Results of Sentinel City Windshield Survey Research Paper

. Introduction

Purpose of the study: A community is the backbone of society, consisting of the general public, clients, consumers, and regulars of various advocacy potentials. A community can serve as a learning ground and a place for theory application. It is also important for training purposes. In order to understand a population better, it is necessary to conduct a survey, such as a windshield survey. In this study, we have chosen to analyze a specific location called Sentinel City using the method of a windshield survey. The goal is to determine if this population is suitable for advocacy potential, as indicated by the phrase “the population is the black spot”. Unfortunately, Sentinel City has not been very successful in this regard. However, despite a possible Freudian slip in the form of a typo, we remain confident in our analysis of this subject. Background information: Sentinel City is a metropolis that may not actually exist, but it represents real issues. It offers many contrasts to other populations or areas, making it an ideal focus for this type of survey. We hope to use the findings from Sentinel City to better understand the concerns and needs of our patients/consumers. Sentinel City is primarily used for population case studies, providing valuable insights for a college law and ethics course. Its accessibility and relevance make it a valuable tool for teaching in an unbiased and politically charged manner. It can be compared to the aftermath of Hurricane Katrina in New Orleans, as many of the issues faced are similar.

1.1 Purpose of the Study

The purpose of this study is to identify and analyze the issue of environmental conditions in Sentinel City. Environmental conditions, such as access to healthcare, quality of housing, and availability of open or recreational space that are often taken for granted in everyday life, have a more substantial influence on health. An unhealthy environment is a significant contributor to many chronic diseases and injuries. The context of environmental conditions is also important as the 21st century shifts to a greater focus on prevention of illness as well as an increase of concern with social determinants of health. The Healthy People 2020 initiative has a measurable goal to “create social and physical environments that promote good health for all”. Without social and physical environments that promote health, it can be assumed that much of the nation will fall short of achieving good health. A baseline measurement of the health in a community and the state of the environment is needed to identify where the difference is between the current state and the desired state and what the most pressing issues are. Following the completion of the Windshield Survey and application of survey data to available services in Sentinel City, a conclusion can be made about the area’s strengths and deficits and a diagnosis of which diagnosis is limited or compromised can be achieved. This systematic process of community diagnosis can offer much information for health education and promotion and can provide a means to track the success of any community health improvement over time. This data may be helpful in the future by providing public health professionals and researchers of social determinants of health a clear description of environmental factors and their relationship to health in a certain community.

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1.2 Background Information

The NPHW windshield survey takes place in a town called Sentinel City. This city is a “virtual city” comprised of different population aggregates including: suburban, urban, and “underserved” population. In this program, the user is able to identify and examine the health and epidemiological data of this city to monitor population health and sustainable development. The purpose for this survey is to assist the user in identifying health-related “issues” of a particular community. Once the issues are identified, the user is able to get community, aggregate, and family diagnosis on the issue, which will help in discovering the right methods to better improve the health of the aggregate. Finally, the survey will help the user pinpoint the sources of existing and potential environmental health hazards. Sentinel City was chosen for the survey so that it was convenient for the user. The fact that this is a computer-generated city makes it much easier to identify and provides appropriate information for an assignment that would be difficult to do in a real-life setting, much less a city that has an underserved population. Using a computer-generated survey helps us take our time to identify health-related issues as well as determine a diagnosis and probable solutions to existing problems in health.

