running head: sdh: banta community assessment 1 social
TRANSCRIPT
Running head: SDH: BANTA COMMUNITY ASSESSMENT 1
Social Determinants of Health: Banta Community Assessment
Melissa L. and Jennifer L. Rouse
California State University, Stanislaus
SDH: BANTA COMMUNITY ASSESSMENT 2
Social Determinants of Health: Banta Community Assessment
Banta Elementary School is located in the small rural community of Banta, California
(CA), just outside of Tracy, CA in San Joaquin County. For the purpose of this paper, the
community of Banta is defined as the area within the Banta Elementary School District, as found
on the Statistical Atlas (2015). The authors of this paper recently performed a community
assessment of the Banta Elementary School site and its surrounding community of Banta, using
various methods. These assessment methods included oral interviews with students (kindergarten
through eighth grade) and staff during the Give Every Child A Chance (GECAC) after-school
program, online database searches, and walking and windshield surveys of the school and
community. Where secondary data were not available for Banta Elementary School District, data
for Tracy, the zip codes in Banta, or San Joaquin County are substituted and noted. Any stated
observations or data that do not have specified secondary data sources were obtained through
personal interviews and walking/windshield surveys performed by the authors of this paper. This
paper will discuss the Banta community assessment, prioritization of community risk factors, and
public health and nursing implications, along with theoretical underpinnings to support these
implications.
The Banta Community
According to the National Center for Education Statistics (NCES) (2014), Banta
Elementary currently serves 318 students. Data provided by the Statistical Atlas (2015) show that
the community of Banta includes 514 households and 5,311 people. It is within San Joaquin
County, is considered part of the Stockton Metropolitan Area, and includes the 95304 and 95330
zip codes (Statistical Atlas, 2015). It is not its own city, but includes unincorporated areas as well
as small parts of the cities of Lathrop and Tracy (Statistical Atlas, 2015). Its residents consist of
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8.81% children (ages 0 to 17 years), 5.25% college-aged (18 to 21 years), 49.3% younger adult
(22 to 39 years), 32.2% older adult (40 to 64 years), and 4.46% senior (65 years or older)
(Statistical Atlas, 2015).
Social Determinants of Health and Community Risk Factors
The World Health Organization (WHO) (2015) has identified the social determinants of
health (SDH) as “the conditions in which people are born, grow, work, live, and age, and the
wider set of forces and systems shaping the conditions of daily life. These forces and systems
include economic policies and systems, development agendas, social norms, social policies and
political systems” (WHO, 2015). As public or community health nurse, it is important to
understand these conditions through assessment in order to determine the needs of a community,
identify risk factors and appropriate interventions to address any pertinent issues. The following
will describe each SDH in depth as it relates to the community of Banta, CA.
Neighborhood and Built Environment
Boundaries. The community of Banta as described by its students and staff is the
residential area and farm land directly around the school. For the purposes of the community
assessment, the community will be defined as the Banta Elementary school district which goes
beyond that described of the students and staff. USBoundary.com (2015) defines the area as 37.2
square miles, bordering the Middle River on the north, the San Joaquin River on the east,
Valpico road on the south border and North Chrisman road on the west (USBoundary.com,
2015). The community is called Banta and the name “Banta” appears on street signs, and
buildings such as the Banta General store and the Banta Inn. There are a few neighborhoods
within the community, but not enough to create subcommunities. Many of the square miles
which make up the community include farm land.
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Housing and zoning. The houses of this community tend to be built around the middle of
the 20th century, but the types of homes vary greatly throughout the small Banta neighborhoods.
Most homes are made of wood and stucco. The style of homes vary greatly, some ranchette style
laid out on open orchard farm-land, while others are small and contained to smaller lot sizes. The
size of the lots vary anywhere from under one acre to many acres. There are a variety of single-
family homes while multi-family homes were not seen. The majority of homes do not have signs
of disrepair; however, the homes that display disrepair are those that are older and have broken
windows and fences, propped up by wood or other material. According to the information founds
on USBoundary.com (2015), out of the 511 housing units, 42 are considered vacant with the
remaining occupied. Eight homes are for rent and five homes are for sale. The majority of homes
are occupied by two people (USBoundary.com, 2015).
Signs of decay. The neighborhoods are quiet, isolate and do not appear to be “alive.” The
homes are old, but most homes and yards are neat and well-maintained. In some areas, there is
minimal trash, boarded-up buildings such as old stores and dilapidated sheds. Vacant lots appear
to have the more “run-down” structures. The community does not have signs of poor drainage or
disease vector harborage. Although the neighborhoods and built-environments are old, they do
not appear to have poor sanitation/hygiene.
Street people. The windshield survey was done during daylight hours and it was
observed that people were not walking/wandering the streets. Those that were seen outside were
working in their yards, dressed casually while gardening, cleaning, and maintaining property.
Some yards contain large or small pets such as horses, dogs and livestock, but there are few or no
strays visible on the streets.
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Neighborhood amenities. The neighborhoods have very few sidewalks and crosswalks.
