Importance of Smoke Alarms in Homes Research Paper

Importance of Smoke Alarms in Homes - Research Paper Example This paper will outline the significance of installing smoke alarms in homes as a means to secure them from risks of potential fires. A fire disaster is a dreaded situation, which can result from gas leaks, short-circuits or overheated appliances. Smoke alarms are very helpful in considerably reducing the chances of fire hazards in homes. However, there are many households that have neglected to install smoke alarms, despite their life-saving potential and low cost, or have been careless in maintaining the installed detectors. Like any other battery-operated device, smoke alarms also require regular maintenance to ensure that they are in good operating condition and have sufficient batteries at the time of a hazardous situation (UL 2011). Effective and reliable smoke alarms are easily available at reasonably low prices; whereas more advanced models can be linked to a security system that automatically notifies the fire department. According to a recent study by the US Fire Administra tion (USFA), the number of household fires has increased on a year-on-year basis by almost 2%, resulting in an overall loss of over 2,500 lives and 6.5 trillion dollars (USFA 2011). Another research, carried out by the National Fire Protection Association (NFPA) has estimated that 96% of all households have a smoke alarm present, but only 70% of these are in working condition. However, from the 400,000 household fires that have been approximately reported, 72% of the deaths were caused by either an unmaintained or missing smoke alarm (NFPA 2011). Most of these fires also cause injuries, which may result in disfigurement and other mental effects (Miller et al. 1982). A working smoke alarm  doubles  the chances of survival from a fire (NFPA 2011). The majority of fire hazards take place at night, especially when people are asleep and may not detect the spreading smoke or fire. Smoke alarms keep that risk down by alerting everyone in the household when smoke is detected. It helps t he occupants find a safe passage out of their homes, before they become trapped in the fire. Most of the deaths that take place are usually due to suffocation from smoke or other gaseous substances, which are invisible to the human eye and can spread rapidly around the house. Hence, without smoke alarms, smoke is likely to go unnoticed, especially during the night, posing a great threat to the occupants of the house (DOS 2007). However, with a functioning smoke detector, the residents can easily discover and sense if there is smoke spreading in the house and save themselves and their loved ones from possible dangers. Smoke alarms do not prevent fires, but because they provide warnings of small fires, or smokes, that can be easily extinguished, they reduce the number of fires that become serious enough to cause injuries or burns, leading to fatalities. In a recent tragic incident, a family was using a space heater to heat their house. Their house did not have a smoke alarm installed. Unfortunately, the heater malfunctioned, causing a small local fire, which went unnoticed due to the absence of a smoke alarm. The fire spread rapidly, and in a couple of minutes, the fire had engulfed the house completely, trapping the whole family inside it. Sadly, by the time the fire department arrived at the scene, the family members were critically injured. They were immediately shifted to a hospital, where three children succumbed to their injuries and passed away. The parents are still recovering

Globalization Research Paper Example | Topics and Well Written Essays - 750 words - 1

Globalization - Research Paper Example Development of international media such as radios, televisions and the international web are examples of avenues towards interconnections. Economic factors also contribute to international connections through demand and supply forces that move resources from their regions of surplus productions to areas that experience scarcity across regional and international borders. Another concept of globalization is its â€Å"rapid and discontinuous change† with time and across regions as indicated by historical data (Parker, 2005, P. 7). The level of developed interconnections for example grows with identified kinks that relates to major economic changes in regions. Different communication efficiencies across regions also identify variation in the rate of globalization across different areas. This is because initiated factors in a region transfers to other regions at different speeds, based on the achieved regional connections (Parker, 2005). Higher number of different participants in e conomic units also defines globalization. Its concept of interlinked domestic economies and developed international transportation and communication infrastructure for example allows more players, who were previously disadvantaged, to gain access and explore foreign markets. The increased number and types of participants also identifies increased level of complexity in the formed networks, a factor of the interlinked cultures and systems (Parker, 2005). Interdependence is another concept of globalization that has largely manifested across territorial boundaries. Economic interdependence has for example led to specialization among countries and international trade for exchange. Political interdependence is also evidence through developed diplomatic ties among nations. Existence of international organizations with regulatory authority over members also identifies dependence as a concept of globalization (Milardovic, Paukovic and Vidovic, 2008). The following graph shows the non-unifor m trend in GDP and imports, indicators of globalization, for the United States. The forecast shows non-uniform but constantly changing trend in the values or GDP an imports in the future short run, an indication of forecasted kinky impacts of globalization. (WTO, 2012) Differences between an open and a close economy The major difference between open and closed economies is their different exposure to international markets. An open economy lacks barriers to international trade while a close economy has strict limitation to international trade. An open economy is therefore vulnerable to consequences of globalization than a close economy. Restricted international trade also identifies lack of exportation, importation, and transfer of assets into a close economy. The elements are however characteristics of an open economy (Arnold, 2008). Advantages and disadvantages of a country with an open economy A country with an open economy has a number of advantages and disadvantages that are ass ociated with the allowed international trade between the country and foreign markets. The transfer of commodities across the country’s borders for example allows its citizens to access varieties of commodities that are produced in other markets. This improves consumers’ utility levels. Available international market also promotes surplus production for higher income. Further, an open economy has associated increased employment opportunities than if

