There are 30 cities within Tartan County, and four towns. Fort Worth is the county seat. (“Tartan County history’) According to the 2014 census, Tartan County’s population is 1,945,360 with a population density of 2142 people per square mile (very high (“State and county’) and is the 3rd most populated county in the state of Texas (out of 254 counties) Fort Worth has the highest population of people in this county, with 803,674, followed by Arlington, with 383,204. Tartan County lies in the “UDF Metropolis”; an economic and cultural hub of the region known as “North Texas”.
It is considered the largest land- locked metropolitan area in the United States. “Dallas-Fort Worth Metropolis,”) Tartan County is known for hot summer months, with mild winters. It gets 34 inches of rain per year, three inches less than average US cities, with an average of only 2 inches of snow. Tartan County residents see approximately 232 sunny days per year, but the high humidity during the summer months, can make outdoor activities uncomfortable. (“Climate Tartan County’) Tartan County sits in the southeast corner of “tornado alley, but has low risk for tornados activity.
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In 2000, a tornado hit downtown Fort Worth, Texas, killing 2 people with multiple injuries. “2000 Fort Worth tornado’) Tartan County has a wide range of economy, with areas of extreme wealth, and areas of extreme poverty. Opportunity for the residents of wealthy neighborhoods differs greatly from those who live in the areas where poverty prevails. Community Tartan County is home to many tourist attractions, such as Six Flags over Texas, AT&T Stadium, (Dallas Cowboys Stadium) Texas Ranger baseball stadium in Arlington, Texas, Fort Worth Stockyards, and the Fort Worth Zoo.
The arts district is home to the Kimball Art Museum, Ammo Carter Museum of American Art, and many more. Sacs Manama, and the Bass Performance Hall, entertains people with nationally known musicals and plays. Tartan County is home to Southwestern Baptist Theological Seminary, one of the largest seminaries in the world. UDF International Airport resides in both Tartan County and Dallas County. Tartan County has many colleges and universities, including Texas Christian University, University of Texas at Arlington, Texas Wesleyan University, and Tartan County Community College.
Tartan County has some of the best hiking and bike trails anywhere in the State of Texas. Fort Worth has over 40 miles of paved trails, known as the Trinity Trails. In the heat of the summer, and even during the winter ice storms, these trails host many walking, running and biking enthusiasts! (Keller, 2010) With the warm climate, and mild winters, area lakes provide an opportunity for swimming, camping, fishing and boating. There are a plethora of restaurants, movie theatres, and shopping centers. Driving between Dallas and Fort Worth gives multiple options for a night out.
The median age of residents is 33. 8 years, 50. 3% male, and 49. 7% female. According to Quick-data. Com, the racial/ethnic groups are: White (50. 0%) Hispanic (27. 6%) and Black (14. 9%). Asian- 4. 6% Two or more races-I . 7% In 2012, the median household Income was $56,859, however, 15. 3% of residents live in poverty. Geographical Aggregates urban population – Rural population – 23,304 Educational Attainment Age 25 and older, Percent high school graduate and higher- 84. 5% Age 25 and older, Percent bachelor’s degree or higher-29. % Labor Force: Total for all sectors 141,069- Retail trade-18, 906 Professional, scientific and technical services-18,412 Education-16,427 Arts, entertainment and recreation-12,012 Construction accounts for 9,660. Top three employers: MAR Corp.. (American Airlines and Envoy Air) Texas Health Resources Financial Lockheed Martin Annual Unemployment Rate in 2014- 5%. Total county income – Per capita income – $28,265 Political Tartan County has consistently supported Republican Party presidential candidates in recent decades. Tartan County profile) Religious Affiliation Evangelical Protestant-30. 1% catholic-11. 1% Mainline Protestant-7. 8% Other-4. 2% (Tartan county, Texas ) Transportation Interstates 20, 30, IOW, 820 U. S. Highways 81, 287, 377 state Highways 10, 26, 114, 121, 183, 199, and 360 Bus service- “The T” The Trinity Railway Express- a commuter train, that takes passengers through many ties of Tartan County, and Dallas County. This serves close to 2. 1 million passengers annually, and is a quick and economical option to get across town.
