Running head: THE CITY OF SOUTH TUCSON 1

Community As Partner Report for the City of South Tucson

Cassidy R. Leroux, Amanda T. Nguyen, Shane M. Pendleton

University of Arizona
THE CITY OF SOUTH TUCSON 2

The City of South Tucson

Introduction

While Tucson is a fairly well-known city, few are aware that there lies a city within the

city. The City of South Tucson, census tract (CT) 23, is an embedded town with a rich history,

community, and culture. However, it often gets neglected by the rest of Tucson, leaving the city

to face numerous public health concerns. Therefore, we hope to address these issues to ensure

the city’s residents are able to reach their highest level of health and well-being.

Community Nursing Assessment

The 1.04 square mile city houses only 5,624 people out of the over a million people in

Pima County. Nearly 78% of citizens are Hispanic or Latino and consequently, 58.7% of the

people in the city speak Spanish, more than double that of Pima County. The Hispanic culture is

abundant throughout CT 23. Family-owned Mexican restaurants and markets, such as tortillerias,

dominate the area. Aspects of Mexican culture, such as food, history, and Catholicism, were

common themes of murals that covered nearly every street and building (Pima County Health

Department Public Health Nursing Community Profile CT 23, 2019).

Over 54% of buildings were built before 1959, compared to only 14.1% in Pima County.

Most homes were single-unit homes but were subleased to multiple people. Many homes were

for rent or for sale, and many were abandoned altogether. Trash and rubble filled many

household backyards and streets. Other safety hazards included potholes in residential streets,

lack of adequate night lighting, limited parking availability, and numerous stray dogs. Over 46%

of residents in the CT live in poverty compared to 18.3% in Pima County. Median household

income is $21,160, less than half of that of the county. Political presence was minimal in the CT,
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but many of the same individuals have been serving the city for a long time (Pima County Health

Department Public Health Nursing Community Profile CT 23, 2019).

CT 23 has suffered from nearly 2,000 crimes in the past six months of mainly property

crimes and illegal drug use. Yet, resources only allow two officers from the City of South

Tucson Police to be on patrol. South Tucson Fire Department transports residents to Banner

South or St. Mary’s, as there are no hospitals or urgent cares in the CT. La Frontera is the only

mental health service in the area. The Salvation Army Tucson Adult Rehabilitation Center offers

an in-house program that allows substance abusers to get counseling and engage in work-

therapy. Primavera Foundation and the Gospel Rescue Mission help the homeless receive rapid

re-housing and rent and utility assistance. The Young Women’s Christian Association supports

small business owners, especially women, and aids senior citizens in their instrumental activities

of daily living (Pima County Health Department Public Health Nursing Community Profile CT

23, 2019).

In CT 23, only 59.6% of people have graduated high school and 4.2% have bachelor’s

degrees compared to 88.2% and 31.6% of all people in Pima County, respectively. Ochoa

Elementary School, Mission View Elementary School, and Las Puertas Community School are

part of the Tucson Unified School District and are the only schools inside of the CT. Most

students travel to middle and high schools outside of the CT. Recreational options for the

children and public are limited. However, the John A. Valenzuela Youth Center in the CT

provides a safe space for at-risk youth to promote academic achievement and positive lifestyle

skills. Also, the Sam Lena Library provides free wifi and weekly programs such as Citizenship

Class in Spanish and Eating for Energy. While these programs exist, the managing librarian

(personal communication, January 19, 2019) stated that she struggles with attendance because of
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the communication and language barriers. Most homes do not have wifi, and free internet access

is minimal. Therefore, most communication is done by word of mouth and dual language fliers

(Pima County Health Department Public Health Nursing Community Profile CT 23, 2019).

Community Nursing Diagnosis

The City of South Tucson has multiple strengths that have helped build the community.

Nearly every key informant noted that CT 23 is family driven. The Hispanic culture places

family involvement as a high priority, being the central motive for most decisions and actions

(high school principal, personal communication, January 19, 2019). Another strength is that the

city has strong community ties with a strong sense of pride in where they live, so much that most

people are multi-generational residents living in the same house that their parents and

grandparents grew up in (fire captain, personal communication, January 18, 2019). The small,

yet tight-knit community is invested in each other’s well-being, and there has been an increase in

the number of people who are working on behalf of the city to promote a better quality of life

and build a strong community backbone (health teacher, personal communication, January 18,

2019). Lastly, there is a strong sense of hope in the betterment of the community’s future. The

managing librarian (personal communication, January 19, 2019) also noted that new businesses

are starting to take a chance on South Tucson, hopefully bringing in more customers, investors,

and property owners to the area to improve the economic status.

