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Running Head: COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

Community Health Nursing in Action in DuPage County


Haralambos Vavlas
University of South Florida

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

Community Health Nursing in Action in DuPage County


The purpose of this paper is to understand community health nursing as it pertains to a
certain county, DuPage County. In order to fully understand DuPage County, one must have a
better understanding of the countys environment, people, and culture. This paper will explore
DuPage County in multiple facets. By doing so, it is possible to determine the overall health of
the entire county and determine the need for health policy improvement in DuPage County.
Community Assessment and Local Findings
DuPage County has a population of 933,736 people (Illinois Demographics, 2016).
DuPage is the second most densely populated county in Illinois (Illinois Demographics, 2016).
DuPage is mostly urbanized and developed, with 75% of its land urbanized and 25% consisting
of more rural areas (The County of Dupage, 2016). The top three major employers of DuPage are
Mcdonalds Corporation, Dover Corporation, and Arthur J. Gallagher & Company (Choose
DuPage, n.d.). Together all three provide more than 460,000 jobs to the residents of DuPage
(Choose DuPage, n.d.). There are several major healthcare systems of DuPage County which
include Central DuPage Hospital, Edward Hospital, Elmhurst Memorial Hospital, Adventist
Hinsdale Hospital, Advocate Good Samaritan Hospital, Adventist GlenOaks Hospital, and
Marianjoy Rehabilitation Hospitals and Clinics (The County of Dupage, 2016).
The population in DuPage that is 25 years old or greater and has acquired a high school
diploma is 92.3% (United Sates Census Bureau, n.d.). This figure is greater when compared to
the entire state of Illinois, which is 87.6% (United Sates Census Bureau, n.d.). In addition,
DuPage also has a better percentage of families below the poverty level compared to the state of
Illinois, 7.9% versus 14.4% respectively (United Sates Census Bureau, n.d.). DuPage has a
greater percentage (26.2%) of people greater than or equal to the age of 5 years old who do not

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

speak English compared to the state of Illinois (22.5%) (United Sates Census Bureau, n.d.).
Access to health care is vital to the health of the community. Primary care providers are found in
abundance in DuPage. There are 152.6 primary care providers for every 100,000 people (Centers
for Disease Control and Prevention, n.d.). In comparison, there is only 95.7 primary care
providers for every 100,000 people in Illinois (Association of American Medical Colleges,
2013).
DuPage County Strengths and Weaknesses
The health of the individuals residing in the county is based on both the strengths and
weaknesses the county possesses. In order to determine which aspects of DuPage are strengths or
weaknesses, they will be compared to the top US performers. By comparing the strengths and
weaknesses of DuPage, one is able to get a better picture of the overall health of the residents
that call DuPage home.
Three strengths of DuPage are access to exercise opportunities, physical inactivity, and
the percentage of individuals who attended some college. Access to exercise opportunities in
DuPage was found to be 99% compared to 91% in the top US performers (County Health
Rankings, 2016). Access to exercise includes the countys ability to provide its population with
locations of physical activity including parks, recreational facilities, and various gyms and
community centers (County Health Rankings, 2016). DuPage has thousands of acres of
woodlands including numerous rivers, lakes, and trails, which give its citizens an abundant
amount of places to exercise. DuPage also provides its citizens with indoor ice skating rings, and
gyms for the snowy weather.
Physical inactivity is another strength of DuPage County. In DuPage, 18% of residents
are physically inactive (County Health Rankings, 2016). This is lower than the national

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

benchmarks, which is 20% (County Health Rankings, 2016). In order to be considered as


physically inactive, adults that are 20 years old or greater that reported no physical activity
during their spare time were included (County Health Rankings, 2016). Due to the numerous
opportunities to exercise listed above, it understandable as to why the percentage of physically
inactive individuals in DuPage is lower than the national benchmarks.
Finally, the third strength that was found in DuPage was the percentage of individuals
that attended some college. In DuPage, it was found that 77% of individuals attended some
college, which is well below the national benchmark of 72% (County Health Rankings, 2016).
This percentage included individuals that were anywhere from 25 to 44 years old that completed
coursework at a college or university following high school (County Health Rankings, 2016).
This is beneficial to a community because it has been shown that the more education the head of
the household has, results in better health outcomes in those they are caring for (Centers for
Disease Control and Prevention, 2012). DuPage county truly values education. DuPage is home
to one of the largest community colleges in the United States, The College of DuPage. In
addition, DuPage is home to many other smaller colleges including Elmhurst College, Wheaton
College, Benedictine University, and North Central College. DuPage is also home to many
public high schools and private schools. It makes sense as to why there are many individuals
who live in DuPage with some sort of college experience.
Although there are numerous strengths of DuPage, no county is without weaknesses and
areas that need improvement. One weakness of DuPage is that it has severe housing problems
(County Health Rankings, 2016). Severe housing problems include the percentage of homes in
DuPage that have inadequate kitchen and plumbing facilities or homes in which multiple
families reside in a single residence, causing overcrowding (County Health Rankings, 2016). The