Crime Violent crime, (murder, rape, robbery, and aggravated assault) on a scale from 1 (low) to 100, is 48, compared to the US average of 41. 1 . Property crime, burglary, larceny, vehicle theft on a scale from 1 (low) to 100, is 52, compared to the US average of 43. 5. (Crime in Tartan) Health Care Facilities- Tartan County has over 40 healthcare facilities, specializing in acute care, rehabilitation, and mental health services. John Peter Smith Hospital, coated in Fort Worth, serves as the county hospital.
Texas ranks #1 in the US for uninsured residents with 32% of residents without health insurance. According to the 2010 statistics, Tartan County had 24. 4% uninsured residents. A summary of national data by the Congressional Budget Office has identified those with the likelihood of having no health insurance. People living at the poverty level Hispanics Young adults, age 19-34 People with part-time work Individuals in poor health Health Concern-Adult Obesity Obesity is defined as abnormal or excessive fat accumulation that may impair lath.
Body mass index (IBM) is commonly used to determine obesity. It is a measurement of weight for height. A IBM> 30 identifies a person as obese. Obesity arises from the imbalance of intake of calories, and calories expended. According to the World Health Organization, (WHO) In 2014, more than 1. 9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese. Overall, about 13% of the world’s adult populations (11% of men and 15% of women) were obese in 2014. In 2014, 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight.
The worldwide prevalence of obesity more than doubled between 1980 and 2014. High-income countries have greater rates of obesity than middle- and low-income countries; however, people in America who live in the most poverty-dense counties are those most prone to obesity. (Levine, 2011) The evidence is overwhelming; obesity places adults at a high risk for a number of health care concerns such as; diabetes, cardiovascular disease, sleep pane, hypertension, arthritis, and certain cancers.
Our nation’s health care problems will continue to soar, if obesity rates continue to rise. Baa. Background Information According to website, “State of Obesity in America,” 39% of American adults are obese, with 40% of American adults between 40-50 years of age are obese Higher percentage of obesity seen in Black adults, (47. 8%) Hispanic adults, (42%) compared to White. (32. 6%) Nearly 25% of Latino households are considered food insecure, with less access to supermarkets and nutritious, fresh foods, and less access to safe places to be active. The same is true for low income Blacks) The highest adult obesity rates are in the South and Midwest Twenty states have an adult obesity rate of 30% r higher The highest rates of type 2 diabetes are in the South Mississippi and West Virginia have the highest obesity rates (35%) There is a direct correlation between lack of physical activity, healthy food intake, and obesity 28 states have policies regarding the use of school playgrounds, and gyms for community use, with safe routes to school to support physical activity for children and adults. Http://stereotypes. Org/fascists/ Obesity in the state of Texas has steadily increased since 2000, and is seen in all socio-economic levels. Texas data is similar to that of the US. Texas now has the 15th highest adult obesity rate in the nation; 30. 9 percent, up from 25. 3 percent in 2004 and from 10. 7 percent in 1990. Http://stereotypes. Org/states/TX/ Healthy People 2020, set goals for increasing physical activity, nutritional intake, and decreasing obesity nationwide. A 13. 6% in reduction of obese adults, and a 37. 5% increase in intake of vegetables is needed to meet the goals of Healthy People 2020.
This goal can reduce the probability of co- morbidity’s such as cardiovascular disease, diabetes, hypertension, and other diseases that increase mortality. (Nutrition, physical activity) bib. Data Related to Health Concern The US has seen a dramatic increase in obesity. Obesity-related conditions have increased. Most Americans, do not eat a nutritious diet with decreased physical activity leading to poor health. Vegetable consumption in adults and adolescence is lacking, as well as the amount of physical activity required to maintain optimum health.