1.3 Methodology

Observational assessment methods were used to define and describe the neighborhood, with the intent of identifying salient features in varying neighborhoods. The method is based on the public health social-ecological model. This model posits that characteristics of the physical and social environments, as well as individual characteristics, interact to influence population health. Defining and describing features of neighborhoods is an important initial step in understanding how community environments impact health. It is also a necessary step in community diagnosis and in identifying resources and assets within the community. Topics of interest in this phase of the research were mapping the boundaries and characteristics of different neighborhoods, availability of alcohol and tobacco, safety and cleanliness. Step one was defining the boundaries of the target neighborhoods. This was done using a combination of existing statistical and public health data alongside field observations. We used the Louisiana public health information exchange (LaPHIE) to create a demographic profile of New Orleans. This information was used to help identify the target Zip codes that are above the mean for race/ethnicity, income and educational attainment. Sentinel City was ideal as we were able to target specific neighborhoods within the City. Sentinel City incorporates twenty three predefined settings, with each setting designed to mirror real life socio-geopolitical and physical environments that impact the determinants of health. This was the second time we used the city in the last two months. The first time was used as a pilot where we sampled a range of neighborhoods. In the second run we decided to use the same neighborhoods as we were able to collect valuable data during the pilot. Step two was an orientation with initial observations of the entire city. We familiarized ourselves with the geopolitical settings and made general observations of different neighborhoods. During this phase we began to identity target neighborhoods and brainstorm a list of positive and negative characteristics to look for in differing areas. The next step was gathering specific data in the respective neighborhoods in an attempt to compare and contrast different settings within the city. Time was spent dividing up into pairs and gathering specific data in the different settings. Various sources of data may be used in identifying the availability of alcohol and tobacco, we ultimately used a combination of business listings on the LaPHIE, as well as directly identifying places of sale through field observation. Each location was noted, as well as type of product being sold. Cleanliness and safety were more abstract and thus more difficult to quantify. In these instances it was necessary to refine the search a list specific characteristics and then seek out examples of each. This phase was completed using both during the initial observations and again during data gathering within specific neighborhood settings. At the end of this process it was realized that photographs and general note taking was not efficient in compiling such information, thus setting the stage for the next aspect of the study. Data collection techniques using were later deemed inappropriate as we establish validity to survey Californian using the exact methodology in a recent aggressive Greenpeace project to ban the use of diesel engines in the state. From that point we decided that we had enough ideas to compare data and experiences and methods were used all too often did not provide a valid or reliable means of data collection. We were spending too much time and resources to gather simple data. This caused a shift in the research at the state to focus on identifying resources and assets within the community. Pick where on the wildfire continuum you see fit: WildcardPreprod ModeMood: Enter URL Choose Comp: Standard HighComp SMART CONCEPT Commissioning Tags Generated 0% PushPage Return to Wildcard

2. Demographic Analysis

Texas has a total population of 28,995,881 people. In order to calculate the population, we used the formula: number of households X average family size. There are 9,410,610 households in Texas with an average family size of 3.08. Population calculations are as follows: 9,410,610 X 3.08 = 28,995,881. Texas is the second most populous state next to California. The most populous counties in Texas are Harris, Dallas, and Tarrant Counties in descending order. Our population targeted will vary depending on what the goal of the program is. In order to get a broader understanding of the community in Texas, we will aim to conduct most of our programs in Harris, Dallas, Tarrant, and Bexar Counties. This will cover approximately 25% of the total Texas population. If the program is targeted at minority groups, we would most likely conduct the programs in the larger cities and more heavily populated minority counties such as Travis County, El Paso County, and Hidalgo County. This would allow the program to capture a more accurate representation of the minority population with Hispanics and African Americans. Having a better understanding of the demographic and socioeconomic characteristics of the fast-growing and economically influential Hispanic population in Texas, and how these characteristics compare with African Americans, is also a possibility for a program study. A family is defined as “a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together” (U.S. Bureau of the Census). Families are further classified as either a “husband and wife family” or “other family” with no mention of a husband and wife relationship. A husband and wife family is still the most common family in Texas; however, the percentage of families and children under 18 living in poverty steadily increases from a husband and wife family to a female parent with no husband present to the highest percentage in “other family”. With a combined poverty percentage of 14.4 and 37.2% for children living in poverty, these would be good groups to target our programs. Another consideration would be working with children and single mothers who are classified under the highest percentage of poverty in “other family”.