Radical Approaches in Journalism Research Paper

Radical Approaches in Journalism - Research Paper Example This paper will cover journalism in the western democracies and how the works of two philosophers have influenced the journalism process in these western parts. The two philosophers to be covered in this case are Slavoj Zizek and Jean Baudrillard. Slavoj Zizek was born in the year 1949 and is known to be a Slovene Philosopher as well as a cultural critic. He writes on a varied range of topics which include: culture studies, psychoanalysis, political theory, theology and film theory. Zizek is an individual who aims at provoking the society to think anew about many issues that happen around. His work in the eyes of many is seen to represent one of the two current notions of a progressive substitute- that of socialism rather than organizational imagination. There are two major themes of evaluation of ideas from Zizek which are lack of firmness in argumentation and failure to point out an effective alternative in his condemnation of current economic, social and political arrangements. Hi s political and philosophical positions have always been known not to be clear because of his lack of proper argumentation. He critiques have also made him known as a failure since he lacks consistency in his work. He has claimed to offer support to the revolutionary project by Marxist but one thing that has made the project unclear is his lack of vision. Zizek’s work is generally known to lack facts of history which makes his work be more provoking rather than infighting.sighting. In this case he is generally known to bring on confusion because he contradicts what is produced by other individuals. Information disseminated to the public through various ways is contradicted by his own findings because he lacks historical facts and has poor argumentation. This gives a clear impression that individuals who go through his findings are usually confused since they do not know whether to believe Zizek or other sources of information. It makes it difficult for people to understand th e happenings around them due to contradiction that occurs between the sources of information. In the western democracies, Zizek has played a role in undermining the importance of journalism because of his undertakings. Journalism is meant to brief people on all that happens so as to keep them posted but is has been difficult for them to understand because of Zizek’

Leveraged Buyouts and Private Equity Essay Example | Topics and Well Written Essays - 3250 words

Leveraged Buyouts and Private Equity - Essay Example According to the research findings leveraged buyout first came into the picture as an important phenomenon in 1980s. It was predicted that these types of organizations would form the major portion of organization which will eventually become the dominant one. These types of private equity firms involved themselves in various measures like providing incentives based on managerial abilities, and introduced the concept of active governance. They relied upon the possibility of junk bond financing. A few years later the junk bond market crashed resulting in bankruptcy of several leveraged buyouts and the leveraged buyouts of public to private transactions vanished in the starting phases of 1990s. But the market of leveraged buyout was also suffering a gloomy phase as the private equity firms continued their operation by acquiring private companies. The US experienced the boom in market of leveraged buyout in the mid 2000s. The evidences supported by various researches on some selected com panies reveals that private equity investors took the advantages of time factor between the debt and equity markets. The importance of leveraged buyout lies in the usage of financial leverage in order to strengthen the acquisition of the company that has been targeted. The generated cash flow from the bought out business is used to cover he debt incurred in the acquisition. The debt holders are usually expected to earn affixed return while the equity holders seem to grasp all the benefits in a successful buyout. The factors that influence a good leverage buyout includes strong consumer base, small amount of debt on balance sheet, the management team consisting of dependable hands and continuous cash flow (Tuck School of Business at Dartmouth , 2003, p.p. 7-8). Private equity firms Private equity firms are characterized by firms where general partners take the initiative to manage funds while the other partners take the responsibility to provide capital. The limited partners comprise of pension funds, wealthy individuals, and companies operating in the insurance sector. It is important for a partner to contribute to at least 1 percent of the wealth of the firm. The private equity firms has the opportunity to invest the committed capital for at least five years but the period can be extended to ten to thirteen years to return the capital. Again the fund has the life of ten fixed years but can have the extension to thirteen. The limited has little liability in the working of the capital as long as the initial agreements are met. The agreements include restrictions on the amount of capital that can be invested in a company, the particular form of securities in which to invest, and on the level of debt. There are three ways to compensate a general partner. With an annual management fee which is usually a portion of the committed capital and then as a portion of capital employed when the investments are realized. The general partners also earn a share of the profits and they can also charge fees for deal and monitoring to the companies where they put their money in. Portfolio

