District Health Department #10 Lake County Wikipedia: The Free Encyclopedia (2006). File:Map of Michigan highlighting Lake County.svg. Retrieved from: http://en.wikipedia.org/wiki/File:Map_of_Michigan_highlighting_Lake_County.svg.

Lake County Teen Pregnancy Group Project Tonya Allendorf, Karley Daniel, Michael Dugan, Gena Furgeson, Tracy Giraud, and Kathy LaPonise Ferris State University References for the slide

Lake County Lake county is a rural community with a population of 11,498 (Census Bureau, 2013) located in the northwestern part of Michigan’s Lower Peninsula, 80 miles north of Grand Rapids. “Home to 200,000 acres of public-owned land, Lake County is intersected by two major highways, US-10 and M-37” (Lake County Chamber of Commerce [LCCC], 2013). Lake County is a seasonal town that uses tourism as an industry (LCCC, 2013). The lakes offer wildlife and fishing opportunities, there are trails for motorsports, and several annual events throughout the summer months (LCCC, 2013). While Lake County has annual summer events, the overall health of the community depends upon the year-round industry of the area. Lake County began as a logging and Railroad County after the Civil War, but when the industry stopped it was not until the early 1900’s when it became a cement production center that industry began again (Lake County Chamber of Commerce [LCCC] History, 2013). In 1912-1964, an area of Lake county known as Idlewild became the African American summer destination and musical entertainment center as part of the “Chitlin’ Circuit” (LCCC History, 2013). Lake County now contains many ghost towns, which remain from this industrial time, and are obsolete or the industry moved to locations that are more favorable. The removal of industry in the area leads to high unemployment rates and now few available jobs. *******Gena, I am not good at power point. I tried to change the color of the second to the last sentence and was unable to. I copied and pasted from your assessment data, but it does not make sense to me. Can you reword some, thanks! Kathy

Community Strengths Community Assets Beautiful natural resources Safe community Collaboration between agencies and resources available Existing services Lake County Chamber of Commerce Satellite Health Clinic Lake County Health Department. Baldwin Family Health Center Teen School Health Clinic Lake county has natural resources and recreational areas that bring tourism to the area. Lake County is part of West Michigan's five county area known as "Michigan's Great Outdoors“ (LCCC, 2013). This is a way to revitalize the area and provide income for area residents. The are no major industries or farming establishments that would emit fumes or chemicals in the air. This provides good air quality for residents. Lake county has lower asthma rates than the state. Lake county has far less violent crimes compared to Michigan and the United States. Lake county had only 0.4 violent crimes per 100,000 people. Michigan had 6.6 and 5.4 in the United States (Carl Frost, 2013). This county is more diverse than surrounding counties even though it is still primarily white. General demographic information from the 2010 census states the racial composition of the population is approximately 87 percent white, nine percent African American, two percent Hispanic or Latino, two percent Native American, and less than one percent Asian, Pacific Islander, and other races (United States Census Bureau [USCB], 2010). There Lake County Chamber of Commerce works with over 100 area business in the county promote economic development and strengthen business. This in turn can improve the quality of life in the 6 communities that they serve (LCCC, 2013). There is a proposed reopening of the prison in the area that would create jobs (Carl Frost, 2013). The are health services available in Lake county. Baldwin is the county seat and the location for the Lake County Health Department. The health department offers service like family planning, immunizations, and WIC. Baldwin is also the location for the Baldwin family health center and the teen school health clinic.

