COMMUNITY CAPTSTONE SUMMATIVE PAPER: Evidence based Community Interventions
Palm Beach County is located in southeast Florida. It is the largest
county in Florida by area, at 2386.33 square miles (1974.1 square miles of
which is land), and third largest county by population (1.33 million). Palm
Beach County is considered an urban setting, and is comprised of 12 cities,
including West Palm Beach. Education by the Palm Beach County School District
provides the most jobs for this county’s population, followed by Retail, and
Professional, Scientific, and Management Services. This is based on employment
of people ages 16 and above. There are 14 hospitals in Palm Beach County, 9 of
which have obstetric services, and 13 of which provide medical surgical
services (King, 2013).
As far as socioeconomic status, the percent of families below the poverty line is 14.3% compared to the state’s 16.5% in 2010. The population over the age of 25 with a high school diploma is 87.1%, while the state of Florida has an estimated 85.5%. The population over five years of age that does not speak English is 27.4%, compared to the state’s 27% who are not English-speaking (King, 2013).
As far as socioeconomic status, the percent of families below the poverty line is 14.3% compared to the state’s 16.5% in 2010. The population over the age of 25 with a high school diploma is 87.1%, while the state of Florida has an estimated 85.5%. The population over five years of age that does not speak English is 27.4%, compared to the state’s 27% who are not English-speaking (King, 2013).
Based on Palm Beach
County’s Health Profile, three health indicators that would be considered
strengths are diabetes, adult obesity, and heart disease. There were 32,874
hospitalizations due to diabetes complications in 2010 compared to Florida’s
566,381 diabetes related hospitalizations (Alonso, 2012). Palm Beach County
ranked 66 out of 67 counties in Florida for obesity, which reflects 19.4%
compared to the state’s 27.2%. Hospitalizations due to heart disease showed a
downward trend from 2008 to 2010. Palm Beach County had 6,115 compared to
Florida’s 98,075 cases of heart disease in 2010.
Three areas that need improvement in Palm Beach County include excessive drinking, sexually transmitted infections (STIs), and suicide deaths. Excessive drinking accounts for 20.1% of the county’s population, compared to the state’s 19.8% in 2010. The reported rate of new cases of STIs in Palm Beach County out of 100,000 was 264 in 2010, compared to Florida’s rate of 398 new cases (Alonso, 2012). Of the 398, Palm Beach County made up 66% of new STI cases in Florida, among other counties. Suicide and other self inflicted injuries accounted for 189 deaths in Palm Beach County during 2010. The estimated rate of suicide deaths out of 100,000 people was 13.8, while Florida’s rate was 13.6 for every 100,000.
Three areas that need improvement in Palm Beach County include excessive drinking, sexually transmitted infections (STIs), and suicide deaths. Excessive drinking accounts for 20.1% of the county’s population, compared to the state’s 19.8% in 2010. The reported rate of new cases of STIs in Palm Beach County out of 100,000 was 264 in 2010, compared to Florida’s rate of 398 new cases (Alonso, 2012). Of the 398, Palm Beach County made up 66% of new STI cases in Florida, among other counties. Suicide and other self inflicted injuries accounted for 189 deaths in Palm Beach County during 2010. The estimated rate of suicide deaths out of 100,000 people was 13.8, while Florida’s rate was 13.6 for every 100,000.
Recreational drinking has turned into excessive or binge-drinking activity in Palm Beach County, and has increased the percent of the population struggling with alcoholism. The prevelance of excessive alcohol consumption is higher than that of the state percentage, and has been trending as such in the past four to six years. Progressive drinking can lead to dependence and addiction, as well as disease, injury, and unintentional harm to others. The chain of events is usually quite obvious. Hypothetically speaking, a teenager starts drinking around 14 years of age throughout high school, becomes dependent on alcohol which may lead to alcoholism, losing a job, driving while intoxicated, and possibly an accident that kills an innocent person. Binge-drinking can lead to various health issues such as high blood pressure, stroke, poor control of diabetes, and neurological damage (CDC, 2012). Such behavior also costs the United States billions of dollars per year from business loss, health care, crime and other expenses (CDC, 2012). I believe that change begins at the community level, and that is why I think excessive drinking as a negative health indicator should be made priority in Palm Beach County.
