Professional Portfolio_Final (1)

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Running head: PROFESSIONAL PORTFOLIO
Professional Portfolio
Ariana Ochoa
ALH495
Clinical Practicum
Dr. Kim
California Baptist University
April 11, 2016

PROFESSIONAL PORTFOLIO 2
Table of Contents
Practicum Experience Plan and Evaluation.....………………Pg. 3-4
Practicum Information……………………………………….Pg. 5
Philosophy of Health and Professional Goals………………..Pg. 6-7
Resume…………………………………………………….....Pg. 8-9
Certifications………………………………………………....Pg. 10
References…………………………………………………....Pg. 11
Honors/Awards………………………………………………Pg. 12-13
Summary of Student Learning Outcomes……………………Pg. 14-15
Health Insurance Analysis……………………………………Pg. 16-19
Prevalence, Causes, Coping Strategies of Stress amongst Junior and
Senior Female College Students……………………………..Pg. 20-41
Violence Prevention for Gang Affiliated Youth……………..Pg. 42-54
Hoarding: A Community Health Problem………………...…Pg. 55-61

Practicum Experience Plan and Evaluation
Health Science Major Student Learning Outcomes (SLOs)
Student
Learning
Outcomes
(SLOs)
Write specific student
learning outcomes
below
Activities (Reports, projects, or
assignments) that address the
SLOs.
SLO #1 Understand the U.S.
healthcare system.
Conduct an interview with a
healthcare professional asking
questions regarding health
insurance policies, ethical issues,
quality of healthcare, and the
impact of their role in healthcare.
SLO #2 Display effective
communication skills
By interacting with healthcare
professionals, patients, and
various individuals, I will have
the opportunity to improve my
communication skills in several
settings. For example, I may
conduct a research survey design
for individuals to assess their
experience after interacting with
me. This will serve to keep a
record of my ability to effectively
communicate.
SLO #3 Demonstrate
competence in applied
statistical analysis.
With a sample size of more than
50 participants from the surveys
listed above, I will analyze and
SLO #4 Demonstrate a
thorough
understanding of the
relationship between
disease prevention and
health promotion.
Interpret this data
using the SPSS
Statistics software.
Based on learning of health
promotion and disease prevention
in previous courses, I will
practically apply that information
to a real healthcare setting. I
would do this by developing a
case study from observation and
presenting possible improvements

SLO #5 Demonstrate the
ability to evaluate the
scientific literature,
understand and
synthesize relevant
information from it,
and be able convey
that information both
orally and in writing.
or solutions stemming
from evidence-based
research.
Assess an article related to a
common health issue among
patients in a clinical setting, write
a summarized report, and briefly
present to the preceptor as if
explaining the information to a
patient. This will serve to
evaluate my understanding of the
issue and the language used in the
article.

Student Name: Ariana Ochoa
Agency and Department/Division: SoCal Emergency Medicine Urgent Care Centers
Preceptor Name: Julie Bearie
Dates of Practicum Plan: 2/15/2016 – 4/15/2016
I have met with practicum supervisor (preceptors) to discuss activities (projects, reports, and
assignments) that enable me to attain the student learning outcomes in this practicum experience.
Student’ signature
Preceptor’s signature

Philosophy of Health and Professional Goals
Ariana Ochoa
Clinical Practicum
ALH495
February 8, 2016

Philosophy of Health and Professional Goals
Health is a broad term that literally means being free from illness or injury, not only in
the physical aspect. This encompasses mental, emotional, spiritual, and social health along with
physical health. An area of healthcare that addresses all of these is public health, which deals
with health promotion and disease prevention. This does not only refer to the health of
individuals, but whole communities.
Soon, I will be working alongside other phenomenal healthcare professionals as a
physician assistant, who collectively are working towards the same goal; to improve the overall
health of the community. The motive behind my goal is based on my faith, which is to be of
service to others through the knowledge and skills I gain throughout. A verse in the Bible from 1
Peter 4:10 states “Each of you should use whatever gift you have received to serve others, as
faithful stewards of God’s grace in its various forms”. Serving as a physician assistant is only
one manner in which I can reflect the grace given to me and impact at least on area of health in
the lives of many.
As I continue my educational journey, I must first apply this concept to my own health in
order to serve as an example to others. My personal goal as a healthcare professional is to strive
to always better every aspect of my state of health. Along with this, I will work towards
educating myself on new strategies and technology to be an even more effective provider. In
terms of relationships with co-workers, I will be of service to them as well in order to create an
environment that is pleasing to employees and patients alike.

Ariana Ochoa
22880 Bay Avenue #A, Moreno Valley, CA 92553 | arianaelizabeth.ochoa@calbaptist.edu | 951-3998376
Education
Riverside, California
Bachelor of Science: Health Science | Concentration: Pre-Physician Assistant Studies
Expected Graduation
April 2016
Provost’s List
Spring 2014
CBU Allied Health Scholarship Fall
2014 - Present
CBU Women’s Choir Scholarship Fall
2013 - Present
Relevant Coursework
Medical Terminology, Anatomy and Physiology I & II, Survey of U.S. Health Care Delivery, Public
Health Promotion and Disease Prevention, Microbiology, Ethics in Health Care, Research Methods,
Health Communication, Health Care Policy, Clinical Practicum, and Health Behavior Change
Experience
Moreno Beach Urgent Care Moreno
Valley, California
Clinical Practicum Student
February 2016 – Present
• Obtained medical history, chief complaint, and partial SOAP notes with supervision of a PA
• Conducted research using survey sampling and used SPSS to demonstrate applied statistical
analysis
• Understood the U.S. Health Care system through interviews with health care professionals
• Assessed scientific literature, wrote a summarized report, and presented information to a
preceptor
Additional Experience

Women’s Choir Section leader September
2015 – Present
• Led the Soprano II section in reading and singing a wide array of music
• Organized sectionals with the Soprano II section
International Service Projects
• Thailand: Community Engagement
Summer 2016
Student Leader o Organized various
fundraising events
o Taught English in various schools ranging from elementary to high school
Skills
• Computer: SPSS, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Language: Spanish – Conversational Proficiency
• Medical : CPR, First Aid, and Emergency Medical Services
• West Coast EMT
Emergency Medical Technician Certificate
Summer 2015

Certifications
CPR/First Aid (Medical)
The purpose of this certification is to have an individual prepared in cases of
general medical emergencies, especially those pertaining to the field of healthcare.
Some situations may include cardiopulmonary resuscitation, proper use of an AED,
broken bones, etc.
Emergency Medical Technician Certificate
The purpose of this certificate is to educate those who will be working under an
emergency ambulatory service. Those who receive this certificate have
demonstrated a basic understanding of human anatomy and physiology, healthcare,
precautions, and emergency medical care.
National Institute of Health Certificate
The purpose of this certificate is to train individuals on the principles used to define
ethical research using humans and the regulations, policies, and guidance that
describe the implementation of those principles.

References
Pennee Robertson
RN, MSN, CCRN
Assistant Professor Nursing
8432 Magnolia Ave, Riverside, CA 92504
Work phone: (951)552-8305
Email: probertson@calbaptist.edu
Relationship: International Service Project: China, Leader
Julie Bearie
RN, BSN
Vice President
SoCal Emergency Medicine: Urgent Care Centers
27640 Eucalyptus Ave, Moreno Valley, CA 92555
Work phone: (909)797-8900
Email: jbearie@socalem.com
Relationship: Clinical Practicum Proctor
Ruben Elias
Pastor
Iglesia Pentecostal: Fuente de Vida
12125 Day St Suite G301, Moreno Valley, CA 92557
Work Phone: (951)777-8203
Email: eliasministries@yahoo.com
Relationship: Pastor

Honors/Awards
Provost’s List - GPA 3.88 Fall 2014
CBU Allied Health Scholarship Fall 2014 – Present
CBU Women’s Choir Scholarship Fall 2013 – Present
Private Organization Scholarship Fall 2012
Attachments

Summary of Student Learning Outcomes
Ariana Ochoa
ALH 495
Clinical Practicum
Dr. Kim
March 7, 2016

Summary of Student Learning Outcomes
1. Understand the U.S. health care system
The U.S. health care system is comprised of many aspects. For example, the clinical
setting (i.e. medical knowledge and treatment), Health Insurance, Ethics, etc.
2. (2 & 5) Demonstrate understanding of research methodology and the scientific
method.
Demonstrate competence in applied statistical analysis.
This involves statistical analysis collected from a large sample size and analyzing this
data.
3. Demonstrate a thorough understanding of the relationship between disease prevention
and health promotion.
4. (4 & 6) Display effective communication skills. Demonstrate the ability to evaluate the
scientific literature, understand and synthesize relevant information from it, and be able
to convey that information both orally and in writing.

