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COMMUNITY PARTNERSHIPS IN SOUTH PARK
Clinical Instructor: Robin Evans-Agnew, RN, PhD
Conducted by:
Adwell, S., Hassinger, F., Marshall, H., Neal, C., Quintana, V., Reavis, L., Tran, A., Volberding, N., Wotherspoon, L., Yoon, L.
ABSTRACT Background:
Ten University of Washington School of Nursing students partnered with new and existing organizations in South Park to help fulfill unmet needs in the community. The four organizations we worked with were: South Park Girls Group, Puget Sound SAGE, Community Breakfast, and Senior Exercise Program.
Objectives:
Our objective was to use broad community and project-specific assessments to identify how to fulfill the needs of our community partners in South Park. Once needs were identified, we used theoretical models and evidence-based research to plan and implement interventions aimed at improving the health and well being of the community.
Methods:
We assessed community strengths, weaknesses, opportunities and threats through interviews, qualitative surveying, and participation in community meetings and events. We utilized Health Belief and Logic theoretical models to monitor, educate, and mobilize the community. We organized and attended a retreat for young women; door-knocked & phone banked to promote a health fair; located resources to increase funding and promote healthy eating choices; and conducted outreach to advertise existing programs to the community.
Results: 2
1) Nurtured partnerships and participated in knowledge-exchange with four South Park community organizations. 2) Organized a retreat and educated 12 young women about healthy relationships, anti-bullying, and goal setting. 3) Outreached 400 residents and merchants to promote a health fair and educate on adverse effects of diesel emissions. 4) Located five possible funding resources to enhance nutrition options for the Community Breakfast program. 5) Recruited members for senior exercise program, increased community awareness of the opportunity and educated on the benefits of exercise on arthritis.
Conclusions:
Existing and new UW School of Nursing community partnerships in South Park were validated through community assessment and mobilization efforts. Our team was able to inform the community about health topics including healthy teenage relationships, diesel exhaust emissions, nutritional breakfast options, and the importance of physical activity for seniors.
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TABLE OF CONTENTS
Abstract 1 INTRODUCTION TO SOUTH PARK 6
COMMUNITY THEMES AND STRENGTHS 8
LOCAL PUBLIC HEALTH SYSTEM 9
COMMUNITY HEALTH STATUS 11
FORCES OF CHANGE 12
PARTNERSHIP OVERVIEW 13
Project Reports 14 PUGET SOUND SAGE 14
Theoretical Model: Logic Model 17 Evaluation 26 Conclusions and Recommendations 26
SOUTH PARK GIRLS GROUP 29
Partnership Overview 29 Theoretical Model: The health belief model 30 Community Assessment 31 Team Planning and Intervention 36 Evaluation and Conclusions 41
BREAKFAST PROGRAM 46
Theoretical model: The health belief model 47 Breakfast Program: Assessment 48 Breakfast Program: Results 49 Evaluation 51 Conclusion and Recommendations 59
SENIOR FITNESS PROGRAM 60
Theoretical model: The health Belief model 63 4
Community Assessment 63 Evaluation 66 Conclusions and Recommendations 67 South Park Project Conclusions and Recommendations 68
References 70
Appendices 73 APPENDIX 1: SAGE PROJECT 73
Community health survey/partners 73 2009 Community health survey results 93 toxic tour logic model 94 DEEDS Smartchart 99 Door knocking schedule 106 Health fair activities 107 Health Fair Floor Plan 127 Final health fair report 128
APPENDIX 2: GIRLS NIGHT OUT 130
Letter to Parent and Packing List 130 South Park Girls Night Out Pre-Retreat Survey 133 Original Itinerary and Notes from Planning 137 Evaluation Surveys 140 Session 1 Lesson Plan: How to Be a Good Friend 149 Lesson Plan for Puberty/Health Relationships 152 Goal Setting Lesson Plan: 158 Results From Survey Graph and Demographic Information 161
APPENDIX 3: BREAKFAST PROGRAM 163
Nutritional value of south park’s breakfast 163 Standard menu pattern: 165 Health and pyschosocial survey 166 Health and Psychosocial Survey Results 167 Poster 170
APPENDIX 4: EXERCISE PROGRAM 172 5
Fitness Check Paperwork Email 172 South Park Fall Prevention and Fitness Program Key Players 173
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INTRODUCTION TO SOUTH PARK South Park is a combined residential and industrial neighborhood located South of downtown Seattle. The neighborhood is bordered by urban roads and water. To the north and east, South Park is bounded by S.W. Michigan St. and the Duwamish River. The southern boundary is defined by S. Director St., S. Cambridge St., and S. Barton Street. The western edge is created by Meyers Way S., 1st Avenue S., Washington State route 509, 2nd
Avenue S.W., and W. Marginal Way S.W.
Accessing South Park became difficult after the June 2010 dismantling of the South Park
Bridge due to structural damage. The bridge, which transported over 20,000 vehicles per day, connected the main street of 14th Ave. S in South Park to Georgetown and functioned as a commerce lifeline. Neighborhood restaurants, bars, and local businesses, have struggled to stay financially viable, relying on local residents for revenue due to the loss of other patrons as a result of the bridge closure and the subsequent isolation. Our 14th
Street walkabout group noted three empty commercial buildings in prime retail locations near current bridge construction. Many businesses are experiencing a 25-50% decline in profits compared to when the bridge was open, creating a palpable atmosphere of insecurity along the main drag that will likely persist and possibly become more acute prior to the reopening of the bridge in 2013.
A few small stores offer convenience foods such as pre-packaged food items, milk, and beer but there is not a wide range of grocery items available. Our walkabout group noted a scarcity of fruits and vegetables, finding a few dried-up lemons, small oranges, and avocados. We were unable to find additional items considered staples to the fruits and 7 vegetable selection in other grocery sections such as lettuce, onion, and additional fruits and vegetables.
Larger grocery stores and business able to augment South Park’s retail can be found at the
White Center area, a neighborhood between SW Roxbury Street and SW 128th street about two miles southwest of South Park. There is a sizable supermarket that belongs to a
Vietnamese-Chinese owner in which consumers can find fresh vegetables, fruits, and varieties of Asian foods. In addition, White Center is notable for numerous bars. There are more than three bars at or nearby White Center. In a discussion with a neighbor who lives in the area, she stated that the population of White Center is also very diverse. The population largely consists of individuals from ethnic minority backgrounds including
Vietnam, Cambodia, and Mexico. From SW Roxbury Street and toward the south, the neighborhood has higher rates of crime, robbery, and violence compared to the White
Center neighborhood (Helen Nguyen, personal communication, January 3rd, 2012). South
Park contains one fire station, station #26 and lacks a police station, bank, and post office. A stroll through the neighborhood might lead an observer past a large and colorful mural, to a library, by the soccer field just beyond the main entrance of the community center where the community youth gather in the afternoons, or through a busy intersection to an open space along the Duwamish River. In residential areas of South Park, houses at all levels of repair sit on tree-lined streets in close proximity to auto garages, public gardens, empty buildings, community parks and industrial work sites.
Originally inhabited by members of the Native American Duwamish tribe, development led to the area being settled by immigrant Italian and Japanese farmers. From the 1900s to the 8
1970s, Marra farm was owned and operated by an Italian family as a truck farm and became one of the original suppliers of produce for Pike Place market in downtown Seattle.
During this time farming was the major economic force in the area, giving way to an influx of industry in the area in the early twentieth century with the arrival of Boeing Airplane
Company and the rechanneling of the Duwamish river. Low cost housing became available, attracting new immigrants to settle in the neighborhood.
COMMUNITY THEMES AND STRENGTHS
In response to many challenges and difficulties, the South Park community has developed several community organizations that provide important services to its residents. The
South Park Neighborhood Center (SPNC) is a former brick fire station that houses the South
Park Neighborhood Association staff, the South Park Information and Resource Center
(SPIARC), Providence Regina House food and clothing bank, Environmental Coalition of
South Seattle (ECOSS), the South Park Senior Program (SPSP), and a community kitchen and dining room. The community kitchen provides three meal programs each week. A breakfast program is available Monday through Friday in partnership with the Union
Gospel Mission, the South Park Latino community provides lunches every Tuesday, and the
SPSP provides dinners every Monday and Friday. The SPSP also sponsors an exercise program entitled Enhance Fitness® on Monday and Friday prior to dinner, and cards and games before and after dinner. The food bank is widely supported by a few significant community efforts. Marra Farm is a four-acre farm located in South Park that supplies organic produce to the food bank hosted at the Providence Regina House. Lettuce Link’s
Giving Garden grows over 13,000 pounds of produce each year to this food bank. The Mien
Community Garden also donates to South Park’s food bank, as well as helping to feed its 9 community members and seniors. Healthy Foods for South Park is a new project being launched by ECOSS to make healthy foods more accessible in the community of South Park.
It is partnering with Marra Farm to increase the availability of healthy food and drink options to children and youth and in local businesses, such as corner stores and restaurants. The South Park Community Center is a Seattle Parks and Recreation facility that serves residents of all ages in the South Park area. Most notable is the daily after school programs for South Park youth. The basketball court is consistently busy and organized games provide a healthy and safe environment to expend their energy.
LOCAL PUBLIC HEALTH SYSTEM When driving through downtown South Park, the Sea Mar clinic appears as a prominent health resource located on the main thoroughfare, 14th Avenue South. As stated earlier, South Park has a significant Hispanic population, comprising more than one third of the population. Appropriately, Sea Mar’s mission is to provide “quality, comprehensive health and human services to diverse communities, specializing in service to Latinos”, making this clinic an optimal space to meet the needs of this population. With limited transportation options in the area, Sea Mar’s central location may increase access to health systems for this population. This community health center boasts a variety of services and is open from Monday to Saturday from the hours of 8:00AM-
5:00PM. Weekend hours may allow for more access to the clinic for those who work during the week. The clinic provides immunizations, well-child check-ups, physicals, DSHS evaluations, L&I claims, prenatal care, breast exams, pap smears, mammograms, obstetric ultrasounds, behavioral health, health education, social work, family planning, chronic disease management, smoking cessation, and testing and treatment for tuberculosis, 10 hepatitis and HIV. Additionally, Sea Mar has a functioning laboratory and x-ray services available on site, as well as a full pharmacy. Further south on 14th Avenue South Sea Mar operates a dental clinic, which is significant given the lack of Medicare and Medicaid reimbursement for dental services. However, orthodontic services are not available, and only pediatric services are available on Saturdays, which may prevent working adults from being able to access routine care.
Sea Mar clinics are unique in their mission to provide care regardless of
“immigration status, or citizenship”. With the large undocumented population living in
South Park, this creates greater access to care for an underserved population. One service lacking seems to be vision testing. While screening using a Snellen chart is accessible within the Sea Mar clinic, patients must be referred to an optometrist who can help with vision correction. The nearest optometrist is in White Center and there is no guarantee they accept Medicare or Medicaid.
The Sea Mar clinic provides care to persons of “all cultural and socioeconomic backgrounds”. This includes the homeless population within South Park. However, while they intend to provide care to everyone, the rate at which people from different populations access care may differ. To fully assess which populations seek the most care at
Sea Mar, more time must be spent in the community. There are some barriers for extremely low-income and homeless patients. The Sea Mar website states that patients may need to pay between twenty and forty dollars for medical, behavioral, or dental visits, with the possibility of additional charges. While this may not seem like a lot, it may prevent some from seeking care. 11
Sea Mar works to improve the social determinants of health in areas such as housing. The Cesar Chavez Village is a housing facility that provides affordable housing to low-income persons. It also provides five of the twenty-five available town-homes to help those transitioning from homelessness. Additionally, access to Maternity Support Services and WIC are available through Sea Mar. However, these programs are both at risk of being discontinued due to anticipated budget cuts at the state level. All in all, Sea Mar clinic is credible and available source for the members of South Park to access quality and diverse health care.
COMMUNITY HEALTH STATUS According to City-data.com, South Park’s population is 3,828 (2012). With a large number of undocumented immigrants in the community, however, this is likely an underestimate. More than a third of the residents are of Hispanic origin compared to 5.3% citywide, and several ethnic minorities are present in the neighborhood making South Park one of Seattle’s most diverse and historically interesting neighborhoods (City-data.com,
2012). A full third of South Park residents are foreign born (34%), 40% of whom have come into the U.S. in the last five years and the percentage of residents who are not fluent
English speakers in South Park is 16.8% compared to Seattle over all at 4.3%. South Park is also a very young community, with 35% of the population younger than twenty years of age. The socioeconomic status of the area is markedly lower than that of the greater Seattle area, with a per capita income of $15,826, about half of the per capita income of King
County ($29,521). Approximately 12.5% of the inhabitants live below the federal poverty level (US Census Bureau, 2003). Eleven percent of South Park residents live in poverty and
89% of local elementary students qualify for free or reduced-fare lunches. Only 33% of 12 people over the age of 25 have completed high school, compared to a citywide estimate of
90% (Matsuno, 2006).
According to the King County Public Health Department’s Health of King County report published in 2006, the chronic disease age-adjusted death rate was higher for 8 out of 10 measured chronic diseases in South Seattle compared to Seattle overall. The chronic diseases with higher age-adjusted death rates were cancer, lung cancer, colorectal cancer, breast cancer, stroke, diabetes, diabetes-related, and chronic liver disease. In this report
South Park is not measured exclusively, but is combined with both Beacon Hill and
Georgetown, two other South Seattle neighborhoods. The same report also informs us that the infant mortality rate is higher in these South Seattle neighborhoods at 6.8% compared to 4.9% in Seattle overall (Public Health- Seattle & King County, 2012).
FORCES OF CHANGE Although the closure of the South Park Bridge affects the community negatively for the time being, the prospect of positive change in South Park is also afoot. The Lower
Duwamish Waterway, part of which forms the eastern boundary of the South Park neighborhood, was declared a Superfund site by the U.S. Environmental Protection Agency in 2001. The Waterway has been part of Seattle’s major industrial area since the early
1900s, during which time pollution by industrial waste, raw human waste from sewer overflows, and storm drain discharge that it is now described as a “toxic stew” of chemicals that are known to cause cancer, reproductive problems, developmental problems, and a variety of other impediments to good health. Cleanup will be underway in 2013 at an especially polluted section of the Waterway that is in South Park, along with two other highly polluted sites just upriver and just downriver from South Park. In addition, in 2013 13 the EPA will present its plan for cleanup of the overall waterway at community hearings, a necessary step in the lengthy federally led process of cleaning the entire waterway. The issues surrounding the waterway have galvanized community and environmental activists and local businesses to come together, resulting in the formation of an organization called the Duwamish River Cleanup Coalition. This group may remain a force for positive change in the area even after the waterway cleanup work has been completed.
PARTNERSHIP OVERVIEW South Park has been the focus of our 2012 community health clinical, where we have applied the tenets of the community-based participatory research model in the
“practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences” (American Nurses Association, 2007). Students worked with community members, organizers and leaders to identify and address some of the health concerns of the community. We were challenged to form relationships based on mutual trust and respect with these members of the community and to use our time in the neighborhood both as an opportunity to learn about public health nursing and to provide something of value back to the neighborhood we worked with.
As we learned about community health theory and method in our weekly lectures, we also learned about the history and identity of South Park, the people who live there and the resources the community has to offer. We then attempted to integrate and translate this knowledge into tangible work and services that would sustainably benefit the people of South Park.
This quarter we attended a meeting with many of the leaders of community programs, who offered our clinical group potential projects to engage in that would help 14 the community move towards these goals. We broke up into four groups, and spread our efforts over the different locations. Our experiences, projects, assessments, data and evaluations along with the community health theories and methods applied are described in this paper and illustrated in-depth in the subsequent case studies.
PROJECT REPORTS PUGET SOUND SAGE
PARTNERSHIP OVERVIEW AND ASSESSMENT METHODS
Addy Adwell, Faith Hassinger, and Hunter Marshall have partnered with Genevieve
Aguilar and Melanie Jung of Puget Sound SAGE on an environmental justice project concerning diesel exhaust and air pollution. The partnership effort this quarter is to outreach for, organize, and conduct a Diesel Exhaust 101 and Asthma and Health fair for the communities of South Park and Georgetown. The goal of the health fair is to highlight the problem of diesel air pollution in the community, disseminate information about the adverse health consequences of diesel exhaust, such as in contributing to illnesses like asthma, and to invite community members to participate in a diesel monitoring effort that will provide data for future policy levied at reducing air pollution in the area.
During the initial community assessment, Genevieve Aguilar provided a tour around the Port of Seattle and nearby South Park community (appendix A6). This “toxic tour” enhanced our knowledge of the geography of the area as well as increased our awareness of port activities that contribute to poorer air quality in the South Park and surrounding areas. For instance, drivers of trucks transporting containers from terminal to rail often idle their engines while awaiting their cargo. Port truckers are also often forced to drive 15 through and park their trucks in surrounding neighborhoods including South Park for lack of adequate city provide parking. In addition to the quantity of diesel trucks in and around the South Park area, air quality is further deteriorated due to close proximity to additional diesel emitting factors close to the neighborhood including: Waste Management parking facilities, school bus parking facilities, and an airplane fly strip that grazes just overhead. These diesel sources lie within close proximity to areas likely to be especially sensitive to diesel pollution such as the Concord International Elementary School, Marra
Farm, and residential housing throughout South Park.
During our tour, Genevieve was also able to explain barriers that may impede policy aimed to decrease diesel emissions within the South Park community. Some of these barriers include lack of parking facilities for Port trucks and the fact that Port truck drivers are considered independent contractors rather than employees. As an independent contractor, a truck driver potentially bears the burden of cost for truck upgrades that are known to decrease diesel exhaust levels. Since an independent contractor is unable to band with other drivers and bargain to shift the burden of cost onto the port trucking companies that control virtually all driver related activities, this burden of cost is substantial and potentially hazardous to the livelihoods of individual drivers and the communities through which these trucks drive.
Another community assessment method utilized this quarter during the partnership with Puget Sound SAGE was interviews conducted while door knocking in the South Park community. By engaging with the South Park community members in this way, we hoped to learn what the community knows regarding air quality and adverse health consequences, as well as what the community desires to see in a diesel exhaust exposure 16 study such as where to monitor and/or how to monitor. Communication through door knocking allowed us to determine what the community feels to be key strategies toward decreasing diesel exhaust levels.
While structural inequities are interrelated, the main structural inequity impacting
South Park is wealth. Poverty limits opportunities for communities to exert control over their environment leading to high-polluting facilities being located in poor areas. For example, it was proposed that a Port of Seattle container facility be placed at Pier 90 or 91, located on the waterfront of Magnolia and Queen Anne. Residents of these communities were able to mobilize and force the facilities to be located near South Park and Georgetown
(Norton, 1995). These communities are able to do this using resources such as money and social capital. Money and social capital grant access to the political process and the legal system, which are two main avenues for effecting change on a large scale. Public hearings and community meetings in which industry projects are discussed are more accessible to those in wealthier communities, as transportation, safe neighborhoods, and traditional work schedules are more common. Residents have verbalized these as barriers to attendance and community involvement during our door-knocking trips. For these reasons, when the interests of industry come up against the interests of a community like
South Park, industry wins, as evidenced by the recent decision to allow a third runway at
Boeing (Green, 2008)
Another more subtle way wealth impacts the health of this community is through the misclassification of port truckers as independent contractors. This misclassification prevents drivers from joining unions or demanding legal rights employees are entitled to
(e.g. restroom facilities). As a result of the fact that these drivers own their own vehicles 17 and lack parking facilities, they drive high emissions trucks, and park in the South Park neighborhood, exposing the community to more diesel exhaust.
THEORETICAL MODEL: LOGIC MODEL Made up of four basic components which follow a systematic “If-Then” sequence. Each will be discussed and then elaborated on prior to discussing the next “if- then sequence.” This model can be applied well to the diesel monitoring project we are working on with Puget Sound Sage (appendix A6). The first part of the model needing to be addressed are the inputs, or the resources that are needed in order for the program to be successful. These resources can be human, financial, organizational, or originate within the community. An assessment that was done and discussed during the recent conference call allowed us to discuss these resources. The main resources discussed were, UW research expertise, Sage community expertise, connections to community partners, Spanish language skills on the team, enthusiastic volunteers and interns working on the team. Other more tangible inputs are the extensive budget of Sage and UW researchers.
The second part of this model is activities, or the processes, events or actions that use the inputs in order to obtain a desired output. While there are a number of different activities that are taking place in order to achieve the desired output, the one we have been working most closely with is planning a respiratory health fair. Building upon the inputs listed above, we will use the expertise of Sage and UW researchers, as well as connections to community partners (and the enthusiasm of nursing students) to host a health fair giving the populations of South Park and Georgetown the opportunity to learn more about the impact that diesel emissions have on the health. Getting to this desired output of hosting a 18 respiratory health fair, there is a great deal of work to be done, much of which was discussed during the conference call. These activities included, door knocking in South
Park and Georgetown, mailing postcards, making phone calls, outreach at various community spaces (food bank line, senior breakfast, neighborhood center etc), using connections at Concord elementary, as well as online outreach on South Park and
Georgetown blogs and websites.
This easily leads into the outputs. Outputs are the products of these activities and they should be objective and measurable. In this case, the hope is that this health fair will build the knowledge base of the community with regard to the effect of diesel emission on health. This can be objectively measured by doing before and after assessments of knowledge using a questionnaire or survey of some kind. The other activities leading up to the health fair are more objectively measured. The number of doors knocked, calls made and postcards sent out are all easily measurable. The list that was discussed on the conference call included, 40 people attending the health fair and recruiting 10 active community advisory board members.
Outcomes are the changes to the target population. The outcomes can be broken down into initial, intermediate, and long-term outcomes. The overall changes to the target population that we are hoping to see include, increased involvement in issues relating to diesel emissions in their community. This could look any number of ways including community enthusiasm about becoming involved with diesel emissions monitoring, involvement in activism to reduce emissions within the community and involvement in broader issues of environmental justice. However, it seems that to guarantee success, the steps leading up to the outcomes must be community driven. This will likely be the biggest 19 challenge going forward. Success also depends on the program not being started with inadequate resources to complete each step. It establishes a clear framework for program evaluation. It also ensures that the outcomes and have a reasonable chance of being realized with the proposed inputs, activities and outputs (Savaya & Waysman 2005). See appendix A6.
COMMUNITY ASSESSMENT SAGE
Community themes and strengths:
In an effort to better understand South Park and Georgetown residents’ thoughts about Port of Seattle operations and perceived health impacts, our community partner
Puget Sound Sage, co-conducted a door-to-door survey operation in 2009. A total of 230 surveys completed from June-July 2009 revealed that 62% of respondents were concerned that Port of Seattle activities negatively impacted their health. In regard to trucking activity,
60% of surveyed residents thought that port truck pollution affected their health and the health of their family. Furthermore, 34% of surveyed residents rated their health status as
“poor” or “fair”. Based on these survey results, it became clear that quality of life in these communities was perceived to be negatively affected by Port of Seattle operations. These survey results suggested that it was important for community members to more accurately determine the real impacts of port activities on health, in particular health effects due to diesel exhaust.
Taking into consideration concerns related to port trucks, Puget Sound Sage partnered with a research group at the University of Washington to further explore port trucking and related diesel exhaust levels. As a result, the partnership launched the current project entitled: Diesel Exhaust Exposure in the Duwamish Study (DEEDS). The DEEDS 20 project is planned to be implemented in four phases:
1. Community engagement, and involvement
2. Assessment of exposure - Implementation of diesel exhaust monitoring
3. Data analysis
4. Report results in publication and to the community (South Park and Georgetown)
The focus of our community health involvement with Puget Sound Sage was to assist in implementation of the first phase of the DEEDS project. The first phase seeks to reach out to the communities of South Park and Georgetown to create awareness of the
DEEDS project and to elicit assistance from community members. Community assistance on this project is requested in terms of contributing to discussions that determine how best to monitor diesel exhaust (where and how) and also in terms of cooperation allowing implementation of diesel exhaust monitoring devices throughout the community, perhaps including on private property.
