Teen Pregnancy Precede-Proceed Phase 1 Although we have s.docx

Teen Pregnancy
Precede-Proceed Phase 1: Although we have seen pregnancy
rates decline in the past two
decades, substantial health disparities remain in both social and
economic aspects for teenagers
that are at risk. Many individuals are affected nationwide
directly and indirectly, from being the
teenagers who face unplanned pregnancies to lost tax revenue.
Both social and behavior factors
exist and have a major impact on teenagers living in the United
States. Many teenagers are
easily influenced by their peers, but they also serves as targets
of the media. We must improve
adolescent reproductive health in central San Diego by
improving the behaviors with
encouraging positive attitudes, extracurricular activities, and
offering counseling services.
Strategies used in sex education courses at high schools can be
improved by including
information about health services that are offered in the
community and not only encourage the

delay of sexual intercourse, but also provide education on the
risks associated risky sexual
behavior. There are many studies that have been conducted on
sex education and teen
pregnancy. Our health promotion program and plan will
incorporate the most effective strategies
previously used.
Precede-Proceed Phase 2 (National Level): “Despite declines
since 1991, the teen birth
rate in the United States remains as much as nine times higher
as in other developed countries”
(Pazol, et. al. 2011). This is unusual for being such an
industrialized, developed country. “Each
year, teen childbearing costs the United States approximately $6
billion in lost tax revenue and
nearly $2 billion in public expenditures” (Pazol et. al, 2011).
According to Jessica Pika,
Assistant Director, Communications for The National Campaign
to Prevent Teen and Unplanned
Pregnancy Organization states, teen pregnancy is a major issue
for the U.S. because it not only
affects pregnant teens, but their family, friends, and people they
have never met (i.e., taxpayers

who pay for “teen childbearing costs” (personal communication,
November 20, 2012). Teen
pregnancy affects everyone (J. Pika, personal communication,
November 20, 2012). Since teen
pregnancy can be prevented, this is a lot of money that the
country is losing annually.
“Approximately one third of the teenaged females in the United
States becoming pregnant and
once pregnant, are at risk of becoming pregnant again” (Basch,
2011). Getting pregnant once
during one’s teenage years raises the risk of conceiving again.
In a recent interview with Marcy
Clayson an Engagement Specialist at Planned Parenthood a
statement she made advocates for
Basch’s belief about teen pregnancy risks of conceiving again,
she stated, “A lot of our teen
moms are children of teen parents. That is a common factor. It’s
almost a social norm in their
communities. We make sure that our teens know that they can
prevent an unplanned for a second
pregnancy once they’ve graduated and received further
education.”
Precede-Proceed Phase 2 (State Level): On the state level, in
2005, teen pregnancy of

Californian girls, ages 15-19 years old, according to The
National Campaign to Prevent Teen and
Unplanned Pregnancy (2012), was 96, 490. The 2005 California
teen pregnancy rate for girls of
the same age range (i.e., 15-19 years old) was 75 compared to
the United States (U.S.) teen
pregnancy rate of 70 (The National Campaign to Prevent Teen
and Unplanned Pregnancy, 2012).
The number of California teenage girls who gave birth in 2010
ages 15-19 years old was 43, 149
(The National Campaign to Prevent Teen and Unplanned
Pregnancy, 2012). Furthermore,
during 2010, the number of Californian “girls under 15” who
gave birth was 433 (The National
Campaign to Prevent Teen and Unplanned Pregnancy, 2012).
The 2010 California “teen birth
rate” for girls ages 15-17 years old was 16.4 while girls ages
18-19 years old was 53.4 (The
National Campaign to Prevent Teen and Unplanned Pregnancy,
2012). The “number of teenage
births” data in California was further narrowed down to
“race/ethnicity” (The National

Campaign to Prevent Teen and Unplanned Pregnancy, 2012).
Therefore, “Hispanic girls” in
2010 had 31, 580 teenage births (The National Campaign to
Prevent Teen and Unplanned
Pregnancy, 2012). This population had the highest “number of
teenage births” than other
ethnicities (e.g., “Non-Hispanic White girls” had 5, 800 teenage
births and “Non-Hispanic Black
girls” had 3, 737) (The National Campaign to Prevent Teen and
Unplanned Pregnancy, 2012).
Furthermore, “Hispanic girls’” 2010 California “teen birth
rate”, 48.1, also had the highest rate
than other ethnicities (e.g., “Non-Hispanic White girls” had
14.1 and “Non-Hispanic Black girls”
had 37.7) (The National Campaign to Prevent Teen and
Unplanned Pregnancy, 2012).
Precede-Proceed Phase 2 (Local Level): With a teen population
of 709, 916 in the city of
San Diego alone, according to the County Health Ranking,
statistics within the past year, there
have been 26,385 teen pregnancies. (County Health Rankings.
2012) In a city with such a diverse
group of ethnicities it has been found that when it comes to teen
pregnancy, San Diegans with

Hispanic background tend to have a higher pregnancy rate.
Pregnancy and birth rates among
teenage Latinas are actually high nationwide and locally. Rates
among Latina teens have failed
to decline as rapidly as rates among other ethnic groups. While
Latinos comprise just over a
third of the teenage population in San Diego County, Latinas
account for more than three-
quarters of teen births in the area. (National Campaign to
Pregnancy, 2012)
Precede-Proceed Phase 2 (Risk Factors at the National Level): It
is commonly found that
teenagers, who live in areas where their community has a lower
socioeconomic status, have a
greater risk of risky sexual behavior and getting pregnant.
“Many studies show that adolescents
who live in disadvantaged communities with high poverty rates
are more likely to have sex,
become pregnant, and give birth. In contrast, teens who live in
more affluent communities are
less likely to engage in risky sexual activity” (Manlove et. al,
2002). Unfortunately, it has also

been shown that “teen childbearing also perpetuates a cycle of
disadvantage; teen mothers are
less likely to finish high school, and their children are more
likely to have low school
achievement, drop out of high school, and give births
themselves as teens” (Pazol, 2011).
According to Talia Perez, a Community Engagement Specialist
from Planned Parenthood of the
Pacific Southwest, Planned Parenthood has a program called
Teen Success. The national average
of teens that have a second pregnancy is 20%. Perez explains
that Teen Success is for pregnant
or parenting teens and helps these individuals prevent a second
pregnancy by helping them focus
on school, graduate from high school, and seek secondary
education. Teen Success started in
1990. For teens enrolled in Teen Success, only 4% have a
second pregnancy, which is
significantly lower than the national average. There are many
risk factors associated with teen
pregnancy and risky sexual behavior. These not only include
gender, age, race and ethnicity but
also the following: attitudes (i.e. peer pressure, social
acceptance), the adolescent’s family, and

involvement in activities. According to a study conducted on
teen pregnancy and the risk
factors, “Teens whose parents talk about sex and birth control
with their children, and
communicate strong disapproval of sexual activity, are more
likely to have positive reproductive
health outcomes” (Manlove, et. al, 2002). To support this
statement, Jessica Pika, Assistant
Director, Communications for The National Campaign to
Pregnancy Organization states, open and honest and
communication between parents and teens
will help increase awareness about how to prevent and reduce
teen pregnancy because teens are
knowledgeable about the options of abstinence, having safer sex
with the use of contraceptives,
or having unsafe sex with a higher risk of becoming pregnant
(personal communication,
November 20, 2012). Parents who also talk to their teens not
only on sex, but also love, dating,
and good relationships increase their teens’ awareness on sex
and relationships (J. Pika, personal

communication, November 20, 2012). In addition, it also has to
do with social acceptance, the
teenagers’ attitudes on sex, and the perception of sex among
their peers. One major factor is,
“those who believe sexual experience will increase others’
respect for them are also more likely
to have sex” (Manlove, et. al, 2002). Another report shows that
school involvement and/or
involvement in extracurricular activities play a significant role.
“Adolescents’ engagement and
performance in school, religious activities, and sports (among
girls) are all associated with more
positive reproductive health behaviors, which indicates that
involving teens in positive activities
may help them avoid other risk-taking behaviors” (Manlove, et.
al, 2002).
Precede-Proceed Phase 2 (Risk Factors at the State Level): No
single state has the same
number of racial/ethnic populations. Therefore, teen pregnancy
may affect different racial/ethnic
populations differently. In the state of California, African
American and Latina teens have the
highest number and risk for teen pregnancy. Many studies have
not shown any genetic risk