Though CT 23 has multiple strengths, there are some areas of concern. As stated, nearly

50% of the population lives below the poverty line. Subsequently, there is a high homeless

population and many families who struggle to remain financially stable (manager of the Young

Women’s Christian Association, personal communication, January 22, 2019). Drug and alcohol

abuse has been a growing issue in the city as well. The intake coordinator of the Salvation Army
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Rehabilitation Center stated only about 30% of enrolled men fully complete the program and

remain clean, while the majority drop out and use again at lethal doses (intake coordinator,

personal communication, January 19, 2019). Finally, CT 23 lacks access to healthy foods. With

only one supermarket and predominantly fast food restaurants seen in the CT, the residents are

limited on options to maintain a nutritious diet. Nearly every key informant stated that this food

desert has led to a noticeable number of obese individuals and diabetics (personal

communication, January 19, 2019). Based on these three stressors, we completed a Priority of

Care Table to further evaluate the needs of the CT. Refer to Appendix A for a copy of the table.

Therefore, we determined an appropriate nursing diagnosis for this community is, “At risk of

obesity among the children of the City of South Tucson related to lack of access to healthy food

options, lack of health education, and low socioeconomic status as evidenced by unanimous key

informant statements of concern and windshield survey observation of minimal health food

options and plentiful fast food in the community.”

Community Nursing Program Plan

After conducting key informant interviews, it was decided that unhealthy eating

behaviors in the children of the City of South Tucson was a major point of concern in the

community that we could address. The good goal that we developed for CT 23 was to improve

the knowledge of healthy eating habits of the children of the City of South Tucson through

teaching about the importance of healthy eating. It is our hope that this intervention will lead to

long-term prevention of obesity and related health concerns.

Evidence-Based Article

An evidence-based article that addresses the good goal is titled “Results of a 3-year,

nutrition and physical activity intervention for children in rural, low socioeconomic status
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elementary-schools” (King & Ling, 2015). In this study, nutrition education was presented to

elementary-school children once a week for three years. The children’s nutrition knowledge was

measured at baseline and evaluated every 12 weeks throughout the course. The strategy of this

study was to improve nutritional knowledge of children through weekly classes and additional

education workshops (King & Ling, 2015). Our strategy was to improve nutrition education of

the children after just one presentation. Though the study had a more in-depth and long-term

approach to education, the strategies that we utilized were very similar to those in the study. The

purpose of the article was to evaluate the longitudinal effects of three years of nutrition education

on elementary school students, which is very similar to our purpose, which was to improve the

nutritional education of elementary school children after one presentation (King & Ling, 2015).

The sample of the article was 999 children from kindergarten to fifth grade, and the sample of

our intervention was 16 fourth and fifth grade children (King & Ling, 2015). Though our sample

size was much smaller than that of the article, the demographic and age is very similar to that of

the study. The article’s intervention was performed in a school setting, whereas we completed

our teaching in a library. The strength of the evidence in this article is level three, as it is a quasi-

experimental design (King & Ling, 2015).

Healthy People 2020 & Policy

Healthy People 2020 places importance on promotion of health and prevention of health

problems through healthy behaviors. The most applicable overarching goal from Healthy People

2020 is to “promote quality of life, healthy development and healthy behaviors across all life

stages” (Healthy People 2020, 2019a). A Healthy People 2020 topic area related to the

intervention performed is nutrition and weight status. The goal related to this topic area is to

“promote health and reduce chronic disease risk through the consumption of healthful diets and
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achievement and maintenance of healthy body weights” (Healthy People 2020, 2019b). The

related objective is NWS-17.3 under food and nutrient consumption, which focuses on reducing

consumption of calories from solid fats and added sugars (Healthy People 2020, 2019c).

A current policy that related to the good goal is the 2015-2020 Dietary Guidelines for

Americans (U.S. Department of Health and Human Services and U.S. Department of

Agriculture, 2015). These guidelines serve as the basis for most nutritional education in the

United States, as well as helping guide healthcare professionals when advising patients about

their nutritional needs. This is considered public policy, as it applies to all members of society

(Gist, 2015).