Puget Sound Sage utilized our assistance during the first phase of the DEEDS project in two ways. First, we contributed effort toward the goal of door knocking on 400 homes to create awareness of the DEEDS project and to invite community members to a sequence of community based events discussing project goals and implementation. Second, assisted in planning the first of the three sequential events, a ‘Diesel Exhaust 101’ and ‘Asthma and
Health Fair'. This event focused on educating residents about the known health impacts of diesel exhaust including diesel exhaust’s contribution to illnesses such as asthma. The event also provided a forum for community members to meet the researchers and learn more about the study. Two more community meetings will follow this event. These meetings will address where and how to monitor diesel exhaust by gathering input from 21 the community about diesel hot spots. During our first door knocking effort, our group of eight broke apart into three teams and knocked on approximately 40 doors. We were successful in engaging a handful of residents about their current thoughts about diesel exhaust, and about how they perceive diesel exhaust to contribute to their health. Our preliminary findings reveal that residents display a spectrum of concern about diesel exhaust and health implications ranging from great to little concern. One resident who voiced great concern was a new homeowner and raising a family. She expressed concerns over health consequences for her family related to diesel exhaust. She stated desire to attend the March 1 Diesel Exhaust 101 and Asthma and Health fair event. She also stated interest in allowing implementation of a diesel exhaust monitoring device on her property.
Another resident, also a homeowner with children stated that ‘I am more concerned about the planes that fly overhead than the diesel trucks.’ This resident perceived that his home was buffered from the effects of the diesel exhaust due to his home’s location near a green belt. Another resident, a truck driver by occupation, stated little concern about diesel truck exhaust ‘I have lived here 52 years; I am too old now to worry about diesel exhaust.’ This resident did state some concern for younger residents in the neighborhood, however.
Our general observations of the community through our preliminary door knocking effort first indicated that there may be a shift from the 2009 survey findings in terms of what residents perceived to be causing air pollution. Many residents we spoke to at least mentioned some level of concern about plane exhaust. This shift toward greater concern about plane exhaust, compared to the 2009 survey, may be related to closure of the 14th street Bridge and resultant diminished truck volume in recent history. Second, our group was surprised to experience an overall openness of community members to engage in 22 discussion. Several members of our team, prior to door knocking, worried about having doors slammed on our faces. We did not experience this phenomenon. In fact, we felt that the community members of South Park displayed a general community engagement by being open to a discussion of an issue.
We feel that the greatest community assets related to this project are both the general community engagement along with the partnership that Puget Sound Sage and UW are bringing to the community. Puget Sound Sage has funding to be committed to this project until 2013. We feel that the level of funding along with the resources that Puget
Sound Sage is able to mobilize will contribute toward gaining knowledge about the levels of diesel exhaust in the South Park and Georgetown communities. We feel that this knowledge can in turn be used by the community to fight for policy change around Port of Seattle activities, especially if diesel exhaust levels are found to be significantly higher than surrounding areas and known to be contributing to ill health consequences.
Local Public Health Systems A local health systems resource available to residents is home air testing done by the American Lung Association. During our door knocking, we met a woman who had her home tested after becoming sick for a prolonged period of time. It was found that the foundation of her chimney cracked as a result of the vibration caused by nearby trucks letting water in. The ALA will have a Master Home Environmentalist will come by and do an assessment of the home free of charge. One limitation is that they will not clean or repair anything. The cost of remedying any problem may be a barrier to creating a healthier home environment. 23
Community health status
A recent survey in 2009 looked at the overall health concerns and perceptions of health of the residents of South Park and Georgetown. Three of five residents reported being worried about environmental impact on health, especially related to the activities at the
Port of Seattle. One third of the residents rated their health as “poor” or “fair.” In King
County at large, only one in ten rate their health this way. These poor health perceptions are grounded in reality. Children in South Park, Georgetown and Beacon Hill have the highest asthma hospitalization rates in all of King County. Cancer rates are also high for these areas. A study in 2009 by the Environmental Protection Agency discovered cancer rates 27 times higher than the national average (Reported by the Puget Sound Clean Air
Agency (PSCAA). Information Sheet: 2002 National Air Toxics
Assessment. 2009. Available at: http://www.pscleanair.org/airq/basics/PSCAA_4_16_09_NATA_info_sheet.pdf ).
As discussed previously, the community health survey of South Park and
Georgetown found that there is concern about the health impact of living in such an industrial area. Yet, we were able to see many people who are raising their children in this community. This is (not in all cases but in some cases) related to location as a structural inequity. A lack of control over ones environment can lead to chronic stress, which is bad for health independent of the pollution (though that is bad for health as well).
Forces of Change:
The Port of Seattle operations and associated truck activities and emissions are leading forces of change that have potential to affect the health of the South Park community. In 2011, the Port of Seattle moved 2.03 million TEUs (20-foot equivalent units) 24 between ship, rail, and road. To accomplish this movement of freight, an estimated 8,000 trucks are registered by the Port of Seattle, and it is thought that 2,000 regularly work at the port (McClure, 2011). Considering the amount of truck traffic that circulates in and through the port which lies just north of the South Park community, the quantity and quality of diesel exhaust emitted from port trucks has the potential to influence respiratory health of South Park community residents.
Despite the Port of Seattle’s ten year initiative, beginning January of 2008, to update port trucks to engine-year 1994, this initiative falls short of the latest federal air-pollution regulations for diesel run vehicles that promote truck upgrades to engine-year 2007.
Furthermore, recent studies conducted by the U.S. Environmental Protection Agency (EPA), the Puget Sound Clean Air Agency (PSCAA), and the federal Agency for Toxic Substances and Disease Registry indicate current engine improvement measures have done little to ease illness burden in the South Park and Georgetown communities related to respiratory health (McClure, 2011). For example, South Park and Georgetown residents experience the highest rates of hospitalization for childhood asthma in all of King County (McClure, 2011).
Puget Sound Sage and other advocacy groups are calling on the Port of Seattle to require port trucks engine upgrades to align with the latest federal regulations.
The cost burden from cleaner air legislation may be a complex issue, however, when we consider that port truck drivers are currently classified as independent contractors because drivers own their own trucks. There is concern that cost burden for upgrades may fall solely to drivers. Despite drivers being classified as independent contractors, this designation in actuality is relatively inaccurate. Port trucking companies, not individual drivers, direct most driving related activities. For example, port trucking 25 companies often display a company logo on the driver’s cab, inspect the truck, dispatch the driver each morning, and pay the driver per load shipped. By not being recognized as employees, drivers are denied hourly wages and benefits. Furthermore, they are unable to unionize and gain bargaining rights demanding that the port trucking companies share engine upgrade costs. A current hearing in Olympia is discussing port truck driver classification: http://www.joc.com/portsterminals/trucking-industry-teamsters-clash- over-owner-operator-bill
TEAM PLANNING AND INTERVENTION
The primary intervention in this phase of the DEEDs project to address the health issue of outdoor air quality was an Asthma Health Fair and Diesel 101 information session.
This strategy was developed in partnership with Puget Sound Sage, the DEEDS research team, and a UW graduate nursing student. Our goal was to outreach 400 residents in the neighborhoods of South Park and Georgetown with the hope that 40 people would attend.
To meet this goal we participated in weekly door knocking, outreach at community events such as the food bank and senior meals, and phone banking.
The strategy of extending a personal face-to-face invitation to community members through door knocking was chosen because it had a higher likelihood of success in a community that is experiencing study fatigue. We also attempted to make our efforts culturally sensitive by bringing along language interpretation services as they were available. This was necessary in order to reach the Vietnamese and Spanish speaking residents of South Park. The strategy is a primary prevention strategy because the study is seeking to ultimately address the source of a health factor. 26
At the health fair itself, we had a variety of booths to engage people around issues of respiratory health in different ways. Organizations such as the American Lung Association,
Puget Sound Clean Air Agency, and SeaMar Clinic were in attendance to talk about respiratory health and outdoor air pollution. The nursing students each created a table activity related to respiratory health and presented that activity to the attendees of the health fair. The activity list for the health fair can be seen in appendix A4.
EVALUATION Our team was able to meet both our goals of outreaching to 400 residents of the identified neighborhoods and having 40 residents attend the Diesel 101 health fair. In terms of reaching a broad audience, our strategies were not as effective. Most of the attendees of the health fair were white and there were very few Spanish-speaking or
Vietnamese-speaking attendees. This was in spite of the outreach efforts specifically targeted toward these populations.
The dual event of a respiratory health fair in combination with the Diesel 101 information session was a success. The booths and activities that had been planned to engage people around respiratory health issues prior to the presentation performed the function of gathering people’s attention well. The presentation was well received and community members participated with questions and contributing concerns. Puget Sound
SAGE and the DEEDS team plan to do two more events in a similar style. The research team and organizing team were pleased with the outcomes of the event.
CONCLUSIONS AND RECOMMENDATIONS 27
This section will start with a quick recap of our activities and goals to give some reference for our conclusions and recommendations. Faith, Hunter, and Addy partnered with the organization Puget Sound Sage for Winter quarter of 2012. To summarize, the focus of the current project is a follow up to an assessment done in the community in 2009 looking at resident environmental concerns. Diesel exhaust was the largest concern with
60% of residents believing that levels of diesel exhaust impacted their health. The current focus is to complete a community driven diesel monitoring study that looks at diesel exhaust levels throughout the neighborhoods of Georgetown and South Park.
This project was in the early phases when we began working on it. Further community interest and feedback was needed to make decisions such as; where to monitor, how to monitor, what types of monitors to use, and what will be done with the data. To engage the community and come up with answers to these questions, the Puget Sound Sage team decided hosting a series of three community meetings in which community members could give input and be the driving force behind how this study was conducted. Given the importance of these three meetings, our work throughout the quarter consisted of outreach to the communities of interest. The quarter for us culminated in hosting the first of these three community meetings (see above sections).
Throughout our work in the community, it became clear that a lack of wealth is a contributing factor to the current problems in the communities. Given that English abilities, education, immigration status, etc all play a role in the ability to find employment and accumulate wealth (though clearly the situation is more cyclical than that), these structural inequities will need to be addressed to effect a lasting change and reduce the pollution in these communities. 28
At the community meeting that was held, it was quite clear that the demographics of the meeting were not representative of the communities we were targeting. The group that came to the meeting was almost completely Caucasian. Using the empowerment theory, it might be possible to specifically target marginalized communities within South Park and
Georgetown and do outreach using empowerment as a framework to increase participation.
Recommendation for future groups would be to increase efforts at doing outreach to
Hispanic and Vietnamese groups within the South Park and Georgetown community. Previous efforts detailed in the preceding paragraphs were unsuccessful and new strategies should be used. Potential strategies include conducting in-home interviews instead of expecting these groups to attend community meetings outside of the home. Outreach at Latino soccer league in South Park may be an opportunity to get interest of families in South Park who spend time outdoors exercising. The assumption is they would have more concern about the quality of the air.
Many people are asking the question, “What do we do after the study to actually reduce the amount of pollution from diesel?” This is a good question and one that doesn’t have a clear answer yet. It would be worth investigating other areas in which a similar project has been done and seeing what interventions were planned to reduce pollution. The graduate student Rachael who has been working on this project is in the process of putting together a number of case studies looking at what has been done elsewhere and can be done here. This would be a good resource to find once complete. Looking at what efforts are currently underway to improve and having 29 opportunities for resident involvement may help residents feel empowered and give them an ability to become engaged and involved in improving their environment.
SOUTH PARK GIRLS GROUP
PARTNERSHIP OVERVIEW Lauren Wotherspoon, Natalie Volberding, and Vivian Quintana worked with Carmen
Martinez and Yvette Tolson with the South Park Community Center Girls’ Group. Our goal was to organize and execute a weekend retreat for the girls, which would include fun activities and sessions centered around healthy friendships, puberty and sexual health, and goal-setting. The program was pioneered by UW Nursing students a couple of terms ago to help get the community's adolescent girls involved in the community center. After-school and late-night teen programs were making a huge difference for the adolescent boys, so they created a Friday night event specific to the girls called “Girls’ Night Out”, which also sponsored the retreat. Since the debut of the retreat was such a great success with the girls, both Carmen and the girls would like it to be available in the future.
This fall, nursing students were able to raise some funds for the retreat in February and outline a sustainable biannual retreat for years to come. They gathered a binder full of evidence-based curriculum that the South Park Girl’s Group can turn to each year. They also planned and set up a funding system with local businesses that is replenished every time it rains, entitled “Save for a Rainy Day”.
Throughout the quarter, our team met with Carmen to discuss plans and ideas for this year’s retreat, and she provided us with insight into the lives of these adolescent girls.
Many of them come from difficult home situations where the parents are addicted to 30 alcohol or drugs, which leads many of the teenagers to get involved at an early age. These girls have little vision of a life outside of South Park. One of Carmen’s hopes for this retreat is to show the girls that they can discover their full potential and that living in South Park should not limit their goals or dreams. She also noted a recent history of conflict among the girls, which means this retreat can be a positive place for them to build stronger relationships. Carmen said, “this is all we have, you have to get along”. Our hope for this retreat is that the girls would feel more confident in themselves, feel empowered to make positive and healthy decisions, and build community with the SPCC staff.
THEORETICAL MODEL: THE HEALTH BELIEF MODEL
The Health Belief Model (HBM), developed in the 1950s, seeks to identify the factors that facilitate or impede individuals from participating in a particular program or activity.
The HBM “is based on the assumption that the major determinant of preventative health behavior is disease avoidance” (Nies & McEwen, 2007, 42). It was an attractive model because of its usefulness in situations where behavior change is the goal of the intervention. It is also applicable to programs in which individuals are targeted in order to affect the behavior change (National Cancer Institute, 2005).
The HBM breaks down an individual’s (or population’s) readiness to act into six concepts. These concepts include: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. The Girl’s Night Out project group used the Health Belief Model in the discussions stimulated on the retreat. By including these young women in conversations about stereotypes, self-esteem, and peer pressure, we hope to increase their awareness of these issues and how they affect them and 31 their peers, as well as empower them with steps to take. Specifically, through the self- esteem and goal-setting aspects of the retreat, we hope to see what the girl’s think- what they perceive their barriers to be or what perceived severity of their situation. We created a survey to hear from the girls about what issues they want to discuss most or believe are most important to cover on the retreat.
COMMUNITY ASSESSMENT This winter quarter of 2012, a team of three UWSON students met with Carmen
Martinez, Teen Programs Coordinator, at the South Park Community Center. Carmen shared with them her concerns for the girls’ group and her hopes for the future of the group. She expressed concern for the neighborhood teen girls’ safety and their future, and shared with us a vision to engage the girls in the community center. She explained how the
Community Center started ‘Late Night’ teen programs, which operate until midnight on
Friday nights, to keep gang members off of the streets and involved in other activities with their peers during the late hours. Additionally, the late night hour’s program brought more kids into the Center, but drug and alcohol use became far more apparent. Kids would often show up drunk or high, some passed out on the lawn, and on many occasions youth were seen partaking in illegal activities on the bleachers in the field adjacent to the Community
Center building. Carmen expressed, the teen girls specifically were not engaged in the community center activities, instead being focused on boys or using alcohol and drugs.
These observations became Carmen’s rationale for creating more girl-specific interventions, and in the fall of 2009 they started Girl’s Night Out (GNO) with a group of
UWSON graduate students. 32
Megan Vaughan, a graduate student planning Girl’s Night Out programs, described self-esteem building and fun as goals for the girls group. Carmen noted that recently the pre-teen girls in the community attended these activities more than older girls, and felt like new ideas for activities that reached the older girls was an important modification to the existing group. She also wanted to incorporate more fitness and self-esteem building into their schedule.
Carmen expressed that on multiple occasions teens have approached her for advice about pregnancy concerns, or to obtain a pregnancy test. As far as formal sex education, the community center had a Planned Parenthood speaker in the past, but this was not well received. A smaller group discussion was mentioned as a possible solution. One of our predecessors from last quarter told Carmen about a wonderful experience she had at a youth camp a few years ago. She explained how the camp setting allowed for sharing a curriculum in a more private type of setting and wondered if a retreat would provide the
South Park teen girls the same learning experience. Carmen liked the idea and the group began formulating plans to organize a South Park Girls’ Retreat.
During our first meeting at the South Park Community Center, UWSON students Natalie, Lauren, and Vivian partnered with Carmen to plan the retreat. She spoke of her primary desire for us to focus on the Girls’ Retreat by planning all the activities and events for the weekend. This retreat, she explained to us, would be a way to provide a personalized educational experience without the distractions of daily life, to teach the participants life-lessons concerning puberty changes, self-esteem, general female mental and physical health, how to be a better friend and prevent bullying, and goal setting for their future. Carmen has witnessed a high level of unintended pregnancies in the South 33
Park teen population. Although teen pregnancy is a health concern in many communities,
Latina youth pregnancy rate is the highest in the United States (Gilliam, et al., 2007) so we will certainly address safe sex issues for their current or future sexual relationships.
Another alarming statistic from the King County Public Health website states that the
White Center/Skyway area of South Seattle, which includes South Park, has the highest rate of adolescent pregnancies in the county: 28.8/1,000 births (Barkan, 2003).
Throughout the quarter we met a total of five times with Carmen where we worked out the logistics of the weekend retreat and offered opportunities for these pre-teenage girls to visit University of Washington campus, although these activities did not come to fruition. In planning the retreat curriculum, we created a survey to hear the girls’ views on what they would most like to learn about and discuss. What emerged was a blending of the girls’ desires of puberty changes, how to be a better friend, and Carmen’s wishes to address self-esteem and goal setting.
At the conclusion of our initial meeting with Carmen, through researching various statistical data bases, we formulated questions to help us identify the aspects of the Health-
Belief Model (HBM) that would best support the health benefits of the retreat for the South
Park female youth. Disease avoidance, including unintended pregnancies, and increasing self-esteem and self-efficacy we felt, were fundamental for this population in attaining their most beautiful selves. In formulating the curriculum and activities for this retreat, we wanted to answer the following questions:
1. In following the HBM, we wanted to identify what areas of healthy lifestyle education
were missing or lacking in the developmental aspects of the girls’ lives. To what extent
can we expand their knowledge to help them perceive their susceptibility to unhealthy 34
lifestyles; understand the severity of the consequences of their actions and the actions
of others; empower them to overcome perceived barriers to healthier more satisfying
lifestyles; and cue them to action to receive the benefits of healthy life choices (Nies &
McEwen, 2011)?
2. What techniques and tools can we use to facilitate engagement and participation of the
South Park female youth in the learning lessons during the retreat and in programs
offered by the GNO?
3. Would the isolation afforded by Camp Bethel’s secluded and distant environment allow
for these girls to be more receptive to these lessons thereby increasing the likelihood of
retention and self-efficacy to apply these trainings to their lives?
According to Gilliam et al. the overall instance of early initiation of sexual practice for Latina teens age 17 or under has fallen by 24% from 1995 to 2002, yet these girls are at a higher risk for pregnancy and acquiring sexually transmitted diseases than their counterparts of other ethnicities. The focus of their study was on the factors influencing Latina youth’s sexual decision making. They employed a mixed-method research by obtaining qualitative data from seven focus groups of the target population and existing literature, and then formed peer-reviewed and pre-tested quantitative survey tools. These surveys measured the influence of culture, family, friends, and partners, familial demographics, and reflections upon when the girls first became sexually active and their application of protective measures. They found Latina youth to be “more likely to delay sexual initiation compared with other youth populations” (2007). However, “when they do have sex they are less likely to use contraception” (2007). The authors attribute cultural values and norms such as pressure upon Hispanic males to engage in early sexual 35 activity, “gender inequality, power imbalance with romantic relationships, and pressure to repress” communication about sexual feelings to be major influencing factors in Latina youth sexual practices. They cited mixed evidence concerning acculturation effects on the
Latina youth. The older the age of the partner had a strong correlation to the early initiation of sexual activity for Latina teens (Ibid). From the data they collected, the authors ascribed strong family expectations for their child’s education and future goals as a major contributor to Latina youth decisions to delay sexual initiation.
Many of the South Park girls lack stable family environments. This deficit, along with the above mentioned influences have played key factors in early onset of and risk taking in sexual activity for the girls in this community. During past retreats, many of the 11 to 18 year-olds confided in staff that they were sexually active and did not use protective devices during vaginal, anal, and oral sex. The girls attributed not using protection to a number of beliefs concerning risks of unprotected sexual activity such as: “You cannot get pregnant or acquire an STI if the guy pulls out early”, “you cannot get pregnant the first time a person has sex”, and “you will not acquire an STI with oral or anal sex.”
At our third meeting with Carmen, we met Yvette Tolson who directly oversees the girls’ activities. During this meeting, and in the course of consecutive meetings, numerous emails, and phone calls, our team of three along with Yvette and Carmen brainstormed to create a retreat where the learning sessions would be engaging while still addressing our major topics. To facilitate involvement in the weekend’s curriculum, past retreats have included activities like roller skating, dinner outings, and an afternoon at the beach.
We learned to exercise much flexibility throughout the process as ideas were dismissed or often modified due to logistics, or deemed unfeasible in meeting the specific 36 needs of this teen population. After many revisions to the retreat (curriculum, evaluation forms, scheduling of events and so forth), we came up with a plan of action we all felt would best fulfill the girls’ needs during the limited time allotted us.
We highly valued Carmen and Yvette’s input as we orchestrated this retreat, recognizing their wealth of knowledge concerning the South Park community and culture. While we may need to further cut costs of future retreats, extra activities help to break up the learning sessions into more digestible segments. This was a key element in organizing the curriculum and retreat schedule for the South Park girls. According to
Carmen and Yvette, these youth reside in an underserved community struggling with the effects of poverty (U.S. Census Bureau, 2000), high crime incidence, gang activity, unstable familial structures, frequent cases of domestic violence, and isolation. A lack of middle or high schools in the neighborhood requires the students to commute a couple hours every school day using public transportation. These factors have created an environment that does not foster favorable study habits or initiative to overcome perceived barriers to healthier life-choices.
The Health Belief Model provided us with a workable theoretical framework to build our project upon. The assessment process for the girls’ retreat was ongoing throughout the planning stage, and continued into the evaluation phase as the intent of this project was to develop an annual, sustainable retreat formulated around the specific mental and physical health needs of the South Park female youth.
TEAM PLANNING AND INTERVENTION Logistical planning was largely taken care of by the group of UW SON students that preceded us in working with South Park Community Center during the fall of 2011. They 37 established funding in partnership with several businesses as well as with the South Park
Community Center, and secured a place at Ensign Ranch (a camp affiliated with the Church of Jesus Christ and Latter Day Saints in Cle Elum, WA) where the retreat was originally going take place. Their efforts provided us with a solid ground in developing and strategizing for the retreat, and enabled us to focus on more specific details. Many of the details that the previous students organized, however, were changed in light of the circumstances.
Our planning for the retreat involved meeting weekly with Carmen Martinez and
Yvette Tolson. While meeting together, we discussed in detail the logistics for the course of the retreat, the overall composition of the lessons for the retreat, generalizations and trends of the local adolescent females of South Park concerning behavioral practices, transportation, and food menu (See Appendix B). An established vision that the South Park
Community Center staff and volunteers have in collaboration with the UW SON students is that the adolescent females who will be attending the retreat will leave with a strong sense of empowerment thus enabling them to make healthy decisions for themselves in all aspects of life. Furthermore, we hoped the retreat would be a safe place for the girls to share difficult life struggles and have an opportunity to experience a weekend outside of
South Park. We prepared an informational letter with permission form to send the parents or guardians of the girls we hoped would attend the retreat (See Appendix B1).
Towards the end of the planning sessions, we discovered that the previous agreed upon location of Camp Ensign had a clause requiring guests to observe the Sabbath, during which no camp activities would be available. Additionally, we discovered that we would be split into two cabins and have to sleep on the floor because there were no bunk beds. With 38 what we had planned, Carmen and Yvette decided it would be best to return to the previously attended Camp Bethel in Hoquiam, WA, as that camp was more tailored to our specific needs. Since Camp Bethel was outside of our budget, the Girls Group will have to do extra fundraising when they get back from the retreat.
