NAP 2

HS 3053.01 Community Health

Spring 2021

Table of Contents

Introduction ………………………………………………………………..4

Geographic boundary………………………………………………………..4

History ……………………………………………………………………….5

Demographics………………………………………………...........................6

Key Leaders……………………………………………………......................6

Community Gatekeeper Interviews……………………………………………6-8

Epidemiological assessment.…………………………………………………….8

Key Health Issue………………………………………………….……………..9

Behavioral and environmental assessment………………………………….…9-10

Appendix A …………………………………………………………………….10

Appendix B……………………………………………………………………...11

References……………………………………………………………………..12-13

Needs Assessment Project - Maternal Mortality

Community Description. Comment by Alex Quezada: You’ve taken a different approach to this assignment. Typically, a geographic community is targeted, such as City of Dallas or Denton County. You’ve put together a well-developed section so I’m going to just go ahead and leave it mostly as is.

Geographic boundary . African Americans are one of the largest minority groups in the United States. Low income African American women contribute to about 13% of the total female population and are making impressive strides in various sectors including but not limited to health, education, and participation (Black Demographics, 2020). However, there exist significant disparities between them and their white counterparts in areas like Dallas, Texas. As a result, new policies have been over time implemented to improve their lives in an attempt to close the gap. Additionally, although African American women are spread across the entire U.S, more of them live in the south or north. For example, Dallas happens to be one of the largest cities that many low- income women move to because of how expanded their opportunities are in receiving a job, housing, or even resources to assist with their situation. For example, tThe major program that the City of Dallas relies on is the Section 8 Housing program. Comment by Alex Quezada: It looks like you’re targeting the city of Dallas so in this section, tell me about Dallas. When was it founded? Where is located? Size? Comment by Alex Quezada: Move this to your Key Health Issue section

The Ssection 8 program in Dallas provides about 75 percent of funding for household living at or below 30 percent of the area median income (EndHomelessness). Moreover, low income African American women contribute to 52% of the total Bblack population, meaning that they have outnumbered the Black male population.

Demographics. Likewise, as of 2019, the population size of low income African American women in Dallas was about 22 million, with their average age being 36 years. They contribute to 13 percent of the total women population in the U.S. About 39% of the African American women are aged 18-35. In terms of economic standing, 72% of the total African women aged 16-64 are currently in the labor force, while 92% of them are employed. 24% of the total black American women live below the poverty level compared to 14% of their white counterparts (Black Demographics, 2020). 64% of the black women have white collar jobs, 8% are working in blue collar jobs while the rest 28% work in service occupations. Generally, statistics show that there is a higher rate of unemployment among Afro-American women, which is 10% compared to the 6% of all women. Comment by Alex Quezada: Don’t start sentence with a numeral – write it out or rearrange the sentence Comment by Alex Quezada: Unless your describing a different group, stay consistent in your verbiage (African American)

Key Leaders. There are various key leaders and personalities who have inspired the African American women community, with the former first lady Michelle Obama being among them. Other personalities who have become role models of the community include sportsperson such as Serena Williams. The issues of concern to the African American Women community vary widely. One of the key issues is their underrepresentation in the government at all levels. Of the ninety-eight women in the congress, only fourteen of them are Afro-Americans. Besides, the underrepresentation is not limited to the political arena but also goes beyond politics to facets such as employment, which has contributed significantly to high poverty levels among the community. Another key issue of concern to the community is that they are health issues. The case is so because 1 out 4 Afro-American women is not insured (Newman & Kaljee, 2017). BesidesAdditionally, various diseases such as hypertension are highly prevalent among the community. Comment by Alex Quezada: I recommend identifying key African American women leaders in the Dallas area. Comment by Alex Quezada: Relevant information but not a good fit for this section Comment by Alex Quezada: Cite

Civic Involvement and Community Assets. African American women have in recent times been involved in various civic engagements including political issues and the fight for their rights through spreading public awareness via movements. The Black Lives Matter (BLM) and other national movements are other civic engagements that have seen women contribute significantly with an aim of raising more awareness and holding police accountable for their deeds. In terms of assets and resources, African American women have been by far behind their white counterparts. For instance, in 2007 the estimated median wealth of African American women was about $100 compared to $45,400 of white women (Richard, 2014). However, the case has been improving and in 2018, the median salary for a full-time African American woman was about $36,695. The Afro-American women own assets such as social security, Medicaid, Medicare, vehicles, home, and bank accounts, among others.