Health Insurance Analysis:
United Healthcare Insurance Company
HSC 104
Ariana Ochoa
Professor Fletcher
November 11, 2013

United Healthcare Insurance Company
Brief Background
I am currently enrolled in the health insurance plan that the school provides, due to the
fact that neither me nor my family have medical anymore. I would still have coverage; however I
was required to have a job while I was in school. So, because of circumstances I temporarily am
under the United Healthcare Insurance Company. This company provides a variety of different
plans for a vast group of people. It strives to make healthcare affordable and accessible to all.
Some of their goals include; “improving the quality and effectiveness of healthcare for all
Americans, enhance access to health benefits, create and products and services that make
healthcare more affordable, and use technology to make the healthcare system easier to
navigate”. (2013). Some of their plans include copay, health savings account, high deductible,
short term medical, and student coverage. This company provides services to approximately 70
million Americans, and their pharmaceutical management programs provide more availability
and affordability of prescription drugs to over 13 million people. In seeking improvements in all
areas of healthcare, United Healthcare has made several investments in research and
development, technology, and business process improvements.
My Health Insurance Plan
The plan that I am on is a PPO network. I do not pay a monthly premium. The overall
cost of the insurance is $770 and is included with the cost of my tuition. Included with my health
insurance coverage is access to the Collegiate Assistance Program. This allows me to speak with
either a registered nurse or student assistant specialist any time of the day and week. I can speak
with them if I have questions regarding any symptoms I may be experiencing, taking care of a
certain illness, information on medications, and many other things. I also have global emergency
services included on my plan. This is a comprehensive program providing 24/7 medical and

travel assistance service. The last thing included on my health insurance plan and coverage is the
United Health Allies Discount Plan. This allows me to save 10% to 20% on a variety of health
services such as; annual eye exams, active apparels books and other media, dental checkups, and
so many more things. From what I have learned about my insurance provider and plan, I do not
see any restrictions placed on any physicians or hospitals. I also do not see any incentives to use
any certain health care providers. It seems that this insurance plan mostly just provides discounts
on any services I might use. Since I have just received this kind of insurance, I have not had the
need or opportunity to use their services yet. Personally, I do not like the fact that this insurance
is so expensive and does not necessarily cover much health expenses, but rather gives me a
discounted price. However, it does seem like a reliable insurance company. I am aware of the
fact that there many insurance companies, not only health insurances, that do a poor job of
helping you find the best plan for you and sometimes you end up spending more than what the
insurance plan covers.

References
"Health Insurance Plans for Individuals | UnitedHealthcare." Health Insurance Plans for
Individuals | UnitedHealthcare. N.p., n.d. Web. 11 Nov. 2013.

Prevalence, Causes, and Coping Strategies of Stress amongst Junior and Senior Female
College Students

Abstract
In this survey research 50 females of the junior and senior class in California Baptist
University were asked various questions regarding lifestyle behaviors from major work load,
grade point average (GPA), sleeping, eating, and exercise habits, and relationship status. The
purpose of this study was to identify the causes, management, and perceived levels of stress
among female college students. The survey was organized with questions pertaining to
demographics, descriptive research questions, and perceived levels of stress scales. Four scales
measured stress relating to school, work, relationships, and other sources. Descriptive analysis
was conducted to find the relationship between lifestyle behavior and stress levels. It was
expected that there is a proportional relationship between level of physical exercise, healthy
eating patterns, and sleep. Those who sleep within 6-9 hours should have lower stress levels and
they should increase if sleep is inadequate below 6 hours of sleep or above 9 hours. Also those
who have healthy eating patterns, eating 3 full meals, should have lower stress levels. Routine
exercise has previously demonstrated to decrease stress levels. This research helped determine
whether a load of responsibilities increase level of perceived stress such as unit load,
extracurricular activities, relationships, and jobs.

Table of Contents
CHAPTER 1: INTRODUCTION 5
Purpose of this Study 5
Research Question 5
Significance 5
Limitations of the Study 6
Delimitations of the Study 6
CHAPTER 2: LITERATURE REVIEW 7
CHAPTER 3: RESEARCH METHODOLOGY 11
Design 12
Participants 12
Measures 13
Procedures 14
Data Analysis 15
CHAPTER 4: RESULTS 15
Demographics 15
CHAPTER 5: DISCUSSION 19

Conclusion 19
Discussion 20
Recommendations 21
REFERENCES 23

CHAPTER ONE
INTRODUCTION
The purpose of this research was to analyze the prevalence, causes, and coping strategies
amongst junior and senior female college students. There is lack of research demonstrating how
lifestyle behaviors and stress from different sources affects female students. The correlations that
caused stress were identified through the lifestyle of 50 female college students, which included
work, school, relationship, and lifestyle behavior. The American Journal of Health Studies
states, “Emotional and Cognitive reactions to stressors occurred more frequently, and behavioral
and physiological reactions to stressors were reported less often” (Misra & McKean, 2000). It
also concluded that there was greater correlation between stressors and reactions to stressors
with time management behaviors than with leisure satisfaction. Strategies that reduced
behavioral reactions to stressors and increased cognitive reaction were through goal setting and
prioritization of time.
Research Questions
1. How does social support affect stress form work, school, relationship, and other factors?
2. How does stress from one source affect another? (i.e. stress from school, association to
stress from work)
3. How do student lifestyle behaviors such as amount of sleep, activity level, and eating
patterns, unit load, and GPA affect perceived levels of stress?
Significance
In previous research there is evidence by The American College Health Association that 42.8%
of college students have reported more than average stress (ACHA, 2013). According to ACHA
the overall stress levels have increased amongst female college students with a total of 56.8%,
reporting more than average stress and tremendous stress within the last twelve months. A

significant amount of the student population reported that stress affects academic performance.
Some of the correlations that were investigated in this study that played a role in the
development of stress were, relationships, employment, school, and social support. Given the
impact on academic performance college administrators should assess the factors among female
college students. This research can provide affective resources that help mitigate stress
symptoms and is helpful for coping techniques.
Limitations of the Study
It was expected that participants in this study were to answer the questions honestly,
completely, and to the best of their knowledge. There may be misunderstandings on the
interpretation of the questions. The time when the surveys were administered to the participants
was during the middle of the course semester. Stress levels vary from those of the beginning of
the semester and those at the end of the semester. This was a convenience sampling, which
indicate that some of the participants come from different college departments and it’s expected
that certain schools are excluded such as engineers.
Delimitations
In one study it demonstrated that first and second year students have added stress from
transitions to new environment and more rigorous courses than their upper classman peers (Ford
et al., 2014). Based on this, the study was conducted to junior and senior female college students
to eliminate stress from transitions. Women tend to perceive situations as being more stressful
than men (Eaton & Bradley, 2008). It was beneficial to focus on the female population to get a
better understanding of their correlations associated with stress from different sources.
CHAPTER TWO
LITERATURE REVIEW