Through coordination with Carmen and meeting the girls a few times during the planning period before the retreat we had a total of 12 girls scheduled to attend. The retreat took place on the weekend of 2/17/12-2/19/12. Personnel for the retreat included
Yvette, three South Park Community Center employees (Marlene aka Hip Hop, Lovely, and
Amphone aka AP), and Vivian, Lauren and Natalie involved in this project. South Park arranged for one city van for the trip, while Lauren and Hip Hop drove their own cars for luggage and food. We met at South Park around one o’clock in the afternoon to run last minute errands with Carmen. After we picked up the van for the trip, we hurried over to
Cash & Carry and Costco to buy food for the trip. Carmen was great to shop with and let us, for the most part, choose the food we would need from our agreed upon grocery list. After the food was bought, we needed to pick up one of the South Park Girls Group leaders from her job in West Seattle. After all that running around, we got back to the community center in South Park around 4 pm, just as the girls were showing up with their things.
Once everyone had arrived the girls and personnel ate Subway for dinner just prior to departing for Camp Bethel. The retreat consisted of games and activities at Camp Bethel, three forty-five curriculum sessions including activities and teaching lessons (See Appendix
B3). We also took the girls on two separate outings. One was to a nearby restaurant, followed by a roller-skating rink. For the second outing, we took the group to the Tacoma
Mall for some shopping. The entire outing was led and monitored by leaders in attendance, 39 and ultimately under the legal protection of Parks and Recreation of Seattle. Consent forms were signed by participants and their legal parent or guardian. In collaboration with
Carmen and Yvette, it was decided that activities and outings were an important piece to the retreat. We wanted the girls to have a memorable time away from home, and in doing so, learn a significant amount about a variety of health-related topics.
The retreat’s curriculum was created and implemented by the three UW SON students, Lauren, Natalie and Vivian. Primary sources for the curriculum itself was from government websites affiliated with the Office on Women’s Health, a career development center, and class lectures. While doing our ongoing assessment of the adolescent girls of
South Park, we felt that friendship building, puberty and healthy sexual relationships, and goal setting were priorities in our curriculum. Research done with minority adolescent females in the United States has found that poor psychosocial health in adolescents is positively related to the disadvantaged socioeconomic status of their families (Champion &
Collins, 2010). Furthermore, surveys created by the pervious UW SON students were distributed to South Park adolescent girls. In this survey, girls expressed an interest in learning about the topics of puberty, friendship building, and goal setting.
Taking this into consideration, Lauren began the first session by leading the girls in a discussion about “How to be a good friend”. We began with a teamwork activity involving
PVC pipes and a marble. Each person received a portion of a PVC pipe, and the goal was to send the marble through all of the pipes from one side of the room to the other. The keys to success were to work together, to be quiet, and listen, so we could hear the marble move through the pipes. The girls enjoyed this activity, which highlighted the benefits of teamwork and listening. We then launched into a conversation about the qualities of good 40 and bad friends. Two girls volunteered to act out a scene from Shrek in which Donkey holds
Shrek accountable for his behavior and forgives him for not being a good friend. This was a huge hit and the girls loved it, leading us to a discussion about how to effectively deal with conflict with friends. We ended by talking about how to help a friend who does not quite know how to express her needs or struggles, like someone with an eating disorder, alcohol problem, abuse, suicide, or homicide. The Community Center staff volunteered a few extra points that helped the girls to bring some of the conversation home, which was really nice.
Natalie started the discussion about puberty with the changes a girl goes through during puberty, from breast development to the menstrual cycle. As expected, there was some giggling at first but that gradually subsided. There were some brave girls who asked questions about inserting a tampon and we demonstrated how a tampon applicator works.
After this discussion, we went into a discussion about sexual relationships. The girls were given an opportunity to leave if they preferred to not discuss sex yet, because some girls were only 11 and have not started their periods yet; we didn’t want to overwhelm them with too much new information. However, no one chose to leave so the discussion continued with the varying levels of intimacy from kissing to oral sex and sexual intercourse. The main two ideas we addressed were: 1) You are only given one body in this life and you need to respect it, especially if you want respect from your partner; and 2) If you are too embarrassed or uncomfortable to talk about a certain level of intimacy with your partner, then you probably should not engage in that activity. The lesson concluded with a discussion about STDs and contraception, demonstrating how to put a condom on with a banana as an example. 41
Finally, Vivian’s session focused on setting goals and making plans for the future. We started by making a collage on a poster board by cutting out magazine pictures of anything that could represent a goal. Some of the girls got really into it and some girls didn’t participate at all. Vivian started her session by discussing how to set an attainable goal and the difference between a wish and a goal. Next, she talked to the girls about the difference between short term and long term goals and the importance of making short term goals as steps to achieve a bigger goal. She finished by sharing her story of how she reached her goal of being a nurse and gave the girls ideas of different programs that could assist them in achieving their academic goals.
All in all, the retreat was filled with fun and education, and the girls all stated they had a great time (See Appendix B8). To objectively show the results of the retreat, the adolescent girls, South Park Community Center employees, and the three UW SON students filled out evaluation forms at the end of the retreat (See Appendix B4). Hopefully the information the girls learned at the retreat will leave a lasting impression on them and they will spread the word of the fun times they had to more girls back home.
EVALUATION AND CONCLUSIONS The Health Belief Model was used to focus on the work with the girls’ group, addressing perceived knowledge. After our discussions with the SPCC staff, we decided to focus our teaching sessions on friendships, puberty and sexual health, and goal setting. The curriculum that we created focused on educating and expanding the knowledge of each girl on all of these topics (See Appendices B5-B7). According to Carmen, some of these barriers are low socio-economic status, lack of family support, and lack of health insurance. To 42 overcome these barriers, we sought to empower these young women by providing information and initiating dialogue on topics perceived to be valuable by the girls and staff.
The second question created focused on techniques and tools that would facilitate participation of the Latina teen youth. For this, we used interactive games and lessons. The games consisted of teamwork exercises with PVC pipes and a marble, role-play of a scene from the movie “Shrek”, practicing putting a condom on a banana, and creating a collage of future goals with magazine cutouts. At the end of the weekend, we asked the girls to write letters to themselves about what they learned on the retreat, which will be sent back to them three months after the retreat. These activities helped the girls stay engaged in our discussions.
The third question addressed the retreat’s location and environment. We hoped that taking the girls out of their home environment would enhance their learning, participation, and retention, as well as show them a snapshot of life outside of South Park. After the sessions, Yvette helped to lead a conversation where each girl reported a short- and long- term goal and gave advice to the girls younger than themselves. Unfortunately, there is no way for us to measure how well the girls will apply this information to their lives, as we are not following them into their personal relationships.
Overall, the weekend was a success largely because we remained flexible.
Throughout the retreat we had to re-evaluate and adjust our plans in order to work with the staff on the retreat. Everyone leading the retreat had different expectations of how things would go, and this became especially difficult when the retreat moved to the same location as the previous year. Many of the girls were excited to repeat activities that we had not included in our plans. For example, we had discussed seeing a movie for our outing on 43
Saturday, but ended up going roller-skating at the same rink they had gone to the year before. The South Park staff added valuable insight to our sessions as people more familiar with this community, such as an explanation of why it is more valuable to deal with conflict face to face than over text messages. Before leaving Camp Bethel we had each of the 12 girls fill out a survey (See Appendix B2). The surveys were really helpful to get feedback from the girls for future retreats, although not all of the surveys were filled out completely.
Everyone was able to rate her knowledge before and after the retreat on nine goals we chose based on our lessons. Each girl reported an increase in knowledge on at least four of the goals off the survey, except for one survey where the “before” knowledge was left blank. Things that were enjoyed by the girls ranged from roller-skating, to the Chinese buffet, to learning new things. Things that “sucked” about the trip were not related to the curriculum. Those that mentioned anything talked about leaving, needing to sleep (they stayed up until 5:30AM), and the rain. Overall the girls seemed to express in the surveys and in conversation that they enjoyed this trip and would like to do something similar in the future.
The staff was also able to fill out evaluation forms (See Appendix B4). From these evaluations we could identify ways to improve future curriculum and schedules. Strengths mentioned by the staff included a smaller group of girls, age appropriate sessions, and energy and enthusiasm from the nurses. Ways to improve the retreat next year would include a more defined itinerary, more interactive team-building activities, and using more age-appropriate language. Prior to the retreat, the staff had goals to cover different topics, keep sessions shorter around 45 minutes, and show the girls a fun time outside of South
Park. We believe we succeeded in meeting these objectives. One girl who had attended the 44 retreat last year wrote, “it was a good time to stay chill and [I] learned different stuff”. We made an effort to talk about new things that the staff felt important for these girls to hear.
Some topics the staff recommended for future retreats include hygiene, “facebook stuff”, and workshops for the senior girls who will likely attend next year.
Largely, from the UW SON students’ perspectives, the weekend was successful. The retreat was a wonderful experience for the girls to get out of their home environments where they had no worries and could just be kids. While we were not able to spend a lot of time with the girls before the retreat, our conversations with Carmen, Yvette, and Lovely were very helpful, providing insight to the girls’ lives at home, feedback from last year’s retreat, and challenges and strengths in this community. It was a great opportunity for the girls to spend a weekend away from the stresses of their lives at home, spend time with each other, and eat a lot of food. It is notable that many of the girls were extremely excited about eating at a Chinese all-you-can-eat buffet in Hoquiam. They ate plate after plate, and one of the staff people reflected that this is probably because at home, they do not know when they will get their next meal. This retreat is a huge gift for the girls of South Park, and it is a unique opportunity to provide rest, empowerment through knowledge, and build relationships with the staff.
As always there were some challenges to the weekend. Our plans changed weekly, highlighted by a location change two weeks before the event. We also reflected on the potential negative aspects of having temporary nursing students involved with this retreat.
It is very difficult to get involved with teens that need consistency and strong relationships in their lives. As nursing students we cannot provide that for them, so we made a point to 45 encourage the girls to lean on the staff from the community center, who will be there for them longer than this weekend.
One activity did not go as well as we expected. We had the girls’ caregivers write them letters which we distributed on the second night. We hoped that the letters would be encouraging for the girls to read. However, most were pretty quiet, read their notes, put them back and were ready to move on. It was not the touching moment we were hoping for. Yvette made the comment that the nice words on the cards probably do not match what the girls experience at home, so they do not really know what to do with them. Next year, we recommend that the community center staff to write these notes because of their supportive role in the girls’ lives.
Another challenge involved the availability of resources. While approximately $300 was raised by the nursing students in the fall, this was not sufficient for the weekend due to the location change. Heavy fundraising will be required in the upcoming year in order to fill the hole created by this retreat, as well as prepare for another retreat next winter. In the past, students have suggested holding a second retreat in the fall, but it is unclear whether one retreat a year is sustainable with community level fundraising and state resources. We recommend involving the girls in fundraising for future retreats, which creates a personal investment in an event that they already appreciate.
We also recommend involving the older high school age students in leadership roles. We heard their insight and knowledge when they gave advice to the younger students during Yvette’s portion of the weekend, and believe it would be valuable to further empower them as leaders and examples in the community. For example, they could provide ideas during the planning stage, as well as lead small group discussions during the 46 retreat. This also might create an opportunity to focus the retreat on middle school students, rather than trying to teach age-appropriate material to 11-18 year old girls.
It is the goal of the Community Center to continue to advance the girls group in the
Community Center. One goal of us nursing students was to provide a stepping block for the
Community Center to build on and keep doing this weekend retreat each year. Completing this weekend retreat allowed for both parties’ goals to be obtained.
BREAKFAST PROGRAM
BREAKFAST PROGRAM: PARTNERSHIP OVERVIEW
The South Park Breakfast Program is held in the cafeteria of the South Park
Neighborhood Center, which was once an old firehouse station. The breakfast program, which started about 5 years ago, was first set up and run by the grassroots organization called the Neighborhood Association. Prior to the bridge reconstruction, there was a restaurant across the bridge from South Park where many of its community members went to eat breakfast in the mornings. However, after the bridge closure and loss of customers, the restaurant unfortunately closed down. Under these circumstances, some of the members of the Neighborhood Association banded together to start what is now known as the Breakfast Program.
For 5 years, a few community member volunteers were running the program, but it lacked consistency and commitment. There were days when breakfast would not be served because no one was there to help organize and cook. In August of 2011, the Union Gospel
Mission saw a need for more volunteers and decided to partner with the South Park
Community, and provided volunteers like Sheila and Aleina to be the head cooks. Now, the 47
UGM provides 5 dozen eggs every week for the program. The Breakfast Program has been partners with the Providence Regina House, a food bank, and ECOS, the Environmental
Coalition of South Seattle for a long time as well. In addition, the Food Life Line and
Northwest Harvest provide free food to help sustain the program. The breakfast program has also continued to stay afloat with its financial aid of about $1,800 a year from the request of a $3 donation with each meal, most of whom cannot afford to donate. Currently, they are in the process of requesting more funding now that breakfast is consistently served Monday through Friday with an increasing number of people, serving about 35-40 people each morning, (M. Engstrom, personal communication, January 5, 2012 & C.
Dagmar, personal communication, February 2, 2012).
THEORETICAL MODEL: THE HEALTH BELIEF MODEL The health belief model (HBM), developed in the 1950s, identifies the factors that facilitate or impede individuals from participating in a particular program or activity. The
HBM “is based on the assumption that the major determinant of preventative health behavior is disease avoidance” (Nies & McEwen, 2007, pg.42). It is an attractive model for two of the South Park groups because of its usefulness in situations where behavior change is the goal of the intervention. It is also applicable to programs in which individuals are targeted in order to effect the behavior change (National Cancer Institute, 2005).
The HBM breaks down an individuals (or populations) readiness to act into 6 concepts. These concepts are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The concept of the health belief model that we will use to evaluate the breakfast program is perceived benefits. We will analyze the calorie in each meal and propose a nutritional improvement with a serving 48 of some types of vegetable or fruits in the breakfast menu. We will promote healthy eating choices through advertisements. We will also locating resources for increased funding to afford for quality foods.
BREAKFAST PROGRAM: ASSESSMENT The UW Nursing Program partnered with the breakfast program for the first time this year to help improve the breakfast menu, which usually consist of 2 slices of French toast or pancakes or biscuit, seasoned potatoes, eggs, and sausage or bacon. They also have the option of cereal and milk, some juices and coffee, and occasionally some yogurt and fruit salad. After meeting with Dagmar Cronn, the head leader of this program, we decided to focus on two major concerns: to analyze whether the breakfast is meeting the
Washington State guideline for a health and nutritional breakfast, and to help Dagmar find several funding agencies where the program may be good candidates for funds.
We believe that wealth is one of the major structural inequities this program experiences. One obvious reason is that this program lacks funding from other organizations, which would be helpful in purchasing healthier foods because they tend to be more expensive. South Park is also not an affluent neighborhood, rather suffers from a high rate of unemployment, so providing food for oneself or the family may come as a significant daily challenge. Although the program has been able to sustain merely on donations, the financial circumstances for the community members make it difficult for them to donate more, if any, therefore funds are very limited for the breakfast program.
This is why we plan to explore how this inequity has been affecting South Park’s breakfast program. 49
BREAKFAST PROGRAM: RESULTS Surveys The community health problem that is the focus of the morning breakfast at South
Park Neighborhood Center is wealth. In assessing the community health problem, my group did a survey with people who came to the breakfast program on Thursday, February
2, 2012. The results of all the answers are shown on a table in appendix C2
Surveys: Income We found that the reported poverty level is consistent with the intake form that recipients filled out every year. In the intake form, most of the people reported having incomes below 30% or 50% of the poverty level. We learned that out of the 22 people who filled out the survey, 13 were unemployed, some related to retirement, disability, and being a full time student. The other 8 had temporary or seasonal jobs, such as being a food vendor, a handyman, and a drywall taper, and 1 had a full time job as a carpenter. We also interviewed Alex, the building manager at the neighborhood center. His thoughts agree with the surveys, stating that most of the people coming to breakfast are low-income, where a lot of them have temporary or handy jobs and many others issues with alcohol and drugs. Overall, these community members are not living above the poverty line. In addition, many people do not have cars or rely on other people for transportation. As a result, going to grocery stores or restaurants to buy foods seems nearly impossible for these people.
Surveys: Health and Diet As you can see from the survey, we asked several more questions about their health and diet. We asked if they had health insurance, and 11 reported yes and the other 11 reported no. While there were more people who had health insurance than we expected, 50 we still have to face the fact that only 50% of the people surveyed have health insurance, which is still devastating. We also asked the members how often they eat fruits and vegetables. 6 of the answers ranged from 0-1 times a week, 8 of the answers ranged from
2-3 times a week, 6 of the answers ranged from 5-6 times a week, and the other 2 did not respond to that question. Once again, we see that there is a handful of people who eat fruits and vegetables nearly every day, but 63% of the people do not have the luxury to eat it every day, let alone more than one serving per day.
We also identified a conflict between eating what is given versus choosing to eat the healthier choices of food, such as the yogurt and fruits when available. However, out of the
16 who answered the question about how often they eat lunch and dinner, 7 of them, which is 43%, answered eating anywhere from 1-5 lunch/dinner meals a week. Although eating nutritiously is what we are striving for, to many of these community members, eating the high caloric and fat filled breakfast may be their only meal of the day, which in case, explains why they want to pack in as much food as possible. So then this continues to be an issue of wealth.
Surveys: Health Conditions
Lastly, we asked them about their health conditions and whether they considered themselves to be healthy. Many were either unsure of any existing health conditions; however, considered themselves as to be healthy. As healthcare providers, we understand that many diseases or health conditions are not explicitly symptomatic, rather disguised within the physiologic level of the body until a full assessment and tests are done. In order 51 to do that, one needs to be either insured or able to afford the costs of diagnostic tests, which is nearly impossible to many of the people in South Park.
Attendance
South Park Community Breakfast is one of the programs that was created at the South
Park Neighborhood Center to address the issue of wealth. The breakfast program has been serving breakfast from 7 am to 9 am, Monday through Friday. According to Peter Nguyen, one of the program coordinators, the number of people coming to breakfast has been increasing every year. The highest recorded number of people coming for breakfast was 60 people. This emphasizes the need for the continuation of the breakfast program.
Date Number of People coming
to the breakfast Total # of attendance of
January 12th, 2012 35 January (the whole
January 26th, 2012 60 month) = 620 people
February 2nd, 2012 42
February 9th, 2012 40 Total # of attendance of
February 16th, 2012 36 February (the whole
February 23rd, 2012 32 month) = 680 people
March 1st , 2012 35
EVALUATION According to an article written by Rebecca Dodd and Lise Munck, poor people are vulnerable to illness because they are forced to live in environments that expose them to high-risk behaviors, bad eating habits, unhealthy food choices, and poor access to health 52 care (2011). Despite these facts, when we analyzed the components of the breakfast meals that people eat every morning, the high calorie meals could increase their risks of diseases such as diabetes, high cholesterol, cardiomyopathy, and bowel cancer. We are working on helping the community get more funding for the program so that there will be more vegetables, fresh fruits, and nutritious foods available to be served at this community breakfast program.
What do we know generally about the health concern?
In 2010, the percentage of people living under the poverty line in the United States was 15.1%, amounting to about 46.2 million people, which is the highest it has been in 53 years (Tavernise, 2011). For the King County, poverty has increased from 9.5% in 2006 to
12.5% in 2010. The percentage of people without health insurance also increased from
10.4% in 2008 to 12.7% in 2010. More specifically, the people under poverty line in Seattle jumped from 10.6% in 2008 to 14.7% in 2010 (Broom & Mayo, 2011). As we can see from the statistics, wealth as a health concern is not only an issue for South Park, but for King
County, and the United States as a whole.
According to the Bureau of Labor Statistics, the U.S. unemployment rate is at 8.3% as of December 2011. For the greater metropolitan areas in Washington State, the Seattle-
Tacoma-Bellevue area stands at 7.3% (2012). Interesting, if our structural inequality of wealth can be also translated into the idea of unemployment, according to Feeding
America, this is an accurate predictor of a concept called food insecurity (2010). Food security on the other hand is defined as any household member having access to healthy food at all times to sustain an active and healthy life. According to Feeding America, in
2010, 48.8 million Americans, 32.6 million adults and 16.2 million children, lived in food 53 insecure households (2010). Food security is an important concept to understand because it encompasses the idea of nutritional food rather than solely meeting the daily caloric needs of a person, which we have been doing at the breakfast program. According to the breakfast’s nutritional value table, (see Appendix C1) the community members are consuming roughly around 760 calories during this one meal, which is about 38% of ones total caloric needs. How much of it is really healthy and provide the proper energy and nutrients needed to sustain a healthy life? South Park’s members lack prosperity and wealth, as a result of major factors like unemployment, which in turn forces them to reach out for the free or least inexpensive foods, such as the breakfast program meals, where the nutritional content may be too high and insufficient in nutritional value. However, this is another important reason as to why it is imperative that we start finding the funds needed in order to provide healthier food choices for the people of South Park.
How are other food programs providing nutritional meals? With the high percentage of poverty, unemployment, and food insecurity that exist in America, USA TODAY reports 1 in 8 Americans, about 37 million people, get help at a food bank (Koch, 2010). Some of the successful food bank programs that exist in Seattle are the Union Gospel Mission’s food services and the University District Food Bank. For
UGM, their goal is to “continue to recruit and partner with churches and civic groups to host community meals, and assist with food distribution,” (UGM, 2010). For the University
District Food Bank, it has 18 organizations that donate food to them, along with being a cooperating member of 8 organizations, such as Food Lifeline and Northwest Harvest, which are organizations that the Breakfast Program receives their donated food from.
From looking at their list of sponsors, the U-District food bank has connected with the local 54 churches and grocery stores nearby, and also have a running website that lists the different materials and foods they need.
Unlike these other food banks, South Park does not have the luxury of having bountiful resources, such as major groceries stores, like Safeway and QFC, to help support and donate foods like fruits and vegetables. Nor does South Park have local grocery stores, churches, and cafés willing or even having enough extra food or money to help support and donate to the program without being concerned for its own sustainability. In addition, the breakfast program lacks manpower to organize all these connections with other organizations. Dagmar, who is in charge of this program, on top of several other ones, cannot give all her time to help this program thrive. So once again, South Park’s lack of wealth as a neighborhood becomes a structural inequality on the nutrition to the breakfast program.
Community Resources The Seattle Department of Neighborhood has gathered numerous residents, business owners and organizations of South Park together to create an Action Agenda plan for South Park. The website states “The South Park Action Agenda is a community-driven partnership with the City of Seattle, which targets 162 different recommendations across 5 topic areas to improve the South Park community including: Environmental and Physical
Improvements, Business and Transportation, Community Engagement, Youth
Development, and Public Safety” (Matsuno, 2006). Their goal under the ‘Environment &
Physical Improvements’ is most closely related to the health issue of wealth, stating that
South Park “seek[s] a variety of improvements designed to improve the quality of life in 55
South Park, promote economic development, and protect public health and safety”
(Matsuno, 2006).
With the different types of policy changes and programs being initiated through this agenda plan, the South Park community seems to be increasing their resources and capacity to improve this issue of wealth in order to bring a higher quality of life to the people, which include their health. This is a huge step towards improving and refining
South Park; however, there are still many challenges, deficits, and limits the community faces. Although the community set out this agenda, it is evident that the whole agenda is still a work in progress. From what has been discussed, it seems like a lot of the programs in South Park have existed no longer than 4-5 years. Although much can be accomplished during that span of time, it requires the whole community to stand up and make these changes in their community, which is another reason why the breakfast program is just running along. Another question to think about is what the program leaders can do to bring in more of the South Park community members’ support and volunteers, which will bring more unity amongst them.
Team Planning and Intervention
In planning our intervention, we made an appointment to meet with Dagmar Cronn.