Gatekeeper Interviews. The first interview was conducted with a resident of Denton, a health studies student from Texas Woman’s University, Ms. Cox. This was an opportunity to gain knowledge and insight into her experience, as the community has grown over time. She was chosen as one of the interviewees because she is a representation of our targeted population, she is an African American young woman who has encounters with hypertension. She was also chosen due to her interest in providing service to the less fortunate. Due to the status of the pandemic, this interview was conducted via Ffacetime. We were able to discuss many things and Ms. Cox expressed any concerns she may have. Those concerns were targeted towards the black population, hypertension. Hypertension is high blood pressure and can commonly be caused by things such as family history, obesity, smoking or unhealthy eating habits. Hypertension is a prevalent health condition within the black community and has been identified as an underlying condition that can cause further compromised health conditions. Ms. Cox mentioned assets that she deemed were essential, they were libraries, shelters, and hospitals. This allows the opportunity to be knowledgeable about the subject and ways to help the community’s public health. It is encouraged that more individuals take the initiative and visit their primary care physician. If the community is given resources on the matter, they can change their habits that may be detrimental to their health. Comment by Alex Quezada: I’m not sure if Ms. Cox is a good fit for the gatekeeper interview. Keep in mind that gatekeepers typically have some control or influence over access. These are individuals that if we as outsiders wanted to have access to a certain community, these people would have the power and influence to connect us/give us acccess to that community Comment by Alex Quezada: Unclear – do you mean that she focused on discussing hypertension within the Black community?

The second gatekeeper interview was performed with Tameka Anderson, an Intervention Support Specialist at AVANCE that travels throughout Texas to help young African American mothers. This interview was conducted over the phone and she mentions that she has lived in Texas her whole life and travels to different cities to where she is needed. Ms. Anderson was chosen due to her seeing first- hand how maternal complications cause further health issues in African American women and their children. Specifically, the role of Ms. Anderson is to determine learning disabilities early when it comes to low income families in Head Start services. Furthermore, Ms. Anderson was asked what she perceived as a major health concern amongto the communities that she serves. The gatekeeperMs. Anderson stated that a lot of young women reveal that their newborns were premature when they were born. She also mentioned that mothers state they “suffer from high -blood pressure and that they are the reason their children were underweight” ( T. Anderson, personal communication, February 1, 2021). With that being said, Ms. Anderson discloses that most mothers she interacts with are between the ages of 18 and 26. Anderson conveys that these women are too young to suffer from such conditions and that it may be caused by their environment and not inherited. Comment by Alex Quezada: Good Comment by Alex Quezada: Anderson or Ms. Anderson is fine; you just want to remain consistent with the term you use

Epidemiological, Behavioral, and Environmental Assessment.

Epidemiological assessment. According to the U.S. Department of Health and Human Services ([USDHHS], 2011-2015, see Appendix A), bBetween 2011 and 2015, 31.3% of pregnancy-related deaths occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days 1-6 postpartum, 21.4% 7–42 days postpartum, and 11.7% 43–365 days postpartum. There is a significant racial disparity between the number of maternal mortality deaths as black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women (Centers for Disease Control and Prevention, 2020), (see Appendix B). There are many factors that play a role in these deaths such as nutrition, access to healthcare, and previous health issues. In Dallas Ccounty alone, according to the Dallas County Community (Dallas County Community Health Needs Assessment, 2016), many women have little or no access at all to any form of health insurance. 38% of residents in South Dallas, 29% of residents in Southwest Dallas, and 25% of residents in Southeast Dallas do not have health insurance. Comment by Alex Quezada: As well as structural racism. Comment by Alex Quezada: Avoid starting a sentence with a numeral