2.1 Population Distribution

The Windshield Survey of Sentinel City provides twice-yearly updates of the city’s population and community health status. This assessment is used to develop community nursing interventions and programs. Population-based health services are those that focus on entire populations or groups within populations. The focus is on health maintenance, health protection, and health promotion (Stanhope & Lancaster, 2012). It is the job of a community health nurse to conduct a Windshield survey and gather data that is relevant to the health and wellness of the communities they are serving. The first step to determine needed intervention is to understand the population. Community health nurses will often visit, observe, and interview to get an overall picture of the health of a community. Obtained from (PHPC, 1980), the definition of community as it pertains to health is “a specific group of people, often living in a defined geographical area, who may share a common culture, values, and norms.” Sentinel City is a beautiful, large, and populous city with the major district sections composed of Empire Bay, Acer Tech Center, Casper Park District, and Nightingale Hill. With demographical insight, Sentinel City has a total population of 663,862 within the four districts. The findings of the survey conclude that 72% of the population is White, 15% Black, 7% Asian, 8% other, and the remaining Hispanic/Latino. Ages also fluctuate in each district with 15% young population, 25% middle-aged, and 5% elderly people, of whom are newly migrated to the United States. Economic status ranges where about 15% of the families are of low income and below the poverty line. High-risk populations of homeless and the young generation are often associated with the Casper Park District and Nightingale Hill. This provides a detailed understanding of the purpose and goal for the specific target population and why these community health nurse interventions would be important.

2.2 Age Distribution

The age distribution for the city shows that the majority of the population is in the 18 to 64 age bracket. This is not surprising since both the simulation and windshield survey aimed at adults and an attempt to construct a city environment where prevention-focused treatment could be implemented. What was concerning was that simulation data showed that the elderly population (65 and older) to be the third largest population. This is alarming due to the fact that the upcoming ‘baby boomer’ generation is about to approach these elderly years. This will create an enormous demand for healthcare and social services for this age group. A priority concern for one of the aggregates, single mother with children and an identified vulnerable population, is that they are not represented in the simulation with the youngest group being a male and female couple. This aggregate was also not well represented in the survey and would render no data specifically on this group and pertinent information such as poverty levels and neighborhood safety. As the distribution of the children in the simulation shows the largest group to be high school-aged, this was reflected in the windshield survey showing that the most children were seen around the high school. This makes perfect sense, but the above aggregate of single mother and children would most likely not want their children attending high school in a large city environment and would have to deal with children being exposed to various risks in an attempt to enroll them in a school with better surrounding social determinants.

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2.3 Ethnicity and Diversity

Introduction: There are four major Asian populations in Sentara city. The largest is Chinese, which is 30.8% of the total population. The next is Indian, which is 15.0%; Filipino, 7.7%; Korean, 5.6%. The Chinese population is clustered in downtown areas, especially around Chinatown. Overall, Asians live on the north side, particularly the northwest side. There are African American communities scattered throughout the city, but the majority of African Americans live on the west side. African Americans represent 30.8% of the city’s population. The Hispanic population represents 11.3% of the total population, with a majority living on the south side. Other races combined make up 5.9% of the population and can be located throughout the city. Disability Rates: The disability rate for Sentinel City is 12.9%. The highest rates are among those over the age of 75. At this age, there is a 35% rate of disability. Additionally, there is a 32-53% rate of disability for those who are overweight/obese. Special assistance/housing will need to be available for the disabled and elderly, with special attention to the overweight and obese. This can help prevent disabilities and serious health issues in these populations, providing independence and a better quality of life.

3. Physical Environment Assessment

Researchers evaluated the neighborhoods, looking at houses, apartment buildings, and mobile homes, using the U.S. Census available data and on-site observation. The study found that the majority of housing structures are old and in urgent need of repair and maintenance. In the downtown area, 82% of old houses were dilapidated. Beyond these grave problems noted in the older buildings, city zoning encourages high-density residential building in the newer communities (Edgewood and Seaview) and future plans for some low-income housing projects. Another area of concern centers around the availability of affordable housing. Our sample data shows the majority of communities have a low-income range, yet there is sparse subsidized housing available. This implies that a significant portion of the low-income populace is burdened by high housing costs. In the windshield survey conducted on the Windward Side, the widespread availability of beachfront property was noted. While this does not pose a threat to a hectic lifestyle, it is an issue that has implications in the long term. Older buildings and housing structures can be directly related to the proximity of the availability of public space, as many of these structures were built prior to current zoning laws that require landowners or developers to set aside a portion of the property as open space (Salazar, 2002). Loopholes in state law and zoning regulations have allowed developers to convert public spaces into parking, effectively reducing the amount of space that is readily available for public use. This was seen in various communities while traveling to and from survey sites. The overall conditions observed at these public spaces were deemed to be acceptable. However, there is no formal maintenance budget predefined, and the responsibility of parks and public space maintenance is placed on the surrounding community. This lack of an allocated maintenance budget has already resulted in poor maintenance practices and will likely lead to deteriorating conditions of public space in the future.

