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Community Health Assessment

Community Health Assessment Crystal Emery, Cassandra Hall, Cheryl Mroz, Melissa Singh UWM- Parkside College of Nursing Nursing Science V: Care of Aggregates November 3, 2009

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Our preliminary search for a specific zip code did not yield search data. We decided to enlarge the area for our windshield assessment to include zip codes 53140, 53142, 53143, and 53144. We surveyed an area from Lake Michigan, west to Interstate 94, and from County Highway KR south to Highway 50. Our drive through this portion of Kenosha County yielded the following observations. Windshield Assessment On October 12, 2009 we met in the morning at Parkside to perform our windshield assessment. The framework we used in conducting our windshield survey were questions provided to us from Nies and McEwen, Box 5-2 (2007, p.79). The weather was cool so we did not see many people; most were probably at home or work because of the time of day. We did see an older Caucasian woman walking a dog and two Caucasian elderly men smoking cigarettes in front of Mar’s Cheese Castle on Highway S. The people we did observe were appropriately dressed for the weather, and appeared well nourished. We did not see any loitering adults or witness any suspicious behavior. We did not observe any children on the school playgrounds because it was Columbus Day and the schools were closed. We also did not see any handicapped individuals, pregnant women, mothers with children, tourists, homeless people or those who appeared under the influence of alcohol or drug use. When we initiated the assessment we observed multi-family homes, campus dorms, apartment buildings and primarily catholic churches. Homes varied in age from early 1900’s through 2009. The sizes and structures varied and appeared to be a mix of economic classes. We did not observe any public housing or signs for neighborhood crime watch. Single family homes

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and farms increased in value as we drove further west. Most of the houses were well kept, but a few were in need for repair. We noticed some areas of dilapidated structures and boarded up buildings, as well as bars, schools, parks, and businesses, which eventually spread out until we reached an industrial area and farms. We noticed automobiles were the primary mode of transportation followed by service vans, and semi trucks for delivery of goods which emitted noxious gas. Public transit appeared adequate, although we did not observe benches or sufficient shelter at the bus stops. St. Catherine’s and Aurora Medical Center on Highway 50, Kenosha Medical on 62nd street, and the Kenosha Health Department on Sheridan Road are all accessible by bus. There are a variety of businesses in Kenosha including large corporations such as Jockey, Chrysler, Snap- On Tools, Ocean Spray, and retail stores such as Wal-Mart, Sam’s Club, Kmart, Shopko, Kohl’s, and Target which were all handicap accessible. Others are small family owned businesses such as Tenuta’s. None of these establishments posted signs indicating need for employment. For those seeking employment, the Kenosha County Job Center, located on Sheridan Road and the Marine Recruiting Center on 52nd street are available. In the rural areas, we saw corn stalks, cabbages, and pumpkins, but could not determine if there were family farms or agricultural business due to deficient signage. During our drive, we noticed a large billboard, on Washington Road, sponsored by the Kenosha Visiting Nurses Association that advertised flu shots. Other than this, there was little evidence of prevention/wellness access to care or use of alternative medicine in the community. We did not notice any signs advertising radio or television stations, or political interests.

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Educational opportunities are abundant including: Gateway Technical College, Herzing University, UW- Parkside, Bullen Middle School, and Bradford High School. There are many parochial and grade schools, child care centers such as the one located at Parkside, and the Kenosha Montessori School. The healthcare resources we observed included Dental Associates, Kenosha Community Health Center, several dental offices, pharmacies and nursing homes. We did not observe any other specific services, and therefore cannot determine if resources are appropriate or sufficient to address community problems. We did not see any standing water, oil spills, or anything that would make us suspect ground and water pollutants. Some of the roads are in poor conditions with many potholes and had been under construction for long periods of time. All of the traffic lights were in working order and appeared sufficient for the traffic volume. The east side which is more urban, had a greater number of sidewalks, whereas, communities to the west lacked sidewalks. Railroad crossings displayed adequate warning signs and barriers. Where there were potential hazards such as sharp curves rumble strips were installed. There are several county and city parks playgrounds and recreational opportunities such as the YMCA and the KYF. We observed several bars, fast food restaurants, and buffets. Due to the time of year, we did not observe anyone eating outside nor did we observe any insects or rodents.

