Running Head: NEWAYGO COUNTY

Health Concerns in Newaygo County

Ashley Couturier, Tyler Nickels, Nicole Prins, Victoria Volway, and Ashleigh Windel
Ferris State University

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Abstract
In community health, it is important to gather data on communities in order to explore the
environment in which our patients live. This way we can start working to identify health
concerns and potential risk factors that may be detrimental to ones health, and work to facilitate
better care. As a team, we worked to gather information on Newaygo City, a small city in
Newaygo County, Michigan. Our goal was to evaluate this city, identifying possible health
concerns for this specific population, and develop interventions to help address the main
concerns.

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Health Concerns in Newaygo County

Community is defined by many individuals based on environment that individual was
raised or is presently living in now. According to Community and Public Health Nursing
community is a group of people sharing common interests, needs, resources, and environment
(Harkness & DeMarco, 2012). In public health nursing the environmental resources and
conditions that are apparent are critical to understanding the demographic population as a whole.
Windshield surveys are a snapshot assessment for public nurses to understand possible health
risk the community may experience. Community nursing top goal is to prevent and control
threats against health before detectable (Meuke, 1984). The purpose of this paper is to look at
the city of Newaygo, identify possible health concerns for this specific population, and develop
interventions to help address the main concerns.
Assessment and Analysis
According to The District Health Department (DHD) #10 (2013), the state of Michigan
has a population of 9,883,360 individuals. The city of Newaygo has a population of 47,959
people with 16.8% over 65 years of age and 29.9% under age 18. This population does not
appear culturally diverse, with 96.1% of the population is White (DHD, 2013).
According to Sperling (2014), Newaygos cost of living is 14.7% lower than the United
States average. Even with the lower cost of living, many individuals, approximately 17.9% of
the population find themselves in poverty. This poverty level can make it difficult to gain
insurance and access to adequate health care. The DHD (2013), showed that in Newaygo 11.4%
of the population have no provider, 13.9% have no access due to cost, and 19.3% are
uninsured. This, in itself is a big health concern. Without access to health care and yearly
wellness screenings, individuals are more likely to acquire a chronic illness that would

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eventually cost additional money and be more detrimental to ones health. In addition, lack of
healthcare visits to a primary care provider decreases the opportunity for education on important
healthy habits that could prevent chronic illness.
Another health concern is the obesity level in Newaygo. Overweight individuals make
up 31.7% of the population; that is a greater percentage than the amount of overweight
individuals in the whole state of Michigan. On top of that, 28.7% are obese, meaning their body
mass index (BMI) is above 30 (DHD, 2013). With 60.4% of the total population of Newaygo
being overweight or obese, numerous health concerns arise. This places individuals at a higher
risk for diabetes, heart disease, hypertension, coronary artery disease, and even cancer. The
mortality rates of these diseases have already shown to be relatively high for this county with
109.3 per 100,000 dying from diabetes or diabetes related morbidities, 162.1 per 100,000 from
heart disease, 231.9 per 100,000 from cardiovascular disease, and 192.1 per 100,000 from
cancer.
A big factor that may play into these rates of obesity is diet. In the journal, Preventing
Chronic Disease (2011), it is stated that the prevalence of obesity consistently increases with
frequent consumption of fast-food meals. In fact, fast-food consumption is quite high in the state
of Michigan, with a majority of people stating they eat there purely for convenience (PCD,
2011). Numerous families with low income often succomb to eating foods that are cheap and
convenient, which typically lack in nutrition. The DHD chartbooks (2013) show that 78.4% of
the population has inadequate intake of fruits and vegetables.
Community-focused Nursing Diagnoses
Childhood obesity on the rise public health nursing is critical to find ways to decrease
incidence before morbidity and mortality exist. Taking data from windshield survey it is

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apparent that the main concern is the youth of Newaygo. Obesity can not only cause chronic
illnesses such as diabetes, cardiovascular disease, and orthopedic problems (Department of
Public Health, 2011). Mental health aspect can be hindered also by social isolation and
depression. Risk factors that affect adolescents are genetics, dietary fat intake, sweetened drinks,
family eating patterns, level of physical inactivity and television (Story et al., 2002). According
to Online Journal of Rural Nursing & Health Care (2008), empowering youth to manage their
health while meeting their individual needs is critical. Cochran claimed that improving selfesteem, self-motivation, and empowerment were key to improving the health of obese
children. Newaygo lacked many resources that would increase the risk of obesity in that
community. Nursing diagnoses that would be appropriate at this time would be risk of
imbalanced nutrition; more than the body requires, knowledge deficit, ineffective health
maintenance, activity intolerance, and sedentary lifestyle. Those nursing diagnoses are hard to
understand because child do not have much control over a lot of them. The barriers that a
community nurse face are lack of parent involvement, lack of motivation, and lack of support
systems throughout the community (Story et al., 2002). Interventions are needed to increase
change in all aspects. To go back to the empowerment model referenced by Cochran, it first has
to start with self than organization plan and finally the people need to work together for the
common goal (Cochran, 2008). In order for nurses to perform prevention for children that face
obesity there needs to be a reasonable expectation for weight loss, change in focus of not just
weight loss but also feeling better, huge support system from family and community, nutrition
education, and encourage participation in meal planning and preparing (Cochran, 2008).
Implementing interventions ultimately improves the health of individuals in the community
which is the goal of a community nurse.

