running head: sdh: banta community assessment 1 social

Running head: SDH: BANTA COMMUNITY ASSESSMENT 1

Social Determinants of Health: Banta Community Assessment

Melissa L. and Jennifer L. Rouse

California State University, Stanislaus

SDH: BANTA COMMUNITY ASSESSMENT 2

Social Determinants of Health: Banta Community Assessment

Banta Elementary School is located in the small rural community of Banta, California

(CA), just outside of Tracy, CA in San Joaquin County. For the purpose of this paper, the

community of Banta is defined as the area within the Banta Elementary School District, as found

on the Statistical Atlas (2015). The authors of this paper recently performed a community

assessment of the Banta Elementary School site and its surrounding community of Banta, using

various methods. These assessment methods included oral interviews with students (kindergarten

through eighth grade) and staff during the Give Every Child A Chance (GECAC) after-school

program, online database searches, and walking and windshield surveys of the school and

community. Where secondary data were not available for Banta Elementary School District, data

for Tracy, the zip codes in Banta, or San Joaquin County are substituted and noted. Any stated

observations or data that do not have specified secondary data sources were obtained through

personal interviews and walking/windshield surveys performed by the authors of this paper. This

paper will discuss the Banta community assessment, prioritization of community risk factors, and

public health and nursing implications, along with theoretical underpinnings to support these

implications.

The Banta Community

According to the National Center for Education Statistics (NCES) (2014), Banta

Elementary currently serves 318 students. Data provided by the Statistical Atlas (2015) show that

the community of Banta includes 514 households and 5,311 people. It is within San Joaquin

County, is considered part of the Stockton Metropolitan Area, and includes the 95304 and 95330

zip codes (Statistical Atlas, 2015). It is not its own city, but includes unincorporated areas as well

as small parts of the cities of Lathrop and Tracy (Statistical Atlas, 2015). Its residents consist of


8.81% children (ages 0 to 17 years), 5.25% college-aged (18 to 21 years), 49.3% younger adult

(22 to 39 years), 32.2% older adult (40 to 64 years), and 4.46% senior (65 years or older)

(Statistical Atlas, 2015).

Social Determinants of Health and Community Risk Factors

The World Health Organization (WHO) (2015) has identified the social determinants of

health (SDH) as “the conditions in which people are born, grow, work, live, and age, and the

wider set of forces and systems shaping the conditions of daily life. These forces and systems

include economic policies and systems, development agendas, social norms, social policies and

political systems” (WHO, 2015). As public or community health nurse, it is important to

understand these conditions through assessment in order to determine the needs of a community,

identify risk factors and appropriate interventions to address any pertinent issues. The following

will describe each SDH in depth as it relates to the community of Banta, CA.

Neighborhood and Built Environment

Boundaries. The community of Banta as described by its students and staff is the

residential area and farm land directly around the school. For the purposes of the community

assessment, the community will be defined as the Banta Elementary school district which goes

beyond that described of the students and staff. USBoundary.com (2015) defines the area as 37.2

square miles, bordering the Middle River on the north, the San Joaquin River on the east,

Valpico road on the south border and North Chrisman road on the west (USBoundary.com,

2015). The community is called Banta and the name “Banta” appears on street signs, and

buildings such as the Banta General store and the Banta Inn. There are a few neighborhoods

within the community, but not enough to create subcommunities. Many of the square miles

which make up the community include farm land.


Housing and zoning. The houses of this community tend to be built around the middle of

the 20th century, but the types of homes vary greatly throughout the small Banta neighborhoods.

Most homes are made of wood and stucco. The style of homes vary greatly, some ranchette style

laid out on open orchard farm-land, while others are small and contained to smaller lot sizes. The

size of the lots vary anywhere from under one acre to many acres. There are a variety of single-

family homes while multi-family homes were not seen. The majority of homes do not have signs

of disrepair; however, the homes that display disrepair are those that are older and have broken

windows and fences, propped up by wood or other material. According to the information founds

on USBoundary.com (2015), out of the 511 housing units, 42 are considered vacant with the

remaining occupied. Eight homes are for rent and five homes are for sale. The majority of homes

are occupied by two people (USBoundary.com, 2015).