Interpersonal communication about When Harry met Sally movie Essay

Interpersonal communication about When Harry met Sally movie - Essay Example One of the producers and writer, Nora Ephron won an Oscar award. The main characters, Harry and Sally whose real names are Billy Crystal and Meg Ryan were also nominated as the best actor and actress. The film received critical reviews, which were positive (Internet Movie Database, 1990). Some of the most credible critics cited that the film had some of the most entertaining scenes and funny. The theory proposes that relational closeness always progresses from a superficial state to one which is intimate (Kanu, 2008). Harry and Sally’s relationship only grew when they were alone after separating from their lovers. For example, Sally had broken up with her fiancà © Joe and had to disclose it to Harry. In another scene, Harry is seen alone (Reiner, 1989). Similar to what the theory proposes, the closeness between two people develops as a result of self-disclosure. The RDT theory posits that relationships between people always reflect the tensions existing when people are communicating which usually arises from conflicts (Kanu, 2008). In addition, the theory proposes that relationships focus on the opposing behavior of people. In the film, it is clear that Harry and Sally began to regret because of spending a night together. The characters depicted a sense of guilt in different scenes (Reiner, 1989). As proposed by the theory, there are opposing tendencies because a relationship cannot exist without parties sacrificing their self-rule. Harry said he felt it was a mistake. While Sally agreed to Harry’s opinions verbally, her non-verbal tone in one of the scenes indicated she did not feel it was a mistake. The film confirms that the concept of just being friends and not lovers is not true. The theory proposes that when there is an interaction between people, the uncertainty between them reduces (Kanu, 2008). The theory presumes that when the relationship is beginning to grow, there are many doubts. Harry and

The Rape of Lucrece Essay Example | Topics and Well Written Essays - 250 words

The Rape of Lucrece - Essay Example The first stanzas of the poem acknowledge how poetic rhetoric is used in the work to repress praise and violence. Generally the poem highlights the rhetoric behind sexual violence especially in the American culture today which sometimes tends to be hipped with ironical praises. In the rape of Lucrece by Joel Fineman, Lucrece has the confidence to speak after the rape incidence. This incidence limits her ability to celebrate her life sacrifice by acting precisely (Fineman 170). At this juncture, we do not believe the performers. Someone who has been robbed off her innocence will be understood better if she is presented quite, worried and in a state of shock which is contrary to the rape of Lucrece by Joel Fineman. In addition, Lucrece’s suicide is cast as the only way women can intervene politically (Fineman 171). Once someone has committed suicide, she will be gone forever, how can this same person come back to enjoy the political favors sought after. The rape of Lucrece by Joel Fineman’s performance is

Working as a registered nurse Essay Example for Free

Working as a registered nurse Essay I have been working as a registered nurse in Tacoma, WA since 2011 and I have chosen to assess the community health of Pierce County. Tacoma is the county seat of Pierce County and the largest city in the county and third largest city in the state (US Census Bureau, 2014). Pierce County is located south of Seattle and is comprised of 1,679 sq. miles, many of which front the Puget Sound. Northern areas of the county are comprised of islands and peninsulas only accessible by bridges or boats. It also contains one of the nation’s national parks and the state’s tallest peak, Mount Rainier. The Park’s boundaries largely define the eastern border of the County and the White and Nisqually Rivers make up the North and South boundaries respectively. (Snob Hollow Designs, 2014) Population Economic Status Assessment Nearly 820,000 people call Pierce County home. It boasts a high population density with 481 people per sq. mile. Urban areas comprise 93 percent of the county. (City-Data, 2014) The median household income in 2013 was estimated to be close to $60,000 and 12 percent of residents are living below the poverty level. (US Census Bureau, 2014) Blacks and African Americans make up the majority of low-income people despite the fact that they comprise only 7 percent of the County population. The majority of residents (76.5 percent) are white, 10 percent are non-black Hispanics and 6 percent are Asians. The median resident age is 35 years and 12 percent of residents are 65 years or older. (University of Wisconsin Population Health Institute, 2014). More than a third of Pierce County children are eligible for free lunch benefits and 8.9 percent of residents are unemployed. As many as 16 percent of residents are uninsured despite a per capita personal health expenditure of $8,160 annually. Ten percent of those uninsured are children. What’s more, close to 6 percent of residents make less that $10,000/year. It’s estimated that 15 percent of residents are not able to see a health care provider when they need to because they can’t afford it. When they can afford to, primary  care providers (PCP) are in short supply and overworked. There are an estimated 1500 patients for every PCP in Pierce County. (University of Wisconsin Population Health Institute, 2014)Medicare is the primary payer of health care expenditures for 10 percent of County residents. (City-Data, 2014) Pierce County has some of the highest rates of obesity in the nation with a 31 percent obesity rate. This is despite the fact that nearly 80 percent of residents reported exercising in the previous month. (University of Wisconsin Population Health Institute, 2014)The County has numerous parks, hiking