Dagmar writes most of the proposal letters for grants and funding for South Park community, including the community breakfast. When Dagmar first came into the cafeteria for the breakfast Thursday, February 2nd, 2012, we noticed that the first thing she asked the head chef was what were the components of the breakfast for the day. When we interviewed Dagmar, she said that her suggestion was that the head chef would include 56 vegetable or fruits in each breakfast so there will be more healthy food choices for the people in the community.
Dagmar explained to us about the Washington Nutritional Standard required for the senior meal. Because the senior meal is funded by the state, there are several criteria that are required to meet in order to continue receiving funding. The community breakfast is not required to meet these requirements; however, Dagmar suggested us to look at this state nutritional standard and compare it with our breakfast meal, hoping that if it were to meet it, funding organizations would be more interested in funding it. And if the meal does not meet the standards, she would want the program to work towards meeting the guidelines.
In regards to finding more grants for the community breakfast, Dagmar introduced us to the Northwest website which include a searchable online database for over 150
Northwest foundations that we can seek for more funding for the community breakfast.
This website also include a tool which grantmakers can publish information about their giving programs. These foundations include private and family foundations, individual families, corporate foundations and giving programs, public and community foundations, government grantmaking programs, and tribal corporations and nations. These organizations make charitable grants to multiple organizations in the states of Alaska,
Idaho, Montana, Oregon, Washington and Wyoming. Our goal is find a few grants that
Dagmar may be able to use in the future to help fund the Breakfast Program.
To begin our intervention in promoting healthy eating choices, we made flyers to advertise the benefits of milk and cereal. For our first flyer, we chose an attractive picture of cereal and milk with a caption underneath depicting milk as a good source of calcium 57 that supports healthy bones and teeth. On another flyer, we made a table of the recommended daily calcium intake in each age category. The table is located below for reference. We decided to post the flyers on the wall next to the coffee table because coffee is often the first thing people get when they come to the breakfast. We also posted these advertisement flyers on the table where there was milk, cereal, juice, and yogurt.
Age Daily calcium requirement
4 to 8 1000 mg
9 to 18 1300 mg
19 to 50 1000 mg
50+ 1200 mg
Pregnant or lactating women 18+ 1000 mg
1 cup of milk/250ml = 300mg Calcium
We noticed that despite these visual advertisements, people who came to the community breakfast still did not choose to eat cereal with milk. There were one and half gallons of milk at the beginning of the day and there was one full gallon of milk left after the breakfast. Most of the milk was used as an additive to coffee. We realized that visual 58 advertisement alone is not effective. Therefore, additional direct education or teaching would be a recommendation for future student groups.
Next, a comparison between the Washington State Guideline for healthy and nutritious meals, given by Dagmar for us to use, and the foods the breakfast program consistently provides were done (see appendix C1). Out of the 6 food group categories, only half are meeting the standards. While important good groups such as vegetables are not being met, and in our case, not even being served or offered on an occasional basis, the amount of carbohydrates are being served in excess. Fruit is being barely met because orange juice is almost always offered, but people have expressed that real fruits would be preferable. The milk category is also being met because milk is always provided at breakfast. Although the meat category is meeting the standards in regards to serving size, the quality and type of meat is definitely not healthy for the body as you can see from appendix C1 along with the amount of fat that is being consumed. In order to meet the standard guideline, the breakfast will have to adjust the type of foods being served. For example, in order to reduce the amount of fat being consumed, a different type of meat will have to be served. Unfortunately, in order to find an alternative to better quality meat, the program will need more funding to purchase them, along with the vegetables that are missing in the meal. Even if the breakfast were to meet the state guideline with those adjustments, the actual nutritional breakdown need to be taken into consideration because the total caloric intake exceeds 1/3 of the total daily caloric need that the state guideline requires. 59
Our next intervention was to find as many funding resources for the community breakfast as possible. After paying $165 for a 12-month subscription, Dagmar provided us the user name and password to access the Philanthropy Northwest website. As a member benefit from the subscription, we were able to access the Northwest funders directory to find information posted by the grant-maker foundations. We were then directed to the funder search where we could narrow down the foundations that are most appropriate for the community breakfast. Many grant-maker foundations are designed to support specific
Northwest regions such as Walla Walla and Tacoma. Therefore, we went through each grant-maker foundation’s description to find appropriate funding resources that are specifically designed to support King County or the Seattle area. As a result, we were able to locate nine possible funding resources. The grant-maker foundations that we found are
Kongsgaard Goldman Foundation, Raven Foundation, Starbucks Coffee Company and
Foundation, United Way of King County, Bill and Melinda Gates Foundation, Dupar
Foundation, Puget Sound Energy Foundation, Ben B Cheney Foundation, and Medina
Foundation.
CONCLUSION AND RECOMMENDATIONS In conclusion, we were able to successfully accomplish the two main interventions requested by Dagmar. As for the next group, we have several recommendations we would like to make in regards to the breakfast program. 1) Coordinate with Dagmar to write proposal letters to these grant-maker foundations as an initial step to gain funding for the breakfast program. 2) Determine and organize where the foods are donated and purchased from. With the foods the program purchases, work with the budget to find alternative foods that are healthier, eg: whole wheat or whole grain 60 pancakes/waffles/toasts, more fruits and vegetables, oatmeal, healthy cereals, etc., OR omitting certain items. This should be accomplished in order to move towards the expected outcome of the meals meeting the State guideline requirements.
4) Contact the following: MARA farm and other farmer markets, churches, grocery stores, other food organizations, located outside of South Park in the Seattle area willing to partner with the breakfast program and donate fresh produce. 5) Lastly, we recommend promoting and advertising the breakfast program throughout the community through bulletins flyers at the community center, the library, SeaMar clinic, etc. If more people are able to attend, the program will better recognized by the grants organizations. All of these recommendations are suggested to continue to address the importance of nutritional foods to improve overall health for the residents of South Park.
SENIOR FITNESS PROGRAM
PARTNERSHIP OVERVIEW AND COMMUNITY ASSESSMENT METHODS
The South Park Senior Program (SPSP) sponsors an exercise class twice per week at the South Park Neighborhood Center (SPNC). A grant from the Healthy Aging Partnership’s
(HAP) Aging at Home Initiative allows the classes to be offered free of charge at South Park.
The grant request was entitled South Park Fall Prevention and Fitness Program, and the exercise class that was selected as the basis for the fitness program is called
EnhanceFitness® (EF). EF is an evidence-based fitness program developed by the
University of Washington’s Health Promotion Research Center and Group Health in the mid- 1990s. EF and its partner program EnhanceWellness® are managed by Project 61
Enhance, a department of Senior Services, and the programs have been implemented across King County, Washington State, and the entire United States.
The one-hour EF class includes low impact aerobics, strength training, flexibility, and balance. It is especially designed for adults aged 50 and up regardless of their current fitness or ability level. The goals of EF are to improve cardiovascular fitness and prevent falls of older adults whether they be fit or frail. Vivan Bowles teaches the senior fitness classes at South Park, and she is certified by Senior Services with special training as an
EnhanceFitness® instructor which helps her tailor exercises based on participants’ abilities and fitness levels.
The UW School of Nursing students who worked with the South Park Fall
Prevention and Fitness Program were Carla Neal and Lisa Reavis. As outlined by the South
Park Neighborhood Association President, Dagmar Cronn, the primary task at hand was to recruit more participants in the exercise program as current participation had plateaued at about eight regular attendees. Additional requirements were to provide necessary reports to Senior Services who manages Project Enhance and complete Fitness Checks for existing participants.
Assessment methods included conducting interviews with key players in the South
Park Senior Program, talking with participating seniors and non-participating seniors, reading Project Enhance’s instructor and site coordinator manuals to understand the
EnhancedFitness® program, assessing the larger community for opportunities to advertise to groups who would benefit from the exercise classes, and researching on the internet 62 about demographic information, education information, and studies about exercise benefits and healthy aging.
The overarching goal of our work in South Park was to increase the health of the community. For this team project, we chose to address education as a structural inequity that causes a health disparity in South Park’s older adult population. When discussing education inequity, one might assume that the focus would be on schools and the young people who attend them, and not on older adults in the community. We found that a lack of awareness of the EF classes being offered, a knowledge deficit about aging healthfully, and a need to understand the benefits of exercise all impacted participation in the EF classes at the SPNC. Because patient education is one of the primary interventions performed by nurses, we are especially qualified to make the effort to mitigate the structural inequity of education among the older adults in South Park.
The 2000 Census data showed that 19%, or 684 residents, of South Park were over age 55 and 8%, or 304 residents were over age 65 (Seattle Department of Planning and
Development, 2010). Of the residents over age 25, 61% had attained a high school diploma or higher, 19% had attained an associate’s degree or higher, and 10% had attained a bachelor’s degree or higher (Seattle DPD, 2010). No statistics could be found on the education levels of the age 50 and older population.
According to a report by the U.S. Surgeon General in 1996, over 75% of older adults do not meet the recommended activity levels, and that inactivity increases with age. Also, women are less active than men, persons with lower incomes are less active than those with higher income levels, and the more educated a person is, the more active they are 63 likely to be (U.S. Surgeon General, 1996). These statistics emphasize why our work in South
Park had a meaningful purpose to improve the health of the community.
THEORETICAL MODEL: THE HEALTH BELIEF MODEL
Theoretical models help practitioners to “think outside the box” when planning and conducting public health interventions by reminding them, in a structured way, that there are multiple factors that affect behavior, and that change is a dynamic process. The theory that we selected to inform our actions in this project was the Health Belief Model, which was developed in the 1950s to help explain why such a small number of people participated in programs to prevent or screen for diseases (National Cancer Institute,
2005). The social psychologists who developed the model concluded that six factors determine whether a person will or will not act to take health promoting actions: perceived susceptibility to the condition; perceived severity/consequences of having the condition; perceived benefits of taking action to avoid the condition; perceived barriers to/costs of taking action; presence or absence of cues to take action, and confidence in ability to successfully perform the action(s).” Consideration of two factors in particular -- presence or absence of cues to take action and perceived benefits of taking action to avoid the condition -- helped us to focus on the problem of low participation rates in the South Park senior fitness program, and also fell in line with the structural inequity of education among the community’s older adults.
COMMUNITY ASSESSMENT Low levels of physical activity contribute significantly to multiple health problems faced by older adults. A relatively clear way to absorb this idea is to consider the situation 64 in reverse; that is, to consider the health benefits to older adults of engaging in regular physical activity. According to Prohaska et al., regular physical activity significantly reduces a person’s risk of developing the chronic diseases of hypertension, heart disease, osteoporosis, and type 2 diabetes; as well as reducing the risk of colon cancer. The risks associated with diseases are also linked to increased age (2006). Regular physical activity also reduces the risk for falls (Belza et al., 2006), the incidence of depression in older adults, and helps to delay functional decline (Hunter et al., 2011).
Despite extensive researching showing broad benefits to older adults of regular physical activity, relatively few older adults report being physically active on a regular basis: in the year 2000, only 31% of Americans ages 65 to 74 were physically active for 20 minutes on three or more days per week. Activity rates for Americans ages 74 and above were even lower (U.S. Department of Health and Human Services, 2002). It is clear that many older Americans do not get enough physical activity to provide important health benefits.
The problem of low levels of physical activity among older adults affects the quality of life of older adults, their families and loved ones, and the rest of our society since
Medicare spending is currently financed by payroll taxes of the younger working-aged population. Thus, the problem of low levels of physical activity among older adults represents challenges on both an individual and societal level. Addressing the structural inequity of education by increasing awareness about aging healthfully and the benefits of exercise for older adults can decrease the prevalence of low physical activity, minimize the risks of several age-related chronic health conditions, and benefit society as a whole. 65
At our first class seminar, our clinical instructor Robin Evans-Agnew told us, “As
(community health) nurses…we don’t have the automatic ‘authority’ that nurses do in, say, a hospital setting.” Appreciating his point, our team decided to try and get a good idea of what the exercise program was all about before we started thinking about how we might help with it. We participated in the exercise classes, attended the meeting where new officers of the SPNC Senior Program were elected, and talked with participants and nonparticipants who were at the Neighborhood Center for other reasons. We participated in other events held at the Neighborhood Center and met with people at Sea Mar and at the
South Park Community Center. We toured the community on foot, by car, and by bus. Our assessment of the community and its needs was ongoing throughout the quarter.
According to the South Park Senior Program, there are 181 people aged 55 and older who have participated in some portion of the senior program in the last two years.
Therefore, the SPSP is reaching approximately 26% of their potential population per the
2010 Census data. We believe that barriers to participation in the exercise program could include a lack of transportation, uneven and/or nonexistent sidewalks that present safety hazards to people who might otherwise come on foot, darkness during the winter by the time the class ends at 4:30 p.m., lack of awareness of the program in the community, and lack of awareness of the benefits of the program on personal health. Attitudes toward physical activity may play a part, as well; one of the class participants stated, “People of our generation weren’t raised to think about doing exercise. We were raised to think you hit sixty and then you sit and wait.” A different participant stated, “A lot of people here don’t speak English, either…we tried to get the people who speak Spanish to come…tried really hard…but they don’t mix.” Finally, a lack of support for the exercise program among some 66 of the leadership of the South Park Senior Programs was apparent, and we feel that this lack of support may be affecting participation in the exercise program negatively.
TEAM PLANNING AND INTERVENTION
After speaking with Dagmar Cronn and Peter Quenguyen the primary task identified was to recruit more participants for the fitness classes. Other tasks included providing
Senior Services with required reports and conducting fitness checks for any new and existing participants. To achieve our goals, we created flyers with information about the
South Park exercise classes and visited several community organizations to request that they post our class information. We were met with enthusiasm from all of our points of contact, and they were very willing to share information about the fitness classes with their clients and residents. Some of the organizations that were willing to post our information included the SeaMar clinic, the South Park Manor House, Arrowhead Gardens senior housing, and the South Park Community Center. We also hung flyers around the
Neighborhood Center, had a portable signboard made to advertise the classes at different locations throughout the South Park neighborhood, and worked with Senior Services to mail out postcards to all members of the South Park Senior Program with class information.
The fitness instructor attended a class on the benefits of exercise on arthritis and how to self-manage arthritis pain, and we scheduled, advertised, and attended the class. Finally, we conducted the fitness checks for new and existing participants, and assisted the SPSP re- establish their reporting relationship with Senior Services.
EVALUATION The exercise classes at SPNC were largely on autopilot at the beginning of the quarter. There were a group of regular participants, but overall participation had dwindled 67 since inception of the classes in 2010. Multiple priorities on the part of the key players of the SPSP and lack of support from the SPSP board members further complicated the situation. The EF instructor expressed her discouragement with the program because of the lack of participation, and repeated interruptions and distractions from non-participants that showed a general lack of respect for the fitness class, the participants, and the instructor.
CONCLUSIONS AND RECOMMENDATIONS Future work with the SPSP EnhanceFitness® program should begin with a planning meeting between Dagmar, Peter, and Vivian. Perhaps including a SPSP board member would also be beneficial. The goal of the meeting will be to ensure that all of the key players agree on the tasks and priorities, understand the requirements of the grant from HAP, understand the reporting requirements of the EF program, and how to manage the program. Both the key players and any newcomers should read the EF instructor manual prior so that they have a clear understanding of the resources and requirements of the EF program.
Our recommendation is that the program needs to have an active leader and manager. A volunteer would work, but without someone to perform the administrative tasks, the program will remain in a less than optimal state of functioning. The EF program is only one aspect of the South Park Fall Prevention and Fitness Program. Matter of Balance classes and education on emergency preparedness are also part of the grant requirements.
A higher level of prioritization and active management of the program will likely improve participation. Further partnership with area organizations and contact with residents to eliminate barriers to physical activity will also be beneficial to the program. 68
SOUTH PARK PROJECT CONCLUSIONS AND RECOMMENDATIONS Our group of ten UW nursing students partnered with four community projects in order to achieve two goals: learn about community health nursing and to work with community in need. With the help of our amazing community partners and expert clinical instructor we can confidently conclude that we achieved our first goal to learn about community health nursing. In order to maximize our learning, we participated in weekly seminars, wrote and read weekly reflections, and applied community health principles from our weekly theory class. As a learning group, we relied also relied on each other’s suggests, support, and observations to enhance our learning- a practice we hope to carry forward into our nursing careers.
Our second learning goal was achieved through assessment methods, application of theoretical models, and guidance from our community partners, which we have discussed in the above paper. Each small group of students was able to identify an area of community need and put effort toward that need that we hope will benefit the South Park community. Although we have all been able to identify short-term outcomes we experienced during this quarter, we know that the long-term impacts of these projects cannot be known to us. Our hope is that the work we have done in South Park lasts beyond the ten weeks when we were present.
For future students we first recommend that they approach this clinical experience with an open mind and a desire to learn from the community of South Park and the community partners. We also recommend that future students remain flexible and willing to adapt to the challenges and needs that the community setting presents- there will be 69 many! Finally, we recommend that students share their experiences- good, bad, and ugly with each other and attempt to find the learning moments present in all situations.
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REFERENCES
American Nurses Association (2007). Public Health Nursing, Scope and Standards of Practice. American Nurses Association. Barkan, S. (2003). Adolescent pregnancy, birth and abortion in King County, 1980 – 2001. Public Health Data Watch, 6(1): 1-12. Belza, B., LoGerfo, J.P., Phelan, E.A., Shumway-Cook, A., Snyder, S.J. & Williams, B. (2006). The effects of a community-based exercise program on function and health in older adults: The EnhanceFitness Program. The Journal of Applied Gerontology, 25(4), 291- 306. Boom, J. & Mayo, J. (2011, September 21). Census: more residents sinking into poverty. The Seattle Times. Retrieved from http://seattletimes.nwsource.com/html/localnews/2016279575_census22m.html Bureau of Labor Statistics. (2012). Local area unemployment statistics [Data file]. Retrieved from http://bls.gov/web/metro/laummtrk.htm Census 2000, Summary File 3. Retrieved February 16, 2012 from http://www.seattle.gov/dpd/cms/groups/pan/@pan/documents/web_informatio nal/dpds_07824.pdf Champion, J. D., & Collins, J. L. (2010). The Path to Intervention: Community Partnerships and Development of a Cognitive Behavioral Intervention for Ethnic Minority Adolescent Females. Issues of Mental Health Nursing. 31:739-747. doi: 10.3109/01612840.2010.512697 City-data.com. (2012). South Park neighborhood in Seattle, Washington. Retrieved from:http://www.city-data.com/neighborhood/South-Park-Seattle-WA.html Dodd, R. and Munck, L. (2011). Dying for change: poor people’s experience of health and ill- health. The World Bank. Retrieved from: http://web.worldbank.org/WBSITE/ external/topics/exthealthnutritionandpopulation/extpah/0,,contentMDK:2021693 8~menuPK:460203~pagePK:148956~piPK:216618~theSite K:400476,00.html Feeding America (2010). Hunger and poverty statistics. Retrieved February 19, 2012 from http://feedingamerica.org/hunger-in-america/hunger-facts/hunger-and-poverty- statistics.aspx 71
Gilliam, M., Berlin, A., Kozloski, M., Hernandez, M. & Grundy, M. (2007). Interpersonal and personal factors influencing sexual debut among Mexican-American young women in the United States. Journal of Adolescent Health, 41(5): 495-503. Green, S. (2008, September 26). Sea-tac's third runway set to open after years of delay. Retrieved from http://seattletimes.nwsource.com/html/localnews/2008204574_ thirdrunway26m.html Hunter, R.H., Sykes, K., Lowman, S.G., Duncan, R., Satariano, W.A. & Belza, B. (2011). Environmental and policy change to support healthy aging. Journal of Aging & Social Policy, 23(4), 354-371. Koch, W. (2011, February 2). Study: 1 in 8 get help at food banks. USA TODAY. Retrieved February 19, 2012 from http://www.usatoday.com/news/sharing/2010-02-01- hunger_N.htm Matsuno, B. A. (2006, September). South Park Action Agenda. Retrieved from http://www.seattle.gov/neighborhoods/southpark/ National Cancer Institute (2005). Theory at a Glance: A Guide for Health Promotion Practice, Second Edition. Retrieved from http://www.cancer.gov/cancertopics/ cancerlibrary Nies, M. A., & McEwen M. (2011). Community / Public Health Nursing Promoting the Health of Populations (5th ed). Canada. Prohaska, T., Belansky, E., Belza, B., Buchner, D., Marshall, V., McTigue, K., Satariano, W., & Wilcox, S. (2006). Physical activity, public health, and aging: Critical issues and research priorities. The Journals of Gerontology Series B, 61(5), S267-S273. Public Health- Seattle & King County. (2012). King County community health indicators. Retrieved from: http://www.kingcounty.gov/healthservices/health/data/chi2009.aspx Seattle Department of Planning and Development. (2010). Characteristics of age: Neighborhood planning areas. Retrieved from http://www.seattle.gov/dpd/Research/Population_Demographics/Census_2000_D ata/Data_Maps_for_Locally_Defined_Areas/DPDS_007016.asp. Seattle Department of Planning and Development. (2010). Characteristics of education: Neighborhood planning areas. Retrieved from 72
http://www.seattle.gov/dpd/cms/groups/pan/@pan/documents/web_informatio nal/dpds_007843.pdf. Seattle’s Union Gospel Mission (2012). Mission initiative: hunger. Retrieved February 19, 2012 from http://www.ugm.org/site/PageServer?pagename=Catalyst_Hunger Self Nutrition Data (2011). Nutrient search. Retrieved from January 19, 2010 from http://nutritiondata.self.com/tools/nutrient-search Senior Nutrition Program Standards. (2004). Washington State Department of Social and Health Services. Retrieved from: http://www.aasa.dshs.wa.gov/professional/SNP/ Smith, C. (2011, May 19). The high health costs of a Seattle’s Superfund site: it can take years off your life. Retrieved from http://invw.org/content/the-high-health-costs- of-a-seattles- superfund-site-it-can-take-years-off-your-life Tevernise, S. (2011, September 13). Soaring poverty casts spotlight on ‘lost decade.’ The New York Times. Retrieved from http://www.nytimes.com/2011/09/14/us/14census.html? pagewanted=all University District Food Bank (2012). Sponsors and affiliates. Retrieved February 19, 2012 from http://www.udistrictfoodbank.org/sponsors.php U.S. Census Bureau, American fact finder (2000). Retrieved February 28, 2011, from http://factfinder.census.gov/servlet/SAFFFacts?_event=Search&geo_id=&_geoConte xt= &_street=&_county=98108&_cityTown=98108&_state=0 U.S. Census Bureau, Census 2000. (2003). South Park Neighborhood Planning Level. Retrieved from: http://www.cityofseattle.net/DPD/demographics/local_subj_rep/reports/ NhoodPlan/southpark.pdf United States Department of Health and Human Services. (1996). Physical activity and health: a report of the Surgeon General. Retrieved from http://www.cdc.gov/nccdphp/sgr/pdf/sgrfull.pdf United States Department of Health and Human Services. (2002). Physical activity and older Americans: Benefits and strategies. Retrieved from http://www.ahrq.gov/ppip/activity.htm.
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APPENDICES
APPENDIX 1: SAGE PROJECT
COMMUNITY HEALTH SURVEY/PARTNERS
Coalition for Clean and Safe Ports
Survey on Community Health and the Port of Seattle
SURVEY #: ______
SURVEYOR NAME: ______
DATE OF SURVEY: ______
TIME OF SURVEY: ______74
Introduction
Hi, is ______home? (If not, ask for another registered voter. If no registered voters in HH, survey person responding to knock.)
I’m ______and I’m a volunteer with Community Coalition for Environmental Justice.
We’re a part of the Coalition for Clean & Safe Ports. We are organizing to make the Port of Seattle more accountable to community residents, especially those who live closest to the Port.
To help with our campaign, we’re conducting a survey about community health and your experience of living in a neighborhood so close to the Seaport and Airport. The survey can take as little as 15 minutes – longer if you want to be more thorough.
