

chronic illnesses. The first objective was to have 50% or more of the children participating in

the education presentation at Valencia library be able to differentiate between healthy and

unhealthy food choices by the end of the presentation on Wednesday November 1, 2017. The

second objective was to have 50% or more of the children participating in the education

presentation at Valencia library be able to identify the health benefits of certain foods by the end

of the presentation on Wednesday November 1, 2017. To accomplish these objectives, we

generated a program plan to guide our implementation of the health education project. Three

program activities included in the plan were to (a) arrange a date and time to provide nutritional

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education to children at the library with the Valencia Library librarian by Oct. 26, 2017; (b)

create a poster-board for the activity, cut-outs of food options, and a post-activity worksheet then

rehearse the lesson plan by Oct. 30, 2017; (c) verify the date, time, and lesson plan with the

librarian and clinical instructor via email by Oct. 31, 2017. To evaluate the project, we had the

participating children complete a five question post-activity worksheet directly after the

presentation on Nov. 1, 2017 that instructed the children to circle the food option that they

should eat more of for five different pairs of foods, then match the healthier food choice to its

associated health benefit (see Appendix C). This evaluates both SMART objectives.

To successfully implement our health education project, our group collaborated with the

Valencia Library manager and the leader of Create Club. The library manager acted as a liaison

between us and create club leader, which made communication efforts more challenging, as

misinformation is more likely when more people are involved. We agreed to present an

educational lesson during Create Club. The content of the project was derived from needs

identified from key informant interviews, suggested content from the library manager about

healthy food options, and the public health nurses (PHN) support of nutritional

education. Having a specified topic, audience, time period, and classroom location was helpful

in guiding what resources we would need. We utilized a tri-fold poster board, healthy snacks,

and Velcro for interactive activities purchased from Target and the Dollar Tree and popsicle stick

response cards that we put together ourselves. We communicated with our Public Health Nurse

(PHN) and instructor as we completed each milestone throughout this project.

The level of prevention that the intervention addressed is primary prevention. According

to the natural history of disease, the intervention addressed the stage of susceptibility (Centers

for Disease Control and Prevention, 2012). The intervention provided education on which foods

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have a greater nutritional value. If the recommended teachings are followed then the risk of

getting a disease associated with improper nutrition such as diabetes or heart disease may be

lower.

The first constraint we experienced was having a wide age range of children to teach.

Some of our information fell above or below some childrens learning levels. Secondly, we

presented during craft time so some children were distracted. We also had several families come

in during the presentation, which was distracting, and added to the loud noise level from our

growing audience.

Implementation of Community Nursing Intervention

We provided a health education project focused on teaching school-aged children about

making healthy food choices, and the health benefits of certain foods (See Appendix B). The

project was presented on Wednesday, November 1, 2017 at Valencia Library to a group of 20 to

30 school-aged children (primarily ages 8-12). At the beginning of the presentation, 20 children

attended the presentation, but more children and adults trickled in throughout the event to make a

total of 31 children in total and 11 adults. The presentation took place during Create Club, an

after school activity at the library. One unanticipated challenge we faced involved the large

number of children and parents that attended the event. We had planned to teach 20 children, but

by the end of the presentation, 31 children were in attendance. Another barrier during the

presentation was the increased the noise level in the room and distractions experienced by the

children from the large group of participants coupled with the Create Club activity. In regards to

successes, our intervention was met with enthusiasm. The Create Club leader, library manager,

and attendees were interested in the information presented and involved in the hands-on

activities. Overall, the project was received well by both parents, and children. The interactive

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activities included matching Velcro foods to their corresponding food group, popsicle stick

response cards in stating to eat more or less of each food, and a matching and circling evaluation

worksheet (See Appendices C and D).

Evaluation of Community Nursing Intervention

The worksheet described above was administered to evaluate if the participants

understood how to differentiate between healthy food choices and match healthy food choices

with the associated health benefits. The evaluation had two parts. The first portion showed two

images of foods from each food group and asked the children to circle the food they thought was

the healthier choice. The second portion required them to draw a line from the food to the

matching health food benefits (See Appendix C). We collected all of the worksheets from the 20

participating children. The first objectives was met because 50% or more of the children could

differentiate between the healthier food choices. However, our second objective was not met, as

less than 50% of the children were able to match the specified food with its health benefit. The

main challenge we faced was ensuring the participants were focused on the evaluation

worksheet, not their Create Club activity. The inattention could have skewed the results.

Conclusion

We assessed the assigned CT, which is composed of mainly Hispanic or Latino

individuals: 91.2% compared to 35.7% in Pima County (U. S. Census Bureau, n.d.d.). There are

many strengths in this community such as family unit, transportation and proximity to resources.

