1. Recognizing the issue
   grass roots- citizen oriented; organized from bottom-->up 
   top down/outside in- from outside community
2. Gaining  entry into the community
   gate keepers- those who control, both formally and informally the political climate of the community
   cultural competence- must be aware of cultural differences within the community and effectively work with the cultural context 
3. Organizing with the people
   identify leaders and executive participants
4. Assessing the community
   community building- orientation to community that is strength-based and stresses identification, nurturing, and celebration of assets
   needs assessment- data is collected and analyzed
   mapping community capacity- literally using a map to identify community assets; primary, secondary, potential building blocks
5. Determining priorities and setting goals
6. Arriving at a solution and selecting intervention strategies
   health communication, health education, health policy/enforcement, environmental change, or health-related community services
7. Implementing
8. Evaluating
9. Maintaining
10. Looping Back
    
    

• communities can develop the capacity to deal with their own problems
• people want/can change
• people should participate in making changes
• changes are self-imposed and have meaning that imposed changes don't have
• 'holistic approach' can successfully address problems that 'fragmented approach' cannot cope
• democracy requires cooperative participation and action in affairs of the community, and people must learn skills to make this possible
• frequently, communities of people need help in organizing to deal with their needs

• congenital abnormalities
• preterm/LBW
• SIDS
• pregnancy complications
• respiratory distress syndrome

• 84% received prenatal care in 2003; Healthy People 2010 goal is 90%
• Black, Native American, Hispanic, poorly educated are significantly less likely to receive early prenatal care

• 1998- 21%, 2010 target 15%
• already had c-section or uterus surgery
• baby is too big
• baby is breeched/transverse
• placental problems
• labor is too slow
• HIV infection/herpes
• twins
• birth defect

• infection
• increased blood loss
• decreased bowel function
• respiratory complications
• longer hospital stay and recovery time
• reaction to anesthesia
• premature birth
• low Apgar scores

• leading cause of LBW
• 20-30% LBW, 10% infant deaths
• dropped from 19.5% in 1989 to 10.% in 2003
• 99% goal for 2010

• hemorrhage
• embolism
• pregnancy-induced hypertension
• sepsis/infection
• anesthesia- related complications

1. Unintentional injuries
2. Cancer
3. Homicide
4. Suicide
5. Heart Disease

1. Unintentional injuries
2. Homicide- #1 for African Americans
3. Suicide
4. Cancer
5. Heart Disease

• unintentional injuries
• violence
• substance abuse and mental health
• sexual health
• lifestyles leading to problems later in life

Risk Factors to Adolescent Violence

• poor monitoring/supervision
• exposure to violence
• poverty
• poor attachment to parents
• peer groups

• parks and recreation programs
• SADD
• school lock-in on prom night
• VERB campaign

1. Unintentional injuries
2. Cancer
3. Heart Disease
4. Suicide
5. Homicide

1. Cancer
2. Heart disease
3. Unintentional injuries
4. Diabetes
5. Stroke
6. CRLD

• single best behavioral change- stop smoking
• only 22% get enough exercise to achieve fitness
• 2/3 of 20-74 year olds are overweight or obese

• self-monitoring
• goal-monitoring
• stimulus control
• self-reinforcement
• social support
• *Relapse Prevention Model