In previous research there is various evidence that demonstrates perceived level of stress
is affected by a multitude of different stimuli. Stress is a stimulus response interaction between
the subject and internal and external factors. There is research that has shown that there is
correlation between lifestyle decisions that result with different levels of perceived stress.
However, there is a majority of research that demonstrates that students typically experience
moderate to high levels of perceived stress. In a 2013 Research on Dietary Patterns studying
relationship with perceived level of stress among college students showed that perceived level of
stress among college students tend to be moderate with the majority, 68.3% of students within
the moderate level. They also found that there was no association with income, gender, BMI,
perceived level of stress, and perceived course load. However, it did find that course load was
significantly correlated to perceived levels of stress (Fabian et al., 2013). A study done on
pharmaceutical students also found that there was a significant direct association between
academic workload and perceived academic stress (Ford et al., 2014). In fall of 2009 National
college health assessment reported that 20% of college students in a nationwide survey reported
sleep difficulties as a factor for that contributes to academic performance ranking 2nd
after stress.
In addition poor quality sleep has shown to make students tenser, irritable, anxious, depressed,
angry, and confused. It was also interesting to find that there is disconnect between how students
perceive their sleep quality and their day-to-day motivation to getting things done. Other studies
demonstrated poorer sleeping patterns and more suffering of consequences from college female
students than men. This leads to poor academic performance, and more physical, social and
emotional problems (Orzech, Salafky, & Hamilton 2011).
When referring to how women and their coping strategies, one study found that women
tend to perceive situations as more stressful and they cope by using emotionally focused
techniques (Eaton & Bradley, 2008). When looking at social connectedness, which is a construct

of a sense of belonging, social inclusion and exclusion, and loneliness, it was significantly
correlated with perceived level of stress among women and men. It demonstrated strong
correlation of perceived level of stress by measuring social connectedness through social
appraisal. With negative appraisals there was a direct negative effect of social connectedness.
However, there was only a 9% variance between perceived level of stress and social appraisal,
which suggests that there are other personal and social factors contributing to stress. This study
had a subject pool size of 214, with 111 men and 103 women participating. It showed that
women have more interdependent self-construal. So when measuring social connectedness there
was a 21% total variance. In other words, women who gave more positive appraisal have more
social connectedness. The article suggests that women who feel more socially connected tend to
also be able to cope with stress more effectively (Lee, Keough, & Sexton, 2002). Another study
also suggests female students engaged in talking twice as often as either attending class or
studying which indicates a high degree of social connectedness. However, at times it was also a
source of stress in college women school activities such as out of class assignments, class
attendance, class projects have accounted for largest amount of stress. Also communicating,
mobility, and work were rated as highly stressful (Larson, 2006). Indicative of coping
mechanisms studies show that individuals who make behavioral attributions to chance have
higher perceived levels of stress and poorer wellbeing than those with high demand and high
control (Carvahlo et al., 2009) and (Larson, 2006).
Another article presents information on psychological distress among female college
students. It states that, “College presents a number of potential stressors that may lead to
psychopathology, such as academic overload, continual pressure to succeed, competition against
peers, financial hardship, and worries about the future (Vázquez, Otero, & Díaz, 2012). These
stressors increase the probability of developing personality disorders, depression, work

difficulties, anxiety, and social problems. A sample that was done within Spanish college
students, 60% displayed psychological distress and 33% had elevated depressive
symptomatology, which means individuals have a high risk of developing depression. None of
the studies in this article compared relations between mental health problems with their area of
study or year of study. Studies that were done on women only, mainly amongst developed
countries, females were more likely to present higher rates for mental disorders such as anxiety
and depression. The methods used for this study were first term of academic year from 2008-09’;
a population of 42,138 female college students registered in three universities of Galicia located
in a region of Spain. Random sampling was used for 1,054 women who were 1st
-3rd
year, or
4th
6th
year. Via postal study or telephone were applied to this study to inform the participants
about the study, its risks, and benefits. The results of the study were that females under 20 years
of age showed more distress than older women, for example, younger females revealed greater
sensitivity. Students with financial difficulties and working while studying have poorer mental
health. The limitations of this study included random sampling, cross-sectional design; it did not
analyze origin or etiology of emotional distress; it focused mainly on psychological distress.
In the article, The Influence of Perceived Stress, Loneliness, and Learning Burnout on
University Students’ Educational Experience, explains that stressors such as loneliness and
burnout are encountered during student’s educational career. Loneliness is experienced through
social network and relationships. The authors also state, “Essentially, several factors can initiate
the feeling of loneliness, including a lack of satisfaction with one’s social relationships,
expectations not meeting the reality of social status, or a deficit in emotional connectivity”
(Stoliker & Lafreniere, 2015). According to this article, these types of stressors may develop
poor physical health, depression, and psychological distress. “Burnout” develops through
academic pressure, homework overload, psychological factors, emotional exhaustion, etc.

University students develop stress because one deals with homework, exams, work, clubs,
volunteer positions, and family problems. There were 150 undergraduate students at a medium
sized university located in Ontario, Canada that played a role in this study. A multi ethic
population was used in this study and in order to participate in the study students had to be
registered in at least one psychology class and be registered in the Psychology Participant Pool.
Throughout the study, “it was concluded that feelings of perceived stress were associated with
poor physical and psychological symptomology, such as depression, high blood pressure, greater
susceptibility to infection, as well as social (Cohen et al., 1983). The feeling of loneliness and
learning burnout would negatively influence individual’s academic experience, which was
assessed by educational engagement and academic performance, and perceptions of stress
(Stoliker & Lafreniere, 2015). In an article by Ranjita Misra and Michelle McKean it states,
“Stressors affecting students can be categorized as academic, financial, time or health related,
and self-imposed” (Goodman, 1993; LeRoy, 1988). It is reported that females experienced
higher self-imposed stress and more physiological reactions to stressors than males. Males show
lower anxiety levels and experience satisfaction through leisure activities. Females are able to
manage their time wisely, plan for their future, and approach tasks and workplace better than
males.
CHAPTER THREE
METHODOLOGY
Taking into consideration previous research studies a hypothesis was formed to study the causes,
management, and perceived levels of stress in female college juniors and seniors. A survey study
was designed to observe relationships between behaviors and perceived levels of stress. This
could contribute with identifying behaviors that can exacerbate stress for female college juniors

and seniors, and find solutions to decrease unnecessary stressors. The research can also help in
improving attitudes towards stimuli that cause stress. Using a randomized survey study from
participants of different college departments allowed a generalized understanding of stresses that
affect upper-classmen females.
Design
This research design was a cross-sectional non-experimental administrative survey study. These
surveys were distributed to female students on the California Baptist University campus at
different points during a five day period. Female students were informed of their contribution to
the research study also noting that this questionnaire was completely anonymous. The survey
provided self-reported estimations.
There were various independent variables measuring four categories of sources of stress. These
four sources were school, work, relationships, and other. The variables influencing the perceived
levels of stress were physical activity, unit load, social support, amount of relaxation and sleep,
activity involvement, and residential status. The dependent variables are the self-reported
perceived levels of stress.
Knowing that stress has various factors contributing to it, a few questions were designed to
measure behaviors and attitudes of their daily living. A few examples of these types of questions
are knowledge based questions such as “Do you think social support is important to your
wellbeing?” Questions were also used to assess certain behaviors such as those pertaining to
amount of sleep, relaxation, unit load, and number of meals per day.
General demographic data was also collected. The data collected involved college of major,
class, GPA, residential status, and age. No medical histories were collected, nor were any
samples from participants collected for testing.