Signs of decay. The neighborhoods are quiet, isolate and do not appear to be “alive.” The

homes are old, but most homes and yards are neat and well-maintained. In some areas, there is

minimal trash, boarded-up buildings such as old stores and dilapidated sheds. Vacant lots appear

to have the more “run-down” structures. The community does not have signs of poor drainage or

disease vector harborage. Although the neighborhoods and built-environments are old, they do

not appear to have poor sanitation/hygiene.

Street people. The windshield survey was done during daylight hours and it was

observed that people were not walking/wandering the streets. Those that were seen outside were

working in their yards, dressed casually while gardening, cleaning, and maintaining property.

Some yards contain large or small pets such as horses, dogs and livestock, but there are few or no

strays visible on the streets.


Neighborhood amenities. The neighborhoods have very few sidewalks and crosswalks.

Safe routes to school via children walking were not determined present. The town has one

market called Banta General which functions as a convenient store. The neighborhoods appear to

be safe because most of the homes have fences or gates. It was observed that the streets do not

have any stray animals roaming; however, animals are present in the front yards of the homes.

Crime and violence. Per the crime and violence rates, data on specifically Banta

Elementary school district are not available. Instead, the data regarding the city of Tracy will be

used in lieu of Banta because they are geographically very close together. According to

Neighborhood Scout (2015), Tracy, CA ranks 24th on the crime index where 100 is the safest.

This indicates that “Tracy is safer than 24% of the cities in the US.” In Tracy, there are 114

crimes per square mile compared to California having 89 crimes per square mile. It is indicated

that “the chances of becoming a victim of either violent or property crime in Tracy is 1 in 33 and

according to the FBI crime data, Tracy is not one of the safest communities in America. Relative

to California, Tracy has a crime rate that is higher than 69% of all cities and towns of all sizes in

the state.” The types of crime include, violence such as rape, assault, murder, and property crime

such as vandalism and robbery (Neighborhood Scout, 2015). In the town of Banta, there are no

actual areas for incarceration; however, in the city of Tracy, the California Department of

Corrections and Rehabilitation (CDCR), (2015) identifies the Deuel Vocational Institution (DVI)

as “ a reception center that receives inmates from 29 Northern California counties.” The DVI

does not house juveniles, but instead adults who are determined level one or two inmates

(CDCR, 2015).

Health and Health Care


Service centers. There are no hospitals, doctor’s offices, dental offices, social agencies,

community clinics, recreation centers, or health-career-related school that were observed in

Banta. There is one occupational health clinic on the outskirts of Banta’s school district lines,

which only serves the Tracy Defense Depot (CHMA, 2009). U. S. Hospital Finder (2015)

confirms that there are no hospitals within Banta, though the closest hospital, Sutter Tracy

Community Hospital, is only 3.58 miles away in Tracy, CA. The next two closest hospitals are

Kaiser Foundation Hospital, 7.41 miles away in Manteca, CA, and Doctors Hospital of Manteca,

9.98 miles away in Manteca, CA (U. S. Hospital Finder, 2015). Tracy, being the nearest city to

Banta, offers most of the medical and health services that Banta lacks. In Tracy, there are many

primary care options, including providers at Sutter Health’s Tracy Care Center at 2151 West

Grant Line Road; Dentistry options include Millennium Dental at 436 W. Beverly Place;

Community clinics include Planned Parenthood’s Tracy Health Center at 1441 North Tracy

Boulevard; Social agencies include VBR Foster Family Agencies, Inc. at 72 W. Eleventh Street,

Suite A; And recreation facilities include Tracy Sports Complex at 955 Crossroads Drive

(iMatrix Dental, 2015; iSport, 2015; Planned Parenthood Foundation of America, 2014; Sutter

Gould Medical Foundation, 2013; VBR Foundation, Inc., 2014). These are only a few of many

healthcare options available in Tracy.