trails, walking paths and enjoys a temperate climate with little snow accumulation and mild summer temperatures. Poor nutrition is likely a key contributor with 16 percent of residents classified as food insecure. The County has the lowest access to healthy foods with 8 percent of people living in urban areas where the nearest grocery store is more than a mile from their home. Access to convenience stores is slightly better. (University of Wisconsin Population Health Institute, 2014). Neighborhood and Community Safety Any Pierce County resident can testify to smelling the â€Å"Aroma of Tacoma† on a regular basis. At various parts of the day, a pungent smell not unlike that of rotten eggs fills the air. The source of the stench is attributed to industries located at the Port of Tacoma, the forest industry, car exhaust, or the tidal changes on the Puget Sound. The extent of air pollution in the area is large. More than three quarters of county residents drive alone to work every day. Just 3 percent take public transportation. The County ranks 16th in counties reporting high carbon monoxide one hour concentration. It is among the dirtiest 10 percent of US counties for its release of water and carcinogens. Chief among these deadly chemicals is methanol and hydrochloric acid. (City-Data, 2014) (Good Guide, 2011) There are four Superfund Sites in the County that continue to cause contamination of drinking water. One of these sites is Commencement Bay, the hub of the Port of Tacoma, one of the world’s busiest ports. The biggest polluter in the area is the Simpson Tacoma Kraft Company, a forest product  company that prides itself on using â€Å"every part of the tree except its shadow.† (Simpson, 2014) Another well-known polluter and also a major area employer is the US Military. Superfund Sites exist at both McChord AFB and the US Army Fort Lewis Range. (Good Guide, 2011) Cultural Assessment For a personal perspective of life inside Pierce County I consulted with a colleague who works as a lactation consultant. She is a 50-year-old college-educated white female who also works as an instructor in a local vocational college. She reports that her cohort’s attitude toward aging is not altogether positive. She is beginning to feel the gradual decline in her body functions and says that she and others like her find it frustrating that their bodies don’t work as well as they did in their youth. That attitude of reluctance tends to affect how readily her peers seek assistance, especially if it means accepting the realities of aging. Some of the physical health problems common in her cohort involve vision, sleep apnea, joint pain, and decreased stamina. She states that individuals in her cohort tend to be individualistic and prefer their yards, both physically and metaphorically, to be fenced. This perspective crosses over to how children are parented with a high value placed on raising adults that are independent and self-sufficient. Her children have either graduated from college or are currently attending university. She considers financial independence a mark of adulthood. A ritual associated with adulthood is moving out of the family home and their own. One of the challenges she sees in her cohort is that of obtaining access to mental health care. A colleague recently lost her son to suicide after numerous attempts to help him gain access to care failed and he committed suicide. She feels that only those who are going to hurt others or hurt themselves are recipients of care in a broken system. Because so many are aching for help in the community and a greater awareness of the need, the result has been a reduced stigma associated with mental illness. Acknowledging that mental illness is far from being treated on plane with biological illness, she reports that the awareness of an individual’s lack  of control over what is a real disease is growing. Disaster Assessment and Planning The incredible amount of physical beauty present in Pierce County is also a source of danger to its residents. The area has been declared as a disaster area 19 times in recorded history. Most of these events were the result of severe storms that caused flooding, landslides, and mudslides. The area is situated on or near several tectonic plates giving it an earthquake risk that is 355 percent greater than the national average. In 2001, a magnitude 6.8 earthquake was centered just 10.8 miles from the city center and caused tens of thousands in damage. An earthquake centered even farther away could affect the county via a subsequent Tsunami. Coastline areas comprise many of the County’s industries, parks, and homes and could be destroyed by a tsunami’s tidal surge. Mt. Rainier frames many of Tacoma’s picturesque views but it is a volcano that could come back to life at any moment. Its last eruption is estimated to have occurred more than 150 years ago but a recent e ruption could cause massive downstream flooding in nearly the entire County. (City-Data, 2014) Disasters caused by flooding precipitated by a tsunami, volcanic eruption, or one of the areas many rainstorms could displace many residents from their homes and block access to urgent and chronic healthcare services. Sewage systems could be affected by the flooding as well as decrease access to clean water. A massive earthquake could destroy many of Tacoma’s older buildings, many of which were built in the early 1900s and well before any seismic construction rules went into effect. Falling objects from an earthquake and resulting fires could result in massive injuries in the short-term and damage to public infrastructure in the long-term. (Pierce County Department of Emergency Management, 2010) Many of the possible disasters that could strike the area do not have the luxury of advance warning. Severe storms may give as little as a day or two notice, tsunamis and flooding just a few hours. Many residents are unlikely to understand the severity of a disaster until they are in i ts midst. Because the residents lack the ability to prepare, The Pierce County Department of Emergency Management has five departments to deal with every day emergencies and  large-scale disasters. The services include emergency management, enhanced 9-1-1 services, fire prevention, radio communications