Participants
The target data collected were from female juniors and seniors attending California Baptist
University. Disqualifying factors for participants was based on sex and age of students. This
group was chosen to eliminate factors due to home sickness and resistance to change and
adaption to social environment.
In total, 50 participants were necessary to provide statistically significant findings. The selection
of these participants was completely random to exclude any possibility of bias.
Measures
The total amount of survey questions were 17 used to examine the selected population. The
questions and reporting scales that were used were based on standardized tests.
Demographics
At the beginning of our questionnaire were self-reported demographic questions meant to provide
general information of the participant. Participants were provided the option of choosing the school in
which their major was classified under. The options listed were College of Allied Health, College of
Architecture, Visual Arts, and Design, College of Arts and Sciences, College of Engineering, School of
Behavioral Sciences, School of Business, School of Christian ministries, School of Education, School of
Music, School of Nursing, and Online and
Professional Studies (OPS). There was also the option of choosing under which category classes
fall under such as in during the day, night, OPS, or other. Residency questions were asked in the
form of checking either living off campus within an hour away, off campus (1hr or more away),
or on campus. Information on the participant’s class status was asked as junior or senior. GPA
information was divided into 5 clusters: 2.0 - 2.49, 2.5 - 2.99, 3.0 - 3.49 or 4.0 - above.

Participants were asked to fill in their age. Finally, was marking whether participants had a
parttime job, full-time job, more than one job, or no job.
The rest of the questions focused on the causes, management, and perceived levels of
stress.
Part A
Part A of the survey focused on research dedicated to collect information of causes,
management, and attitudes and behaviors in terms of social support. Three questions of Part A
focused on possible causes of stress. Two questions were dedicated to attitudes and behaviors
towards social support. The last four questions of Part A were aimed to determine management
habits of stress.
The portion of the questionnaire based on causes of stress asked students’ involvement in
different activities, relationship status, and the amount of units taken in the spring 2015 semester.
The questions relating to attitudes and behaviors of social support used a likert scale. Participants
were given options of circling 1-5; one being strongly disagree and 5 being strongly agree. The
remainder of the questions consisted of amounts of exercise, relaxation, sleep, and meals. These
questions are force response.
Part B
Part B of this survey was dedicated to researching perceived levels of stress in various
areas of their life. This portion of the survey asked participants to circle their perceived level of
stress using a likert scale ranging from 1-5 in the areas of school, work, relationship, and other;
one being no stress to minimal stress and 5 being very stressed.

Procedures
Participants were chosen randomly from the California Baptist University Campus within
a five day period. The selection of these participants was done in person, and all surveys were
completed via hard-copy. Each participant was informed on the purpose of the study and all
information provided in the survey was completely anonymous and was not traceable.
The majority of the questionnaires were completed within ten minutes. Each survey was marked
with a random number to identify the case prior to being handed out. Once all surveys were
completed and collected, they were filed randomly for future analysis.
Data Analysis
Provided by the university, we used the software program, Statistical package for the
Social Sciences (SPSS). This program was used to enter data and relate findings under
supervision and counseling. Every case was based on the identification number given to each
survey.
CHAPTER FOUR
RESULTS
Demographics
Of the 50female participants of the junior and senior class, 24% (n=12) are Behavioral Science
majors, 22% (n=11) are College of Allied Health majors, 14% (n=7) are College of Arts and
Sciences majors, and 12% (n=6) are School of Nursing majors. Of the 50 participants of the
junior and senior class, 90% (n=45) are enrolled in day classes and 10% (n=5) are enrolled in
night/Online Professional Studies (OPS). Of the 50 participants of the junior and senior class
56% (n=28) reside on campus and 32% (n=16) reside off campus within an hour away, and12%
(n=6) reside off campus more than an hour away. Of the 50female participants of the junior and

senior class, 68% (n=34) are juniors and 32% (n=16) are seniors. Of the 50 participants of the
junior and senior class, 36% (n=18) have a grade point average (GPA) of 3.5 and above, 36%
(n=18) have a GPA of 3.0-3.49, 18% (n=9) have a GPA of 2.5-2.99, and 10% (n=5) have a GPA
of 2.0-2.49. Of the 50 participants of the junior and senior class, 37% (n=19) are 21 years of age,
18% (n=9) are 23 years of age, 18% (n=9) are 22 years of age, and 12% (n=6) are 20 years of
age. Of the 50 participants of the junior and senior class, 66% (n=33) have a part time job, 20%
(n=10) have no job, and 10% (n=5) have a full time job.
Major Findings
Research question #1: How many units are you taking this semester?
Analysis: Of the 50 female participants of the junior and senior class, 56% (n=28) are taking
1518 units, 40% (n=20) are taking 12-14 units, and 4% (n=2) are taking more than 18 units.
Research question #2: Are you in a relationship?
Analysis: Of the 50 female participants of the junior and senior class 64% (n=32) are single, and
36% (n=18) are in a relationship.
Research question #3: Do you feel like you have a strong social support
Analysis: Of the 50 female participant of the junior and senior class 40% (n=20) strongly agree
that they have strong social support, 36% (n=18) agree that they have strong social support, 12%
(n=6) neither agree nor disagree, 6% (n=3) disagree that they have strong social support, and 6%
(n=3) strongly disagree that they have strong social support.
Research question #4: Do you think social support is important to your well-being? Analysis:
Of the 50 female participant of the junior and senior class 46% (n=23) agree that social

support is important to their wellbeing, 42% (n=21) strongly agree that social support is
important, 8% (n=4) strongly disagree that social support is important to their well-being, 4%
(n=2) neither agree nor disagree.
Research question #5: How many hours per week do you exercise?
Analysis: Of the 50 female participants of the junior and senior class, 46% (n=23) exercise 1-2
hours per week, 20% (n=10) does not exercise, 20% (n=10) exercises 3-4 hours a week, 14%
(n=7) exercises 5 or more hours per week.
Research question #6: Generally sleep about how many hours per night?
Analysis: Of the 50 female participants of the junior and senior class 60% (n=39) sleep about 6
to 9 hours per night, 36% (n=18) sleep less than 6 hours per night, and 4% (n=2) sleep more than
9 hours.
Research question #7: Normally eat how many meals per day?
Analysis: Of the 50 females participants of the junior and senior class 50% (n=25) normally eat 2
meals per day, 40% (n=20) normally eat 3 meals per day, 6% (n=3) normally eat 4 meals per
day, and 4% (n=2) normally eat 1 meals per day.
Research question #8: Circle perceived level of stress from school
Analysis: Of the 50 female participants of the junior and senior class 56% (n=28) have a
perceived level of stress of 4, 24% (n=12) have a perceived level of stress of 5, 14% (n=7) have
a perceived level of stress of 3, and 6% (n=3) have a perceived level of stress at 2.

Research question #9: Circle perceived level of stress from work
Analysis: Of the 50 females from the junior and senior class 30% (n=15) have a perceived level
of stress from work of 1, 32% (n=32) have a perceived level of stress from work of 2, 22%
(n=11) have a perceived level of stress from work of 4, 12% (n=6) have a perceived level of
stress of 3, and 4% (n=2) reported no stress from work.
Research question #10: Circle perceived level of stress from relationships
Analysis: Of the 50 females from the junior and senior class 42% (n=21) reported they have a
perceived level of stress from relationships of 1, 16% (n=8) reported they have a perceived level
of stress of 2 from relationships, 20% (n=10) have a perceived level of stress of 3 from
relationships, 16% (n=8) have a perceived level of stress of 4 from relationships, and 6% (n=3)
have a perceived level of stress of 5 from relationships.
Data Interpretation
In order to interpret the data in SPSS, Spearman correlation was used. Statistically significant
findings included the following: stress from school and social support, stress from work and
social support, and stress from other sources and social support. Other findings included
relationships between one stress and another such as: stress from school and work, stress from
school and other, and stress from other and relationships. Other correlations were between other
and social support being important to well-being, amount of relaxation and stress from school,
and amount of relaxation and stress from other.
It was found that as stress increases from work so does stress from school. There was also a
direct relationship as stress from school arises so did stress from other factors and vice versa.
Subjects who agreed that social support was important to their well-being tended to have lower

