Sentinel City: The Health Issues

Needs Assessment

For the needs assessment, I used four assessment tools. I utilized the Windshield Survey, Demographics, Neighborhood Safety, and Scavenger Hunt. All four of those tools were beneficial in helping me to collect and analyze data for Sentinel City.


Sentinel City has a total citizen population of 663,862. There are four neighborhoods within Sentinel City. The breakdown of the population for each area is that Nightingale Square has a population of 103,974, Casper Park District has a population of 352,643, Acer Tech Center has a population of 168,390, and Industrial Heights has a population of population 38,855 (Sentinel U, 2022).

The homeless rate for Sentinel City is reported to be 0.87%. The percentage of each neighborhood is for Acer tech Center at 0.03%, Casper Park District at 0.24%, Industrial Heights at 0.59%, and Nightingale Square at 0.01%. Those numbers are correct for Sentinel City when you use the total population of Sentinel City (663,862) as the denominator and the number of homeless in each district as the numerator. In each neighborhood, the number of homeless for Acer Tech Center is 199, Casper Park District 1,593, Industrial Heights 3,917, and Nightingale Square 66. When you use the population of each neighborhood as the denominator, the percentage rate for each area is Acer Tech 0.12%, Casper Park District 0.45%, Industrial Heights 10.08%, Nightingale Square 0.06% (Sentinel U, 2022).

Sentinel City lists the median household income as $49,091. Per neighborhood, the median household income for Industrial Heights is $24,672, Nightingale Square is $269,550, Acer Tech Center is $166,300, and Casper Park District is $80,134 (Sentinel U, 2022).

Each neighborhood also has several people without health insurance under the age of 65. Industrial Heights has 37.5%, Nightingale Square has 0.7%, Acer Tech Center has 1.5%, and Casper Park has 22.7%. No data is given for 65 and over without health insurance (Sentinel U, 2022).

The percentage of people under 65 with disabilities for Industrial Heights is 12.9%, Nightingale Square is 3.5%, Acer Tech Center is 6.7%, and Casper Park District is 6.8%. Unfortunately, no data is given for people 65 and over with disabilities (Sentinel U, 2022).

Sentinel City lists the number of people 65 years and over at 10.5%. The percentage for each neighborhood for ages 65 and over is Industrial Heights has 0.9%, Nightingale Square has 13.9%, Acer Tech Center has 19.8%, and Casper Park District has 6.5%. The percentage of people under 18 years old in Sentinel City is 21.7%. The percentage per neighborhood for those under 18 years of age is Industrial Park has 20.8%, Nightingale Square has 5.9%, Acer Tech Center has 7.0%, and Casper Park District has 33.8% (Sentinel U, 2022).

The Public Health Department lists immunization percentages for different ages of children. The US percentage for DTAP 5 is 95.1%, MMR is 94.3%, Varicella is 93.8%, and exemptions are 2.2% for kindergarten students. Sentinel City breaks down the percentage by neighborhood. Nightingale Square for DTAP 5 is 95%, MMR 94.5%, Varicella 91% and exemptions 4.4%. Casper Park District DTAP 5 is 87%, MMR 91%, Varicella 90%, and exemptions are 2.1%. Acer Tech Center for DTAP 5 88%, MMR 91%, Varicella 90%, and exemptions 2.3%. Industrial Heights DTAP 5 85%, MMR 88%, Varicella 86%, and exemptions 0.6% for those in kindergarten (Sentinel U, 2022).

For Sentinel City, immunization rates for 19-35 months old’s children list Nightingale Square at 96%, Casper Park District at 87%, Acer Tech Center at 88%, and Industrial Heights at 85%. For the ages of 13-17 years old, the US percentage for these vaccines is Tdap 88.9%, HPV (female) 69.9%, HPV (male) 66.3%, Meningococcal 50.8%, and Hepatitis B 92.1%. The percentage of the same vaccines for the neighborhoods of Sentinel City is Nightingale Square Tdap 90%, HPV (female) 72%, HPV (male) 68.3%, Meningococcal 60%, and Hepatitis B 94.5%. The Casper Park District rates are for Tdap 87, HPV (female) 66.5%, HPV (male) 63.4%, Meningococcal 48%, and Hepatitis B 89%. For Acer Tech Center the Tdap 89%, HPV (female) 70.4%, HPV (male) 66.2%, Meningococcal 49.8%, and Hepatitis B 90.7%. Industrial Heights Tdap 86.9%, HPV (female) 64.1%, HPV (male) 60%, Meningococcal 45%, and Hepatitis B 88.8%. For adults ages 18 and older, the US percentage for these vaccines is Pneumococcal at 24.5%, Tetanus at 63.4%, and Influenza at 45.4%.