The Determinants-of-Health-Model as stated by HealthyPeople,
uses a range of personal, social, economic, and environmental factors that
influence health status, which are known as determinants of health.
Determinants of health fall under various categories, including policymaking,
social factors, health services, individual behavior, and biology/genetics
(HealthyPeople 2020, 2012). Policies at the local, state, and federal level
affect individual and population health. Increasing taxes on alcohol sales, for
example, can improve population health by reducing the number of people buying
alcoholic beverages. Some policies affect entire populations over extended
periods of time while helping to change individual behavior. If underage
drinking laws were more strictly enforced and those breaking the law were given
consistent consequences, then there may be less people who begin drinking at an
early age, putting them at less risk for later dependence or addiction.
Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, play, work, and age (HealthyPeople 2020, 2012). In relation to alcohol consumption, some social determinants might be availability of resources or education, exposure to crime, violence or social misconduct. Exposure to mass media and technology would be included as social determinants of health as well. The internet and other technological tools provide information that is readily available to people, which can directly determine how and where the public gains health knowledge. Quality schools and transportation options are also examples of social determinants. Education plays a key role in healthy behavior, whether it is learned in a health class, taught online, or demonstrated on a daily basis. Transportation determines where and when people can get access to health care, health classes, and other health services mainly based on opportunity and demographics.
Access to health services and the quality of health services impact community health. Lack of or limited access to health care greatly impacts an individual’s health status. People are less likely to get treatment or preventative care if they do not have health insurance. Delaying medical attention can cause illnesses to worsen to the point of needing emergency or even long term care (HealthyPeople 2020, 2012). For example, a person struggling with alcoholism or excessive drinking habits neglects the signs/symptoms of cirrhosis of the liver until he or she is in complete liver failure and in need of emergent surgery.
Individual behavior also affects community health outcomes. Positive changes in individual behaviors can improve health and reduce the rates of chronic illness in the country as a whole. Public health interventions focus on behavior determinants that may need to be changed, such as substance abuse, diet, physical activity, and hand washing in order to achieve better health (HealthyPeople 2020, 2012). This is true of someone who not only realizes he needs to change his drinking habits in order to be a fully functioning, healthy member of his community, but who actually makes the decision to do so. This is why education is so important for the process of intervention implementation.
Biological and genetic factors are also considered determinants of health, and affect specific populations more than others. Some examples include age, sex, HIV status, inherited conditions (hemophilia, CF, etc.), and family history. Alcoholism is also thought to be genetically inherited (Soderpalm, 2011).
The Determinants-of-Health Model can help a Community Health Nurse determine what makes some people healthy and other unhealthy. It can also aid in creating a society in which everyone has a chance to live long, healthy lives. The interrelationships between the various factors listed determine individual and population health (HealthyPeople 2020, 2012). Interventions that target multiple determinants of health are most likely to be effective.
Alcoholism has been directly related to family history and genetics (human biology). The topic has been of great interest to researchers for many decades. Soderpalm and associates conducted a study that suggests subjects who are family history positive (FHP) show different sensitivity to alcohol, causing them to be more likely to consume more than someone who is FHN (Soderpalm, 2011). Such a low response to alcohol at a young age is supposed to increase a person’s risk of future alcoholism by 4. This is normally the case in sons of people suffering from alcoholism.
Environment also contributes to excessive drinking and is considered a health determinant. A study done by Hawkins and associates examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence later in life (Hill, Hawkins, Bailey, Catalano, Abbott & Shapiro, 2010). Evidence showed a correlation between behavior disinhibition and poor family dynamic with an increased likelihood of both alcohol abuse and dependence by the age of 27. In consistently well-managed families, high levels of behavioral disinhibition, or heightened impulsivity, did not increase risk for later alcohol abuse or dependence. It was shown that the effects of increased impulsivity in young adults were made worse by an alcohol risk environment. The study provided evidence that strengthening family environment during adolescence might have preventive effects in the development of alcoholism.