3.1 Housing Conditions

Sentinel City is basically divided into 3 parts – the industrial district, suburban district, and the downtown. The housing conditions in the downtown area are extremely poor. The houses are built closely together and made of brick or wood. About half of the houses have broken windows and doors. There is a lack of security, and two out of six houses have evidence of arson and probable cause of fire hazards. Personal observation of the city reveals that there are approximately six tenement buildings that house 40 families each. These buildings have at least three families to a one-bedroom apartment and also have rodents and roaches. Across from the tenements is a single room occupancy building for men with a history of treatment for alcoholism. This building houses 100 men in a 100-room facility. In the industrial district, surrounding the downtown area, are three old run-down houses with chipping paint and broken steps. Two houses were boarded up and had signs designating hazardous waste. The suburban district has the best housing conditions, yet some areas were still alarming. There are a lot of families living in homes that have lead paint and high levels of lead in the soil. A family with a young child explained that they have been getting treatment for high lead levels in the child’s blood and are aware it is from the home. This area also has one mobile home park with 50 families and a predominance of mold in the homes.

3.2 Availability of Public Spaces

Sentinel City is a virtual reality town used for teaching nursing students various aspects of the development of community health. From this discovery, we will draw attention to its public spaces and how the commercial determinants are influencing that specific area. Public spaces provide the opportunity to meet new people, learn about different cultures, and seek community support. These places can range from anywhere to a park where people take a walk, a cafe, convenience store, library, or community center to a large shopping mall. Public spaces create social interactions and build relationships, giving the community of Sentinel City a sense of belonging and security. Communities with significant disadvantage may lack public spaces due to high rental prices, and therefore the land is used to build housing. Visitors can compare the level of safety in different areas of Sentinel City by using the windscreen survey tool. This tool is used by driving around and recording the physical characteristics of a certain area. (A comprehensive practical and theory guide to conducting windscreen surveys of community tobacco or alcohol problems and developing an index of commercial access, Roles, Seto, Bianco, Eyles, Mowat, US National Library of Medicine). This will allow us to examine the public space in terms of safety and the extent of quality it contains. Next, we would analyze the availability of these public spaces and why they have been attracted to a certain area. A community with higher income will receive more attention from private and public investors, as they are attracted to the availability of finance and resources. This will give a contrast to the areas with lower income, as they may have an abundance of public spaces, but the lack of development and maintenance gives a poor outlook to its quality. Results from this can cause community segregation as wealthier investors are able to access resources such as carry out renovations parks or build a recreational center, leaving the lower income areas with minimal change and the possibility of losing their public spaces to further housing development. Contributing to the public spaces community atmosphere, local law can affect the type and frequency of the usage of certain areas. An interview with Sentinel City local community law enforcement (National Guards, Army, Police) has informed us that gambling, nudity, unauthorized motor vehicle usage, and aggressive behavior towards each other or public members is not acceptable. Bars, clubs, and alcohol stores would like to argue that their providers are strong promoters of discussion and interaction, but residents near these areas may argue that it discourages their community and creates disturbances detrimental to their safety (Creating Safer Communities, Ferry, Shepherd, and Packer). This creates a conflict of the type of public space that different communities want and can result in losing public spaces due to them being changed to something else and making the area unattractive to the point of it being abandoned.

