Read a local newspaper or watch a newscast that covers the community in Anne Arundel County or Annapolis (Maryland). Make note of reports of motor vehicle accidents, domestic violence incidents, public violence, or other environmental risks. Write a brief paragraph regarding your findings, and offer a brief description of what a public awareness campaign could say to help reduce these risks. How would you get the word out effectively?

Vulnerable populations at Risk

In almost every community across this nation, there are aggregates or groups that are at a greater risk for poor health than the rest of the population. These groups each have certain characteristics, risk factors, or traits (also known as disparities) that increase their vulnerability to poor health. Vulnerable populations are groups that are more likely to develop health-related problems and are more likely to experience a poor outcome or shorter life because of a health problem. These groups are often not well-integrated into the health care system because of ethnic, economic, or geographic characteristics. Some examples are: the homeless, the disabled, the severely mentally ill, and the very young and very old. The Affordable Care Act has the potential to reduce many of the barriers these groups face related to health insurance coverage. If the family you are working with as part of your assignment for this course has any of these characteristics, you may want to check out these resources.

It is natural to assume that a community-based intervention will also benefit vulnerable groups within the population. However, you must consider which vulnerable groups are present in the community and what constitutes an increased risk. Please read the article “The Inequality Paradox: The Population Approach and Vulnerable Populations.” Many of these groups have multiple risk factors that further increase their level of risk. These multiple-risk-factor groups create a challenge for a nurse who is planning and evaluating community-level interventions. Planning a community intervention to include these groups requires careful evaluation of the risk factors or characteristics of each group. Read the article, “Vulnerability and Unmet Health Care Needs,” by Leiyu Shi and Gregory Stevens (in eReserves), and pay careful attention to the identification of unmet health care needs and ways to mitigate the challenges posed by these needs.

Finally, many of the characteristics of these groups are societal issues and impact societal values. As nurses, we have an ethical responsibility to these groups. Society’s view of these groups can be considered a risk factor in itself. These issues are discussed in the article “Vulnerable People, Groups, and Populations: Societal View.”

Social and Family Violence

Violence in society is a worldwide health concern. The World Health Organization (WHO) adopted a resolution on May 24, 2014, to strengthen the role of the health care system in addressing violence. You can read the resolution on the WHO website. This resolution calls the increasing rate of violence a worldwide public health problem.

In the United States, violence prevention is one of our national health objectives. This problem is so widespread that in 2002 the Centers for Disease Control and Prevention implemented the National Violent Death Reporting System (NVDRS). NVDRS is a “state-based surveillance system that links data from law enforcement, coroners and medical examiners, vital statistics, and crime laboratories to assist each participating state in designing and implementing tailored prevention and intervention efforts” (Centers for Disease Control, n.d.). You can view the most recent data on the CDC website using their data management software (WISQARS). You can run reports on the types of violence for a specific state. You will also find examples of community-based interventions based on data from this reporting system.

One community health intervention that has been studied to determine its impact on violence is a home visitation program. Read this article from the Journal of the American Medical Association: “Preventing Child Abuse and Neglect with a Program of Nurse Home Visitation: The Limiting Effects of Domestic Violence.” This study followed participants over 15 years. The outcomes were significant under specified circumstances. The study also includes references to the impact of domestic violence. Can you identify the risk factors for participants in this study? Do you think the information is this study is valid?

The next article you should read is “Social Perspectives on Violence” by Thomas Blume (in eReserves). Pay close attention to the implications for prevention and intervention as they will aid you in preparing your health education project. This article examines violence using several social theories. Specifically of interest is the systems theory, as this theory is a cornerstone of community/public health nursing. The central concept of the systems theory is that separate elements are connected. An example of this theory from our studies is the family’s interconnection with the community. It is quite interesting to approach violence from this perspective.

This next report, “Salinas Comprehensive Strategy for Community-wide Violence Reduction, 2013-2018” is an excellent example of a strategy to reduce violence. Compare the goals and objectives of this strategy to the previous reading (“Social Perspectives on Violence”). You should recognize a correlation between these goals and the disparities that increase risk factors in vulnerable populations.