Protective services. Tracy Fire Station # 92, which used to be located in the center of

Banta, can now be seen on Grant Line Road just outside of Banta at 1035 East Grant Line Road,

Tracy (City of Tracy, 2015a). There is no police department in Banta, but the Tracy police

department is also located just outside of Banta, at 1000 Civic Center Drive, Tracy (City of

Tracy, 2015b). Neither police nor fire vehicles were observed on the roads or responding to calls

in Banta during times of observation.


Health and morbidity. While the infant mortality rate for Banta was unavailable, the

infant mortality rate for San Joaquin County was 5.8 per 1,000, which is higher than the

California state infant mortality rate of 4.7 for 2011 through 2013 (Lucile Packard Foundation

for Children’s Health, 2015a). In 2015, 88.2% of Banta’s incoming Kindergarteners had all of

the required immunizations, compared to 95.6% of San Joaquin County’s Kindergarteners, as a

whole (Lucile Packard Foundation for Children’s Health, 2015b). Obesity is the primary

observable chronic health condition of this community. From direct observation, there is no

evidence of accidents, communicable diseases, alcoholism, drug abuse, or mental illness.

However, the data show that some of these health issues are, indeed, faced by both Banta

students and the whole community. According to WestEd’s California Healthy Kids Survey of

Banta’s seventh grade students, 24% of these students have ever used drugs or alcohol, 4% have

ever smoked a whole cigarette, 8% currently use alcohol or drugs, and 4% have used drugs or

alcohol on school property (WestEd, 2014). A total of 36% of these seventh grade students

reported having ridden in a car driven by someone who had been drinking (WestEd, 2014). This

strongly suggests that alcoholism is a problem in Banta. The top known causes of death of

residents of the 95304 and 95330 zip codes in 2012 were cancers, heart disease, and stroke

(California Department of Public Health [CDPH], 2012). These are likely to be some of Banta’s

biggest chronic health concerns, at least two of which may also be tied into Banta’s observed

obesity problem. Banta’s 2013-2014 Physical Fitness Report states that 18.2% of Banta’s fifth

graders and 23.4% of its seventh graders need improvement in their aerobic capacity to the point

where their health is at risk (California Department of Education [CDE], 2015c). In addition,

12.1% of Banta’s fifth graders and 23.4% of its seventh graders are at a health risk related to

their body composition (CDE, 2015c). There were 387 deaths and 4,165 non-fatal


hospitalizations due to accidental injury in San Joaquin County in 2013 (CDPH, 2013).

California, as a whole, had a total of 17,417 deaths and 251,485 non-fatal hospitalizations due to

accidental injury in 2013 (CDPH, 2013). The primary acute conditions observed in this

community were colds (rhinopharyngitis), fractures, and abrasions.

Social and Community Context

Parks and recreational areas. During the afternoon and evening, very few people were

observed out and about in the community. This could be due, in part, to the lack of parks and

recreational areas in Banta. Beyond the school gates, there are no sports fields, parks,

community centers, or youth centers in the Banta community. According to Banta students, the

primary locations for recreation and sports in Banta are the school’s own fields, gym, and

playgrounds. These areas are primarily used by Banta’s students. However, the fields are in need

of some renovation, according to GECAC students and staff. The current fields consist of some

green grass, dead grass, and patches of dirt. “We twist our ankles when we try to run”, “If I could

change one thing about my school, I would add new fields to play on”, and “The fields aren’t

really useable, unless you want kids to get hurt”, were some of the statements from staff and

students, related to the school’s current fields. In addition, the fields and black top areas, where

students spend most of their outdoor time while at school, lack shade during the late morning

through early evening hours. Most children interviewed go into Tracy and other larger towns and

cities for their recreational and social activities outside of school.

