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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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Most participants were attentive, engaged in the activities, and asked questions throughout the
lesson (e.g. What kind of cancer does marijuana cause?). Relevant health-related stories were
shared by South Park residents which enhanced the lesson. The lesson was ~55 minutes long and
Carmen Martinez played an integral role in helping with our success. Due to time constraints, not
all participants were able to listen to different lung sounds via the heart/lung mannequin.
The Nutrition Lesson was successful because we achieved most of our learning
objectives based on the survey responses and received positive feedback from our community
partners. There were ~25 attendees at the event. DVYC covered the cost of healthy snacks which
was prepared by Jennifer Lynn. Materials for the healthy food plate activity, images of the
USDA & HHS healthy food plate recommendation which was available in Spanish, a drink
board, and surveys were the items distributed. This lesson took ~40 minutes in total and Paulina
Lopez, an Outreach Specialist and Community Based Participatory Research expert of South
Park, contributed her insights which enhanced the outcome of our lesson. If more time was
permitted, we would be able to practice reading nutrition labels and discuss more in depth about
making healthier shifts in eating. A theme from the surveys include the youth expressing how
they will make a healthier change in their diet. We used the CBPR principle by assessing the
strengths and challenges related to eating a nutritious diet in South Park. The community lacks a
supermarket that sell affordable nutritious foods, so our lesson focused on empowering the youth
to make healthier food choices within their cultural context as well as identifying individual and
community resources to support healthy eating.
Recommendation:
According to Paulina Lopez, South Park currently has one of the highest obesity rates in
Washington and a contributing factor to this problem is not having a supermarket that sells
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affordable healthy foods in South Park. The Hunger Vital Sign Survey that we conducted
revealed that some participants rated “sometimes true” to the statement “Within the past 12
months, your family worried that your food would run out before you got money to buy more.”
Food security is an important social determinant of health and we recommend future nursing
students to work on improving access to affordable and healthy foods at South Park. Without
access to affordable health fruits and vegetables within South Park’s built environment, these
residents are at greater risk for developing negative health outcomes such as cardiovascular
disease, diabetes, stroke, and cancer (Schroeder & Smaldone, 2015). Residents of South Park
deserve to have the resources they need to adopt and sustain a healthy eating pattern.
Conclusion:
We collaborated with the DVYC to improve the health and wellbeing of South Park and
the Greater Duwamish Valley neighborhood. Carmen Martinez identified respiratory illness and
inadequate nutrition as the top health priorities in the South Park community. We used education
as our primary prevention strategy. We served as nurse educators for the youth and engaged in a
power-sharing and co-learning process; we shared evidence-based research, gained knowledge
about community resources and experiences, and actively exchanged ideas with South Park’s
community leaders. The respiratory health and nutrition lessons were provided in partnership
with a South Park community leader and the strengths of South Park were highlighted in order to
positively reinforce community-identified interventions that promote health and prevent or
alleviate illness and injury. In order to empower and build the capacity of the DVYC youth, we
supported efforts made by the youth to disseminate their acquired knowledge and experiences to
other South Park community members through the DVYC Youth Forum.
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Appendices: Duwamish Alive!: This is when we collaborated with Dirt Corps Duwamish Alive! to restore a piece of wetland that the Hamm Creek runs right through. We planted 300+ trees, shrubs, and various plants. We are hoping to see salmon swim through the creek this year.
Respiratory Health Lesson: heart and lung mannequin with an electronic stethoscope, healthy vs. unhealthy lung image handout, incentive spirometers, powerpoint presentation, audio clip (http://www.seattleglobalist.com/2016/03/30/49490/49490), videoclip (https://www.youtube.com/watch?v=TVJSmfYtXyw), asthma trigger image handout.
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Nutrition Lesson: visual board of sugar content in beverages, healthy food plate activity, US HHS & USDA healthy food plate guideline image,
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Duwamish Valley Youth Corps Youth Forum: program advertisement, planning, and implementation
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Surveys: ● Respiratory+Health+Survey+
○ What+is+one+thing+that+you+learned+today?+○ What+is+one+positive+thing+you+can+do+to+reduce+asthma+rates+in+your+
community?+○ How+many+people+do+you+know+have+asthma+in+the+South+Park+community?+○ What+is+your+resource+when+you+have+a+health=related+concern?+○ Do+you+have+any+questions+or+feedback?+
● Nutrition Survey ○ Why is it important to eat a healthy diet? ○ What does “eating healthy” mean to you? ○ What healthy foods are already in your diet? ○ Based on what you learned today, will you make any changes to your diet (if yes,
please specify the changes. If no, please specify your reason.) ○ Where do you get your source of healthy foods? ○ Do you have any questions or feedback?
● Hunger Vital Sign ○ Within the past 12 months, your family worried that your food would run out
before you got money to buy more. ■ Often True ■ Sometimes True ■ Never True
○ Within the past 12 months, the food your family bought didn’t just last and you didn’t have money to get more. ■ Often True ■ Sometimes True ■ Never True
Lesson Plan Learning Objectives: ● Respiratory Health Learning Objectives:
○ Describe the negative health and academic impacts of smoking marijuana among adolescents
○ Identify asthma and mortality rates in South Park in comparison to King County ○ Describe the pathophysiology of asthma ○ Describe the signs and symptoms of asthma ○ Identify asthma triggers and ways to manage them ○ Describe an asthma attack and how to appropriately respond ○ Identify ways to reduce the rates of asthma in the South Park community ○ Describe how to maintain a healthy lung capacity
● Nutrition Learning Objectives:
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○ Describe the importance of healthy eating ○ Define a healthy eating pattern ○ Describe the dietary guidelines provided by the USDA and HHS ○ Describe the importance of reading nutrition labels ○ Demonstrate how to read nutrition labels ○ Identify ways to make healthier food choices ○ Identify the barriers to healthy eating ○ Identify ways to promote healthy eating
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