Air Pollution Education Plan For the Nursing Student
Community Education Project
In planning for the health of a population, consideration to the age, sex, culture, living and working conditions is crucial because they affect the health of the people in important ways. Determining and studying the patterns, causes, and effects of health and disease conditions in distinct populations is the cornerstone of public health. This data helps to develop policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine (Kulbok, Thatcher, Park, & Meszaros, 2012). Davis county is a county Utah that is in close proximity to the state capital of Salt Lake City. It is Utah's smallest county by land size, with a total of 298 square miles of land and 329 square miles of water (http://www.co.davis.ut.us). Heavily populated, with 248,000 residents living in the County's fifteen communities, it is the third largest county in Utah in terms of population. The area is the fastest growing of the four major urban communities in Utah (County emergency plan, 2009). Davis County is projected to increase in size with a population of close to 390,000 by the year 2030 (http://www.co.davis.ut.us). The population growth has increased the diversification of the population with a wide mix of people representing many ethnic, cultural, and religious backgrounds .
General Health of the Population
According to the CDC Behavioral Risk Factor Surveillance system Survey Questionnaires, the general health status score of Davis County residents is 3.7 (Utah Department of Health, 2012). This score is better than average with a score of 1 being poor and 5 excellent. Other risk factors assessed showed excellent scores on exercise, tobacco use and dental visits while weight and alcohol use had adverse scores. 82.6% of Davis County residents exercised in the past month (Utah Department of Health, 2013). This is higher than average and is important because in addition to decreasing the chance for obesity, being physically active has shown to have a protective factor against cardiovascular disease. Physical activity has also been shown to reduce the risk of many disease processes such as type 2 diabetes, stroke, some cancers and heart disease and has a positive impact on mental health; improving effective disorders such as depression and anxiety (Kraschnewski et al., 2013). Studies have shown regular physical activity can help to relieve osteoarthritis pain and increase the quality of life and help the elderly live independently longer (Utah Department of Health, 2012).
Access to Healthcare
In Davis County, close to 60% of residents have been seen for a routine medical visit in the last year (Utah Department of Health, 2013). Health preventive services are important for maintaining good health for a variety of reasons. Early detection and treatment of disease improves the odds of recovery and health behaviors can be influenced through physician counseling (Ezzati, Henley, Thun, & Lopez, 2005). Another area Davis County showed a higher than average rate is residents who visit the dentist regularly, which is at 76.1% (Utah Department of Health, 2013). Regular dentist visits help to avoid high risk dental infections. Dental Caries are painful and can also potentially lead to dangerous health conditions including septicemia (Komisar, 2013).
Health care access has an important role in the overall healthiness of the community. Individuals who cannot obtain needed health care tend to have higher rates of death and disability from chronic disease. Cost is the most commonly reported barrier to getting needed health care (Komisar, 2013). In Davis County 12% of residents report cost as a barrier which is among the lowest in the state (Utah Department of Health, 2013). Rising costs for health care services and health insurance premiums is a growing burden for families. Davis County has the lowest rate of uninsured residents at 6.8% (Utah Department of Health, 2013). People without health insurance are less likely to have regular primary and preventive care. Cost is not the only barrier to timely and effective health care, physician supply has been associated with increased health care access and improved outcomes (Komisar, 2013). Physician availability is vital for access to care. Physicians per 100,000 population is a good indicator of the availability of providers. Davis County has a lower than state and nation average at less than 500 per 100,000 (Utah Department of Health, 2013) .
Modifiable Health Risks
The percent of Davis County residents that have smoked 100+ cigarettes in their lives is 22.4% (Utah Department of Health, 2013). Although this is less than average, tobacco use is one of the top preventable cause of illness, disability and death worldwide. The use of tobacco is known to cause cancer, heart disease, lung diseases, premature birth, low birth weight and infant death (Ezzati et al., 2005). The tobacco users are not the only population affected; secondhand smoke can cause heart disease and lung cancer in non-smokers. In addition, secondhand smoke also causes a number of health problems in children and infants including severe asthma attacks, respiratory infections, ear infections and sudden death (US Department of Health and Human Services, Office of the Surgeon General, 2004). Tobacco use remains the leading preventable cause of death and disease in the United States. In Utah, smoking claims more than 1,150 lives each year (Utah Department of Health, 2012).
The average weight of females in Davis County is about average at 157 pounds but males weight in above average at 197 pounds with the overall percent of obese adults at 24.9% (Utah Department of Health, 2013). Over the last decade, the percentage of adults who were overweight or obese increased steadily in Utah and the United States. The percentage of overweight or obese persons in Utah increased from 39.3% in 1989 to 60.3% in 2011(Utah Department of Health, 2012). The obesity epidemic within the community is threatening to reverse the progress made in reducing death from chronic disease. Genetic factors may increase the risk for being overweight for some people, but anyone whose calorie intake exceeds the number of calories they burn is at risk for obesity (Kraschnewski et al., 2013). A healthy diet is important for maintaining a healthy weight and reducing risk factor related to obesity.