Race, ethnicity, and religion. It was observed that the students at Banta Elementary

were primarily of Caucasian and Hispanic descent, with small of African-American and Asian

students. According to the CDE, Banta Elementary’s students are 64.5% Hispanic, 28.6% White,

4.6% two or more races, 1.7% African American, 0.3% Asian, and 0.3% Pacific Islander


(2015b). There is a larger percentage of English learners at this school, making up 33.8% of the

students, compared to the San Joaquin County percentage of 23.11%, and the California state

percentage of 22.3% (CDE, 2015b). According to the Statistical Atlas (2015), Banta’s overall

population has a similar but slightly different make-up, consisting of 44% White residents, 32%

Hispanic residents, 17.2% Black residents, 2.7% Asian residents, 2.6% Mixed residents, and

1.4% “Other” residents. In Banta, the top three ethnicities of residents of European and African

descent are “Other”, at 65.1% of this specific population, Irish, at 11.6%, and German, at 11.2%

(Statistical Atlas, 2015). The top three ethnicities of residents of Hispanic descent are Mexican,

at 81.1%, “Other Hispanic”, at 7.9%, and Puerto Rican, at 6.6% (Statistical Atlas, 2015). The top

three ethnicities of residents of Asian descent are Cambodian, at 19.0%, Filipino, at 19.0%, and

Laotian, at 17.6% (Statistical Atlas, 2015). Of those residents who were actually born in a

country other than the United States, the majority, 68.4%, was born in Mexico, followed by

Portugal, at 9.7%, and the Philippines, at 4.3% (Statistical Atlas, 2015). There is one church in

Banta, called The Mission, which is located right beside Banta Elementary School. While no

people were observed at the church on the weekdays and weekday evenings of observation, the

sign in front of it listed the church’s service times as Saturdays at 6:00 PM and Sundays at 10:15

and 11:30 AM. According to the church’s website, the church building is called The Mission, but

the church, as a group of people, is known as Mission City Church (Mission City Church, n.d.).

They do not specify any denomination, but state their vision as being “to see people far from

God encounter love and life through Christ” (Mission City Church, n.d.).

“Commons”. While no community gatherings or social meetings were directly observed

in this community, there is still evidence of some organized community gatherings and events.

For example, the 24th annual Banta Hay Day took place on the Banta Elementary campus on


Saturday, October 3rd, 2015. It was open to everyone, including community members outside of

the school and strangers. Many students at Banta Elementary expressed excitement about the

Hay Day, and there was a large sign announcing it in the preceding weeks at the community’s

only intersection with a stoplight: Grant Line Road and El Rancho Road. Similar to Banta

Elementary acting as the primary recreational and sports area, it seems that it also acts as the

main place that people gather and ”hang out” in this small community, even beyond school

hours. In addition to the school, there is a bar-and-restaurant called the Banta Inn, which can be

seen and visited in the main community, and a Mexican restaurant called Casa Mendoza right at

the border of the school district. According to Yelp! (2015a), the Banta Inn is open from 11:00

AM to 2:00 AM Mondays through Thursdays, 8:00 AM to 2:00 AM Fridays and Saturdays, and

8:00 AM to 10:00 PM on Sundays. Casa Mendoza is open from 6:00 AM to 2:00 PM, except on

Sundays when it opens at 7:00 AM instead (Yelp!, 2015b). These also appear to serve as

community hangouts. Finally, while no people were directly observed at the Mission, it has

potential to serve as a community hangout, as well. Outside of the school, church, and two

restaurants, it seems that most social activity takes place within homes or outside of this

community.

Class. This community’s residents appear to be a mixture of lower, working, and middle

class. This is primarily based on the appearance of the homes and neighborhoods in this

community, as well as the appearance of GECAC students and the family members or friends

who pick them up. This is also supported by the data in the “economic stability” section of this

paper.

