Community-Based Respiratory and Nutritional Health ...

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Community-Based Respiratory and Nutritional Health Education Duwamish Valley Youth Corps Carmen Martinez Maria Gorodyuk Julie Trang

Ellie Marsh MN, RN Clinical Instructor Fall Quarter 2017 NCLIN 409

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Abstract: This fall quarter University of Washington nursing students Maria Gorodyuk and Julie

Trang were partnered with South Park community leader and Duwamish Valley Youth Corps (DVYC) program coordinator Carmen Martinez to work in collaboration with adolescent youths participating in the DVYC. We spent time developing lesson plans about respiratory health and nutrition and providing education to the DVYC youths. We supported community projects including Duwamish Alive! and the DVYC Youth Forum. We worked together using the Community-Based Participatory Research (CBPR) approach that integrates a collaborative, equitable relationship amongst researchers and community partners to create and implement interventions within the South Park community.

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Introduction:

This fall quarter we worked with the Duwamish Valley Youth Corps (DVYC) to serve

and learn from the individuals of the South Park community. We collaborated with Carmen

Martinez to assess and determine what the DVYC would like us to focus on. We created a

respiratory health presentation that would address the concerns of the community including high

asthma rates in South Park and marijuana use among youths. For our next project we discussed

nutrition. Given that South Park is a food desert, we talked about healthy food options and the

impact it has on the future of each individual (USDA, 2015; Smith, 2011). We raised questions

like "How could we improve access to healthy and affordable foods to South Park?" that can be

passed onto the next group of nursing students. We also contributed to help DVYC with

addressing social determinants of health by planting trees, educating the community through the

DVYC Youth Forum, helping at meetings, and sharing our nursing expertise.

Assessment:

Geography and Demographics

South Park is a small neighborhood located in the southwest end of Seattle, Washington. Annexed into Seattle in 1907, South Park is surrounded by numerous commercial and industrial businesses, highways, and is proximate to the Lower Duwamish Waterway Superfund site (Lange, 2001; WA Department of Ecology, 2017; EPA, 2017). It also has a rich history of community activism and a strong presence of locally owned businesses. South Park is home to approximately 3,991 people and of these people, 42.3% identify as being Hispanic or Latino, 30.6% identified as White, 9.9% as Asian, 4.4% as Black, 5% as Mixed, and 5.6% as Other (U.S. Census Bureau, 2015). In terms of citizenship and national origin, 61.5% are American born citizens while 21.6% are not (U.S. Census Bureau, 2015). Non-English languages spoken at South Park include Spanish (35.5%), the Pacific Island language (5.7%), Vietnamese (4.3%),

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Cambodian (2.7%), and Chinese (2.5%) (U.S. Census Bureau, 2015). South Park is also disproportionately poorer than the greater Seattle metropolitan area; the median household income in South Park is $43.9k in comparison to Seattle's median income of $67.7k (U.S. Census Bureau, 2015). In terms of education, 28.5% of South Park's population has completed less than a high school graduate education compared to 8.5% of Seattle's total population (U.S. Census Bureau, 2015).

Community Assets and Challenges A windshield survey was conducted in South Park to assess for community assets and challenges. Guided by the CBPR principle that recognizes community members as equitable partners, interviews of South Park residents were also conducted (Israel et al., 2005). Community assets include the strong sense of community; respect for the Duwamish River and environment as evidenced by the establishment of the Duwamish River Cleanup Coalition/Technical Advisory Group (DRCC/TAG) and annual Duwamish Alive!; public recreational areas such as Cesar Chavez Park, South Park Community Center, and Duwamish Waterway Park; Marra Farm, private residential gardens, and Providence Regina House; painted murals and public art sculptures; cultural diversity; and community-based programs such as the DVYC. Challenges include South Park residents have a lower life expectancy of 8 years compared to King County (73.3 years vs. 81.5 years) (Cummings & Gould, 2013); South Park residents have a higher rate of hospitalization for asthma compared to King County (240.4 vs. 143.4 people under age 18 years old per 100,000 people) (Cummings & Gould, 2013); South Park residents have a higher rate of mortality related to lung cancer compared to King County (52.3 vs. 41.4 people per 100,000 people); "South Park has one of the highest obesity rates in Washington" (Lopez, interview, 2017); and South Park qualifies as a food desert and poor

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nutrition related to limited access to healthy foods increases the risk of cardiovascular disease,

stroke, cancer, and diabetes (Smith, 2011; Schroeder & Smaldone, 2015). Also, industrial and

commercial pollution is a significant problem in South Park (Cummings & Gould, 2013).

Duwamish Valley Youth Corps

DVYC is a community-based program that supports adolescents from the Duwamish

Valley neighborhoods of South Park and Georgetown by engaging them in environmental and

health improvement projects, helping them gain job and leadership skills, and providing them

opportunities for civic engagement. Carmen Martinez is the Program Coordinator of DVYC and

describes the youth as "ages 13-19 years old and ~80% speak Spanish fluently" (Martinez,

interview, 2017). This program was established in 2014 by the DRCC/TAG and DVYC

members have made significant contributions to their community (DRCC/TAG, 2017).

