Suggestions for Health Education Program Planners? Address how health education can address the predisposing, reinforcing, and enabling, and factors related to the health issue. You may refer to specific health education strategies in this section. For example, if you read a peer-reviewed journal article that describes a health education intervention with a sub-population that is similar to your target sub-population, you can refer to that information in this section; be sure to cite it accordingly.
?Recommend a health education theory/model (other than PRECEDE) that could be used as afoundation for planning a health education program to address the key health issue in the target population. Be sure to use key constructs or concepts from the selected theory/model to enrich/support your discussion. Remember, the theory/model must be a good fit. ? Indicate what community assets/resources are available to assist health education program planners in addressing the key health issue.? Describe community individuals and organizations with influence in the community who might support efforts to address this issue.? If relevant, briefly discuss policies or statutes within the community that can support health education efforts to address the key health issue. ? Feel free to add any other information that you deem to be pertinent to this section.
Health Issue -Sexual Health
Location - Denton County, TXRunning Head : COMMUNITY ASSESSMENT PROJECT Community Assessment Project: Sexual Health Maria Martinez, Aayusha Adhikari, Sydney Fongnaly, Ifrah Fahmi-Wilson Dr. Mandy Golman HS 3053.01 Community Health Texas Woman’s University December 5th, 2022 1 Running Head : COMMUNITY ASSESSMENT PROJECT 2 Community Assessment Project: Sexual Health Part I SOCIAL ASSESSMENT History: Shortly after Texas decided to join the union, Denton County was established by the Texas legislature on April 11, 1846, (Denton County History, n.d.). Though before its creation, Denton County was included in extensive areas of Peters Colony, a land grant obtained by William S. Peters in 1841 (Denton County History, n.d.). The county was named after John B. Denton, a Methodist minister, lawyer, political candidate, and soldier who was killed in a raid against Native Americans (Reverend John B. Denton, Jr., n.d.). Since its establishment, the county has had four county seats, the first was located along Pecan Creek and was named Pinckneyville, the second and third locations were both named Alton, and the current county seat resides in what is now known as present-day Denton (Denton County History, n.d.). Following the end of the Civil War, Denton County began to thrive. With the development of wheat and cotton farms and more railroads being built across the county, the economy began to boost. In addition, Denton County became home to several higher-level institutions. The most well-known colleges in the region include The University of North Texas, which was founded in 1890, and Texas Woman’s University, which was founded in 1901 (Odom, 2012). As a result, the county saw a surplus in population, and by the 1970s, Denton County became one of the fastest-growing counties in the nation (Denton County History, n.d.). Geographic Boundary: According to the U.S. Census Bureau (2020), Denton County is located in the Northeast region of Texas and spans approximately 900 square miles. It is surrounded by Collin, Cooke, Wise, Tarrant, Dallas, and Grayson Counties and is closely associated with the Running Head : COMMUNITY ASSESSMENT PROJECT 3 Dallas metropolitan area as major highways in the county include Interstate 35, which forks extensions towards Dallas and Fort Worth (Denton County, n.d., see Appendix A). Denton County also encompasses several towns and cities such as Argyle, Carrollton, Lewisville, and Frisco (Denton County, TX: Official Website, n.d.). Demographics: As of July 2021, the Denton community consists of a total of 148,146 residents. Of these, 57.4% are White, 25.2% Latino/ Hispanic, 10.1% Black, 4.0% Asian, 0.9% American Indian and Alaskan Native, and 0.2% Native Hawaiian. (U.S. Census Bureau, 2021) There are a total of 51.4% female residents and 48.6% males. This percentage has been constant throughout previous years as well. A majority of the population are people under 18 years of age, which account for 19.8%. People over 65 years of age follow with 11.3%, while children under 5 consist of only 5.8% of the total population. There are quite a few veterans in the community, consisting of 6,201. Out of all Denton residents, 8.1% have a disability. 16.5 % of the total Denton community do not have any type of health care coverage. 67.2% of Denton residents are currently employed, which is better than the national average of 61.6% Poverty has affected Denton residents more than the national average. Denton consists of 15.3% for people in poverty, while the national average is 11.4% (U.S. Census Bureau, 2020) The median household income is also lower than the national average, standing at $62,542. Denton is a college city, which aligns with the 91.0% high school graduation rate. However, those with a Bachelor's degree accounts for 39.5% of the total population. Key Leaders: There are 20 individuals who are listed on the Denton County Website as their ‘Leadership Team.’ This team consists of; Dayton Arkansas (Assistant Bioterrorism Coordinator), Jodi Ashbaugh (Assistant WIC Director), Marty Buchanan M.D (Division Manager, Health Authority/Medical), Tammy Eoff (Health Administrator), Leslie Freeman Running Head : COMMUNITY ASSESSMENT PROJECT 4 (Environmental Health Coordinator), Joe Paul Gallo, RN (Division Manager/Disease Control and Prevention), Kamilah Hasan (Health Education Program Coordinator), Jennifer Hernandez (Senior Forensic Death Investigator, Felicia Hopkins(Division Manager-Health Preparedness & Response), Fara Jaimes (Administrative Manager), Heather Lee(Assistant Nursing Supervisor), Sarah McKinney(Immunization Program Coordinator), Kathleen Oliver (WIC Director). Alex Reed (Division Manager/Community Health), Matt Richardson (Director of Public Health), Isabel Rodriguez (Indigent Care Coordinator), Juan Rodriguez (Assistant Director/ Chief Epidemiologist), Carden Sanders (Juvenile Health Administrator), Catherine Sembajawe-Reeves (Division Manager Administration and Compliance/ Privacy Officer), and Kristine Sledge (Clinical Nursing Supervisor). (Leadership Team, n.d.) The Denton key leaders constitute of a diversified group of people, including the mayor of Denton; Gerard Hudspeth, as well as Police Chief Frank Dixon (City of Denton - TML City Officials Directory, 2022) Civic involvement and community assets: The TWU Denton campus allows for multiple opportunities for civic engagement, encouraging students to get involved and participate in the different resources and activities offered around campus. For example, there are initiatives like Walk to the Polls, and Pioneers Vote, that highlight the importance of voting, while educating students on voter registration and local polling sites. This is combined with resources made available by TWU on election information. On the other hand, there are multiple services offered, (Helping Hands, Alternate Breaks, Big Event, and Make a difference Day), that give students a chance to be a part of volunteer projects and take sanctioned trips to continue civic duty in the global community (Civic engagement 2022). While we have a vast amount of volunteer opportunities and community service, there isn’t anything apparent regarding sexual health volunteering and much civic involvement in these sources of community engagement. Running Head : COMMUNITY ASSESSMENT PROJECT 5 Community assets for the TWU Denton campus specifically are well-ranged and inclusive. With multiple clubs and access to create your own club, the student life is impeccable for those who have the opportunity to participate in all its activities. There are multiple lounge areas, indoor and outdoor, meditation rooms, rock climbing, yoga studios, fitness and recreation center, with different on-campus workouts by student instructors, as well as intramural sports, open gym, etc. A lot of great resources such as a wide range of food sources, water bottle refill stations placed around campus, transportation, bike racks, volunteer programs, and the list continues (Find Resources 2022). Gatekeeper Interviews: The gatekeepers were decided based on previous fields of study, and current positions held in the TWU Denton Campus. Faculty with backgrounds in sexual health, family, and overall wellness were ideal and were the main prospects reached out to. The questions in the interview were geared towards views on the health systems in place on TWU Denton Campus. Moreover, it was important to grasp if these practices were sufficient in meeting the sexual health needs of students, and what needed to be assessed to access as many students as possible. In this, there is a need to assess the broader community, Denton County, and its efforts with ensuring healthy sexual habits. The best format for the first interview was by sending a list of questions via email and having the gatekeeper respond with answers. In Dr. Menn’s interview, the need for sexual health care access 24/7, or after business hours was addressed numerous times. As well as, assistance for students commuting or distanced from campus who need access to healthcare information and facilities. It was important to mention that the sexual health needs for those students were lacking and that it needed to be addressed with new practices in place on campus, online, etc.(M. Menn, personal communication, October 4, 2022, see Appendix B.). It is important to mention Running Head : COMMUNITY ASSESSMENT PROJECT 6 that the interview was cut short due to unknown reasons, yet the full interview is listed below regardless. In addition to faculty members, it was important to receive insight from a student’s perspective, specifically one who is involved in the community’s planned programs. Therefore, the second interview was conducted in person with TWU’s Residence Hall Association finance officer, Miranda Lizcano. In Miranda’s interview, she addressed the lack of visibility and awareness for sexual health on campus. She also believed that TWU does not provide accessible access to students with all of their health needs. For reference, she mentioned that although there are several health services on campus, TWU does not provide dental services despite having a dental hygiene program on campus (M. Lizcano, personal communication, November 29, 2022, see Appendix C.) EPIDEMIOLOGICAL, BEHAVIORAL, & ENVIRONMENTAL ASSESSMENT Denton has several health issues affecting almost every group within the county. These are largely chronic diseases and addictions that can have lifelong effects. To best address these issues, it is important to understand the epidemiological data of