perceived levels of stress than those who disagreed with the claim. Those who agreed with the
claim “Do you think that social support is important to your well-being?” also had felt they had a
strong social support. Also, high levels of stress correlated to less time to relax.
CHAPTER FIVE
DISCUSSION
Conclusion
Using Spearman two-tailed analysis the research found significant associations between social
effect and perceived level of stress, and stress affecting another source of stress. Regarding the
former, female students that felt strong social support demonstrated to have lower levels of stress
than those who reported feeling weak social support. Regarding the latter, stress from one source
had direct relationship with another source of stress. The study found if perceived level of stress
from school increased then perceived level of stress from work also increased. The same
relationship was found for stress from other and stress from school and stress from relationships
and other. There was no significant association between any student lifestyle behaviors and
perceived level of stress. Student behaviors such as sleeping, eating patterns, and exercise did
not correlate with perceived level of stress.
Discussion
The study supports previous research on how social support effects perceived stress in college
females. Females who report strong social connectedness tend to cope more effectively with
stress than those who do not have a sense of support. As mentioned previously in other findings,

women have a more interdependent self-construal. There was also evidence of a direct
relationship between stress from one area and another. A previous study on financial stress
demonstrates that students who work more than twenty hours per week reported high stress
levels that impact academic progress (Trombitas, 2012). It was particularly interesting that the
study found no association between student lifestyle behaviors and stress. Previous studies
demonstrate that exercise can mitigate stress for individuals and lack of sleep has demonstrated
to increase mental health problems for female students. (Orzech, Salafsky, & Hamilton, 2009).
The lack of evidence of significance could be due to error in survey question design. Since the
answers were written in a nominal method, it could not be measured by SPSS means. An ordinal
design of the answers might have been more effective.
Recommendations
The research suggests that school administrators would benefit to assess stress among students
on campus so they may provide effective resources to cope with stress. With correlations
showing that there is evidence of stress rising, when work stress rises, administrators may
provide education to the student body about how to manage time wisely. Social connectedness
was shown to have an inverse relationship with perceived level of stress, which indicates that
community is important to the college environment. Knowing this, prospective female students
should account for sense of community and connectedness when making decisions on a college
to attend.
For future research the data found no correlations between students’ lifestyle behaviors and
stress levels. There may be error in the design of survey questions since there is a significant

amount of research that demonstrates that there is association between amount of sleep, activity
level, and workload. It is imperative that survey be designed with ordinal scales to assess degree
of association. Also ‘stress from other’ is a broad and general term which needs to be defined
since there is indication that stress from ‘other’ sources are affecting stress within the academic
spectrum. These other sources may be club involvement, outside commitments such as weddings
or community events, or financial stress. Since this study was focused on upper-classmen
students there is also an imposed stress from plans of future employment with no certainty. A
more focused population on a particular major would also help adapt stress coping resources for
students within a certain field.

References
American College Health Association. (2013). Reference Group Executive Summary. American
College Health Association.
de Carvalho, C. F., Gadzella, B. M., Henley, T. B., & Ball, S. E. (2009). Locus of Control:
Differences Among College Students' Stress Levels. Individual Differences Research,
7(3).
Eaton, R. J., & Bradley, G. (2008). The role of gender and negative affectivity in stressor
appraisal and coping selection. International Journal of Stress Management, 15(1), 94.
Fabián, C., Pagán, I., Ríos, J. L., Betancourt, J., Cruz, S. Y., González, A. M., ... & Rivera-Soto,
W. T. (2013). Dietary patterns and their association with sociodemographic
characteristics and perceived academic stress of college students in Puerto Rico. Puerto
Rico health sciences journal, 32(1).
Ford, K. C., Olotu, B. S., Thach, A. V., Roberts, R., & Davis, P. (2014). Factors Contributing to
Perceived Stress Among Doctor of Pharmacy (PharmD) Students. College Student
Journal, 48(2), 189-198.
Larson, E. A. (2006). Stress in the lives of college women:“Lots to do and not much time”.
Journal of Adolescent Research, 21(6), 579-606.
Lee, R. M., Keough, K. A., & Sexton, J. D. (2002). Social connectedness, social appraisal, and
perceived stress in college women and men. Journal of Counseling & Development,
80(3), 355-361.
Misra, R., & McKean, M. (2000). COLLEGE STUDENTS'ACADEMIC STRESS AND ITS
RELATION TO THEIR ANXIETY, TIME MANAGEMENT, AND LEISURE
SATISFACTION. American Journal of Health Studies, 16(1), 41-51.

Orzech, K. M., Salafsky, D. B., & Hamilton, L. A. (2011). The state of sleep among college
students at a large public university. Journal of American College Health, 59(7), 612619.
Stoliker, B. E., & Lafreniere, K. D. (2015). The Influence of Perceived Stress, Loneliness, and
Learning Burnout on University Students' Educational Experience. College Student
Journal, 49(1), 146-160.
Trombitas, K. (2012). Financial stress: An everyday reality for college students. Lincoln, NE:
Inceptia.
Vazquez, F. L., Otero, P., & Diaz, O. (2012). Psychological distress and related factors in female
college students. Journal of American College Health, 60(3), 219-225.

Violence Prevention for Gang Affiliated Youth
Ariana E. Ochoa
HSC310
Public Health Promotion and Disease Prevention
Dr. LaChausse
November 24, 2014

Violence Prevention for Gang Affiliated Youth
The issue of gangs has been one that has existed since the1500s, and began to receive a
significant amount of attention in the past 80 years, particularly the participation of delinquent
youth. Sheldon et al. (2004) acknowledge an early study by the Illinois state police, in it is
mentioned a gang called the Forty Thieves founded in New York around the 1820s. It is believed
to be the first youth gang formed in the United States. (p. 2). These gangs would typically
“mark” their names on walls, commit acts of murder and robbery, and had a high rate of racial
tensions. We can see that these are all characteristics of gangs that exist today. After the Great
Depression, public attention to gangs oscillated, and didn’t gain very much back until the 1950s.
The media raised much public concern for the growth of youth gang activities. There came a
“rapid deployment of technology, databases and the proliferation of gang experts…” (Sheldon,
Tracy, & Brown, 2004, p. 3). With the rise of this awareness, especially in schools, gang
awareness and resistance techniques were incorporated into lectures. Students were not allowed
to wear what was considered “gang-related” clothing. Teachers and educators were trained to be
able to identify gang members and any concealed weapons they might be carrying. The rise of
these gang affiliated youth are typically found in inner-cities, however are spreading to urban
areas and smaller communities. With the spread and growing commonality, it is extremely
difficult to find a region in the United States that is without youth gangs.
Now, public health promotion specialists are conducting research studies and
implementing programs to reduce the prevalence of these gangs, violence affecting their
communities and the population as a whole; even preventing the risk of personal victimization.
Factors being considered are delinquency, mental health, gender differences, school status, class
status, minority populations, and problem behaviors. Those working in the public health
department find that youth gangs is an important issue to address because it causes tensions

between people groups; upper class versus lower class, and tensions between specific races. The
violence that arises from involvement in gangs leads to the death of lives and incarceration of
minors. Involvements in these types of groups also demonstrate a threat or existing signs of
social and psychological consequences to the individual and future generations. In various
projects, researchers are attempting to find the root of the cause and the solution in reducing the
prevalence of youth gangs.
Every year, law enforcement in the National Youth Gang Survey (NYGS) reports gang
problems. It was found that there was a 15 percent increase in youth gang problems between
2002 and 2008. In different segments of the U.S., populations reported increases in gang
problems; in suburban counties a 22 percent increase, in rural counties a 16 percent increase, in
smaller cities a 15 percent increase, and in larger cities a 13 percent increase. In the mid-1990s,
the presence of gangs in schools was 28 percent. That statistic decreased to 17 percent in 1999,
however, began to increase again up to 23 percent in 2007. (Howell, 2010, p. 2). According to
Howell and Hawkins (1998), there seems to have been “a spread in adolescence-limited
offending rather than an increase in the prevalence of life course-persistent offenders in the
population.” (p. 273). As previously mentioned, there are consequences to certain behaviors to
being involved in a gang, and one of the major contributing factors is violence. Ellickson et al.
(1997) conducted a research study in which a longitudinal database of over 4,500 high school
seniors and dropout from California and Oregon was used. Their measures include violent
behavior, substance use, school status, academic orientation, mental health, and delinquency.
What they found was that 54 percent of the participants had engaged in some sort of violence in
the past year, and 23 percent committed violent acts towards family members or acquaintances.
One in four had been involved in at least one type of predatory violence including carrying a
hidden weapon. Of those carrying a weapon, 25 percent had the intention of hurting or killing