Safe routes to school via children walking were not determined present. The town has one
market called Banta General which functions as a convenient store. The neighborhoods appear to
be safe because most of the homes have fences or gates. It was observed that the streets do not
have any stray animals roaming; however, animals are present in the front yards of the homes.
Crime and violence. Per the crime and violence rates, data on specifically Banta
Elementary school district are not available. Instead, the data regarding the city of Tracy will be
used in lieu of Banta because they are geographically very close together. According to
Neighborhood Scout (2015), Tracy, CA ranks 24th on the crime index where 100 is the safest.
This indicates that “Tracy is safer than 24% of the cities in the US.” In Tracy, there are 114
crimes per square mile compared to California having 89 crimes per square mile. It is indicated
that “the chances of becoming a victim of either violent or property crime in Tracy is 1 in 33 and
according to the FBI crime data, Tracy is not one of the safest communities in America. Relative
to California, Tracy has a crime rate that is higher than 69% of all cities and towns of all sizes in
the state.” The types of crime include, violence such as rape, assault, murder, and property crime
such as vandalism and robbery (Neighborhood Scout, 2015). In the town of Banta, there are no
actual areas for incarceration; however, in the city of Tracy, the California Department of
Corrections and Rehabilitation (CDCR), (2015) identifies the Deuel Vocational Institution (DVI)
as “ a reception center that receives inmates from 29 Northern California counties.” The DVI
does not house juveniles, but instead adults who are determined level one or two inmates
(CDCR, 2015).
Health and Health Care
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Service centers. There are no hospitals, doctor’s offices, dental offices, social agencies,
community clinics, recreation centers, or health-career-related school that were observed in
Banta. There is one occupational health clinic on the outskirts of Banta’s school district lines,
which only serves the Tracy Defense Depot (CHMA, 2009). U. S. Hospital Finder (2015)
confirms that there are no hospitals within Banta, though the closest hospital, Sutter Tracy
Community Hospital, is only 3.58 miles away in Tracy, CA. The next two closest hospitals are
Kaiser Foundation Hospital, 7.41 miles away in Manteca, CA, and Doctors Hospital of Manteca,
9.98 miles away in Manteca, CA (U. S. Hospital Finder, 2015). Tracy, being the nearest city to
Banta, offers most of the medical and health services that Banta lacks. In Tracy, there are many
primary care options, including providers at Sutter Health’s Tracy Care Center at 2151 West
Grant Line Road; Dentistry options include Millennium Dental at 436 W. Beverly Place;
Community clinics include Planned Parenthood’s Tracy Health Center at 1441 North Tracy
Boulevard; Social agencies include VBR Foster Family Agencies, Inc. at 72 W. Eleventh Street,
Suite A; And recreation facilities include Tracy Sports Complex at 955 Crossroads Drive
(iMatrix Dental, 2015; iSport, 2015; Planned Parenthood Foundation of America, 2014; Sutter
Gould Medical Foundation, 2013; VBR Foundation, Inc., 2014). These are only a few of many
healthcare options available in Tracy.
Protective services. Tracy Fire Station # 92, which used to be located in the center of
Banta, can now be seen on Grant Line Road just outside of Banta at 1035 East Grant Line Road,
Tracy (City of Tracy, 2015a). There is no police department in Banta, but the Tracy police
department is also located just outside of Banta, at 1000 Civic Center Drive, Tracy (City of
Tracy, 2015b). Neither police nor fire vehicles were observed on the roads or responding to calls
in Banta during times of observation.
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Health and morbidity. While the infant mortality rate for Banta was unavailable, the
infant mortality rate for San Joaquin County was 5.8 per 1,000, which is higher than the
California state infant mortality rate of 4.7 for 2011 through 2013 (Lucile Packard Foundation
for Children’s Health, 2015a). In 2015, 88.2% of Banta’s incoming Kindergarteners had all of
the required immunizations, compared to 95.6% of San Joaquin County’s Kindergarteners, as a
whole (Lucile Packard Foundation for Children’s Health, 2015b). Obesity is the primary
observable chronic health condition of this community. From direct observation, there is no
evidence of accidents, communicable diseases, alcoholism, drug abuse, or mental illness.
However, the data show that some of these health issues are, indeed, faced by both Banta
students and the whole community. According to WestEd’s California Healthy Kids Survey of
Banta’s seventh grade students, 24% of these students have ever used drugs or alcohol, 4% have
ever smoked a whole cigarette, 8% currently use alcohol or drugs, and 4% have used drugs or
alcohol on school property (WestEd, 2014). A total of 36% of these seventh grade students
reported having ridden in a car driven by someone who had been drinking (WestEd, 2014). This
strongly suggests that alcoholism is a problem in Banta. The top known causes of death of
residents of the 95304 and 95330 zip codes in 2012 were cancers, heart disease, and stroke
(California Department of Public Health [CDPH], 2012). These are likely to be some of Banta’s
biggest chronic health concerns, at least two of which may also be tied into Banta’s observed
obesity problem. Banta’s 2013-2014 Physical Fitness Report states that 18.2% of Banta’s fifth
graders and 23.4% of its seventh graders need improvement in their aerobic capacity to the point
where their health is at risk (California Department of Education [CDE], 2015c). In addition,
12.1% of Banta’s fifth graders and 23.4% of its seventh graders are at a health risk related to
their body composition (CDE, 2015c). There were 387 deaths and 4,165 non-fatal
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hospitalizations due to accidental injury in San Joaquin County in 2013 (CDPH, 2013).