and an urban search and rescue task force. The Department is working to enroll all residents in an emergency alert system via text. Area hospital employees also have an alert system that sends a text message to employees to report to duty in the event of an emergency. The enhanced 9-1-1 system automatically finds the street address for landline calls. The radio communications team works to ensure that radio remains active in the event cell towers fall during an earthquake or are damaged during severe flooding. Urban Search and Rescue can provide vital services in the event of an earthquake, mudslide, avalanche or abandoned mine collapse. (Pierce County Department of Emergency Management, 2010) Windshield Survey Housing The majority of housing options available in Tacoma are single-family detached homes. A housing boom in the 1990s resulted in many newer homes and apartment buildings in both high and poor-income areas. Housing density appears to be highest in high-income neighborhoods. Many homes in both areas have grassed front and back yards. Although the area was heavily wooded when settled in the 1890s, much of the native evergreen trees are gone. Tree replacement appears limited to higher-income areas and is limited to non-native deciduous trees. Housing in lower-income neighborhoods appears to be in fair to moderate repair. Very few homes in these areas have bars over windows or doors. (Patamia, 2015) Open Space In Tacoma, there appears to be a moderate amount of open space, especially considering it is an urban area. I saw a large strip of valuable waterfront in the Ruston area dedicated to a walking path and docks used for office space and dining. The jewel in the crown of the Tacoma Metropolitan Park System is Wright Park, a 27-acre parcel spanning more than 10 city blocks in the heart of the city that features an arboretum, lawn bowling, playgrounds, and a pond. In addition, Mt Rainier National Park has more than 235,000 acres of protected forestland and numerous State parks dot the County. All of these spaces are open for public use and park passes are enveloped as part of the residents’ vehicle tax. Boundaries The boundaries of the area are largely natural features like rivers and mountains. Neighborhoods begin and end without notification but poorer areas tend to have more chain link fences, fewer shopping areas, and homes that lack fresh paint and ornamental landscaping. Ironically, the most expensive homes in the county have roads that are either gravel or so unkempt that potholes dominate. Commons People in the county tended to congregate around grocery stores and the strip malls that surround them. I visited an upscale grocery store in the middle of the day and found parking difficult despite an ample lot. Areas surrounding the Port of Tacoma business district tend to always have a large amount of traffic, especially large trucks carrying containers to and from the ships docked in Commencement Bay. Transportation Pierce County, despite the low numbers of residents who use public transportation has numerous options for getting out of your car. Buses travel to every part of the county, even across the Tacoma Narrows Bridge to the Olympic Peninsula town of Gig Harbor. Residents can travel to Seattle using rail or bus. Residents enjoy the capability of attaching their bikes to city buses but since the area is very hilly and frequently rainy, few take advantage of the service. For all of its access capabilities in Tacoma, getting around in surrounding communities is difficult. Interstate 5 intersects the county, enabling easy access for Port of Tacoma traffic to Canada and the western states. Several state highways run through the community and many are currently undergoing expansive improvement projects. Long-term plans include expanding Seattle’s light rail into Tacoma but recent initiatives to expand inter-county bus services was voted down by residents. Service Centers One of the most impressive things about Pierce County is how new and beautiful its schools are. Around these areas, it’s easy to spot social service centers such as YMCAs or Community Healthcare Clinics. Even in the poorest areas of the County, I saw many dentist offices, parks with  playground facilities, and sidewalks. I drove by a newer looking middle school several times during my survey and always saw it occupied by students despite heavy rain. Stores Commercial areas in the county appear to be centered on large chain grocery stores. There are few non-chain, independent dining options and those that are tend to offer high-calorie, high-fat options like hamburgers and milkshakes. I did not see any signs advertising farmers markets but there were more than a few community gardens where residents could grow their own fruits and vegetables. I was also impressed by how few grocery stores there were outside of major shopping areas and how far even the wealthiest had to travel to buy food. In more than one area, there were several grocery stores in close proximity to each other. People Out and About I saw several people walking around the County during my survey but all of them appeared to be walking for exercise and leisure, not for transportation. Almost all of these walkers were white and non-obese. A majority of those I saw were wearing Seahawk jerseys and/or colors. It was so persuasive that I felt out of place with an orange sweatshirt. Dogs accompanied many of the walkers and every dog was leashed. Signs of Community Vibrancy The Pierce County Community is very diverse but in nearly every area I traveled, I saw signs of vibrancy evidenced by hanging flower baskets, children playing outside, areas of preserved natural beauty, easy access to healthcare, and a lack of abandoned homes, stray animals, or countless homeless people. Race/Ethnicity Given that nearly three-quarters of Pierce County residents are white, its not surprising to see mostly white people in the County. Surprisingly, there are two major Indian Reservations, the Nisqually and Puyallup, inside Pierce County yet less than 2 percent of residents are Native American. Most of the County looks and feels American with few ethnic grocery stores or signs in a language other than English. Areas where whites live tend to be predominantly white