a person. It was also found that males were up to five times more likely to be involved in most
types of violence than females. (Ellickson, Saner, & McGuigan, 1997, p. 985-987). In
various articles and studies conducted all over the United States it is found that members of
these gangs are typically male, of a minority group, live in certain geographic locations, and
typically have a low socioeconomic status. “According to the 2008 NYGS, half
(50%) of all gang members are Hispanic/Latino, 32% percent are African American/black, and
11 percent are Caucasian/white.” (Howell, 2010, p. 3). We can also see that larger and more
populated cities have the highest rates of gang activity.
As we can see from the data provided by dedicated public health departments, that there
is a huge issue with violence among youth, and that violence is amplified with the involvement
in gangs. Howell and Hawkins (1998) state “Current violence prevention approaches seek to
reduce or eliminate factors that predict a greater probability of violence in adolescence and
young adulthood and strengthen factors that mediate or moderate exposure to risk.” (p. 263).
Although there are certain factors that contribute to putting an adolescent at a high risk for
violence and delinquency cannot be changed, having the knowledge can help distinguish the
populations that need preventive interventions the most. In such interventions, the goals are to
decrease risk and increase protection.
As we were previously informed, there are several factors that that can determine and
explain the reasons that certain behaviors are present. The involvement of an adolescent in this
type of group can have serious long term effects, especially since they are in a stage of
adjustment and development. The initial consequences of their membership are violent behaviors
and serious delinquency. The longer an adolescent is involved in a youth gang, the probability of
arrest and conviction in adult life is greater. Dupere et al. (2007) tells us of the consequences this
can have; “In the longer term, joining a youth gang appears to be a key element in a process of

distancing oneself from conventional society, a process with consequences that persist well
beyond the actual period of gang involvement.” (p. 1035). Often times, these adolescents place
themselves in premature adult roles such as parenthood and school dropout. One of the reasons
that there are cities with higher rates of youth gangs is because of impoverished neighborhoods.
They typically have a “reduced capacity for effective social control over the behavior and
activities of youth groups.” (Dupere, LaCourse, Douglas Willms, Vitaro, & Tremblay, 2007, p.
1036).
It is true that youth gangs tend to accumulate in disadvantaged communities. This
increases the likelihood that a teen might join a youth gang, however there are many adolescents
that are predisposed and are more probable to join a youth gang despite their current
circumstances. In a study conducted in Montreal, Canada, it was found that those with high
levels of hyperactivity, low levels of pro-sociality, and anxiety in kindergarten were at a greater
risk to join a youth gang. According to Dupere et al. (2007), this type of profile in children could
indicate early psychopathic tendencies. (p. 1036). Blair et al. (2001) describe psychopathy as a
disorder of a combination of insensitiveness, incapability to feel guilt or regret, prone to
boredom, and poor behavioral controls. Criminals characterized by this disorder are known to
commit a large amount of crime, constantly go against societal obligations, appear to lack
loyalty, and not concerned when confronted with the destructive nature of their behavior. (Blair,
Colledge, Murray, & Mitchell, 2001, p. 491). Children that show psychopathic tendencies are
reinforced when adolescents select peer groups that seemed to accept them. This means that
teens with risks on neighborhood and family levels were in particular likely to affiliate with
anomalous peers and exhibit behavior problems.
While disadvantaged communities and psychosocial tendencies play major roles in
determining the probability an adolescent will join a youth gang, there are several other factors to

take into consideration. These factors can be traced back as early as life in the womb. “Early
predictors of childhood oppositional behaviors have been identified. These include prenatal and
perinatal difficulties…” (Howell & Hawkins, 1998, p. 269). Howell (1998) also has found some
evidence that prenatal distress and complications during pregnancy lead to violent children who
are raised in unstable home environments. (p. 269). Aggressive behavior may also be linked to
neuropsychological disorders that affect cognitive processes. The same goes for attention
problems such as ADHD. Another prominent factor is academic difficulty. It may be argued that
difficulty in this area is linked to antisocial behavior; having problems in learning, reading,
speech, writing, and memory. Youths who frequently change schools are often found to be more
violent later in life. Both antisocial behavior and academic difficulty are linked to violent
behavior in childhood leading up to adolescence.
We know that the majority of a child’s peers are from school. We also know that violence
spreads in social contexts. The interaction between peers can escalate to the spread of violence.
Those known as “instigators” are youth who tend to be older with a longer offense history;
“joiners” are youth that are less experienced, but gain experience through their “instigator” peers.
A large proportion of school-related victimizations, better known as bullying, come from peer
interaction in daily activity. The majority of this violence occurs mostly in areas that are not
supervised by teachers or school staff, and may even be provoked. Provocation can be in the
form of insults, rough play fighting, or verbal teasing. The violence in school settings is only the
beginning of the larger issue of youth gangs. (Howell & Hawkins, 1998, p. 274-275).
As children grow and develop, they take on characteristics of their environment; taking it
as a model for their behavior. The biggest influences on this are parents. When parents do not
clearly delineate the expectations for behavior from their child, are too harsh, or are inconsistent
in punishment, they place their child in a state that may increase their risk for aggressive

behavior. “Child-rearing practices such as poor supervision, poor communication, parent-child
conflict, and frequent physical punishment predict physical aggression…” (Howell & Hawkins,
1998, p. 271). It has been found that relations between parents and their children is the strongest
predictor of adolescent behavior. In order to prevent this, parents must realize that it is crucial to
be involved in their child’s life and provide opportunities to bond as a family.
When addressing the issue of violence in adolescence, there are two main groups to take
into consideration. First, are those who begin to demonstrate oppositional and aggressive
behavior from childhood; these continue on into adolescence and even adulthood with increased
intensity of violent acts. The proper term for these offenders is life-course-persistent offenders.
Second, are those that commit these violent behaviors in adolescence. These are referred to as
adolescent-limited offenders. Life-course-persistent offenders begin in childhood, where they
engage in troublesome behaviors and often times lack an ability to concentrate. These children
also demonstrate antisocial behavior in different environments and circumstances. At different
stages of their lives is when certain behaviors are more prevalent. For instance, “…biting and
hitting at age four, shoplifting and truancy at age ten, selling drugs and stealing cars at age
sixteen, robbery and rape at age twenty-two, and fraud and child abuse at age thirty.” (Howell &
Hawkins, 1998, p. 265). As opposed to a history of childhood antisocial behavior in life-
coursepersistent offenders, adolescent-limited offenders do not. This characteristic does not arise
until adolescence. Engaging in antisocial behavior can also depend on whether responses are
beneficial to them and vice versa. Behavior can also vary with different situations. A teenager
might shoplift with a group of friends, but abide by school and family rules. Both groups of
adolescents are at risk to being lead into a youth gang.
When adolescents are involved in or affiliated with a youth gang, there are several
consequences that accompany this sort of activity; such as monetary, social, and personal costs.