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Demographic Characteristics Social Characteristics According to the American Fact Finder (2005-2007) the total population of Kenosha County was 161,254 with 49.7% male and 50.3% female. This compares with WI (2006-2008) data of 49.7% male and 50.3% female and U.S. data of 49.2% male and 50.8% female. The median age of Kenosha County residents was 36.3 years, compared with WI 37.9 years and U.S. 36.4 years. Age distribution in Kenosha County was 6.9% under age 5, 73.7% 18 and older, and 11.2% 65 and older, WI 6.3% under age 5, 76.5% 18 and older, 13.2% 65 and older, and U.S. 6.9% under age 5, 75.3% 18 and older, and 12.5% 65 and older. The Kenosha population consists of 85.9% Caucasian, 9% Hispanic, 5.7% African American (AA), 0.4% American Indian/ Alaskan Native (AI/AN), and 1.3% Asian. The WI population consists of 87.6% Caucasian, 5.9% AA, AI/AN 0.9%, 2% Asian, and 4.9% Hispanic. The U.S. population consists of 74.1% Caucasian, 14.7% Hispanic, 12.4% AA, 0.8% AI/AN, and 4.3% Asian. According to the CDC (2007) and American Fact Finder (2006-2008) county, state, and national data, named English and Spanish as the top two spoken languages Economic Characteristics American Fact Finder (2005-2007) statistics indicate 67.5% of Kenosha resident over the age of 16 were in the workforce compared to WI 69.3%, and the US 64.7%. The median family income was 66,940 compared to 60,374 in the US. The data was not available for WI. Kenosha families below the poverty level are 7.6%, compared to WI 7% and the US 9.8%. Individuals below the poverty level in Kenosha county 11.8%, compared to WI 10.7%, and the US of 13.3%.

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The unemployment rates according to American Fact Finder (2006-2008) are follows in 4.5% Kenosha, 3.8% WI, and 4.1% in the US. Health Statistics The WI Department of Health Services (2005-2008) reported that the average life expectancy for males is 77 years and 81.8 years for females, compared with the U.S. average of 74.75 years for males and 81 years for females. The 2008 Wisconsin death rate was 8.2 per 1000 population with the 3 leading causes of death (heart disease, cancer, and strokes) accounted for 54% of all deaths. Accidents were the leading causes of death for females from 1-24 and for males 1-44 years old. Kenosha County Community Health Survey Report (2003) provides behavioral and lifestyle data with prevalence and risk factors as well as disease conditions. Only 12% of residents rated their health fair or poor. Health care coverage was not provided for 8% of people and up to 19% of other household members. Routine check-ups were sought by 82% of the population within the last two years. Several sought alternative treatments ranging from acupuncture to massage therapy and Chiropractic services. Risk conditions in the past 3 years include high blood pressure, high blood cholesterol, heart disease, asthma, and diabetes. Many (49%) of residents do not get sufficient exercise, 58% are overweight, and only 28% eat 3 or more servings of vegetables each day. According to the UW Population Health Institute County Health Snapshot (2008) the obesity rate in Kenosha county was 29.9%, WI was 25.4% compared with the national average of 34.3% according to the CDC (2006). According to the CDC (2006-2008) those in the midwest non-Hispanic black 36.3% are obese compared with 25.4

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white, 29.6% Hispanics. According to the CDC (2005) the top three cancers in WI were lung and bronchus 48.7%, prostate 26.9%, and breast (female) 22.7%, as compared with the U.S. cancer statistics of lung and bronchus 52.8%, prostate 24.7%, and breast 24.0%. Wisconsin’s alcohol consumption of 5+ drinks at one time is higher, 26%, than the national average, 15%, but Kenosha’s average is lower, 14%. Seat belts are utilized by 82% of adults and 98% of children.

Social Problems According Idcide.com (2009), crime rates for Kenosha were lower than the state of Wisconsin in every area of property crimes and violent crimes, except in the case of rapes. There has been a slow decline in the case of forcible rape as the 2006 total was fifty-two, while the 2008 total was 40, and the 2008 national average was 33.1. Also, according to the Wisconsin Department of Corrections (2009), the number of registered sex offenders within the following zip codes include: 53140 has 124 registrants under 320 names; 53142 has 34 registrants under 75 names; 53143 has 71 registrants under 148 names; 53144 has 46 registrants under 98 names. These statistics include sexual offenses against both women and children. Environmental Characteristics According to Scorecard, the Pollution Information Site, Kenosha is in a nonattainment area and fails to meet national ambient air quality standards for ozone. According to the American Lung Association (2007) lung cancer deaths rose 4% from 1999 to 2004 with 83-87% of lung cancer deaths attributed to cigarette smoking (American Cancer Society, 2002). Radon exposure is estimated to be the second leading cause of lung cancer. According to the Wisconsin