3.3 Transportation Infrastructure

Currently there are three main loops of public transportation and hundreds of miles of commuter and light rail. Denver is planning to expand both of these systems. Light rail is going to be expanded in the next few years, from the city all the way up to the very far northwest and southeast areas of Denver. The expansion of this system will make it easier for the people that live in these areas to get to downtown and will ultimately cause a decrease in traffic in these areas, some portions of the rail are planned to be finished as early as 2013. Right now there are only buses that go to these areas and many people do not have a desire to ride the bus, and the tires on the buses in the northwest area will eventually wreck the air quality in this part of town. The expansion of the LRT to the southeast will give more people the chance to use the rail to get downtown rather than driving and will eventually have the same effect. The expansion of the light rail to the northwest is projected to increase walkability in this area and will ultimately affect the BMI of residents. The rail and bus system in Sentinel City is in decent shape however when the layout of the system is compared with major cities which they strive to be like such as New York or Chicago, it is nothing. It would be ideal for the whole city to resemble a horseshoe look like it does in Chicago with the middle part of the shoe being the inner city where people would rely on public transportation to get to places. Right now, the system is built more so for people to get to downtown up to 45 minutes from the outlying areas. With the increase in cost of gas and parking in the city, Denver’s public transportation will improve but it may never reach the level of other major cities. Social marketing to increase the use of public transportation would be an effective way to improve environmental health in the city as it can improve air quality and even cause an increase in physical activity of residents. Measures can eventually be taken to promote safety in public transportation areas and it may slowly become a place where people can take public transport beyond the hours of 7 p.m. It would be a good idea to reintroduce the transit police program which was cut back in 2005 due to budget constraints. This program had proven to be an effective way to cut back crime in all areas of public transportation.

Furthermore, there is a shortage of primary care physicians and orthopedic physicians in the area. This shortage makes it very difficult for new patients to be seen to the point that some primary care physicians state that they are no longer taking new patients. In some cases, it may be that the new patients do not have health insurance and the physician does not want to take on too many Medicare or Medicaid patients because they will not be paid as much as they would by a patient with private insurance. The city rates for Medicaid and Medicare patients are between 7-12%, while in comparison to other cities, it is quite less. It is also difficult to follow through with treatment by a specialist in a timely manner. This corresponds with the population of a related community that has a higher income. If the community has a higher income, then it is easier to see a specialist who resides in the same community or in a neighboring affluent community. Because of the disparity in income, it will take longer to be seen and treatment will not follow through. This inadequate access to healthcare and treatment is then reflected in Sentinel City’s health disparities, showing a higher rate of illness, illness-related deaths, and infant mortality.

4.1 Access to Healthcare Services

Introduction Access to healthcare services within Sentinel City is very much the result of the “haves” and the “have nots.” Elms Street and Cambie Street (communities in Sentinel City) are the affluent areas. These areas also have access to public and private transportation. Sentinel City has a public transportation system of buses and light rail. The “have nots” reside on Bleeker St. This area is made up of the homeless, mentally ill, and victims of domestic abuse. According to the windshield survey of Bleeker St., access to healthcare services is made difficult for the residents because there is no nearby clinic, hospital, or doctor’s office. If a resident was in need of medical attention, they would have to travel at least a mile to get to a free clinic and the closest hospital is two miles away. These residents have no access to public or private transportation and would have to walk to their destination. This is a health hazard for the mentally ill and the abuse victims. Any medical attention that they receive would have to be a self-initiative and if a resident is disabled in any way, it would be very difficult for them to get to where they need to go. Due to these access barriers, the quality of healthcare services depends on the community in which a person resides. Health Indicators Access to healthcare services is a large determinant of the overall health of the residents in a community. According to the map of Bleeker St., the health of these residents varies. There is a free clinic run by University Hospital, but the residents would have to travel a mile away to get to it. This clinic is most likely the services utilized by the homeless because it is a short walk from the homeless shelter. The quality of the services here could not be determined, but one could assume that it is better than those received by the homeless at the local mission. The mentally ill and disabled can probably provide more services for their needs. Since the services are at the University Hospital, it is likely that the homeless and those with mental or physical disabilities would be sent to other services in a location with the clinic, taking them away from their own community. Those residing in the abuse victims’ shelter would have to travel the same distance to get to the same clinic. Any victims with a current case of domestic abuse would not be able to get to the free clinic because abuse victims are not allowed to leave the shelter for safety purposes. Any victims of abuse would probably receive medical attention from services done at a location where the clinic is or they would receive in-home visitation.

