1

Santa Cruz County Community Assessment and Program Plan

Annette Chavez, Brianna Gonzalez, Sky Predovich, Caroline Ridgewell, Praj Shapiro, Paola

Vidana

Mel and Enid Zuckerman College of Public Health, University of Arizona

HPS 350: Principles of Health Education and Health Promotion

Christine L. Girard

May 10, 2022

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Table of Contents

Executive Summary__________________________________________________________ 4-5

Geography and Environment___________________________________________________ 6-7

1. Geography, Environment, Built Environment__________________________________ 6

2. Environmental Health Risks_______________________________________________ 7

Demographic Information_____________________________________________________ 7-8

Cultural Factors_____________________________________________________________ 8-9

Health Statistics____________________________________________________________ 9-11

1. Mortality____________________________________________________________ 9-10

2. Morbidity___________________________________________________________10-11

3. Perceptions and Descriptions______________________________________________ 11

Socioeconomic Stratification_________________________________________________ 11-12

Education________________________________________________________________ 12-13

Occupational Data_________________________________________________________ 13-14

1. Employment and Unemployment Rates_____________________________________ 13

2. Labor Demographics____________________________________________________ 14

Local Health Resources_____________________________________________________ 15-16

1. Healthcare Facilities_____________________________________________________ 15

2. Health Resources_______________________________________________________ 16

Housing__________________________________________________________________ 16-17

Transportation_____________________________________________________________ 17-19

Food Supply_________________________________________________________________ 19

School Health and Nutrition Programs__________________________________________ 20-22

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1. Santa Cruz Valley Unified School District___________________________________ 20

2. Nogales Unified School District_________________________________________ 20-21

3. Santa Cruz Elementary School District___________________________________ 21-22

Social Welfare Programs____________________________________________________ 22-23

Community Organizations______________________________________________________ 23

Community Factors Impacting Health_________________________________________ 24-25

Community Assessment Program_____________________________________________ 25-32

1. The Problem Statement_______________________________________________ 25-26

1. Hypothesis______________________________________________________ 26

2. Theoretical Framework________________________________________________ 26-27

3. Program Description__________________________________________________ 27-28

4. Program Implementation Plan__________________________________________ 28-32

1. Target Population & Awareness______________________________________ 28

2. Faculty, Equipment, Staffing Needs__________________________________ 29

3. Program Budget__________________________________________________ 30

5. Program Evaluation Plan & Quality Improvement__________________________ 31-32

References_______________________________________________________________ 33-37

Appendix A______________________________________________________________ 38-39

Appendix B_______________________________________________________________ 40-41

Table of Figures

Figure 1.1___________________________________________________________________ 26

Figure 1.2___________________________________________________________________ 30

Figure 1.3___________________________________________________________________ 30
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Executive Summary

Overview

Through the Santa Cruz Community Assessment and Program Plan, our group conducted various

research studies to analyze multiple factors that are affecting the county’s health and also

described the various local resources and factors that contribute to their overall health. The

factors assessed in this paper include social, political, cultural and health components that are all

intertwined to create a proper plan for prevention and treatment of obesity. It is important that

through the program people can modify their current behavior and lifestyle choices so they can

actively participate in their own health and are also able to prevent diseases.

Problem Statement

Our group focused our community assessment and plan around obesity. Focusing on obesity

affecting low-income adults from age 20-60. Leading a healthy-lifestyle can be costly affecting

these low-income citizens as they may not have access to healthy food or their jobs and current

schedules may be affecting their eating schedule and these individuals resort to "fast food"

eating. Failure for individuals to lead a nutritionally balanced diet can result in many diet related

diseases such as heart disease, stroke, diabetes, and fatty liver disease among others.

Plan

Main goal for this plan is to educate our targeted population about health and dietary changes

that can be made to prevent long term health diseases and complications from such diseases. The

health belief model centers around individuals taking action to improve their health behavior

based on four beliefs (Nutbeam, 2010). The four beliefs will be used in our program plan to

guide the planning since the program will require teaching individuals who are in the overweight

category about leading a healthy lifestyle with a nutritionally balanced diet and physical activity.
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Through the plan it is important that individuals have access to various local resources in which

they could acquire healthy food through the local food bank and by giving physical activity

instructions to these individuals that are easy to complete at home or at a local park. Through the

program it is expected that through the behavioral changes and by adopting a healthier lifestyle

they can see changes not only in weight but overall health well-being.

Program Requirements

Necessary facility, equipment and staffing includes a registered dietician or nutritionist, a

medical professional, licensed personal trainer or physical education specialist, psychologist and

volunteers that will carry out the program's activities. The program would be carried out in a big

facility equipped to fit large numbers of people such as a school cafeteria or gym. Other

materials needed for the program include basic electronics such as computers or access to the

internet, yoga mats and other physical activity equipment and access to printing facilities to

produce pamphlets, recipes, and program flyers. With the necessary equipment, staffing, and

facility our budget of $52,000 should suffice to cover necessary expenses.

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Geography and Environment

Geography, Environment, and Built Environment

Santa Cruz County is located within the southernmost central part of Arizona. The county

borders the entrance to Sonora, Mexico, a main entry way for crossroads between the United

States and Mexico, as well as Pima County to the north and west, and Cochise County to the east

(Santa Cruz County, 2022). It is considered the smallest county within Arizona, taking up only

1,238 square miles of the state's land (Santa Cruz County, 2022). There are ten towns and cities

that encompass Santa Cruz County: Amado, Beyerville, Kino Springs, Elgin, Nogales,

Patagonia, Rio Rico, Sonoita, Tubac, and Tumacacori. Majority of this area is covered by desert

lands and mountains, except for the few rivers that flow through the towns. The county’s name

originated from the Santa Cruz River, a river that flows from Arizona into Mexico, ​(Arizona

Commerce Authority, 2022). Santa Cruz County is also known for its numerous national parks.