the county. This report will provide an overview of the epidemiological data for Denton County to understand the health needs of the population better. Data will be collected from leading health agencies both within and outside Texas. One of the country's most pressing issues is breast cancer, whose incidence rate is regarded as very poor. Notably, the incidence rate, as of 2021, was 112.8 compared to the national US value of 125.9. Besides, the data from the last decade shows an increasing trend in the incidence rate, which is worrying (Breast Cancer Incidence Rate (National Cancer Institute), 2022). There are also other concerning reports on other cancers whereby the incidence rates are seen to be closely approaching the averages set by the US. For example, Denton's value stands at Running Head : COMMUNITY ASSESSMENT PROJECT 7 408.5 compared to 407.7 and 448.7 for Texas and the United States, respectively (Cancer Incidence Rate; All Causes (National Cancer Institute), 2022). Although not as prevalent, deaths as a result of Parkinson's disease are equally concerning. For example, Denton's value is 9.5 compared to 8.1 for Texas, meaning that the county's residents are more susceptible to the disease than most of the counties within the state (Age-Adjusted Death Rate due to Parkinson's Disease, 2022). Equally important is alcohol abuse, whereby Denton County is seen to have 21% of adult binge and heavy drinkers. These rates are higher than the national average, which stands at 15%, and that of the State of Texas, which stands at 20% (2021 Annual Report, 2021). Accordingly, the epidemiological data is in congruence with the different health concerns outlined by different community gatekeepers. For instance, a leading concern is breast cancer which is backed by data showing a high incidence rate in the county. Similarly, high rates of alcohol abuse are also corroborated by epidemiological data. This means that the community's health concerns are based on real data, not just perceptions (2021 Annual Report, 2021). In light of the data given, there is no doubt that breast cancer is the main health concern in Denton County. The issue largely affects women above the age of 19 years. Notably, there are different risk factors associated with breast cancer. Some of these include genetic, behavioral, and environmental factors. In genetic factors, Welch (2009) notes the prevalence of breast cancer among some women because of certain genetic factors inherited from parents. The genes BRCA1 and BRCA2 are particularly cited as some of the most common gene mutations linked to breast cancer, whereby the risk can be as high as 70%. Behavioral factors include alcohol consumption, obesity, and not getting enough exercise. Notably, even moderate consumers, such as those who drink a day, can be susceptible to breast cancer, particularly women. Lastly, the environmental factors include exposure to radiation and Running Head : COMMUNITY ASSESSMENT PROJECT 8 certain chemicals. For example, women who have had radiation therapy to the chest area are more prone to developing cancer compared to those who are yet to be exposed. Similarly, women who often interact with certain chemicals, such as those found in hair dyes and some cosmetics, can develop breast cancer, although the risk is not as much. Notably, this risk also depends on the level of exposure (Merrill et al., 2016). Some of these chemicals include benzene and formaldehyde, which can be found in women's products and some environments like gasoline stations, as seen in Tunsaringkarn et al.'s (2012) study. References 2021 Annual Report. (2021). PART ll Educational & Ecological Assessment PRECEDE Analysis. The PRECEDE model examines the predisposing factors, reinforcing factors, and enabling factors that affect a community’s quality of life, in this case, the key issue is sexual health. An illustration of a PRECEDE model can be found in Appendix D. Predisposing factors: There are several predisposing factors that contribute to an individual’s sexual health and behavior. For example, disparities in healthcare-seeking behaviors amongst different genders, specifically for sexual and reproductive health seem to be an area of concern. In fact, studies have shown that men are less likely to seek preventative medical care than their female counterparts and also lack knowledge of specific sexual health issues (Burrell et al., 2019.). This is an important matter of concern, as Denton County’s cases of sexually transmitted diseases such as HIV continue to increase (Health North Texas, n.d.). Therefore, it is crucial for people to take preventative measures to forestall the spread of the disease despite not showing any symptoms. Running Head : COMMUNITY ASSESSMENT PROJECT 9 In addition, a person’s ethnic beliefs can cause them to face challenges regarding their sexual health, including cultural resistance to sexual education. For instance, many parent-adolescent relationships are affected by taboos surrounding sexuality and often refrain from the topic of sexual health. As a result, adolescents become vulnerable to threats such as coercion, sexual abuse, pregnancy, HIV, and other sexually transmitted infections (Latifnejad Roudsari et al., 2013.). Though another factor may include family structure. Studies found that adolescents in married, biological two-parent families are less likely to partake in unprotected sex and early sexual initiation compared to those from