The vaccination patterns for each neighborhood follow the same pattern as the other vaccinations percentages, with Industrial Heights having the lowest vaccination rates of the different areas and below the US percentage. For example, Industrial Heights percentages for these vaccines are Pneumococcal 19.2%, Tetanus 55.6%, and Influenza 55% (Sentinel U, 2022).

Neighborhood Safety Assessment

In all the neighborhoods of Sentinel City, I saw garbage with rats running throughout the trash. The crosswalks were not easily defined, and no pedestrian walking signals were seen. By the gas station and hospital, the inlets and outlets for vehicles were obstructing the sidewalk (by the hospital), or the sidewalk ends (between the gas station inlet and outlet has no sidewalk but a grass island type). I did not see any dedicated bike lanes, and the bicyclers had to weave around parked cars and share lanes with other vehicles. There are broken-down cars on the streets in places, and one of the broken-down cars blocks a bus stop area.

In the Industrial Heights area, broken-down cars were on the street, and graffiti was on many buildings. The buildings were rundown looking and in need of repair. The city water tank is below many of the taller buildings. I saw a stray cat and a dog, and a dog not on a leash. Industrial Heights had even more garbage with rats seen than in the other neighborhoods.

City Hall Police Department reports that 16% of arrests involved a controlled substance, and 6% were for public intoxication last year. The City Parks and Recreation report that 16% of their citations are related to intoxication or public drug use. Sentinel City pharmacy information says that the population using drugs last year was tobacco 24%, alcohol 36%, marijuana 12%, cocaine 5%, heroin 7%, methamphetamines 10%, and prescription drug abuse 18%. In addition, 11% of the population in Sentinel City have been prescribed hydrocodone. The Bodega reports tobacco sales for ages 18-24-year-olds at 7.8%, ages 25-44 at 16.5%, ages 45-64 at 16.3%, and 65 and older at 8.4% (Sentinel U, 2022).

I compared emergency response times to three other cities. The times for Sentinel City were as such: the Fire response team was in first place with a response time of 6.33 minutes, the EMS response team was 2nd with a response time of 7.46 minutes, Advance Life Support was 3rd with a response time of 7.54 minutes, and Shock Time was also in 3rd place with a time of 6.37 minutes. Compared to the three other cities, Sentinel City has the lowest rate of 30 paramedics and 250 firefighters per 100,000 population. Sentinel City also had the most sudden cardiac arrest victims at 145. In addition, Sentinel City has the lowest percentage of a population trained to perform CPR and AED use at 0.047%. Cardiac arrests with CPR performed by citizens were tied for 3rd place with 0.02%, and sudden cardiac arrest survival was also tied for 3rd with 0.04% compared to the three other comparison cities (Sentinel U, 2022).

Last year, the reported violent crimes in Sentinel City were murder 20, rape 312, robbery 559, aggravated assault 1,231, and 2,122 violent crimes. Other common arrests were battery at 17%, criminal trespassing at 9%, reckless conduct at 6%, warrant at 23%, and a category other at 23%. The gang-related crimes as reported by the police department for last year are aggravated assault at 100, robbery at 40, simple assault at 38, and homicide at 20 (Sentinel U, 2022).

Scavenger Hunt

The City Parks and Recreation offer swimming lessons, nutrition courses, gardening courses, and adult fitness courses. They also provide kids with summer and after-school programs and city sports leagues.

The Healthcare System has elderly services, and the percentages of services used by the elderly were, Senior Transportation 6.8%, Service Animals 2.5%, Meals on Wheels 1.3%, Elderly Abuse Prevention Advocates 0.9%, Community Center 2.9%, Government Entitlement Assistance 7.6%, and Medical Care Advocates 8.3%. It also lists some dentistry statistics. For childhood dental cavities per 1,000 citizens, children ages birth to 23 months old, dental caries went up from 23% one year ago to 42% this year. For ages 2-5 years old, it was 29.9% last year and 31% this year. The 6-11-year-olds the previous year had 55.2% last year, and this year they had 53%. The ages 12-18 had 56% one year ago and 40% this year.

The number of specialty clinics stayed the same for orthodontists and endodontists but increased in the number of dental hygiene clinics and pediatric oral surgery in the last two years. Sentinel City didn’t have any pediatric oral surgery clinics five years ago. Last year they had one, and this year, they have 2. They also list the special dental programs they have for children. The children’s ages in special dental programs are 8% for two-year-olds, 12% for three-year-olds, 22% for four-year-olds, 27% for five-year-olds, and 31% for six-year-olds (Sentinel U, 2022).

City Hall has information for various departments in the city. It lists programs that the social service department has available. For example, protective services for the adult and child have 30 programs for childcare providers accepting subsidy benefits, 30 for stay-at-home programs, 95 for youth independent living services, 105 for head start and early head start programs 425 for adoption services (Sentinel U, 2022).