4.2 Crime Rates

Crime Sentinel City’s community is no doubt plenty of crime, but the crime also transforms the Rawls community (Sentinel) into a safer community with the help of the proper law and order system with justice figures which maintain the peace and rights of the community. Here is the figure that shows the crime rate in 2005. The above figure showed the types of crime in Sentinel City in the year: robbery, aggravated assault, property crime, and motor vehicle theft. But with the proper system and punishment, Rawls said that most of the cases are already solved. So he said that it is safe to take a step to make an improvement in the no scatter city. The proper police system, which maintains peace, even though it still needs some improvement with hiring a new police that record in device. The jail facilities are enough, he said. Most of the criminals were caught because of the cop and the neighbor from the criminal report. “It is predictable that the crime rate will drop significantly by the year 2020 if we keep the same figures, and the people can live a lot safer than before” (Simmons, 2011). And with his spirit to achieve a safer community, with the bottom-up and top-down approach, it still needs time to transform the community despite the efforts worthy to be tried.

As defined by the Family Resource Coalition and the National Organization on Adolescent Pregnancy, Parenting, and Prevention, levels of social support can be understood as physical and emotional sustenance that we receive from family, friends, and community. The support can be in the form of tangible services (such as child care or transportation) or information or guidance. Low-income women typically have few supportive relationships, a loss which is compounded by the absence of warm, trusting relationships with earlier caregivers and the fact that many are isolated by familial immigration. In a study of predominantly low-income African American and Latina women, instrumental support was noted as the most valued type of assistance received from social service providers. The type of person providing the support is an important factor in how easily the support is accepted; although all providers are sources of information and linkage with resources, mental health services and other highly stigmatized services are best provided by quality support providers in the form of close, supportive relationships. These findings lead us to believe that the amount and type of social support available in Sentinel City varies by different demographic groups and is an important factor to consider in the health needs of the population. The community health nurse can attempt to improve access to beneficial resources or attempt to affect healthful behavior changes by providing support in the forms that are most likely to be accepted by targeted groups. This may involve improving the availability of services, changing the types of services available, or assisting individuals to associate with different support providers. The overall goal would be to increase supportive relationships and resources, thus improving clients’ quality of life and facilitating behavior changes that are conducive to the client’s health. With the vulnerable population in mind, health prevention and promotion services should target resources that are lacking and focus on enhancing natural and informal support systems. Since support is seen as such a valuable resource to these clients, the nurse’s ability to improve access to resources and enhance support systems would have a significant effect on the health of the vulnerable population. An increased quality and availability of support may even change the outcome of health disparities within the population.

4.4 Health Disparities

The city of Sentinel has substantial health disparities that exist across populations in terms of the access and availability of resources to attain optimal health. There are certain groups that experience a higher burden of illness, injury, premature death, and potential years of life lost. The map below clearly illustrates the disparities in health status across the city. The more the color of the area tends to red, the unhealthier the particular area is compared to the one whose color tends to green. Areas with people below the poverty line and children are the unhealthiest, whereas old people tend to live in a healthier environment. To see the health disparity, there can be a comparison drawn between two different areas of the city. Consider the case of Hamilton Park with that of Forest Lane. In Hamilton Park, the percentage of the population with below the poverty line income is 19, compared to the meager 1.3 in Forest Lane. The unhealthy days, as reported by the survey, are 5 in Hamilton Park, which is double compared to the days reported in Forest Lane. Now, the healthy air quality days are only 71% in Hamilton Park, compared to 95% in Forest Lane. Steps can be taken to improve the health status in Hamilton Park by identifying the modifiable risk factors and reducing disparities in risk.