but areas with larger populations of Blacks, Asians, and  Hispanics are well integrated. In one strip mall, there was a Mexican taqueria next door to an Asian grocery store. Religion While only 30 percent of Pierce County residents report being affiliated with a religious congregation, nearly half of them are non-denominational Christian churches. A third of residents report an affiliation with a Roman Catholic Church. I saw many more churches in the less affluent areas of the County than I did in wealthy ones. I also saw one Buddhist temple and Muslim Mosque. Health There are 10 hospitals serving Pierce County the largest of which is Tacoma General Hospital that has more than 400 beds and a level II trauma center. A few blocks away with the area’s second level II trauma center and a level III NICU is St Joseph Medical Center with 367 beds. Signs of homelessness are slightly invisible in Pierce County and tend to be clustered around area shelters or service providers such as the Union Gospel Mission and the YWCA. It’s estimated that 2,000 people including children are homeless on any given night in Tacoma. One of the area hospitals, Western State Hospital, provides services exclusively to the mentally ill but the lack of services to the homeless and mentally ill is striking. There are an estimated 368 mentally ill people for every mental health provider in Pierce County. Top performing counties have 521 providers per patient. The State ranks 49th in number of available psychiatric beds and several agencies have recently closed their doors or decreased services due to the economic turn down. (League of Women Voters Pierce County, 2013) (Good Guide, 2011) Forty percent of female tenth-grade children are classified as depressed. The Tacoma Pierce County Health Department lists mental health as its #1 priority in the coming years. Politics I toured the area in January when the nearest election was months or years away. Cars I viewed had a mix of bumper stickers that indicated the metropolitan area voted for Obama in the previous presidential election, supports the legalization of marijuana, and is a fan of the Seattle Seahawks. Media No matter the area, evidence of satellite dishes was seen on nearly every home. I did not see any newspaper boxes around area stores. It seems that the primary form of communication medium is through television and the Internet. Television stations accessed by residents are primarily in English but there are two stations that are exclusively in Spanish. Physical Environment As mentioned previously, Pierce County is a very beautiful place with views of mountains, water, dense forest, and even a volcano visible from nearly every corner of the County. During my survey, I even viewed a pair of bald eagles playing over the Puget Sound. The areas around the Port of Tacoma and the two Indian reservations tend to be the least attractive areas of the city where billboards for nearby tribal-run casinos predominate the landscape. Scavenger Hunt Women, Infants, and Children (WIC) WIC is a nutrition program that helps ensure that pregnant women, nursing moms and children under five have access to healthy foods. They also provide health education and breastfeeding support including peer counselors. Women who use WIC get money to purchase fresh fruit and vegetables, milk, cheese, whole grain breads and tortillas. They also ensure that children are vaccinated and stay on recommended growth curves. A family of four is eligible for WIC benefits if they have an annual income equal or less than $43,000. Accessing the services requires visiting a WIC location, which are located on major bus routes near hospitals, health clinics, or in tribal offices. There are more than 15 WIC locations in the county and offer services in English, Spanish, Vietnamese, Korean, Russian, Tagalog, and Cambodian. (Tacoma Pierce County Health Department, 2015) YMCA The YMCA of Pierce and Kitsap Counties offer a variety of services including seven healthy living centers, a summer camp and more than 70 child care sites. Their mission is to offer programs that â€Å"build a healthy spirit, mind and body for all.† (YMCA of Pierce and Kitsap Counties, 2014) Monthly fees that are based on household income support membership and financial aid is  available. There are steep discounts for members of the military and their families. The variety of services available at the healthy living center is broad. Members of the Tacoma facility take piano lessons, learn how to box, and enjoy an indoor pool. Family Renewal Shelter There are 16 different resources for those dealing with domestic violence in Pierce County. Among them is the Family Renewal Shelter. They provide emergency services by way of confidential shelters, self-defense classes, spiritual support, and pet therapy. They also offer help with access to vehicles, educational scholarships, and relocation. Support for the organization comes from private donations from individuals, foundations, businesses, and churches. Access to services is via the organization’s 24-hour crisis line. Information about domestic violence is available on the organization’s website including a button that allows a user to leave the site quickly and eliminate a computer trail. (Family Renewal Shelter, 2014) National Alliance on Mental Illness – Pierce County The purpose of NAMI is to support people and those who love them with the challenges of mental illness. Members are people whose lives have been touched by mental illness and can share resources, lessons learned, and empathy with one another. They also advocate for change on local and legislative issues. Support group meeting occur three times a week and are located in a local Episcopal Church. They are free to attend. NAMI Walks occur several times a year and help to reduce the stigma of mental health and expand services, especially in education of mental health issues with police, fire and other first responders. (NAMI Pierce County, 2015) Planned Parenthood A group of community volunteers opened the first Planned Parenthood clinic in Tacoma in 1972 to address concerns about high rates of teen pregnancy and sexually transmitted infections. The organization believes that everyone has the right to choose whether and when to get