Planning:

Respiratory Health Lesson

The goals of the Respiratory Health Lesson included educating the youth about the prevalence of asthma in South Park, the pathophysiology of asthma, and the health impact of living in a polluted environment (see appendix for complete learning objectives). We wanted to present the statistics that were stacking against the community to bring awareness of the social determinant of their ecological location. Our planning process consisted of a few weeks of corresponding with Carmen Martinez and researching. During the planning process, we used community-based participatory research (CBPR) and the core Public Health Nurse competencies which aim to increase knowledge of the community and then integrate it into interventions within the community. The CBPR principle we used "focuses on the local relevance of public health problems and ecologic perspectives that recognize and attend to the multiple determinants of health" (Israel, 2005, p. 1464). For example, we collaborated with Carmen Martinez to

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identify asthma and weed smoking as an important health concern related to South Park's ecological determinant of health because "South Park residents have up to a 13-year shorter life expectancy [at birth] than wealthier parts of Seattle" and higher rates of asthma compared to King County (Cummings, 2013, p. 2).

Nutrition Lesson Planning the Nutrition Lesson involved assessing the challenges and assets of South Park. Due to South Park's limited access to affordable and nutritious foods, our learning goals aimed at helping the youth gain knowledge about nutrition, make healthier shifts in eating, and strengthening their community assets (see appendix for complete list of goals and objectives). We presented a discussion about the sugar content in soft beverages and its impact on health in the long term. The healthy food plate activity allowed participants to explore healthy eating within their cultural context. Youth could think about the ingredients in their cultural foods and ways to modify it to adopt a healthier eating pattern (e.g. using brown rice or quinoa for burrito, using romaine lettuce leaves in place of tortillas for fajitas, adjusting the portion size of chorizo). The US Department of Health and Human Services (HHS) and of Agriculture (USDA)'s healthy food plate recommendation was provided in Spanish. Using the CBPR principle that "builds on strengths and resources within the community" (Israel, 2005, p.1464), which means that as partners of South Park, we wanted to conclude with assets in the community that can be used to support healthy eating. Implementation:

Respiratory Health Lesson The CBPR principle used to implement this lesson was "promoting collaborative and equitable partnerships in all research phases and involves an empowering and power-sharing

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process" (Israel, 2005, p. 1464). We collaborated with Carmen Martinez to make an authentic, equitable presentation that included ideas from the DVYC and the UW nursing students. The lesson began with a conversation with the DVYC about the negative impact of weed on school performance and health. A picture that compared a healthy lung and a smoker's lung was shared and the youth identified the differences between the lungs. We engaged in the CBPR principle of facilitating "co-learning and capacity building among all partners," (Israel, 2005, p. 1464) when we learned from Carmen Martinez that South Park's asthma rates are highest in Seattle area. We validated her knowledge by providing current statistical data about hospitalization rates for asthma and average lifespan in South Park in comparison to King County. The youth underscored that respiratory health is a significant concern in their community when almost every hand was raised in response to a live-poll that asked "who here has asthma or knows someone with asthma?" We shared information about the pathophysiology of asthma, engaged the youth in the bent straw activity so they can develop empathy for individuals with asthma, engaged the youth in identifying different asthma triggers, and had the youth share how they can support a friend with asthma. We created a safe and inclusive atmosphere, allowing current DVYC members to share their personal health stories related to respiratory health. For example, a DVYC youth shared that his dad has asthma and manages it by recognizing the symptoms of asthma and knowing his asthma triggers. We discussed the positive impact that DVYC has made to promote the health of their community. We concluded the presentation with a fun activity that measured the youths' lung capacities using incentive spirometers. We encouraged the youth to keep exercising as it increasing lung volume and benefit their health. We brought in an electronic mannequin for the youth to listen to healthy and unhealthy lung sounds.

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Nutrition Lesson The Nutrition Lesson took about two weeks to plan and create. We created a drink board which consisted of a poster board with empty beverage containers and the correlating sugar amount hanging below (see appendix). This visual tool showed how much sugar was in each drink and was compared to the daily amount of added sugar recommended by HHS & USDA. We used white paper plates and markers for the next activity where each member created their own healthy plate. The youth had the opportunity to think about the meaning of eating healthy and compared their ideas with the recommended dietary guidelines provided by the HHS & USDA. We emphasized that HHS & USDA's recommended plate model was not a prescription but a guide that can be adjusted based on one's personal, cultural, and traditional preference. The nutrition presentation was discussion-based and discussion topics covered chronic disease in association with bad eating choices, the prevalence of the diseases, why healthy eating is important, and how South Park can support healthy eating (e.g. smart snacking in school, Georgetown's Urban Farm and Forest, Mara Farms, food bank, etc.). The CBPR principle used was focusing on the local relevance of public health problems, which is South Park's high obesity rates. The ecological perspective in this lesson that related to the social determinants of health was the lack of resources to healthy foods. We discussed what the community can do like voice and advocate for a grocery store at South Park that sells affordable and nutritious foods. Evaluation: The Respiratory Health Lesson was successful because we achieved all our learning objectives based on the survey responses and received positive feedback from Carmen Martinez. There were ~23-35 attendees at the event. The cost of the project was ~$25. The healthy snacks, healthy vs. unhealthy lung image, asthma trigger images, and surveys were the items distributed.

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