California, as a whole, had a total of 17,417 deaths and 251,485 non-fatal hospitalizations due to
accidental injury in 2013 (CDPH, 2013). The primary acute conditions observed in this
community were colds (rhinopharyngitis), fractures, and abrasions.
Social and Community Context
Parks and recreational areas. During the afternoon and evening, very few people were
observed out and about in the community. This could be due, in part, to the lack of parks and
recreational areas in Banta. Beyond the school gates, there are no sports fields, parks,
community centers, or youth centers in the Banta community. According to Banta students, the
primary locations for recreation and sports in Banta are the school’s own fields, gym, and
playgrounds. These areas are primarily used by Banta’s students. However, the fields are in need
of some renovation, according to GECAC students and staff. The current fields consist of some
green grass, dead grass, and patches of dirt. “We twist our ankles when we try to run”, “If I could
change one thing about my school, I would add new fields to play on”, and “The fields aren’t
really useable, unless you want kids to get hurt”, were some of the statements from staff and
students, related to the school’s current fields. In addition, the fields and black top areas, where
students spend most of their outdoor time while at school, lack shade during the late morning
through early evening hours. Most children interviewed go into Tracy and other larger towns and
cities for their recreational and social activities outside of school.
Race, ethnicity, and religion. It was observed that the students at Banta Elementary
were primarily of Caucasian and Hispanic descent, with small of African-American and Asian
students. According to the CDE, Banta Elementary’s students are 64.5% Hispanic, 28.6% White,
4.6% two or more races, 1.7% African American, 0.3% Asian, and 0.3% Pacific Islander
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(2015b). There is a larger percentage of English learners at this school, making up 33.8% of the
students, compared to the San Joaquin County percentage of 23.11%, and the California state
percentage of 22.3% (CDE, 2015b). According to the Statistical Atlas (2015), Banta’s overall
population has a similar but slightly different make-up, consisting of 44% White residents, 32%
Hispanic residents, 17.2% Black residents, 2.7% Asian residents, 2.6% Mixed residents, and
1.4% “Other” residents. In Banta, the top three ethnicities of residents of European and African
descent are “Other”, at 65.1% of this specific population, Irish, at 11.6%, and German, at 11.2%
(Statistical Atlas, 2015). The top three ethnicities of residents of Hispanic descent are Mexican,
at 81.1%, “Other Hispanic”, at 7.9%, and Puerto Rican, at 6.6% (Statistical Atlas, 2015). The top
three ethnicities of residents of Asian descent are Cambodian, at 19.0%, Filipino, at 19.0%, and
Laotian, at 17.6% (Statistical Atlas, 2015). Of those residents who were actually born in a
country other than the United States, the majority, 68.4%, was born in Mexico, followed by
Portugal, at 9.7%, and the Philippines, at 4.3% (Statistical Atlas, 2015). There is one church in
Banta, called The Mission, which is located right beside Banta Elementary School. While no
people were observed at the church on the weekdays and weekday evenings of observation, the
sign in front of it listed the church’s service times as Saturdays at 6:00 PM and Sundays at 10:15
and 11:30 AM. According to the church’s website, the church building is called The Mission, but
the church, as a group of people, is known as Mission City Church (Mission City Church, n.d.).
They do not specify any denomination, but state their vision as being “to see people far from
God encounter love and life through Christ” (Mission City Church, n.d.).
“Commons”. While no community gatherings or social meetings were directly observed
in this community, there is still evidence of some organized community gatherings and events.
For example, the 24th annual Banta Hay Day took place on the Banta Elementary campus on
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Saturday, October 3rd, 2015. It was open to everyone, including community members outside of
the school and strangers. Many students at Banta Elementary expressed excitement about the
Hay Day, and there was a large sign announcing it in the preceding weeks at the community’s
only intersection with a stoplight: Grant Line Road and El Rancho Road. Similar to Banta
Elementary acting as the primary recreational and sports area, it seems that it also acts as the
main place that people gather and ”hang out” in this small community, even beyond school
hours. In addition to the school, there is a bar-and-restaurant called the Banta Inn, which can be
seen and visited in the main community, and a Mexican restaurant called Casa Mendoza right at
the border of the school district. According to Yelp! (2015a), the Banta Inn is open from 11:00
AM to 2:00 AM Mondays through Thursdays, 8:00 AM to 2:00 AM Fridays and Saturdays, and
8:00 AM to 10:00 PM on Sundays. Casa Mendoza is open from 6:00 AM to 2:00 PM, except on
Sundays when it opens at 7:00 AM instead (Yelp!, 2015b). These also appear to serve as
community hangouts. Finally, while no people were directly observed at the Mission, it has
potential to serve as a community hangout, as well. Outside of the school, church, and two
restaurants, it seems that most social activity takes place within homes or outside of this
community.