single-parent, families (Mmari et al., 2016.). Additionally, individuals whose parents have higher education and income are both associated with sexual postponement and consistent contraceptive use (United States, 2001). However, having older siblings may also influence sexual behaviors in adolescents especially if the older siblings are sexually active or have experienced an adolescent pregnancy (United States, 2001). Reinforcing factors: Reinforcing factors consist of rewards or encouraging feedback, whether that is positive or negative, that people receive from other community members (Doyle et al, 2019, p. 124). In reference to sexual health on the Texas Woman’s University campus, some factors include peers’ actions and behaviors toward sexual health. The continued perceptions, attitudes, and overall outlook on sexual health topics will influence those within the community moving forward. For example, if a majority of the student’s beliefs on using condoms are that it is not needed, then that will reinforce that unsafe sex health practice. Another factor that plays a vital role in what the standard is in social/community norms is the media. A study done back in 2014 found that most of the respondents (73.5% of 400 undergraduate students) opined that the Internet has a bad influence on youths' sexual behavior, and concluded that uncontrolled Running Head : COMMUNITY ASSESSMENT PROJECT 10 exposure to mass media and the Internet could negatively influence the sexual patterns and behavior of youths (Asekun-Olarinmoye et al, 2014). The media can reinforce exaggerated ideas of campus culture in relation to sexual activity. With a variety of movies, television shows, social media platforms, radio, etc. there is a lot of information being presented on how sex is perceived and how to approach engaging in sexual activities. These factors can continue to reinforce outdated, or unsafe practices in college students, and it continues to do that even seen on TWU’s campus. On the other hand, an overall positive reinforcement is the student health center, guidance counselors, and sexual health initiatives on campus. Continuing to hear from key holders, and people who have knowledge in sexual health can help drown out the unsafe practices, and reinforce sexual health. Enabling factors: An environment may lead to the motivation of a certain act, a behavioral change in an individual, or it can also have no effect at all. Enabling factors in regard to this survey include: the culture of the campus i.e., if there is any known positive reinforcements or negative persuasions in practices of one’s sexual preferences, personal views on sexual wellness, as well as how common health barriers such as having no insurance might play a role in the ultimate decision of the student’s involvement with their sexual health. The term campus culture is a broad statement that encompasses social constructs such as peer pressure, and how this may change the perceptions of TWU students. This term also entails inclusivity and how it is embraced throughout campus, as well as how well-equipped TWU is with helpful sexual wellness resources. These sources may include but are not limited to: providing free condoms, having an accessible clinic, or providing sexual education presentations to students about the importance of sexual wellness. Running Head : COMMUNITY ASSESSMENT PROJECT 11 Instrumentation and Data Collection The instrument used for data collection is based on a survey created by Texas Woman’s University Students in 3053.50 (Appendix B). There was an extended group discussion on what students thought to be focal problems surrounding our campus. Sexual health, pregnancy, as well as mental health were some topics that were interesting to the class. After some thought, all peers decided that the topic of sexual health would lead to extended discussions that could potentially help address problems surrounding this topic not only throughout the TWU campus, but in Denton county as well. After ample thought, there was a focus on four major research questions: 1. How important is sexual health to TWU students? 2. What are barriers to accessing sexual health services? 3. Where do TWU students receive sexual health information? And lastly, 4. What do TWU students think about the sexual health culture on campus? Once the research questions were formulated, the class now had the task to determine underlying questions that fit the four research questions. It was discussed that it would be best if the survey was a non-randomized purposive sample. This way, there were no specific obligations from the participants, therefore all TWU students could partake in the survey. Another key discussion was whether to have a mix of qualitative, quantitative, or both types of questions. The surveyors quickly realized that a mix of both types would be most beneficial, that way, the group could formulate conclusions based on repeating themes throughout answers provided by those who took the survey: to gain a better understanding of the actual factors that play in the sexual health of TWU students, instead of perceived issues by one’s experiences. After producing a variety of questions, the class grouped them based on how fit the questions were for each research question. Subsequently, this led to a rough draft of the survey, which was modified to have flow and elevated vocabulary so participants would be able to Running Head : COMMUNITY ASSESSMENT PROJECT 