For the healthcare assistance programs, ACA has 38,771 citizens using it, Medicaid has 200,036 citizens using it, Medicare has 104,240 citizens using it, and Charitable Healthcare has 4,116 citizens using it (Sentinel U, 2022).

Five years ago, WIC had a total of 98 women enrolled. Last year they had 96 women enrolled in WIC. Previous year’s SNAP recipients, 24,359 were low-income persons, 15,320 were in training programs, 17,359 were disabled, and 9,953 were elderly 60+ years (Sentinel U, 2022).

The Better Health Clinic offers various services, including contraceptive services, pregnancy testing, counseling, achieving pregnancy, basic infertility services, preconception health, sexually transmitted diseases services, breast cancer screening, cervical cancer screening, and other preventative health services (Sentinel U, 2022).

The Interfaith Church has a soup kitchen and serves a variety of people. For example, 64% are homeless adults, 3% are homeless children, 6% are disabled adults, 12% are veterans, 6% are elderly, 6% are healthy adults, and 2% are healthy children. The soup kitchen’s sources for supplemental nutrition are provided by; 613 from Commodity Supplemental Food Program, 155 from Emergency Food Program, 429 from Food Assistance, and 129 from USDA Commodity Programs. The soup kitchen provides many meals each month, with April being the lowest month with 39,509 meals served and July being the highest month with 51,426 meals served (Sentinel U, 2022).

The Affordable Housing Project has studio, one-bedroom, and two-bedroom apartments for rent. Last year, the average yearly income for those who rented a studio was $26,500, those who rented a one-bedroom was $31,000, and those who rented a two-bedroom was $35,800. It is located in the Casper Park District. The apartment complex has a 10% vacancy rate for the two-bedroom, 5% for the one-bedroom, and 2% for the studio. It had 14 property crimes last year. Common tenant complaints were 18% for pests/mold, 21% for factory smoke, 6% for police activity, 13% for loitering, 10% for high rent, 17% for noise, and 15% for other (Sentinel U, 2022).

The Public Health Department has a list of notable diseases. Sentinel City’s notable diseases cases are Hepatitis A with 11 cases, Hepatitis B with 39 cases, Salmonellosis with 84 cases, Shigellosis with 27 cases, Hepatitis B with 39 cases, Influenza A with 185 cases resulting in hospitalizations, and death related from pneumonia of 67 cases. In addition, Sentinel City has several instances of vaccine-preventable infections per 100,000 residents. For Measles, the rate is 0.64. Meningococcal rate is 0.9, Mumps rate is 1.9, Pertussis rate is 5.1, and Tetanus rate is 0.15. The United States cases per 100,000 are Measles 0.40, Mumps 1.7, Pertussis 4.8, and Tetanus 0.01 (Sentinel U, 2022).

Windshield Survey

During the windshield survey, I started in Nightingale Square. I saw a man walking down the sidewalk using a cane. The sidewalk is made out of large bricks with irregular spacing. If the man accidentally places the end of his walking cane in one of the spaces, it could lead to a fall/injury.

Lilly’s restaurant has information on their major food safety violations, the restaurant waste, and the sources of calories consumed by age. Lilly’s restaurant reports that the calories for the ages 2-18-year-olds are 23% from school, 49% at home, 21% from fast food, and 7% from restaurants. The calories for age 19+ are 72% from home, 21% from fast food, and 7% from restaurants (Sentinel U, 2022).

The road signs look lower than they should be, and there is a car parked on the wrong side of the road. The buildings look like brick and are in reasonably good shape, with some cracks noted in the mortar and occasional graffiti. There is a barbershop, dental office and a bar noted.

While in Nightingale Square, I was able to get off the bus and talk with some residents. The Pham family consists of Quang, a male 29-year-old married (wife Hien) business owner married with two children. Quang has been living in the USA for 12 years, and his vaccines were up to date on his arrival. He has private pay health insurance and under dental health lists “none.” Quang’s diet consists mainly of lean protein, refined grains, and vegetables. His hobbies are playing the mandolin and soccer. He lists no daily exercise routine. His wife, Hien, is a 27-year-old female with private pay health insurance, “none” listed under dental health, and has been exposed to DDT. She eats a diet of lean proteins, refined grains, and low residue foods (she has Chrons disease). On the weekends, she likes to go bicycle riding with her children. Duong is an 8-year-old male that is up to date on his vaccinations, has private health insurance, and gets routine preventative dental health. He likes to draw and play soccer. Mai is a 5-year-old female with the same health insurance (private pay) as the rest of her family and gets routine preventative dental care like her brother. Mai is also up to date with vaccinations. She likes coloring and puzzles (Sentinel U, 2022).