Class. This community’s residents appear to be a mixture of lower, working, and middle
class. This is primarily based on the appearance of the homes and neighborhoods in this
community, as well as the appearance of GECAC students and the family members or friends
who pick them up. This is also supported by the data in the “economic stability” section of this
paper.
Transportation. The most commonly observed method of transportation in and through
the community of Banta is private motor vehicle transportation. Its streets seem reasonably well
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maintained, with visible road stripes and without any major potholes or debris. There are no
designated bike lanes on the roads. Banta is near the intersection of two major interstates:
interstate 5 and interstate 205. These interstates appear to be used fairly heavily by semi-trucks
transporting goods and commuters- many commuting into the San Francisco Bay Area. There are
not any Tracy TRACER bus routes, nor any San Joaquin Regional Transit District (RTD) bus
routes that go into or through Banta (City of Tracy, 2014; San Joaquin Regional Transit District,
2015). Tracy does offer Paratransit curb-to-curb pickup for seniors and those who are disabled to
the point that they cannot get to or on the bus, but the service area is not specified, and the one
map shown does not include Banta (City of Tracy, 2014). Train tracks run through town, but
appear to primarily serve cargo trains. The closest Amtrak train stations are in Tracy, 5.29 miles
from Banta’s center, and in Lathrop, 6.59 miles from it (National Railroad Passenger
Corporation, 2015).
Politics. There were no political posters or party headquarters observed in Banta, so it
cannot be assumed that there is a particular predominant political party based solely on
observation. Banta includes the congressional districts CA-9 and CA-10, the state Senate district
CA-5, and the state Assembly districts CA-12 and CA-13 (Statistical Atlas, 2015). The
representatives of Banta’s congressional districts are Jerry McNerney, a Democrat, for
congressional district CA-9, and Jeff Denham, a Republican, for congressional district CA-10
(United States House of Representatives, n.d.). The representative of Banta’s state Senate district
is Cathleen Galgiani, a Democrat (California State Senate, 2014). The representatives of Banta’s
state Assembly districts are Kristin Olsen, a Republican, for district CA-12 and Susan
Talamantes Eggman, a Democrat, for district CA-13 (California State Assembly, 2011). With
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three Democratic and two Republican representatives, it seems the data agree that while Banta’s
area may be slightly more Democratic, neither party is strongly dominant.
Education
Preschool. Within the Banta school district boundaries, there is one preschool which is
located on the Banta Elementary School site. The preschool/day care program available called
“Creative Child Care.” According to ChildcareCenter.us (2015), this program serves children
ages three to five, has a maximum capacity of 48 children and is a non-subsidized childcare
program (ChildcareCenter.us, 2015).
K-12 education. Two types of schools exist within the Banta School district community.
First is Banta Elementary which serves students in kindergarten through eighth grade. According
to the NCES, Banta Elementary currently serves 318 students (2014). Of these children, 98 are
White, 202 are Hispanic, six are Black, two are Asian/Pacific Islander and no students are
American Indian/Alaskan. There are 165 males and 153 females. The student/teacher ratio is
22.71 (NCES, 2014). The California Department of Education (CDE) states that of the students
who attend Banta 72.3% qualify for a free or reduced lunch (2015b). The Standardized testing
and reporting (STAR) scores have been a struggle of Banta Elementary. In grades two through
seven, the English scoring of the STAR for each category is as follows: 12% in advanced, 27%
proficient, 35% basic, 18% below basic and 10% far below basic. In grades two through seven,
the mathematics scoring of the STAR for each category is as follows: 15% in advanced, 25%
proficient, 25% basic, 19% below basic and 3% far below basic (CDE, 2015a). The CDE
provided specific scores for each grade, but the authors took the data and computed the average.
At Banta Elementary, there is not a school nurse on site; however, the San Joaquin County
Office of Education (SJCOE) sends out Public Health Nurses to the school site to teach staff
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basic first aid, administer immunizations and evaluate the school environment as it relates to
health. The Banta School district does not contain any high schools (ninth through twelfth
grade), so those who enter into high school from this district attend Tracy High School in Tracy,
CA. Information obtained from Tracy High School’s 2013- 2014 School Accountability Report
Card indicates that during the 2013-2014 school year, the high school graduation rate was
88.69% (School Innovations & Achievement, 2014). This rate is higher compared to the average
of public high schools in California which had an 80.44% graduation rate in the same school
year (School Innovations & Achievement, 2014). Data provided by the Statistical Atlas (2015)
show Banta’s educational attainment rate as 37.8% with no high school diploma, 54.4% have a
high school diploma and 7.7% have a higher degree. In California, 18% of people have no high
school diploma, 44% have a high school diploma and 38% have a higher degree The people
included in the data are over the age of 25 years old (Statistical Atlas, 2015).