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Department of Health Services (2009) Kenosha county is higher than the EPA recommended radon levels (see appendix). Housing The city of Kenosha was created in 1835 and is considered the fourth largest community in Wisconsin. Kenosha County itself covers 272.83 square miles, with an average of 547.9 persons per square mile, while the state of Wisconsin has an average of 98.8 persons per square miles. According to the Wisconsin Historical Society, the oldest home still standing in Kenosha County is located on Third Avenue and was built in 1899. The community has continued to expand noticeably away from Lake Michigan, with homes still be built today. Sixty-five Kenosha homes are currently on Kenosha’s official list of historical places. As of 2000, there are 36,004 housing units in Kenosha County, with 2,321,144 in Wisconsin as a whole. The home ownership rate is only 32.2% while Wisconsin stands at 68.4%. As of 2007, 3,980 of the 295,087 Wisconsin homes are known to be vacant in Kenosha County. Also in Kenosha County, 23873 of the homes are owner-occupied and 11890 are renter-occupied while 1605995 of the Wisconsin homes are owner-occupied and 665015 are renter-occupied. But Kenosha County and the state of Wisconsin have similar residence standings since 40% of residents have lived at their current County residence for five or more years and the average for the state is 39%. Annual residential turnover rates include 18% for Kenosha County and 17% for the state of Wisconsin. The average rate for years of residence actually tends to be 3.6-3.8. The top four zip codes for the average value of home equity include: 53142 at $197493, 53144 at $175246, 53143 at $165630, and 53140 at $141778. But the average home sale price is $151000

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and the average value of home equity is $164918 for the county. While the average home equity rate for Wisconsin is $176971. But the average mortgage debt is $316914, with an average of $350190 for the state. Public Services Kenosha County has a wide variety of public services, including, but not limited to: adult and child health screenings, adult and child protective services, aging and disability resource center, communicable disease control, community intervention center, community support program, family care, flu/pneumonia vaccines, food stamps, foster care, housing authority, home visiting nursing care, intoxicated driver program, job skill assessments, Medicaid, prenatal care coordination, veteran’s assistance, WIC, and the Wisconsin Works program. Each of these services does have separate required criteria in order to receive its benefits. But these services are also made readily available to both the rural and urban communities. In fact, a county office at 19600 75th Street is open for the rural community at designated dates and times for each type of program and service. Educational Attainment According to American Fact Finder (2008), adult educational attainment in Kenosha varied from less than 9th grade 3.2%, some high school 9%, high school 33.7%, some college 22%, associate’s degrees 10.1%, bachelor’s degrees 14.7%, graduate/professional degrees 7.2%. Compared with WI educational attainment 7.2% some high school, 34.4% high school, 20.3% some college, 8.8% associate’s degrees, 16.9% bachelor’s degrees, and 8.5% graduate/ professional. Compared with US data less than 9th grade 6.4%, some high school 9.1%, high

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school 29.6%, some college 20.1%, associate’s degrees 7.4%, bachelor’s degree 17.3%, graduate/professional degree 10.1%. Primary/Secondary Education There are currently twenty-one elementary schools, seven high schools, eight middle schools, three kindergarten to eighth grade, and two pre-k schools in all of Kenosha County. There are playgrounds at each of the pre-k schools, elementary schools and the kindergarten to eighth grade schools, as well as a gym class for each grade level at each school. Kenosha County schools do have a policy on the temperature outside as well as the time allotted for the children to play on the playgrounds. This weather policy is as follows: temperature outside is below 0ºF, the children remain indoors; 0º to 9º F, the children will have a shortened recess; 10º F, the children will have a full recess. Analysis of Data Strengths Kenosha county offers many resources for health services and recreation. Public transportation provides accessibility to health and educational resources. 82% of Kenosha resident sought routine check-ups. Crime rates, except rape, are lower than the national average. The high school graduation rate for Kenosha is higher than the national average. The median family income is higher than the national average. Challenges Air quality and environmental pollutants are causes for concern and difficult to change, although awareness can decrease exposure. Whereas behavioral causes such as cigarette smoking

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can be modified. According to the Burden of Tobacco in Kenosha County (2002), 36% of adults smoke versus 24% of Wisconsinites. This contributes to lung cancer, heart disease, respiratory disorders, and other tobacco related cancers. Crime in Kenosha was less than the national average except rapes in women and children. This indicates a closer investigation into possible causes and interventions which may be related to reduction in the number of police officers. Looking at the registered offenders website indicated a larger scale problem than mere numbers can signify. Perceptions of health may not be indicative of morbidity. Insufficient fruit and vegetable intake, excessive alcohol intake, along with lack of physical activity and obesity statistics. Leads us to believe a more pro-active stance is needed in educating and adopting positive lifestyle changes. Summary Exposure from cigarette smoking, environmental pollutants, and radon increase risks of lung cancer in Kenosha residents and contributes to mortality. As only 16% of patients who are diagnosed with lung cancer are expected to survive more than five years (American Lung Association, 2007). Social characteristics are similar between the Kenosha, Wisconsin, and US statistics regarding gender and age. However the population in Kenosha and Wisconsin is predominantly white but the US statistics indicate larger Hispanic population. When comparing the national average the Kenosha unemployment rate is higher, the median family income is higher, and the poverty level is lower. Life expectancy for males in Wisconsin is higher than the national