Health Education Project

The health education project that we planned focused on promotion of healthy eating

habits to elementary school children. This intervention was chosen because it was reported by

multiple key informants within the schools that students ate an alarming amount of unhealthy

foods. The project was performed on February fourth at Sam Lena Library and was attended by

16 fourth and fifth grade students from the John A.Valenzuela Youth Center. The aim of this

project was to improve the knowledge of healthy eating habits amongst the children and to set

them up for a healthy lifestyle to prevent obesity and diabetes. We played interactive games,

discussed the importance of healthy eating, and brainstormed healthy snack ideas with the

children in an attempt to allow them to engage with their dietary choices. We developed three

SMART objectives for this health education project:

● After we present a presentation on healthy eating habits to the fourth and fifth graders of

John A. Valenzuela Youth Center at Sam Lena Library on February 5, 2019, at least 50%

of the students will be able to correctly identify healthy and unhealthy snack options.
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● After we present a presentation on healthy eating habits to the fourth and fifth graders of

John A.Valenzuela Youth Center at Sam Lena Library on February 5, 2019, at least three

students will be able to state understanding of what a fat and a sugar is in relation to

nutrition.

● After we present a presentation on healthy eating habits to the fourth and fifth graders of

John A. Valenzuela Youth Center at Sam Lena Library on February 5, 2019, at least three

students will be able to identify the importance of eating healthy.

Program Plan

Plan for Implementation

a. On January 31, 2019, we contacted the Sam Lena Managing Librarian to set up a healthy

eating presentation for the fourth and fifth graders of John A. Valenzuela Youth Center.

b. On January 31, 2019, we decided on three main goals to address the topic of healthy

eating with the fourth and fifth graders: identifying a fat and a sugar, choosing between

healthy and unhealthy foods, and the importance of eating healthy foods.

c. On February 1, 2019, we made a tri-fold poster with healthy snacking information. The

poster included explanations of fats and sugars as well as the fat and sugar content in

popular healthy and unhealthy foods.

d. On February 5, 2019 at 3:00 p.m., we presented our information at the Sam Lena library

to an audience of 16 fourth and fifth graders.

Plan for Evaluation

a. We instructed students to raise red and green flags in response to questions about healthy

and unhealthy foods before and after the presentation. Students raised the green flags in

response to healthy choices, while red flags were raised in response to unhealthy choices.
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This evaluated the students’ ability to choose healthy snacks before and after the

presentation.

b. We asked students at the beginning and the end of the presentation to raise their hands if

they knew what a fat is and what a sugar is. Students were asked to explain. We counted

the number of students who raised their hands before and after and compared. This

allowed us to evaluate the students’ knowledge of fat and sugar both before and after

teaching.

c. We asked the students to raise their hand if they could explain the consequences of eating

too much fat and sugar. We counted the number of students who raised their hands. We

also asked them what too much fat and sugar does to their bodies. We asked them the

same question after the presentation and counted the number of students who raised their

hands. This identified the change in the students’ knowledge of the effects of healthy and

unhealthy foods on their bodies as well as the importance of healthy eating.

Community Partners

We worked with several partners in the community to make our health education project

successful. The key informants we talked to helped describe the most pressing issues in the

community as well as useful health education topics. Early on, we identified that we wanted to

do our health teaching to school-age children in the community. The managing librarian of the

Sam Lena library was a great partner for us during this process. When we told the librarian that

we wanted to teach students about healthy eating, she contacted the John A. Valenzuela Youth

Center and invited their students to come to the library for our health education project. We

remained in contact with the Pima County Health Department public health nurse assigned to CT
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23 and kept her updated on our progress and our findings. We also received support from the

University of Arizona College of Nursing which supplied us with a tri-fold poster.

Level(s) of Prevention

Our health education project is an example of primary prevention. We addressed

potential health problems that we identified in this community. Overconsumption of food high in

fats and sugars can lead to obesity, diabetes, and many other complications. In the natural history

of disease, the school-age children of CT 23 are in the stage of susceptibility. This education

project targets children in which risk factors are present, but health problems do not yet exist.

Resources and Constraints

Implementation of Community Nursing Intervention

On February 5, 2019 at 3:00 p.m. we presented our health education project to a group of

16 fourth and fifth grade students. The presentation lasted one hour and was generally successful.