Anna Jordan also lives in Nightingale Square. She is a 68-year-old female and lives with her long-term partner Joan who is 65 years old. Anna has supplemental Medicare insurance. She has dentures and reports getting influenza and pneumonia vaccines yearly. Anna also reports no regular exercise routine and eats a high fat, high sodium diet. She rides the bus or gets rides from friends. States she doesn’t go out much in the cold months due to fear of falling (Sentinel U, 2022).

Acer Tech Center has two restaurants named Lilly’s, and the Lilly’s by Sentinel Museum has outside seating available. Acer Tech Center also has a business center, condominiums, Sentinel Museum, the Historic Hotel, Community Center, Radio Buzz 96.5FM, and a Farmers Market. The billboards in the neighborhood have advertisements promoting vaccinations and quitting smoking. I see some trash along the sides of the buildings, with rats noted. City Hall has protesters on the grounds, and they were protesting taxes. Police Officers are calmly standing nearby. Bicyclers were seen and were riding helmets on.

Buzz Radio 96.5FM states that 35% of the listeners last year were 65 or older, with decreasing percentages as the listener ages decrease, and the ages of 12-17 represent only 1% of their listeners. Radio Buzz 96.5FM has public service announcements. Played by topic, 19% are political, 17% health, 13% children and teens, 9% transportation, 8% each for public safety and armed forces, 7% for wildlife/environment conservation, 3% each for crime and education, 2% on domestic or stray animals, and 11% on “other” category. Last year 39% of their radio programming was on advertising (Sentinel U, 2022).

I was able to speak to some of the residents who live in the Acer Tech Center neighborhood. I met Alicia Keys. She is a 35-year-old married woman who has Multiple Sclerosis and uses a wheelchair. She is unable to work. She is on her husband’s group HMO insurance plan and does obtain routine preventative dental checkups. She prefers salads and lean meats. Her husband prepares breakfast, and a neighbor makes Alecia’s lunches. Physical Therapy comes to her home three times a week and Occupational Therapy twice a week. Alicia has had all her childhood vaccinations and likes to knit and do crossword puzzles. She said the public transportation is not wheelchair accessible (Sentinel U, 2022).

Zaira Abdallah is a 20-year-old female college student. She has health insurance through the Student Health Services and has had no dental care since high school. For exercise, Zaira has daily walks on campus, uses public transportation, and has a diet of lean meat, vegetables, and refined grains. In addition, she has had the MenACWY and Tdap vaccine (Sentinel U, 2022).

Julia Benjamin is a 48-year-old married female with two teenage daughters. She is a District 3 Representative. For health insurance, Julia has a PPO, and for dental health, it lists that she has preventative care and had braces as a teenager. She gets a yearly flu shot, but the last Tetanus is unknown. Julia lists herself as a vegetarian, drinks black coffee with fruit for breakfast, and often misses her lunch. Occasionally she goes to a gym for exercise. Her hobbies are quilting and reading. She states she is proposing increased recreational facilities and after-school programs. She also has concerns about the drinking water because there has been an increase in pesticides and other contaminants spilling into the reservoir. In addition, residents have told her that teens and homeless persons hang out at the reservoir. The water supply for Sentinel City comes from the Sentinel reservoir (Sentinel U, 2022).

Major Franklin Hill informed us that Sentinel City water is naturally fluoridated, and the city monitors the fluoridation levels. He encourages us to go to City Hall and Parks and Recreation building to learn what Sentinel City has to promote healthy living. He also added that the Interfaith Church has classes and activities available for the homeless. The mayor would like a sports complex built and more parks to encourage outside activities. He would also like to introduce more bike lanes (Sentinel U, 2022).

Charles Cruz is a 43-year-old male that works as a police officer. His health insurance is C HMO, and he gets his teeth cleaned yearly and is up to date on vaccines. Charles admits to eating copious amounts of fast food, and at home, his meals are high in fat. For exercise, he occasionally plays basketball with his stepson (Sentinel U, 2022).

In the Casper Park District, primary ethnicity is White at 81.3%, and secondary ethnicity is Hispanic or Latino at 3.7% (Sentinel U, 2022). In the Casper Park District, I saw the Park View apartments, Casper Senior Living Center, ABC daycare, a fine art gallery, a bookstore, a sushi restaurant, and the affordable housing project. The neighborhood also has a business redevelopment project. A considerable size lot is next to the project. It has brick-type ground and only two benches for people to sit on. A small food cart sells produce in the lot (Sentinel U, 2022).

The billboards in the area are advertising jazz music, addiction prevention, vaccinations, no texting and driving, and “vote country.” I see prisoners on work release cleaning up an open lot with garbage, oil drum type containers, and wooden boxes with people sitting on them talking to each other. The buildings around the space have graffiti on the walls. A Firetruck is parked along the street with two different numbers on it-T11 and 157. I hear sirens but do not see anyone noticing the noise.