The aforementioned data shows that without insurance or access to healthcare at all these women's prenatal and postnatal health care is weakened and access to healthcare is vital in getting these women screened for any concurring or previous health issues that could be potentially life threatening. Many of these deaths are preventable and can be helped by getting these women the healthcare that they need and deserve. Without health care we are seeing an increase in not only maternal mortality but infancy prematurity as well which leads to a plethora of other complications and health issues. Comment by Alex Quezada: Good statement Comment by Alex Quezada: cite

Key Health Issue & Target Population. Based on the information received from the gatekeeper interviews, the key health issue relates to financial burdens affecting the access to proper healthcare. Maternal health issues with African American women are influenced by low-income communities. Residents in the Dallas community expressed their concerns of not having proper access to healthcare due to their financial situations and burden. Because of the lack of resources that are readily available to mothers, this causes young women between the ages of 18 and 26 in Dallas County to have babies that are born prematurely affecting both mother and baby. The risk of having maternal and infant mortality complications are increased because they do not receive early identification and treatment of potential disabilities and health conditions. Which is why most women of color suffer from pregnancy related complications such as high blood pressure. This population was chosen based on the increasing number of African American women having pregnancy complications in Dallas County. Comment by Alex Quezada: explain - unclear Comment by Alex Quezada: incomplete sentence

Behavioral and environmental assessment. Physiological and behavioral risks are common among women that are African American. Poverty, limited support, and depression are all significant contributing factors to pregnancy complications in Dallas County. According to Dallas County Community Health Needs Assessment (2016), The lack of behavioral health services and primary care for individuals who don’t have the money to pay for services are seen as a significant gap in the Dallas County health system. Specialty care was mentioned by many respondents as facilities outside of the hospital settings are difficult to access for most low- income individuals and families (DCHHS, 2016). To conclude, several residents of Dallas County believe the locations and times of operation are not easily accessible.

Places where people live and work can affect a person's mental and physical health. Environmental and social factors affect maternal health status by having access to health care programs, education, income opportunities, social support, and the availability to meet daily needs (Healthy People, 2020). However, most areas of Dallas have extreme poverty which sustains prevents women from having access to great healthcare when it's needed.

Appendix A Comment by Alex Quezada: Good presentation of data

([USDHHS], 2011-2015)

Appendix B

(Center for Disease Control and Prevention, 2020)

References Comment by Alex Quezada: Good start

Black Demographics. (2020, July 12). Black Women Statistics. Retrieved February 7, 2021, from https://blackdemographics.com/population/black-women-statistics/

DCHHS. (2016). An eEquitable, hHealthy aAnd sSafe Dallas County. Dallas County Health and Human Services. Retrieved February 7, 2021, from https://www.dallascounty.org/Assets/uploads/docs/hhs/dcha/DallasCountyCommunityHealthNeedsAssessment2016-FINAL.PDF Comment by Alex Quezada: Write out

Healthy People. (2020). Maternal, Iinfant, and cChild hHealth. Retrieved February 7, 2021, from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

HHS. (2020). The Surgeon General’s Call To Action To Improve Maternal Health. Health and Human Services. Retrieved February 7, 2021, from https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf Comment by Alex Quezada: Write out Comment by Alex Quezada: Lower case

Infographic: Racial/ethnic disparities In PREGNANCY-RELATED deaths - United States, 2007–2016. (2020, February 04). Retrieved February 07, 2021, from https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html

National Alliance to Eend Hhomelessness. (2020). End Homelessness. Retrieved February 7, 2021, from https://endhomelessness.org/

Newman, L. A., & Kaljee, L. M. (2017). Health disparities and triple-negative breast cancer in African American women: Aa review. JAMA surgery, 152(5), 485-493. Comment by Alex Quezada: Write out

Richard, K. (2014). The wealth gap for women of color. Center for Global Policy Solutions.

Total: 44/50

Good work everyone. This was well written with only a few writing errors. You took a different approach to this project but I’m going to leave your work mostly as is. I like that your work was focused and relatively narrow. I do want you to provide a little more information on the City of Dallas (or Dallas County) in the first section of this NAP.