Some of these parks include Tubac Presidio State Historic Park, Catalina State Park, and Agua

Caliente Park (Santa Cruz County, 2022).

Santa Cruz County is known to be one of the healthiest counties within Arizona in regard to

health outcomes, but health factors cause the county to be ranked in the lower-middle range in

the state. Looking into the built environment of this county, in all it is a relatively moderate

walkable county (Well Being in the Nation Network, 2022). The more south the populations are

within the county, the higher the walkability rate is (Well Being in the Nation Network, 2022).

About 64% of the population in the county are within 0.5 miles of a national park, making

walking an accessible means of traveling. Unfortunately, housing is an apparent problem with it

being too costly for some families. On average, 37.7 hours of work are needed to pay for

affordable housing (U.S. News, 2022).

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Environmental Health Risks

According to the Well Being in the Nation Network (2022), Santa Cruz County has dangerously

high levels of air pollution. In 2014, the Center for Disease Control recorded an average of

0.30% days per year “with levels of PM2.5 pollution above the regulator standard” (Well Being

in the Nation Network, 2022). A majority of the air pollution comes from the use of burning

fossil fuels from diving vehicles, power plants, as well as forest fires. This type of population is

considerably dangerous because the particles are small and can travel deep into the lungs and

bloodstream, increasing the risk of health conditions such as heart disease and asthma (Well

Being in the Nation Network, 2022). Additionally, the U.S. News reports Santa Cruz County has

an environmental score of 72 for lack of water and air quality (U.S. News, 2022). About 25 per

one million members within the county are at risk of developing cancer from airborne pollutants,

as well as 31% of people will develop serious respiratory complications throughout their lifetime

(U.S. News, 2022). One of the more commonly built environmental issues within this county

includes severe housing problems. Problems within this category include overcrowding, high

housing costs, and lack of kitchen facilities or plumbing (Well Being in the Nation Network,

2022). As of 2021, 22% of the Santa Cruz County population faces severe housing problems

(County Health Rankings & Roadmaps, 2022). A majority of the environmental issues within the

community do not show to affect any specific populations more than others.

Santa Cruz County Demographic

Santa Cruz County is a smaller county within Arizona that has about 47,883 people as of July of

2021 (U.S. Census Bureau, 2021). The population is made up of various racial and ethnic groups

of all ages. According to the U.S. Census Bureau (2021), females make up 51.8% of the

population of Santa Cruz County while males make up the remaining 48.2% (U.S. Census
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Bureau, 2021). The age distribution goes from 5 and under to 65 and over and has different race

origin groups. Listing the race origin of the population from highest to lowest Hispanic or Latino

is found to be 83.3%, White is 15.0%, American Indian and Alaska Native 1.4%, African

American 1.0%, Asian was 0.8%, Native Hawaiian and Other Pacific Islander is 0.1% (U.S.

Census Bureau, 2021). The age percentages include people under 5 being 6.9%, people under 18

are 26.6%, people 65 and over are 18.5% (U.S. Census Bureau, 2021).

Cultural Factors

Santa Cruz County has a large Hispanic population with over 80% of the population

sharing a Mexican heritage (Santa Cruz County Sheriff, n.d.). Nogales, Arizona sits on the

U.S.-Mexican border and neighbors Nogales, Sonora, and Mexico. There is a rich Mexican

heritage in Nogales (Santa Cruz County Sheriff, n.d.). Much of the culture in Santa Cruz County

is shared with Mexican culture with similar values. Many of the citizens of Nogales, Sonora also

share close relative ties with citizens of Santa Cruz County, so this increases the Mexican tourists

coming into the country through the port of entry located in Nogales, Arizona in order to do

some local shopping or visit the historical sites of Santa Cruz County (Santa Cruz County

Sheriff, n.d.). When traveling from the United States to Mexico a passport is not needed so many

American tourists swarm to Nogales, AZ in order to visit the city of Nogales, Sonora and engulf

in the rich Mexican culture (Hello Nogales, n.d.). This Mexican heavily influenced culture of

Santa Cruz County is due to Arizona previously being part of Mexico in 1822, when the United

States bought this territory many of the established settlements of the time were Mexican

families that decided to stay in this area (Hello Nogales, n.d.).

Santa Cruz County also has a rich western culture such as that of Tubac and Amado

where the citizens of the area are primarily ranchers (Santa Cruz County, n.d.). Santa Cruz
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County is also home to indigenous tribes like the Apache, the Yaqui, and the Hohokam who have

their settlements along the Santa Cruz River and Sonoita Creek (Santa Cruz County, n.d.).

With the great variety of cultures in Santa Cruz County, there is also a vast amount of art

and culture within this county. Painting, sculptures, carvers, and weavers there is a lot of

tradition surrounding the artwork of this county (Santa Cruz County, n.d.). The artwork is meant

to represent the beauty of the desert, the history, and the multiple cultures that came together to

become part of Santa Cruz County. These artworks are usually displayed in the many art

exhibitions throughout the cities of this county.

Health Statistics

Health statistics allow public health officials to identify the groups of people impacted the

most by certain health issues and the populations that must be protected from further damage. It

is important to analyze these statistics because it can expose the populations that are harmed the

most from certain issues and allow public health workers to focus on those groups of people. The

health statistics must consider different populations in a community such as ethnic groups, sex,

and age in order to identify the groups most at risk.