12 understand what the surveyors were trying to observe. When the final draft was finished, Google Forms was used as the medium to receive responses. After the data collectors had an idea of the layout of the survey, there was a discussion about the method of delivering the survey to all TWU students. It was determined that the snowball effect would be beneficial, not only because it does not require extra resources, but also because it was rather simple; tell two friends, then tell those friends to pass it on to two others, and so on. However, there was a realization that this method did not generate the number of responses needed. Therefore, a QR code was created as well as a flyer that was sent out via email to others. After this, there was an overwhelming amount of responses, which was well over our goal of a hundred. The group ensured to include a brief statement before beginning the survey that way, participants did not feel as if they had to continue throughout the questionnaire if they felt uncomfortable. The participants were also given a quick synopsis of the purpose of the survey and assured of the anonymity and confidentiality of their data. Part III Pilot Study Results Data Analysis: The data from the survey was collected and analyzed using both google sheets and google forms. The google form the survey was initially created in, automatically generated the totals and percentages of responses, which were then translated into graphs and charts. Participant demographics: The total number of participants was (n=168), all of whom were Texas Woman’s University students between the ages of 18 and 59. The results from the survey illustrated that there was a diverse group of people, where Caucasians accounted for the Running Head : COMMUNITY ASSESSMENT PROJECT 13 majority of participants at 47.6%, followed by Hispanic/Latino at 26.2%, Black/African American at 22.6%, Asian/Asian American at 9.5%, Biracial/Multiracial at 6.5%, American Indian/Native Alaskan at 4.8%, Middle Eastern at 2.4%, Guyanese at 0.6% and 1st generation Indian American at 0.6% (see Appendix). Of the students who took the survey, 88.7% were female, 8.3% were male, 3.6% were non-binary, 3% were genderqueer, 0.6% were agender, and 0.6%, were genderfluid (see Appendix E). When presented with the question of what best describes their sexual orientation, 65.5% responded with straight/heterosexual, 20.8% responded with bisexual, 8.9% responded with pansexual, 6% responded with queer, 4.2% responded with lesbian, 3% responded with questioning, 2.4% responded with asexual, and 1.2% responded with gay, (see Appendix). Perceived Quality of Life: When participants were asked where they currently live, 48.8% responded off-campus, 27.8% responded with parents or family members, and 27.2% responded on-campus (see Appendix). When it came to asking participants about their primary source of health insurance, 29.8% said by their parents/guardians plan, 22% said by employers, 20.2% said by their parents/guardians/spouses plan, 15.5% said by Medicaid, Medicare SCHIP, or VA/Tricare, 14.3% said they had no insurance, and 1.8% said by a student health insurance plan (see Appendix). To help assess if individuals prioritize their sexual health, the survey included questions that asked males how frequently they have physical check-ups and females how frequently they have gynecological check-ups. According to the survey, of the 20 males who participated, 15 said once every 12 months, 3 said never, 1 said once every 2 or more years, and 1 said at least twice within a 12-month period (see Appendix). On the other hand, of the 152 females who took the survey, 64 said they visited the gynecologist once every 12 months, 43 Running Head : COMMUNITY ASSESSMENT PROJECT 14 responded never, 26 responded once every 2 or more years, 17 responded at least twice within a 12-month period, and 2 responded with don’t know. Survey Question 9: What does sexual health mean to you?: To get an understanding of participants’ knowledge of sexual health, the first qualitative question asked in the survey was “what does sexual health mean to you?”. After analyzing the responses, there were various students who said sexual health means practicing safe sex, getting regular checkups, communicating with partners, and being educated on the matter. The full detailed responses can be seen in Appendix E. Survey Question 10: Do you believe sexual health is important? Why? It is clear to note that the participants in this survey agreed that sexual health is important to them. Not only do they believe this, but many insist on promoting education that encourages safe sex, as well as regular testing to younger audiences. Responses of reproductive rights and bodily autonomy were also a commonality that supported participants’ claims on why sexual health is important to them. Safety (condom usage) and the maintenance of adequate health was also a commonality on reasonings behind why sexual health is important in the lives of TWU students. (See Appendix G) Survey Question 11: How important is sexual health education to you? A Likert scale was used to determine the importance of sexual health to TWU students. Rankings 1 (not important at all)- 5(very important) were used to generate answers based on individual opinions. Out of a total of n=168, more than the majority, 76.8%,(to be exact) agreed that sexual health is very important (5) to them. This does not only demonstrate that