factors associated to teen pregnancy yet. However the risk
factors that greatly affect teenagers,
such as Latina teens who reside in California, are behavioral
and environmental. According to
MedlinePlus (2012), “poor academic performance” and poverty
can be both behavioral and
environmental risk factors that increase the risk of teenage girls
becoming pregnant. For
example, “poor academic performance” can be both behavioral
and environmental because some
teenagers do not believe that education is important or they may
have to fill in the role of a
parent to a younger sibling if they live in a single parent
household, which in turn leads them to
not have education as their number one priority (MedlinePlus,
2012). Furthermore, where a
teenager lives may not have the best schools/universities, hence
“poor academic performance”
(MedlinePlus, 2012). Latina teenagers have the risk factors that
MedlinePlus listed. To support
this claim, Frost and Driscoll (2006) explain, “Latinas’ higher
rates in poverty and lower
educational attainment place them at a higher risk of teen

pregnancy and also translate into fewer
resources to cope with the difficulties of teen parenting” (as
cited in Biggs, Antonia, Ralph,
Minnis, Arons, Marchi, Lehrer, Braveman, Brindis, 2010, p.
78). From this quote, having fewer
resources is an environmental risk factor for teenagers
regardless of their race/ethnicity because
they have fewer coping and educational methods if they have
disadvantaged lives. Another
behavioral risk factor that increases the risk of teen pregnancy
is having an “older male partner”
(MedlinePlus, 2012). In California, Latina teens “are more
likely than teens of other
racial/ethnic groups to choose partners who are significantly
older, placing them at higher risk
for early childbearing” (Darroch, Landry, & Oslak, 1999 as
cited in Biggs et al., 2010, p. 79).
An environmental risk factor that increases the risk of teenage
girls becoming pregnant is
experiencing “gangs and gang activity” in their neighborhood
(Richardson & Nuru-Jeter, 2012,
p. 69). “Studies show that adolescent involvement with gangs
is associated with risky sexual
behavior, including lower use of condoms” (Richardson &

Nuru-Jeter, 2012, p. 69). Thus, teen
girls (e.g., Latinas) whose partners are affiliated with a gang
have a high “incidence of
pregnancy” (Richardson & Nuru-Jeter, 2012, p. 70).
Precede-Proceed Phase 2 (Risk Factors at the Local Level):
Latino teens in fact share
many of the same common goals and concerns with those of
other ethnic backgrounds.
However, it is still clear that there are also differences as well.
Young Latina mothers are likely
to face different circumstances than those of non-Hispanic
mothers. Latinos not only have lower
educational and income levels throughout San Diego, but they
are also more likely to be located
in high poverty neighborhoods (e.g., Skyline, Lincoln Park,
Paradise Hills, Barrio-Logan, Logan
Heights, etc.) (Murphy-Erby, 2011). The types of contraception
used by Latinos also contribute
to higher pregnancy rates. Latino teens are less likely than
other ethnic groups to use condoms
and are less likely than white teens to use birth control pills.
Furthermore, Latino teens are more

likely to use less effective approaches, such as the pull out
method as well as the rhythm methods
(East, 2010).
Precede-Proceed Phase 3 (Predisposing, Enabling, and
Reinforcing factors): One
predisposing factor of teen pregnancy is not having the
knowledge of contraceptives. Some teens
have never been educated about contraceptives where they are
available. Another predisposing
factor is the glamorization of teen pregnancy on
television/movies. An enabling factor of teen
pregnancy low income/ underserved teens do not have “access
to health care facilities” because
they are not aware that they can utilize their community health
clinic services (Mckenzie,
Neigor, & Thackeray, 2009, p. 22) Another enabling factor is
resources are not available, such as
health care facilities and social support from family and friends,
without these resources teens
have a higher risk of risky and unsafe sexual activities. One
reinforcing factor of teen pregnancy
is peer pressure. Having an older partner or being in a long-term
relationship, a teenage girl
might be pressured to have sex without protection. Another

reinforcing factor is some teens do
not have parents that discourage risky and unsafe sexual
activities because parent-teen they do
not have an open and honest parent-teen relationship
Precede-Proceed Phase 4 (Goal, Objectives, and Interventions)
are listed below:
The teen pregnancy rates have declined nationally but at state
and local areas, there do still exist
issues. This is especially the case among Latino adolescents.
Our goal is to reduce the teen
pregnancy rates within the Latino community in central San
Diego County. San Diego Teen
Pregnancy Prevention Program (STEPPP) will help lower the
teen pregnancy rate in central San
Diego by incorporating new curriculum in the high schools’ sex
education course. Students will
be offered the chance to enroll in the sex education course upon
parental consent. We will pilot
test STEPPP in the central San Diego area to compare between
STEPPP at Garfield High School
and the current sex education course at Lincoln High School,
using the quasi-experimental

design.
1.1 Process Objective: STEPPP would be pilot tested at Garfield
High School and Lincoln High
School (control). Program staff members and volunteers will
disseminate informational
brochures on how to prevent and reduce teen pregnancy. In
addition, there will be flyers listing
resources that are available at local community health clinics.
The information will be targeting
25% (target: entire freshman class) of high school students
when they are taking a sex education
course (upon parental consent).
1.1 Activities/Strategies: The informational brochures and
flyers will be available at schools and
other facilities such as the following locations: YMCA, school
nurse’s office, school
advisor/counselor’s office, and where parent-teacher
conferences are generally held. The
information would not only reach our target population but also
parents and others in the
community.
2.1 Learning (Awareness) Objective: After listening to guest
speakers, half of the students in the

sex education course would be able to identify multiple risk
factors of teen pregnancy that
individually affect them.
2.1 Activities/Strategies: Guest speakers (e.g., pregnant teens,
teen mothers, family and friends
of pregnant teens, health care workers who work with pregnant
teens and their families) will
visit and share personal experiences with the students enrolled
in the sex education course. The
students will be able to have open discussions with the guest
speakers after they have made
their presentation.
2.2 Learning (Knowledge) Objective: During the group
discussions, 2 out of 4 high school
students will be able to explain the risk factors of teen
pregnancy and how those risk factors
impact their life in an ecological perspective.
2.2 Activities/Strategies: The class will be divided into small
groups to complete an assignment
through discussion. The instructor(s) will have handouts for the
students. These handouts will
include teen pregnancy topics in an ecological perspective. Each

group will also be given a
script/scenario to role-play/act out in front of the class. Role-
playing in certain scenarios can
help students learn more about teen pregnancy and how they can
protect themselves. Incentives
(e.g. gift cards, movie tickets, etc.) will be given after the
completion of the group
discussion/presentation.
2.3 Learning (Attitude) Objective: After the completion of the
sex education course, 50% of
students would pledge to refrain from unsafe sexual activities.
2.3 Activities/Strategies: Pledge cards will be handed out to the
students and they will have the
opportunity to make their pledge individually.
2.4 Learning (Skill) Objective: Upon completion the sex
education course, at least 75% of
student can demonstrate resistance strategies to having unsafe
sexual activities.
2.4 Activities/Strategies: Pre- and post-test assessments/surveys
will be given to Garfield high
school students to gather information and data to see if they are
grasping the concepts and other
learning objectives of the course. Handouts and pamphlets on

teen pregnancy prevention will
be given to the students. Multiple group discussions will be
held in the duration of the sex
education course to help the students further understand the risk
factors and potential
disadvantages of those directly/indirectly affected by teen
pregnancy.
3.1 Action/Behavioral: By the end of a semester, the majority of
the students who complete the
sex education course will comply with their pledge to refrain
from unsafe sexual activities.
3.1 Activities/Strategies: Pledge cards will be handed out to the
students and they will be given
the opportunity to make their pledge individually.
4.1 Environmental Objective: During the sex education course,
a majority of students will have
access to newly built-in/placed condom dispensers in the
advisor/counselor’s and school nurse’s
offices.
4.1 Activities/Strategies: Newly built condom dispensers will be
installed in the school advisors
and school nurse’s offices.

4.2 Environmental Objective: As part of the sex education
course, 100% of the students (those
with parental consent) will participate in a field trip to local
community health clinics, which will
allow them to learn more about the facilities and their services.
4.2 Activities/Strategies: Field trip to local community health
clinics; access to community
resources. Each community health clinic will have a tour guide
(staff member who works at the
facility) to show students the different areas of the clinic. The
tour guide will also explain to the
students the different services and classes that are offered to
teenagers. The students will have
the chance to make appointments or sign up for classes if they
so choose to and ask questions
during the field trip.
4.3 Environmental Objective: During the sex education course,
100% of students will have
access to the newly created student Facebook page (co-
partnered with local community health
clinics through community organization and community
building) that will include not only the
upcoming events of the high school, but links to local

community health clinics and their
upcoming events. This will serve as a resource for students,
parents, and others in the
community. Instructors and other staff members can encourage
students to visit the high school’s
Facebook page to access information. On the Facebook page,
there will be public service
announcements (PSAs) that students can watch.
4.3 Activities/Strategies: The students will have a classroom
activity that includes browsing the
Internet for local community health clinics. The Facebook page
will serve as one of the internet
resources and as a social media tool for the students. There will
be public service announcements
for students to watch.
5.1 Outcome: To lower teen pregnancy rates among the Latino
population in central San Diego
by 10% within a year time span.
Activities/Strategies: Implementation of the objectives’
activities and strategies listed above into
the sex education course.