Physical activity can be positively influenced by the environment, such as safe streets, adequate sidewalks for walking, and bicycling, parks, walking trails, public swimming pools, and availability of these resources. (Physical activity) Hispanics, specially those without a high school education, and those at poverty level are overweight and obese. Food insecurity (the inability to afford nutritionally adequate food) affects one in five in Tartan County. The number of families in Tartan County receiving Supplemental Nutrition Assistance Program (SNAP) increased 52% from 2008-2011.
Low income individuals are at greater risk for obesity. They face greater challenges with opportunities for physical activity, and access to nutritional food. Some of these nutritional challenges are: Lack of full service grocery stores- Those without transportation may be forced to arches food from neighborhood corner stores, where quality fresh produce and low-fat foods are limited. Healthy foods may be more expensive- Families may stretch their budget by purchasing cheap, energy dense, high sugar foods that are linked to obesity.
Greater access to fast foods, easy to eat Fewer opportunities, resources for physical activity, such as sidewalks, safe streets, public pools, safe attractive playgrounds and park Lack of involvement in organized sports due to expense and lack of transportation Limited health care Often single parent households, with 2 or more Jobs (Factors contributing to) 3. Target Population Obesity has become an epidemic, and is related to increase co-morbidity’s such as cardiovascular disease, diabetes, hypertension, and cancer.
We have seen a rise of adult obesity, and unfortunately, we are seeing a rise in childhood, and adolescence obesity. A scientific statement from the American Heart Association described an emphasis on obesity prevention in the population at large to prevent the development of obesity in the adults who are still within their normal weight range. (Kayaking et al. , 2008) Also, targeting adults living at a lower socio-economic level ay create healthier families, with less risk for co-morbidity’s in a population that is already predisposed to chronic health conditions.
Baa. Link to Health Inequity and Health Disparity MM . Data Obesity is costly, and is putting a strain on health care across the United States, causing an increase in related conditions that include heart disease, stroke, type 2 diabetes and certain types of cancer. According to the CDC Adult Obesity facts, “The estimated annual medical cost of obesity in the U. S. Was $147 billion in 2008 U. S. Dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. Adult obesity facts) The link between obesity, inactivity, and poverty is very costly, and difficult to ignore. Obesity-associated diseases account for 70% of U. S. Health costs. Counties with greatest rates of poverty have greatest diabetes rates. Obesity alone is a substantial risk factor for cardiovascular disease. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Medical costs associated with obesity and related diseases have risen dramatically and are expected to rise more in the future. Obesity and cardiovascular, 2006) The estimated annual health care costs of illness related to obesity are close to $190 billion, or 21% of annual health care spending in the US. The US will be paying more for disability due to obesity related illnesses. Many businesses suffer due to obesity-related Job absenteeism. (Economic costs of,) According to “Trust for America’s Health Examines States’ Obesity Rates and Related Costs,” current trends in adult obesity: Could exceed 44 percent in every state, and exceed 60 percent in 13 states.
Type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis-?could increase tenfold between 2010 and 2020, and then double again by 2030. The financial cost of treating preventable, obesity-related diseases could increase by more than 10 percent in 43 states and by more than 20 percent in nine states. (Feistier, 2014) Obesity is a problem that affects many Americans. Obesity puts a burden on our health care system, and is responsible for increased morbidity and mortality. The fast food industry also contributes to the obesity problem in the US, including Texas.
In a recent University of Texas study on fast food intake, “for every mile the participants lived from the closest fast-food restaurant, there was a 2. 4 percent decrease in their IBM. (IBM, fast food) Fast food restaurants continue to increase in Tartan County, in spite of many initiatives to eat healthier food. 84. Resources and Partners The Get Fit Texas State Agency-Recognizes and rewards employees for meeting required amounts of physical activity. The Texas Mother-Friendly Worksheet Program- Recognizes worksheet that encourage and support nursing mothers.
Tartan County Food Bank- Area food bank serving Tartan, and 13 surrounding counties to provide healthy food, and Job opportunities for those who live with food insecurity, living in food desserts, and many other undeserved. Blue Zones Project- A community-wide well-being initiative for healthier lifestyles in Fort Worth, Texas, such as increasing activity, and increasing fruit and vegetable consumption to promote better health. Healthy Tartan County Collaboration- A partnership of hospitals, public health organizations, and universities to build healthier communities.