The other school that exists and is listed on the Banta Elementary School District website
(2015) is the Next Generation STEAM (Science, Technology, Engineering, Arts, and Math)
Academy and is a dependent charter school for kindergarten through eighth grade students
located in Lathrop, CA (Banta Elementary School District, 2015). The school website for the
STEAM Academy (2015), describes this school as focusing on “project-based learning” which
encompasses a wide variation of curriculum and skills (STEAM Academy, 2015).
Post secondary education. The closest colleges to the Banta Elementary school district
are those of San Joaquin Delta College and UEI Community College in Stockton, CA and San
Joaquin Valley College and Modesto Junior College in Modesto, CA. These colleges range
anywhere from 15-30 miles from the Banta Elementary school district. The students at Banta
Elementary have access to tablets which are ‘mini’ computers with internet access. Also, of those
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students who attend Tracy High School they are able to use the school library for internet and
research on post secondary education information and research. The Banta School district does
not have any public libraries; however, Tracy has a public library, which offers free access to
internet and resources to the public.
School based health services. At Banta Elementary, the school based health services
provided are primarily through education. GECAC is an afterschool program aimed at helping
every child become successful in what they do. Part of their afterschool curriculum includes
health education such as talking about healthy foods, healthy behaviors, and being physically
active. The education is tailored to each developmental level in order for the students to
understand the teaching. Although there are no school based clinics, staff and nursing students
from the SJCOE administer vaccinations such as the flu shot and DTaP to students on campus.
Economic Stability
Jobs. Statistical Atlas (2015) identifies the median average annual household income for
those living in the Banta Elementary school district as $64,200. The average annual household
income for people in California is $61,100. The average annual income of families who qualify
for food stamps is $7,300, and of those, 72.8% are children. The unemployment rate is 1.2% as
defined by people who currently do not have a job, have looked for a job in the past four weeks
and are able to work. In California, the unemployment rate is about 8%. Another category exists
called ‘other’ which is defined as those who are not in the labor force and do not meet the criteria
of being employed or unemployed during data collection. In the Banta Elementary school
district, the other category is made up of 85.2% compared to California at 35%. Currently, the
most common occupations are management, transportation, farming and administration which of
10-14% of people. Construction, repair and material moving make up about 6%. Business,
SDH: BANTA COMMUNITY ASSESSMENT 15
education, sales, food service, personal care, production, law enforcement, engineering and
entertainment account for 3-5% (Statistical Atlas, 2015). A few children expressed concerns of
food insecurity at home, with statements like “sometimes it’s hard for my mom and grandma to
get food… with the money, it’s hard, you know” and “I think we try to eat healthy, but
sometimes my parents only have a little money”. There are many vacant buildings which were
observed as run down, no longer in service and abandoned.
Stores. The Banta Elementary school district does not have supermarkets, neighborhood
stores, laundries, dry cleaners, food banks or homeless shelters. The only store in the community
is Banta General, which is a small convenient/drug store. Other buildings include one Subway,
one restaurant, a mechanic auto shop and the Banta Inn. In order for the citizens of the
community to access supermarkets, restaurants, stores, and other resources, they drive into
Tracy.
Key Findings: Prioritization of Risk Factors
Top Risk Factor: Food Insecurity
The top risk factor that the authors of this paper identify in Banta is food insecurity. Not
only are there no local grocery stores or supermarkets, some families may also lack the necessary
resources, like money and transportation, needed in order to obtain adequate amounts of healthy
food. The relative food desert status of Banta is supported by the community assessment findings
in the “Transportation”, “Jobs”, and “Stores” sections of this paper. The $7,300 average annual
income of families who qualify for food stamps is especially alarming (Statistical Atlas, 2015).
According to Maslow’s Hierarchy of Needs, physical needs, such as food, are the first and most
important needs a person has (Huitt, 2007). Healthy food is an everyday physical need, so food
insecurity is ranked as the top risk factor in this community.
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Second Risk Factor: Lack of Public Transportation and Access to Healthcare
The second highest risk factor in Banta is lack of transportation, especially related to
access to healthcare. As discussed in the “Service centers” and “Transportation” sections of this
paper, there are no hospitals, clinics, or primary care providers in Banta, and although Tracy
offers various types of healthcare, a private motor vehicle is required to travel between Banta and
the resources in Tracy. There is no public transportation between Banta and Tracy for people
without private motor vehicles, and Tracy’s Paratransit, which qualifies people only based on
age and disability, may not serve the Banta area. This combined lack of transportation and access
to healthcare combines to create a serious health risk for Banta residents. The first and second
levels of Maslow’s Hierarchy of Needs, physiological needs and safety/ security needs, are both
put at risk by this lack of transportation and access to healthcare (Huitt, 2007). Since these needs
fall primarily into the second level of safety and security, but also fall into the first level during
times of illness and injury, this is rated just below food insecurity, as Banta’s second highest risk
factor (Huitt, 2007).