Mortality

The mortality rate is the total number of deaths in a certain community which can be split into

multiple categories. In Santa Cruz County, the total number of deaths in 2019 was 335 in total

(Arizona Department of Health Services, 2022). Out of these deaths, 179 (53%) were males and

156 (47%) were females (Arizona Department of Health Services, 2022). A majority of the

deaths were primarily white and Hispanic people because these ethnic groups make up a majority

of the population in Santa Cruz County. The white population had a total of 85 (25%) deaths, 54

(16%) of them being males and the other 31 (9%) being females (Arizona Department of Health
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Services, 2022). The Hispanic population in Santa Cruz County had a total of 245 (73%) deaths,

121 (36%) of them being males and the other 124 (37%) females, which was the group with the

most deaths (Arizona Department of Health Services, 2022). The rest of the ethnic groups had no

deaths due to the very small population, except for African Americans who had a total of 10

(3%) deaths (Arizona Department of Health Services, 2022).

Morbidity

Morbidity statistics for the citizens of Santa Cruz County are not available to the public

but have been identified for the state of Arizona. The major morbidity statistics include the rates

of cancer, heart disease, and unintentional injury and are collected as a ratio. For the white

population in Arizona, the rate of heart disease is 140:4, the rate of cancer is 136:9, and the rate

of unintentional injury is 60:5 (Arizona Department of Health Services, 2022). The Hispanic

population’s rate of heart disease is 107:9, cancer is 181:3, and unintentional injury is

48:3(Arizona Department of Health Services, 2022). For the African American population, the

rate of cancer is 173:5, the rate of heart disease is 188:3, and the rate of unintentional injury is

60:4 (Arizona Department of Health Services, 2022). The last ethnic group that is the least

affected by these conditions is the Asian population, their rate of cancer being 98:4, rate of heart

disease 86:7, and a low rate of unintentional injury at 22:9 (Arizona Department of Health

Services, 2022).

Diseases such as gonorrhea, chlamydia, and syphilis also can be included in the morbidity

statistics. The group impacted the most from gonorrhea are males ages 35-39 with a rate of 414:8

(Arizona Department of Health Services, 2022). Chlamydia mostly affects females that are 35-39

with a morbidity rate of 505:9. Lastly, syphilis is mainly contracted by females aging 20-25

(Arizona Department of Health Services, 2022).

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Perceptions and Descriptions

The citizens of Santa Cruz County were asked to fill out surveys about the overall health

of their community and the areas most needed for improvement. The main health issues within

the county include obesity, drug abuse, alcohol abuse, and lack of exercise (Santa Cruz County

Community Health Improvement Plan, 2013). Different age groups were also asked about their

main health concerns in the community. Older adults believed that Santa Cruz County was most

in need of more medical facilities and providers, retention of the medical providers, and allowing

more people to be involved in policy making (Santa Cruz County Community Health

Improvement Plan, 2013). The youth believed that the community should focus on more

education about drug use and sexuality, more personal development programs, and increased risk

reduction education earlier in school (Santa Cruz County Community Health Improvement Plan,

2013). Senior service providers also had recommendations for better elderly care. These included

more affordable medications, better care coordination, an increase in the amount of assisted

living homes, and a lack of transportation (Santa Cruz County Community Health Improvement

Plan, 2013).

Socioeconomic Stratification

The median household income in Santa Cruz County is $41,259 (Data USA, 2022). This is

below the median household income of $65,712 annually found across the United States (Data

USA, 2022). The average person per family is 2.88. The average per person income is $21,686.

There is 23.3% of the population in poverty in Santa Cruz County which is higher than the

12.3% of population in poverty in the United States. Of this population living in poverty males

aged from 25-34 makeup the largest demographic, females between the ages of 25-34 make up

the second largest demographic, and males 3-11 are the third largest demographic living in
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poverty within this county (Data USA, 2022). The biggest racial or ethnic group that is living in

poverty in Santa Cruz County is Hispanic with a poverty population of 9,793 people (Data USA,

2022). The white poverty population is second with 8,907 individuals (Data USA, 2022). Other

mentionable groups who suffer less from poverty in Santa Cruz County include those of two or

more races, Native Americans, African Americans, and the Asian population (Data USA, 2022).

The total percent of civilian labor force in Santa Cruz County for ages 16 and older is 54.6%

(Data USA, 2022).

Education

As of 2022, there are 27 schools within Santa Cruz County that serve 9,976 students. In

total, there are nine high schools, twelve middle schools, nineteen elementary schools, five Pre-k

schools, four charter schools, and four private schools (Rio Rico, AZ, 2022). There are three

districts in Santa Cruz County. These include Santa Cruz Valley Unified School District, Nogales

Unified School District, and Santa Cruz Elementary School District (Rio Rico, AZ, 2022).

Francisco Vasquez De Coronado Elementary School is named the number one public school in

Santa Cruz County. Little Red Schoolhouse is named the number two school in the Nogales

Unified school district (Rio Rico, AZ, 2022). Santa Cruz Elementary School district is home to

217 students K-8. This district has about an 80% graduation rate with a 18:1 student: teacher

ratio. 97% of their students are of Hispanic ethnicity and the other 3% are White (K-12 schools,

2022).

There are many different school options for high school levels of education. The main

high schools are Nogales High School and Rio Rico High school both being within these

districts. There is a private school that is the most popular pick of high schools in Santa Cruz
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County being Lourdes Catholic High School. Santa Cruz County their dropout rates are higher

than their nearby county. About 21% of the Santa Cruz County population, between the ages of

18 and 24, has dropped out and received less than a high school diploma (Nogales, AZ, 2022).