Q: Can you help us out and take the survey? If no: Q: Are other registered voters available? If no: Another time? If yes: Are you 18 or over? Would you like to sit somewhere to do this?
We will not share the answers you give to the survey with anyone outside our survey team. Your answers will only be added together to get overall results, we won’t pull out individual results that may identify you.
*************************************
We’re doing the survey now because there’s an upcoming election of Port Commissioners and now is a critical time to raise community issues. We’d like to get your opinions about the Port and how the Port affects your family and community health.
As you may know, the Port of Seattle is a government body that is run by a Commission that we all elect. Some of the taxes you pay go to the Port. The Port is accountable to us.
Q: Did you know that the Port of Seattle runs both the seaport and SeaTac Airport?
The seaport includes the docks down by Qwest Field where the big ships load and unload containers. You can tell where the docks are by the huge cranes.
Have you seen these kinds of heavy trucks? (Show Picture) If you see a container on the back, these are trucks that are coming from or going to the Port.
There are also docks for cruise ships and barges from Alaska. SeaTac airport is the big airport south of Seattle in the City of SeaTac. (The Port does not run Boeing Field, however.)
Between the Seaport and the Airport, the Port oversees about 30,000 jobs. 75
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A. General
I’d like to start with some general questions about your neighborhood and how you feel about it.
Surveyor: Throughout the entire survey DO NOT read “Don’t Know”, “Refused”, and “Missing” (also, “DK”, “Ref”, and “M” on tables) answer options.
1. How long have you been living in this neighborhood?
ENTER NUMBER of years |______| or months |______| Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
2. What do you like most about living in this neighborhood?
Notes:
3. What improvements would you like to see in your neighborhood?
Notes:
B. Household Profile
Now, I’d like to start the survey by asking some questions about your household.
4. Not including yourself, how many people live in your home?
ENTER NUMBER: |______|
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
IF LIVE ALONE, SKIP TO QUESTION 7.
5. Not including yourself, how many of those people are related to you?
ENTER NUMBER: |______| 77
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
6. How many children under 18 live in your home?
ENTER NUMBER: |______|
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
If Children:
6a. What schools do children in your home attend?
Notes:
C. Pedestrian Safety
I am going to ask you some questions now about walking in your neighborhood.
7. What places do you, and people in your home, walk to in your neighborhood?
Notes:
8. What are the busiest streets in your neighborhood?
Notes:
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I’m going to talk now about heavy trucks driving through the neighborhood. By heavy truck, I mean this the big semi trucks with big trailers (show picture). These are not delivery trucks or trucks the size of a U-Haul.
For the following questions, I’d like you to think about walking in your neighborhood and about traffic safety. For the purpose of these questions, neighborhood means within a 20 minute walk from your home.
I’m going to read some statements and I’d like you to tell me one of the following: Do you 1) strongly agree, 2) somewhat agree, 3) neither agree nor disagree, 4) somewhat disagree or 5) strongly disagree?
Strongly Somewhat Neither Somewhat Strongly D Ref M agree Agree agree nor Disagree disagree K disagree 9. Heavy truck traffic makes it difficult or unpleasant to walk in my 1 2 3 4 5 6 7 8 neighborhood.
10. My family and I feel safe crossing streets in my neighborhood during 1 2 3 4 5 6 7 8 the day.
If strongly disagree or disagree: 10a. Why do you or your family feel unsafe?
Notes:
11. My family and I feel safe crossing my own street 1 2 3 4 5 6 7 8 during the day.
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If strongly disagree or somewhat disagree: 11a. Why do you or your family feel unsafe?
Notes:
12. There are too many heavy trucks driving in 1 2 3 4 5 6 7 8 my neighborhood.
13. There are too many heavy trucks driving on 1 2 3 4 5 6 7 8 my own street.
14. When walking in the neighborhood there are a lot of truck exhaust 1 2 3 4 5 6 7 8 fumes.
15. My family and I walk less in my neighborhood because of heavy truck 1 2 3 4 5 6 7 8 traffic.
Strongly Somewhat Neither Somewhat Strongly D Ref M agree agree agree nor disagree disagree K disagree 16. There are places in my neighborhood that I 1 2 3 4 5 6 7 8 don’t walk to because of heavy truck traffic. If strongly agree or agree: What places have you chosen not to walk to? 16b. Do you go to this place often? (surveyor – write in places listed below) a. Yes No DK Ref M b. Yes No DK Ref M c. Yes No DK Ref M d. Yes No DK Ref M e. Yes No DK Ref M f. Yes No DK Ref M
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17. In the last 12 months, have there been any incidents where you or anyone in your home felt endangered by heavy truck traffic while walking in your neighborhood?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
If Yes: 17a. Can you tell me more about what happened?
Notes:
D. Noise
For the following questions, I’m going to ask you about noise from port activities in your neighborhood. For these questions, neighborhood means within a 20 minute walk from your home.
Please choose the answer that best applies to you and your neighborhood.
Never Sometime Disturbed Frequently Very D Ref M disturbed s disturbed frequently K disturbed disturbed 18. How often are you or your family disturbed by heavy 1 2 3 4 5 6 7 8 truck noise in your neighborhood?
19. How often are you or your family disturbed by 1 2 3 4 5 6 7 8 airplane noise in your neighborhood?
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20. In the past 12 months, has the noise from heavy truck traffic disturbed your sleep or the sleep of someone in your home?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
If yes: 20a. On average, how many times a week was sleep disturbed?
ENTER NUMBER: |______|
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
21. In the past 12 months, has the noise from airplane traffic disturbed your sleep or the sleep of someone in your home?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
If yes: 21a. On average, how many times a week was sleep disturbed?
ENTER NUMBER: |______|
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999 I’m going to read some statements and I’d like you to tell me one of the following: Do you 1) strongly agree, 2) somewhat agree, 3) neither agree nor disagree, 4) somewhat disagree or 5) strongly disagree?
Strongly Somewhat Neither Somewhat Strongly D Ref M agree agree agree nor disagree disagree K disagree 82
22. Noise from airplanes or from trucks affects the health of me or my 1 2 3 4 5 6 7 8 family.
If agree: 22a. Can you tell me how?
Notes:
23. Are there any changes you would make to reduce noise in your neighborhood from heavy trucks and airplanes?
Notes:
E. Airplane and Truck Pollution
Please choose the answer that best applies to you and your neighborhood. Neighborhood means within a 20 minute walk from your home.
I’m going to read some statements and I’d like you to tell me one of the following: Do you 1) strongly agree, 2) somewhat agree, 3) neither agree nor disagree, 4) somewhat disagree or 5) strongly disagree?
Strongly Somewhat Neither Somewhat Strongly D Ref M agree agree agree nor disagree disagree K disagree 24. I can smell airplane fuel in my neighborhood. 1 2 3 4 5 6 7 8
25. Airplane pollution in my neighborhood affects the health of me or my 1 2 3 4 5 6 7 8 family.
26. Heavy truck pollution in my neighborhood affects 1 2 3 4 5 6 7 8 the health of me or my family. 83
F. Port Truck Parking
I’m going to ask some questions about heavy trucks parking during the day or overnight in your neighborhood. (SURVEYOR: Show Picture)
27. Are heavy trucks parked in your neighborhood during the day?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
28. Are heavy trucks parked in your neighborhood during the night?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
IF NO TO 27 & 38, SKIP TO 32
29. What streets in your neighborhood have the most parked heavy trucks?
Notes:
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For the next question about parked heavy trucks, please choose the answer that best applies to you and your neighborhood. Neighborhood means within a 20 minute walk from your home.
I’m going to read some statements and I’d like you to tell me one of the following: Do you 1) strongly agree, 2) somewhat agree, 3) neither agree nor disagree, 4) somewhat disagree or 5) strongly disagree?
Strongly Somewhat Neither Somewhat Strongly D Ref M agree agree agree nor disagree disagree K disagree 30. Heavy trucks parked in my neighborhood are a hazard to me or my 1 2 3 4 5 6 7 8 family.
If strongly agree or agree: 32a. Can you tell me why you think a parked heavy truck is hazardous?
Notes:
G. Responsiveness of Port
I’d like to now ask a few questions about whether or not you think the Port of Seattle is responsive to community health needs.
Again, please choose the answer that best applies to you and your neighborhood. Neighborhood means within a 20 minute walk from your home.
I’m going to read some statements and I’d like you to tell me one of the following: Do you 1) strongly agree, 2) somewhat agree, 3) neither agree nor disagree, 4) somewhat disagree or 5) strongly disagree? 85
Strongly Somewhat Neither Somewhat Strongly D Ref M agree agree agree nor disagree disagree K disagree 31. I am concerned about Port of Seattle activities, such as airplanes and heavy trucks, negatively 1 2 3 4 5 6 7 8 affecting the health of me or my family.
32. I think that the Port of Seattle cares about health issues in my neighborhood when 1 2 3 4 5 6 7 8 making decisions about truck and airplane traffic.
33. I think the Port of Seattle should take more action to reduce heavy truck traffic, noise, or 1 2 3 4 5 6 7 8 pollution in my neighborhood.
34. I think the Port of Seattle should take more action to reduce airplane noise 1 2 3 4 5 6 7 8 or pollution in my neighborhood.
35. I think the Port of Seattle should make more of an effort to hire people 1 2 3 4 5 6 7 8 from my neighborhood for Port related jobs.
36. Have you or your neighbors ever tried to raise any concerns about Port activities, such as airplane or heavy truck traffic?
No ...... 0 Yes ...... 1 DK ...... 7 86
Refused ...... 8 Missing ...... 9
IF NO, SKIP TO 37: IF YES: 36a. To who?
Notes:
36b. Please describe what you did.
Notes:
36c. Have government officials responded to these concerns? If so, please describe their response: what have they done?
Notes:
I. Health
37. Are you or someone in your household suffering from a health problem? (If yes) What is it? (DO NOT READ – CIRCLE ALL THAT APPLY)
Asthma ...... 1 Respiratory problems (other than asthma) 2 Cancer, type______...... 3 Diabetes ...... 4 Heart problems ...... 5 Other ...... 6 None ...... 10 DK ...... 7 Ref ...... 8 Missing ...... 9
If “Other”: 87
40a. Please specify.
Notes:
38. Is anyone in your household taking medication for asthma?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
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39. Has anyone in your household ever been hospitalized for asthma?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
40. Overall, how would you rate your health over the past 12 months? Would you say it was…
Excellent ...... 1 Good ...... 2 Fair ...... 3 Or Poor? ...... 4 DK ...... 7 Ref ...... 8 Missing ...... 9
41. In the past 12 months, how did you or your family pay for health care? (circle all that apply)
Health insurance through an employer or purchased on your own . 1 * Medicaid/Health Families ...... 2 Medicare ...... 3 The State’s Basic Health Program ...... 4 Veteran’s Administration ...... 5 Indian Health Services ...... 6 Pay cash (no insurance) ...... 7 DK ...... 8 Ref ...... 9 Missing ...... 10
*Health Insurance means: Private insurance, Blue Shield, HMO, etc.
J. Household Economic and Other Demographic Questions
Now I’d like you to tell me a little bit about yourself and your family.
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42. Surveyor: Mark respondent’s sex (ask if in doubt at all)
Male ...... 1 Female ...... 2 Transgendered ...... 3 Missing ...... 9
43. How old were you at your last birthday?
ENTER NUMBER: |______|
Don’t Know ...... 777 Refused ...... 888 Missing ...... 999
44. What is your race? Please respond to all that apply.
Native American ...... 1 Latino/a ...... 2 Black or African American ...... 3 Asian or Asian American ...... 4 Pacific Islander ...... 5 White ...... 6 DK ...... 7 Ref ...... 8 Missing ...... 9
45. Do you consider yourself an immigrant?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
46. How many people over 18 in your home work?
ENTER NUMBER: |______|
DK ...... 7 Refused ...... 8 Missing ...... 9
47. Does anyone in your home work at the seaport, the airport or Port of Seattle?
No ...... 0 90
Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
48. Has anyone in your household lost a job in the last 12 months because of the down economy?
No ...... 0 Yes ...... 1 DK ...... 7 Refused 8
Missing 9
49. I’d like you to think about the total income of everyone in your household. Which of the following categories does it fall in?
$0-25,000 ...... 1 $26,000 to $50,000 ...... 2 $51,000 to $75,000 ...... 3 Above $75,000 ...... 4 DK ...... 7 Refused 8
Missing ...... 9
K. Follow-Up
50. Would you like us to send you the results of this survey? (Get name if we don’t have it)
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
51. Would you be willing to get together with a small group of people from your neighborhood to talk more about the Port and community health?
No ...... 0 91
Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
52. If the opportunity arises for us to get portable air monitors to measure diesel pollution, would you be willing to put one in your home for a short period of time?
No ...... 0 Yes ...... 1 DK ...... 7 Refused ...... 8 Missing ...... 9
******************************************** This concludes the survey. Thanks a lot for participating.
Q: Do you have any questions for me about the survey?
NOTES 92
FINAL STATEMENT
At the end of July, if you are registered to vote, you will receive a ballot for the primary. (Also on the ballot will be the Seattle Mayor’s race and King County Executive.)
I urge you look into the candidates to see who will be responsive to your concerns about how the Port can make your neighborhood a safer and healthier place to live.
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2009 COMMUNITY HEALTH SURVEY RESULTS
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TOXIC TOUR LOGIC MODEL Toxic Tour
The Toxic Tour, lead by Genevieve Aguilar with our community partner: Puget Sound Sage, was given to highlight diesel exhaust emission sources throughout the south Seattle area, in and around South Park. The tour was provided for: Addy Adwell, Rachael Desouza, Faith Hassinger, and Hunter Marshall at the beginning of our partnership. Map supplied from google maps:
Industrial District West: Container movement- load & unload cargo containers - movement involves ships, short haul trucks, and rail. Short haul trucks often idle while waiting for cargo.
Parking for Short Haul Trucks This parking space provided by the Port of Seattle for short haul trucks. Unfortunately, minimal space is provided, only enough for up to 150 trucks to park from a fleet of over 2,000 trucks forcing many trucks to park in nearby residential areas such as South Park.
LaFarge Cement Plant Long suspected by many residents in South Park to spew chemicals into the air. The Lafarge cement plant has been cited at least once by the Puget Sound Clean Air Agency for harmful emissions.
Waste Management Depot 95
Under construction, but will bring greater quantity of diesel exhaust vehicles into the area when completed.
School Bus Depot Marra Farm Duwamish River
Parking area accommodates Plot of farmed land Port of Seattle activities related school bus parking. Allows a surrounded by industrial to transportation of cargo greater quantity of diesel activities. containers operate along the exhaust vehicles into the area. length of this river. This transportation network, utilizing short haul trucks and rail, contributes to increased diesel exhaust levels.
Logic Model
Model Flow Moves L R
Imputs Activities Outputs Outcomes Long Term Goals
The resources that The processes, The products of The changes to the are needed in events, or actions activities. These target population. order for the that use the need to be as The outcomes can program to be inputs in order to specific and be broken down successful. These obtain a desired measurable as into initial, resources can be output. possible. intermediate, and human, financial, long-term organizational, or outcomes. originate within the community.
Human: Door knocking: Door knocking: Initial Outcome: Long Term Goals: Puget Sound Sage - 2009 Door knock on South Park and community 400 doors. Georgetown Potential policy UW nursing health survey resident interest change: students participants in a diesel exhaust monitoring effort. -Tighter UW Corson Center - South Park and Phone banking: regulation on Volunteer Georgetown Phone bank 100 diesel exhaust residents - South emitting phone calls to Park and Georgetown and vehicles UW Research Georgetown 96
Team lead by PI - businesses. South Park - Potential Joel Kaufman: community reroute of diesel Professor, members and Intermediate exhaust emitting Outcome: Environmental & Phone banking: sierra club vehicles away Occupational members. South Park and from residential Health Sciences, - 2009 Georgetown areas and Epidemiology community resident Professor, health survey Postcard participation in a Medicine participants Mailing: diesel exhaust Ultimate Long monitoring effort. Term Goal: - Sierra Club Mail 200 post members Financial: cards Reduce sources of diesel Kresge Foundation Analysis of diesel emissions Postcard exhaust levels in exhaust in the Outreach at the South Park Mailing: Community Duwamish and Georgetown Valley. - 2009 Events: neighborhoods. community Organizational: Attended 5 health survey Community Puget Sound Sage participants events Dissemination of analysis and results of DEEDS Community: Outreach at study to South Community Park and South Park Events: Series of Three Georgetown residents Diesel Exhaust Communities. - Community Georgetown Monitoring breakfast Events: residents program Host 12 booths - Food bank related to outdoor air quality and Series of Three respiratory health at Diesel Diesel Exhaust Monitoring Exhaust 101 and Events: Asthma & Health Fair event on - First Diesel March 1, 2012. Exhaust 101 and Asthma & Health Fair event on Recruit 30-40 97
March 1, 2012 community members to - Second April 12, attend the the diesel Diesel Exhaust prioritization 101 and Asthma meeting & Health Fair - Third diesel event on March monitoring 1, 2012. selection meeting
Two main types of theories: 1. Explanatory theory describes the reasons why a problem exists. It guides the search for factors that contribute to a problem (e.g., a lack of knowledge, self-efficacy, social support, or resources), and can be changed. Examples of explanatory theories include: Health Belief Model Theory of Planned Behavior Precaution Adoption Process Model.
2. Change theory guides the development of health interventions. It spells out concepts that can be translated into program messages and strategies, and offers a basis for program evaluation. Change theory helps program planners to be explicit about their assumptions for why a program will work.
Examples of change theories includes: Logic Model
Figure 1. illustrates how explanatory theory and change theory can be used to plan and evaluate programs
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Theoretical Models used in 2010:
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DEEDS SMARTCHART Spitfire Strategies Smart Chart 3.0
Step One: Program Decisions Broad Goal: What do you want to achieve over the long term?
Reduce sources of diesel emissions exhaust in the Duwamish Valley. Objective: What's the first measurable step you need to accomplish within the next 12 months to move toward your goal?
Conduct a community based participatory research diesel exposure study. Decision Maker: Who can make your objective a reality by taking a specific action or changing a specific behavior?
South Park and Georgetown residents participating in community meetings or providing feedback through small group discussions, home visits and by phone. Step Two: Context Internal Scan: What are your organizations's assets and challenges that may impact your outreach strategy?
Assets: UW Research expertise Sage community expertise Connections to community partners Spanish language skills on team enthusiastic and skilled volunteers and interns
Challenges: Lacking Vietnamese language skills Training time for new team members Short time frame for monitoring selection Limited funds for monitoring approaches
External Scan: What is already happening outside your organization that may impact your strategy – both assets and challenges?
Assets: Collaboration potential with partners at events Good time of the year for outreach Lots of attention on health and the environment Great community listservs, websites and centers of communication
Challenges: Confusion over all of the environment and health projects taking place in the Duwamish Valley Lots of events to compete with Large amounts of outreach needed in a short period of time Community may not be interested in diesel as much as other air pollutants Residents only have a limited amount of time Other institutions may want to steer community selection and prioritization 100
Define Your Position: Do you need a plan that will frame, fortify and amplify or reframe the debate? Just note which position you're in here – you can figure out the details later.
Diesel exhaust is detrimental to public health. We need to have a better sense of where diesel exhaust is concentrated throughout the Duwamish Valley. Step Three: Strategic Choices Audience Target: Who must you reach to achieve your objective?
Georgetown and South Park community members in the following categories: -Active residents -non-active residents -Families with young kids -Elderly -Low-income residents -Bikers -Employees -Renters -Homeowners -People with or at risk for asthma or other respiratory diseases -Spanish speakers -Vietnamese speakers Readiness: Is your audience in Stage 1, Stage 2 or Stage 3?
Stage 2 Core Concerns: What existing value can you tap into to engage and resonate with your target audience(s)? What existing belief might be a barrier you have to overcome?
Active Residents V:Autonomy, active community, protection, resources in community (ie food bank, exercise probram) B:Know too much about other toxins, see outsiders as intruding, not prone to taking leadership roles, just want to participate
Gate keepers: V: know what is going on in the community B:Lots of directions for involvement
Non-active residents (not at meetings, not at listserv, not involved in community) V: Family, safety, access, individuality B: Not interested in topics outside of family or home
Families with young kids V: Family, health, safety, protection, future B: Overwhelmed by thought of solving the problem
Elderly (single living - may be less represented by intergenerational seniors) V: Health, safety, friends & family B: Immediate health concerns greater priority 101
Low-income residents V:Family, survival, resilience B: Asthma may be low on their priority list, monitoring fatigue, study fatigue
Bikers, athletic residents (heavy breathers of air) V: Safety, Health, accessible transportation options, environmental issues B: Lack of control over mobile diesel emission sources, lack of impact on issues, lack of connection to trucks / trains, may be commuters, not necessarily residents.
Bus commuters, pedestrians commuter cyclysts: V: Safety, health, accessible transportation options B: lack of control, time, choice for communicating
Recreaters, athletic residents (heavy breathers of air) V: Health, family, active lifestyle B:, may be hard to reach this time of year
Employees V: Safe, healthy workplace, thriving community B: Don't see themselves as part of community, limited time for involvement in their work community
Renters (we do not know rental prices…) V: Safe, clean home for families B: Possible short term connection to community, belief that there they have no control over environment
Homeowner V: Protection of investment, autonomy, low-risk takers B: Study might threaten their investment value
People at risk of or having asthma or other respiratory issues V:Health, safety, vibrant life B:Other health factors contributing to asthma may seem easier to tackle
Spanish Speakers V: Family, safety, vibrant community B:Knowledge about the issue, , low-priority, language, don't want more bad information
Vietnamese Speakers V: family, safety, community B: language, don't want bad info
Health Providers V: want to help patients B: info. about environmental health, time
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Theme: What is the best theme to use to reach your audience(s)?
Top priorities Easy actions, build Knowledge; powerful clean air outcomes Easy Actions = powerful outcomes
Build Knowledge, Protect Your Health Protect your family's health, discover diesel sources Easy Actions = powerful outcomes
Other options Find out where the dirtiest diesel pollution happens Get to the bottom of dirty air, find out where diesel is polluting Communities leading the way on clean air Discover diesel concentrations Family First, Diesel Last Put family first, dig out diesel sources Dig into your family's health, discover diesel sources Keep Georgetown/South Park beautiful, determine diesel sources Create Knowledge, Protect your Health Dream Big, Deter Diesel Build Knowledge, Build Power Protect your health, protect your community I choose to be diesel free Discover dirty diesel polluters What's damaging the air in the Duwamish Valley More information = more control Take control, know more Protect health Happy lungs=happy families Get to the root of the problem, discover diesel sources Message: What key points do you want to make with your target audience(s)? Make sure to list all four points (tap value, overcome the barrier, ask, echo vision) for each audience.
Value Message: Easy actions, build Knowledge; powerful clean air outcomes
Build Knowledge, Protect Your Health Discover Dirty Diesel Polluters Easy Actions, Powerful Outcomes Protect your family's health, discover diesel sources
Misconception Message (what are we doing, how is it different?) -Past studies have only use one data point. We want to see how diesel impacts different parts of Georgetown and South Park 103
-We've never had this kind of concentrated study in the Duwamish - Point to previous studies - This study is partnered with the community
The Ask Message - Participate in meetings to guide how diesel exhaust is measured and monitored in the Duwamish Valley
Vision Message -We will know how diesel affects different parts of the community. -By pinpointing where diesel is most concentrated, you can identify how to reduce it. Messengers: Who will best connect with your audience(s)?
Community leaders Community groups Nurses
Step Four: Communications Activities Tactics: What activities will you use to deliver your message(s)?