Community Weaknesses No hospital in Lake County High ratio of patients to available primary care providers. Lack of health coverage High percentage of the population on Medicare and Medicaid. No public transportation Teen pregnancy rate of 68.5 per 1,o00 or 6.85 percent 28.6 % of teens 15-19 have a repeat teen pregnancy (Hill et al, 2011, p. 43) High rate of smoking while pregnant High rate of child abuse/ neglect High poverty rates High unemployment rates Low rates of high school graduation Low percentage of continuing education and advanced degrees After looking at the data from District #10, there were several health indicators that were of concern for our group. Here is brief list of what we felt was most concerning. Teen birth rates are the highest in the District #10 Health Department area.Teen pregnancy rate Lake county 68.5 per 1,000. DHD-56.0, MI-53.6. Healthy People 2020 target 36.2 (Dhd#10, 2013). Repeat teen birth rates 28.6%. Michigan 18.4% and US 19%. Lake county’s rate of repeat teen pregnancy is almost double that of the state and nation (Hill et al., 2011, p.132). Rate of confirmed child abuse/neglect twice as high as the state and three times as high as the nation. Closest hospital is in Osceola County-Reed City Hospital-Spectrum Health-no OB services Luddington Memorial Hospital about 35 miles away or Grand Rapids would be the closest OB services (phone conversation with Susan Tripp, April 3, 2013). There is 1 primary care provider for every 11,017 people in Lake County. Michigan average is 1:874 (Hill et al., 2011). 1 in 10 residents have no health coverage. 1 in 5 -18.8% have no personal health care provider. 37.6% had no routine physical in past year., 15.1% have no health care access in past 12 months due to cost (Hill et al., 2011).

Community Weakness Focus Area Teen pregnancy and repeat teen pregnancy “There is a strong association between teenage pregnancy and child well-being. Morbidity associated with children of teenage pregnancy includes pre-term birth, low birth weight, child abuse, neglect, poverty and premature death” (Harkness & DeMarco, 2012, p. 441). After looking at the data from District #10, there were several health indicators that were of concern for our group. Here is brief list of what we felt was most concerning. Rate of confirmed child abuse/neglect twice as high as the state and three times as high as the nation.

Community Risks Potential risks Lake County teens are at a risk for higher pregnancy rates due to it being a rural community. Teen birth rates in rural counties are 1/3 higher than the rest of the country, 43% in rural settings compared to 33% in urban ones (The National Campaign, 2013). Teen pregnancy leads to high costs to taxpayers. Increased health care, increased foster care, increased incarceration rates, and lost revenue due to lower education and job status all add to taxpayer burden. In 2008, it was estimated that it cost $11 billion dollars in U. S. tax dollars due to teen pregnancy (Centers for Disease Control and Prevention (CDC, 2012). Pregnant teenagers and their children have lower school performance, higher drop out rates, more health problems, higher incarceration rates, and unemployment (CDC, 2012). This can strain and be a drain on community resources. Poverty is a cause as well as a consequence of early childbearing; approximately one quarter of teen mothers goes on well-fare within 3 years of the child’s birth. After looking at the data from District #10, there were several health indicators that were of concern for our group. Here is brief list of what we felt was most concerning. Rate of confirmed child abuse/neglect twice as high as the state and three times as high as the nation. Rate of teen pregnancy higher in rural communities than in urban settings. This predisposes the rural Lake County teens to higher pregnancy rates. Lake County has low economic opportunities for it’s residents. Pregnant teens are shown statistically to not finish school and therefore have lower economic status due to reduced education levels and lack of jobs in area.

Community Nursing Diagnosis Risk of pregnancy among teenagers in Lake County. Related to poverty, lower levels of educational attainment, high rates of confirmed child abuse and neglect, and a large percentage of children living in single parent households. As demonstrated by teen pregnancy rate at 68.5 per 1,000 and repeat teen births at 28.6%. Teen birth rates are the highest in the District #10 Health Department area.Teen pregnancy rate Lake county 68.5 per 1,000. DHD-56.0, MI-53.6. Healthy People 2020 target 36.2 (Dhd#10, 2013). Poverty rate in Lake County is 23.4, Michigan is 16.2, US-14.3. Approximately 1 in 5 families live in poverty (Hill et al, 2011). Three in 10 Lake County residents have not graduated from high school. Michigan percentage of high school graduates is 87.4%. Lake County residents has 8.3% of the population that has a bachelors degree or higher. Michigan has 24.5% and US has 27.5% (Hill et al, 2011). Rate of confirmed child abuse/neglect is twice as high as the state and three times as high as the nation (Hill et al, 2011) Children who live in single parent households are 44% (Hill et al, 2011).