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average, but the same for females. Leading causes of death include heart disease, cancer and strokes. Crime rates are lower in the national average except for rape cases. Kenosha has increased levels of ozone and radon. Home equity in Kenosha is about 165,00 compared to the Wisconsin average of 177,000. Educational attainment is higher for associate degree, but lower for bachelors or advanced degrees. Kenosha public education exceeds those of the national average. Nursing Diagnoses Increased risk of lung cancer among Kenosha County adults related to cigarette smoking as demonstrated by 83-87% of lung cancer deaths attributed to cigarette smoking. Risk of heart disease and stroke among African American adults as demonstrated by Kenosha obesity rates of 36.3% and hypertension in 46% of females and 42% of African American males.

Increased risk of injury among Kenosha women and children related to reported rapes as demonstrated by a higher number in Kenosha versus the U.S. city average of 1.92 full-time law enforcement employees per 1,000 residents versus that of the U.S. city average of 3, as well as having a ratio of 338 resident to 1 sex offender.

Group Process

Overall we worked well together . We followed the group norms that we established in

the beginning. Throughout the whole process and writing of the paper, we utilized consensus. Personal and school responsibilities posed some challenges, therefore we had to change

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scheduled meeting dates or times. Initially we thought we collected sufficient data, but after sifting through the information, we realized that much of it was irrelevant. We then had to go back to our resources to collect appropriate comparisons. We worked synergistically; we listened to each other’s ideas, provided constructive criticism, we were positive in our interactions and felt we accomplished what we set out to do.

 

References

American Cancer Society HYPERLINK "http://www.cancer.org/downloads/COM/ WisconsinFF2007.pdf" http://www.cancer.org/downloads/COM/WisconsinFF2007.pdf retrieved 11/4/09 American lung Association HYPERLINK "http://www.lungusa.org/lung-disease/lung-cancer/ resources/facts-figures/lung-cancer-fact-sheet.html" http://www.lungusa.org/lung-disease/lungcancer/resources/facts-figures/lung-cancer-fact-sheet.html 11/4/09 Kenosha County Community Health Survey Fall 2003 http://www.aurorahealthcare.org/yourhealth/comm-health-reports/art/kenosha.pdf

Community Health Assessment Centers for disease control and prevention (2007) Emergency preparedness and response HYPERLINK "http://www.bt.cdc.gov/snaps/data/55/55059.htm" http://www.bt.cdc.gov/snaps/ data/55/55059.htm October 17, 2009

Melissa data HYPERLINK "http://www.melissadata.com/lookups/CrimeCity.asp? state=WI&city=Kenosha" http://www.melissadata.com/lookups/CrimeCity.asp? state=WI&city=Kenosha

Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Deaths, 2008 (P-45368-08). October 2009

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References

American Cancer Society HYPERLINK "http://www.cancer.org/downloads/COM/ WisconsinFF2007.pdf" http://www.cancer.org/downloads/COM/WisconsinFF2007.pdf retrieved 11/4/09 American lung Association HYPERLINK "http://www.lungusa.org/lung-disease/lung-cancer/ resources/facts-figures/lung-cancer-fact-sheet.html" http://www.lungusa.org/lung-disease/lungcancer/resources/facts-figures/lung-cancer-fact-sheet.html 11/4/09 Kenosha County Community Health Survey Fall 2003 http://www.aurorahealthcare.org/yourhealth/comm-health-reports/art/kenosha.pdf Centers for disease control and prevention (2007) Emergency preparedness and response HYPERLINK "http://www.bt.cdc.gov/snaps/data/55/55059.htm" http://www.bt.cdc.gov/snaps/ data/55/55059.htm October 17, 2009

Melissa data HYPERLINK "http://www.melissadata.com/lookups/CrimeCity.asp? state=WI&city=Kenosha" http://www.melissadata.com/lookups/CrimeCity.asp? state=WI&city=Kenosha

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Scorecard HYPERLINK "http://www.scorecard.org/env-releases/cap/" http:// www.scorecard.org/env-releases/cap/ 10-18 Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Deaths, 2008 (P-45368-08). October 2009

2008 daily ozone standard dnr.wi.gov/air/doc/2008OzStdNonattOptionsKenosha.ppt PAGE Rates of cancer by state CDC http://apps.nccd.cdc.gov/uscs/Table.aspx?Group=5f&Year=2005&Display=n http://uwphi.pophealth.wisc.edu/pha/wchr/2008/snapshots/kenosha.pdf Wisconsin County Health Rankings UW Population Health Institute