Transportation. The most commonly observed method of transportation in and through

the community of Banta is private motor vehicle transportation. Its streets seem reasonably well


maintained, with visible road stripes and without any major potholes or debris. There are no

designated bike lanes on the roads. Banta is near the intersection of two major interstates:

interstate 5 and interstate 205. These interstates appear to be used fairly heavily by semi-trucks

transporting goods and commuters- many commuting into the San Francisco Bay Area. There are

not any Tracy TRACER bus routes, nor any San Joaquin Regional Transit District (RTD) bus

routes that go into or through Banta (City of Tracy, 2014; San Joaquin Regional Transit District,

2015). Tracy does offer Paratransit curb-to-curb pickup for seniors and those who are disabled to

the point that they cannot get to or on the bus, but the service area is not specified, and the one

map shown does not include Banta (City of Tracy, 2014). Train tracks run through town, but

appear to primarily serve cargo trains. The closest Amtrak train stations are in Tracy, 5.29 miles

from Banta’s center, and in Lathrop, 6.59 miles from it (National Railroad Passenger

Corporation, 2015).

Politics. There were no political posters or party headquarters observed in Banta, so it

cannot be assumed that there is a particular predominant political party based solely on

observation. Banta includes the congressional districts CA-9 and CA-10, the state Senate district

CA-5, and the state Assembly districts CA-12 and CA-13 (Statistical Atlas, 2015). The

representatives of Banta’s congressional districts are Jerry McNerney, a Democrat, for

congressional district CA-9, and Jeff Denham, a Republican, for congressional district CA-10

(United States House of Representatives, n.d.). The representative of Banta’s state Senate district

is Cathleen Galgiani, a Democrat (California State Senate, 2014). The representatives of Banta’s

state Assembly districts are Kristin Olsen, a Republican, for district CA-12 and Susan

Talamantes Eggman, a Democrat, for district CA-13 (California State Assembly, 2011). With


three Democratic and two Republican representatives, it seems the data agree that while Banta’s

area may be slightly more Democratic, neither party is strongly dominant.

Education

Preschool. Within the Banta school district boundaries, there is one preschool which is

located on the Banta Elementary School site. The preschool/day care program available called

“Creative Child Care.” According to ChildcareCenter.us (2015), this program serves children

ages three to five, has a maximum capacity of 48 children and is a non-subsidized childcare

program (ChildcareCenter.us, 2015).

K-12 education. Two types of schools exist within the Banta School district community.

First is Banta Elementary which serves students in kindergarten through eighth grade. According

to the NCES, Banta Elementary currently serves 318 students (2014). Of these children, 98 are

White, 202 are Hispanic, six are Black, two are Asian/Pacific Islander and no students are

American Indian/Alaskan. There are 165 males and 153 females. The student/teacher ratio is

22.71 (NCES, 2014). The California Department of Education (CDE) states that of the students

who attend Banta 72.3% qualify for a free or reduced lunch (2015b). The Standardized testing

and reporting (STAR) scores have been a struggle of Banta Elementary. In grades two through

seven, the English scoring of the STAR for each category is as follows: 12% in advanced, 27%

proficient, 35% basic, 18% below basic and 10% far below basic. In grades two through seven,

the mathematics scoring of the STAR for each category is as follows: 15% in advanced, 25%

proficient, 25% basic, 19% below basic and 3% far below basic (CDE, 2015a). The CDE

provided specific scores for each grade, but the authors took the data and computed the average.