Doorknocking in South Park & Georgetown Doorknocking community health survey participants Doorknocking Sierra Club members Mail Postcards Phone calls to community health survey participants and new contacts from doors South Park outreach at food bank line South Park outreach at senior breakfast South Park outreach at community center South Park outreach at other neighborhood center events South Park outreach at SeaMar & their public health forum South Park outreach to asthma promotores and clinic staff Outreach to parents and children at Concord Elementary Flyers & Posters at South Park and Georgetown businesses Conversations with employees at South Park and Georgetown businesses Georgetown outreach at Neighborcare Clinic Georgetown outreach at playfield Georgetown outreach at South Seattle Community College Community Advisory Board Conversations with individuals via Spanish and Vietnamese Interpreters Outreach at other environmental and health events in the Duwamish South Park & Georgetown listservs South Park & Georgetown websites & blogs National bike to work day (MAY - potentially set up a table) Work with other communities in environmental justice groups. Website 104
Communit Timeline: When will you implement each of your tactics?
January- Doorknocking & Development of Outreach Materials February 16 - CAB Mtg 1 March 1 - Diesel 101 March 29 - CAB Mtg 2 April 12- Diesel Prioritization Mtg April- Houston CBPR Conference May 3 - CAB Mtg 3 May 17 - Diesel Monitoring Selection Mtg
Assignments: Who will implement each activity?
-UW Graduate Student (Rachael): Asthma Awareness Plan Development, Concord Elementary, Community Meeting Logistics, asthma fair coordination, Neighborcare outreach -UW Undergraduate Nursing Team (Faith, Addy & Hunter -January - March):Doorknocking, flyering and outreach to South Park community businesses, identify method of reaching out to bicyclists, procurement of materials for asthma awareness plan & asthma fair implementation, calls to contacts made during doorknocking, assistance preparing & mailing postcards, h, food bank line outreach, assistance wit Concord Elementary outreach -UW Undergraduate Service-Learning Student (Jessica): Spanish language doorknocking and outreach, SeaMar outreach, outreach to South Park ESL class, senior breakfast, Georgetown playfield outreach -Sage Organizer (Melanie)-overall outreach activities including doorknocking, phone calls, conversations with businesses, residents. Recruitment and coordination of community advisory board, design and coordination of postcards, coordination of translations and interpreters, flyering and outreach to Georgetown businesses -Sage Port Coordinator (Genevieve)- coordination with community groups, research team, Coordination of Sage team
Budget: How much time and money will you spend on each tactic?
Budget for January - May is yet to be determined. Step Five: Measurements of Success Outputs: What will you produce to reach your objective?
60 people at each of the three community meetings 10 active community advisory board members 200 doors knocked before each large community meeting
Outcomes: What are the results of your outputs that demonstrate incremental progress toward your objective?
Community selection of diesel monitoring An informed community Identification of individuals to help implement field monitoring Step Six: Final Reality Check Test for accuracy: What additional steps do you need to take to ensure your strategy is solid?
May need to review whether we're motivating people appropriately and utilizing the best persuasion practices. 105
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DOOR KNOCKING SCHEDULE DAY TEAM TIME
Monday Jessica – Rachael - Melanie 4.00 pm – 7.00 pm
Genevieve (?)
Tuesday
Wednesday
Thursday Addy – Faith – Hunter – Jessica 3.00 pm – 7.00 pm – Melanie – Rachael
Friday
Saturday Addy - Hunter – Melanie 10.00 am – 2.00 pm
Genevieve (?) 2.00 pm – 5.00 pm
Volunteers
Sunday
Thursday and Saturday as primary outreach days. Recruiting Spanish speaking volunteers for Saturday Georgetown outreach. Hourly limit for any/all? Georgetown doorknocking on Monday and Saturday.
DOORKNOCKING QUANTITY/TIME BREAKDOWN: Need 400 doors knocked by March 1 meeting. Average 100 doors in 1 week. Average 6 -8 doors in 1 hour. Average outreach trip is 3.5 hours. One team on one trip averages 21 – 28 doors. Thursday (3 teams) + Saturday AM or PM (2 teams) = 105 – 140 doors Thursday (3 teams) + Saturday AM and PM (2 teams) = 205 – 238 doors
DAY TEAM TIME
Monday, 01/30 Jessica, Rachael, Genevieve, 4.00 pm – 7.00 pm Melanie (Georgetown)
Thursday, 02/02 Addy, Faith, Hunter, Jessica, 3.00 pm – 7.00 pm 107
Melanie, Rachael
Saturday, 02/04 Addy, Hunter, Melanie 10.00 am – 1.00 pm (Addy)
Volunteers (?) 2.00 pm – 5.00 pm (Hunter)
Thursday, 02/09 Addy, Faith, Hunter, Jessica, 3.00 pm – 7.00 pm Melanie, Rachael,
Saturday, 02/11 Hunter, Melanie 2.00 pm – 5.00 pm
DOORKNOCKING DETAILS: Each trip will have 30 minutes for lunch/break, with a 30 min – 1 hour debrief/victory meal afterwards depending on how people feel.
HEALTH FAIR ACTIVITIES Asthma and Health Fair(s) Themes and Activities:
Diesel exhaust has been associated with the following health outcomes, and I’m hoping we can have activities that address each of them. This list of diesel exhaust related health outcomes is for your reference. Keep in mind that among all the health outcomes, asthma exacerbations will be the main theme at our fair: URIs, asthma exacerbations: “Like all fuel-burning equipment, diesel engines produce nitrogen oxides, a common air pollutant….Nitrogen oxides can damage lung tissue, lower the body's resistance to respiratory infection and worsen chronic lung diseases, such as asthma. They also react with other pollutants in the atmosphere to form ozone, a major component of smog.” [1] Cardiovascular disease: “Exposures to particles are associated with elevated risk of premature cardiac death as documented in the two largest air pollution studies ever conducted. …A link between exposure to particles and vascular inflammation/ atherosclerosis has been found in animal studies and could explain how particles are linked to heart attacks. …Researchers documented a 24% increase in risk of women having a cardiovascular event and an overall 76% increase in risk of death from cardiovascular disease for each 10 ug/m3 of PM2.5 in the ambient air. Within- city risks were higher than the risk between cities suggesting the importance of local sources of particles, such as diesel vehicles.” [11] Lung Ca: “studies provide strong evidence that long-term occupational exposure to diesel exhaust increases the risk of lung cancer. ...diesel-particle levels measured in California's air in 2000 could cause 540 "excess" cancers (beyond what would occur if there were no diesel particles in the air) in a population of 1 million people over a 70-year lifetime. Other researchers and scientific organizations, including the National Institute for Occupational Safety and Health, have calculated cancer risks from diesel exhaust that are similar to those developed by OEHHA and ARB.” [1] Short-term effects: “Exposure to diesel exhaust can have immediate health effects. Diesel exhaust can irritate the eyes, nose, throat and lungs, and it can cause coughs, 108
headaches, lightheadedness and nausea. In studies with human volunteers, diesel exhaust particles made people with allergies more susceptible to the materials to which they are allergic, such as dust and pollen. Exposure to diesel exhaust also causes inflammation in the lungs, which may aggravate chronic respiratory symptoms and increase the frequency or intensity of asthma attacks.” [1] Childhood illness, childhood lung function: “Diesel engines are a major source of fine-particle pollution. ...Exposure to fine particles is associated with increased frequency of childhood illnesses and can also reduce lung function in children.”[1]
This document is organized into types of activities:
A. Asthma exacerbations B. Cardiovascular disease C. Lung cancer D. Short term effects: irritation of eyes, nose and throat, upper respiratory infections, bronchitis headaches, cough, lightheadedness
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A. ASTHMA ACTIVITIES
1. Asthma hospitalization rates poster a. Description of activity: Display posters of the information below about childhood asthma hospitalization rates in King County. Talk with viewers about the following: i. Poster 1: Children have higher asthma hospitalization rates than adults. ii. Poster 1: Regardless of age, people with less money have more asthma hospitalizations than people with more money. iii. Posters 2-3: asthma hospitalization rates are worst in south Seattle (the neighborhoods of our focus). 1. Note that the legend is different in each poster – sorry I couldn’t find better graphics from CHARS. 2. Could whoever takes this booth possibly zoom in poster 3 so that it shows Duwamish area more clearly (like Poster 2)? 3. Also, although there’s no graph, from 2005-2009 we know that for every 100,000 minors (age less than 18) in the Duwamish, about 240 were hospitalized for asthma. Compare this to the King County average, which is 143 minors hospitalized for asthma for every 100,000 living there. Adult hospitalization for asthma is also higher in Duwamish than in other areas of King County. In the Duwamish, for every 100,000 adults, there are 83 hospitalized for asthma, but in other areas there are only 54 asthma hospitalizations.
Poster 1: Asthma Hospitalization rates by age and community poverty level (1995-2004) [9] 110
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Poster 2: Childhood Asthma Hospitalization rates in King County (1998-2002) [2]
Poster 3: Childhood asthma hospitalization rates (2000-2004) [10]
b. Materials needed: i. Large print out of maps ii. Tape to hang it up
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2. Breathing through straws to mimic asthma exacerbation [3] -- Addy a. Description of activity: First tell people, “If you have asthma or other respiratory illness, do not participate in this activity.” Then, give each participant a jumbo straw and a regular straw, each individually wrapped. If they want to, have the participant do 10 jumping jacks (if they don’t want to do jumping jacks, it’s ok. The activity will still work). Then, tell them to breathe through the normal straw- deep breaths in and out for 3 times. Then have them do the same jumping jacks, but then breathe through the regular straw. Engage their participation by asking them if they felt a difference. Then explain that this exercise was done to simulate what it would be feel like for someone who was having an asthma attack (experiencing symptoms of their asthma). As you all just felt—having an asthma attack is not something to take lightly and can be a scary experience, especially for children. b. Materials needed: i. Jumbo straws 1500 clear plastic jumbo straws individually wrapped $6.00 http://www.costco.com/Browse/Product.aspx?Prodid=11300153&w hse=BD_827&Ne=4000000&eCat=BD_827|11124|49699&N=403419 5&Mo=18&No=3&Nr=P_CatalogName:BD_827&cat=49699&Ns=P_Pri ce|1||P_SignDesc1&lang=en-US&Sp=C&topnav=bd ii. Regular straws 500 regular straws individually wrapped $4.50 http://www.costco.com/Browse/Product.aspx?Prodid=11615 960&search=straw&Mo=19&cm_re=1_en-_-Top_Left_Nav-_- Top_search&lang=en- US&Nr=P_CatalogName:BD_827&Sp=S&N=4007786&whse=BD_827& Dx=mode+matchallpartial&Ntk=Text_Search&Dr=P_CatalogName:BD_ 827&Ne=4000000&D=straw&eCat=BD_827|11124&Ntt=straw&No=0 &Ntx=mode+matchallpartial&Nty=1&topnav=bd&s=1 iii. Or if we want coffee stirrer types (these are very effective for people who decline the jumping jacks) Royal Sip ‘N Stir 5” Plastic Stir Sticks, 1000ct, $2.30, Item # 204842 http://www.costco.com/Browse/Product.aspx?Prodid=11218932&se arch=straw&Mo=19&cm_re=1_en-_-Top_Left_Nav-_- Top_search&lang=en- US&Nr=P_CatalogName:BD_827&Sp=S&N=4007786&whse=BD_827& Dx=mode+matchallpartial&Ntk=Text_Search&Dr=P_CatalogName:BD_ 827&Ne=4000000&D=straw&eCat=BD_827|11124&Ntt=straw&No=9 &Ntx=mode+matchallpartial&Nty=1&topnav=bd&s=1 iv. trash can
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3. Asthma knowledge jeopardy [4-8] – Faith a. Description of activity: Like the TV show, but I’m not sure if our audience will know “Jeopardy,” so I’m just imagining this to be a quiz game. There are five categories (Facts, Triggers, Solutions to triggers, Meds, and Resources) with five questions each. People play until they reach 15 points (or some other number, what do you think?) and then they win a prize. Feel free to be creative with the game – I have a “wheel of fortune” you could borrow for example, if you wanted to involve wheel spinning. Or you could also play with the idea of bingo cards…it’s up to you. b. Materials needed: i. Large game board to mount on wall ii. Place markers for each quiz question iii. Tape iv. Prizes 1. Dust mite proof pillow cover Standard size pillow cases are at Bartell’s in the University Village, $12 2. Disposable incentive spirometer 3. Sticky paper (to collect air contaminants for fun) 4. Green cleaning supplies (vinegar, baking soda, liquid soap, sponge, murphy’s oil…) 5. Coloring book about asthma 6. Toothbrush and toothpaste (for oral hygiene post inhaler use) v. Vertical wheel of fortune available – ask Rachael
Asthma Jeopardy
Category Pt Question Answer Asthma 1 What is the most common chronic disease for Asthma Facts children?
2 Can asthma be controlled? Yes
3 Every day in the USA, how many people miss c) 40,000 school or work due to asthma:
a) 400 b) 4,000 c) 40,000
4 True or False: In the USA, African Americans True have higher asthma hospitalization rates than Caucasians.
5 In the USA, which ethnic group has the a) Puerto Ricans highest rates of asthma: 114
a) Puerto Ricans b) Caucasians c) African Americans
Triggers 1 What is an asthma trigger? Asthma triggers are things that bother the airways and/or make it hard to breathe, which causes asthma symptoms.
2 True or False: Mold and smoke are common True asthma triggers
3 What are the tiny animals that live in Dust mites mattresses, teddy bears, and anywhere where there’s dust?
4 Do we know for sure what causes asthma? No, scientists aren’t sure what causes asthma, but they have lots of information about what makes asthma symptoms worse.
5 The 2008 Olympic athletes with asthma were Beijing. In response, the city made worried about competing in this city because huge efforts to clean itself up. It of its outdoor air pollution, heat, and banned 300,000 diesel trucks humidity. before and during the Games, and implemented high car emissions regulations (equal to the EU) afterwards.
Solutions 1 Storing food in closed containers can Cockroaches to decrease the number of what pests? Triggers 2 Mixing ¼ cup of what in 2 cups water makes Vinegar a good, non-toxic window cleaner?
3 Let’s say a person who smokes also lives with Some ideas are: a child who has asthma. What can that person do to decrease the child’s asthma 1) Quit smoking symptoms? 2) Only smoke outside (not inside, not in the car) 3) Keep a separate smoking jacket that does not come indoors.
4 True or False: sealing stuffed animals in True plastic bags and then freezing them over 115
night can kill the dust mites inside them.
5 Keeping your bathroom fan on for 45 Mold minutes after a shower can reduce the growth of which asthma trigger?
Medicatio 1 True or False: Everyone with asthma uses the False. Everyone with asthma ns same type of medication and in the same way needs an individualized plan, which they create with their health care provider by recording their personal symptoms and triggers.
2 What are the two types of asthma The two types are: medication? 1) Rescue/ quick relief/ Bronchodilators 2) Maintenance/ controller/ Corticosteroids
3 Will people with asthma always have to use It depends. Some people their asthma medication? experience less asthma symptoms as they get older, and therefore need less medication. And for others, the symptoms increase
4 People with exercise-induced asthma should 10-15 minutes take their medications how long before they exercise?
5 During an asthma attack, which medication Take the rescue med first. This should you take first: the rescue med or the med opens the airways, which maintenance med? allows the maintenance med to then go in.
Resources 1 What does ALA stand for? American Lung Association
2 True or False: Anyone in Seattle can have a True free home health assessment through the American Lung Association.
3 If my asthma attack is out of control, what Have someone call 911. You can should I do? also go to the Emergency Department: Highline Medical Center in Burien and Harborview Medical Center in downtown 116
Seattle have Emergency Departments.
4 True or False: Odessa Brown is a pediatric True clinic in the Central District that serves family regardless of their ability to pay
5 What is the name of the large medical clinic Sea Mar in South Park?
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4. Spirometry a. Description of activity: Practice spirometry tests with people interested in seeing what a lung function test is like. Be careful to point out that “This is not a diagnostic test about your health.” i. Note: We have access to 5 portable spirometers from the Occupational and Environmental Health Sciences Department at the UW School of Public Health. A person blows into them and results show on a computer screen. Faith and Rachael received basic training on how to use this equipment. There were some technology glitches, though, so we may use instead either 1) peak flow meters, 2) ohio spirometers, or 3) disposable incentive spirometers. b. Materials needed: i. Portable spirometers (from UW) 1. Computer 2. Power source 3. Disposable mouthpieces ii. (possibly) peak flow meters and their disposable mouthpieces Where to get these? iii. (possibly) ohio spirometers and their disposable mouthpieces These are available through Jane Koening. She will follow up with us iv. (possibly) disposable incentive spirometers ActiveForever.com - medical supplies, safety equipment & innovative health products $7.95 each http://www.activeforever.com/p-1746-volumetric-incentive- spirometer-by-airlife.aspx?cm_mmc=g-_-oxygen%20therapy-_- volumetric%20incentive%20spirometer-_- incentive%20spirometer&gclid=CPDPp8vE7q0CFQVkhwodlST5qw v. Chair for participant vi. Trash can for disposable mouthpieces My big comment with this activity is that health fair spirometry is discouraged in the national asthma guidelines. You cannot screen for asthma. Spirometry is dramatic... but is that the effect you want and why? Asthma control tests such as the ACT, available through the doh website, are recommended, to show people what level of control from their symptoms they should expect. http://www.doh.wa.gov/cfh/asthma/providers/med-prof.htm
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5. Asthma items show and tell a. Description of activities: Have huge model inhaler exhibited outside in the parking lot. Display each item on the table with its description. Explain how it works to viewers. Answer questions. b. Materials needed: i. Huge model inhaler (from Sierra Club. Sierra Club to cover set up, break down, and associated costs) ii. Inhaler iii. Spacer iv. Mask v. Nebulizer vi. Diskus vii. Peak flow meter viii. Asthma medication kit 1. Note: Faith is acquiring items from the UW SON Learning Lab soon. Depending on what they don’t have, we’ll have to look around more. Update to follow. ix. Asthma diary” (any notebook will do, but we’ll need to prep the pages to list: data, symptoms, medication use, etc…) x. Asthma action plan print out xi. Descriptions of each item
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6. Asthma information table a. Description of activity: various handouts will be available. Explain and offer them to viewers b. Materials needed: i. Print outs of handouts (handouts are on following pages) 1. What to do in an asthma emergency in children 2. Is your asthma controlled (well)? 3. Tips for watch students at play… looking for asthma 4. My asthma action plan 5. Port Facts: Ports, movement of goods, and community health (this is not included below; please ask me for it) 6. Case Studies (to be created. Sit tight.) 7. ii. Possibly other brochures Brochure Costs: organizati Brochure Cost Web link on
American Mix and match $0.45 1- https://aaaai.execinc.com/store/Default.asp Academy quantities of 99 of Allergy any brochure to $0.35 Asthma & obtain bulk 100- Immunolo discount 999 gy $0.25 (AAAAI) 1000+
AAAAI Prevention of $0.45 https://aaaai.execinc.com/store/product.asp?pr Allergies and oductid=91 Asthma in Children
AAAAI Asthma and $0.45 https://aaaai.execinc.com/store/product.asp?pr Exercise oductid=84
AAAAI Asthma triggers $0.45 https://aaaai.execinc.com/store/product.asp?pr and oductid=81 Management
AAAAI Asthma, $0.45 https://aaaai.execinc.com/store/product.asp?pr Allergies, and oductid=79 Pregnancy
AAAAI Childhood $0.45 https://aaaai.execinc.com/store/product.asp?pr Asthma oductid=82 120
AAAAI Peak Flow $0.45 https://aaaai.execinc.com/store/product.asp?pr Meter oductid=104
AAAAI Inhaled Asthma $0.45 https://aaaai.execinc.com/store/product.asp?pr Medications oductid=99
AAAAI Indoor $0.45 https://aaaai.execinc.com/store/product.asp?pr Allergens oductid=87
AAAAI Outdoor $0.45 https://aaaai.execinc.com/store/product.asp?pr Allergens oductid=90
AAAAI Occupational $0.45 https://aaaai.execinc.com/store/product.asp?pr Asthma oductid=89
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Is your asthma “controlled”? Take the 30 Second Asthma Control Test
1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work or at home? None of the time Some of the time A little of the time most of the time all of the time
2. During the past 4 weeks, how often have you had shortness of breath? Not at all 3 to 6 times a week Once or twice a week once a day more than once a day
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning? Not at all Once a week Once or twice 2 to 3 nights a week 4 or more nights a week
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)? Not at all A few times a week Once a week or less 1 or 2 times per day 3 or more times per day
5. How would you rate your asthma control during the past 4 weeks? Completely controlled Somewhat controlled Well controlled Poorly controlled Not controlled at all
If you checked any blue answers, your asthma may not be well controlled. Be sure to talk to your healthcare professional about your asthma treatment plan.
Developed by: ASTHMA ACTION AMERICA (www.AsthmaActionAmerica.org) Long Beach Alliance for Children with For More information call: Asthma Long Beach Alliance for Children with Asthma 562-427-4249 122
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B. Cardiovascular disease
1. Heart Model a. Description of activity: Children will crawl through large boxes that mimic the circulatory system to learn about how it works. b. Materials needed: i. Must follow up with Katie Frevent for full description. ii. The Bellevue Lakeshore Learning Store has some reusable boxes for kids games like this (the kind kids can crawl through). If we need boxes, check them out at http://www.lakeshorelearning.com/general_content/store_locations /storeLocations.jsp?selectedstores=all&store=009
2. Others? 124
C. Lung Cancer
1. Healthy vs. Cancerous lung a. Description of activity: Display health and cancerous lung. Explain what is lung cancer basics – see UpToDate’s Patient Information Lung Cancer handouts for this information. b. Materials needed: i. Picture or model of healthy lung ii. Picture or model of cancerous lung iii. UpToDate handouts: still need to read and summarize. Who wants to do this? 1. Lung cancer risks, symptoms, and diagnosis 2. Lung cancer prevention and screening 3. Non-small cell lung cancer treatment; stage I to III cancer 4. Non-small cell lung cancer treatment; stage IV cancer 5. Small cell lung cancer treatment 2. Others?