The first resident I spoke with who lives in the Casper Park District is Gary Johnson, a 17-year-old male with a tenth-grade education who is currently homeless and unemployed. He has no health insurance and has not had dental care for five years. He does not remember his vaccination status. He visits the soup kitchen for his diet and tries to earn money for food by prostitution and playing with the bongos. He also accepts handouts. He shoplifts for his care items like toothpaste. He sleeps by the reservoir or a park bench (Sentinel U, 2022).

Jeremy Sims is a 32-year-old male that is on prison work release. He has no health insurance, and dental health lists gingivitis. For exercise, he does weightlifting. Unfortunately, his diet is prison food, and it is high in fat when not in prison — no information on vaccines status (Sentinel U, 2022).

Jennifer Graham is a 25-year-old female with two kids, ages 5 and 3. She has Medicaid for her health insurance, gets routine preventative dental care, and her immunizations are up to date. Jennifer attends the gym three times a week and eats a gluten-free diet. She says the daycare nurse monitors her children’s immunization records and has information about resources for immunizations. Her children, Karl and Karla, have Medicaid insurance also and are up to date with vaccinations but have had no dental health care. No regular exercise activities are listed or hobbies for the children (Sentinel U, 2022).

Looking around Industrial Heights, I see Inn-Studio Condominiums, an Italian restaurant, four Aoud Qade tradings, Bodega Supermarket & Deli. I was able to walk into the Bodega, and I saw very few fresh foods, and most were processed foods for sale. The Bodega has information on tobacco sales by age and race. It also has nutrition information. Industrial Heights residents have the lowest yearly expenditure on produce at 6% and the highest on prepacked foods at 12% compared to the other three neighborhoods. The Bodega also has information about race/neighborhood/nutrition programs SNAP and WIC. Industrial Heights has 45 households receiving supplemental nutrition assistance (Casper Park District has 38, Acer Tech Center has 25, and Nightingale Square has 9) (Sentinel U, 2022).

Across from the Bodega is a center island between two roads area that reminds me of the similar type of area where the Farmers Market is held across from Radio Buzz 96.5FM in Acer Tech Center. A stray dog was noted wandering along the sidewalk.

Sentinel City School District resides in Industrial Heights, and I noticed the school bus drops the kids off on the other side of the street, and the kids have to walk across the street to get to the school. There is a crossing guard, but he waits on the school side of the road for them. When he signals them to cross, he enters the middle of the crossing area and escorts them. A group of young-looking children walks around the school and through an unescorted alley.

A small playground is located right next to the school. I noticed some men hanging out by it. I saw one adult in the playground with the kids. The playground didn’t look big enough to be able to run much or play dodgeball—no basketball hoops.

Sentinel City Department of Transportation reports the daily travel time and cost of transportation. For people who can travel by bicycle, that cost is $0.00 with a travel time of 35 minutes. By bus, the price is $3.06 with a 59-minute travel time, and the car cost is $9.80 with a travel time of 14 minutes. They also have a breakdown of who rides the bus by race/ethnicity, gender, and persons from the Casper Park District. They also have information on street maintenance and an expenditure budget total of $40,977,796. Snow removal is the third most costly item in their budget (Sentinel U, 2022).

More garbage was seen alongside buildings with rats around them. I saw some construction workers near the site of the redevelopment housing project. Three police are standing near a store that looks to have been recently robbed.

There is an area with a significant pipe leaking, spraying brown-colored liquid from the leak. There are holding containers near the leak with a hazard sticker on them. More rats were seen, a stray dog wandered around, and graffiti on the walls.

I was able to talk with some of the residents of the Industrial Heights neighborhood. Raja Kakkam is a 55-year-old male. He has ACA health insurance, periodontal disease, and no immunization records and has been in this country for 15 years. He has no regular exercise program but does heavy lifting at his place of business and eats a vegan diet (Sentinel U, 2022).

Dwayne Thomas is a 35-year-old male veteran who is unemployed. He has VA for health insurance. He reports he has dental cavities and is currently homeless. Dwayne was last immunized before deployment to Iraq. He eats at the soup kitchen two meals daily, walks his dog during the day, and often sleeps at the reservoir at night (Sentinel U, 2022).

Michael Adams is a 45-year-old male that doesn’t state if he has health insurance but usually goes to the emergency room for healthcare. He has dental implants and all standard immunizations in college. Michael eats spicy food seafood and has a sweet tooth. His hobbies are soccer and swimming, but he has no regular exercise routine. Instead, he sits most of the day and occasionally goes for a bike ride (Sentinel U, 2022).

Data Analysis: Interpretation of Data

After using the four tools to collect data, I was aware of many concerning health issues in Sentinel City. Some concerning health problems were oral health, immunization status, nutrition, environmental health, and physical activity.

