NR 436 Week 3 Community Assessment Vaping Priority Example

Community Assessment of Linden Hollow: Adolescent E-Cigarette Use as the Priority Problem in a Composite Suburban School District

Student Name

College of Nursing, Chamberlain University

NR 436: Community, Public, and Population Health Nursing

Instructor Name

Month Day, Year

Community Assessment of Linden Hollow: Adolescent E-Cigarette Use as the Priority Problem in a Composite Suburban School District

Community Profile

Linden Hollow is a composite suburban community of 38,400 residents on the outer ring of a large metropolitan area, defined for this assessment by the boundary of the Linden Hollow School District, which covers 41 square miles and includes one high school, two middle schools and six elementary schools. The district boundary was chosen because it matches the unit for which the most local data exist, the biennial district youth survey, and because it is the unit through which any school-based program would be delivered. Residents aged 12 to 17 number 3,420, or 8.9 per 100 residents, and they are the denominator for every adolescent rate reported below. The median household income is above the state median, the poverty rate is 9 per 100 residents, and 84 per 100 adults hold at least a high school diploma. The population is 72% White, 14% Hispanic or Latino, 8% Black and 5% Asian, with most growth over the past decade among Hispanic families in newer apartment complexes near the highway interchange.

The data sources are the composite district youth survey from the most recent spring, which had a response rate of 81% among high school students; composite county and state health department figures; national data from the National Youth Tobacco Survey (Birdsey et al., 2023); and a windshield survey completed two weeks ago. Following the structure of a community health assessment described by Nies and McEwen (2019), the sections move from the population to its environment, then to health status compared with outside figures, then to assets, and end with prioritized community diagnoses.

Environment and Resources

The windshield survey found a community built around cars, with large residential subdivisions, strip shopping centers along two state routes and limited sidewalks outside the older town center. Seven retail outlets selling tobacco and vapor products were counted within the district boundary, including two dedicated vape shops, and three of the seven sit within half a mile of the high school or a middle school. Both vape shops displayed flavored products in their windows, with fruit and candy names visible from the sidewalk. The high school campus is posted as tobacco-free, including electronic devices, and the school handbook lists a first-offense consequence of a one-day suspension.

Health and social resources are relatively strong. The district employs one registered nurse for each school building, a school-based health center operates two days a week at the high school, and a county health department satellite office in the town center offers immunizations and tobacco cessation referrals. A regional hospital system operates an urgent care clinic and two primary care practices within the boundary. Adolescent behavioral health services are the clear gap: the nearest outpatient program that accepts adolescents has a waiting list that school counselors estimate at eight to ten weeks.

Health Status Compared With County, State and Nation

Current e-cigarette use, high school students (past 30 days): Linden Hollow 16.8 per 100; state 11.2 per 100; national 10.0 per 100 (Birdsey et al., 2023). Source: district youth survey, composite state survey, National Youth Tobacco Survey.

Current e-cigarette use, middle school students: Linden Hollow 6.1 per 100; state 5.0 per 100; national 4.6 per 100.

Daily or near-daily use among current high school users: Linden Hollow 31 per 100 current users; national about 25 per 100 current users.

Current cigarette smoking, high school students: Linden Hollow 1.9 per 100; state 2.2 per 100. No meaningful difference.

High school students reporting persistent sadness or hopelessness in the past year: Linden Hollow 38 per 100; state 40 per 100.

Obesity, adolescents (measured at school screening): Linden Hollow 15 per 100; state 18 per 100.

Adolescent emergency department visits for vaping-related illness: too few events in the county to report a stable rate.

What the Comparison Shows

Most health indicators in Linden Hollow sit at or better than state levels, which is consistent with the community's income and education profile. E-cigarette use is the exception. The high school rate is about one and a half times the state rate and well above the national figure, and among students who vape, the share using most days is higher than the national share, which suggests established dependence rather than experimentation. Cigarette smoking has not risen alongside vaping, so the problem is specific to the product rather than a general tobacco trend. The district survey also asked where students obtained devices; the most common answers were friends and older siblings, followed by purchase at a store, despite the legal purchase age of 21.

These findings matter clinically. The Surgeon General's report on youth e-cigarette use concluded that nicotine exposure during adolescence can harm the developing brain and that e-cigarette use among young people is a public health concern (U.S. Department of Health and Human Services, 2016). School nurses interviewed for this assessment described students leaving class to vape in restrooms, asking for help with headaches and irritability during the school day, and being suspended repeatedly without being offered any cessation support. The suspension policy removes students from school without addressing dependence, which suggests the community's current response treats the problem as discipline rather than health.

Community Strengths

Linden Hollow has assets that any plan would lean on. A nurse in every school building provides a trusted point of contact with every adolescent in the district. The school-based health center already bills for adolescent visits and could add cessation counseling without a new structure. The county health department office runs a youth tobacco prevention coalition that has met quarterly for three years, though it has focused on cigarettes. Parent-teacher organizations at all three secondary schools are active and have hosted health evenings before, and the high school has a student health advisory group that asked the principal last year for a response to vaping other than suspension. Finally, the town council has previously passed a local ordinance on tobacco retail licensing, which shows a willingness to use local policy.

Prioritization and Community Diagnoses

Three problems were identified: high adolescent e-cigarette use, limited access to adolescent behavioral health services, and car-dependent design that limits physical activity. They were ranked using three criteria, with each problem scored from one to three on each: severity of the health consequence, the number of people affected, and whether residents themselves have raised it. E-cigarette use scored highest overall, with a high score on the number affected (about one in six high school students), a moderate to high score on severity because of dependence, and a high score on community concern, since students, nurses and parents all raised it. Limited behavioral health access ranked second, with high severity but fewer residents directly affected. Car-dependent design ranked third; it affects everyone, but the health consequence is gradual and residents did not raise it.

The priority community diagnosis is written in the three-part form used for populations. Risk for nicotine dependence among high school students in Linden Hollow related to easy access to flavored e-cigarette products near schools, peer supply, and a school response that relies on suspension without cessation support, as evidenced by a current e-cigarette use rate of 16.8 per 100 high school students compared with 11.2 per 100 statewide, and daily or near-daily use among 31 per 100 current users.

The second diagnosis is ineffective access to adolescent behavioral health care among students in Linden Hollow related to the absence of an in-district adolescent outpatient program and long wait times in neighboring programs, as evidenced by counselor-reported wait lists of eight to ten weeks and persistent sadness or hopelessness reported by 38 per 100 high school students. The two diagnoses are linked, since adolescents who vape often report using nicotine to manage stress, and a plan that addresses vaping should connect students to behavioral health support rather than treat nicotine in isolation. Healthy People 2030 includes objectives to reduce e-cigarette use among adolescents (Office of Disease Prevention and Health Promotion, n.d.), which places the priority diagnosis within a national goal and offers a benchmark for later evaluation.

References

Birdsey, J., Cornelius, M., Jamal, A., Park-Lee, E., Cooper, M. R., Wang, J., Sawdey, M. D., Cullen, K. A., & Neff, L. (2023). Tobacco product use among U.S. middle and high school students: National Youth Tobacco Survey, 2023. Morbidity and Mortality Weekly Report, 72(44), 1173-1182. https://doi.org/10.15585/mmwr.mm7244a1

Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). Elsevier.

Office of Disease Prevention and Health Promotion. (n.d.). Tobacco use. Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use

U.S. Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the Surgeon General. Centers for Disease Control and Prevention, Office on Smoking and Health.