pregnant and works to prevent unwanted pregnancies. They rely heavily of individual donor support to provide basic low-cost health care, adoption planning, vasectomy services, and fitting for menstrual cups. They also provide abortion services and are  frequented by protestors. (PPGNW, 2015) Tacoma Rescue Mission There are more than 36 homeless shelters in Tacoma offering everything from emergency shelter, transitional housing, and assisted housing for people dealing with domestic violence, drug addiction, and sexual trafficking. They are a Christian organization funded by the United Way of Pierce County and the cities of Lakewood and Tacoma in addition to funding from Pierce County itself. They report that they provide shelter to more than 400 people nightly and provide food for 26,000 people who have no other access to food. They work to help people overcome drug and alcohol addiction with rehabilitation serves, educational assistance and case management. (Tacoma Rescue Mission, 2015) Interpretation of Collected Data Epidemiology examines how health status or health events are distributed across a community and what determines it. The preceding examples give a broad stroke painting of health in Pierce County. Overall, the birth rate (15 per 1000) exceeds the death rate (7.3 per 1000) in Pierce County and the infant mortality rate (6.5 per 100,000) is in line with the national average (6.15 per 1000). (City-Data, 2014) Pierce County offers many assets that empower the health of its residents. Among these are a large population of college-educated people with 90 percent of adults 25 years and older completing at least high school or obtaining a GED. Although 8 percent of residents are foreign born, more than 80 percent of these report speaking English fluently. The people of Pierce County have access to nature and local foods, including the nation’s largest crop of rhubarb. Strong faith communities with social outreach programs help neighbors in need. The community brims with people who are largely open-minded and access complementary care such as massage, acupuncture, and chiropractic adjustments is common. (Tacoma Pierce County Health Department, 2014) Community Diagnosis In my analysis of the data collected, it appears that Pierce County’s top three problems are access to mental health services, high rates of obesity, and access to quality health care. Access to mental health services A community that is mentally healthy is productive, enjoys fulfilling relationships with others in the community and is resilient through life’s challenges. Without it, even the healthiest body can fall into disrepair quickly. It’s no wonder then that mental illness is one of the most common causes of disability. The National Institute of Mental Health estimates that as many as one in every 17 people has a seriously debilitating mental illness. The good news is that mental, emotional, and behavioral disorders can be prevented. We know more about how the brain functions than ever before and current research indicates that greatest opportunity to prevent illness is to get people into treatment early and often. (Healthy People 2020, 2015) With Washington State’s dismal rankings in the availability of psychiatric beds and the high patient load of mental health care providers in the County, there is much work to be done. Healthy People 2020 goals state that 87 percent of primary care facilities should provide mental health treatment onsite or by paid referral. This goal represents a 10 percent improvement over the baseline rate of 79 percent in 2006. (Healthy People 2020, 2015) High rates of obesity Pierce County’s high rate of obesity is well above the national average and may be attributed to large number of food deserts, especially in urban areas. People who have healthy weights and access to fresh foods have lower rates of chronic disease and a higher quality of life. Addressing obesity is complex, however, and requires a multi-faceted approach. As with mental health, the most powerful interventions are aimed at prevention. According to Healthy People 2020, more than 10.4 percent of children ages two to five were considered obese in 2008. The 2020 goal is to reduce that number to 9.4 percent. (Healthy People 2020, 2015)One of the most cost effective ways to achieve that goal is to increase the number of children who are breastfed. A history of breastfeeding, especially exclusive breast milk feeding for the first six months, is associated with an estimated 40 percent reduction in childhood obesity. (AHRQ, 2009) Unfortunately, just  14.1 percent of infants born in 2006 achieved this. Healthy People 2020’s target is 25.5 percent. (Healthy People 2020, 2015) Access to quality healthcare Optimal health is not a state achieved without support, education and intervention. Ensuring that Pierce County residents get the help they need when they need it is a big part of preventing chronic disease, improving quality of life, and preventing unnecessary death. Some of the reasons people do not see a health care provider are they can’t find one, they can’t afford it, or they don’t have insurance coverage. The most recent data suggests that as many as 16 percent of County residents do not have health insurance. (Good Guide, 2011) According to Healthy People 2020, the national average is slightly higher at 16.8 percent. The objective is an ambitious one with 100 percent of individuals covered by private insurance or Medicaid/Medicare by 2020. (Healthy People 2020, 2015) According to Washington State’s Department of Public Health, there are approximately 543 providers in Pierce County including doctors, ARNPs, CNMs, and PAs. A little more than half of them report that they are accepting new Medicaid and Medicare patients. (Washington State Department of Public Health, 2011) Interestingly, Healthy People 2020 has yet to define specific goals for increasing the number of practicing providers in all areas. (Healthy People 2020, 2015) Primary Prevention Topic When John Snow, the â€Å"father of epidemiology,† was investigating cholera outbreaks in mid-nineteenth century London, the chief cause of unnecessary death was communicable disease. Today, chronic disease that damages the heart, pancreas, and lungs are more likely to kill