Based on an increase in excessive drinking in Palm Beach County, a Negative Nursing Diagnosis would be used to describe the population’s health need. The population subgroup includes anyone ages 14 and above who drinks on a regular basis or who may be on the edge of excess. The risk situation includes excessive or binge-drinking activities, such as drinking games, or use of any object meant to quicken intoxication. The population characteristics related to risk are heredity and environment. Evidence of related risk would be the fact that in Palm Beach County, 19.2% of the population drinks in excess to the point of intoxication or harm.
Primary prevention for the issue of excessive drinking/alcoholism would be in the form of counseling given to the overall population of Palm Beach County, independent of drinking habits or related problems (Bradley, Curry, Koepsell &Larson, 1995). This would be done before the identification of an actual problem. A primary intervention, such as alcohol education or teaching would be geared towards a community, at schools, hospitals, clinics, offices, etc. In order to evaluate the population’s drinking habits and promote better health, surveys and questionnaires would be given to patients, students, and workers in the community. These screening tools can help indicate what age adolescents begin drinking, how often, and if they are indeed at risk of developing a drinking problem or alcoholism later in life. If there is evidence in the primary prevention process that participants are questioning whether or not they may have a drinking problem, further assessment should be done and additional information given on preventative measures. According to the Intervention Wheel Model, collaboration with other agencies or groups can aid in altering people’s attitudes, beliefs, and knowledge in order to modify their risk of developing alcoholism (VCU School of Nursing, 2009).
The intervention would focus on community members in Palm Beach County, including adolescents, families, workers, and patients. To implement primary prevention of alcoholism or excessive drinking, the Community Health Nurse could educate the population by giving out brochures at schools, hospitals, offices, and public health agencies. Surveys would be beneficial in order to better identify the population in need of further intervention and possible treatment referral as a secondary prevention option.
Secondary prevention would be the actual identification of hazardous alcohol consumption before serious alcohol-related problems develop. This would also include the development of interventions aimed at changing drinking behavior in individuals. Once the surveys are collected, the Community Health Nurse or research team would review each individually. The populations’ answers would ideally reflect the amount of people who drink alcohol, how often, what kind, their mood when doing so, and triggers such as environment or known heredity. This method would be a form of screening in order to confirm whether or not excessive drinking and binge-activity is a definite negative health indicator for Palm Beach County. The results of this secondary prevention tool would be given to health care providers seeking prevention answers, community members looking for feedback, and possibly funding sources who may be able to aid in supporting agencies geared towards alcohol awareness/education.
A study done in 2007 by Me- Yu Yeh and associates helped identify interventions that were not necessarily medically-based treatment options for alcoholism. The goal was to break the sense of dependence people had, while identifying underlying social problems. Alcoholics felt that their family, interpersonal relationships, jobs, and finances all hit “rock bottom” after a long period of alcohol dependence and abuse. Surveys were given with questions that were used to gauge how each person was functioning on a day-to-day basis. The results were used to provoke the arousal of an alcoholic’s conscience, therefore resulting in a new drive for abstinence from alcohol (Me-Yu, Hui-Lian, Li-Wei &Fen Fang, 2008). This process would be considered a form of secondary prevention.