Within this group, the majority of individuals stopped attending school at elementary school

(Nogales, AZ, 2022). The county of Santa Cruz has trouble with keeping its younger population

in school long enough to receive a high school diploma.

Occupational Data

Employment and Unemployment Rates

As of February of 2022, 7.8% of the Santa Cruz County population is unemployed while 17,783

individuals are employed, which is approximately 38% of the population (University of Arizona

Eller College, 2022). The average percentage of unemployed individuals within the United States

currently is 4%, while Arizona’s average unemployment rate as of January of 2022 is 3.7% (Data

USA, 2022). Comparing the unemployment trends, the unemployment rate among the Santa

Cruz County population is higher than the national and state average. The top 10 employers

within the County of Santa Cruz include the Santa Cruz Valley Unified School District, Javid

LLC, Bureau of Customs and Border Protection, Nogales Unified School District, Becton

Dickinson and Company, Santa Cruz County, United Parcel Service, Otis Elevator International

Inc. and Company, as well as Dependable Nurses Inc. (AZMag, 2022).

Labor Demographic

The largest industries of employment within this county include Retail Trade (2,282 people),

Health Care & Social Assistance (1,962 people), and Transportation & Warehousing (1,770
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people) (Data USA, 2022). In regard to common jobs by ethnicity there is no data collected for

the current Santa Cruz County population. Within the state of Arizona, the White population

holds many of the positions of retail salespersons, managerial positions, firstline supervisor

service, and customer service representative positions (Data USA, 2022). The African American

and Native American demographic are the second and third most common populations to hold

those positions (Data USA, 2022). Other demographics known to work in these common jobs

include Asian, Other Native American, American Indian, and those of two or more races (Data

USA, 2022). The Asian demographic, although small in regard to population size, has the highest

annual salary with a median of $63,858 annually (Data USA, 2022). The median annual

household income in Santa Cruz County is $41,259, with men making on average $63,958

annually and women $49,297 annually (Data USA, 2022). Men hold many of the positions of

every category of work within the common jobs of Arizona. Health risks associated with

employment within this county may include and are not limited to chronic health conditions,

communicable disease, workplace injury, and accidents (U.S. News, 2022). Those working

within healthcare and social assistance are more prone to communicable diseases. Transportation

and warehousing are occupations more prone to workplace injury, as well as mining, oil, gas

industry workers.
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Local Health Resources

Health Care Facilities

Health care facilities are crucial and often can be further out in developing communities. With

Santa Cruz County being so close to the border, the population around them might suffer when it

comes to health care and assuring they have the necessary resources. The Mariposa Community

Health Center is located in Nogales, Arizona. This health center offers care to everyone, and they

offer a variety of different care like medical, dental, and disease prevention with health

promotion services (Health Center, 2022). With a facility including different types of services, it

allows those who might not have one nearby to travel to this location and get all the treatments in

one visit. The only difficult part is not having a facility within a 10-mile radius which can be

very difficult, especially during a desperate medical emergency.

Health Resources

The Mariposa Community Health Center includes internal adult medicine, pediatrics (for

children), obstetrics and gynecology, general surgery, dentistry, behavioral health, and

pharmacies (Health Center, 2022). The Mariposa Community Health Center has a variety of

departments that benefit the Santa Cruz County population by providing care for all patients

regardless of age and gender. Additionally, they provide specialty care for women and children's

health. They have an entire building devoted to Women, Infants, and Children (Health Center,

2022). The building provides care that includes prenatal and postpartum care, breast and cervical

screenings, family planning, breastfeeding training and support, and gynecology care (Health

Center, 2022). Showing the involvement of pushing for healthcare in those counties that need it
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the most shows how there can be potential growth and start the process of developing more of

these health centers.

Housing

Quality and Quantity of Housing

Santa Cruz county has numerous homes built in the 1900s, with many of these homes being in

original condition the value of the homes become much lower. People in Nogales, AZ have

owned these homes for many years, but other people opt to rent these older homes they might

have to invest in renovating or maintaining the house. In the cities of Tubac and Amado many

people of the ranching community have bought big lands in order to keep their cattle.

According to the US Census in Santa Cruz County there are around 18,524 housing units

available with about 67% of those units being owner occupied. The median monthly cost for

ownership with a mortgage is around $1,000 and the median gross rent being around $657 (US

Census, 2021).

Housing Opportunity for Low Income Households

For those of low income there are some opportunities to help them in finding affordable housing.

There are many apartment complexes that offer Equal Housing Opportunity which eliminates

housing discrimination by allowing people to have rent accommodations based on personal

income (US Department of Housing and Urban Development, n.d.). Individuals who find

themselves homelessness have many shelters available to them, mostly in Nogales, AZ. The

Crossroads Mission Shelter, Nogales Housing Authority and Chicanos Por las Causa are

examples of homeless shelters in Santa Cruz County (Public Housing Program, n.d.). The

Nogales Housing Authority takes applications through their website where they determine
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housing for community members based on income, U.S citizenship or eligible immigration

status, being elderly, a person with a disability, or as a family (Public Housing Program, n.d.).

The non-profit homeless shelter Crossroads Mission offers housing, food, resources such as job

opportunities and recovery programs with people fighting addiction (Crossroads Nogales

Mission, n.d.). Adequate housing in the county is very scarce, many of the government programs

like the Nogales Housing Authority require lengthy application process and an additional wait

time for screening process and approval (Crossroads Nogales Mission, n.d.). Many of the

non-profit organizations are doing a very good job in helping those they can however they do

depend on donors and these non-profit organizations are not available in the other cities of the

county.