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

percentage of severe housing problems in DuPage is 16% compared to the national benchmarks
which is 9% (County Health Rankings, 2016). It has been found that over 52,000 homes in
DuPage qualify for severe housing problems (County Health Rankings, 2016). Rationale for
severe housing problems may be due to the large percentage of Hispanic or Latino population
that reside in DuPage County. In the Hispanic culture, it is not uncommon to see family members
other than the immediate family living in one household. In DuPage, 13.3% percent of the
population is Hispanic or Latino, which is close to the 15.8% found in the entire state of Illinois
(United Sates Census Bureau, n.d.).
Another weakness of DuPage County is the percentage of individuals who excessively
drink (County Health Rankings, 2016). In DuPage, 21% of individuals excessively drink
compared to the national benchmark of 12% (County Health Rankings, 2016). Excessive
drinking is defined as the percentage of men who drink more than five drinks and the percentage
of women who drink more than four drinks at one time in the previous month (County Health
Rankings, 2016).
The final weakness that was found in DuPage was alcohol impaired driving deaths. It was
found that the percentage of deaths related to alcohol was 26% compared to the top US
performers, which was 14% (County Health Rankings, 2016). Statistics also show that an
estimated 47% of all deaths from car accidents involve alcohol (Drive Sober Illinois, 2008).
Excessive drinking and alcohol impaired driving death may be attributed to the numerous college
towns and bars that are found within the county of DuPage.
Identification of a Priority Health Issue
Although occasional alcohol use has shown no harmful affects to an individual, issues
become apparent when alcohol use becomes excessive. Excessive drinking can be defined as

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

consuming a high volume of alcohol, more than five drinks for men and more than four drinks
for women, in one sitting (Impact DuPage, n.d.). In the United States alone, alcohol is attributed
to the deaths of 88,000 Americans (Impact DuPage, n.d.). Alcohol is known as an addicting drug
and repeated use can lead to dependence, which may not only interfere with an individuals
physical and mental health, but also their family and social lives (Impact DuPage, n.d.).
Excessive alcohol use can be detrimental to an individuals overall quality of life (QOL), which
can lead to hypertension, cardiovascular diseases and numerous forms of cancer including breast,
esophagus and liver (Impact DuPage, n.d.). Mental health problems may also become apparent
with excessive alcohol drinking including depression and anxiety (Impact DuPage, n.d.). In
2010, it has been reported that 37% of car deaths involved alcohol (Impact DuPage, n.d.).
Excessive alcohol drinking amongst individuals under the age of 21 is also a major problem and
has been attributed to more than 4,300 deaths in the US and 189,000 emergency room visits in
2010 (Impact DuPage, n.d.). In addition, young individuals who abuse alcohol are prone to legal
issues, school and social misconduct, and physical and sexual assault. Finally, three Healthy
People 2020 objectives involve reducing alcohol consumption (Impact DuPage, n.d.). For these
reasons in addition to the two weaknesses stated above, excessive alcohol drinking should be a
top priority for DuPage County.
Determinants of Health
The Determinant of Health Model is a model that describes what makes some individuals
healthy and others unhealthy (HealthyPeople.gov, 2016). The main determinants of ones health
include social, personal, environmental, and economic factors (HealthyPeople.gov, 2016). A
single factor is not the sole determining factor of an individuals health, rather it is the
interrelationship of all factors together that determine the health status of the individual

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

(HealthyPeople.gov, 2016). Interventions which focus on attacking several determinants seem to


be most effective in improving overall health (HealthyPeople.gov, 2016). Further determinants of
health include income and social status, education, physical environment, genetics, and health
services (HealthyPeople.gov, 2016). The Determinant of Health model is a great tool to develop
interventions for population based health issues. By using this model, we are able to establish
policies that address many health determinants instead of only focusing on one. We can
positively influence and improve the conditions in which individuals work, live, and play
therefore creating a healthier society. By knowing the interrelationship of factors that determine
health, we are better able to understand and create policies that will benefit the health of the
population as a whole.
Multiple factors contribute to the priority health issue of excessive drinking which
include biological factors, impact of health system, environmental factors, and lifestyle factors.
Neurotransmitters such as serotonin, dopamine, and GABA, are found to be biological factors
that play an important role on the effects of alcohol on the brain and excessive alcohol use
(Anacker & Ryabinin, 2010). Dopamine and Serotonin also play a role in impulsive behavior,
which is more commonly seen in those who excessively drink (Leamy, Connor, Voisey, Young,
& Gullo, 2016). It has also been noted that girls who experience puberty early are more likely to
drink at a young age due to their association with older boys (Windle, 2016). The total cost of
excessive alcohol use in the US is an estimated 223.5 billion dollars (Centers for Disease Control
and Prevention, 2014). Of this, 11% is attributed to excessive drinking and healthcare costs
(Centers for Disease Control and Prevention, 2014). Research has shown that environmental and
lifestyle factors also contribute to excessive alcohol consumption. Research demonstrates an
individuals upbringing, culture, accessibility to alcohol, media, relationship with family and