Precede-Proceed Phase 5 (Implementation): STEPPP will be
pilot
tested/implemented at Garfield High School and compared the
current sex education course at
Lincoln High School. This will begin January 2013 for the
spring semester of the academic year.
Precede-Proceed Phase 6 (Process Evaluation): Key informant
interviews from local
community health clinics will be conducted prior to the start of
STEPPP. Data will also be
gathered from internet sources and other agencies/organizations
associated with teens and teen
pregnancy prevention in the community. In order for the pilot
testing to begin, it must be
presented to and be approved by the stakeholders. During the
pilot testing, the program will take
effect and be available to students at Garfield High School. The
program will include multiple
group activities that will help reinforce making healthy choices.
By implementing new strategies
into the sex education course, we can better equip each
generation with tools to make healthier,
safer decisions in life. In addition, collaboration with local
community health clinics will help

with facilitating field trips and other activities. For satisfaction
evaluation of STEPPP, we can
include questions in the pre- and post test assessments. Many of
the interventions will be
measured through the pre- and post test assessments. Evaluators
will be assigned to sit in the sex
education class during key classroom activities (those
mentioned in the Learning Objectives) to
observe the interactions between students and instructors.
Surveys will be given to students after
each key classroom activity for the evaluators to interpret and
prepare for monthly staff
meetings. Monthly meetings will be held for program staff
members to assess the quality and
effectiveness of the current methods used as the learning
objectives of STEPPP.
Precede-Proceed Phase 7 (Impact Evaluation): According to
McKenzie, Neiger, and Thackeray
(2009), “impact evaluation relates to changes in behavior, and,
in some cases, changes in
awareness, knowledge, attitudes, and skills” (p. 359). As
program planners of STEPPP, we will
evaluate these changes (i.e., behavior, awareness, knowledge,

attitudes, and skills) in high school
students through observations and pre- and post-test
assessments/surveys. There will be a weekly
assessment of number of people accessing student Facebook
page by using a website counter.
Program staff will observe students throughout the course of
the sex education program. As for
the field trip, we will assess the number of participating
students who signed in the sign-in sheet.
They will observe the students’ behaviors through the various
activities/strategies implemented,
such as visiting guest speakers, group discussions, and role-
playing scenarios. Changes in the
students will also be evaluated through pre- and post-test
assessments/surveys. These pre- and
post-test assessments/surveys will have both closed and open-
and closed-ended questions. An
agency will be assigned to evaluate, analyze, and interpret the
results.
Precede-Proceed Phase 8 (Outcome Evaluation):
Outcome: By the end of program the evaluating consultant will
identify that the quasi-

experimental design was implemented throughout STEPPP.
With our target population mainly
aimed towards Latino teens to the Central San Diego region we
concentrated our focus on two
specific schools that we felt would benefit most with the
program (Lincoln High School and
Garfield High School.) Both schools we’re chosen due to their
location and student population.
Garfield High School is well known for taking in troubled teens
as well as teen moms/soon to be
teen mothers throughout the San Diego county, therefore
implementing the program into the
school would give those students who need it the most the
proper education and allow them to be
aware of different available resources that are open for their
taking. Lincoln High school was
also chosen because of a Regional Occupational Program (ROP)
that they already have
implemented into their school. We felt that by being able to
compare Lincoln High School’s
ROP to STEPPP would improve education to the teens in the
future.
Reporting: After one academic school year, the results of
STEPPP will be presented to

the program staff, Garfield High School’s officials, Lincoln
High School officials, parents, the
San Diego County Office of Education, the community, the
local community health clinics, and
the County of San Diego: Health and Human Services Agency.
The STEPPP results will be
reported to these stakeholders in order to evaluate and improve
the quality and effectiveness of
the program for future endeavors (McKenzie, Neiger, &
Thackeray, 2009, p.336). Further
explanations and presentations will be given to show how much
of an impact the program has
made on the students at Garfield High and the possibilities that
could arise if implemented to
Lincoln High School as well. Key informants will also be
brought back to emphasize on the
different area’s they found would be beneficial to implement
within the STEPPP program, to
further explain the thought process and reasoning as to why
certain activities were chosen. A
display of numerous activities (pre- and post tests, surveys,
field trip sign in sheets etc.) that were
done by the students would be displayed for the viewers to see

and take note on the progress
STEPPP has made in educating them. STEPPP continues its
program at Garfield high, and is
also implemented at Lincoln the following year. Other local
schools in the Central San Diego
region are open to partake in the STEPPP and eventually will be
open to all of San Diego in the
coming years.
References
Basch, C. (2011). Teen pregnancy and the achievement gap
among urban minority youth.

American School Health Association. 81(10), 614-618.
Biggs, M., Ralph, L., Minnis, A.M., Arons, A., Marchi, K.S.,
Lehrer, J.A., Braveman, P.A., &
Brindis, C.D. (2010). Factors associated with delayed
childbearing: From the voices of
expectant Latina adults and teens in California. Hispanic
Journal Of Behavioral
Sciences, 32(1), 77-103. Retrieved from
http://ezproxy.nu.edu/login?url=http://search.ebscohost.com/log
in.aspx?direct=true&db=
eric&AN=EJ876995&site=eds-live
East, P. L., & Chien, N. C. (2010). Family dynamics across
pregnant Latina adolescents'
transition to parenthood. Journal Of Family Psychology, 24(6),
709-720.
doi:10.1037/a0021688
McKenzie, J.F., Neiger, B.L., & Thackeray, R. (2009).
Planning, implementing, & evaluating
health promotion programs: A primer (5
th
ed..). San Francisco, CA: Pearson Benjamin
Cummings.

Manlove, J., Terry-Humen, E., Papillo, A. Franzetta, K.,
Williams, S., Ryan, S. (2002).
Preventing teenage pregnancy, childbearing, and sexually
transmitted diseases: what the
research shows. Child Trends.
MedlinePlus. (2012, October 23). Adolescent pregnancy.
Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/001516.htm
Murphy-Erby, Y., Stauss, K., Boyas, J., & Bivens, V. (2011).
Voices of Latino parents and teens:
Tailored strategies for parent-child communication related to
sex. Journal Of Children &
Poverty, 17(1), 125. doi:10.1080/10796126.2011.531250
in.aspx?direct=true&db=eric&AN=EJ876995&site=eds-live
in.aspx?direct=true&db=eric&AN=EJ876995&site=eds-live
Pazol, K., Warner, L., Gavin, L., Callaghan, W., Spitz, A.,
Anderson, J., Barfield, W., Kann, L.
(2011). Vital signs: teen pregnancy – United States, 1991-2009.
Morbidity and mortality
weekly report, 60(13).

Richardson, D., & Nuru-Jeter, A. (2012). Neighborhood
contexts experienced by young
Mexican-American women: Enhancing our understanding of risk
for early childbearing.
Journal Of Urban Health: Bulletin of The New York Academy
Of Medicine, 89(1), 59-73.
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San Diego, California, Teen birth rate, County Health Rankings.
(2012). County Health
Rankings. Retrieved from
http://m.countyhealthrankings.org/node/357/14
State Profiles: The National Campaign to Prevent Teen and
Unplanned Pregnancy. (2012).
The National Campaign to Prevent Teen and Unplanned
Pregnancy.
http://www.thenationalcampaign.org/state-data/state-
profile.aspx?state=California
State profiles: California. (2012). The National Campaign to
Pregnancy. Retrieved from
http://www.thenationalcampaign.org/state-data/state-

profile.aspx?state=California
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SKIN CANCER AWARENESS 1
Introduction
San Diego is well known for great weather, fun filled
attractions, shopping, and more.
Most of these attractions are spent outside in sunny San Diego.
The San Diego Zoo, Sea World,
Seaport Village, and Petco Park, are just a few fun in the sun
activities families can enjoy.
Spending time on the San Diego beaches and parks are other
ways to have a great time outdoors
too. Some parents even encourage their kids to get out of the
house, take a break from using their
electronic devices and “play”, enjoy the weather, and exercise
outside. Usually, summer weather