Transportation

Transportation is an essential service in a community for making sure community members are

able to travel. This can relate to a community’s public health because it is what allows

individuals to travel to essential health services or completing everyday tasks. Santa Cruz County

has been working to expand their transportation services over the past decade because of

population growth. Three ports of entry between the United States and Mexico are located in

Santa Cruz County, which has resulted in large amounts of traffic volume in commercial and

noncommercial transportation (Nogales Santa Cruz Transportation Plan Final Report, 2012). The

Union Pacific Railroad line is also a major mode of transportation in Santa Cruz County, which

runs through downtown Nogales and crosses the county along its north-south line. The railroad is

key for their economy because it regulates international trade between Mexico and the US

(Nogales Santa Cruz Transportation Plan Final Report, 2012).

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In regard to public transportation, Santa Cruz County has very minimal options. The Greyhound

bus service only travels to major cities in Arizona There is also the Tufesa Bus Lines which

travel across the border. Taxi services, such as the Acosta Taxi Service, Angeles Taxi, and

Hernandez Taxi are also available to county residents (Tucson Shuttles, 2022). This means that

the citizens do not have access to reliable public transportation and must rely on their own means

of transportation. Not everyone is able to afford their own transportation, so not having a bus

system around the county limits many people from traveling to essential services.

The price for a ticket on the Greyhound bus from Nogales to Phoenix is $34 (Tucson Shuttles,

2022). This is a reasonable price for a ticket since the trip is almost three hours long. The Tufesa

Bus line is also affordable for the citizens of Santa Cruz County and only costs $18 for a ticket to

Tucson (Tucson Shuttles, 2022). The taxi services follow similar rates to the other taxi services

in Arizona, which is around $2.20 per mile of travel (Tucson Shuttles, 2022). This cannot be

easy for everyone to afford and the price quickly adds up.

The major transportation challenges have to do with the very small population in Santa Cruz

County and the low amount of funding available. It is not cheap to run public transportation

services in a community and requires a large amount of the population to be using these services.

Since Santa Cruz County is so small, it is hard to create these public transportation services

because not enough people will use them. It is hard to justify creating new transportation services

if it will result in the county losing money and not enough of the citizens putting them to use. It

would be beneficial if the county possibly created a small bus route that was found in the center

of the county, or only traveled to the most desired locations. This would cut down the cost to
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create and maintain these services, but just be enough for people to travel to essential locations

such as hospitals or work.

Food Supply

Residents of Santa Cruz County don’t have to travel far to purchase groceries, and the majority

of the population has access to stores that sell groceries. Santa Cruz County has a score of 15.0

per 100k compared to the score of Arizona of 1.6 per 100k and the score of the United States of

4.3 per 100k (U.S. News, 2022). Santa Cruz County also has a bigger share of at-home food

expenditures on fruits and vegetables of 13.7%, compared to the United States of 11.9% (U.S.

News, 2022). Santa Cruz County also demonstrates to provide adequate and healthier food for all

residents since the county has a Food Environment Index Score of 16.52, compared to Arizona’s

score of 9.04, and the United States score of 9.53 (U.S. News, 2022). As the higher the Food

Environment Index Score indicates the availability of healthy food rather than unhealthy food, it

shows us the nutrition conditions in Santa Cruz County (U.S. News, 2022). The provision of

adequate food can be stated that it is for all residents since one of the main accessible resources

of food in Santa Cruz County is the community food bank which gives out food including many

fruits and vegetables and is provided to all residents. This organization called the Community

Food Bank of Southern Arizona is a nonprofit organization that relies on charity and volunteers

(Community Food Bank of Southern Arizona, 2022). There’s also the Borderlands Food Bank

which is a government agency that provides fresh produce to families. The public service called

Nogales Community Food Bank partners with the Community Food Bank of Southern Arizona

to provide food distribution and provides services such as guidance on how to apply for food

stamps (Nogales Community Food Bank, 2022).

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School Health and Nutrition Programs

Santa Cruz Valley Unified School District

There are three main school districts in Santa Cruz County. Santa Cruz Valley Unified

School district (SCV, n.d.) is responsible for the majority of the high schools in this county.

These high schools in this district are mainly public-school high schools. Santa Cruz Valley has a

program that will feed children 18 years old or younger (SCV, n.d). Anyone is eligible to receive

a free meal; children do not need to be enrolled in SCV35 schools. The children that do attend

this district will need to show a school I.D to receive a meal. Those children not enrolled in

SCV35 must provide their name, age, and school district they do attend (SCV, n.d). With this

being said, any child under 18 years old will be able to receive a meal. This meal program is

provided all school year long, the program does not stop over the summer. With this program

being provided during the summer there is a bus program (SCV, n.d). This bus program will pick

up and drop off children wanting to eat a free meal. These bus routes are open Monday,

Wednesday, and Friday (SCV, n.d). SCV35 provides two meals breakfast and lunch with the help

of Sodexo Quality of Life Services (Santa Cruz Valley Unified School District, n.d). With this

organization a child has the resources to see the menu for the week with a breakdown to show

ingredients that students can be allergic to. This program is provided in English and Spanish.

Nogales Unified School District

The next school district is Nogales Unified School District (NUSD Food Service

Program, n.d.). This school district also has a food program to provide food services to children

and adults. The main difference from SCV35 is that adults can pay a small price to receive food

from this program (NUSD Food Service Program, n.d.). The Business Office is responsible for

determining eligibility for free and reduced-price meals of schools that participate in the National
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School Lunch and breakfast programs and Title I programs (NUSD Food Service Program, n.d).