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

peers, poverty and crowding conditions all contribute to excessive alcohol consumption
(Anacker & Ryabinin, 2010).
Population Diagnoses
Residents of DuPage are at a high risk of multiple comorbidities due to excessive alcohol
consumption. It was found that in DuPage, 21% of adults report having excessive amounts of
alcohol (County Health Rankings, 2016). This is significantly more than the top counties in the
nation, which was 12% (County Health Rankings, 2016). Alcohol abuse claims the lives of
88,000 Americans each year (Center for Disease Control and Prevention, 2015). There are
several characteristics that are associated with excessively drinking. One of these characteristics
is gender. Men report a higher percentage of binge drinking (30 %) compared to women (16.4%)
(Center for Disease Control and Prevention, 2015). Another characteristic is age, in which most
individuals who excessively drink are between the ages of 18-25 years old (Center for Disease
Control and Prevention, 2015). The two ethnicities with the highest prevalence of excessive
drinking were the American Indian or Alaskan Native and Hispanic or Latino (Center for Disease
Control and Prevention, 2015). Evidence of related risk can be seen through the numerous
complications alcohol causes. Excessive alcohol use increases the risk of getting several types of
cancer such as breast, mouth, liver, and colon (Center for Disease Control and Prevention, 2016).
In addition, excessive alcohol consumption increases your risk of hypertension, heart disease,
stroke, and liver disease (Center for Disease Control and Prevention, 2016). Excessive alcohol
consumption even increases your risk of mental problems such as anxiety and depression and
social issues such as family violence and the inability to attain a job (Center for Disease Control
and Prevention, 2016).

COMMUNITY HEALTH NURSING IN DUPAGE COUNTY

Primary Level of Prevention


Primary levels of prevention aim to prevent a disease before it has begun (TrulioLondrigan & Lewenson, 2013). Due to the fact that alcohol is so easily accessible, efforts should
be placed on preventing alcohol consumption in schools and in individuals under the age of 21.
Many school programs have been initiated such as Project ALERT, which provides age
appropriate information to children about drugs and their consequences (Komro & Toomey,
2002). Further primary prevention strategies include role playing, discussions, and in class
activities to engage students in learning about the effects of alcohol (Komro & Toomey, 2002).
Research has shown that strategies that incorporated active participation by students was more
effective in preventing youth alcohol consumption opposed to children not interacting or actively
participating (Komro & Toomey, 2002). Further policies include increasing the legal age of
drinking and decreasing alcohol related media advertisements (Komro & Toomey, 2002). State
legislators should be involved as they are responsible for making the laws as to the legal age of
drinking, in addition to providing funding for alcohol in the media. Teachers should also be
involved as they are at a prime place to teach the youth about the consequences of alcohol abuse.
Community health nurses have a pivotal role in teaching children and parents about the
consequences of alcohol and providing resources for support.
Secondary Level of Prevention
Secondary prevention includes the use of imaging and other techniques in order to screen,
detect, and treat individuals and prevent the disease from progressing (Trulio-Londrigan &
Lewenson, 2013). Due to the fact that men between the ages of 18-25 years old are most likely to
excessively drink, this population should be a primary focus for secondary prevention (Center of
Disease Control and Prevention, 2015). Excessive alcohol consumption is very detrimental to

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internal organs and may cause liver damage and cirrhosis of the liver (Center of Disease Control
and Prevention, 2016). Various types of screening can be done to detect alcohols effect on the
liver, including magnetic resonance imaging (MRI), liver function tests, biopsy of the liver,
clotting factors, and kidney and liver function. Although these interventions are very important,
they are also very expensive. Unfortunately, not all individuals are insured or have the means for
such extensive screening and testing. Free clinics are a way to provide some necessary screening
for these individuals who cannot afford it. Health care professionals including nurses and
physicians play a pivotal role in secondary prevention as they are the ones who screen and
educate patients about their diagnosis. The role of the community health nurse during this
intervention is to educate the patient on the findings and provide information and support to
prevent the disease from progressing.
Tertiary Level of Prevention
Tertiary prevention involves decreasing and managing the negative impact of the disease
and increasing the patients quality of life (Trulio-Londrigan & Lewenson, 2013). Men between
the ages of 18-25 years old will again be the primary focus because they are most likely to
excessively drink (Center of Disease Control and Prevention, 2015). Tertiary preventions include
monitoring the patients liver enzymes continuously to examine any disease progression. Tertiary
prevention also consists of monitoring patient compliance with regular check ups, medication,
drinking cessation, and consuming a low sodium diet to prevent ascites. Referrals to support
groups can also be included in tertiary prevention such as Alcoholics Anonymous (AA). These
support groups offer support from members who are experiencing the same conflicts. State
legislators are in a pivotal role to help support these groups and provide funding in order for
these groups to continue to help their members. Due to cirrhosis of the liver being an incurable