brings teenagers out of their rooms to bask in the sun for a
perfect tan, however being exposed to
the sun without protection can be drastically life changing.
Phase 1: Quality of life: Social Diagnosis
Teens have a perception that sun bathing is a great way to have
perfect skin or even
going to the Tanning Salon. Most teens are not aware of the
future damages that the sun may
cause them; it can alter their image in a negative way and even
become dangerous and deadly.
When there is an abnormal growth of cells in the body this
disease is called, Cancer (CDC,
2014). Skin cancer is when the cancer cells start in the skin
(CDC, 2014). This disease does not
favor any race, culture, age and/or gender; it can affect anyone
(CDC, 2014). Skin Cancer is a
topic that not many teenagers are aware of. Teens may be talked
to or lectured on in regards to
drinking/texting and driving or safer sex, and/or a healthier
diet. A subject like cancer is not easy
to teach in high schools, although informing high school
students of what they can do now can
prevent them from developing skin cancer later may be

accomplished in several ways. This
health education program will target the age group between 15
to 19-year-old high school
students attending Otay Ranch High School of the high risk for
the most common skin cancer.
The following pages will explain the data collection and
analysis found in skin cancer at a
national, state, and local level. Describes the genetic,
behavioral, and environmental risk factors
associated with skin cancer, and express the need of a program
focus. The intervention strategies
will be later discussed, as well as the process and outcome
evaluation of the health education
program.
PHASE 2: EPIDEMIOLOGICAL ASSESSMENT
Epidemiology of Skin Cancer
Skin Cancer is the most common form of cancer and also the
fastest growing cancer.
There are three types of skin cancer: basal cell carcinoma,
squamous cell carcinoma, and

melanoma. According to the American Cancer Society there are
3.5 million of cases of basal and
squamous cell skin cancer, and 73,000 of melanoma in 2015
(ACS, 2015). The latest data
gathered by the EPA, states that in California, melanoma makes
up 75% of all skin cancer in the
state (2009). The same report states that in California, there are
800 deaths a year which is about
2 deaths per day (2009), making it a health problem that
requires more awareness than it has
been receiving. The determinants of Skin Cancer may be due to
genetic, behavioral or
environmental risk factors.
Genetic Risk Factors
Genetics plays a big role in determining an individual’s
chances of getting Skin Cancer.
The Center for Disease Control and Prevention 1999- 2011
surveillance of the incidence rate and
death rate of Skin Cancer reveals just how Caucasians are
disproportionately affected by skin
cancer, compared to other races. White men and white women
have the highest rates of
incidence and deaths due to Skin Cancer (CDC, 2014). Nine of

ten who are diagnosed with the
most dangerous form of skin cancer, melanoma are White (CDC,
2014). Even when the rates of
incidence for Asians/Pacific Islander, Hispanics, Blacks and
American Indians/Alaskan Natives
are combined, they are still at a lower rate compared to the
white population. The results are also
the same when comparing the death rates. The race with the
lowest rates or incidence and deaths
was the African American population.
An article in a periodical for genetics refers to different studies
conducted that would
explained that the reason for this disparity is due to
pigmentation. People with pigmentation
traits such as: fair skin, blue or green eye color, red and blonde
hair and freckles are at a higher
risk of getting skin cancer (Vogan, 2008). Darker pigmentation,
which is determined by
chromosomes, according to the same article, has the ability to
protect the skin from the sun

damage (Vogan, 2008).
Behavioral Risk Factors
Genetics is a risk factor for skin cancer that no one can control,
and is determined by
nature. Fortunately, a change in behavior can help lower the
risk of getting skin cancer. The
behaviors linked to skin cancer are over exposure to the sun,
use of indoor tanning, not wearing
sun-protective clothing, and lack of sunscreen usage. By
reducing sun exposure, not using indoor
tanning, wearing proper clothing and using sun screen before
exposure can dramatically reduce
the chances of getting skin cancer.
It is a well-known fact that sun exposure has many benefits
including mood
enhancement, and providing the body with vitamin D, but too
much exposure can harm the skin
due to the suns’ ultraviolet radiation. Ultra violet radiation has
been linked to premature aging,
eye damage, a suppressed immune system, and other skin
damage (WHO, 2015). Using
sunscreen can reduce damage done to the skin, and prevent skin
cancer growth. Unfortunately,

not everyone uses sunscreen. According to a study, sunscreen
usage in the general population has
fallen rapidly and only 30% actually use sunscreen (Johnson,
2011). The study suggest that it
may be due to the perceived susceptibility being low, and the
lack of skin cancer knowledge
(Johnson, 2011). Some people who get skin cancer do not get it
from the sun, instead they get it
from an alternative way of tanning with the use of tanning
bed/booths. There are thousands of
tanning salons all across the United States, and over a thousand
in California alone. These
bed/booths are used to achieve a darker complexion without sun
bathing. A study in Europe
found that artificial UV lights from these tanning beds/booths
increases the risk of melanoma by
75%, if expose to it before the age of 35 (Benmaharnia, 2013).
Environmental Risk Factors
The environment an individual is in has an influence on their
risk of getting Skin Cancer.

Due to the fact that California has such beautiful weather, and
the sun is out majority of the year
increases the risk of developing a skin cancer later in life.
Since the weather is so beautiful in
California, most individuals find themselves enjoying activities
outdoors. Any injury to the skin
can result in abnormal skin cell growth, which can happen
outdoors during these activities.
Phase 3: Educational and Ecological Assessment
Predisposing factors may include lack of education, as the main
reason individuals do
not protect themselves against skin cancer. Bringing awareness
to the topic may help parents in
teaching, and practicing healthy ways to protect their skin.
Since some skin cancer do not
develop until later in life, protecting your skin is important at
younger ages. Some parents may
feel that applying sunscreen takes too much time, and they do
not want to keep reapplying even
if they initially put it on their children. Of course this becomes
more difficult if society deems

tan skin to be fashionable, and in style. Individuals may also
have a low perception that skin
cancer can happen to them, and that may prevent themselves
from protecting themselves.
Enabling factors would be the individual’s accessibility to
proper protection from the
sun’s ultra-violet (UV) light. Along with being uneducated
about the risk of skin cancers, some
individuals might not know where or just cannot afford
sunscreens. Wearing sunscreen is one of
the main steps to protecting your skin, however, proper hats,
and UV protective clothing is also
available. Once again this goes back to accessibility to these
types of resources.
Reinforcing factors would be to not develop skin cancer in the
future; this is the main
reward for protecting your skin. Protecting your skin from UV
damage can also keep you
looking younger, and can slow the aging process. Over exposed
skin, especially in the face can
result in wrinkles faster than aging alone. Protecting your skin
can keep your youthful glow, and
wearing sunscreen is a major contributor to protection.

Program Focus
The health education program name that will be implemented is
called, “Sun Safe:
SASSE”. SASSE stands for S: Sunscreen use, A: Avoid peak
midday sun exposure, S: Stay in
the shade, S: Sun safe clothing, E: Exposure limitation. Health
educators will visit one high
school campus from the Sweetwater High School District during
the month of July, to educate
students of their risk, and inform them of preventative measures
that can be taken.
Phase 4: Intervention Strategies
Program Goal and Objectives
Goals Statement:
High School.
Process Objective:

speaker with skin cancer
to discuss their experience with the cancer.
contact sunscreen companies to
help provide free samples of sunscreen for the students.
Learning Objective:
High School students be
aware of sun safety practices.
majority of the students
from Otay Ranch High School will be able to identify abnormal
skin spots.
% of Otay Ranch High
School students will be able
to identify three risk factors for skin cancer.
Behavioral Objective:
High School students will
intend to wear sunscreen daily between the hours of 10am- 2pm,
when outdoors.
Environmental Objective:

at Otay Ranch High School
will be covered by shade structures.
ol year, all locker rooms at Otay
Ranch High School will have
sun screen pumps installed.
Outcome:
attended the “SASSE” health
awareness program will use sunscreen more than students from
another high school who
did not participate in the program.
Health Communication Strategies/Health Education Strategies
for Process Objectives
In order to have a successful health awareness program,
program planners need to have
certain strategies in place to fulfill the programs process,
learning, behavioral, and outcome
objectives. To complete the process objective program planners

will need certain materials such
as age appropriate brochures, and visual aids. Program leaders
will write a proposal to
Sweetwater High School District to allow our curriculum in the
Otay Ranch High School. After
receiving approval from the district, program planners will then
reach out to patients who are
willing to share their experiences living with skin cancer with
students. After confirmation from
these patients, we will then schedule them as guest speakers for
our presentations. Program
planners will contact several sunscreen companies in order to
receive free sample to be
distributed to the students. Otay Ranch High School has about
2,750 students, they will be
divide by grade level in order to reach as many students as
possible during the month of July.
The program will consist of eight presentation being conducted
over a month long period of
time. The first week of July will be for the freshman class,
second week for sophomores, third
week for juniors, and the fourth week for seniors. The
presentations will be held in the