Tertiary Prevention would take place after a drinking problem is identified, which would show based on the results from the secondary prevention tool, or survey. Treatment of alcohol dependence and abuse would be on an individual basis, and would be determined by each person’s answers to the questions. The questions would ask about family history, biological risk factors, as well as socioeconomic status, and environment. Triggers would be determined, and then taught how to be avoided. Patients struggling with alcohol dependence who are willing to receive treatment would be given medical and rehabilitation options in order to monitor their progress. Referrals would be made to patients seeking help, and education on health promotion given to all who need it. Provided with adequate information, medical care, and support, further negative impact on health can be avoided. Alcohol misuse patterns, such as heavy episodic drinking (binge drinking), drinking to intoxication, or drinking in association with other activities, such as driving, increase the risk for accidents, injuries, and life problems (U.S Preventive Services Task Force, 2004). Liver disease and other cancers are also related to excessive drinking, and contribute to more hospitalizations and deaths in Palm Beach County as a whole. Various sectors of the health department could be utilized in order to decrease the number of community members struggling with alcoholism or similar drinking characteristics. In order for the prevention process to be effective public officials need to be involved in the implementation process as well as legislators. The Community Health Nurse needs to have the ability to not only distribute information and education materials to schools and workplaces, but also needs a way of following up with the population at risk.
Health policies have brought about significant improvements to public health outcomes such as alcoholism and excessive drinking. Many of the changes are usually seen locally, however some policies yield results quickly at the county and state level, affecting whole populations (Brownson, Seiler & Eyler, 2010). In the policy-making process, data are collected from many sources to gain insight into a particular topic. The best available quantitative and qualitative evidence is used in order to monitor policy outcomes. A public health problem must first be defined, and then policy measures can be identified in order to achieve a strategy, such as monitoring alcohol consumption. Politics and public opinion also play a role in the effectiveness of a health policy, because they provide either support or opposition (Brownson, Seiler& Eiler, 2010). The goal in creating a health policy is to bring about change in a health behavior or problem that is more than likely, negatively effecting a region or area’s population.
In hopes of decreasing the portion of Palm Beach County’s population who drink excessively, I will focus on a primary prevention method, which is geared toward Palm Beach County communities. I propose that screenings and counseling for alcohol misuse be performed in the workplace, at schools, health fairs, clinics, and offices. I think it is important to cover all grounds, and even make it mandatory for new hires upon employment. The stakeholders affected by this policy would include community members, public officials (in the health department), legislators, and health care providers. I would think that health care providers would support this policy, because their goal is to better the health of the community as well. If medical professionals are consistent in giving out the surveys and questionnaires, then report back to health agencies the policy would be fairly effective. Opposing forces might be those funding this policy, depending on whether it proves to be a success. If there is no funding to continue research and assign community health workers for this project, the policy will more than likely fall through. If nothing is done, the percentage of the county’s population struggling with alcoholism will increase, which in turn will cause other health factors to increase in prevalence as well.
To implement this policy, I would first identify the problem and health need in Palm Beach County, which has already been established. I would present it to a committee or board in charge of health affairs in Palm Beach County. The local health department would most likely be where I would begin. I would need compiled research and data from recent studies, as well as statistical evidence reflecting the need for an intervention regarding excessive drinking. There are multiple branches this health policy would have to go through to be approved, and I realize it could take quite a while to pass. I would need financial support from various interest groups in public health as well. My proposed health policy will help identify and focus on the county’s population that is most at risk for developing alcoholism. The community as a whole will be educated on the risks of alcohol intoxication, and how it can lead to dependence, accidental injury, and other health issues. If individual drinking behaviors and health beliefs can change, so can Palm Beach County’s violence, crime, and death rates decrease.
Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, play, work, and age (HealthyPeople 2020, 2012). In relation to alcohol consumption, some social determinants might be availability of resources or education, exposure to crime, violence or social misconduct. Exposure to mass media and technology would be included as social determinants of health as well. The internet and other technological tools provide information that is readily available to people, which can directly determine how and where the public gains health knowledge. Quality schools and transportation options are also examples of social determinants. Education plays a key role in healthy behavior, whether it is learned in a health class, taught online, or demonstrated on a daily basis. Transportation determines where and when people can get access to health care, health classes, and other health services mainly based on opportunity and demographics.