Oral health for the residents of Sentinel City needs to be improved. The rate of dental caries for children has dramatically increased this last year for infants up to age 23-months and 2-5-year-olds. In addition, 17-year-old resident Gary Johnson, who is homeless, said that he hasn’t had dental care for five years and has to steal for care items like toothpaste. Many other residents I interviewed either were behind on their preventative visits or had gingivitis, periodontal disease, dentures, or implants. Many did not have dental insurance.

Many residents are not up to date with their immunizations. For example, the Industrial Heights residents have the lowest immunization rates of the four neighborhoods and are below the national average for the 13-17-year-old and those starting kindergarten. Casper Park and Acer Tech center also fell behind the national average for immunization rates.

Environmental Health is also a concern. Common tenant complaints at the affordable housing project were noise, factory smoke, and pests/mold problems. In addition, District 3 Representative Julia Benjamin expressed concerns about the drinking water because there has been an increase in pesticides and other contaminants spilling into the reservoir where the town gets its drinking water. Some citizens hang out there or sleep there at night. During my windshield survey, I saw garbage with rats running around the outside of buildings. I also saw a leaking pipe spraying brown material near hazardous waste containers.

I am also concerned about the nutrition status of the residents of Sentinel City. I saw one area across from Radio BUZZ 96.5FM where there was a farmers’ market in the Acer Tech Center, and then I saw another small produce stand in the Casper Park district. Industrial Heights has the Bodega in the neighborhood, but the Bodega looked on the windshield survey to carry very little fresh produce and a lot of processed foods. Acer Tech Center resident Charles Cruz admitted eating much fast food and high-fat foods. The other residents of Sentinel City who did say they ate vegetables and lean meats also said they eat refined grains. One resident said he depends on the soup kitchen for two meals a day.

I didn’t see many areas where people could do physical activities. The playground next to the school didn’t have enough open spaces where the kids could do aerobic exercises (soccer, baseball, basketball, to name a few). I did see a tennis court by the Parks and Recreation building in the Nightingale Square neighborhood. In my opinion, the almost empty lot by the business redevelopment project in the Casper Park District is currently underutilized. It may become a good site for a future basketball court. Another consideration is that Sentinel City is in an area that experiences cold winters (as evaluated by the amount the city pays each year on snow removal). Many residents talked about activities they liked to do, like gardening, soccer, and bike riding. Some did say they go to the gym.

Community Diagnosis

Three Problem Areas

Physical Activity

The top three problem areas identified in this scenario and correspondingly discussed below are physical activity, oral health, and environmental health. The first discussed problem is physical activity (PA) or, to be exact, lack thereof among the citizens of Sentinel City, as uncovered by assessments and interviews. This problem is addressed to “improve health, fitness, and quality of life through daily physical activity,” as stated by the Office of Disease Prevention and Health Promotion (ODPHP) on the Healthy People webpage (2020c, para. 1). Specifically, regular exercise entails “participation in moderate- and vigorous-intensity physical activities and muscle-strengthening activities” (ODPHP, 2020c, para. 2). This activity may be affected by personal, social, economic, and environmental factors. However, this aim for improvement may be unreachable in the city’s current state, and the situation is particularly dire in the Industrial Heights neighborhood.

Concerning the definition of regular PA, only four surveyed citizens, Jennifer Graham, Jeremy Sims, Dwayne Thomas, and Gary Johnson, are the closest ones to meeting the ODPHP requirement. Some, like Zaira Abdallah, may engage in regular walks, but the amount is not sufficient. Others, including the Pham family, Julia Benjamin, Charles Cruz, Michael Adams, and Raja Kakkam, have a sporadic exercise routine they describe as “occasional.” Many citizens mentioned some leisurely activities they infrequently do, like gardening, soccer or basketball, and cycling. Lastly, like the Jordan family, some are not physically active altogether.

Jennifer attends the gym three times a week, which is a concrete number compared to the ‘occasional’ visits mentioned by some other citizens. Her level of exercise is sufficiently regular, given that she has two small children. Unfortunately, Jennifer did not specify any regular exercise regimen for her kids. Jeremy engages in weightlifting, which may be a great source of physical fitness. However, his prison environment and dietary habits heavily impact his overall health and diet. Dwayne and Gary engage in long daily walks, but this is likely due to them being homeless and thus unable to use alternative modes of transport like driving. Additionally, Dwayne and Gary’s social determinants put them at high risk for other health and safety problems, meaning that their health, fitness, and quality of life may suffer from other factors.

One factor potentially precluding the citizens from going outside and being active is their concern for their neighborhood’s safety. In Industrial Heights, a store that had recently been vandalized was observed, pointing to some degree of criminal activity in the area. Further, the reported violent crimes counts in Sentinel City were high (Sentinel U, 2022). According to ODPHP (2020c), safe neighborhoods are among the factors that are positively associated with PA in adults. Additionally, Industrial Heights is the poorest of the city districts. According to ODPHP (2020c), low income is another factor that often prevents adults from executing an appropriate exercise regimen. Therefore, in neighborhoods with high crime rates and low incomes, people are less likely to go outside for exercise.