Applications are sent out each year but can also be found online and at the Business office. For a

child to be eligible for free or reduced-price benefits, the household must submit an application

and either be eligible or have a household income at or below the amounts on the USDA income

chart (NUSD Food Service Program, n.d.). For NUSD to maximize district funding, they require

an application on file for each household, even if you do not qualify. A new application needs to

be submitted each school year. NUSD has over 5,000 students that qualify for the free and

reduced-price program (NUSD Food Service Program, n.d). The district also has a Universal

Free Breakfast Program for all its students. Elementary, Middle, and High school students are all

eligible for a free breakfast with a small fee starting at two dollars for lunch (NUSD Food

Service Program, n.d). For elementary lunch it starts at two dollars going up by twenty-five cents

for middle and high school. Reduced Lunch is $0.40 at all grade levels with the opinion of milk

or juice. Meals must be paid in advance and may be paid for on a daily, weekly, or monthly basis

(NUSD Food Service Program, n.d).

Santa Cruz Elementary School District

The last school district is Santa Cruz Elementary district (SCED28). This district is

responsible for Little Red Elementary, the most popular elementary school in this county. With

this school district they do not have a food program. This district does not have a program due to

the fact that breakfast and lunch are provided completely free for all students (SCED,

n.d).During the 2020-2021 school year each meal will be provided for free (SCED, n.d). Since

these two meals are free, they do not provide another meal after school. They do have tips for

parents on the district website on how to handle a hungry child after school. These tips are,

when picking up a child after school bringing a snack along for the ride home. For students that
 22

ride the bus a tip was provided to have a designated place with an after-school snack waiting

(SCED, n.d). This being said , SCED28 does not have a food program because they give two free

meals to all enrolled students.

Social Welfare Programs

Santa Cruz County has multiple programs established for county members to access

when in need of financial assistance. The Santa Cruz County government has a program known

as the CDBG Emergency Assistance program that accepts applicants who are struggling to pay

their mortgage and are in need of help (McNamara, 2022). The organization accepts low to

moderate-income families and offers free, emergency short-term grants and cash to keep families

in their homes (McNamara, 2022). The Nogales Arizona by Southeastern Arizona Community

Action Program and Santa Cruz County also administers a program called the Arizona

Community Action Program. The program is designed to help community members pay off their

utility bills, especially during the hot summer months when the need for air conditioning is high,

and reduce their energy bills (McNamara, 2022). The funds for this program come from the

Home Energy Assistance Fund, created by a combination of Community Action Agencies,

federal, state, and local government, private individuals, and utility companies (McNamara,

2022). Additionally, there are many faith-based programs that also support those in need of

emergency assistance. The Nogales Catholic Charity organization includes churches, charities,

and non-profit organizations that make up some of the various social and emergency services

offered within the county (McNamara, 2022). Examples of services offered include free food and

meals, low-cost transportation for important appointments, healthcare checkups, funds for bills,

rent, and clothing, as well as other resources like referrals or case management (McNamara,

2022). Medical assistance is also offered at the St. Elizabeth’s Health Center where patients from
 23

all backgrounds can access medical and dental services with reduced charges based on their

financial needs (McNamara, 2022). The aim of these social welfare programs is to help those in

need of assistance. The groups that are targeted within these programs include the elderly,

low-income families, and the poor population.

Community Political and Governmental Programs

Santa Cruz County is filled with many people and each of them has its own unique job or

area of focus. Santa Cruz County offers various programs and resources to the public, including

one called Emergency Preparedness Resources (Website, 2022). There, individuals can access

information to financial and support programs when necessary to them. It is a great form of help

for those who might face hardship and need assistance.

Within Santa Cruz County there is an organization called the Environmental Health

Department. With this organization they focus mainly on the health of the community and their

area of needs. They focus on drinking water protection, public education, and department

sanitarians (Website, 2022). They are constantly inspecting the water to assure it is not infected

or contaminated with any harmful chemicals and assure all the water lines are running smoothly.

With public education they try to educate the people of Santa Cruz County when it comes to

health, especially with food sanitation. Lastly, with department sanitarians, it focuses on the

surrounding areas such as the environment. They try to track the air quality and contamination to

avoid any ongoing health problems that can come with lack of air quality. This department helps

the community to assure they have the necessary resources. The department has its own goals

and purpose on what they hope to help the community with and how they can benefit from their

changes. Some of these goals being, inspecting mobile food vendors, public pools, restaurants,

school cafeterias and facilities (Website, 2022).

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Community Factors Impacting Health

The determinants of health are assessed to determine the factors affecting individual and

community levels of health with one of the determinants being personal behavior and lifestyle

choices. Many programs in the Santa Cruz community established through various organizations

in the community are established with the purpose to raise awareness in the community so

individuals may take action for their personal health and well-being. The Community Health

Services Department from Mariposa Community Health Center has created various programs

and health classes dedicated to both individuals and families. Health classes provided include

prenatal classes, sex education, diabetes prevention programs and woman-focused depression

therapies (Health Center, 2022).

The Mariposa Community Health Center also funds many programs directed towards the

younger population. The Summer Youth Institute is a seven-week program which offers

teenagers skills in health promotion, education in tobacco/drug prevention, sex education and

certifications such as CPR certifications (Health Center, 2022). Through these programs they

strive for raising awareness in the community starting with each individual in order to establish

healthy behaviors.