these participants emphasize their sexual health education, but this gives the surveyors a greater insight on the extent that Running Head : COMMUNITY ASSESSMENT PROJECT 15 health education persistis within TWU students. (Appendix H shows the total number of responses from rankings 1-5). Survey Question 12: Do you prioritize your sexual health after hearing a health education presentation about the topic? Results were retrieved through a Likert scale for this question where 1 equated to least likely to prioritize sexual health after hearing an health education presentation on the topic, and 5 set to . Survey Question 13: My peers generally practice safe sex. The following question was also formatted using a Likert scale, with one being strongly disagree and five being strongly agree. Of the participants (n=168), 9 students responded with 1, 26 responded with 2, 56 responded with 3, 47 responded with 4, and 30 responded with 5. It is apparent that a majority of participants were either unsure or believed that their peers are practicing safe sex. A visual representation of the data can be seen in Appendix K. Survey Question 14: How often are you practicing safe sex? Health Education Conclusion Amongst the 168 study participants, it is clear that sexual health is very important to these TWU students. Running Head : COMMUNITY ASSESSMENT PROJECT 16 References Age-Adjusted Death Rate due to Parkinson's Disease. Denton County, Texas. (n.d.). Retrieved October 4, 2022, from https://denton.tx.networkofcare.org/ph/HealthIndicatorsDetails.aspx?hid=60674 Asekun-Olarinmoye OS, Asekun-Olarinmoye E, Adebimpe WO, Omisore AG. Effect of mass media and Internet on sexual behavior of undergraduates in Osogbo metropolis, Southwestern Nigeria. Adolesc Health Med Ther. 2014;5:15-23 https://doi.org/10.2147/AHMT.S54339 Breast Cancer Incidence Rate (National Cancer Institute). Denton County, Texas. (n.d.). Retrieved October 4, 2022, from https://denton.tx.networkofcare.org/ph/HealthIndicatorsDetails.aspx?hid=60236 Burrell, C. N., Sharon, M. J., Bassler, J., & Davidov, D. M. (2019). Gender Differences in Sexual Health Knowledge Among Emerging Adults in Acute-Care Settings. The Journal of the American Osteopathic Association, 119(5), 289–298. Retrieved November 7, 2022, from https://doi.org/10.7556/jaoa.2019.050 Cabinet and Staff - Texas Woman's University. (2022, August 30). Texas Woman's University. Retrieved December 5, 2022, from https://twu.edu/chancellor/cabinet-and-staff/ Cancer Incidence Rate; All causes (National Cancer Institute). Denton County, Texas. (n.d.). Retrieved October 4, 2022, from https://denton.tx.networkofcare.org/ph/HealthIndicatorsDetails.aspx?hid=60166 Running Head : COMMUNITY ASSESSMENT PROJECT 17 Civic engagement. Civic Engagement - Texas Woman's University. (n.d.). Retrieved October 9, 2022, from https://twu.edu/civic-engagement/ Denton County, TX: Official Website. Denton County, TX | Official Website. (n.d.). Retrieved October 4, 2022, from https://www.dentoncounty.gov/ Denton County. Denton County | TX Almanac. (n.d.). Retrieved October 8, 2022, from https://www.texasalmanac.com/places/denton-county Denton County History. Denton County History. (n.d.). Retrieved October 8, 2022, from https://www.dentoncounty.gov/352/Denton-County-History Doyle, E., Ward, S., & Oomen-Early, J. (2019). The process of community health education and promotion (3rd ed.). Long Grove, IL: Waveland Find resources. Find Resources - Texas Woman's University. (n.d.). Retrieved October 9, 2022, from https://twu.edu/student-life/find-resources/ Healthcare Team - Texas Woman's University. (2022, August 11). Texas Woman's University. Retrieved December 5, 2022, from https://twu.edu/student-health-services/healthcare-team/ Healthy North Texas. Healthy North Texas :: Indicators :: HIV Diagnosis Rate :: County : Denton. (n.d.). Retrieved November 7, 2022, from https://www.healthyntexas.org/?module=indicators&controller=index&action= view&comparisonId=&indicatorId=1584&localeTypeId=2&localeId =2635 National Poverty in America Awareness Month: January 2022. (2022, January 21). Running Head : COMMUNITY ASSESSMENT PROJECT 18 U.S. Census Bureau. Retrieved October 9, 2022, from https://www.census.gov/newsroom/stories/poverty-awareness-month.html Latifnejad Roudsari, R., Javadnoori, M., Hasanpour, M., Hazavehei, S. M. M., & Taghipour, A. (2013, February). Socio-cultural challenges to sexual health education for female adolescents in Iran. Iranian journal of reproductive medicine. Retrieved November 7, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941358/ Mmari, K., Kalamar, A. M., Brahmbhatt, H., & Venables, E. (2016, November 7). The influence of the family on adolescent sexual experience: A comparison between Baltimore and Johannesburg. PLOS ONE. Retrieved November 7, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0166032 Odom, D.E. (2012). Denton, Tx (Denton County). Texas State Historical Association. Retrieved October 8, 2022, from https://www.tshaonline.org/about/people/e-dale-odom Reverend John B. Denton, Jr.. Reverend John B. Denton, Jr. | Denton County, TX. (n.d.). Retrieved October 8, 2022, from https://www.dentoncounty.gov/375/Reverend-John-B-Denton-Jr Shrider, E. A., Kollar, M., Chen, F., & Semega, J. (2021, September 14). Income and Poverty in the United States: 2020. U.S. Census Bureau. Retrieved October 9, 2022, from https://www.census.gov/library/publications/2021/demo/p60-273.html Tunsaringkarn, T. (2012, April 