Teenage Sexual Activity and Pregnancy

According to many reports, the number of teenagers who are sexually active and the number of teenage pregnancies are declining. However, in many communities there are still a significant number of these risk factors present. A nationwide initiative to decrease this risk factor has been underway for almost a decade now. The National Campaign to Prevent Teen and Unplanned Pregnancy has an interactive website that provides data at the state level, as well as information on religion and values, behaviors, costs to public health, and impact on community health. You can access the different topics by clicking on the titles in the top right of the web page. Examples of effective education programs, interventions, and evaluations of these programs are also available through interactive video and PowerPoint Presentations. Additional information and statistical data are available on the Healthy People 2030 website, under Adolescent Health Objectives.

“Preventing Adolescent Health-Risk Behaviors by Strengthening Protection During Childhood,” by Hawkins, Catalano, Kosterman, Abbott, and Hill (in eReserves), evaluates the effectiveness of early intervention as a means of decreasing health risk behaviors in adolescents. Make note of the package of interventions used in this study. The participant receives interventions from several areas: school, social settings, and parents. The outcome discussion notes that bonding between those involved at all three levels of the interventions was an unintentional outcome. Overall, the study reports a positive outcome. Think about the simple yet effective measures this study used and how similar measures might be used in the development of your own health education plan. This study demonstrates the effectiveness of using a proactive approach to decrease an identified or potential health risk.

Substance Abuse and Dependence

The citizens of this country have struggled with substance dependence and abuse since the early 1900s. At the time the Harrison Narcotics Act was passed in 1914, about one out of every 400 US citizens had a substance dependence issue. The unregulated use of opium, cocaine, and alcohol contributed to these numbers. The Harrison Narcotics Act required all narcotics dealers to be registered with the Internal Revenue Service.

Our country continues to struggle with alcohol and substance dependence and abuse. President Richard Nixon declared a war on drugs in 1973; President George H. W. Bush declared a war on drugs in 1989; and President Bill Clinton signed the Crime Bill into law in 1994, which calls for life in prison after three drug offenses. President George W. Bush continued the effort by reauthorizing the Drug-Free Communities Act. There are many community, state, and federal initiatives that continue the fight against substance and alcohol abuse and dependence.

Substance and alcohol abuse and dependence is one of the greatest health and social problems of our time. These two issues place an enormous burden on our economy, health care systems, and on the health of our communities. Visit Healthy People 2030 to view the statistical data on substance and alcohol abuse and dependence across the United States. You can also view the national health objectives and interventions by accessing the tabs across the top portion of the web page.

It is important to understand the difference between the terms abuse, dependence, and addiction.

A US federal agency, the Substance Abuse and Mental Health Services Agency, collects national data on this problem. Please read the NSDUH website for the most recent reports. This report outlines the incidence and prevalence of substance and alcohol abuse and dependence as of 2013. It presents substance abuse and dependence trends as well. One cannot consider the issue of substance abuse without including treatment for mental health disorders in the reporting data. Pay close attention to the section of the report describing the disparities.

A second overview of the impact is summarized by the National Institute for Drug Abuse (NIDA). The magnitude and scope of this problem has led many communities to form collaborative partnerships, or coalitions, to help reduce the impact of substance abuse and dependency. Coalitions typically involve many entities from a community and provide multiple-level interventions and services aimed specifically at this target population.

An example of the process, development, and evaluation of community coalitions is Project Freedom. This community coalition in Wichita, Kansas was formed to reduce the use of illegal drugs, tobacco, and alcohol in school-age children. As you read this evaluation, make note of the community partners and what roles they played in the interventions and/or services provided to the community. Please read “Evaluating Community Coalitions for Prevention of Substance Abuse: The Case of Project Freedom” by Fawcett, Lewis, Paine-Andrews, Francisco, Richter, Williams, and Copple (in eReserves).

In order to plan effective interventions, it is important for the community health nurse to understand the significance and impact of substance and alcohol abuse and dependency. First, we must understand the concept of addiction. The most often-used theory to understand this concept is the biopsychosocial theory. The article “Understanding the Disease of Addiction,” by Kathy Bettinardi-Angres and Daniel Angres, will provide you with an overview of the theory. Understanding the behaviors involved in addiction allows us to develop interventions focused on the behavioral changes necessary to overcome it. Think about the interventions in the Project Freedom coalition study and the behaviors in the biopsychosocial theory of addiction. Do the coalition’s interventions align to the behaviors identified in the theory? Were the interventions effectively developed to address the behaviors identified in the theory?