Another risk factor found an higher than average rate of adult residents drank alcohol in the past 30 days at 62.2% (Utah Department of Health, 2013). There are approximately 80,000 deaths resulting from excessive alcohol use each year in the United States, making it the 3rd leading lifestyle cause of death in the United States (Patton, 2012). Alcohol abuse is associated with injuries and violence, chronic liver disease, fetal alcohol syndrome, and risk of other acute and chronic health conditions. In 2006, the economic costs of excessive alcohol consumption in were estimated at $223.5 billion (Bouchery, Harwood, Sacks, Simon, & Brewer, 2011).
The population of Utah, on a percentage basis, are on average younger than the rest of the United States. According to the Census Bureau's 2010 American Community Survey, Utah had the youngest state population in the U.S. with a median age of 29.2 years versus 37.2 years nationally . In Davis County, the population is spread out with 34.1% under the age of 18, 9.69% from 18 to 24, 28.13% from 25 to 44, 19.92% from 45 to 64, and 8.15% who were 65 years of age or older (Utah Department of Health, 2013). Due to the large percentage of the population consisting of young children, it is important that key preventive health measures and screenings are made available to identify developmental delays at a time when treatment is most effective (Patton, 2012).
Race and ethnicity play an important factor in determining public health plans because both race and ethnicity can help predictor risk for disease (Kulbok et al., 2012). The racial composition of Davis County is 85.6% White, 8.6% Hispanic or Latino, 1.3% Black or African American, 0.7% Native American, 1.9% Asian, 0.7% Pacific Islander, and 2.2% from two or more races (United States Census Bureau, 2010). Hispanics showed the highest rate of poor health while all racial minorities had higher rates of adult diabetes than the white population (Utah Department of Health, 2013)
Davis County enjoys a prosperous economy with the median household income at $67,147 (United States Census Bureau, 2010). This is in part due to Davis County's largest employer, Hill Air Force Base. As a dominant feature of the economy of Davis County, the base accounts for about 12% of the economy of Davis County and about 2.6% of the economy of Utah. Hill AFB provides employment for roughly 23,000 military and civilian personnel with civilians earnings at almost double the state average (http://www.co.davis.ut.us). The percentage of people with income below the poverty level is 5.1% with 2% at with income below 50% of the poverty level (Utah Department of Health, 2013). The unemployment rate in Davis County is at 3.4% (United States Census Bureau, 2010). These are all significantly lower than both the state and national levels.
Davis County residents have a high level of education compared with state and national averages (Utah Department of Health, 2013). Education level is strongly correlated with health status . The most likely reasons for this is that higher levels of education most often results in higher income, self-determination and understanding of health and illness factors (Patton, 2012). All of which are factors that can produce better health. In Davis County adults over 24, 92% adults have education levels of high school or higher and 28.8% have bachelor's degrees or higher. There are 14,267 adults in the county that are currently in college (Utah Department of Health, 2013). Assessing the education level of residents in the county using the personal performance of the population also shows elevated education levels. Performance factors of income, health, unemployment rates and poverty rates all imply a high level of education within the county.
The value system of the community is one based around family and religion. Davis County has a high prevalence of religious congregation affiliation at 78.2% of the population compared to 50.2% average of the United States as a whole. 92.1% of those affiliated with a religion are Latter Day Saints. The percentage households that are families is 81.2% , 68.8% are married and 12.4% are single-parent households. Home ownership is high at 78.6% and over 90% of the households have been living in the same house for 1 year or more (United States Census Bureau, 2010). Thus, being a highly religious family oriented community, the people in the community look out for each other's welfare. This can have an important influence on community health nursing. If only a small portion of the community are aware the programs and services available the knowledge grows rapidly since the people of the community are actively trying to help those in need.
Environmental Impacts to Populations Healthcare
Air pollution contributes to a number of health problems for many people in Utah. Air pollution can affect a person's health in a variety of ways depending on the pollutants, the time and concentration of the exposure and other health problems the individual has. Poor air quality has been shown to exacerbate asthma and heart disease, increase the risk of developing respiratory infections and impact fetal development (American Lung Association, 2013). One area of air pollution problem in Utah is particulate matter (PM), also known as particle pollution, is a complex mixture of very small dust, soot particles and a number of other components. Increased PM levels effects everyone, but it is especially dangerous in children , older adults, people with lung diseases such as asthma, and people who are physically active outdoors. Utah has a couple causes for increase PM levels. One is wind blowing through the desert sands and the other is due to winter time inversions. Inversions occur during winter months when the cool air that is normally above the warmer air close to the ground are inverted. These inversions trap a dense layer of cold air under a layer of warm air and act like a lid, trapping pollutants along with the cold air near the valley floor (County emergency plan, 2009). The longer the inversion lasts, the stronger the pollutants concentrate within it. The federal standard PM level for good air is less than 15.5 and at 35 it is considered hazardous. The average pm levels during an inversion is 37.4 they have been shown to get over 90 when inversion lasts more than 4 days (Utah Department of Health, 2013). Not only is it dangerous during these increased levels of PM but health impacts on the human body remain for a month after such pollution spikes (American Lung Association, 2013). This places a considerable health risk on the population of Davis County. This community hazard could be contributing to rate of adverse birth outcomes in newborns which has increased in Utah over the last 10 years. Approximately 7.0% of births will be low birth weight and 9.8% will be pre-term (Utah Department of Health, 2013).