gymnasium on Tuesdays, and Thursdays during the Extended
Learning Period (ELP) at which
time we will divide each grade into two separate classes
alphabetically.
There will be a list of student names, and a sign in sheet that a
program planner will supervise to
ensure accuracy of attendance. Those who could not attend on
Tuesday’s presentation can attend
Thursday’s presentation for make-up.
for Learning and Behavior
Objectives
Informal interviews with three students from Otay
Ranch High School revealed that skin
cancer was not believed to be a major health issue concerning
high school students. They
believed that there were much more important health concerns,
such as teen pregnancy, under
age alcohol consumption, marijuana use, and obesity. Due to the
fact that perceived
susceptibility to getting skin cancer is low, behaviors that can

help prevent skin cancer is not
practiced. Therefore, the behavior change model that will be
used to change the health behavior
of these students will be the Health Belief Model.
Students attending Otay Ranch High School currently
have no form of skin cancer
awareness, nor has the school ever had a skin cancer awareness
program. That means that there
are almost 3,000 students who are probably not informed on
how to identify skin abnormalities,
risk factors of skin cancer, or sun safety practices that could
help prevent it. In order to reach
these learning objectives, program planners will demonstrate
the proper way to apply sunscreen,
and bring visual aids of clothing and accessories that can help
protect the skin from sun
exposure. The program planners will also present pictures of
skin abnormalities that indicate skin
cancer to provide a guide and be able to know what these
abnormalities look like. All

information provided in the curriculum will be researched based
and distributed through power
point presentation, but a portion will be provided by a guest
speaker who will be a young skin
cancer survivor. The guest speaker will be able to highlight risk
factors through their personal
experience.
As stated earlier, the Health Belief Model (HBM) was
used to confirm the need for this
awareness program. By using the HBM, getting someone to
change his or her behavior may be
challenging, however with the in-depth presentation on Sun
Safe: “SASSE” program, using the
Health Communication Strategy will be more effective.
Especially, in the point made on “A”,
“A” is the acronym meaning to “Avoid” sun exposure during the
mid-day peak hours of 10am-
2pm when outdoors. Thus, by end of the presentation the
majority of Otay Ranch High School
students will intend to use sunscreen when outdoors specifically
between the mid-day peak hours
of 10am-2pm.
Environmental Change Strategies for Environmental Objective

The step to full fill an Environmental Objective is using
the Environmental Change
Strategy. By using this strategy, the goal will be met by having
shade structures installed in the
lunch area at Otay Ranch High school. In addition to installing
shade structures, hand pumps of
sunscreen will also be installed in the locker rooms for
everyone to use in a quick and easy
application. The first step is to write a proposal to the
Sweetwater High School District
requesting the need for an environmental change on the shade
structure, and the installation on
sunscreen hand pumps at the Otay Ranch High School. The head
coordinator of the Sun Safe:
SASSE program will write this proposal. This process may take
a few weeks to a few months.
After getting the approval for both proposals by the district, the
shade structures will be installed
as well as the sunscreen hand pumps for Otay Ranch High
School. The maintenance of the shade
structure will be included in the proposal for the general

maintenance on high school premises to
take care of. To maintain each hand pump in the locker rooms
of Otay Ranch High School the
Associated Student Body (ASB) or assistant student coaches
will refill all hand pumps as
needed.
for Outcome Objective
To complete a successful awareness program, the
outcome objective is to ensure that
majority of those who attended the “SASSE” health awareness
program at Otay Ranch High,
will use sunscreen more than other high schools in the district.
Program planners will conduct
surveys at the end of the school year, in order to measure how
effective our curriculum was at
Otay Ranch High School compared to the district. Marketing
this program will not be necessary,
due to the fact, after approval from the school district this
program will be implemented into the
curriculum.
Phase 5: Implementation
The “Sun Safe: SASSE”, skin cancer awareness

program will be implemented in the
month of July. Between the months of May and June, the pilot
test and revisions will be
completed in time for full implementation of the program. All
students of the Otay Ranch High
School will be in attendance for a 45 minute long presentation
during the schools Extended
Learning Period on Tuesdays, and Thursdays. The students will
be meeting in the school
gymnasium for an informative power point presentation on skin
cancer, and an anecdotal
presentation from a young survivor of skin cancer.
Phase 6: Process Evaluation
To assess the quality of the program content and
implementation, the program planners
must conduct a process evaluation. The process evaluation will
be used to measure how the
program was successfully implemented according to the

programs process objectives.
Qualitative data collected via survey by the students who
attended the intervention program at
Otay Ranch High School will be compared to the survey
conducted at the comparison school. A
timeline checklist in the form of a Gantt chart provides a
measurement of program status, in
which program planners will follow.
Gantt Chart
M
a
r
A
p
r
M
a
y
J
u

n
Jul
1
st
week
Jul 2
nd
week
Jul 3rd
week
Jul
4th
week
A
u
g
S
e
p

t
O
c
t
N
o
v
D
e
c
J
a
n
F
e
b
M
a

r
Prepare curriculum - -
Purchase supplies necessary for
presentation
- -
Contact & secure possible
speakers for the presentation
- -
Seek approval from district for
shade structure construction
- -
Solicit sun screen samples - -
Pilot test -
Make revisions based on pilot
test evaluation
-
Pre-test survey for ORHS and
comparison school
-
Full implementation for
Freshmen students of ORHS
---
Full implementation for

Sophomore students of ORHS
---
Full implementation for Junior
students of ORHS
---
Full implementation for Senior
students of ORHS
---
Conduct post-test surveys for
all students of ORHS after the
presentations
----- ----- ------ -----
Continue to check on
environmental objectives
- - - -
Construction of shade structure
and sunscreen pumps should be

complete
-
Conduct surveys for all
students of ORHS on
effectiveness of new structure
and sunscreen pumps
-
Conduct a post-test survey for
behavior objective
-
Conduct surveys for all
students of comparison school
-
Evaluate the program - - - - --- ---- ---- ---- - - - - - - - -
Write final report -
The programs process objectives were to secure a skin cancer
survivor speaker, whom
would attend the intervention presentations, and secure
sunscreen samples provided by sunscreen
companies. The students via a post program survey will

evaluate the programs expert speaker.
By completing this survey, this will measure how well or poorly
the expert speaker reached the
students. Upon receiving free samples of sunscreen given by
varies companies along with
sunscreen pumps provided by the school district, programs
planners would observe usage by the
students.
Phase 7: Impact Evaluation
In order to determine the effectiveness of the
intervention, an impact evaluation must be
conducted. Through this evaluation the program planners will
be able to determine if the
learning, behavior and environmental objectives has been
achieved. The evaluation design will
be based on quantitative data collected from students who
attended the intervention, and students
from the comparison school who did not attend the invention.
The learning objectives include teaching the students sun
safety practices, identifying

abnormal skin spot and identifying risk factors for skin cancer.
To determine if the intervention
was the cause of the students to new gain knowledge, a pre-test
will be conducted a month prior
to the implementation of the program. The pre-test would give
an insight of what students knew
prior to the intervention. By doing so, it would rule out any
confounding variable that could
possibly have an effect on the validity of the results. A post-test
would then be conducted soon
after the presentation to determine their knowledge on risk
factors of skin cancer, identifying
abnormal skin spots and sun safety practices.
The behavior objective is to encourage Otay Ranch High
School students to wear sunscreen
daily especially during peak hours while outdoors. The pre-test
would include information on
their daily sun screen use. The post-test for the behavioral
objective would be conducted later on
in the year to determine behavior change.
The environmental objective include the construction of
a shade structure to provide
students protection from the sun while eating at the lunch area

and sunscreen pumps in locker
rooms for all students especially those that play outdoor sports.
Program planners will constantly
check on the status of construction to ensure the objective is
achieved. One month after the
constructions has been completed, students at Otay Ranch High
School will be surveyed on their
use of the new environmental change made in their school and
also their satisfaction with the
change. This allows the program planners to determine if the
environmental change served its
purpose and if it should be proposed to other high schools as a
part of skin cancer prevention
measure for young adults.
Phase 8: Outcome Evaluation
While assessing the need of skin cancer, setting a goal, listing
objectives, and
implementing a program including numerous intervention
strategies are equally important in