Further, the physical surrounding of Sentinel City is an environmental determinant that prevents its citizens from exercising. ODPHP (2020c) outlines additional external factors whose presence aids in PA for youth and adults. Specifically, it may be affected by the structural aspects of citizens’ living environment: sidewalks’ presence, “bike lanes, trails, and parks,” access to a neighborhood recreational area, and public transportation (ODPHP 2020c). The streets of the Industrial Heights district present those interested in exercising with stray animals, broken-down cars, rundown buildings, and trash with rats scavenging through. Moreover, the sidewalks were sporadic, poorly defined and constructed, and sometimes outright hazardous. A bus stop area in one part of the district was obstructed by a broken vehicle, and there were no dedicated bike lanes that could encourage the citizens to cycle safely instead of driving or weaving between cars.

Lastly, there were a few areas far and between suited for PA. The school playground did not provide sufficient space for children to engage in aerobic exercises, and the only appropriate space noted (a tennis court) was in Nightingale Square. Therefore, the environment of the city in general and the Industrial Heights region specifically is not conducive to being physically active since it is often unsafe for various reasons.

Oral Health

Another area of concern is the oral health of Sentinel City’s citizens. Healthy People 2020 aims to prevent and control “oral and craniofacial diseases, conditions, and injuries” and improve access to preventative services and general dental care (ODPHP, 2020b, para. 1). Some of the specific manifestations of such conditions include dental caries, periodontal disease, cleft lip and palate, oral and facial pain, cancer of the mouth and pharynx, and xerostomia (ODPHP, 2020b). However, this goal is unmet in Sentinel City for the most part.

The preventative measures in the city entail monitoring fluoridation levels of the public water systems, where the water is naturally fluoridated. According to ODPHP (2020b), this is a highly effective way to reduce the rates of tooth decay in the community. Additionally, the city now has more dental hygiene clinics and pediatric oral surgery. Nonetheless, many residents, like the Pham parents, Zaira, Jennifer’s children, and Gary, have not had routine preventative care and dental insurance, and others like Jeremy or Dwayne report gingivitis or periodontal disease. This breakdown supports the ODPHP (2020b) findings that citizens with lower levels of income and education and those from specific racial or ethnic groups have higher rates of dental diseases. This disparity may be related to these groups’ limited access to services and their inability to afford the high costs of dental repairs.

Furthermore, the community has experienced an increase in cavities (dental caries) frequency in the children ranging from an infant to a five-year-old. This increase may be since the overall rates of special dental programs for kids stay in low percentages, covering, in best cases, barely 30 percent of the total population. Overall, the limited implementation of preventative measures, lack of widely available health programs, and persistence of unaddressed diseases in the socioeconomically disadvantaged communities are the source of concern.

Environmental Health

The last problem area I would like to discuss is environmental health. The Healthy People program aims to “promote health for all through a healthy environment” (ODPHP, 2020a, para. 1). ODPHP’s (2020a) areas of concern focus on six main themes, each highlighting a different element of environmental health. They are as follows: “outdoor air quality, surface and groundwater quality, toxic substances and hazardous wastes, homes, and communities, infrastructure and surveillance, and global environmental health” (ODPHP, 2020a). Out of these areas, the most pertinent ones to the citizens of Sentinel City are water quality, toxic and hazardous substances, and homes and community.

The water quality and the toxic substances issues are intertwined. Some citizens reported an increase in pesticides and other contaminants spilling into the Sentinel reservoir, a drinking water supply for the city. This concern was supported by observations of a pipe connected to the nearby hazardous waste containers leaking brown sludge. According to ODPHP (2020a), compromised water quality may have detrimental and sometimes severe health implications. Moreover, some homeless citizens spend time in areas potentially heavily contaminated by the discharge, but no certain information is available. This fact only highlights ODPHP’s (2020a) statement that those already at risk due to other factors (including socioeconomic ones) will be affected the most by the overall poor environmental quality. Therefore, while the challenges are not limited to the disadvantaged population of Sentinel City, they are the most acute for those people.

Likewise, the issues of homes and community are tightly interconnected with some of the previously mentioned issues. They are particularly evident in the Industrial Heights district and are likely caused by the lack of funding for this area of the city. The issues of inadequate sanitation and structural problems, which ODPHP (2020a) classifies as the ‘homes and communities’ issues, are rampant in that area. For instance, garbage is often piled high in the streets, with rats around it – while this was not unique to the Industrial Heights area, it was certainly more evident there. Further, many buildings lack structural integrity and require repair, putting the health and safety of citizens at risk. Lastly, the Sentinel water tank is positioned below many of the taller city buildings, raising concerns about the water availability in case of emergencies. Overall, the state of environmental health in Sentinel City is concerning, but the extent is not comprehensively understood.

