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Community Assessment Analysis and Problem StatementChristina Bookheimer, Michelle Rowe, Sandra Saylor, Jackie Tiefenthal, Joseph UrbanskiFerris State UniversityAbstractThe purpose of the community assessment analysis and problem statement was to identify an area of public health need in the target population of Kent County, Michigan. The target population is 50-74 year old female residents of this area. The need identified was related to a high incidence of breast cancer in this target population when compared to the state. Data supporting this need has been retrieved, assessed, and analyzed to support our diagnosis. The core areas of air quality, mammography units and unemployment are being discussed. An evaluation plan or statement is also munity Assessment Analysis and Problem StatementKent County which includes the city of Grand Rapids Michigan has a high prevalence of breast cancer. In reviewing the data provided to us it was apparent that this is an issue that requires public health attention. “Breast cancer is the second highest cause of cancer deaths among women in Michigan, as well as nationwide” (Michigan Department of Community Health, 2009). Outside data supported this concern in relationship to poor air quality, lack of breast cancer screenings and the unemployment rate for this area. The area of focus was narrowed to females age 50-74 for purposes of this assessment and analysis. DataIn Kent County the cancer incidence trend for breast cancer for the years 2003-2007 was 370.6 age-adjusted to 124.5 (Michigan Department of Community Health, 2010). In comparison the same numbers for Michigan overall were 6,939.4 and 122.1 respectively (MDCH). Taking into consideration age provides this data: 50-74 year olds in Kent County average number of 7.3 with age specific rate being 343 and Michigan overall of 3844.7 with specific rate of 300.5 (MDCH). The U.S Census Bureau shows a total population of Kent County for the years 2005-2009 to be 304,483 estimated for females of which approximately 88,206 fall within our target audience (U.S. Census Bureau, 2009). An alarming rate of 1,320 deaths and 7,340 new cases of breast cancer were reported for the year 2010 in Michigan (Michigan Cancer Consortium, 2010). Kent County had a “57.4-63.4 percentage of female breast cancer cases localized at diagnosis by county” (Michigan Cancer Consortium) for the years 2004-2006. When compared to the United States it was found that the breast cancer rate was actually quite similar. “Death rates for both Michigan and the United states were similar, 23.8 vs. 34.0 per 100,000” (MDCH, 2007). When taking into consideration the probability of having breast cancer the following information was taken into consideration. “A woman’s chance of being diagnosed with breast cancer is: from age 50 through age 59…..2.38 percent, 60-69…..3.45 percent” (National Cancer Institute, 2010) with this being expressed as one in 42 or one in 29 respectively (NCI). Breast Cancer Screening“Breast cancer remains the second leading cause of cancer deaths for women in the United States” (Centers for Disease Control, 2010). One way to reduce this rate is screening which overall has reduced “breast cancer mortality” (CDC). According to the Center for Disease Control the lowest rate for obtaining mammography in the United States was age 50-59 years at 79.9% (CDC). A barrier that exists to breast cancer screenings is the availability of mammography units. A study was done by the Michigan Cancer Consortium which showed that a relatively large amount of females in Michigan live within 30-45 miles of a mammography unit. Kent County is shown to have 23 such units but this is much lower than other counties comparatively (MCC). Air Pollution“Certain changes in DNA can cause normal breast cells to become cancer” (American Cancer Society, 2011). One area of concern is pollution, most notably air pollution. Air quality in Kent County with focus on Grand Rapids is rated at 32.7 in 2010 with the United States overall at 32.0 (City-Data, 2010). Data broken down per chemical is as follows for our target area: carbon dioxide 0.277, sulfur dioxide 0.912, particulate matter 9.44, and nitrogen dioxide 14.3 (City-Data). These numbers are compared to the United States levels of: carbon dioxide 0.334, sulfur dioxide 2.433, particulate matter 9.59 and nitrogen dioxide 11.6 (City-Data). Kent County/Grand Rapids Michigan is considered to be number 45 on the Top 101 Counties with the highest lead air pollution, number 45 with the highest particulate matter, number 76 with the highest nitrogen dioxide air pollution, and number 97 with the highest carbon monoxide air pollution (City-Data). Several articles were found that supported the relationship between breast cancer and air pollution. “Breast cancer incidence was clearly higher in areas with increased levels of nitrogen dioxide” (Andhra Headlines, 2010) is an example. The Breast Cancer Fund identified that Polycylic Aromatic Hydrocarbons (PAH’s) which are associated with particulate matter have been noted for “increased risk for breast cancer” (Breast Cancer Fund, 2010). PAH’s are “byproducts of combustion…residues are often found in the air and in house dust” (Breast Cancer Fund) also. In relationship to Nitrogen Dioxide it has been reported that “for each increase of 5 ppb NO2 estimated in 1996, the adjusted odds ratio was 1.31” (Crouse, Goldberg & Ross, 2010). Further that they “found an increased risk of approximately 25% for every increase of 5 ppb in exposure” (Crouse, Goldberg & Ross) for breast cancer. UnemploymentIt can be argued that losing a job or unemployment can be correlated with decreased health insurance which can be correlated with decreased ability to obtain health care. “Losing a job affects much more than income, health insurance, too, often becomes a casualty” (Jacques, 2009). The Kaiser Commission shows data that “one-third of individuals who stopped working and left a job that previously provided them with employer-sponsored health insurance became uninsured for six consecutive months” (Kaiser Commission, 2010). Further stating that “57 percent of all adults say they have put off some sort of needed medical care over the past 12 months because of cost” (Kaiser Commission). Unemployment rate for Kent County/Grand Rapids Michigan is shown to be at 12.1% as of March 2011 with the Michigan rate being 11% (City-Data). Resources AvailableThere are numerous resources available to the residents of Kent County and the State of Michigan to address our three core concerns related to