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D. Short term effects: irritation of eyes, nose and throat, upper respiratory infections, bronchitis headaches, cough, lightheadedness
1. Build a lung a. Description of activity: using household items, build a lung with participants. b. Materials needed: Here are two ways that a model lung could be built. I’d like to have some try out each of these activities, and then tell us which one should be at the fair. i. Option one: http://go.hrw.com/resources/go_mk/sc/schst/HSTLBC20.PDF ii. Option two: http://biology.about.com/od/biologylabhowtos/ht/lungmodel.htm
2. Particulate matter and surface area a. Description of activity: display two sponges, one cut up into tiny pieces and one uncut. Explain that when you have particles of very small sizes, like the cut up sponge, there is more surface area on which germs, toxins, etc can stick. Also, the smaller the particle is, the easier it is for it to enter our bodies through our breathing. For these reasons, the tiniest particles (called “PM 2.5”) are especially concerning to health experts. b. Materials needed: i. One normal sponge ii. One sponge cut into tiny pieces iii. a chart (very basic, nothing with too many words or numbers) of the particle sizes that are inhalable and respirable neat! 3. Particulate matter sized to scale a. Description of activity: display a pool noodle floaty toy to represent a human hair. Next to it, display a marble (or skittle or similar tiny object) to represent PM 2.5 b. Materials needed: i. Pool noodle ii. Marble
4. Catch air pollution on sticky paper a. Description of activity: display sticky paper that has been placed outside (at strategic locations) to catch air pollution. Explain that we breathe all that stuff on the sticky paper. Explain how some particulate matter gets further into our bodies than others. b. Materials needed i. Sticky paper (ask Katie exactly what type) that has been placed out in Georgetown and South Park since a week before the fair ii. Sticky paper samples for people to take home and try their own experiments
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Screen HEALTH FAIR FLOOR PLAN Podium & computer Mic
-GA
(Julie and Sheryl) Mic
-GA
PSCAA ALAW DEEDS Sierra (Tania) -Aileen Club (Jill &
Nancy) (Robin Everett) Wheel of Asthma hospital- Fortune ization, KC (Faith) -Maggie
Asthma Straws Asthma ACT and Info Show and PM &Tell Peak (Navpreet 2.5 (Hunter) Flow and team) display Meters Build a (Addy) Lung (Robin Seamar (Melanie) Evans Agnew Client Sticky and Ami) Intake Paper
(Navpreet (Jessica) and team) ALAW Sign-In & Food (DW) Interpreters
(Mendoza) 128
FINAL HEALTH FAIR REPORT MARCH 1 MEETING OUTREACH SUMMARY
380 - 410 doors knocked in total South Park and Georgetown o 40 – 50 businesses in South Park and Georgetown . Fliers in all windows
Community Meetings Attended o Concord PTA Meeting . Also placed in Weekly Bulletin to Parents o Georgetown Merchants Association o Georgetown Community Council o 3 South Park Community Breakfasts o 2 Providence Regina House Food Banks o 2 South Park Senior Dinners o SPIARC ESL Class o Internet . South Park and Georgetown Listservs . ‘All About South Park’ website
Community Interest Level/Community Advisory Board o Out of a scale of 1 – 5 (1 = No Interest, 3 = Neutral , 5 = High Interest) . 52 people were ranked 4 or 5 . 2/3 in South Park (approximately 36 people)
Highlights o Met goal of 400 doors knocked o Contacted (mailings, calls, emails) all Community Health Survey participants, Sierra Club members in 98108, new contacts from doors with interest level 3+ o Made contacts with South Park and Georgetown community leaders, businesses, active residents, families with young kids, homeowners, and people at risk of or having asthma o Have a solid first group of interested residents o General public knowledge of diesel trucks/air quality issues . People can easily identify diesel hotspots without a map . People notice trucks and diesel smell in the air Passive agreement that the study is beneficial o Mid-high broad interest in home monitoring . Families with young children . General volunteers
Room for Improvement o More focused outreach to Spanish speakers, Vietnamese speakers, bikers, low-income residents 129
. South Park Community Center . Georgetown Playfields . Use established community contacts to network to non-active residents
Obstacles at Doors o Interest in other pollutants other than air . Airplanes (dropping jet fuel, noise) . Water (Duwamish Superfund site, drinking quality) . Dirt (PCBs) . Crime/Business o Various opinions on how the air is/not polluted . The river cleans the air . The winds carry the polluted air to/from South Park and Georgetown o General neutrality/uninterest . Environmental concerns are not a top priority
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APPENDIX 2: GIRLS NIGHT OUT
LETTER TO PARENT AND PACKING LIST
February 1, 2012
Dear Parent or Guardian,
We are senior nursing students from the University of Washington working with Carmen Martinez, Yvette Tolson, and Lovely-Frances Domingo at the South Park Community Center. Our project this winter is to coordinate and attend the South Park Girl’s Group Retreat taking place February 17-19th, 2012 at Camp Bethel in Hoquiam, Wa. Last year the weekend was a huge success, so we are excited to continue the tradition and work with the girls in this community in putting on this event again!
Our goals for this weekend are to treat the girls with a fun weekend away, just for them, as well as to educate them on important topics regarding respecting themselves and their peers. These are topics in which the girls have expressed interest. We are planning to meet at the Community Center at 4:00pm on Friday, February 17th with the goal of leaving for the Camp by 4:30pm. Please have everything you will need at the Community Center the night before (see attached list). Between Friday night and Sunday afternoon, possible activities include horseback riding, hiking, shopping at the outlet stores, etc. If they do not have snow or winter clothes available, we will have a borrowed supply with us. Interspersed throughout these activities, we will lead group discussions about self-esteem, puberty, and how to be a better friend. On Saturday night, we plan to treat them to a nice dinner where we would love the girls to wear an outfit they feel beautiful in. We hope to have them back around 2pm on Sunday, but we will keep you posted on our status.
Enclosed is a packing list- please let us know if you will have difficulty obtaining anything on the list. If you would like to contact the girls during the retreat for any reason, they will have limited cell phone use depending on our activity schedule, but we will be available at the numbers below.
We are really excited to spend time with and get to know these girls, as well as learn from them. We believe each and every one of them deserves respect and to know how special they are. Please do not hesitate to let us know if you have any questions or concerns. Thank you!
Sincerely, 131
Lauren, Vivian, and Natalie
UW Nursing Students
Please tear off the following and return to Carmen
------
I have read and understood this letter and give permission for ______to attend the South Park Girl’s Group Retreat February 17th-19th, 2012.
Parent/Guardian Signature ______
Packing List
Sleeping bag (if you don’t have one, please contact Carmen or Yvette by Feb 10)
Pillow
Towels/Washcloth
Flashlight
Plastic Bag (for dirty clothes)
Personal toiletries
Toothbrush
Toothpaste
Shampoo
Soap
Deodorant 132
Prescription medications
Clothes
Long sleeve shirts (sweaters, sweatshirts)… it will be COLD!
Raincoat or windbreaker
Jeans
Sweats
Underclothes
3-4 pairs of socks (preferably warm!)
PJs
Tennis shoes
Gloves
Hat
Boots (rainboots are best, or Uggs)
Warm clothes for evening events (made of polyester, not just cotton)
One outfit you feel beautiful in
Optional
Personal water bottle
No more than $25 spending money for the outlet malls in North Bend
Where we will be:
Camp Bethel 347 Kirkpatrick RD
Hoquiam, Wa 98550 www.campbethel.net
Contact Info:
Camp Bethel: 360-289-3444 133
Lauren Wotherspoon: 206-499-5649
Vivian Quintana: 360-601-2116
Natalie Volberding: 206-245-4930
Yvette Tolson: 206-351-1904
SOUTH PARK GIRLS NIGHT OUT PRE-RETREAT SURVEY
Hey girls! We can’t wait to finalize plans for the retreat this coming President’s Day Weekend but we would love to get your opinion on what you would most like to do and discuss when we are there. Answer these few questions so we can better know what you are hoping to get out of this retreat and we will do our very best to make this the best retreat yet for you girls! Sincerely, Natalie, Lauren and Vivian (UW BSN ’12)
1. If you have attended a previous GNO retreat, what did you like most about the
retreat?
2. Please choose any three topics to discuss and get more information on during the retreat:
Puberty Changes (periods, body changes, etc.)
Sexual Health (STIs, contraception, safe sex)
Self-esteem building
How to be a better friend
Substance Abuse Education (alcohol, drugs, etc.)
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Future Goals for Education, Jobs, etc. (plan for your own future!)
Gender Stereotyping
3. What fun activities would you like to take part in at our North Bend Site? Feel free to suggest some ideas as well! Here are some options:
Horse Back Riding
Tubing at the Pass
Going on a Hike
Shopping at the Outlet Mall (max of $25 allowed for spending money)
Other:______
4. Please tell us why you are or are not looking forward to this retreat.
B3. Final Itinerary
February 17-19, 2012
Day 1: 135
4:00 Meet at Community Center
4:30 Leave for Camp Bethel, pick up Subway sandwiches
7:30 Arrive at Camp Bethel in Hoquiam, WA
- Settle, explore 8:30 Make and eat nachos
9:00 – Set ground rules for retreat
- Session 1: How to be a good friend 10:00 Enjoy the fire place, play games
11:00 Quiet time
Day 2:
9:00 Breakfast
9:45 Session 2: Puberty and Sexual Health
10:30 Free Time
12:00 Lunch at Camp Bethel
1:00 Free Time
2:00 Go to a movie in Hoquiam
5:00 Dinner at Chinese Buffet
7:00 Session 3: Goal-Setting, Self-esteem/letters from parents
8:00 Movie
10:00 Free Time
Day 3:
8:30 Up to clean
9:30 Breakfast
10:00 Write letters to themselves
11:00 Leave Camp Bethel 136
12:30 Shopping at Tacoma Mall
2:00 Arrive at Community Center 137
ORIGINAL ITINERARY AND NOTES FROM PLANNING
NOTES from Planning Day #1
GIRLS NIGHT OUT…. Retreat Theme= “Respect Yourself”
Itinerary
Day 1:
Meet at Community Center 4:00
Leave by 4:30
5:30 XXX burgers in Issaquah
6:00 Arrive at Ensign Ranch
- Settle, explore 7:00 Icebreaker
- Introduction, setting ground rules, respect, what is said here stays here, leads into…. Session 1: How to be a good friend
o Cyber-bullying, conflict resolution Bonfire with games: Catch phrase, signs, maybe Capture the Flag
12:00 quiet
Day 2:
9:00 Breakfast
9:45 Session 2: Body Image, Healthy Relationships, Sex
10:30 Horseback riding/Free Time
12:00 Lunch
12:45 Session 3: Peer Pressure, Saying no to Alcohol/Drugs (Scenarios/Role play)
1:30 BIG activity…. Tubing at Snoqualmie Pass? 30 min drive 138
Rates: Session #3 – 1:30pm-3:30pm $22 for >13y/o, $19 for 6-12 y/o
Session #4 – 3:45pm-5:45pm $22 for >13y/o, $19 for 6-12 y/o
maybe we can ask for a discount? Outdoor clothes from REI… snow pants? OR ropes course at camp if open in winter Get back around 4:15 if early session
- girls will get ready, wear a “nice outfit”, for a nice dinner at the cabin… we will set it up with candles and a table cloth and serve them a special dinner (wear aprons, we will TREAT them for the night!) 6:00 Dinner
- then change and get ready for session 3 7:00 Session 3: Self Esteem
- after talk, girls will receive letters from their parents talking about how proud they are of them, that they love them 8:00 Conclude the night with a really FUN activity!! (still to be determined… something memorable)
Day 3:
9:00 Breakfast and pack up
10:00 Recap, talk about one thing you are going to take home, one thing you learned, evaluation survey, write letters to themselves that SPCC staff will mail them at the end of the year (or sometime)
11:00 Leave Ensign Ranch
Stop in Outlet malls (Bring $25/person)
AND/OR pit stop at Snoqualmie Falls
Each Session will begin with a group mixer game (maybe an upfront game if we have a good one?)
- teamwork PVC pipe game with marble
Girls should bring:
- warm outdoor clothes/shoes - snow clothes (we can provide if they don’t have) - nice outfit - no more than $25 to buy a souvenir at outlets 139
Until then…
We will come meet with Carmen and Lovely sometime Thurs Jan 19 during the day (maybe survey the girls with activities they are interested in, topics they are interested in… Carmen and Lovely, what do YOU think are the most important topics to cover with these girls?)
Girls Night #1, 1/26: Pizza Night! 6:30 Meet the nursing students, what do you hope..maybe play Catch phrase here? Or chick flick night?
Girls Night #2, 2/2: maybe go roller skating?
Girls Night #3, 2/9: come up with another fun idea
2/16: thurs before retreat, meet with Yvette at 23rd and Jackson Starbucks to go over final details.
Prep Work:
- track down outdoor gear from REI, Outdoor Research - sleeping bags too - letters to parents, letters FROM parents TO their kids (or from other close community members)
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EVALUATION SURVEYS
Youth 1. On the following list, please circle the number that best describes your knowledge and skills before and after the learning session during this retreat. Please make sure to mark both the columns on the left (Before Training) and on the right (After Training).
RATING SCALE: 1 = LOW 3 = MEDIUM 5 = HIGH
BEFORE TRAINING SELF-ASSESSMENT OF KNOWLEDGE TO: AFTER TRAINING
1 2 3 4 5 Understanding the difference between good and bad friends 1 2 3 4 5
1 2 3 4 5 Confidence in my ability to resolve conflicts with friends 1 2 3 4 5
1 2 3 4 5 Know who to talk to if I’m worried about a friend 1 2 3 4 5
1 2 3 4 5 Understanding the risks of getting an STD 1 2 3 4 5
1 2 3 4 5 Understanding puberty and the changes my body is going through 1 2 3 4 5
1 2 3 4 5 Degree to which you feel you can say “NO” to unwanted or unsafe sex 1 2 3 4 5
1 2 3 4 5 Understanding the value of a good education and staying in school 1 2 3 4 5
Understanding the difference between a short-term goal and a long- 1 2 3 4 5 1 2 3 4 5 term goal
1 2 3 4 5 Confidence in my ability to set and achieve realistic goals 1 2 3 4 5
1 2 3 4 5 1 2 3 4 5
1 2 3 4 5 1 2 3 4 5
OVERALL EVALUATION OF PRESENTATION
2. Your feedback is valuable to us. Your comments are important in developing future retreats to better meet the needs of the South Park teen girls. Please thoughtfully consider these following questions.
What was GREAT about this retreat?
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What SUCKED about this retreat?
What is your DREAMretreat?
What3 THINGSdid you learn from this retreat? 1.
2.
3.
What additional training and personal development EDUCATIONwould you like to see in future retreats?
Would you be willing to work with Carmen and Yvette to doFUND-RAISING for future retreats and events for South Park girls? 142
3. Please rate the following statements using a 1 through 5 scale where:
1 = Disagree Strongly 5 = Agree Strongly
____ The lesson materials were about the right amount.
____ I can apply the information I learned to my life.
____ Thelessons and activities met my personal needs.
____ Because of this training, I feel more confident in my ability to take control of my body and my life
4. How did we do (Lauren, Natalie, and Vivian)?
Very poor Poor Average Good Excellent
Knowledgeable about the subject
Asked questions and had, or offered to find the answers for the audience
Gave different explanations when things were not clear
Used a variety of materials and activities and encouraged everyone to join in
Gave enough time for the learning sessions and small groups 143
Were patient and respectful to everyone
5. Demographics:
What is your age? ______
What grade are you in? ______
What ethnicity do you identify with? ______
What language is mainly spoken in your home? ______
How many people live in your home? ______
Who do you live with (Please circle one): Single parent ∙ Both parents ∙ Relatives ∙ Foster family ∙ Friend ∙Other
Thank you for joining us this weekend You guys are the BEST!!!
(Educational Technology Services (ETS), 2006).
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SP Personnel OVERALL EVALUATION OF PRESENTATION
1. Your feedback is valuable to us. Your comments are an important contribution in developing future retreats to better meet the needs of the South Park female youth. Please thoughtfully consider these following questions.
What do you feel were the strengths of this retreat (lectures, small group discussions, activities, & etcetera)?
What do you feel were the weaknesses of this retreat (lectures, small group discussions, & etcetera)?
How can we improve on future retreats?
What additional training/development education would you like to see in future retreats?
What ideas do you have, and what resources are you aware of for fund-raising for future retreats and events for South Park female youth?
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2. Please rate the following statements concerning the learning activities and materials, using a 1 through 5 scale where:
1 = Disagree Strongly 5 = Agree Strongly
____ The lesson materials presented were about the right amount.
____ Materials presented during learning sessions were appropriate for the beneficiaries.
____ Materials presented during learning sessions were well organized.
____ Time allocated for the learning modules was satisfactory for this type of retreat.
____ The activities and small group discussions effectively involved every member.
____ The presentation met the girls’ personal needs.
____ The girls can apply the information they learned to their lives.
3. Please rate the UWSON team (Lauren, Natalie, and Vivian) facilitation of learning activities and materials and overall conduct and performance.
Very poor Poor Average Good Excellent
Knowledgeable about the subject
Solicited questions and had, or offered to find the answers
Offered alternative explanations when necessary
Employed a variety of materials and activities to engage participants in the 146 learning process
Class, group and activity participation and interaction were encouraged
Presented themselves as responsible role- models
Demonstrated patience and respect to all members of the retreat
Thank you for your feedback, participation in, and support throughout this retreat. Your contribution was greatly appreciated.
(Educational Technology Services (ETS), 2006). 147
UWSON Team OVERALL EVALUATION OF PRESENTATION
1. Your feedback is valuable to us. Your comments are an important contribution in developing future retreats to better meet the needs of the South Park female youth. Please thoughtfully consider these following questions.
What do you feel were the strengths of this retreat (lectures, small group discussions, activities, & etcetera)?
What do you feel were the weaknesses of this retreat (lectures, small group discussions, & etcetera)?
How can we improve on future retreats?
What additional training/development education would you like to see in future retreats?
What ideas do you have, and what resources are you aware of for fund-raising for future retreats and events for South Park girls?
What suggestions do you have for future UWSON student teams involved with this project and/or the South Park community female youth?
2. Please rate the following statements,concerning the UWSON team (Lauren, Natalie, and 148
Vivian) facilitation of learning activities and materials using a 1 through 5 scale where:
1 = Disagree Strongly 5 = Agree Strongly
____ The lesson materials presented were about the right amount.
____ Materials presented during learning sessions were appropriate for the beneficiaries.
____ Materials presented during learning sessions were well organized.
____ Time allocated for the learning modules was satisfactory for this type of retreat.
____ The leaders initiated activities whichengaged the girls in the learning process.
____ The leaders demonstrated patience and respect to all members of the retreat.
____ The activities and small group discussions effectively involved every member.
____ The presentation met the girls’ personal needs.
____ The girls can apply the information they learned to their lives.
(Educational Technology Services (ETS), 2006).
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SESSION 1 LESSON PLAN: HOW TO BE A GOOD FRIEND
HOW TO BE A GOOD FRIEND
1) Make dinner together (sign up for jobs)….. “TEAMWORK” 2) PVC pipe teamwork game 3) Talk about qualities of a good friend. What does a good friend do? a. Respect you, listen to you, don’t pressure you, encourage you, positive life choices b. How do you feel when you are with a good friend that you trust? i. Relaxed, be yourself, encouraged 4) What about a bad friend? a. Pressure you to do things you don’t want to do, make you feel bad about yourself… 5) Act out scene from Shrek a. Key lines… “Cause that’s what friends do. They forgive each other.” b. What did you see in this… what does it say about friendship? c. Is that practical? d. Where do you go if you have a problem with a friend? i. Straight to the source- don’t blame
[Warner, A., Williams, J.H., Katzenburg, J., Adamson, A., and Jenson, V. (2001). Shrek. Dreamworks Animation, USA.]
“Here are 7 ways to know if your friends really care about you:
They want you to be happy. They listen and care about what you have to say. They are happy for you when you do well. They say they are sorry when they make a mistake. They don’t expect you to be perfect. They give you advice in a caring way. They keep personal things between the two of you. “
[Office of Women’s Health (2009). Friendships. Retrieved Feb 1, 2012 from http://www.girlshealth.gov/relationships/friendships/index.cfm]
What are the hard things about the social scene at school?
- cliques, bullying, partying, gossip, etc - peer pressure ways to say no - dealing with conflict with friends 150
CONFLICT RESOLUTION
Step 1. Cool off! Being out of control will keep you from solving the problem.
Count down backwards from 10. Close your eyes and take deep breaths. Think of a peaceful place or something that makes you happy. Slowly say over and over to yourself, "Take it easy." Step 2. Keep it real! Figure out what’s really bothering you.
Do you not agree? Did someone say or do something that made you mad or hurt your feelings? Are you feeling the way you do now because of something else that upset you in the past? Is this a one-time problem or one that keeps happening? Step 3. Deal with the issue. (face to face)
Find a time when you can talk in private. Keep your voice calm and your body relaxed. Make eye contact to show you are serious. o Say exactly what is bothering you. Share how you feel by using sentences that start with “I.” Don’t blame or accuse the other person. Check out the following examples and then practice changing "you" statements to "I" statements. Step 4. Listen. The other person might see the problem in a different way. You may each have a different point of view, but neither of you is wrong. Make sure to listen to his or her side of the story.
Make eye contact. This shows you are interested in what the other person is saying and willing to solve the problem. Listen for what is behind the words — like feelings and ideas. Keep emotions in check. Don’t interrupt, get angry, judge, or be defensive. Try putting yourself in the other person’s shoes to see where he or she is coming from. Step 5. Work it out. Talk about ways to settle the conflict that will meet both of your needs. Be willing to change and keep an open mind. Be willing to say you’re sorry, forgive, and move on.
[Office of Women’s Health (2009). Dealing with Conflict. Retrieved Feb 1, 2012 from http://www.girlshealth.gov/relationships/conflict/index.cfm]
Helping a friend in need top
Are you worried about a friend who isn’t eating? A friend who is smoking or drinking? Or maybe a friend who is having trouble at home? You can listen and give advice, but your friend’s problems may be more than you can handle alone. Don’t be afraid to tell a trusted adult, such as 151 a parent/guardian, teacher, or school nurse. Even though your friend may get mad at you for telling an adult, it is the only way to protect your friend’s health.
If you think a friend may have an eating disorder, read "How to Help a Friend ." If you have a friend who smokes, help him or her quit. Send your friend to the web site TeenQuit . If you think a friend may have an alcohol or drug problem, find out how you can help . If a friend is being abused at home, give him or her the number for the 24-hour Childhelp National Child Abuse Hotline : 1-800-4-A-CHILD (422-4453). If a friend is being hurt by someone he or she is dating, give your friend the number for the 24-hour National Domestic Violence Hotline : 1-800-799-SAFE (7233) or 1-800- 787-3224 (TDD). If a friend is talking about suicide, you must tell a trusted adult right away. You can also give your friend the number for the National Suicide Prevention Hotline : 1-800- 273-TALK (8255). If a friend is talking about hurting someone else, you must tell a trusted adult right away. If a friend is in trouble in other ways, Nineline (800-999-9999) can help.
[Office of Women’s Health (2009). Friendships. Retrieved Feb 1, 2012 from http://www.girlshealth.gov/relationships/friendships/index.cfm]
SO NOW WHAT?
- How are ways that you guys can encourage each other to make good choices? - What is one way that you can be a better friend? - Strong friendships build strong communities which gets things done (like the PVC pipe game) - Community and friendships give you a place to go for support when times are hard.
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LESSON PLAN FOR PUBERTY/HEALTH RELATIONSHIPS I. Puberty
A. Breasts
1. Usually one of the first changes of puberty for girls
2. Average age breast growth begins for girls is around age 11, but can be as early as 8 or 9 and later around age 14.
3. What occurs: area around the nipple gets larger and begins to push outward into a small mound
4. Everyone’s breast are a different size and shape- most woman’s breasts are slightly two different sizes, this is very normal.
5. Breasts can be sensitive or tender particularly during growth or during a woman’s menstrual cycle
6. The purpose of breasts is to breast feed their baby- larger breasted women do not have more milk
7. Bras used to support breasts, make a woman feel more comfortable, or some woman just like the shape a bra gives them. They are not necessary but most woman prefer to wear them.
8. Questions?
B. Menstrual Cycle “Period”
1. When a girl starts her period this means she has begun to shed one of the linings of her uterus (endometrium)
2. The average age for menstruation begins around 12- however there is a lot of variety in this age; some as early as 8 and others around 15. It has a lot to do with genetics, most likely you will start your period around the same age your mother or older sister started hers
3. The typical “cycle” lasts around 28 days and lasts approximately 4 days however every body is different and the regularity of your period is usually hard to track especially at the beginning: TIP when you start your period, mark the day on your calendar; also mark when it ends. Over time you will see how your cycle tends to be and you will be able to predict it more frequently.
4. Pads and Tampons demonstration!
a. Tampons can seem like a scary thing for some girls when they start their period and can be uncomfortable when you first start to use them; start with 153
a smaller size (usually called light flow) and work from there. Gradually you will get used to wearing them and won’t notice they are even in anymore
b. Pads have a sticky adhesive side on them and they stick to the inside of your underwear
c. Change the pad and/or tampon every 4 hours or so; especially a tampon should not worn for more than 6 hours at one time because of risk for infection and a disease called Toxic Shock Syndrome (TSS); some tampons state that they can be used overnight but only for 8 hours so if you plan to sleep longer than 8 hours use a pad instead
5. What about swimming? You can do everything you want to do when on your period, even swim! Having your period should never prevent you from doing sports or anything else you love.