At Banta Elementary, there is not a school nurse on site; however, the San Joaquin County

Office of Education (SJCOE) sends out Public Health Nurses to the school site to teach staff


basic first aid, administer immunizations and evaluate the school environment as it relates to

health. The Banta School district does not contain any high schools (ninth through twelfth

grade), so those who enter into high school from this district attend Tracy High School in Tracy,

CA. Information obtained from Tracy High School’s 2013- 2014 School Accountability Report

Card indicates that during the 2013-2014 school year, the high school graduation rate was

88.69% (School Innovations & Achievement, 2014). This rate is higher compared to the average

of public high schools in California which had an 80.44% graduation rate in the same school

year (School Innovations & Achievement, 2014). Data provided by the Statistical Atlas (2015)

show Banta’s educational attainment rate as 37.8% with no high school diploma, 54.4% have a

high school diploma and 7.7% have a higher degree. In California, 18% of people have no high

school diploma, 44% have a high school diploma and 38% have a higher degree The people

included in the data are over the age of 25 years old (Statistical Atlas, 2015).

The other school that exists and is listed on the Banta Elementary School District website

(2015) is the Next Generation STEAM (Science, Technology, Engineering, Arts, and Math)

Academy and is a dependent charter school for kindergarten through eighth grade students

located in Lathrop, CA (Banta Elementary School District, 2015). The school website for the

STEAM Academy (2015), describes this school as focusing on “project-based learning” which

encompasses a wide variation of curriculum and skills (STEAM Academy, 2015).

Post secondary education. The closest colleges to the Banta Elementary school district

are those of San Joaquin Delta College and UEI Community College in Stockton, CA and San

Joaquin Valley College and Modesto Junior College in Modesto, CA. These colleges range

anywhere from 15-30 miles from the Banta Elementary school district. The students at Banta

Elementary have access to tablets which are ‘mini’ computers with internet access. Also, of those


students who attend Tracy High School they are able to use the school library for internet and

research on post secondary education information and research. The Banta School district does

not have any public libraries; however, Tracy has a public library, which offers free access to

internet and resources to the public.

School based health services. At Banta Elementary, the school based health services

provided are primarily through education. GECAC is an afterschool program aimed at helping

every child become successful in what they do. Part of their afterschool curriculum includes

health education such as talking about healthy foods, healthy behaviors, and being physically

active. The education is tailored to each developmental level in order for the students to

understand the teaching. Although there are no school based clinics, staff and nursing students

from the SJCOE administer vaccinations such as the flu shot and DTaP to students on campus.

Economic Stability

Jobs. Statistical Atlas (2015) identifies the median average annual household income for

those living in the Banta Elementary school district as $64,200. The average annual household

income for people in California is $61,100. The average annual income of families who qualify

for food stamps is $7,300, and of those, 72.8% are children. The unemployment rate is 1.2% as

defined by people who currently do not have a job, have looked for a job in the past four weeks

and are able to work. In California, the unemployment rate is about 8%. Another category exists

called ‘other’ which is defined as those who are not in the labor force and do not meet the criteria

of being employed or unemployed during data collection. In the Banta Elementary school

district, the other category is made up of 85.2% compared to California at 35%. Currently, the

most common occupations are management, transportation, farming and administration which of

10-14% of people. Construction, repair and material moving make up about 6%. Business,


education, sales, food service, personal care, production, law enforcement, engineering and

entertainment account for 3-5% (Statistical Atlas, 2015). A few children expressed concerns of

food insecurity at home, with statements like “sometimes it’s hard for my mom and grandma to

get food… with the money, it’s hard, you know” and “I think we try to eat healthy, but

sometimes my parents only have a little money”. There are many vacant buildings which were

observed as run down, no longer in service and abandoned.

Stores. The Banta Elementary school district does not have supermarkets, neighborhood

stores, laundries, dry cleaners, food banks or homeless shelters. The only store in the community

is Banta General, which is a small convenient/drug store. Other buildings include one Subway,

one restaurant, a mechanic auto shop and the Banta Inn. In order for the citizens of the

community to access supermarkets, restaurants, stores, and other resources, they drive into

Tracy.

Key Findings: Prioritization of Risk Factors

Top Risk Factor: Food Insecurity

The top risk factor that the authors of this paper identify in Banta is food insecurity. Not

only are there no local grocery stores or supermarkets, some families may also lack the necessary

resources, like money and transportation, needed in order to obtain adequate amounts of healthy

food. The relative food desert status of Banta is supported by the community assessment findings

in the “Transportation”, “Jobs”, and “Stores” sections of this paper. The $7,300 average annual

income of families who qualify for food stamps is especially alarming (Statistical Atlas, 2015).