An issue that several scholars address is victimization. According to Miller (1998), because of
gender differences, women are more susceptible to be victimized. This is especially true in
sexual crimes. (p. 433). While some of the consequences are irreversible; such as teen
parenthood, homicide, or suicide, there are programs constantly being planned, implemented and
evaluated in order to prevent further advancement of the issue.
In Howell’s (2010) article, he addresses a few prevention programs; evaluating them
based on the clarity of the framework of the program, program fidelity, the strength of the
evaluation’s design, and evidence proving that the program prevents or reduces problem
behaviors. He has also categorized the programs to be as level 1, 2, or 3. Level having been
scientifically proven, have a high quality research design, contain a control group in the research
design, and may be considered exemplary or model programs. The other levels are based off of
whether they contain these elements and characteristics in their program. (Howell, 2010, p. 13).
The first is a primary prevention program, Level 2. “The Gang Resistance Education and
Training (G.R.E.A.T) Program is a school-based gang-prevention curriculum that has
demonstrated evidence of effectiveness.” (Howell, 2010, p.13). The program lasts 13 weeks and
is offered by law enforcement officers. In these 13 weeks students are taught not only the
dangers of gang-involvement, but also emphasize cognitive-behavioral training, development in
social skills, refusal skills, and conflict resolution. This program is also available to elementary
schools and families, and has a summer program. Although this program is not based on any
theory, it has shown to have short-term effects on the intended goals. Those who evaluated the
program believe that these effects were due to the program and not outside sources because the
program was implemented with fidelity and the evaluation utilized a randomized experimental
design. (Esbensen, Peterson, Taylor, Freng, Osgood, & Matsuda, 2011, p.67).

A model program that provides an excellent example of an effective early intervention
program is the Preventive Treatment Program in Montreal; a secondary prevention program. It
has been successful in reducing gang involvement, although that was not the original purpose of
the program; it was to “prevent antisocial behavior among boys ages 7 to 9 with a low
socioeconomic status who had previously displayed disruptive behavior in kindergarten.”
(Howell, 2010, p. 13). The program had evidence that a combination of parent training and
childhood skill development is able to prevent children from joining gangs before they reach
mid-adolescence. They were able to improve school performance and reduce delinquency and
substance abuse. This program is based on the Social-Cognitive Theory.
A theory that is commonly used in interventions is the Social Cognitive Theory (SCT).
Fertman and Allensworth (2010) describe SCT as defining “human behavior as an interaction of
personal factors, behavior, and the environment.” (p.64). The constructs involved are reciprocal
determinism, behavioral capability, expectations, self-efficacy, observational learning, and
reinforcements. The best programs are based off of evidence of previous programs and theories;
such as the modeling of observational learning in the SCT. A logic model is the best approach to
begin to develop a program in order to address the goal, behaviors, determinants, and base it off
of successful programs. I would also suggest incorporating sessions to teach parents how to
intervene in the lives of their child in an effective and positive manner; also bettering the
community to promote a pro-social environment. These two components along with an in-school
based program. Below is a logic model displaying the major topics discussed previously.

Logic Model: Violence Prevention for Gang Affiliated Youth
Interventions
and Activities
Determinants Behaviors Health
Goal(s)
•
•
•
Gang
Resistance
Education and
Training
(G.R.E.A.T.).
Preventive
Treatment
Program
Aggression
Replacement
Training
(ART)
(Howell,
2010, p.13).
•
•
•
• •
• •
•
•
Family
Adversity
Violent youth
“models”
Spread of
violence across
adolescents in
the population
School Failure
Poor Social
Environments
(Dupere,
LaCourse,
Douglas
Willms, Vitaro,
& Tremblay,
2007, p. 1036).
Rejection/Anger
Attention
Problems and
hyperactivity
(ADHD).
(Howell &
Hawkins,
1998, p. 269).
Victimization
Lack of ability
to concentrate
•
•
•
Persistent
aggressive
behavior as
children
Selfdestructive
behaviors (i.e.
drug/alcohol
abuse)
(Howell &
Hawkins,
1998, p. 271).
Criminal
Activity
Involvement
(Howell &
Hawkins,
1998, p. 265).
Reduce
violence in
youth
affiliated
with a gang
• Antisocial Behavior
(Blair,
Colledge,
Murray, &
Mitchell, 2001,
p. 491).

In regard to future research and practice, I would recommend studying more geographic
locations and determining where to implementing programs. This would be effective in
determining the specific behaviors and determinants that are most prevalent in that population in
order to effectively address that area. The program would function in a much more orderly
fashion and would produce the best results. I would also separate groups by age, gender, and
economic class. This is because the being in a gang affects these groups differently; each has
their own experience as a member. Finally, I would research whether bullying and gangs are
relational and how they affect each other. Studies in this area can reduce violence in more
aspects in the lives of children.

References
Blair, R. J. R., Colledge, E., Murray, L., & Mitchell, D. G. V. (December 2001). A Selective
Impairment in the Processing of Sad and Fearful Expressions in Children With
Psychopathic Tendencies. Journal of Abnormal Child Psychology, 29(6).
Dupere, V., Lacourse, E., Willms, J. D., Vitaro, F., & Tremblay, R. E. (July 2006). Affiliation to
Youth Gangs During Adolescence: The Interaction Between Childhood Psychopathic
Tendencies and Neighborhood Disadvantage. Journal of Abnormal Child Psychology,
35(1035).
Ellickson, P., Saner, H., & McGuigan, K. A. (1997). Profiles of Violent Youth: Substance Use
and Other Concurrent Problems. American Journal Of Public Health, 87(6), 985-991.
Esbensen, F., Peterson, D., Taylor, T. J., Freng, A., Osgood, D. W., Carson, D. C., & Matsuda,
K. N. (2011). Evaluation and Evolution of the Gnag Resistance Education and Training
(G.R.E.A.T.) Program. Journal of School Violence, 10(53).
Esbensen, F., Winfree, L. T., Terrance, He, N., & Taylor, T. J. (2001). Youth Gangs and
Definitional Issues: When is a Gang a Gnag, and Why Does it Matter?. Crime and
Delinquency, 47(105).
Fertman, C. I. & Allensworth, D. D. (2010). Health Promotion Programs: From Theory to
Practice. San Francisco, CA: Society for Public Health Education.
Howell, J. C. (December 2010). Gang Prevention: An Overview of Research and Programs.
Howell, J. C., & Hawkins J. D. (1998). Prevention of Youth Violence. Crime and Justice, 24.
Miller, J. (1998). Gender and Victimization Risk Among Young Women in Gangs. Journal of
Research in Crime and Delinquency, 35(4).
Shelden, R. G., Tracy, S. K., & Brown, W. B. (2004). Youth Gangs in American Society.
Belmont, CA: Wadsworth Cengage Learning.

Peterson, D., Taylor, T., & Esbensen, F. (December 2004). Gang Membership and Violent
Victimization. Justice Quarterly, 21 (No. 4).

Hoarding: A Community Health Problem
Taylor Jenkins & Ariana Ochoa
HSC300 Health Communication
Dr. Parks
December 6, 2015

Hoarding
Overview of Disorder
Hoarding is the insistent difficulty to discard or part with possessions, regardless of their
actual value. This behavior usually has harmful effects emotionally, physically, socially,
financially, and even legally. These effects not only affect the hoarder but also close family
members and friends. People hoard because they believe that an item will be of use or obtain
high value at some point in the future. The items that tend to be kept around have sentimental
value, are irreplaceable, or cannot be decided to throw away. The hoarder may also consider an
item as a reminder that will spark their memory about a certain person or event that they are
scared to forget about. Mostly, they cannot bring themselves to making an executive decision of
where something belongs causing them to settle with keeping it. (Neziroglu, 2015) Hoarding
disorders are very challenging to treat because most people often don't see it as an issue or have
little awareness of how it's hurting their life. Many others are able to realize they have a problem
but are hesitant to seek help because they feel extremely ashamed, embarrassed, or guilty about
it. (National Health Service, 2015)
Importance of Health Issue
A lack of functional living space is a common threat amongst hoarders. Their living
conditions transform into an unhealthy and dangerous environment for any individual entering
the home. Homes affected by hoarding often are furnished with broken appliances, which leave
the homeowner without heat and other necessary comforts. They learn to cope with their
malfunctioning systems rather than opening their home to allow a qualified person in to fix the
problem. The rise of hoarding in America produces serious risk to those who are affected by this
psychiatric disorder. Such unhealthy conditions can drive people to separation or divorce,
eviction, or even loss of child custody. Along with devastating living conditions, hoarding also