Discussion of Community Resources

To address the issue of lacking physical activity for its citizens, Sentinel City has some community resources available. For instance, the Parks and Recreation Department offers local sports leagues, summer and after-school programs for children, swimming lessons, and adult fitness courses. There are some, although not many, public facilities available, such as a tennis court in the Nightingale Square neighborhood. In addition, Interfaith Church provides economically disadvantaged groups like homeless citizens with various classes and activities. Sentinel residents are further encouraged to visit the City Hall and Parks and Recreation building to learn about additional fitness opportunities. Lastly, the city’s healthcare system has services for the elderly, such as tailored senior transportation and the community center, although either is not extensively used.

Primary Prevention Topic

The primary topic I would like to address is physical activity. As a public health nurse, I would conduct independent research and collaborate with the local authorities to ensure maximum coverage. First, I would conduct and present various data assessments and analyses regarding classes and activities currently available to the Sentinel City residents, healthcare, and early disability costs that PA could reduce. This assessment, paired with the Healthy People goals, would allow me to address the gaps in current programs and create a set of corresponding low-cost recommendations on ways to increase activity levels. I would present these findings at open city board meetings to candidates in office or running for political offices. I already gathered that the mayor would like to have a sports complex and more parks and bike lanes in the city, so there would likely be some support for my research initiatives.

Second, I would work with the software developers or designers on some of the city’s available resources across the digital and physical public spaces. This collaboration would aim to facilitate access to fitness-related information, for instance, by highlighting the front-page entries on the main municipal website. Additionally, I would post flyers in public areas where people may congregate, such as bulletin boards at churches, restaurants, food shelves, and schools.

Third, I would continue collaborating with the authorities to establish low-cost PA classes paired with grants and scholarships to empower those without the financial resources to benefit from the programs. I would strive to make these PA classes available in all the city’s neighborhoods for the same reason. Specifically, I would investigate indoor venues such as malls, schools, community centers, and large buildings, where PA programs could be conducted. I would also explore alternative solutions for those who cannot attend a class due to transportation issues, such as online PA classes via Zoom or a similar communication platform.

Simulation Assessment Strategies and Tools: Applicability to My Community

The applicability of the four simulation assessment tools to real-life circumstances is remarkable. First, I am now equipped for gathering data on the communities’ health disparities and what resources are available to its citizens, thanks to my experience of visiting the Sentinel City’s public departments and local churches or soup kitchens. For instance, the investigation of the Soup Kitchen data yielded a comprehensive picture of the struggling demographic, showing the percentages of homeless, disabled, veterans, elderly, and adults to children ratios. Before using this stimulation, such a use of these facilities was unknown to me – however, I will now be able to use this knowledge in real life.

Furthermore, using the simulation community of the Sentinel City enabled me to discern specific data sources crucial for assessing local healthcare needs in my community. For instance, investigating the median household income in the simulation revealed a disparity, especially contrasting between the Industrial Heights and the Nightingale Square incomes, the latter being ten times higher than the former. Given that socioeconomic conditions were established as an important factor in personal health, the importance of such numbers is difficult to overestimate. Therefore, some of the specific points I will examine in my community are the population’s demographics, income and poverty levels, and the percentage of the population that possesses health insurance.

Next, the neighborhood safety assessment for Sentinel City was eye-opening, and I will use that assessment in my city. The important takeaway from this evaluation method was how evident the inter-district issues become when investigated through the lens of safety. The example of neighborhood security affecting the rates of physical activity has shown me the importance of considering many angles of the same problem. I will use the same assessment tool in my community, inquiring whether sanitation, emergency response, and police protection are equal in higher-income areas and lower-income areas for all citizens.

Lastly, the windshield survey taught me to look around my city and talk with the residents to hear concerns and attend to their needs. It is striking how the visual clues, such as certain areas being much cleaner, may provide insight into their inhabitants’ state. Further, having open communication with the locals allowed me to collect comprehensive information on people’s daily routines and aspects that define them. By interviewing Sentinel City residents and having them explain personal aspects like caring for their kids, being disabled, having a prison regimen, and being homeless, I uncovered some underlying healthcare concerns. I will use the personal communication approach in my community with a similar aim to gain a first-hand understanding of health concerns.


Office of Disease Prevention and Health Promotion. (2020a). Environmental Health. Healthy People. Web.

Office of Disease Prevention and Health Promotion. (2020b). Oral Health. Healthy People. Web.

Office of Disease Prevention and Health Promotion. (2020c). Physical Activity. Healthy People. Web.

Sentinel City ( (2022). [Computer software]. Sentinel U. Web.

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