We used a tri-fold poster as a visual aid and utilized several activities to encourage participation.

Refer to Appendix B for a photograph of the poster. The students were eager to volunteer

answers and participate in the activities. Making our presentation interactive was crucial to

keeping the students engaged throughout. One challenge for us was the amount of conversations

between the students during the presentation. It did not help that the teacher was also on his

phone during the presentation. However, the children listened after being asked to quiet down.

For the most part, the students were engaged with the presentation and according to our

evaluation, they learned about the importance of healthy eating.

Evaluation of Community Nursing Intervention

We evaluated the students’ learning by asking the same nutrition questions before and

after the presentation. This allowed us to measure the success of our teaching and count the
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increase in number of students that knew the answers to our evaluation questions after the

presentation. For SMART objective one, 71.9% of the students correctly identified snacks as

healthy or unhealthy before teaching and 87.5% of the students correctly identified snacks as

healthy or unhealthy after teaching. Refer to Appendix C for specific polling data. For SMART

objective two, eight students were able to state understanding of a sugar and two students were

able to state understanding of a fat before teaching. After teaching, 13 students were able to state

understanding of a sugar and six students were able to state understanding of a fat. For SMART

objective three, three students were able to identify the importance of eating healthy before

teaching, and 12 students were able to identify the importance of healthy eating after teaching.

We were happy to see that our objectives were met and the students had learned about nutrition.

One challenge we faced in the evaluation process was confusing wording. Our evaluation

question asked the students to define a fat and a sugar; however, our teaching was more focused

on the differences between healthy and unhealthy fats and sugars. Many of the students were not

able to answer until we rephrased the question and asked them to define the difference between

healthy and unhealthy fats and sugars. Being more specific with our word choice would have

allowed us to evaluate our teaching more accurately.

Conclusion

The City of South Tucson proved to be a proud city with a distinct culture. However, the

“city within the city” faces many unique stressors and challenges. Census data revealed a high

poverty rate and a lack of healthcare resources. Through key informants, we learned of

concerning health problems in the city. Due to limited access to healthy food, obesity and

diabetes stood out as major problems. By teaching fourth and fifth grade students the importance

of healthy eating, we aimed to utilize primary prevention to promote nutrition and decrease the
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incidence of obesity and diabetes. We evaluated the teaching by asking questions before and

after presenting and found that the intended goal of increasing knowledge of healthy eating

habits was achieved. If the health education project was repeated, more precise evaluation

questions would have provided a more accurate assessment of the effectiveness of the teaching.

We presented our findings, community assessment data, and health education project

results to peers and public health nurses at Theresa Lee Public Health Center. Through the

process of working with the community, we learned the importance of seeing the community in

person and talking to key informants versus making judgments based on statistics. Although

census data painted a bleak picture of poverty and struggle, our time in the city has provided a

different perspective of the City of South Tucson: one of resiliency, pride, and hope for the

future.
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Appendix A: Priorities of Care Table

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Appendix B: Visual Aid

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Appendix C: Evaluation for SMART Goal 1

Pre-teaching:

Snack Item Green Flags Red Flags

Takis 9 7

Hot Cheetos 4 12

Donuts 5 11

Bananas 16 0

Post-teaching:

Snack Item Green Flags Red Flags

Takis 2 14

Hot Cheetos 1 13

Donuts 1 13

Bananas 16 0
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References

Gist, J. H. (2015). Partnering with communities for healthy public policy. In E. T. Anderson and

J. McFarlane (Eds.), Community as partner: Theory and practice in nursing, (pp. 116-

118). Philadelphia, PA: Wolters & Kluwer

Healthy People 2020. (2019a). About Healthy People. Retrieved from

https://www.healthypeople.gov/2020/About-Healthy-People

Healthy People 2020. (2019b). Nutrition and Weight Status Overview. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status

Healthy People 2020. (2019c). Nutrition and Weight Status Objectives. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-

status/objectives

King, K. M., & Ling, J. (2015). Results of a 3-year, nutrition and physical activity intervention

for children in rural, low-socioeconomic status elementary schools. Health Education

Research, 30(4), 647-659. Doi: 10.1093/her/cyv029

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015).

2015-2020 Dietary Guidelines for Americans. Retrieved from

https://health.gov/dietaryguidelines/2015/