brings about anger, resentment, and depression amongst family members, which can affect
relationships and the social development of young children. Hoarding may also lead to serious
financial problems. Homelessness can occur if the local Department of Public Health orders the
person out of the home if the landlord can prove that the level of hoarding seriously violates the
terms of the lease. Health problems range from falls or accidents to the inability of emergency
personnel to enter and remove an ill resident. Hoarded items not only include clutter but also
garbage and animal or human feces, which can result in mold or infestation in the house. In the
presence of mold, serious respiratory and cardiac issues can arise. A lack of sanitation can be
especially dangerous to individuals suffering from compromised immune systems. (Health and
Human Services, 2015)
Magnitude and Scope of Health Issue
Perfectionism, indecision, and procrastination are all unique and significant
characteristics commonly associated with hoarding cases. It is suspected that those who have
achieved a higher level of education are more likely to hoard insignificant objects. Hoarding
behavior usually begins in teen years of childhood or adolescence; however it often doesn't
become a burden until the later years of life. The issue has always been present but not relevant
enough that no one has noticed. People with a hoarding disorder have a tendency to be single or
become single due to their condition conflicting with their relationship. Hoarders often avoid any
social outings by choosing to isolate themselves from other people. Hoarding is not a very
common disorder but when it is present it may harm one’s self or affected loved ones. Based on
estimates retrieved from a study conducted by US college students, the prevalence rate of
compulsive hoarding disorder is between two and four percent. The number of those with
Obsessive Compulsive Disorder that also suffer from compulsive hoarding comes out to less
than 1 in 200 people or 0.5% of the population. OCD has a lifetime prevalence of one to two

percent of the population and around 25% to 30% of patients with OCD are also diagnosed as
compulsive hoarders. Compulsive hoarding, however, has not had any major epidemiological
studies conducted treating it as its own disorder. Researchers suspect that this is a very
conservative estimate and it is actually much higher nearing five percent of the population.
(Cluttergone, 2014)
Summary of Research on Biological and Social Determinants of the Health Issue
In the past 25 years, there has been a rising curiosity in hoarding among mental health
clinicians, academic researchers, and ultimately the population. It is estimated that approximately
2-5% of the American population are hoarders. There are still many questions regarding the
cause(s), however it has been found that this appears to impact men more often than women
(Bratiotis, C., 2013, p. 245). In recent studies it was also found that 20-30% of people suffering
from Obsessive Compulsive Disorder (OCD) are hoarders; similar findings was among
individuals with anorexia nervosa, psychotic disorders, depression, and organic mental disorders.
Comparative studies have taken place between non-OCD and OCD hoarding patients; “all
[OCD hoarding patients] have found greater functional disability and more severe
psychopathology in hoarders.” (Saxena, S. & Maidment, K.M., 2004, p. 1146). In this same
study, hoarders had more anxiety, depression, personality disorder symptoms, and family and
social disability. This indicates that compulsive hoarders behave in a unique manner and have
similar characteristic patterns of symptoms and disability. Genetic and family studies have
suggested that the hoarding factor of OCD is different than other OCD symptoms. The hoarding
symptom shows an autosomal recessive inheritance pattern and has been associated to certain
genetic markers. Furthermore, 84% of compulsive hoarders reported a family history of hoarding
behaviors. This may suggest a subgroup or some sort of variant of OCD (Saxena, S. &
Maidment, K.M., 2004, p. 1146).

Hoarding behavior typically begins a young age, however it isn’t as notable or severe until it
reaches the elderly population. The issue is that only 15% of elderly clients that exhibit
substantial problems with hoarding recognized it. In other words, most elderly hoarders do not
realize there is an issue. This lack of discernment may be due to memory-loss or the sense of
responsibility to avoid being wasteful. A characteristic that is typical to the hoarding population
is the strong belief about the necessity of saving possessions. Many even displaying violent
behavior towards friends or family who attempt to dispose of their things (Frost, R., Steketee, G.,
& Williams, L., 2000, p. 229-230).
Interventions towards the Target Audience
In attempts to reduce the progression of hoarding behaviors, there are several treatment
options for patients. These are used to treat the symptoms of the determinants, not necessarily
hoarding itself. A common factor among people with anxiety and depression is the inhibition of
Serotonin in the brain. An effective treatment falls under pharmacotherapy; Serotonin Reuptake
Inhibitor (SRI). The combination of the medication and cognitive- behavioral therapy (CBT) has
been proven to be effective. The basis of CBT model outlines four main problem areas:
information processing deficits, problems in forming emotional attachments, behavioral
avoidance, and incorrect beliefs about the nature of possessions. The goals of the use of the
treatments is to decrease clutter, improve decision making and organizational skills, and
strengthen urges to accumulate and save items (Saxena, S. & Maidment, K.M., 2004, p. 1146).
The most difficult part of approaching the issue of hoarding is receiving knowledge of those
hoarders. Currently, the only intervention there is against this is officials coming to that person’s
home in an attempt to coerce them into seeking treatment and discarding of those items.

Recommended Actions for Target Audience
A recommendation to begin intervention would have to be on any parents’ part. Since we
know that hoarding behaviors begin at an early age, parents would need to teach their children
skills and behaviors that involve beliefs about amounts of possessions and organizational skills.
In terms of addressing this issue in older generations, there would have be reports of hoarders in
communities to confront the issue. However, there may be another way of knowing, instead of
waiting for responses from the community. There could be the possibility of placing a policy in
action to inspect homes every 5-10 years. To be more cost efficient, possibly performing
inspections more frequently in areas where populations are more susceptible to have hoarders.
This would require more studies on individuals in communities, possibly through sample size
surveys. The surveys could focus on questions that would trace symptoms to anxiety, depression,
OCD, and others linked to hoarding. Once hoarders are located, then give a warning to the home
owner to seek treatment and discard of those items, otherwise a fine may be placed on them.
These recommended actions may have a greater impact on reducing hoarding and reduce the
depletion of necessary resources on what could have been addressed earlier.
Conclusion
Hoarding is a terrible condition that affects not only the individual, but can branch out to the
community, and ultimately an entire population. This can potentially threaten every aspect of a
person’s life; financially, legally, physically, emotionally, psychologically, and so on. The
measures taken to handle this issue take a toll on communities’ resources that could hinder
assistance in other areas. There are several steps that individuals and the government can take in
order to prevent it from ever happening or addressing it quickly. Of course, as any intervention,
the process will take time, planning, and funds. However, these goals are attainable with careful
consideration of all contributing factors.

References
Bratiotis, C. (2013). Community hoarding task forces: a comparative case study of five task
forces in the United States. Health & Social Care In the Community, 21(30, 245-253.
Cluttergone. (2014). Prevalence and Demographics. (Cluttergone, Producer) Retrieved from
Compulsive Hoarding: http://www.compulsive-hoarding.org/Prevalence.html
Frost, R., Steketee, G., & Williams, L. (2000). Hoarding: a community health problem. Health &
Social Care In The Community, 8(4), 229-234.
Health and Human Services. (2015). Risks Caused by Hoarding. (C. W. Massachusetts, Producer)
Retrieved from Mass.gov:
http://www.mass.gov/eohhs/consumer/behavioralhealth/hoarding/risks-caused-by-
hoarding.html
National Health Service. (2015). Hoarding Disorder. (N. H. Service, Producer) Retrieved from
NHS Choices: http://www.nhs.uk/Conditions/hoarding/Pages/Introduction.aspx
Neziroglu, F. (2015, July). Hoarding: The Basics. (A. a. America, Producer) Retrieved from Anxiety
and Depression Association of America:
http://www.adaa.org/understandinganxiety/obsessive-compulsive-disorder-
ocd/hoarding-basics
Saxena, S., & Maidment, K.M. (2004). Treatment of compulsive hoarding. Journal of Clinical
Psychology, 60(11), 1143-1154.

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