YMCA of Tartan County- Supports activities in seniors, adults, and the youth of Tartan County by providing education, and activities to promote healthier lifestyles Tartan County Obesity Prevention Policy Council- To drive policy, structural and, environmental hanged in Tartan County communities to promote healthy eating and physical activity. Tartan County Health Department- Educate, and inform the residents of health issues such as communicable diseases, immunization, and work with partners to identify, and address health equity and decrease health disparities.
Baa. Fieldwork Interviews I visited a local Whole Foods store, Just a few miles from my home. I must admit, I never shopped at this store; I was sure it was Just too expensive. The enormous produce section of the store is there upon entering. It is colorful and inviting. I met tit Matthew, from guest relations, and he assured me the prices there are comparable to other stores in the neighborhood, but buyers are assured quality and freshness of all produce. He gave me a tour of the store, and showed me the options for whole grains, nuts, fresh meats, and dairy.
There was much less options for chips, candy, and sodas. They have high standards for the food they sell, and feature food that are preservative free, without hydrogenated fats. There is no candy and chips at the check -out. (a tempting place to linger for adults and children) Matthew assured e Whole Foods is dedicated to providing healthier choices, with fresh, high quality foods. Renee Micron , Registered Dietician, for inpatients at Baylor Regional Medical Center at Grapevine, Grapevine Texas, says “portion control is one of the most important aspects of weight management. She illustrated the “Healthy Eating Plate,” (Figure 2, 3) which divides a smaller size meal plate into food groups; fruits and vegetables, protein, and whole grains. According to the Healthy Eating Plate, One-half of your plate should contain fruits and vegetables, (different colors, and rarities h of your plate should have whole grains, such as wheat pasta, brown rice, barley h of your plate should contain healthy protein Renee believes the culture that consumes fast food is at high risk for obesity.
According to “The Journal of Nutrition,” portion sizes at fast food restaurants have increased since the sass’s, and continue to increase. The term “supervise it” became famous in the sass’s; and food is estimated to be two-five times larger than two decades ago. Portions of pre-packaged foods, such as potato chips, have also increased over the years. (Ladylike, Ell-Martin, & Rolls, 2005) Renee is consulted on al inpatients with a diagnosis of Congested Heart Failure, Diabetes, Acute Coronary Syndrome, (MI, Extents) and coronary revitalization.
Another dietician, Hasten Schaller, is the nutritional counselor for the outpatient population at the hospital. Patients are referred by their physician, and clients work with her to lose body fat, and learn healthy eating habits. She works with adults and children, and identifies several barriers in nutritional counseling, such as fast food, and portion control. Her clients are asked to keep a food diary, and are taught to read labels. Many of her clients have Type II Diabetes, and high cholesterol. Many have cardiovascular disease, and Joint dysfunction.
Her services are covered by insurance, and she sees patients in a 1:1 setting. She says this service has proven to reduce patients IBM, reduce needs for insulin, and cholesterol medications. I spent time with Richard Feinting, D. O. Cardiologist, with Cardiovascular Consultants, Grapevine, Texas. He shared that 30-35% of all of his patients are obese, and close to 50% of the patients in his practice are considered overweight. He acknowledged an increase IBM carries high risks for cardiovascular disease. Many of his patients that are obese also have an obese spouse.
He feels many of his obese patients do not fully comprehend the high risk, and treating them can prove to be very frustrating. He also sees many patients with diabetes; many of them who do not have their Hectic under control. He used to practice in another hospital in a more underprivileged area, and his practice saw over 50% of the patients with diagnosed obesity. He was very vocal about the need to assist those in undeserved areas, and acknowledged the health-care crisis of those without health insurance, and the burden it places on our health care system.