program planning, the most crucial and critical phase is
Evaluation. In following the Precede-
Proceed model, phase 8 is measuring the outcome evaluation.
Having a beneficially health
awareness program that will improve the quality of life for the
community is ultimately what
health program planners want to achieve.
The outcome evaluation includes a strong outcome evaluation
design with rationale as to
why this design was chosen. A design that is worthy of its time
and effort for a positive health
awareness program is Quasi-experimental design. This design
is a pretest-protest design, which
includes an experimental group, and a comparison group. The
experimental group in this
program is Otay Ranch High School, and the comparison group
is Olympian High School. With
this chosen design the SASSE awareness program potentially
will have a great impact on its
target population. A pretest will be conducted for both groups
in June. In following the method
of collecting data for the quasi-experimental design, the
program planners will create a survey

for the students at Otay Ranch High School, and at Olympian
High School. After the
intervention, the posttest will be conducted for both schools.
All data collected from the pre/post
test will ultimately provide necessary feedback to stakeholders
to assess how well or poorly the
program was implemented. Program planners will coordinate
with stakeholders to further
improve program design, and implementation.
Conclusion
Skin Cancer is a serious health problem that affects millions of
Americans, and thousands
of Californians. Skin cancer has claimed lives of Californians
daily, and will continue to claim
lives unless preventative measures are being made. The best
way to tackle this health problem is
to provide education on this issue to populations whom are at a
great risk, for example the young

adults. The “Sun Safe: SASSE” program was created to do just
that. It targets students from Otay
Ranch High School, and provide them with education on the
topic of skin cancer prevention. The
program planners use the Health Belief Model to change the
perception of the health problem
due to the student’s low level of perceived susceptibility.
Program planners have learning,
behavioral, environmental, and outcome objectives that are
intended to reduce the risk of skin
cancer in high school students. In order to achieve this goal,
the program planners plan to use
Health Communication Strategies/Health Education Strategies.
In order to ensure their objectives
have been met, program planners will use quantitative, and
qualitative data collection to evaluate
the programs effectiveness. If the program proves to be
effective, then the program planners will
propose a statewide implementation, and hopefully a nation
wide implementation of the
program. With great optimism this program will be used as a
model across the United States, in
reducing the incidence rate of skin cancer among 15 to 19 year
olds.

References
Benmarhnia, T., Léon, C., & Beck, F. (2013). Exposure to
indoor tanning in france: A population
based study. BMC Dermatology, 13, 6.
doi:http://dx.doi.org/10.1186/1471-5945-13-6
Center of Disease Control. (2014, August). CDC - Skin Cancer
Rates by Race and
Centers for Disease Control and Prevention (CDC). (2014).
Basic Information About Skin
Cancer. Retrieved May 12, 2015, from
http://www.cdc.gov/cancer/skin/basic_info/index.htm
Eastlake High School. (2015). Eastlake High School | About Us.
Retrieved from
http://elh.sweetwaterschools.org/about-us
Johnson, M. M. (2011). A SKIN CANCER MODEL: RISK
PERCEPTION, WORRY AND

SUNSCREEN USAGE. Economics, Management and Financial
Markets, 6(2), 253-262.
Retrieved from
http://ezproxy.nu.edu/login?url=http://search.proquest.com/docv
iew/884339020?accounti
d=25320
Otay Ranch High School. (2015). Otay Ranch High School |
About Us. Retrieved from
http://orh.sweetwaterschools.org/about-us/
Sweetwater Union High School District. (n.d.) School.
Retrieved May 12, 2015, from
http://www.sweetwaterschools.org/schools/
Vogan, K. (2008). Cancer genetics: Pigmentation and skin-
cancer risk. Nature Reviews.
Genetics, 9(7), 502. doi:http://dx.doi.org/10.1038/nrg2409
http://www.cdc.gov/cancer/skin/basic_info/index.htm
http://elh.sweetwaterschools.org/about-us
iew/884339020?accountid=25320
iew/884339020?accountid=25320
http://orh.sweetwaterschools.org/about-us/

World Health Organization. (2014). WHO | Health effects of
UV radiation. Retrieved from
http://www.who.int/uv/health/en/
COH 380 Signature Assignment – Final Paper Rubric
(Condensed)
Criteria
Outstanding = 100%
INTRODUCTION = 2% of grade (2 total points)
Introduction:
PLO 4 CLO 4
2% Weight (2 pts.)
Public health problem (need) and its relevance are clearly and
concisely described.
NEEDS ASSESSMENT = 25% of grade (25 total points)
Program Planning Model:
3% Weight (3 pts.)

Program planning model is used correctly throughout the paper.
Relevant Primary Data Source (i.e., Key Informant Interview)
PLO 4 CLO 4
3% Weight (3 pts.)
Includes a primary data source that is relevant to the chosen
health topic and priority population. Data source is clearly
described including: who; where they work; the nature of their
work; whom they work with; how their data is relevant to the
needs assessment.
Relevant Secondary Data:
PLO 4 CLO 4
10% Weight (10 pts.)
Uses relevant secondary data to thoroughly and clearly describe
the health problem and its impact on the priority population.
Relevant data includes most of the following: death, incidence,
prevalence, morbidity, and mortality rates; data demonstrating
the economic burden of the problem; cultural considerations;
data on social problems related to the heath problem
Genetic Risk Factors
PLO 4 CLO 4
3% Weight (3 pts.)
Needs assessment clearly describes all of the genetic/biological
risk factors associated with the health problem and the priority
population.
Behavioral Risk Factors
PLO 4 CLO 4
3% Weight (3 pts.)
Needs assessment clearly describes all of the behavioral risk
factors associated with the health problem and the priority
population.
Environmental Risk Factors
(i.e., Non-Behavioral) Risk Factors)
PLO 4 CLO 4
3% Weight (3 pts.)
Needs assessment clearly describes all of the environmental risk
factors associated with the health problem and the priority

population.
Conclusion/Program Focus
2% Weight (2 pts.)
Needs assessment clearly and concisely explains the factors that
will become the focus and the purpose of the intervention.
PROGRAM PLANNING = 36% of grade (36 total points)
Goal Statement
PLO 5 CLO 5
2% Weight (2 pts.)
The program goal is simple and concise. It includes both the
priority population and what will change as a result of the
program.
Process Objective(s)
PLO 5 CLO 5
2% Weight (2 pts.)
Objective is written following SMART guidelines. One or more
process objectives that are relevant to the program and which
could be realistically achieved. Objective(s) are properly
written and contain all of the following: the outcome to be
achieved (what); the conditions (when the change will occur) ;
the criterion for deciding when the objective has been achieved
(how much change) ; and the priority population (who will
change).
Activities & Strategies for Reaching Process
Objective(s)
PLO 5 CLO 5
5% Weight (5 pts.)
Specific and detailed activities strategies to reach each process
objective are described. Activities are appropriate for the
priority population and are likely to bring about behavior
change to meet the stated objective. Activities are based on best
practices, experiences, or processes.
Impact Objective: Learning Objective(s)
PLO 5 CLO 5
2% Weight (2 pts.)

learning objectives that are relevant to the program and which
change).
Activities & Strategies for Reaching Learning Objective(s)
PLO 5 CLO 5
5% Weight (5pts.)
Specific and detailed activities and strategies to reach each
learning objective are described. Activities are appropriate for
the priority population and are likely to bring about behavior
Impact Objective: Behavioral Objective(s)
PLO 5 CLO 5
2% Weight (2 pts.)
behavioral objectives that are relevant to the program and which
change).
Activities and Strategies for Reaching Behavioral Objective(s)
PLO 5 CLO 5
5% Weight (5 pts.)
behavioral objective are described. Activities are appropriate
for the priority population and are likely to bring about
behavior change to meet the stated objective. Activities are
based on best practices, experiences, or processes.
Impact Objective:
Environmental Objective(s)

PLO 5 CLO 5
2% Weight (2 pts.)
environmental objectives that are relevant to the program and
which could be realistically achieved. Objective(s) are properly
change).
Activities and Strategies for Reaching Environmental
Objective(s)
PLO 5 CLO 5
5% Weight (5 pts.)
environmental objective are described. Activities are
appropriate for the priority population and are likely to bring
about behavior change to meet the stated objective.
Activities are based on best practices, experiences, or processes.
Outcome Objective(s)
PLO 5 CLO 5
2% Weight (2 pts.
Outcome objectives that are relevant to the program and which
achieved (what); the conditions (when
the change will occur); the criterion for deciding when the
objective has been achieved (how much change); and the
priority population (who will change).
Health Promotion/Education
Materials
PLO 5
2% Weight (2 pts.)
Health promotion/education or other program materials needed
for activities or to reach each objective are described in detail.