The Rotary Club is an international humanitarian organization that strives to promote

peace, improve health, improve water, sanitation, education, and poverty conditions in the world

(Health Center, 2022). They have many chapters established throughout the world with one of

those chapters being in Nogales, Arizona. For over a decade now this club has provided and

distributed millions of dictionaries to third grade students in every school. They also raise and

fund donations to contribute to the orphanage Casa Hogar Ninos Hermanos (Health Center,

2022).
 25

Santa Cruz county is a very community-oriented place where many people will have very

close ties and will be very involved in the community. Nogales, AZ offers many events where

organizations like the Mariposa Health Clinic, the Food Bank and the Rotary Club engage with

the community and enroll them in their classes and offer their services (Health Center, 2022). For

the programs directed towards the younger population they will usually engage with the school

district and offer applications and information flyers for those interested in participating in the

community.

The Problem Statement

The specific health issue for Santa Cruz County is obesity throughout the community.

Obesity would be considered a problem because it affects a large portion of the population and is

a direct cause to many diseases and health issues. The main population that is affected by obesity

in Santa Cruz County and around the U.S. is mainly lower-class citizens and adults ages 20 to

60, the most common age group being 40 to 59 years old (National Institute of Diabetes and

Digestive Kidney Diseases). Living a healthy lifestyle can be costly, so lower-class individuals

have a much harder time eating healthier foods with the essential nutrients for keeping their

bodies clean and robust. Obesity has many risk factors that can cause multiple health issues and

diseases for people later in life. The most common modifiable risk factors (precursors) include

diet, exercise, sleep, and stress (Yasmine, 2021). The most prevalent precursor in the Santa Cruz

County community would be diet. If people do not improve these risk factors, many health

consequences can occur later in life. These consequences include type 1 and 2 diabetes, high

blood pressure, heart disease, stroke, fatty liver diseases, metabolic syndrome, cancer and much

more (National Institute of Diabetes and Digestive Kidney Diseases). Eliminating the problem
 26

will not fully relieve all these consequences, but they will greatly decrease the percentage of

developing them and increase a person’s overall health.

Figure 1.1

Hypothesis: The main risk factor that will be addressed in the program is diet within Santa Cruz

County. The main goal is to educate the younger and older population about health and dietary

changes that can be made to prevent obesity later in life. Education is essential for exposing

people to learn the consequences of their health actions and motivating them to make positive

changes in their life. This program will overall create more people to develop healthier lifestyles

and understand the importance of healthy nutrition.

Theoretical Framework for the Program Plan

The theory or model that serves as the basis for program planning for obesity would be the

health belief model. The health belief model centers around individuals taking action to improve

their health behavior based on the four beliefs (Nutbeam, 2010). These four beliefs are how

likely they are to get the health problem, the gravity of the health problem, the benefits of actions

that reduce the health problem, and the barriers of the negative aspect of taking action such as

cost. This model will guide the planning since the program consists of teaching overweight

individuals, obese individuals, and parents of youth students about leading a healthy lifestyle,

nutrition, and physical activity. When planning for the educational program, there will be a focus

on making sure that the information taught addresses the four beliefs belonging to the health

belief model. As the model shows how the individuals will take action based on these beliefs,

from what these audiences learn through the educational program, they will be more likely to

take action. The health belief model will also help with guidance for planning as the information
 27

taught will also include personal and social aspects that go along with the beliefs like the social

benefits of engaging in physical activity to prevent obesity.

Program Description

The Project Plan for Santa Cruz County will focus on obesity. This program is made to

help overweight and obese individuals by teaching them about nutrition and how to live a

healthy lifestyle. This healthy lifestyle includes teaching about physical activity and proper

dieting. The goal being to help the community of Santa Cruz with resources to educate on

physical health and public health. This community struggles with a lack of resources, one

specifically is education. Due to the rates of low-income rates in this county, lack of recreational

activities, and an abundance of processed food options, these are the root causes of poor eating

and an increase in weight in the community. They do not have programs based on individual

health like teaching about healthy eating. Healthy eating includes fruits and vegetables but also a

well-balanced plate with a low glycemic index. This educational program will be implemented in

schools for parents, young adults, and older adults of the community by educating on basic

health information. This information will include what a healthy plate looks like and

implementing various physical activities they can do every day. These healthy plates are those

that can be cooked at home and where to find local pantries for families that need it. After

implementing this educational program there will be a check after two months on if these parents

remember or have practiced what they were taught. If less than half of these parents have

participated the program will return to be taught twice a month. This is also when the educational

program can be taught to the children at the schools that provide this program.

Program Implementation Plan

Target Population & Awareness

 28

The education program working to decrease obesity in the Santa Cruz County community will

target all ages ranging from 16 years old to 85 years old. All genders and ethnicities are eligible

to participate in this program, as well as all social classes ranging from low-income to

high-income. Due to the large concern of money within Santa Cruz, specifically in low-income

families and those suffering from poverty, this program will be provided free of charge. The goal

is to educate the community about how to improve their health by engaging in more physical

activity and healthier eating, while still maintaining an appropriate budget. The program will

contain information on access to various food drives, financial assistance programs, recreational

programs, financial and budgeting classes, and any other programs that might be deemed helpful

to community members who may be struggling and need support. Examples of external

programs that may be helpful include The Nogales Arizona by Southeastern Arizona Community

Action Program, The Nogales Catholic Charity, and St. Elizabeth’s Health Center (McNamara,

2022). Community members will be notified of this healthy lifestyle program through numerous

pamphlets and flyers that will be distributed by volunteers and leaders of the organization of the

program and put on the homes of all residents within Santa Cruz County. This program will also

be promoted by volunteers and the community government officials through social media,

workplaces, grocery stores, medical centers, newsletters, essentially any form of media or

communication to spread the word of the program. Examples of promoting this program include

billboard displays, flyers posted on bulletin boards and windows of buildings, volunteers

standing outside popular areas handing out flyers, and ads on social media.