Access to health services and the quality of health services impact community health. Lack of or limited access to health care greatly impacts an individual’s health status. People are less likely to get treatment or preventative care if they do not have health insurance. Delaying medical attention can cause illnesses to worsen to the point of needing emergency or even long term care (HealthyPeople 2020, 2012). For example, a person struggling with alcoholism or excessive drinking habits neglects the signs/symptoms of cirrhosis of the liver until he or she is in complete liver failure and in need of emergent surgery.
Individual behavior also affects community health outcomes. Positive changes in individual behaviors can improve health and reduce the rates of chronic illness in the country as a whole. Public health interventions focus on behavior determinants that may need to be changed, such as substance abuse, diet, physical activity, and hand washing in order to achieve better health (HealthyPeople 2020, 2012). This is true of someone who not only realizes he needs to change his drinking habits in order to be a fully functioning, healthy member of his community, but who actually makes the decision to do so. This is why education is so important for the process of intervention implementation.
Biological and genetic factors are also considered determinants of health, and affect specific populations more than others. Some examples include age, sex, HIV status, inherited conditions (hemophilia, CF, etc.), and family history. Alcoholism is also thought to be genetically inherited (Soderpalm, 2011).
The Determinants-of-Health Model can help a Community Health Nurse determine what makes some people healthy and other unhealthy. It can also aid in creating a society in which everyone has a chance to live long, healthy lives. The interrelationships between the various factors listed determine individual and population health (HealthyPeople 2020, 2012). Interventions that target multiple determinants of health are most likely to be effective.
Alcoholism has been directly related to family history and genetics (human biology). The topic has been of great interest to researchers for many decades. Soderpalm and associates conducted a study that suggests subjects who are family history positive (FHP) show different sensitivity to alcohol, causing them to be more likely to consume more than someone who is FHN (Soderpalm, 2011). Such a low response to alcohol at a young age is supposed to increase a person’s risk of future alcoholism by 4. This is normally the case in sons of people suffering from alcoholism.
Environment also contributes to excessive drinking and is considered a health determinant. A study done by Hawkins and associates examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence later in life (Hill, Hawkins, Bailey, Catalano, Abbott & Shapiro, 2010). Evidence showed a correlation between behavior disinhibition and poor family dynamic with an increased likelihood of both alcohol abuse and dependence by the age of 27. In consistently well-managed families, high levels of behavioral disinhibition, or heightened impulsivity, did not increase risk for later alcohol abuse or dependence. It was shown that the effects of increased impulsivity in young adults were made worse by an alcohol risk environment. The study provided evidence that strengthening family environment during adolescence might have preventive effects in the development of alcoholism.
Based on an increase in excessive drinking in Palm Beach County, a Negative Nursing Diagnosis would be used to describe the population’s health need. The population subgroup includes anyone ages 14 and above who drinks on a regular basis or who may be on the edge of excess. The risk situation includes excessive or binge-drinking activities, such as drinking games, or use of any object meant to quicken intoxication. The population characteristics related to risk are heredity and environment. Evidence of related risk would be the fact that in Palm Beach County, 19.2% of the population drinks in excess to the point of intoxication or harm.
Primary prevention for the issue of excessive drinking/alcoholism would be in the form of counseling given to the overall population of Palm Beach County, independent of drinking habits or related problems (Bradley, Curry, Koepsell &Larson, 1995). This would be done before the identification of an actual problem. A primary intervention, such as alcohol education or teaching would be geared towards a community, at schools, hospitals, clinics, offices, etc. In order to evaluate the population’s drinking habits and promote better health, surveys and questionnaires would be given to patients, students, and workers in the community. These screening tools can help indicate what age adolescents begin drinking, how often, and if they are indeed at risk of developing a drinking problem or alcoholism later in life. If there is evidence in the primary prevention process that participants are questioning whether or not they may have a drinking problem, further assessment should be done and additional information given on preventative measures. According to the Intervention Wheel Model, collaboration with other agencies or groups can aid in altering people’s attitudes, beliefs, and knowledge in order to modify their risk of developing alcoholism (VCU School of Nursing, 2009).