I interviewed Linda Fuller, executive director of Healthy Tartan County Collaboration, and was introduced to “The Spectrum of Prevention” tool, (Prevention Institution, 1999) as a meaningful way to look at changes. This tool, developed by Larry Cohen, (founder and Executive Director of Prevention Institute) can be used for any prevention initiative. It identifies many levels of intervention, and helps people move away from the thought that prevention can simply be changed with education. These multi-level ideals, if used together, can produce more powerful outcomes. According to Ms.
Fuller, legislation, and other policy initiatives, gives a “bigger bang for the buck. In other words, much time and effort are placed on individual knowledge and skill, when many individuals do not have sufficient resources in place to be successful. Many people would appreciate the opportunity to increase activity, but if they reside in a neighborhood that is unsafe, with inadequate sidewalks and activity resources, daily activity may not be reasonable. If there is little public transportation, there may be barriers to access grocery stores that can provide fresh fruit and vegetables.
Many areas with the higher rates of obesity in Tartan County have environmental factors that limit many adults to healthy lifestyles. Fuller drove me through some areas in south Tartan County that struggle with obesity. These areas look so different from the North Tartan County neighborhoods where I live and work. This area struggles with poverty, and it was clear; increasing access to recreation, and grocery stores, with better police patrol may enhance the healthy lifestyle of the residents.
I spent several hours at the” Hispanic Wellness Fair,” an annual community event geared to the Hispanic community, and their specific issues. Every presenter was bilingual, and all of the fliers and education material was in English and Spanish. They did health screening, (cholesterol, glucose, IBM, blood pressure, skin assessment) with several services represented (Medicaid, food stamps, WICK, health care agencies, YMCA, Diabetes Coalition) There were several stations, each one representing a community need. They offered cooking demonstrations, and had dieticians, life coaches, and exercise specialists.
The majority of those in attendance were Hispanics, and there were fun and games for children. This annual event provides education and options for wellness to the Hispanic community, and offers free parking with public transportation. Each table gives away pens, cups, magnets, toys for children, etc. , and draws thousands each year. Another interesting interview was with my friend and colleague, Shells W. , who had barbaric surgery in 2009. S. Was 100 pound overweight, and struggled with obesity her entire adult life.
She told me she tried Weight Watchers, Nutria-System, and other fad diets, and she would lose weight, only to re-gain it back, and weigh more than before. She was borderline diabetic, and was on medication for high blood pressure. Her biggest complaint was her inability to be active, and her weight kept her from enjoying daily activities. She was embarrassed to go out, and her self- esteem suffered. A year after her surgery, she lost almost 100 pounds, and has kept the weight off. She no longer has high blood pressure, and her glucose is within normal limits.
She has become more active, and enjoys gardening, and walking. I invited four of my colleagues to lunch, to discuss their perception of obese patients, and barriers in caring for them. Each person interviewed shared negative perceptions of obese patients, sighting the physical demands. They said it takes twice as long to do most of the care for an obese tenant, and so many cannot do anything to help with their care. They are at risk for falls, pressure ulcers, and the staff is then deemed responsible, and must deal with the consequences of hospital acquired injuries.
The high acuity of an obese patient is not considered in making staffing assignments, even though their care is often more time consuming. They also felt our safety was in Jeopardy, and know of many who have suffered back and neck injuries caring for obese patients. Many of the obese patients have longer hospital stays, due to the co-morbidity’s, and the risk of hospital acquired infections is greater. Often, the nursing care can be excellent, but it may still be difficult to prevent hospital acquired injuries. I also spent the day in cardiac rehab, with the nurse Marl, and the exercise physiologist, Whitney.
Patients are referred to cardiac rehab after a cardiac event, such as a Myocardial Infarction, Cardiac Intervention, (Steen placement), or Open Heart Surgery. I shadowed both employees for a different perspective. Marl acknowledged, over 50% of her patients, men and women combined were overweight, and almost 30% were considered obese. Many patients did not have an exercise routine, and most admit to n unhealthy diet. Marl stated the population of patient in this area, were not suffering from food insecurities, but ate fast food on a regular basis, and often ate at restaurants.