Third Risk Factor: Low Educational Achievement
The third risk factor in Banta is low educational achievement. This poses a risk to both
the health of the people in Banta as well as the economy. In an article by US News Education
(2011), authors state that “those with bachelor's degrees, no matter the field, earn vastly more
than counterparts with some college ($1.55 million in lifetime earnings) or a high school diploma
($1.30 million lifetime), indicating that no matter the level of attainment or the field of study,
simply earning a four-year degree is often integral to financial success later in life” (US News
Education, 2011). With this said, educational attainment affects the financial security of an
individual or family, along with other factors such as financial responsibility, financial choices,
SDH: BANTA COMMUNITY ASSESSMENT 17
and sometimes family heritage. As stated previously in sections “K-12 Education” and “Jobs”
there are a high percentage of people who do not have a secondary degree as well as many who
fall into the ‘unemployed’ or ‘other’ categories. With little education, this may create limited
opportunity for financial security/attainment and prevent access to necessities such as adequate
health care. Education early on in life is crucial to developing the knowledge, skills, and
academic drive needed to succeed in the future. Unfortunately, the children at Banta Elementary
school struggle with their State Standardized testing scores as discussed above in the “K-12
Education” section which can ultimately affect their ability to succeed as adults in the future.
This was ranked as the third risk factor because according to Maslow’s Hierarchy of Needs, the
security of health, employment, resources, and property can all be affected by one’s ability to
financial provide, which goes back to educational achievement (Huitt, 2007).
Theoretical Underpinnings
In order to effectively make a change based on the needs assessment, it is important to
relate the process to a theory in order to recognize how it may play out or what the intended
goals are to be. One of the most important and widely used nursing concepts used in Public
Health Nursing is the Public Health Model of Prevention. According to Allender, Rector, and
Warner (2014), this model is composed of a pyramid with three levels of prevention, which build
on each other. The bottom level is primary prevention which consists of health promotion,
education, and protection. The middle level is secondary prevention which is early diagnosis of a
problem and prompt treatment. Tertiary prevention is the top level, which includes rehabilitation
which attempts to reduce the severity of a problem that has already been identified (Allender,
Rector & Warner, 2014).
Public Health and Nursing Implications
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Top Risk Factor: Food Insecurity
At the primary prevention level, a public health nurse should advocate for the
community’s needs of having a local grocery store, supermarket, and/or farmer’s market. This
type of advocacy could be done within discussion at the Public Health Department, grant writing,
or the nurse being a representative at local community board meetings. At the secondary
prevention level, a public health nurse should screen the health status of the local community by
assessing the population's BMI, malnutrition, obesity and overall physical-well being. The nurse
could conduct such assessments by creating a health screening event in which public health
nurses, nursing students, and volunteers come together to serve the community. The nurse can
use his/her resources to obtain necessary equipment for screening and then coordinate volunteers
(other public health nurses and student nurses) to conduct the screening/assessments. At the
tertiary level, a public health nurse could again advocate those who were identified as being
affected by living in a food desert by providing necessary resources for nutrition (WIC program),
food stamps, and bringing farmer’s markets to the community of Banta once a week.
Second Risk Factor: Lack of Transportation and Access to Healthcare
At the primary prevention level, a public health nurse should address the issue of lack of
public transport and access to healthcare in two ways. First, he or she should advocate for bus
routes that extend into Banta to serve this community. Second, he or she should advocate and
even search for grants or other funding for a mobile or permanent primary care and dental
clinic(s) to be set up in Banta, to provide care at least a few days per week. (The St. Joseph’s
CareVan in Stockton, CA is one successful example of a mobile clinic caring for the community
by providing free health services, such as screenings and care for minor, urgent health issues (St.
Joseph’s Medical Center Stockton, n.d.). At the secondary prevention level, a public health nurse
SDH: BANTA COMMUNITY ASSESSMENT 19
should screen for acute and chronic diseases at the proposed clinic(s), as well as continue or
increase screenings that already take place at Banta Elementary. At the tertiary level, a public
health nurse should provide care to ill or injured patients at the proposed clinic(s), as well as
provide or advocate for free, reduced-rate, or sliding scale home-based care for people who are
ill or injured in this community who have no other reasonable means to obtain their necessary
care. In these ways, a public health nurse could comprehensively address this risk factor at all
three levels of prevention (Allender, Rector, & Warner, 2014).