breast cancer. The Michigan Department of Community Health, The American Cancer Society, Breast Cancer Fund, Centers for Disease Control and Prevention, Michigan Cancer Consortium, and the National Cancer Institute all of which have been utilized for this analysis are examples. Physician Groups, Department of Human Services, Michigan Department of Transportation, Environmental Protection Agency, Michigan Department of Environmental Quality, Michigan Works, and Ride The Rapid bussing would or could be agencies involved with correcting this problem. Health related disciplines as resources would be Medical Social Workers, Nurses, Physicians, Radiologists, mammography technicians and possibly therapy services if individuals are having a physical difficulty getting to appointments. Even though the list of resources is quite large, there still remains an issue of the need being met. This is evident in the fact that the Kent County breast cancer incidence rate is greater than the rate of the state. As this is a population specific problem it would seem that a community nursing or public health nursing intervention would be deemed appropriate. The public health nurse would be the greatest resource in identifying the need, establishing a plan, implementing, and evaluating afterwards. “Community/public health nurses work within complex community networks of resources to coordinate care for clients in a variety of ways” (Maurer & Smith, 2009). Community Problem StatementThe development of a community problem statement is an essential key to providing a plan to reduce the incidence of breast cancer in Kent County. “The basis of community health action must be an accurate assessment of the state of health of the community as a whole” (Muecke, 1984). In following the Muecke model for community health diagnosis the following is our community problem statement:Risk of developing breast cancer among 50-74 year old residents of Kent County, Michigan related to poor air quality, lack of screenings, and highunemployment rate as evidenced by age specific rate of diagnosis of 343,lower than average mammography units available in area, high rates of carbon dioxide 0.277, particulate matter 9.44, nitrogen dioxide 11.6, and air quality indicator of 32.7 as well as high unemployment rate of 12.1%.Evaluation PlanEvaluation is an important step in the over-all process of a community assessment and analysis plan. “Evaluation is the process by which a nurse judges the value of nursing care that has been provided” (Maurer & Smith, 2009, p. 454). Another factor in the evaluation process is what questions are answered. “The ANA considers outcomes, structures, and processes as the primary categories of criteria to be used to measure the quality of nursing care” (Maurer & Smith, p. 456). Our evaluation statements are focused on outcome standards:50-74 year old female residents of Kent County, Michigan will havea 50% increase in access to mammography units.Rate of diagnosis of breast cancer in Kent County, Michigan willfall below the state level of 300.5.Target group will have an increased knowledge of air pollution as related to developing breast cancer with a reduction in air pollutionas a contributing factor.ConclusionIn conclusion this community assessment analysis and problem statement has been developed related to breast cancer incidence in the target community of Kent County, Michigan. The group chosen is 50-74 year old female residents of this community. It has been established that the risk of developing breast cancer for this group is above the state average. The core problems identified are related to air pollution/quality, access and knowledge of screenings available, and unemployment rate that could impact insurance coverage and cost of this diagnosis. The data identified supports these core issues. An evaluation plan or statement has been addressed. ReferencesAmerican Cancer Society (2011). Learn about breast cancer. Retrieved from Headlines. (2010). Traffic pollution can double breast cancer risk. Retrieved from on June 16, 2011.Breast Cancer Fund. Chemicals in air and water. Retrieved from Cancer Fund. (2010). Polycyclic aromatic hydrocarbons (PAHs). Retrieved from for Disease Control and Prevention. (2010). Vital signs: breast cancer screeningamong women aged 50-74 years, United States, 2008. Retrieved from on June 14, 2011.City-Data. (2010). Kent County, Michigan. Retrieved from on June 16, 2011.Crouse, D.L., Goldberg, M.S., Ross, N.A., (2010). Postmenopausal breast cancer is associated with exposure to traffic-related air pollution in Montreal, Canada: a case study. Environmental Health Perspectives. Jacques, I. (2009, April 26). Loss of health insurance can be one of unemployment's side effects. Retrieved from Commission. (2010). Assessing the risk of becoming uninsured after leaving a job: a look at the data. Retrieved from , F. A., & Smith, C.M. (2009). Community/Public health nursing practice: Health for families and populations. St. Louis, MO: Saunders Elsevier.Michigan Cancer Consortium. (2010). The cancer burden in Michigan: selected statistics_1992-2010. Retrieved from WhatWeDo/TheCancerBurdenMichiganSelectedStatistics.cfm on June 15, 2011.Michigan Department of Community Health. (2010). Cancer tables: Kent County female 1985-2007. Retrieved from on June 15, 2011.Michigan Department of Community Health. (2009). Michigan critical health indicators: 2007. Retrieved from , M. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), 23-35.National Cancer Institute. (2010). Probability of breast cancer in American women. Retrieved from on June 16, 2011.U.S. Census Bureau. (2009). Kent County, Michigan. Retrieved from on June 14, 2011. Grading Rubric for Group Community Health ProblemGrading AreaWeightEarnedAnalysis of local issue:Benchmark comparison, contributing factors, special groups, existing resources, identified problem appropriate for community nursing intervention, community interest.40%Community problem statement:Format correct, is supported by data, measures are appropriate,20%Evaluation plan:Selection of outcome measure appropriate, accurate in measuring desired change. (need to build plan for evaluation while you plan--no need to evaluate what hasn't happened yet) Remember the AEB--which of those measures are you trying to change.? Or are there intermediate measures you'd track along the way? 20%Paper quality:Clarity, consistency, flow, APA format, quality and accuracy of references and citation of references,20%Submission of group work evaluation formsP/FTotal100% ................
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