Marketing
PLO 5
1% Weight (1 pt.)
Marketing materials needed for activities or to reach each
objective are described in detail.
Timeline (GANTT CHART)
PLO 5 CLO 6
1% Weight (1 pt.)
A GANTT Chart is provided and includes due dates (program
timeline) for each activity are clear, realistic and demonstrate
progress towards completing the activity and reaching the
objective.
PROGRAM EVALUATION = 29% of grade (29 total points)
(Process): Activities
PLO 7 CLO 6 & 7
3% Weight (3 pts.)
Specific and detailed activities to reach each process evaluation
objective are described. Activities cover all elements of a
process evaluation: fidelity, dose, recruitment, reach, response,
and context.
(Process): Measure/Data
PLO 7 CLO 7
3% Weight (3 pts.)
At least 4 different measures are used and collected to conduct a
process evaluation. Measures are relevant and realistic to
collect.
(Impact): Learning Objective Activities & Data
PLO 7 CLO 6 & 7
5% Weight (5 pts.)
Specific and detailed evaluation activities to reach each
learning objective are described. All learning objectives are
measured and evaluation data are relevant and realistic to
collect
(Impact): Behavioral Objective Activities & Data
PLO 7 CLO 6 & 7
5% Weight (5 pts.)

behavioral objective are described. All behavioral objectives
are measured and evaluation data are relevant and realistic to
collect
(Impact): Environmental Objective Activities & Data
PLO 7 CLO 6 & 7
5% Weight (5 pts.)
environmental objective are described. All environmental
objectives are measured and evaluation data are relevant and
realistic to collect
(Outcome): Design
PLO 7 CLO 7
3% Weight (3 pts.)
Outcome evaluation design and the rationale for choosing the
design are clearly and concisely described.
(Outcome): Measure/Data
PLO 7 CLO 6 & 7
3% Weight (3 pts.)
Data collected to measure outcome objectives are relevant and
realistic to collect.
Reporting
2% Weight (2 pts.)
Evaluation reporting is clearly described in the evaluation
activities. All stakeholders are included in the reporting
process.
REFERENCES AND OTHER = 8% of grade (8 total points)
APA 6th Edition
In-text Citations*
1% Weight (1 pt.)
*Note: Include in Needs Assessment Draft
The vast majority of in-text citations are in correct APA 6th
edition format. The vast majority of claims are supported with
appropriate references (e.g., scholarly, government, textbook).
APA 6th Edition References*
1% Weight (1 pt.)

*Note: Include in Needs Assessment Draft
The vast majority of references are in proper APA 6th edition
format. Very appropriate sources are cited.
Writing Style
2% Weight (2 pts.)
The paper is well organized both overall and at the paragraph
level. Sentences are smooth and carefully crafted. There are
virtually no errors in punctuation, spelling, grammar or usage.
Timely Submission
2% Weight (2 pts.)
The final paper is submitted early or on-time.
SIGNATURE ASSIGNMENT PAPER GUIDELINES
Groups of approximately 3-4 students will work together to
develop a health program addressing a significant public health
problem for a chosen target population. The health promotion
program will be described in a 10-page minimum to 15-page
maximum, paper using in-text citations with APA 6th edition
references and formatting. Additional paper requirements
include:
Paper Requirements:
· Title page, table of contents, section headers (Level 1) and
sub-headers (Level 2), and references
· Times New Roman, 12-point, 1-inch margins, double spaced,
first line hanging indent 0.5”

· Prepare and submit one comprehensive group paper. This
paper should include revisions from any drafts and an
evaluation plan of your health program.
· Your final paper should include all revised drafts which come
together into one paper. Be sure to proof read your paper
making sure sections transition smoothly, rather than being
abruptly put together.
Suggestions:
· Have someone else read your paper to make sure it makes
sense to them and to provide feedback on grammar.
· Read your paper out loud when proof reading your paper.
Sometimes you hear the errors that your eyes have missed.
· Schedule an appointment with the National University Writing
Center for assistance with writing the paper in terms of
grammar, sentence structure, organization, APA 6th edition
formatting, APA 6th edition in-text citations and reference
page.
Please see the Grading Rubric and Course Syllabus/Outline for
additional information.
Please note: All sections in bold and underlined must be used as
Level 1 Section Headers. All sections that come under this
section in bold are to serve as Level 2 headers. Please use the
exact same words as provided below, except for chapters and
page numbers which are given for your reference.
Introduction & Needs Assessment
· Public Health Problem: Clearly defines and describes the
assigned public health topic (see Relevant Secondary Data
below as this is how it should be defined).
· Target population: Clearly identifies 1 specific target
population
· Program Planning Model (See Ch. 3): Identifies and uses an
approximateProgram planning model that is used correctly
throughout the paper.
· Relevant Primary Data Source (i.e., Use Content from the Key
Informant Interviews): Concisely summarizes in 1-4 paragraphs

a primary data source that is relevant to the chosen health topic
and priority population. Data source is clearly described
including: who; where they work; the nature of their work;
whom they work with; how their data is relevant to the needs
assessment.
· Relevant Secondary Data: Uses relevant secondary data to
thoroughly and clearly describe the health problem and its
impact on the priority population. Relevant data includes most
of the following: death, incidence, prevalence, morbidity, and
mortality rates; data demonstrating the economic burden of the
problem; cultural considerations; data on social problems
related to the heath problem
· Needs Assessment (See Ch 4): To include all of the following
information:
· Risk factors
· Genetic Risk Factors-Clearly describes all of the
genetic/biological risk factors associated with the health
problem and the priority population.
· Behavioral Risk Factors- Clearly describes all of the
behavioral risk factors associated with the health problem and
the priority population.
· Environmental Risk Factors- clearly describes all of the
environmental risk factors associated with the health problem
and the priority population.
· Conclusion/Program Focus: Clearly and concisely explains the
factors that will become the focus and the purpose of the
intervention.
Program Planning
· Goal Statement: The program goal is simple and concise. It
includes both the priority population and what will change as a
result of the program.
· Process Objectives (See Box 6.5, pg. 143): Objective is
written following SMART guidelines. One or more process
objectives that are relevant to the program and which could be
realistically achieved. Objective(s) are properly written and

contain all of the following: the outcome to be achieved (what);
the conditions (when the change will occur) ; the criterion for
deciding when the objective has been achieved (how much
change): and the priority population (who will change).
· Activities & Strategies for Reaching Process Objective(s):
Specific and detailed activities strategies to reach each process
objective are described. Activities are appropriate for the
priority population and are likely to bring about behavior
· Impact Objective: Learning Objective(s) (See Box 6.5, pg.
143; Box 6.6, pg. 145): Objective is written following SMART
guidelines. One or more learning objectives that are relevant to
the program and which could be realistically achieved.
Objective(s) are properly written and contain all of the
following: the outcome to be achieved (what); the conditions
(when the change will occur) ; the criterion for deciding when
the objective has been achieved (how much change) ; and the
· Activities & Strategies for Reaching Learning Objective(s):
learning objective are described. Activities are appropriate for
the priority population and are likely to bring about behavior
· Impact Objective: Behavioral Objective(s) (See Box 6.5, pg.
144; Box 6.6, pg. 145): Objective is written following SMART
guidelines. One or more behavioral objectives that are relevant
to the program and which could be realistically achieved.
Objective(s) are properly written and contain all of the
following: the outcome to be achieved (what); the conditions
(when the change will occur) ; the criterion for deciding when
the objective has been achieved (how much change) ; and the
· Activities and Strategies for Reaching Behavioral
Objective(s): Specific and detailed activities and strategies to

reach each behavioral objective are described. Activities are
about behavior change to meet the stated objective. Activities
are based on best practices, experiences, or processes.
· Impact Objective: Environmental Objective(s) (See Box 6.5,
pg. 144; Box 6.6, pg. 145): Objective is written following
SMART guidelines. One or more environmental objectives that
are relevant to the program and which could be realistically
achieved. Objective(s) are properly written and contain all of
the following: the outcome to be achieved (what); the
conditions (when the change will occur) ; the criterion for
deciding when the objective has been achieved (how much
change) ; and the priority population (who will change).
· Activities and Strategies for Reaching Environmental
Objective(s): Specific and detailed activities and strategies to
reach each environmental objective are described. Activities are
about behavior change to meet the stated objective.
· Outcome Objective(s) (See Box 6.5, pg. 145; Box 6.6, pg.
145): Objective is written following SMART guidelines. One or
more Outcome objectives that are relevant to the program and
which could be realistically achieved. Objective(s) are properly
achieved (what); the conditions (when
· the change will occur) ; the criterion for deciding when the
objective has been achieved (how much change) ; and the
· Health Promotion/Education Materials: Health
promotion/education or other program materials needed for
activities or to reach each objective are described in detail.
· Marketing: Marketing materials needed for activities or to
reach each objective are described in detail.
· Timeline (GANTT CHART Fig 12.4, p. 326): A GANTT Chart
is provided and includes due dates (program timeline) for each
activity are clear, realistic and demonstrate progress towards
completing the activity and reaching the objective. The GANTT