Third Risk Factor: Low Educational Achievement
At the primary and tertiary level, the public health nurse could implement the
idea/advocate for a school garden along with science-based curriculum. A school garden would
be beneficial to many aspects of childhood education, development and nutrition. Cynthia
Klemmer, director of education and development at the National Garden Association, and her
colleagues performed a study on 647 third, fourth, and fifth graders from Temple, Texas
(Klemmer, Waliczek, & Zajicek, 2005). They provided all teachers with the traditional,
classroom-based science curriculum, which all the 647 students were exposed to and taught. The
experimental group participated in school gardening activities along with the traditional
curriculum, whereas, the control group did not have the hands-on garden experience. After a year
of this study, the students took a grade-appropriate science test, which was based on the criteria
for the school district. In the article, Growing Minds: The Effect of a School Gardening Program
on the Science Achievement of Elementary Students, Klemmer et al. (2005) discuss the use a one-
way ANOVA to determine if any statistical difference existed. Interestingly, students in the
experimental group scored 5.6 points higher on the science achievement test compared to the
students in the control group who did not have experience with the garden. Based on the p-value
SDH: BANTA COMMUNITY ASSESSMENT 20
of 0.001, the findings were statistically significant. This study alone supports the notion that
students who have hands-on, experimental activities have higher knowledge levels (Klemmer et
al., 2005). At the secondary level, teachers could also advocate for continued use of educational
screening such as the California Standardized tests. This would be a way to identify the students
who are having academic difficulty and hopefully allow for quicker intervention.
Banta is a small rural community near Tracy in San Joaquin County, CA. The authors of
this paper recently performed a thorough assessment of this community and found its top three
risks to be food insecurity, lack of public transportation and access to healthcare, and low
educational achievement. The authors discussed potential public health nursing implications for
each of these risk factors and supported these implications with Public Health Model of
Prevention (Allender, Rector, & Warner, 2014). This paper as a whole has provided this
community with assessment, diagnosis, and planning, which are the first three steps in the
nursing process (American Nurses Association, Inc. [ANA], 2015). It has set the stage for the
implementation of interventions that could help improve the health and decrease the health risks
of the little rural community of Banta.
SDH: BANTA COMMUNITY ASSESSMENT 21
References
American Nurses Association, Inc. (2015). The Nursing Process. Retrieved from:
http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-
Need/Thenursingprocess.htmlBanta Elementary School District. (2015).
Allender, J. A., Rector, C., and Warner, K. D. (2014). Community and public health nursing:
Promoting the public’s health. (8th ed.). Philadelphia, PA: Wolters Kluwer Health.
Lippincott Williams & Williams.
Banta Elementary School District. (2015). Banta elementary school district. Retrieved from:
http://bantaesd.sharpschool.net/home
California Department of Corrections and Rehabilitation. (2015). Prison facilities: Deuel
vocational institution (DVI). Retrieved from:
http://www.cdcr.ca.gov/Facilities_Locator/DVI.html
California Department of Education. (2015a). Banta elementary school district. Retrieved from:
http://star.cde.ca.gov/star2013/ViewReport.aspx?ps=true&lstTestYear=2013&lstTestTyp
e=C&lstCounty=39&lstDistrict=68486-
000&lstSchool=6041750&lstGroup=1&lstSubGroup=1
California Department of Education. (2015b). Selected School Level Data: Banta Elementary.
Retrieved from:
http://dq.cde.ca.gov/dataquest/Cbeds4.asp?Tp=on&GradeSpan=on&NumSchls=on&pupl
Teach=on&FreeLunch=on&Enroll=on&PctEL=on&PctHisp=on&PctBlack=on&PctAm=
on&PctAsian=on&PctFil=on&PctPac=on&PctWhite=on&PctTwo=on&PctNone=on&Gr
ads=on&NumDrops=on&cSelect=Banta^Elementary--Banta^Elementar--3968486-
SDH: BANTA COMMUNITY ASSESSMENT 22
6041750&cChoice=SchProf1&cYear=2014-
15&cLevel=School&cTopic=Profile&myTimeFrame=S&submit1=Submit
California Department of Education. (2015c). 2013-14 California physical fitness report:
Overall- summary of results: Banta elementary. Retrieved from:
http://data1.cde.ca.gov/dataquest/PhysFitness/PFTDN/Summary2011.aspx?r=0&t=1&y=
201314&c=39684866041750&n=0000http://data1.cde.ca.gov/dataquest/PhysFitness/PFT
DN/Summary2011.aspx?r=0&t=1&y=2013-14&c=39684866041750&n=0000
California Department of Public Health. (2012). Number of deaths by zip code of decedent’s
residence. Retrieved from:
https://www.cdph.ca.gov/data/statistics/Documents/DeathZip2012.pdf
California Department of Public Health. (2013). Overall injury surveillance. Retrieved from:
http://epicenter.cdph.ca.gov/ReportMenus/CustomTables.aspx
California State Assembly. (2011). Members. Retrieved from:
http://assembly.ca.gov/assemblymembers
California State Senate. (2014). Senators. Retrieved from: http://senate.ca.gov/senators
ChildcareCenter.us. (2015). San joaquin county child care centers: Creative child care-banta.