Nursing Process Assessment Diagnosis Planning Intervention Evaluation References for the slide

Project Overview Pregnant teens smoking Pregnant teens are ______% more likely to smoke than women between the ages of ____ and ____. Identify which teens in the area are most susceptible to ______________. The following services are available in the area, however, the following barriers exist _______. The nearest hospital offering delivery services is in Osceola county _______ miles away and offers the following services____________. However, ____________services are lacking for those in Lake county. The nearest specialty care or NICU is located ________miles away. Evidenced based research states early prenatal care decreases pregnancy related complications by ______% (cite ref) The current resources available _________________ References for the slide

SMART Goal The number of pregnant girls aged 19 and younger who smoke in Lake County will be reduced by 20% from 35.1% pregnant teen smokers in 2010 to 28.1% or fewer in 2020 (District Health Department #10, 2011). References for the slide

Planning Who – pregnant teens and teens in general in Lake County is the targeted population. What – to reduce teen pregnancy in Lake County from 68.5 % to Healthy People 2020 target of 36.2%. When – achieve target goal of 36.2% in 7 years by 2020. Where – Lake County in District Health Department #10 References for the slide

Planning continued Why – to reduce the number of teen pregnancy. Reducing the number of teen pregnancies will benefit the community and individuals by reducing strain on resources, improving educational results, better economical opportunities, and improved health benefits. How – by: Assessment surveys and interviews to gather data. Educational seminars and events to provide information and health promotion to teens, parents, and the community. References for the slide

Planning continued – “How” Creating a multidisciplinary team to research and implement policy and interventions regarding teen sexual behaviors, availability of health providers and centers, safe teen center “hangouts”, and education about the risks and pitfalls of teen pregnancy.

Implementation Recognizing teens at risk and bringing attention to the subject. Providing support and resources to assist teen’s with pregnancy process. Going into county schools, middle schools and high schools and providing resources, education, and providing support. Pushing for more sex education in schools, allowing more support and communication for teenage girls with school nurses, teachers, and other staff members. Encouraging parents to talk to their teens about risks for teen pregnancy. Showing Lake County teen’s statistics and how it can change their lives. Allowing teen mothers to speak about their experiences, their ups and downs. Teaching about condoms and other contraceptives, demonstrating the proper use and how they are used. Speaking and educating on abstinence and peer pressure. Where and when would you turn to for help as a pregnant teenager. References for the slide

Implementation continued Collaborating and working with Lake County Agencies: HELP, Pregnancy Crisis Aid, an agency that provides services and resources for unplanned pregnancies. Lutheran Family Services of Michigan, provide resources, support, and individual tailored plans to families of all ages. Lake County Department of Child Services, assists with many needs including WIC program (Woman Infant Child program). Family health care teen health program, associated in Baldwin school districts. References for the slide

Community Interventions Pregnant teens smoking Pregnant teens are ______% more likely to smoke than women between the ages of ____ and ____. Identify which teens in the area are most susceptible to ______________. The following services are available in the area, however, the following barriers exist _______. The nearest hospital offering delivery services is in Osceola county _______ miles away and offers the following services____________. However, ____________services are lacking for those in Lake county. The nearest specialty care or NICU is located ________miles away. Evidenced based research states early prenatal care decreases pregnancy related complications by ______% (cite ref) The current resources available _________________ References for the slide

Theoretical Support A PAUSE (Adding Power and Understanding in Sex Education) is a program based on a Social Influences Theoretical Model where Social Learning Theory is a central component (Mellanby, Newcombe, Reese, & Tripp, 2011). A teacher and a nurse educate the teens on anatomy, physiology, and health promotion in the middle and high school settings. The teen mothers serve as mentors. This ‘joined up thinking’ team approach works well. The teens receive the factual information better from adult leaders. The peer leaders are more effective in changing attitudes References for the slide

Evaluation A PAUSE is evaluated on a pre and post test. The students answer a questionnaire regarding knowledge and attitudes during the first session and the last session of class. The students answer the questionnaire anonymously to promote honesty. Our goal of decreasing the amount of pregnant teen smokers by 20% in Lake county will be evaluated according the statistics in next years District 10 Annual Report. References for the slide

References Centers for Disease Control and Prevention. (2012). The importance of prevention section. Retrieved from http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm District Health Department #10. (2011). Health Profile Chartbook: Lake County. Retrieved from http://www.spectrumhealth.org/documents/Osceola_and_ Lake_Counties_CHNA.pdf Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer Health / Lippincott Williams & Wilkins. Hill, M., Mullins, M., Warner, L., & VanArk, L. (2011). Health and healthcare landscape of Osceola and Lake counties: Research results from the 2011 community-wide health needs assessment (CHNA Report 11_28_11). Retrieved from Hope College, The Carl Frost Center for Social Science Research, A research project for Spectrum Health Reed City Hospital. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0 CDkQFjAB&url=http%3A%2F%2Fwww.spectrumhealth.org%2Fdocuments%2FOsc eola_and_Lake_Counties_CHNA.pdf&ei=19w0UchF8aFywGWjICAAQ&usg=AFQ jCNFWbpGAwo5ecnIYTNGUhKypWnR9YQ&bvm=bv.43148975,d.aWc