According to Maslow’s Hierarchy of Needs, physical needs, such as food, are the first and most

important needs a person has (Huitt, 2007). Healthy food is an everyday physical need, so food

insecurity is ranked as the top risk factor in this community.


Second Risk Factor: Lack of Public Transportation and Access to Healthcare

The second highest risk factor in Banta is lack of transportation, especially related to

access to healthcare. As discussed in the “Service centers” and “Transportation” sections of this

paper, there are no hospitals, clinics, or primary care providers in Banta, and although Tracy

offers various types of healthcare, a private motor vehicle is required to travel between Banta and

the resources in Tracy. There is no public transportation between Banta and Tracy for people

without private motor vehicles, and Tracy’s Paratransit, which qualifies people only based on

age and disability, may not serve the Banta area. This combined lack of transportation and access

to healthcare combines to create a serious health risk for Banta residents. The first and second

levels of Maslow’s Hierarchy of Needs, physiological needs and safety/ security needs, are both

put at risk by this lack of transportation and access to healthcare (Huitt, 2007). Since these needs

fall primarily into the second level of safety and security, but also fall into the first level during

times of illness and injury, this is rated just below food insecurity, as Banta’s second highest risk

factor (Huitt, 2007).

Third Risk Factor: Low Educational Achievement

The third risk factor in Banta is low educational achievement. This poses a risk to both

the health of the people in Banta as well as the economy. In an article by US News Education

(2011), authors state that “those with bachelor's degrees, no matter the field, earn vastly more

than counterparts with some college ($1.55 million in lifetime earnings) or a high school diploma

($1.30 million lifetime), indicating that no matter the level of attainment or the field of study,

simply earning a four-year degree is often integral to financial success later in life” (US News

Education, 2011). With this said, educational attainment affects the financial security of an

individual or family, along with other factors such as financial responsibility, financial choices,


and sometimes family heritage. As stated previously in sections “K-12 Education” and “Jobs”

there are a high percentage of people who do not have a secondary degree as well as many who

fall into the ‘unemployed’ or ‘other’ categories. With little education, this may create limited

opportunity for financial security/attainment and prevent access to necessities such as adequate

health care. Education early on in life is crucial to developing the knowledge, skills, and

academic drive needed to succeed in the future. Unfortunately, the children at Banta Elementary

school struggle with their State Standardized testing scores as discussed above in the “K-12

Education” section which can ultimately affect their ability to succeed as adults in the future.

This was ranked as the third risk factor because according to Maslow’s Hierarchy of Needs, the

security of health, employment, resources, and property can all be affected by one’s ability to

financial provide, which goes back to educational achievement (Huitt, 2007).

Theoretical Underpinnings

In order to effectively make a change based on the needs assessment, it is important to

relate the process to a theory in order to recognize how it may play out or what the intended

goals are to be. One of the most important and widely used nursing concepts used in Public

Health Nursing is the Public Health Model of Prevention. According to Allender, Rector, and

Warner (2014), this model is composed of a pyramid with three levels of prevention, which build

on each other. The bottom level is primary prevention which consists of health promotion,

education, and protection. The middle level is secondary prevention which is early diagnosis of a

problem and prompt treatment. Tertiary prevention is the top level, which includes rehabilitation

which attempts to reduce the severity of a problem that has already been identified (Allender,

Rector & Warner, 2014).