Several stressors were identified such as nutritional deficits, substance abuse, and language

barriers. The nursing diagnosis states, risk for chronic illnesses, such as obesity, high blood

pressure, and diabetes, among school aged children in CT 39.03 as related to imbalanced

nutrition as evidenced by key informant statements verbalizing high rates of diabetes , obesity

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and lack of nutrition education (Food City produce manager, dietician & fitness director,

personal communication, October 13, 2017; librarian & Open Care Dental receptionist, personal

communication, Oct 12, 2017). A health education project was implemented as an intervention.

Children were taught to make healthy food choices and identify food group benefits. The first

objective was met, where children could identify the healthier food choice, and the second

objective was not met because than 50% identified the foods corresponding health benefit. We

learned that the intervention should have been planned at a time with less distractions, or

postponed snack time until the end. Overall, the project was a success, as the participants were

engaged and demonstrated increased knowledge about making healthy food choices. The

information about CT 39.03 was communicated to public health nurses at the Teresa Lee Public

Health Office on November 3rd, 2017.

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References

Anderson, E. T. & McFarlane, J. (2015). Community as partner: Theory and practice in nursing

(7th Ed.). In E. T. Anderson & J. McFarlane (Eds.), Community assessment: Using a

model for practice, (pp. 167-208). Philadelphia, PA: Wolters Kluwer.

Centers for Disease Control and Prevention [CDC]. (2012). Lesson 1 section 9. The natural

history and spectrum of disease. Retrieved from

https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section9.html

Dudley, D. A., Cotton, W. G., & Peralta, L. R. (2015). Teaching approaches and strategies that

promote healthy eating in primary school children: a systematic review and meta-

analysis. The International Journal of Behavioral Nutrition and Physical Activity, 12, 28.

doi:10.1186/s12966-015-0182-8

U.S. Census Bureau. (n.d.a.). Selected social characteristics. 2011-2015 American Community

Survey 5 year estimates [Census Tract 39.03, Pima County, Arizona]. Retrieved from

www.factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table

U.S. Census Bureau. (n.d.b.). Economic characteristics. 2011-2015 American Community

Survey 5 year estimates [Census Tract 39.03, Pima County, Arizona]. Retrieved from

www.factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table

U.S. Census Bureau. (n.d.c.). Housing characteristics. 2011-2015 American Community Survey

5 year estimates [Census Tract 39.03, Pima County, Arizona]. Retrieved from

www.factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table

U.S. Census Bureau. (n.d.d.). ACS demographic and housing estimates. 2011-2015 American

Community Survey 5 year estimates [Census Tract 39.03, Pima County, Arizona].

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Retrieved from

www.factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table

U.S. Department of Health and Human Services [HHS], Office of Disease Prevention and Health

Promotion, Healthy People 2020. (n.d.a.). Healthy People 2020 framework. Retrieved

from https://www.healthypeople.gov/sites/default/files/HP2020Framework.pdf

U.S. Department of Health and Human Services [HHS], Office of Disease Prevention and Health

Promotion, Healthy People 2020. (2017a). 2020 topics and objectives: Nutrition and

weight status. Retrieved from https://www.healthypeople.gov/2020/topics-

objectives/topic/nutrition-and-weight-status

U.S. Department of Health and Human Services [HHS], Office of Disease Prevention and Health

Promotion, Healthy People 2020. (2017b). 2020 topics and objectives: Nutrition and

weight status objectives. Retrieved from

https://www.healthypeople.gov/2020/topicsobjectives/topic/nutrition-and-weight-

status/objectives

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Appendices

Appendix A
Priorities of Care Table for CT 39.03

Community
health Communi Nursing Severity
Identified Availabili
concern or ty student of Applicable
in Pima ty of
expressio s outcome(

Total score
problem, Countys resources HP2020 Ideas for nursing
n of ability s) Determinan intervention
(stressor, Health relevant
interest in to without t of Health
risk factor, Needs for (Minnesota Wheel).
addressin address effort to
need, Assessme addressin category
g proble address
determinant nt1 g problem
problem2 m problem
)

Individual Health Teaching:

Stressor 1: Behaviors Tech a lesson
1 2 2 2 1 plan at the 8
Nutrition
Valencia Library
addressing
Stressor 1

Screening: Screen
Stressor 2:
for Hepatitis C to
Substance 2 4 1 0 1 Social 8
address Stressor
abuse Factors 2

Social Policy Development

Factors and Enforcement:
Stressor 3: Draft a policy
1 2 0 0 2 5
Poverty altering minimum
wage standards
addressing
Stressor 3

Stressor 4:
2 2 1 1 1 Consultation: 7
DM
Assess
individuals

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Individual disease
Behavior management
practices
addressing
Stressor 4

Appendix B

Health Education Project including the Velcro Food Activity

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Appendix C

Evaluation Worksheet

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Appendix D

Popsicle Stick Bear Response Cards

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