than bacteria. A large contributor to hypertension, diabetes, and heart failure is obesity. In a society obsessed with weight loss and thinness, obesity rates in adults and even children are growing. Just as John Snow found the source of the disease that was claiming lives in his community, we must also find the source but it is unlikely to be in a solitary water pump in the middle of the city. Preventing obesity appears to be a life-long task best started at birth. The data demonstrate that increasing breastfeeding rates is a powerful tool in decreasing childhood obesity. Breastfeeding rates for older, educated and more affluent women are already at Healthy People 2020 targets but women who are young, have low levels of education and who are poor are more likely to never breastfeed and are extremely unlikely to continue to do so for six months. (Grummer-Strawn, Scanlon, Darling, Conrey, 2004) An organization in the community that helps low-income women establish and maintain breastfeeding is the Women, Infants, and Children Program. A team of peer counselors who have themselves struggled with issues common to low-income breastfeeding women including pumping in the workplace help new moms navigate a difficult terrain and provide their children with the best start in life. Area hospital-based birth centers are working toward or have already achieved certification as a Baby Friendly Hospital. This designation indicates that the facility employs evidence-based practice that lead to dramatic increases in breastfeeding rates. (DiGirolamo, Grummer-Strawn, Fein, 2008) Given that the problem of obesity is large in Pierce County, the rewards for reducing it great, and the interventions that are most likely to help are known and inexpensive, I am focusing my primary prevention topic on promoting breastfeeding as a means to reduce obesity in Pierce County. Bibliography AHRQ. (2009). Breastfeeding, Maternal Infant Health Outcomes. Retrieved January 22, 2015, from Agency for Healthcare Research and Quality: http://archive.ahrq.gov/clinic/tp/brfouttp.htm City-Data. (2014). PIerce County, WA. Retrieved January 16, 2014, from City-Data.com: http://www.city-data.com/county/Pierce_County-WA.html DiGirolamo, A., Grummer-Strawn, L., Fein, S. (2008). Effect of Maternity-Care Practices on Breastfeeding. Pediatrics , S43-S49. Family Renewal Shelter. (2014). About the family renewal shelter. Retrieved January 21, 2015, from Family Renewal Shelter: www.domesticviolencehelp.org/aboutfrs.html Good Guide. (2011). Good Guide. Retrieved January 17, 2014, from Score Card The Pollution Information Site: http://scorecard.goodguide.com/community/index.tcl?zip_code=98404set_community_zipcode_cookie_p=tx=11y=11 Grummer-Strawn, L., Scanlon, K., Darling, N., Conrey, E. (2004). Racial and Socioeconomic Disparities in Breastfeeding . Atlanta: Centers for Disease Control and Prevention. Healthy People 2020. (2015). Access to Health Services. Retrieved January 22, 2015, from Healthy People.gov: http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services Healthy People 2020. (2015). Maternal, Infant, and Child Health. Retrieved January 22, 2015, from Healthy People.gov: http://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives Healthy People 2020. (2015). Mental Health and Mental Disorders. Retrieved January 2015, 2015, from HealthyPeople.gov: http://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders Healthy People 2020. (2015). Nutrition and Weight Status. Retrieved January 22, 2015, from Healthy People 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives League of Women Voters Pierce County. (2013, December 11). Introduction to services for the seriously mentally ill in Pierce County . Retrieved January 18, 2015, from National Alliance for the Mentally Ill Pierce County: http://www.lwvwa.org/tacoma/pdfs/Mental%20Health%20Report%20from%20November%202013%20Unit%20Meetings%20%205%20pgs.pdf NAMI Pierce County. (2015). Welcome to the NAMI of Pierce County Web Site. Retrieved January 21, 2015, from NAMI Pierce County: http://www.namipierce.org/ Patamia, K. (2015, January 16). Windshield Survey of Pierce County. (K. Patamia, Interviewer) Pierce County Department of Emergency Management. (2010). Hazard Identification and Risk Assessment. Retrieved January 17, 2015, from Pierce County Emergency Management: http://www.co.pierce.wa.us/DocumentCenter/View/7032 PPGNW. (2015). Who We Are. Retrieved January 21, 2015, from Planned Parenthood of the Great Northwest: http://www.plannedparenthood.org/planned-parenthood-great-northwest/who-we-are Simpson. (2014). Environment. Retrieved January 17, 2015, from Simpson Company: http://www.simpson.com/Environment.aspx Snob Hollow Designs. (2014). County Maps of Washington. Retrieved January 17, 2014, from County Maps of Washington: http://www.countymapsofwashington.com/pierce.shtml Tacoma Pierce County Health Department. (2015). Nutrition Program for Women, Infants and Children. Retrieved January 21, 2015, from Health and Wellness: http://www.tpchd.org/health-wellness-1/wic-nutrition-program/ Tacoma Pierce County Health Department. (2014, August). Pierce County Community Health Improvement Plan. Retrieved January 15, 2015, from Pierce County Community Health Improvement Plan: http://www.tpchd.org/files/library/474287fe72cf69af.pdf Tacoma Rescue Mission. (2015). Rescue Mission. Retrieved January 21, 2015, from About Us: http://www.rescue-mission.org/aboutus University of Wisconsin Population Health Institute. (2014). County Health Rankings and Roadmaps. Retrieved January 17, 2014, from Washington Pierce County: http://www.countyhealthrankings.org/app/washington/2014/rankings/pierce/county/outcomes/overall/snapshot US Census Bureau. (2014, December 4). State and County Quick Facts. Retrieved January 16, 2013, from United States Census Bureau: http://quickfacts.census.gov/qfd/states/53/53053.html Washington State Department of Public Health. (2011, July). Primary Care Provider Survey: Pierce County. Retrieved January 22, 2015, from Office of Community Health Systems: http://www.doh.wa.gov/Portals/1/Documents/Pubs/689048.pdf YMCA of Pierce and Kitsap Counties. (2014). About Us. Retrieved January 21, 2015, from YMCA of Pierce and Kitsap Counties: http://www.ymcapkc.org/about-us/