References continued Lake County Chamber of Commerce. (2013). History. Retrieved from http://www.lakecountymichigan.com/history.html Lake County Chamber of Commerce. (2013). Michigan’s outdoor recreation paradise. Retrieved from http://www.lakecountymichigan.com Mellanby, A., Newcombe, R., Rees, J., & Tripp, J. (2001). A comparative study of peer lead and adult led school sex education. Health Education Research Theory & Practice, 16(4), 481-492. Retrieved from http://spen.org.uk/mymedia/ files/resource_pdfs/sexual_health/comparative%20study%20of%20peer%20led%20ad ult%20led%20school%20sex%20education.pdf Olszewski, J. & Wisdom, K. (2004). Michigan surgeon general’s health status report: Healthy Michigan 2010. Retrieved from http://www.google.com/url?sa=t&rct=j& q=&esrc=s&source=web&cd=1&ved=0CDIQFjAA&url=http%3A%2F%2Fwww.michigan .gov%2Fdocuments%2FHealthy_Michigan_2010_1_88117_7.pdf&ei=19w0UcmhF8aFy wGWjICAAQ&usg=AFQjCNEkBBBTP_OsfdRkctyRnHfaBsH2Mg&bvm=bv.43148975,d .aWc

References continued The National Campaign. (2013). Teen childbearing in rural America (Science Says Number 47). Retrieved from http://www.thenationalcampaign.org/resources/pdf/ss/ss47_teenchildbear inginruralamerica.pdf United States Census Bureau, American fact finder. (2007). All sectors: Geographic area series: Economic-wide key statistics: 2007. 2007 economic census. Retrieved from http://factfinder2.census.gov/ faces/tableservices/jsf/pages/productview.xhtml?pid=ECN_2007_US _00A1 United States Census Bureau, American fact finder. (2010). Profile of general population and housing characteristics: 2010. 2010 demographic profile data. http://factfinder2.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1 United States Census Bureau, American fact finder. (2011). Selected economic characteristics 2007-2011 American community survey 5-year estimates. Retrieved from http://factfinder2.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=ACS_11_5YR_DP03

References continued United Way of Jackson County. (2007). Pursuing hope for our youth: Summary of teen pregnancy prevention strategic planning 2006-2007: Jackson county, Michigan. Retrieved from http://www. google.com/url?sa=t&rct=j&q=&esrc=s& source=web&cd=5&ved=0CEgQFjAE&url=http%3A% 2F%2Fjacksondata.org%2Fsites%2Fjacksondata.org%2Ffiles%2FJCHDpregnancyprevention.pdf&e i=19w0UcmhF8aFywGWjICAAQ&usg=AFQjCNGU6leJPVQoP1WFDW5bvsM1f6ESWA&bvm=bv.4 3148975,d.aWc Wikipedia: The Free Encyclopedia (2006). File:Map of Michigan highlighting Lake County.svg. Retrieved from http://en.wikipedia.org/wiki/FileMap_of_Michigan_highlighting_Lake_ County.svg. Wikipedia. (2013, March 19). Poverty in the United Sates. Retrieved from http://en.wikipedia.org/ wiki/Poverty_line_in_the_United_States Zehnder-Merrell, J. (2012). Right start in Michigan and its counties-2012, Right start in Michigan 2012: A closer look at maternal and infant well-being. Lansing, MI: Michigan League for Human Services. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web& cd=6&ved= 0CE0QFjAF&url=http%3A%2F%2Fwww.milhs.org%2Fwpcontent%2Fuploads% 2F2012%2F04%2FRSwithAppendix.pdf&ei=19w0UcmhF8aFywGWjICAAQ&usg=AFQjCNGbGI97M PM92lu5we77tji1SPIq9g&bvm=bv.43148975,d.aWc