Running Head: NEWAYGO COUNTY

Health Concerns in Newaygo County

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

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.

Health Concerns in Newaygo County

Community is defined and based on the environment that the individual was raised or is
presently living in. 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 risks the community may
experience. The top goal of community nursing 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 being 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 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 eventually cost

additional money and be 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 the rates of obesity is diet. In the journal, Preventing
Chronic Disease (2011), it is stated 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 succumb to eating foods that are cheap and
convenient, which typically lack in nutrition. The DHD chart books (2013) show that 78.4% of
the population has inadequate intake of fruits and vegetables.
Community-focused Nursing Diagnoses
Childhood obesity is on the rise, and public health nursing is necessary to find ways to
decrease obesity before morbidity and mortality increase. Taking data from windshield survey it

is 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, but can also affect
ones mental health via social isolation and depression (Department of Public Health, 2011). 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 the 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 self-esteem, selfmotivation, and empowerment were key to improving the health of obese children (Cochran,
2008). Newaygo lacked many resources that would decrease the risk of obesity in the
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. These nursing diagnoses are hard to
understand because children do not have control over themselves. The barriers a community
nurse faces are a 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 on 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, a 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.

Problem Statement
According to Marjorie Meukes (1984) article on community nursing diagnosis, the
problem statement generated following our 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 and 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 use by its residents. The city also lacked open space for children to play; the areas
that were open in town were either parking areas, or were out of town, and would need adult
supervision to get to. Finally, the grocery resources available to children and their families were
sorely lacking. Grocery stores 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, 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 was be done within the school districts; at the beginning of the school year, fourth and fifth
graders BMIs would be measured to see if they were underweight, healthy, or obese. Every three

months a nurse or health educator would come into the childrens classrooms and teach them
about healthy eating, portion control, and exercising. The schools would provide healthier meal
options for the fourth and fifth graders to see if it changed their diets. During this time their
BMIs would be measured again to see if they are losing, gaining, or staying the same within their
weight category. Every three months someone would 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 the school and at home. Also, the health education program needs to be
reevaluated at the end of the program along with the childrens healthy eating program. By
looking at these two aspects of the intervention we will be able to gauge whether or not the
students gained insight from the information they learned, and if liked the food. Finally, the
exercise program will be looked at to see if it 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% of overweight or obese population, which includes; easy access to fast
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 aged children and provide them with tools and knowledge to lead a healthier
life.

References
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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.
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Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing. Philadelphia,
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