Retrieved from: http://childcarecenter.us/provider_detail/creative_child_care
_banta_preschool_ banta_ca
City of Tracy. (2014). Tracer: System maps and bus schedule. Retrieved from:
http://ci.tracy.ca.us/documents/Fixed_Route_Info_English.pdf
City of Tracy. (2015a). Fire department: Station and apparatus. Retrieved from:
http://www.ci.tracy.ca.us/?navid=880
City of Tracy. (2015b). Police department. Retrieved from: http://www.ci.tracy.ca.us/?navid=53
SDH: BANTA COMMUNITY ASSESSMENT 23
CHMA. (2009). Occupational Health Clinic. Retrieved from:
http://ddjchealthclinic.com/index.html
Huitt, W. (2007). Maslow’s hierarchy of needs. Retrieved from:
http://www.edpsycinteractive.org/topics/conation/maslow.html
Klemmer, C. D., Waliczek, T. M., and Zajicek, J. M. (2005). Growing minds: The effect of a
school gardening program on the science achievement of elementary students.
HortTechnology 15(3) : 448-452.
iMatrix Dental. (2015). Millennium Dental. Retrieved from: http://mdentaltracy.com/about-
us.html
iSport. (2015). Tracy sports complex. Retrieved from: http://softball.isport.com/softball-
fields/us/california/tracy/tracy-sports-complex-1084873
Lucile Packard Foundation for Children’s Health. (2015a). Kidsdata.org: Infant mortality rate.
Retrieved from:http://www.kidsdata.org/topic/294/infantmortality/
table#fmt=2312&loc=2,349&tf=81&sortType=asc
Lucile Packard Foundation for Children’s Health. (2015b). Kidsdata.org: Summary: Banta
Elementary. Retrieved from: http://www.kidsdata.org/region/1271/banta-
elementary/summary#44/physical-health
Mission City Church. (n.d.). Vision. Retrieved from: http://tracymission.org/#/about-mcc/vision
National Center for Education Statistics. (2014). Banta elementary. Retrieved from:
http://nces.ed.gov/globallocator/sch_info_popup.asp?Type=Public&ID=060387000354
National Railroad Passenger Corporation. (2015). Amtrak: Stations. Retrieved from:
http://www.amtrak.com/station-search-results
Neighborhood Scout. (2015). Crime rates for tracy, CA. Retrieved from:
SDH: BANTA COMMUNITY ASSESSMENT 24
http://www.neighborhoodscout.com/ca/tracy/crime/#description
Planned Parenthood Foundation of America, Inc. (2014). Tracy health center- Tracy, CA.
Retrieved from: https://www.plannedparenthood.org/health-center/california/
tracy/95376/tracy-health-center-3856-90130?utm_campaign=tracy-health-
center&utm_medium=organic&utm_source=local-listing
San Joaquin Regional Transit District. (2015). System maps. Retrieved from:
http://www.sanjoaquinrtd.com/maps_and_schedules/system_mapDay.php
School Innovations & Achievement. (2014). Tracy high school: 2013- 14 school accountability
report card. Retrieved from:
https://www.tracy.k12.ca.us/AboutTUSD/1213%20School%20Accountability%20Report
%20Cards/High%20Schools/TRACY%20HIGH%20SCHOOL%202013.14.pdf
St. Joseph’s Medical Center Stockton. (n.d.). CareVan mobile clinic. Retrieved from:
https://www.dignityhealth.org/stjosephs-stockton/services/carevan-mobile-clinic
Statistical Atlas. (2015). Banta elementary school district, CA. Retrieved from:
http://statisticalatlas.com/school-district/California/Banta-Elementary-School-
District/Overview
The STEAM Academy. (2015). Retrieved from:
http://steam.erusd.org/apps/pages/index.jsp?uREC_ID=254659&type=d&pREC_ID=581
025
Sutter Gould Medical Foundation. (2013). Family medicine care centers. Retrieved from:
http://www.suttergould.org/services/family-medicine.html
US Hospital Finder. (2015). Hospitals in Banta, CA. Retrieved from:
SDH: BANTA COMMUNITY ASSESSMENT 25
http://www.ushospitalfinder.com/hospitals/search?search_query=Banta%2C+CA&lng=-
121.37077729999999&lat=37.7543731&cgeo=
US News Education. (2011). How higher education affects lifetime salary. Retrieved from:
http://www.usnews.com/education/best-colleges/articles/2011/08/05/how-higher-
education-affects-lifetime-salary
USBoundary.com. (2015). US area boundary, data, graphs, tools and services. Retrieved from:
http://www.usboundary.com/Areas/Elementary%20School%20District/California/Banta
%20Elementary%20School%20District/159658
VBR Foundation, Inc. (2014). Contact us. Retrieved from:
http://www.vbrfoundationinc.org/contact_us.php
WestEd. (2014). California healthy kids survey: Banta elementary secondary 2013-2014 main
report. Retrieved from: http://chks.wested.org/resources/Banta_Elementary_1314_
CHKS.pdf
World Health Organization. (2015). Social determinants of health. Retrieved from:
http://www.who.int/social_determinants/en/
Yelp!. (2015a). Banta Inn. Retrieved from: http://www.yelp.com/biz/banta-inn-tracy
Yelp!. (2015b). Casa Mendoza. Retrieved from: http://www.yelp.com/biz/casa-mendoza-tracy