6. Other vaginal discharge: this is very normal to have whitish/clear/light yellow discharge when you do not have your period, this is how your vagina stays healthy; IF however you notice green, grey or smelly discharge this could mean an infection and you would need to see a doctor (yeast infection)
7. Problems with Periods: cramps. Some girls get achy in their stomach, back, or other areas. These are called cramps are a result of the changing hormones of your body during the period and your uterus contracting to get the blood out; cramps usually occur during the heavier bleeding times of your period the first 1-3 days solution= movement, heating pad to the problem area, NSAID
8. Questions?
C. Hair Growth/Skin Changes/ Body Shape
1. Girls will begin to notice hair growth in areas that never had hair before really: underarms, legs, and pubic area. The hair will begin lighter and thinner but gradually get darker and thicker. Some girls/women choose to shave this hair away but know there is an increased risk of infection, cuts, etc. Keep clean, do not share shaving products, and take care of cuts should they occur
2. Skin also changes for everyone during puberty (boys too!) This is because the sweat glands in our body begin to develop more due to the fluctuation in hormones. The added stress, hormone changes, and sweat that comes with puberty can mean acne or pimples on your face, chest, and back. Shower regularly, and wash your face every day. Also most people wear deodorant to help control the smell or amount of sweat that can occur with heavy activity or just throughout the day
3. Girls will go through a growth spurt before boys, and reach their adult height around age 18. During this time a girl will usually begin to develop curves in her hips, thighs, and butt. Girls are supposed to have more body fat than boys! 154
4. Questions?
II. Healthy Relationships and Sexual Health
A. Crushes 1. These are intense romantic feelings that teenagers have for someone they like or think is attractive; usually they last for a couple weeks or months 2. These feelings are very strong and very powerful at first but tend to go away after a while; this does not mean those feelings are not real though 3. The difference between a crush and a relationship is that a relationship’s love grows over time rather than being so intense at the beginning. You truly respect and like the person you date and want what is best for them; also that love is reciprocated. Sometimes you can have a crush on someone but they might not feel that intensely back, and that is ok it just means that he/she is not the right person for you and you keep looking! 4. It is fun to have these loving/sexual feelings but since they are so new and you have never experienced such emotions before, you must learn to be responsible- this is all a part of becoming an adult 5. Going out on a date is a good way to get to know someone you are interested in but this can be very scary/intimidating; maybe meeting up with him/her and some friends to do a group activity like skating or going to a movie can make things more comfortable B. How to show affection 1. Holding hands, hugging, and kissing a. All can feel very good and it is so exciting to experience these new things b. Before starting with physical signs of pleasure with someone, make a plan of exactly what you are comfortable doing before you act on it. Make your own decisions about your body; pressure is not love. 2. Touching a. Masturbation: it is natural to experiment with your body and touch yourself as part of self-exploration; it is not wrong and it perfectly acceptable for both boys and girls b. Allowing someone else to touch yourself is a huge decision and can seem like a good idea and fun. ***RULE OF THUMB: However if you cannot even bring yourself to talk about it with your partner, you probably are not ready to engage in more advanced sexual relationship.
3. Oral Sex (stimulating someone’s genitals with your mouth)
a. This is still sex and you can get an STI from this!
b. This is a very intimate form of sexual relationships and is a very personal form of expression of love 155
c. Fellatio (oral sex for a man) and cunnilingus (oral sex for a woman) are the technical medical terms for engaging in oral sex with someone
d. You cannot get pregnant from oral sex, but STIs/HIV are still a huge possibility; oral sex is not a safe alternative to sexual intercourse; if you choose to engage in oral sex with someone you love/respect and vice versa you must still use protection like a condom
4. Sexual Intercourse
a. This is also known as “making love” because usually the two people who have sex are in love with each other and have sex as a way of expressing that love
b. Heterosexual sex is a man pushing his erect penis into a woman’s vagina. Homosexual men engage in anal sex typically and homosexual women have sex through touching, cunnilingus, and other options
c. Whenever a man and woman decide to engage in sexual intercourse pregnancy and STDs are always a risk; pregnancy can occur during the first time a person has sex, in any position, and for any length of time. Even if a boy “pulls out” of the vagina before he ejaculates pregnancy can still occur because there is still an exchange of seminal fluid that comes out of a man’s penis which contains sperm as well
d. You should only have sex with someone you know you can trust completely, you feel comfortable discussing this large step in the relationship, you both agree to only have sex with each other and no one else, and discuss what you would choose to do if pregnancy occurred. If you choose to have sex you should be mature enough to know that means a baby could result of such an act.
e. Contraception: only condoms and abstinence are effective in preventing STDs
Abstinence: 100% effective in regarding protection from pregnancy and any sexually transmitted infections Spermicide: minimally effective when used alone but when paired with a barrier method (diaphragm or condom) its effectiveness increases; does however increase woman’s risk of acquiring STIs and HIV Barrier Methods: 84-89% effective and includes . Condoms= effectiveness determined by their use (right size, application, breakage etc.) . Diaphragms (must be left in vagina for 6 hours post intercourse to prevent pregnancy and be taken out 24-48 hours later) . Female condoms . Cervical plug (spermicidal lube should be used with it to increase effectiveness) . Vaginal Sponge (should also be worn for 6 hours post sex) Intrauterine Device: 99% effective at prevent pregnancy Hormonal Contraception: 92-95% effective 156
. Combined oral contraception (estrogen and progestin) . “Mini” pill (just progestin) . Transdermal patch (most effective in women who weigh less than 198 pounds) . Vaginal Ring (must be refrigerated) . Long Acting (Depo shot or Implanon device) is more effective at 97% Surgical Sterilization: 99% effective . Vasectomy (sometimes reversible) . Tubal ligation
C. STIs 1. Most common are gonorrhea and chlamydia and both can cause pelvic inflammatory disease and infertility; women with these STDs usually do not display outward symptoms which can make it hard to discover; these can be treated with antibiotics and go away HOWEVER these bacteria are becoming resistant to antibiotic treatment now so this therapy may be short lived 2. Syphilis results in crusty red sores in the genital area and if untreated with antibiotics can result in a brain disease and cause a person to display psychotic like symptoms 3. Herpes Simplex Virus: incurable. Causes sores in the genital area that are very itchy and can release a white pus discharge 4. HPV (human papillomavirus) = known to cause cervical cancer. But HPV is also known to cause genital warts and to increase the risk of cancers of the penis, anus and rectum in men; vaccine available and is recommended for girls and boys starting the first series around age 12 5. HIV/AIDS= Early signs of HIV/AIDS infection can include flu-like symptoms, unexplained rashes, fungal infections in the throat, and unusual tiredness. As the disease progresses and the immune system is compromised, cancers and life- threatening infections such as cytomegalovirus can occur. Often, however, early infection with HIV/AIDS has no symptoms; incurable but a wide range of drug cocktails are available to prolong a person’s life 6. ABC’s of STD protection: Abstinence, Be faithful, and Condoms. Condoms do not eliminate the chance of getting an STD but greatly reduce a person’s risk. For example people who used condoms effectively had a 90% reduction in getting HIV
III. Who to turn to for help= If you ever have questions or concerns about sex, puberty or just life in general turn to an adult you can trust: whether if that is your mom, grandmother, teacher, Carmen/Yvette, or another trusted person. There are also agencies like Planned Parenthood that provides free contraceptives like birth control pills and condoms. West Seattle Health Center –9641 28th Avenue SW Seattle, WA 98126 p: 800.230.7526 | f: 206.935.5623
Resource: Barbara Polvie presentation, Contraception slides November 29, 2011
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GOAL SETTING LESSON PLAN:
1. Activity—Give each girl a piece of paper, magazines, scissors and glue and let them make a mini- collage of goals they have for any point in their life
2. Share collages with each other
3. Talk about setting goals
In order for something to be a goal, it has to be important to you, personally It has to be in your power to make it happen through your own actions It has to be something you have a reasonable chance of achieving It must be clearly defined and have a specific plan of action Not every wish can be a goal o Ex: I wish to be famous (could happen, but I don’t have a reasonable chance of achieving it)
4. Short term vs. long term goals
Short term goals can make long term goals easier to achieve Short term goals are just as important A goal should have a deadline
5. My story of how I achieved my goal of becoming a (almost) nurse
Set goal in high school Focused on getting good grades (short term goals are important!) Skills Center and Running Start talk about opportunities for these girls o Running Start available to them at South Seattle Community College . Jr/sr year of high school . Free college credits . Placement test to get in . Academically challenging o Seattle Public Schools Skills Center . Opening Fall 2012 . Aerospace science . Cisco/Microsoft Information Technology academy . Digital animation and game programming . Health sciences Nursing assistant certification . COMING SOON: . Green energy/engineering 159
. Marketing and retail . Construction . Business and entrepreneurship . Fire science . Criminal justice and public safety . Culinary arts . Hospitality, travel and tourism . Green manufacturing . Low impact transportation o Full year program o High school credits o Doesn’t currently provide transportation o Apply for jr/sr year in high school Wasn’t sure I wanted to do nursing until my skills center program o Used CNA license to get hours for nursing school applications Got a free year of college doing Running Start, now graduating from nursing school with a Bachelor’s at the age of 21 Was able to do other things in high school (cheer, work, volunteer), but in college had to choose nursing over other opportunities Took a chance—applied for UW nursing school, didn’t think I would get in but applied anyway Use hard life situations to help fuel your passions and goals! o Everyone has them, my experiences have probably been different from theirs, but still have affected my life o Luke oncology nursing
6. Open up for discussion
Anything girls want to ask/share
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RESULTS FROM SURVEY GRAPH AND DEMOGRAPHIC INFORMATION
Ethnicity of Girls Who Attended the Retreat Native American 17% 25% Hispanic
17% Caucasian
25% Identifies With More Than One Ethnicity 17% Unsure About Ethnicity
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Age Distribution of Girls Who Attended the Retreat 8% 17%
11 Years 12 Years 25% 17% 13 Years 16 Years
17 Years
33%
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APPENDIX 3: BREAKFAST PROGRAM
NUTRITIONAL VALUE OF SOUTH PARK’S BREAKFAST FOOD ITEM NUTRITIONAL VALUE FOOD ITEM NUTRITIONAL VALUE 2 Large Eggs Calories:142 2 Frozen French Calories: 252 Fat Cal: 90 Toast Far Cal: 64 Total Fat: 10g 16% Total Fat: 8g 12% Sat. Fat 4g 16% Sat. Fat: 2 10% Trans fat 0g Cholest.: 96g 32% Cholest.:422mg 140% Sodium: 584mg 24% Sodium: 140mg 6% Total Carbs: 76g 12% Total Carb: 0 Diet. Fiber:1g 6% Protein: 12g Protein: 8g Vitamins and Minerals: Vitamins and Minerals: Vit. A: 8% Vit. A: 4% Vit. C: 0% Calcium: 12% Calcium: 4% Iron: 14% Iron: 8%
2 Sausage Links Calories: 230 1 small potato Calories: 134 Fat. Cal.: 264 (Russet, flesh and Fat Cal.: 2 Total fat: 30g 46% skin, baked) Total Fat: 0 Sat. Tat: 10g 26% Cholest.:0 Cholest.: 74mg 24% Sodium: 19mg 1% Sodium: 802mg 34% Total Carbs: 30g 10% Total Carbs: 0 Diet.Fiber: 3g 13% Protein: 8g Sugar: 1g
Vitamins and Minerals: Protein: 4g
Calcium: 2% Vitamins and Minerals:
Iron: 10% Vit. C: 30%
Iron: 8%
1 tbsp Table Calories: 53 1 tbsp Ketchup Calories: 15 Maple Syrup Total fat: 0 Fat Cal.: 0 Cholest.:0 Total Fat: 0 Sodium: 12 mg 1% Cholest.:0 Total carbs: 14g 5% Sodium: 167mg 7% Sugar: 8g Total Carbs: 4g 1% Protein: 0 Sugar: 3g
TOTAL VALUE Calories: 763 Vitamins and Minerals: (without salt, pepper, and butter Fat Cal.: 211 Vit. A: 12% 164 added) Total Fat: 24g 37% Vit. A: 30% Sat. Fat: 8g 39% Calcium: 16% Cholest.: 296mg 108% Iron: 40% Sodium: 961mg 41% Total Carb: 67g22% Diet. Fiber: 4g 16% Sugars: 12g Protein: 22g
ADDITIONAL NUTRITIONAL VALUE ADDITIONAL NUTRITIONAL VALUE ITEMS ITEMS
1 Cup Calories: 100 1 Container of Calories: 170 Nonfat Milk Fat Cal.: 20 Yogurt Fat Cal.: 15 Total Fat: 2g 4% (Yoplait Original) Total Fat: 1.5 g 2% Sat. Fat: 2g 8% Sat. Fat: 1g 5% Trans Fat: 0 Trans Fat: 0 Cholest.: 12mg 4% Cholest.:10mg 3% Sodium: 107mg 4% Sodium: 85mg 4% Total Carb.:13g 4% Potassium: 230mg 7% Diet. Fiber: 0g Total Carb.:33g 11% Sugars: 13g Protein: 8g Diet. Fiber: 0g Vitamins and Minerals: Sugars: 26g Vit. A: 10% Protein: 5g 10% Calcium: 30% Vitamins and Minerals: Vit. A: 15% Calcium: 50% Iron: 4% Vit. D: 50% 1 Cup Calories: 134 1 Cup Calories: 101 Orange Juice Fat Cal.: 0 Kellogg’s Fat Cal.: 1 Total Fat: 0g 0% Corn Flakes Total Fat: 0.2g 0% Sat. Fat: 0g 0% Sat. Fat: 0.1g 0% Trans Fat: 0g Trans Fat: 0g Cholest.:0mg Polyunsat. Fat: 0.1g Sodium: 5mg 0% Monounsat. Fat: 0g Total Carb: 33g 11% Cholest.:0mg Diet. Fiber: 0g 2% Sodium: 202mg 8% Sugars: 23g Total Carb: 24.4g 8% Protein: 0g Diet. Fiber: 0.7g 3% Vitamins and Minerals: Sugars: 2.9g Vit. A: 2% Protein: 1.9g Vit. C: 62% Vitamins and Minerals: Iron: 2% Vit. A: 10% Vit. C: 10% Iron: 45% 165
STANDARD MENU PATTERN: Food Group Servings per Meal and Portion Met OR Unmet Size (Based on current breakfast menu.) Bread or Bread Alternate 2 servings UNMET (excess) (1 serving equals 1 slice bread; 1 2 = toast, pankcakes, etc. cup cereal) +1= potatoes Bread alternatives: vegetables or ----- fruits high in complex 3 servings carbohydrates (starch), eg. * 1 = cereal Potatoes, yams, plantains Potential for 4 servings Vegetable 2 servings UNMET (1 serving equals ½ cup; 1 cup 0 servings leafy; ¾ cup 100% vegetable *occasional small pieces of bell juice) betters in potatoes An additional vegetable may be served in place of a fruit. Fruit 1 serving MET (1 serving equals one medium 1 = orange juice whole fruit; ½ cup chopped, cooked, or canned; ¾ cup 100% *Canned fruits or fruit salads are juice). occasionally served. An additional fruit may be served in place of a vegetable. Milk or Milk Alternate 1 serving MET (1 serving equals 1 cup fluid milk 1 = Milk or calcium enriched soy milk or juice; 1 cup yogurt; 1.5 oz. *Yogurt is occasionally served. natural cheese) Meat or Meat Alternate 1 serving MET (1 serving equals 2.5-3oz meat, 1 = 1 sausage patty, 2 sausage fish poultry; 3 eggs; 3 oz. cheese) link, or 2 bacon slices +½ = 2 eggs ----- 1.5 servings Fats 1 serving UNMET (1 serving equals 1 tsp) Total Fat = 37% *Limit total fat to 30% and Saturated Fat = 39% saturated fat to 10% of calories. *Additional recommendations: Use whole grain foods and enriched breads, and use fat-free or low- fat dairy products, cooked dry beans and peas, fish, lean meats and poultry to lower total fat (Washington State Department of Social and Health Services Aging and Disability Services Administration, 2004).
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HEALTH AND PYSCHOSOCIAL SURVEY SOUTH PARK BREAKFAST PROGRAM
Age: ______Gender: ______Sexual Orientation: ______
Living Situation:
Where do you live: ______
How many people do you live with: Adults ______Children______
Occupation: ______
Working Conditions: ______
______
Health Conditions: ______
______
______
Do you have health insurance? Yes ______No ______
If you have a health condition and you do not have health insurance, what are you doing to take care of it? ______
Do you believe this is a “healthy” breakfast? Yes ______No______Sort of ______
Is there anything you would like to take out or add in the breakfast menu? If so, what? ______
______
How often do you eat fruits and vegetables throughout the week? (ex. 1-2 servings per day, 4-5 times a week): ______
How often do you eat lunch and dinner? (ex. Everyday OR 5-6 times a week):
______
Do you consider yourself “healthy”? Yes ______No ______Sort of ______
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HEALTH AND PSYCHOSOCIAL SURVEY RESULTS Total Surveyed: Answers #s Who Did 22 Not Answer AGES 15, 21, 24, 28, 29, 30, 34, 38, 40, 42, 42, 47, 48, 53, 54, 54, 0
54, 57, 58, 66, 67, 77
Gender Male: 18 0 Female: 4 Sexual Orientation Straight: 5 12 Heterosexual: 3
Single: 1 Prefer woman: 1 Married Yes: 4 0 No: 18 Living Situation: South Park: 15 1 Downtown: 1 Where do you live? Friend’s couch: 1 Homeless: 1 House: 1 Motor home: 1 Room: 1 Living Situation: Adults 1+: 6 2 Children 1+: 0 How many people do Adults and children 1+ each: 5 you live with? Single: 9 Occupation Body men: 1 1 Carpenter: 1 Drywall taper: 1 Disabled: 1 Disabled Vietnam veteran: 1 Handyman: 1 HEO Construction: 1 None: 1 Retired: 2 School: 2 SSDI: 1 SSI: 1 Unemployed: 4 Vender/food: 2 Volunteer: 1 Working Conditions Able to work: 1 6 Do not work: 1 168
Family’s struggling and has hard time taking care of necessities: 1 Full time plus school: 1 Good: 3 Good/people can be hard to work with: 1 I want to find a job: 1 N/A: 1 None: 4 Normal: 1 Health Conditions Asthma: 1 1 Can’t tell: 1 Dry Skin: 1 Excellent: 1 Good: 4 Good enough: 1 Good health: 1 Hypertension, depression, arthritis: 1 I’m a patient at VA Med Ctr.: 1 I’m going to the doctor today. I have a bladder infection, check up: 1 Minor Health problems: 1 NKA General good health: 1 None: 2 Normal: 1 Ok: 1 Poor: 1 Unknown: 1 Health Insurance Yes: 11 No: 11 If you have a health Community Health Clinic: 1 3 condition and you do Nothing: 4 not have health Pay cash: 1 insurance, what are Pray: 1 you doing to take See MD- Charity case at Harborview Hosp.: 1 care of it? Do you believed this Yes: 18 2 is a “healthy” No: 0 breakfast? Sort of: 2 Is there anything Comments: 7 you would like to It’s great take out or add in No: 3 the breakfast menu? Well rounded If so, what? Suggestions: 169
Add in a salad bar or fruit Asian cuisine like pho and egg rolls Fruits Menudo Maybe flakes Oatmeal Singing waitress/waiters Strawberry milk Tortillas How often do you eat Rare- cannot afford them. 3 fruits and vegetables 0 throughout the 0-1. week? Once a week. 1-2. 2 times a week: 3 2-3 times a week: 2 3 times a week. 3-4. 2 servings a day 4x week. 4-5 times a week. 5. Once a day, 5 times a week: 2 Maybe a few servings per day. When I can. How often do you eat 2 times a week. 6 lunch and dinner? 2-3 times a week. 2-3 times a week, reason we rely on this breakfast. 4 times. Sometimes. 5. 5-6. 6 times a week. Dinner daily, lunch- hit and miss. Everyday: 7 Do you consider Yes:14 2 yourself “healthy”? No: 0 Sort of: 6
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POSTER CEREAL with MILK
BEST way to start the day
An excellent source of calcium that makes our bones and teeth strong
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How much calcium do we need?
Age Daily calcium requirement
4 to 8 1000 mg
9 to 18 1300 mg
19 to 50 1000 mg
50+ 1200 mg pregnant or lactating women 1000 mg 18+
1 cup of milk/250ml = 300mg Calcium
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APPENDIX 4: EXERCISE PROGRAM Message 46 of 247 (89) - Web Alpine 2.0 https://ap34.alpine.washington.edu/alpine/alpine/2.0/browse/0/... FITNESS CHECK PAPERWORK EMAIL
RE: South Park EF: Fitness Check Paperwork & Postcard Mailing Request From: Helen Sielaff
Carla, below is the memo we will soon be sending out. I thought it best to email the new forms to you as we are switching over very soon to this new system. After review, if you have any questions, please don't hesit ate to contact me. Thanks.
Greetings,
We are pleased to announce that EnhanceFitness has launched a new Online Data Entry S ystem (ODES) in January of 2012. We have been developing this system over the past year with the financial support of the Universit y of Washington's Health Promotion Resource Center and the Centers for Disease Control and Prevention. Whilst this system provide s the ease for National sites to enter their EF data locally, Helen Moore Sielaff will continue to enter all data for King County and Group Health sites.
The forms for the new system are non-scannable, which means that we no longer require original forms with a unique identifier. You can now make copies from a Master set, which we enclose in this mailing. As well as b eing available through the secure Site Coordinator's page at www.projectenhance.org in the very near future, your site will also be sent a copy of the forms in pdf format via email. We want to make this transition as easy as possible for you.
Below you will find a list of revisions for the form completion procedure:
* A revised Attendance , Participant Information, Fitness Check, Program Evaluation a nd Health History Forms.
* A separate attendance sheet will need to be used for every calendar month. For ex ample, class dates cannot go from April 15th to May 15th on the same sheet, one set will need to be filled out for April and another for May.
* Classes are now going to be identified by the time they start, so if you have more than one class per day, a separate attendance sheet will need to be used for each class. To make this transition easier, an individual participant can now be associated with more than one class and once we are made aware they attend different classes, their pre-printed name will show up on the different class lists.
* For the sites that receive Group Health reimbursement, there will no longer be a se parate (pink) attendance sheet for those participants. You will now receive only one white set for each month, and the Group Health participants will be denoted by having an asterisk beside their name.
* We will now require completed copies of the Health History form to be attached to t he Participant Information form for each new participant.
* For existing participants, Health History forms will need to be completed once per year. To make it easier for you, we will send you a reminder when this is due.
If you have any questions regarding the enclosed information, please contact Helen Mo ore Sielaff at 206-727-6239 or [email protected] .
Thank you!
Helen Moore Sielaff Local Administrative Assistant II (for KC) Project Enhance, Senior Services The Lillian Rice Center 2208 2nd Avenue, Suite 100 Seattle, WA 98121 ph: 206-727-6239
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SOUTH PARK FALL PREVENTION AND FITNESS PROGRAM KEY PLAYERS
Key Players in the South Park Senior Program Enhance®Fitness Group Exercise Classes include:
1. Dagmar Cronn, President of the South Park Neighborhood Association. Dagmar is knowledgeable about most everything that tracks in the South Park Neighborhood Center, including the SPSP and its programs Contact: [email protected]
2. Peter Quenguyen, Site Coordinator of the SPSP. Peter is a part-time employee of the South Park Neighborhood Association. Peter coordinates anything the SPSP needs in order to administer its programs, and among his many tasks are:
o tracking attendance at the Enhance®Fitness Group Exercise Classes o tracking attendance at the South Park Senior Meal Program o collecting demographic data of people who participate in any of the South Park Senior Program activities o collecting donations for the meals o several reports for grant continuation Contact: [email protected]
3. Vivian Bowles, Enhance®Fitness Group Exercise Class Instructor. Contact: [email protected]
4. Project Enhance is part of Senior Services
a. Andrea Meewes Sanchez, Project Manager: [email protected]
b. Helen Moore Sielaff, Administrative Assistant: [email protected]
Project Enhance c/o Senior Services
2208 2nd Ave
Seattle, WA 98121
Phone: 206.448.5725 174
5. Project Enhance affiliate login for helpful information such as:
Training Resources Marketing Materials Class Equipment An Implementation Guide with forms
http://www.projectenhance.org/home/ctl/login.aspx?returnurl=%2fdefault.aspx
Login: EnhanceFitness
Password: EFQ2&2011