Public Health and Nursing Implications


Top Risk Factor: Food Insecurity

At the primary prevention level, a public health nurse should advocate for the

community’s needs of having a local grocery store, supermarket, and/or farmer’s market. This

type of advocacy could be done within discussion at the Public Health Department, grant writing,

or the nurse being a representative at local community board meetings. At the secondary

prevention level, a public health nurse should screen the health status of the local community by

assessing the population's BMI, malnutrition, obesity and overall physical-well being. The nurse

could conduct such assessments by creating a health screening event in which public health

nurses, nursing students, and volunteers come together to serve the community. The nurse can

use his/her resources to obtain necessary equipment for screening and then coordinate volunteers

(other public health nurses and student nurses) to conduct the screening/assessments. At the

tertiary level, a public health nurse could again advocate those who were identified as being

affected by living in a food desert by providing necessary resources for nutrition (WIC program),

food stamps, and bringing farmer’s markets to the community of Banta once a week.

Second Risk Factor: Lack of Transportation and Access to Healthcare

At the primary prevention level, a public health nurse should address the issue of lack of

public transport and access to healthcare in two ways. First, he or she should advocate for bus

routes that extend into Banta to serve this community. Second, he or she should advocate and

even search for grants or other funding for a mobile or permanent primary care and dental

clinic(s) to be set up in Banta, to provide care at least a few days per week. (The St. Joseph’s

CareVan in Stockton, CA is one successful example of a mobile clinic caring for the community

by providing free health services, such as screenings and care for minor, urgent health issues (St.

Joseph’s Medical Center Stockton, n.d.). At the secondary prevention level, a public health nurse


should screen for acute and chronic diseases at the proposed clinic(s), as well as continue or

increase screenings that already take place at Banta Elementary. At the tertiary level, a public

health nurse should provide care to ill or injured patients at the proposed clinic(s), as well as

provide or advocate for free, reduced-rate, or sliding scale home-based care for people who are

ill or injured in this community who have no other reasonable means to obtain their necessary

care. In these ways, a public health nurse could comprehensively address this risk factor at all

three levels of prevention (Allender, Rector, & Warner, 2014).

Third Risk Factor: Low Educational Achievement

At the primary and tertiary level, the public health nurse could implement the

idea/advocate for a school garden along with science-based curriculum. A school garden would

be beneficial to many aspects of childhood education, development and nutrition. Cynthia

Klemmer, director of education and development at the National Garden Association, and her

colleagues performed a study on 647 third, fourth, and fifth graders from Temple, Texas

(Klemmer, Waliczek, & Zajicek, 2005). They provided all teachers with the traditional,

classroom-based science curriculum, which all the 647 students were exposed to and taught. The

experimental group participated in school gardening activities along with the traditional

curriculum, whereas, the control group did not have the hands-on garden experience. After a year

of this study, the students took a grade-appropriate science test, which was based on the criteria

for the school district. In the article, Growing Minds: The Effect of a School Gardening Program

on the Science Achievement of Elementary Students, Klemmer et al. (2005) discuss the use a one-

way ANOVA to determine if any statistical difference existed. Interestingly, students in the

experimental group scored 5.6 points higher on the science achievement test compared to the

students in the control group who did not have experience with the garden. Based on the p-value


of 0.001, the findings were statistically significant. This study alone supports the notion that

students who have hands-on, experimental activities have higher knowledge levels (Klemmer et

al., 2005). At the secondary level, teachers could also advocate for continued use of educational

screening such as the California Standardized tests. This would be a way to identify the students

who are having academic difficulty and hopefully allow for quicker intervention.

Banta is a small rural community near Tracy in San Joaquin County, CA. The authors of

this paper recently performed a thorough assessment of this community and found its top three

risks to be food insecurity, lack of public transportation and access to healthcare, and low

educational achievement. The authors discussed potential public health nursing implications for

each of these risk factors and supported these implications with Public Health Model of

Prevention (Allender, Rector, & Warner, 2014). This paper as a whole has provided this

community with assessment, diagnosis, and planning, which are the first three steps in the

nursing process (American Nurses Association, Inc. [ANA], 2015). It has set the stage for the

implementation of interventions that could help improve the health and decrease the health risks

of the little rural community of Banta.


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