Many in this community have careers, and busy lifestyles, making cooking at home difficult. Marl conducted a complete history and physical exam, including medication lists for each new patient. Whitney, E. P. , would then see the patient and discuss the exercise program. This 26-36 session program guides patients through exercise while monitoring heart rate, blood pressure and pre and post glucose for diabetic patients. Clients start the program with light exercise, and increase the intensity throughout the program.
Patients also have educational classes from a pharmacist, nutritional classes from their outpatient dietician. They are educated on reading labels and identifying high fat, sodium, and sugar contents in food. They are educated on making healthier choices when visiting restaurants. From these interviews, it was very clear that the obesity crisis here in Tartan County is quite challenging. There are many barriers; both behavioral and environmental issues present. People with busy lifestyles often eat away from home, and are emptied with tasty, but high calorie fast-foods, with large portions.
People don’t often understand the importance of eating a diet based on the Healthy Food Plate, and eat large portions at each meal. “All you can eat” restaurants are very popular, and “supervise it” is a phrase we have all become accustomed to. Unfortunately, many adults in undeserved areas face other struggles; living in food desserts, with little access to grocery stores that have quality, affordable, nutritious foods. Many of these neighborhoods do not offer a positive, safe environment for family activities that can enhance a healthy lifestyle. 5.
Aspects Not Being Addressed In my research, and through the field service interviews, I am aware of different problems in different areas of Tartan County. After speaking with several individuals, it is my opinion that there are two different populations of those struggling with obesity; those who live in undeserved areas, and have minimal opportunity in obtaining healthy food and exercise, and those living in areas with an abundance of choices for nutritional food with opportunity for activity. It is a difficult task to implement plans to reduce obesity, when dealing with different needs of people with different lifestyles.
The population of people living in food desserts, must have means to get healthy food, and must have an environment for safe activity. Policies are needed to enable this population access to healthier food, and provide safer areas where residents can walk, and play without fear. In contrast, those living in more affluent areas have opportunity for healthy choices, with a safer environment for activity; yet, obesity is still a major problem. Many here are living the “busy lifestyle,” Juggling a career, children in sports, and often have little time to prepare nutritional meals.
With the many fast food restaurants available, it has become easy, and almost essential, to get a quick meal, when you are on the go. In my interview with Marl B, RAN, manager of Cardiac Rehab at Baylor Grapevine, I asked her opinion of why there is an abundance of obesity in this affluent area. She believes many of the clients she sees, have very busy lifestyles, and seldom cook at home. She said the majority of the clients acknowledge fast food, and eating away from home, as one of their biggest challenges. Reducing obesity now becomes very complicated.
Different populations, (including different rates of obesity within efferent ethnic groups) within the same county, have different challenges. These challenges can be identified into other sub-groups such as lack of transportation, literacy, education, and poverty. Identifying, educating and providing population specific action plans is the only way to reduce the rate of obesity. CLC . Desired Outcomes, Goals for Improvement Tartan County, Texas, continues to see an increase in the obesity epidemic, threatening the health of many residents, especially those struggling with poverty, and lack of health care.
In Tartan County, the number of overweight and obese adults continue to rise, and continues to be a priority in health initiatives. Overweight: Adults with a IBM of 25-30 – 414,507 (36. 34%) Obesity: Adults with a IBM>30 – 369,325 (27. 80%). Education, and policy reform is needed to provide all residents with the opportunity for nutritional food, safe environments for activity, and education to promote a healthy lifestyle. Implementing policies for healthier lifestyles may offer the best solutions for decreasing obesity in undeserved areas. Obesity rates are higher in families living in poverty.
These neighborhoods have been identified as having poor access to healthy foods, (lack of grocery stores offering affordable, fresh fruits and vegetables,) and struggle with safe environments that are not conducive for outdoor activities and exercise. In my interviews and research, financial resources, and government spending, at many levels, often place priorities and capital on developing large businesses, or the development of new businesses. Educations about healthier fast food choices is necessary for many living in areas with sufficient choices, but are part of a high stressed, fast paced life-style.