Chart can be embedded directly into the paper or provided as an
attachment. If an attachment, the paper still needs to have this
section header and then refer the reader to the attachment.
Program Evaluation
· (Process): Activities: Specific and detailed activities to reach
each process evaluation objective are described. Activities
cover all elements of a process evaluation: fidelity, dose,
recruitment, reach, response, and context.
· (Process): Measure/Data (See Ch 14-15): At least 4 different
measures are used and collected to conduct a process
evaluation. Measures are relevant and realistic to collect.
· (Impact): Learning Objective Activities & Data: Specific and
detailed evaluation activities to reach each learning objective
are described. All learning objectives are measured, and
evaluation data are relevant and realistic to collect.
· (Impact): Behavioral Objective Activities & Data: Specific
and detailed evaluation activities to reach each behavioral
objective are described. All behavioral objectives are
measured, and evaluation data are relevant and realistic to
collect
· (Impact): Environmental Objective Activities & Data: Specific
and detailed evaluation activities to reach each environmental
objective are described. All behavioral objectives are
measured, and evaluation data are relevant and realistic to
collect
· (Outcome):Design: Outcome evaluation design and the
rationale for choosing the design are clearly and concisely
described.
· (Outcome): Measure/Data: Data collected to measure outcome
objectives are relevant and realistic to collect.
· Reporting: Evaluation reporting is clearly described in the
evaluation activities. All stakeholders are included in the
reporting process.
References
· APA style in-text citations must be used throughout the

document. No direct quotes longer than 2 sentences will be
accepted. Only 2 direct quotes are allowed in the entire research
paper.
· References page (not counted in page limit) contains reliable
or scholarly sources (no non-scholarly resources such as
WebMD, Wikipedia, etc. are permitted) and has no or minor
errors.
· Signature assignment must include at least 5 of which 3
references must be from different peer-reviewed journals; no
non-scholarly references will be permitted (e.g., no WebMD,
Wikipedia, etc.).
Running head: [TITLE]
1
Running Head: Tobacco Control Program
2
Group #2 – Tobacco Control Program
COH 380 – Health Promotion Program, Planning and Evaluation
Professor Hoolihan
May 20, 2018

Introduction
Tobacco use is a risk factor for a wide variety of health
problems. In the United States alone, tobacco use kills more
than 480,000 individuals each year, wherein more than 41,000
of these deaths are due to secondhand smoke exposure (Centers
for Disease Control and Prevention, 2018). Surprisingly,
cigarette smoking is higher among individuals currently serving
in the military, particularly those personnel who have been
deployed (Centers for Disease Control and Prevention, 2018).
For instance, tobacco use prevalence, including both smokeless
and smoking, is lowest among Air Force (40%) personnel and
highest among Marines (61%) (Smith, Poston, Haddock, &
Malone, 2016). In this case, health promotion through tobacco
control program provides an excellent opportunity to encourage
military personnel smokers and nonsmokers to improve health
status by preventing tobacco use.
Health Problem
Almost every organ in the body is at risk due to tobacco use.
Cigarette smoking accounts for at least 30% of all cancer
deaths, with most of the case caused by tobacco use is lung
cancer (National Institute of Health, 2018). Also, tobacco use
can cause lung diseases such as chronic bronchitis, emphysema,
asthma, and chronic obstructive pulmonary disease (COPD)
(National Institute of Health, 2018). Additionally, smoking
cigarette can also increase the risk for developing
cardiovascular diseases including stroke, heart attack, vascular
disease, and aneurysm (National Institute of Health, 2018).
Program Planning Model
In this tobacco control program, PRECEDE-PROCEED planning
model is utilized. PRECEDE stands for Predisposing,
Reinforcing, and Enabling Constructs in

Educational/Environmental Diagnosis and Evaluation; and
PROCEED spells out Policy, Regulatory, and Organizational
Constructs in Educational and Environmental Development (as
cited in McKenzie, Neiger, & Thackeray, 2017). This planning
model has eight phases: (1) social assessment, (2)
epidemiological assessment, (3) educational and ecological
assessment, (4) administrative & policy assessment and
intervention alignment, (5) implementation, (6) process
evaluation, (7) impact evaluation, (8) outcome evaluation
(McKenzie, Neiger, & Thackeray, 2017).
Phase 1: Social assessment and situational analysis
The data used in this study was collected from the service-level
health promotion leaders in the military such in the different
branches of the Naval Hospitals, Army Medical Centers, and
Air Force bases. These data include the medical history of the
military personnel who experienced smoking cigarette in the
past and those who are currently smoking.
Phase 2: Epidemiological assessment
It is important to consider the impact of tobacco use on the
different military branches such as in the Army, Navy, Air
Force, and Marine Corps divisions. The level of stress in the
military is a behavioral risk factor for tobacco use. Smoking
cigarette is perceived as a method for countering stress.
Furthermore, the military population is ethnically diverse. It is
essential to examine the ethnic background that drives the
behavioral aspect of tobacco use.
Phase 3: Educational and ecological assessment
Every military personnel have different missions and level of
stress provided by the workforce. And each personnel have
different beliefs, traditions, and way of coping with tension and
stress before and after duties.
Phase 4: Administrative & policy assessment and intervention
alignment
It is significant to define the framework of tobacco use by
assessing the work policy, health intervention, and personal
behavior in the military groups.

Needs Assessment
Primary Data Collection
According to a recent interview conducted, there are different
issues for a different segment of the population, for example,
Mental Health Smokers, Substance Abuse Smokers, Coping
Smokers, Social Smokers, Regular Smokers and Parolee
Smokers all have different needs. The most smokers are not
willing to implement a change with smoking habits until they
are ready to do so. The strategies have been active with clients
who are eager to be educated, supported and connected to
resources to plan for a quit attempt. These groups need support
groups and Local Smoking Cessation Programs.
Secondary Data Collection
Proof based prescribed procedures for tobacco control have
been generally advanced and have prevailing with regards to
diminishing tobacco use in the United States. The advisory
group perceives, notwithstanding, that recognizing the accepted
procedures for particular and assorted populaces can be testing
(Eriksen, 2000). Decreasing tobacco utilize faces uncommon
difficulties since tobacco items are lawful and simple to get,
exceptionally addictive, and vigorously advanced by a tobacco
industry that burns through billions of dollars a year to advance
tobacco as a component of the American culture (Rogers, 2010).
Making a sans tobacco culture will rely upon building up a
situation that empowers forbearance and makes numerous kinds
of successful help and consolation open to differing populaces.
A wellbeing needs evaluation is a deliberate technique to survey
the present and conceivable medical problems confronting a
populace. From this confirmation needs and asset assignment
that will enhance wellbeing and decrease disparities can be
agreed. Needs appraisals can be more extensive than wellbeing
and can incorporate measurements, for example, financial,
similar to the case with this evaluation. Needs assessments are
frequently structured as follows:
Definition of the issue
Epidemiological necessities appraisal

Comparative needs evaluation
Current administration arrangement
Corporate necessities evaluation (partner sees)
Identification of neglected needs
Recommendations for change
This structure freely takes after the Stevens and beam system
and draws on the NICE direction for Health Needs Assessment
yet is separated to center around the partner sees and new
advancements on the Tobacco Control plan.
Conclusion
This paper will focus on health promotion for the military
personnel who are at risk for developing smoking-related
diseases such as lung cancer and diseases and cardiovascular
diseases due to tobacco use.
References
Centers for Disease Control and Prevention. (2018). Burden of
tobacco use in the U.S. Retrieved from
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigar
ette-smoking-in-united-states.html
McKenzie, J., Neiger, B., & Thackeray, R. (2017). Planning,
implementing, and evaluating health promotion programs (7th
edition). United States of America: Pearson Education, Inc.
Retrieved from www.chegg.com
National Institute of Health. (2018). Tobacco, nicotine, and e-
cigarettes. Retrieved from
https://www.drugabuse.gov/publications/tobacco-nicotine-e-
cigarettes/what-are-physical-health-consequences-tobacco-use
Eriksen, M. (2000). Best practices for comprehensive tobacco
control programs: opportunities for managed care organisations.
Tobacco Control, 9(90001), 11-14.
Ranjan, R., & Jain, S. (2018). Strengthening National Tobacco
Control Program (NTCP) to advance tobacco control (TC)
policy in Uttar Pradesh (UP). Tobacco Induced Diseases, 16(1).
Rogers, T. (2010). The California Tobacco Control Program:
introduction to the 20-year retrospective. Tobacco Control,

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