The prevention section of the article “Interventions for Alcohol Use and Alcohol Use Disorders in Youth” lists some examples of interventions. These examples are multi-level and involve multiple entities. Pay attention to the environmental interventions. Were they effective? An interesting outcome, supported by literature, indicates programs that rely primarily on educating about the consequences of drinking are not effective. With this in mind, consider the community you are currently studying. Are there programs that use this intervention? How are they funded? Do they report outcomes? Are they reporting a decreasing substance and alcohol abuse and dependency rate? In some cases, knowing what doesn’t work can be as effective as knowing what has worked in the past.

Environmental Health Risks

The influence of the environment on human health is a complex process requiring an understanding of the interplay of many factors. Social, cultural, political, economic, and physical factors all interact to form the foundation of human existence. It is important to understand the definition of environmental health as it relates to human health. The World Health Organization defines environmental health as follows (2014):

Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behavior not related to environment, as well as behavior related to the social and cultural environment, and genetics.

We must also remember that we are a mobile society, and environmental hazards may vary from location to location. For the most part, each of us exists in several different environmental settings: home, work (occupational), and social or community. Each of these settings has its own hazards.

This article, “Translating Social Ecological Theory into Community Health Promotion,” by D. Stokols (in eReserves) discusses the three major approaches to health promotion: behavioral, environmental, and social. As you read this article, focus on the environmental approaches.

Examples of home hazards include: poisoning, falls, burns, drowning, lead, firearms, air pollutants (tobacco smoke), radon, carbon monoxide, and garbage. Many of the same hazards are present in our workplaces. However, workplace hazards are closely monitored by the Occupational Safety Hazards Administration (OSHA) and state entities. These regulatory bodies provide measures to decrease risks for workers. The most common environmental hazards in the community are chemical/biological, physical, and psycho-social. Some of the largest and most notorious environmental hazards include: the site of the World Trade Center attack of September 11, 2001, Three Mile Island, and the Love Canal. Three Mile Island involved a radioactive material release, and Love Canal involved a toxic waste disposal site.

Most environmental hazards involving toxic chemical exposure initially produce subtle effects on human health, often causing a misdiagnosis and/or delay in treatment. The extent of biological damage to a human from a toxic chemical is calculated using two measurements: the amount of the exposure or dose and the response, or dose response, of the person exposed. Generally speaking, the higher the dose the greater the response.

Biological hazards include infectious diseases when they are environmentally transmitted; for example, when the disease or infectious organism can be spread through a source such as water, food, or an animal vector. Many of these infectious agents have been controlled through a better understanding of sanitation and hygiene. Examples of vector-borne diseases would be those that are carried by flies, mosquitos, ticks, or rodents. Recently, two of these hazards have gained a lot of attention. West Nile Virus and Lyme Disease are both transmitted via vectors (insects). Public health officials have developed awareness campaigns to help individuals alter their behavior to decrease the risk from these two diseases. The last category of environmental hazard is psychological. Psychological hazards are a little harder to describe, and it is much easier to establish a relationship between a disease and a physical agent. Today’s fast-paced society and large-scale natural or manmade disasters can result in environmentally induced stress. Individuals who have the fewest available resources are those who suffer the greatest impact of environmentally induced stress.

Air, water, and soil pollution are some of the more recent environmental hazards in this century. The federal government has funded many initiatives to help reduce these hazards. Many of these issues are addressed in the Healthy People 2020 initiatives and Proposed Healthy People 2030 updates. Read the Healthy People 2030 overview and national health objectives. As you read through this information, ask yourself: Does the community you are studying have these issues? Can you identify any resources to help reduce these risks?

References

Centers for Disease Control. (n.d.). National Violent Death Reporting System. Retrieved October 7, 2014, from http://www.cdc.gov/violenceprevention/nvdrs/statep…

World Health Organization. (2014). Environmental health. Retrieved October 7, 2014, from http://www.who.int/topics/environmental_health/en/