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Problem Statement
According to Marjorie Meukes (1984) article on community nursing diagnosis, the
problem statement generated following a trip to Newaygo City was: a risk for altered nutrition;
more than body requirements among school aged children in Newaygo City related to lack of
grocery resources, gyms and recreational activities, as demonstrated in the amount of obese
individuals seen in the community (p.28). The school aged children grades four to five were our
target demographic to assess due to the increased incidence in obesity within the town. These
assessments were based off of the individuals within the community, the families, and
community structure (Nettle et. al, 1989, p.136). Based on our assessments we found that there
were not many gyms in town, and the parks located within the town were nice, but did not seem
to be put to good use by its residents. The city also lacked open space for children to play; the
areas that were considered open in the town either were parking areas, or were a ways out of
town, and would need adult supervision to get to. Finally, the grocery resources available to
children and their families were sorely lacking. The resources included a Plumbs, Save A lot,
and three Dollar Stores. But located throughout the town were numerous fast food restaurants
where families could pick up a meal quickly, and this added to the growing obesity epidemic
among children.

SMART Goal and Interventions

The SMART goal must be specific, measurable, attainable, realistic, and timely
(Haughey, nd, para 1). Our SMART goal for the city of Newaygo was: to have 70% of fourth
and fifth graders obtain a normal body mass index (BMI) and 30% or less have an overweight
BMI (none with an obese BMI) after one year of intervention. Implementation of the SMART
goal will be done within the school districts; at the beginning of the school year, fourth and fifth

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graders BMIs will be measured to see if they are underweight, healthy, or obese. Every three
months a nurse or health educator will come into the kids classrooms and teach them about
healthy eating, portion control, and exercising. The schools will also provide healthier meal
options for the fourth and fifth graders to see if it changes their diets. During this time their
BMIs will be measured again to see if they are losing, gaining, or staying the same within their
weight category. Every three months someone will come in to educate the kids, and check the
status of their BMIs, and at the end of one year the goal is to have seventy percent of fourth and
fifth graders obtaining a normal BMI, with thirty percent or less having an overweight BMI.
Evaluation
To evaluate the effectiveness of the program set forth for the fourth and fifth graders of
the city of Newaygo their BMIs need to be measured every three months first. This will allow
us to measure whether or not the students are getting adequate nutrition, health information, and
exercise inside of school and at the home. Also the health education program needs to be looked
at at the end of the program along with the childrens healthier eating program. By looking at
these two aspects of the interventions we will be able to gauge whether or not the students gained
insight from the information they learned, and liked the food they ate. Finally the exercise
programs will be looked at to see if they helped the students lose weight throughout the year; this
will also be gauged along with the students exercise outside of school. Evaluating all of these
factors will allow us to decide the effectiveness of our SMART goal.
Conclusion
From a survey and statistics gathered on the city of Newaygo it can be determined that
this is a population largely overweight or obese. There were several factors in this community
contributing to the 60.4% overweight or obese population, which includes; easy access to fast

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food, limited areas for physical activity and inadequate choices for grocery shopping. In order to
lower this percentage we have decided that healthy habits should be started early. The goal is to
educate younger age groups and provide them with tools and knowledge to lead healthier lives.

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References
Anderson, B., Lyon-Callo, S., Fussman, C., Imes, G., & Rafferty, A. (2011). Fast-food
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Cochran, J., (2008). Empowerment in adolescents obesity: state of the science. Online Journal of
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District Health Department #10. (2013). Health profile chartbook 2013: Newaygo county.
Retrieved February 6, 2015, from
dhd10.org/images.Newaygo_Chartbook_2013_Feb_18_2014.pdf
Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing. Philadelphia,
PA: Wolters Kluwer Lippincott Williams & Wilkins
Haughey, D. (n.d.). SMART Goals. PROJECTSMART.CO.UK. http://www.projectsmar
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Department of Public Health (2011). Nursing practice guideline for care of child/adolescent who
is obese or overweight.
http://search.CTgov/search?q=obesity&site=CTgov_&filter=p&getfields=*

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Story, M.T., Neumark-Stzainer, D.R., Sherwood, N.E., Holt, K., Sofka, D., Trowbridge, F.L., &
Barlow, S.E. (2002). Management of child and adolescent obesity: attitudes, barriers,
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