The intervention would focus on community members in Palm Beach County, including adolescents, families, workers, and patients. To implement primary prevention of alcoholism or excessive drinking, the Community Health Nurse could educate the population by giving out brochures at schools, hospitals, offices, and public health agencies. Surveys would be beneficial in order to better identify the population in need of further intervention and possible treatment referral as a secondary prevention option.
Secondary prevention would be the actual identification of hazardous alcohol consumption before serious alcohol-related problems develop. This would also include the development of interventions aimed at changing drinking behavior in individuals. Once the surveys are collected, the Community Health Nurse or research team would review each individually. The populations’ answers would ideally reflect the amount of people who drink alcohol, how often, what kind, their mood when doing so, and triggers such as environment or known heredity. This method would be a form of screening in order to confirm whether or not excessive drinking and binge-activity is a definite negative health indicator for Palm Beach County. The results of this secondary prevention tool would be given to health care providers seeking prevention answers, community members looking for feedback, and possibly funding sources who may be able to aid in supporting agencies geared towards alcohol awareness/education.
A study done in 2007 by Me- Yu Yeh and associates helped identify interventions that were not necessarily medically-based treatment options for alcoholism. The goal was to break the sense of dependence people had, while identifying underlying social problems. Alcoholics felt that their family, interpersonal relationships, jobs, and finances all hit “rock bottom” after a long period of alcohol dependence and abuse. Surveys were given with questions that were used to gauge how each person was functioning on a day-to-day basis. The results were used to provoke the arousal of an alcoholic’s conscience, therefore resulting in a new drive for abstinence from alcohol (Me-Yu, Hui-Lian, Li-Wei &Fen Fang, 2008). This process would be considered a form of secondary prevention.
Tertiary Prevention would take place after a drinking problem is identified, which would show based on the results from the secondary prevention tool, or survey. Treatment of alcohol dependence and abuse would be on an individual basis, and would be determined by each person’s answers to the questions. The questions would ask about family history, biological risk factors, as well as socioeconomic status, and environment. Triggers would be determined, and then taught how to be avoided. Patients struggling with alcohol dependence who are willing to receive treatment would be given medical and rehabilitation options in order to monitor their progress. Referrals would be made to patients seeking help, and education on health promotion given to all who need it. Provided with adequate information, medical care, and support, further negative impact on health can be avoided. Alcohol misuse patterns, such as heavy episodic drinking (binge drinking), drinking to intoxication, or drinking in association with other activities, such as driving, increase the risk for accidents, injuries, and life problems (U.S Preventive Services Task Force, 2004). Liver disease and other cancers are also related to excessive drinking, and contribute to more hospitalizations and deaths in Palm Beach County as a whole. Various sectors of the health department could be utilized in order to decrease the number of community members struggling with alcoholism or similar drinking characteristics. In order for the prevention process to be effective public officials need to be involved in the implementation process as well as legislators. The Community Health Nurse needs to have the ability to not only distribute information and education materials to schools and workplaces, but also needs a way of following up with the population at risk.
Health policies have brought about significant improvements to public health outcomes such as alcoholism and excessive drinking. Many of the changes are usually seen locally, however some policies yield results quickly at the county and state level, affecting whole populations (Brownson, Seiler & Eyler, 2010). In the policy-making process, data are collected from many sources to gain insight into a particular topic. The best available quantitative and qualitative evidence is used in order to monitor policy outcomes. A public health problem must first be defined, and then policy measures can be identified in order to achieve a strategy, such as monitoring alcohol consumption. Politics and public opinion also play a role in the effectiveness of a health policy, because they provide either support or opposition (Brownson, Seiler& Eiler, 2010). The goal in creating a health policy is to bring about change in a health behavior or problem that is more than likely, negatively effecting a region or area’s population.