There are many air quality resources Utah has that can help contribute to health and the prevention of illness, injury, disability, and premature death. The air quality warning system, informs the public when air quality is poor, what activities to avoid and whether wood can be burned. Residents can sign up for email alerts, text alerts and the local weather stations transmit the information (http://www.co.davis.ut.us). The major drawback to the system is that the public does not have the education as to why they should care if it is a hazardous air day. It is common to see residents jogging and children playing at the park on 'red' air days. The community has the resources but is not prepared to use them due to lack of education.
Nursing Community Education Plan Based on Findings
There are significant health risks related to poor air quality, especially particulate matter, in the community manifested by low birth weight, increase physician visits, and increasing chronic health problems (Utah Department of Health, 2013). As a community project, a target group will be educated on the dangers of air pollution. Implementation of the program includes education on the problems associated with air pollution, how to limit exposure and ways people can help reduce pollution. The members of the group will have an individual project where they find people within the community they can educate about the topic such as schools, nursing homes, church or family. The education level of the target audience will be assessed through a questionnaire at the start of the program and modifications can be made to the program as necessary.
The approach to the intervention will be to use a variety of teaching strategies to educate the class. Studies have found that retention of information three days after the occurrence is six times greater when the information is presented both visually and orally than when the information is given orally only (Verdi, Crooks, & White, 2003). The program will include visual aids, including charts, tables, handouts, power point presentation and active learning activities, including open discussions and encouraging new ideas and education opportunities. It has been shown that students who participate in active learning were more competent than their counterparts in the traditional lecture only program (Verdi et al., 2003). Due to adult class structure and the high level of education in the area, the teaching aids will be a mix of basic knowledge and advanced learning in order to achieve the best education results.
The objectives of the program are to increase public awareness of the dangers of PM exposure, help people find ways to limit their exposure and give people the resources they need to contribute to cleaner air. A target audience will be found that can continue to educate others on air pollution. Due to the large portion of the communities population that is affiliated with the LDS Church, the program will start be best if started with one of their community groups. The Church also reaches out to everyone in the community, regardless of religion, for community activities, health fairs and youth sports. The planned target audience is the Women's Relief Society. They are a philanthropic and educational women's organization within the LDS Church. Members of the Relief Society hold local meetings on topics of interest, perform home teaching visits and welfare and compassionate service (https://www.lds.org). They have the capability and desire to educate a wide population based on their service.
The plan is laid out into classes held once per week. The first week is the introduction overview of the entire program along with a short questionnaire to assess prior knowledge of the topic. There will also be a short discussion with handouts on the different types of air pollution, how the State and County rank and the general causes of the pollution in the area. Week two consists of a power point presentation on the statistics of short and long term effects of air pollution on different populations within the community and what the state and county is doing to inform the public and reduce pollution. The third class will be a discussion and review of the different types of air pollution with an in depth analysis of particle pollution with ways to limit exposure and ways to help reduce PM in the community. In the forth class, there will be a short review of prior week's information and the class will help develop pamphlet to give to residents who burn wood in their homes. It will give information for them to understand why they need to comply with county ‘no burn’ days and other ways to limit pollution while being able to still burning wood. The fifth week will be an overview of the prior classes with a question and answer period to address any questions. At this class the final questionnaire will be given to assess the knowledge improvement made by the class. The will also help to identify if any other education is needed before the individual projects. The rest of the time will be spent brainstorming ideas on how each class member can get the message out and the best ways to educate their audience. The last class will be a self evaluation of the individual projects. Discuss any barriers anyone came across and get ideas on ways to overcome them in the future.
The implementation results will be evaluated to two ways. The first is through the before and after questionnaire. It will show if air pollution knowledge has increased within the initial group after the education was given. The overall objective is to create a group of people in the community with knowledge about the local air quality issues and with the ability and drive to continue to educate others on ways to limit exposure and reduce air pollution. The meeting in week six, where the class explains what they did in their individual projects, will demonstrate if the outcome was achieved.
American Lung Association. (2013). State of the Air. Retrieved from http://www.stateoftheair.org/2013/assets/ala-sota-2013.pdf
Bouchery, E. E., Harwood, H. J., Sacks, J. J., Simon, C. J., & Brewer, R. D. (2011). Economic costs of excessive alcohol consumption in the United States. American Journal of Preventive Medicine, 41, 516-524.
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