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disease, community health nurses are in a pivotal role to provide emotional support and further
education to better help the patient deal with the consequences and negative impacts of the
disease. The role of the community health nurse during tertiary prevention includes providing
emotional support and making sure the patient maintains compliance of a low sodium diet,
regular physician visits, and daily medications. The community health nurse may provide
additional information on complimentary or alternative medicine to help the patient deal with the
emotional and physical pain of the disease.
Reflection and Synthesis of Health Policy
Health policy has had a great impact on health care and public health (Brownson, Seiler,
& Eyler, 2010). Some of the most prominent accomplishments of public health such as laws that
regulate seatbelts have come from changes in health policy (Brownson et al., 2010). Under age
consumption of alcohol continues to be a major issue in the United States. It has been reported
that alcohol is the most abused drug in the adolescent population in the United Sates (Windle,
2016). In the previous year, 23.6% of children in the eighth grade reported drinking alcohol and
8.6% reported being intoxicated (Windle, 2016). Children who use alcohol are also susceptible to
further emotional and behavioral problems such as fighting, skipping school, depression, and
suicide (Komro & Toomey, 2002). Furthermore, the earlier the child is exposed to alcohol the
more likely he will develop dependence later in life (Komro & Toomey, 2002). In order to
decrease the accessibility of alcohol to the adolescent population, the health policy proposed for
DuPage County is to decrease the economic availability of alcohol by increasing its price. The
level of prevention that this policy addresses is primary prevention. If adolescents are unable to
purchase alcohol due to its high excise tax, this will prevent excessive drinking in addition to the
multiple diseases that occur from excessive alcohol consumption. The goal of this policy is to

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decrease or eradicate drinking in the younger population. Numerous studies have demonstrated
that as the price of alcohol increased there is a decrease in alcohol consumption in both the
general and adolescent population (Komro & Toomey, 2002). Community members that are of
legal drinking age will be affected negatively. Due to the poor decisions of the younger
population, the individuals of legal drinking age will have to pay more for alcohol. Legislators
will benefit due to an increase in revenue from alcohol taxes. In addition, health care providers
will benefit from decreased alcohol related diseases and fatalities. Supporters of the policy would
be the government due to more revenue on taxes and parents who cant stop their children from
consuming alcohol on their own. Opponents of the policy would be the general population who
has to pay more for alcohol and the alcohol companies who may experience a decrease in sales.
In order to implement this policy, I would first review evidence based research on
policies that have been created by other counties in regards to underage drinking. If the results of
this policy benefited the county and the overall publics health, I would prepare a discussion and
take my policy to key stakeholders such as legislators, public officials, health care providers, and
community members to receive their input. I would first start small and approach community
members and healthcare providers before approaching legislators. This health policy will greatly
impact the county by decreasing alcohol related fatalities, drunk drivers on the road, increase tax
revenue, decrease healthcare costs, prevent alcohol dependence later in life, and most
importantly save the lives of young individuals. It has been shown that alcohol abuse occurs
more frequently in low-income and minority populations (Center for Disease control and
Prevention, 2015). Increasing the price of alcohol would ultimately decrease excessive alcohol
use and the comorbidities that follow in these populations. By initiating this policy there would

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be less injuries from drunk driving, homicide, vandalism, and decreased productivity in the
general population.
Conclusion
DuPage County is a beautiful county with multiple strengths including access to exercise
opportunities, physical inactivity, and the percentage of individuals who attended some college.
Although there are multiple strengths of DuPage County, no county is without its weaknesses.
The percentage of individuals who excessively drink and the percentage of alcohol impaired
driving deaths pose a major problem to the health of DuPage and an opportunity for
improvement. This paper has influenced by career as a nurse in multiple ways. It reminds me of
how great of an impact alcohol has not only on the community but on the entire nation. It has
also made me realize the power that I have as a nurse to be active in my community and discover
the weaknesses in my county. From there, I am at a pivotal role to change peoples lives and make
a difference through education and even creating a health policy to better the health of the entire
county.

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