10). Cancer Risk Analysis of Benzene, Formaldehyde, and Acetaldehyde on Gasoline Station Workers. Herbert Publications. Retrieved October 4, 2022, from https://www.hoajonline.com/jeees/2050-1323/1/1 Running Head : COMMUNITY ASSESSMENT PROJECT 19 United States. Public Health Service. Office of the Surgeon General. (2001). The Surgeon General's call to action to promote sexual health and responsible sexual behavior. Rockville, MD : Office of the Surgeon General, https://www.ncbi.nlm.nih.gov/books/NBK44220/ U.S. Census Bureau QuickFacts: Denton city, Texas. (n.d.). U.S. Census Bureau. Retrieved October 9, 2022, from https://www.census.gov/quickfacts/fact/table/dentoncitytexas/LND110210 U.S. Census Bureau quick facts: Denton County. (2020). Retrieved October 9, 2022, from https://www.census.gov/quickfacts/fact/map/dentoncitytexas,dentoncountytexas/LND110 220 Running Head : COMMUNITY ASSESSMENT PROJECT Appendix A (Denton County, n.d.) 20 Running Head : COMMUNITY ASSESSMENT PROJECT 21 Appendix B Community Health Assessment Full Interview with Dr. Menn 1. How long have you been a faculty/staff member at TWU? a. Since January 2015 2. Are you a Denton resident? a. Yes, I have been a Denton resident since 2019. Prior to living in Denton, I lived in Frisco and commuted into Denton. b. If so, what do you think are your community’s strongest assets/ flaws? i. Assets: Embracing diversity, UNT/TWU/NCTC keeps Denton focused on young people, college students, and new ideas, there are a lot of local events to engage the community ii. Flaws: Mass and low-cost transportation challenges, few 24-hour resources, constant turnover (As student leaders and peer health educators graduate as we want them to, they tend to leave schools or towns to pursue employment. It is tough to sustain programs for longer than a couple of years with high, natural turnover.) Do you believe Denton provides residents with enough resources specific to health or health care? c. Absolutely not 3. Based on your experiences at TWU/Denton, what are the top three sexual health issues that you are most concerned about? a. Access to timely and medically-accurate information and recommendations, especially for LGBTQ students b. Access to sexual and reproductive health care outside of “business hours” on campus c. The invisibility of sexual health services (I could not tell you what resources are available to students without checking the website or making a few phone calls) 4. What do you think are the challenges to addressing these issues? a. The biggest challenge is the substantial number of distance learners attending TWU. I am a huge proponent of distance education. I think distance learning works when it is done correctly. With that said, I think health educators haven’t ‘cracked the code on how to offer sexual health information to students at a distance in a way that cuts through the noise students experience on a daily basis. Students receive countless emails and are flooded with websites, links and QR codes, and social media sites, and I think health educators have a hard time reaching and resonating with distance students like on-campus events tend to do. 5. Do you believe TWU provides accessible access to students with all their health needs? Running Head : COMMUNITY ASSESSMENT PROJECT 22 a. Not yet. There are opportunities for TWU to provide students with more 24-hour opportunities. 6. If not, what types of initiatives would you implement for those who are a part of this community? a. 24-hour medical provider availability on campus b. Sexual health products (condoms, dental dams, Plan B) available widely across campus both in dorms and in non-residential spaces for non-residential students 7. In your opinion, what are the family planning services provided at the community’s health facility? a. Well-woman/well-man exams b. STI/HIV testing c. Pregnancy testing d. Birth control counseling and prescriptions 8. Our Community Needs Assessment focuses on the sexual health and wellness of TWU students. With your time here at TWU, what have you seen to be the biggest challenges faced by students in regard to their sexual health? See my response above regarding challenges. 9. Many campuses have been made aware of the effects of teen pregnancies and unplanned pregnancies and how this can have a major impact on the quality of life of their students. With TWU being made up of mostly female students, it is important to note that TWU does not have IUD clinics available for its students. Do you believe the implementation of these clinics will aid in the number of unplanned pregnancies while bringing awareness to this disregarded issue? This is written as a very loaded and leading question. 10. Being a part of this community, what are the most popular modern methods of contraception that are used by individuals and couples/ if any used? a. Do these methods help combat the spread of STDs and STI’s? 11. Many students may not feel comfortable answering questions regarding their sexual health because it has become a taboo topic. Are there any apparent differences in the number of involvement regarding sexual health between different demographic groups? a. If so, what do you believe are the reasons behind this significant contrast? 12. Is there anything else that you would like to include about your community’s needs and assets? Running Head : COMMUNITY ASSESSMENT PROJECT 23 Appendix C Community Health Assessment Full Interview with Miranda Lizcano 1. How long have you been a faculty/staff member at TWU? a. RHA Finance Officer for 1 year and TWU student for 2 years. 