In hopes of decreasing the portion of Palm Beach County’s population who drink excessively, I will focus on a primary prevention method, which is geared toward Palm Beach County communities. I propose that screenings and counseling for alcohol misuse be performed in the workplace, at schools, health fairs, clinics, and offices. I think it is important to cover all grounds, and even make it mandatory for new hires upon employment. The stakeholders affected by this policy would include community members, public officials (in the health department), legislators, and health care providers. I would think that health care providers would support this policy, because their goal is to better the health of the community as well. If medical professionals are consistent in giving out the surveys and questionnaires, then report back to health agencies the policy would be fairly effective. Opposing forces might be those funding this policy, depending on whether it proves to be a success. If there is no funding to continue research and assign community health workers for this project, the policy will more than likely fall through. If nothing is done, the percentage of the county’s population struggling with alcoholism will increase, which in turn will cause other health factors to increase in prevalence as well.
To implement this policy, I would first identify the problem and health need in Palm Beach County, which has already been established. I would present it to a committee or board in charge of health affairs in Palm Beach County. The local health department would most likely be where I would begin. I would need compiled research and data from recent studies, as well as statistical evidence reflecting the need for an intervention regarding excessive drinking. There are multiple branches this health policy would have to go through to be approved, and I realize it could take quite a while to pass. I would need financial support from various interest groups in public health as well. My proposed health policy will help identify and focus on the county’s population that is most at risk for developing alcoholism. The community as a whole will be educated on the risks of alcohol intoxication, and how it can lead to dependence, accidental injury, and other health issues. If individual drinking behaviors and health beliefs can change, so can Palm Beach County’s violence, crime, and death rates decrease.
References
Alonso, A.
(2012). Palm Beach County Annual Health Profile 2012. Florida Department of Health. Retrieved by: http://www.pbchd.com/pdfs/annreports/annual_report_2012.pdf
Bradley, K.,
Curry, S., Koepsell, T., Larson, E. (1995). Primary and secondary prevention of
alcohol problems. Journal of General Internal Medicine, 10
(2), 67-72. retrieved by: doi: 10.1007/BF02600228
Brownson, R.,
Seiler, R., Eyler, A. (2010). Measuring the impact of public health policy. Preventing
Chronic Disease, 7 (4), A77. retrieved by: http://www.cdc.gov/pcd/issues/2010/jul/09_0249.htm
Hill, K.,
Hawkins, J.D., Bailey, J., Catalano, R., Abbott, R., Shapiro, V.(2010).
Person–environment interaction in the prediction of alcohol abuse and alcohol dependence in adulthood. Drug and Alcohol Dependence, 110(1-2), 62-69. doi: http://dx.doi.org.ezproxy.lib.usf.edu/10.1016/j.drugalcdep.2010.02.005
Mei-Yu Yeh, Hui-Lian Che, Li-Wei
Lee, Fen-Fang Horng. (2008). An empowerment process: successful recovery from alcohol dependence. Journal of Clinical Nursing 17(7), 921-922. Retrieved by: http://ehis.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=7&sid=e6 f8b1c2-9e28-4abb-90a2-096351ba2ac5%40sessionmgr13&hid=7
King, R. (2013).
County Health Rankings and Roadmaps. Florida
Public Health Institute.
Retrieved by: http://www.countyhealthrankings.org/app/#/florida/2013/palm- beach/county/outcomes/overall/snapshot/by-rank
Soderpalm Gordh,
A., Soderpalm, B. (2011). Healthy subjects with a family history of alcoholism show increased
stimulative subjective effects of alcohol. Alcoholism: Clinical and Experimental Research, 35 (8). doi: 10.1111/j.1530-0277.2011.01478.x
(2004). Screening
and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation Statement. U.S.
Preventive Services Task Force. Retreived by: http://www.uspreventiveservicestaskforce.org/3rduspstf/alcohol/alcomisrs.htm
VCU School of
Nursing. (2009). Wheel of Public Health Interventions. Retrieved by: http://www.people.vcu.edu/~elmiles/interventions/
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