Facility, Equipment, Staffing Needs

Since the program is based around living a healthier lifestyle, there are various specialists

that would be recommended to attend and teach in this program. Appropriate staff members
 29

include registered dietician or nutritionist, medical professional, licensed personal trainer or

physical education specialist, psychologist, and volunteers who are trained prior to the program

that are willing to help assist in carrying out activities. Ideally, the program will take place in a

school cafeteria, a setting made to fit many people. The cafeteria kitchen will be used by the

nutritionist or dietician to demonstrate how to cook at least five healthy, easy, and affordable

meals in a timely manner. They will educate on the importance of incorporating all food groups

in appropriate amounts to benefit their health the most. A licensed personal trainer will engage

the members in some brief, basic physical activity that can be used in their everyday routine.

They will explain the different types of physical activity that can be done during their day so they

may find an activity they are interested in, as well as what programs are offered in the county to

engage in physical activity with coupons for reduced or no cost. A medical professional and

psychologist are recommended to help educate the public about the risks of unhealthy eating and

many people are affected by chronic diseases within Santa Cruz County. Equipment needed for

this program include a projector, software to design the presentations (i.e., Google Applications),

a laptop, basic cooking essentials (i.e., bowls, plates, utensils, measuring cups, baking pans and

sheets, etc.), yoga mats, pamphlets and program flyers, healthy snacks, and water. Realistically,

this program is designed to be implemented twice a month so community members may be able

to access these resources when needed. The program is projected to test run for about a year to

see if there is any progress within the Santa Cruz County community.

Figure 1.2

Program Budget Figure 1.3

Item Description Quantity Cost

motion ers, Pamphlets, Posters, Billboard 9,000 $15,000

 30

oking Materials es, Bowls, Utensils, Measuring Cups, 100 $1,500

keware, Cookware

d d distributed from health-oriented companies 85 $8,000

ga Mats ga Mat for physical activity 50 $1,500

ter e of 24 water bottles 375 $750

cks althy snacks available to participants 375 $1,250

cialist Payment ecks written to presenters and guest speakers 96 $24,000

$52,000
A budget of about $52,000 for one year, or about $4,400 per month, would be enough to pay the

specialists, for the food and necessities needed to demonstrate cooking meals, yoga mats,

promotional and media postings, and provided water and snacks. Additional resources can be

brought in by volunteers, the specialists, or used from the school. The program would ideally like

to be implemented as soon as possible, but realistically to be able to create the media, find

volunteers, promote the program, and find specialists willing to put together a program, it will

take about a year to set up and finalize.

Program Evaluation Plan & Quality Improvement

For this intended project plan for Santa Cruz County, we hope to be able to implement an obesity

program. Our program will be called Health Improving within a Person’s Weight. Through our

research, we noticed how obesity was never targeted. They offer different programs, but obesity

was never a big one to focus on. The process evaluation of this program will take some time, as

we develop the learning part of the program and then be able to implement it for the people of

Santa Cruz County. The targeted population is all the people in Santa Cruz County whether they

are struggling with obesity or not everyone can have access to this program to be able to help

others. Implementing it in different languages can be an advantage to allow for those who might
 31

not know English also benefit from our problem. The outcome evaluation will be an evaluation

after we implement the program and to see the differences. Looking at the health of Santa Cruz

County is important to see if the community has progressed or whether it has had no effect on

them. Through all the evaluations, more ideas will be created to implement into the program and

other ways to improve the program. The main forms of getting this data will be looking through

health data, searching for current articles, and physically being present within different areas that

correspond to Santa Cruz County, to see what is needed or what change needs to be made. The

need for this project is to be able to reach those that have an eating disorder that can often be

associated with obesity. The goal is to be able to educate everyone and anyone to allow for them,

to be comfortable and be at a healthy rate. The timeline will be about a yearlong to see the

changes and how the program is helping Santa Cruz County. All data will be able to be observed

at that time. Other useful techniques will be introduced to measure the data and follow up with

the community plan.

 32

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Appendix A

Obesity in the U.S.

Obesity is a serious and costly disease that is very prevalent in adults and children in the United

States. As stated previously, obesity can cause many health-related issues including heart

disease, stroke, diabetes, cancer, and much more. Obesity continues to grow and affect even

more people in the U.S. every year. Obesity prevalence has increased from 30.5% to 42.4% from

1999 - 2018, and severe obesity has increased from 4.7% to 9.2%. This is a very alarming

statistic because even as the population grows, the overall percentage of obesity keeps growing

(CDC: Overweight & Obesity).

https://www.forbes.com/sites/niallmccarthy/2017/10/16/u-s-obesity-rates-have-hit-an-all-time-high-infographic/?sh=32fc9be34bad

https://landgeist.com/2021/05/07/prevalence-of-obesity-in-the-us/

Not only does obesity affect the health of the citizens, it also costs the country and

individuals a large amount of money. In 2008, 147 billion dollars was the estimated annual cost

of obesity in the U.S. The cost has risen due to the increase of obesity in the population. Also,

medical costs are much higher for overweight individuals than people at a healthy weight. On
 38

average, obese people spend $1,429 more on medical costs than people with healthy weight

(CDC: Overweight & Obesity). This should be a major incentive for people in the U.S. to lose

weight because it will not only help the country save money, but also help individuals spend less

on medical needs.

https://howmuch.net/articles/obesity-costs-visualized

Appendix B

Obesity in Arizona

All images:https://landgeist.com/2021/05/07/prevalence-of-obesity-in-the-us/
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