2. Are you a Denton resident? If so, what do you think are your community’s strongest assets/ flaws? a. Not a Denton Resident, but currently lives on campus. 3. Do you believe Denton provides residents with enough resources specific to health or health care? a. I would not be able to tell you if Denton provides residents with enough resources specific to health or health care as I am not from this area and seek help for health-related issues elsewhere. However, I would like to believe that Denton provides the best for its residents. 4. Based on your experiences at TWU/Denton, what are the top three sexual health issues that you are most concerned about? a. The top three sexual health issues that concern me the most are STDs, access to contraceptives such as condoms and birth control, and sexual consent. 5. What do you think are the challenges to addressing these issues? a. I believe the challenges to addressing these issues may be due to the topic of sexual health being taboo, especially since I don’t really hear or see any awareness about sexual health on campus. 6. Do you believe TWU provides accessible access to students with all their health needs? a. Although TWU provides students with access to several health services, I don’t think they help students with all of their needs. For instance, TWU does not provide dental services despite having a dental hygiene program on campus. 7. If not, what types of initiatives would you implement for those who are a part of this community? a. Since I am a member of RHA, we could tailor programs/events toward health needs by working with organizations to provide students with services that are not offered here at TWU. 8. In your opinion, what are the family planning services provided at the community’s health facility? Running Head : COMMUNITY ASSESSMENT PROJECT 24 a. At the community’s health facility I believe they offer pregnancy testing, STI screening, and birth control counseling. 9. Our Community Needs Assessment focuses on the sexual health and wellness of TWU students. With your time here at TWU, what have you seen to be the biggest challenges faced by students in regard to their sexual health? a. The biggest challenge that I have seen faced by students at TWU would most likely be seeking help. Even though TWU provides sexual health services, I feel that many are embarrassed or ashamed. 10. Many campuses have been made aware of the effects of teen pregnancies and unplanned pregnancies and how this can have a major impact on the quality of life of their students. With TWU being made up of mostly female students, it is important to note that TWU does not have IUD clinics available for their students. Do you believe the implementation of these clinics will aid in the number of unplanned pregnancies while bringing awareness to this disregarded issue? a. Yes, however, I believe some students wouldn’t take advantage of IUD clinics especially since many don’t even access the health services offered now. 11. Being a part of this community, what are the most popular modern methods of contraception that are used by individuals and couples/ if any used? a. Do these methods help combat the spread of STDs and STIs? i. The most popular modern methods of contraception that are used include birth control (pill, shot, IUDs) and condoms. ii. I believe condoms are the only form of contraceptive that prevents the spread of STDs and STIs. 12. Many students may not feel comfortable answering questions regarding their sexual health because it has become a taboo topic. Are there any apparent differences in the number of involvement regarding sexual health between different demographic groups? a. If so, what do you believe are the reasons behind this significant contrast? i. I definitely think there is a difference, being a Hispanic and growing up in a traditional household I know that talking about sexual health is not the cultural norm. I think many parents feel as if their children should be abstinent instead of taking the time to educate them on how to practice safe sex if they do become active or even care for their sexual health as a whole. 13. Is there anything else that you would like to include about your community’s needs and assets? Running Head : COMMUNITY ASSESSMENT PROJECT n/a 25 Running Head : COMMUNITY ASSESSMENT PROJECT 26 Appendix D Running Head : COMMUNITY ASSESSMENT PROJECT Appendix E Appendix F 27 Running Head : COMMUNITY ASSESSMENT PROJECT Appendix G 28 Running Head : COMMUNITY ASSESSMENT PROJECT 29 Appendix H “Is Sexual Health important to you?Why?” Theme Response Education Many responses include thoughts on the implementation of education for sexual health. Participants encourage this for the fact that they believe it will increase self awareness as well as driving STI/STD testing to increase especially within the younger generation. Prolonged Health Maintaining health is a factor that plays into why TWU students emphasize the importance of sexual health within their lives. Reproductive Rights According to TWU students, the importance of sexual health also relies on reproductive rights. Having bodily autonomy is a big factor that coincides with students’ sexual health. n=168 Appendix I n=168 Running Head : COMMUNITY ASSESSMENT PROJECT Appendix J n=168 Appendix K 30 Running Head : COMMUNITY ASSESSMENT PROJECT 31