Five Problems, One Priority: A Community Health Assessment of a Composite Rural County and the Case for Teen Crash Prevention
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Master of Science in Nursing Program, Aspen University
N680: Public Health Nursing
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Five Problems, One Priority: A Community Health Assessment of a Composite Rural County and the Case for Teen Crash Prevention
A community health assessment earns its cost only when it helps someone decide what to do next. This assessment was prepared for the health department of a composite rural county of about 38,000 residents, whose board asked the nursing division to recommend one problem for a three-year population health effort. It describes the county, the data sources used and their limits, the five problems that stood out, how they were scored and ranked, and why deaths of teenagers in motor vehicle crashes ranked first. All county figures are composite values constructed for teaching; the sources and methods are those a public health nurse would use with real data.
The County
The county lies along a state highway between two small cities. Its population is older than the state average, 91% White with a growing Hispanic community employed in meatpacking and dairy work, and 14% of residents live below the poverty line. The county's only hospital is a small critical access facility without trauma capability; the nearest level II trauma center is 70 miles away. The high school graduation rate is high, but many young people drive long distances on two-lane roads to school, jobs and sports. Most residents have no public transportation option, so a driver's license at 16 is treated as a necessity rather than a privilege.
Data Sources and Their Limits
Four types of data were used. The County Health Rankings provided standardized county measures across health outcomes and health factors, allowing comparison with the state and nation; its model weights length of life, quality of life and factors including health behaviors, clinical care, income, education and community conditions, and the built and natural environment (Remington et al., 2015). The state's crash records system supplied five years of fatal and serious injury crashes by age, time, seat belt use and road type. The state's vital statistics office supplied death certificate data, and the hospital's emergency department supplied visit counts. Finally, nurses held six listening sessions with parents, students, farmworkers, older adults, faith leaders and first responders.
Each source has limits. Rankings measures combine several years to produce stable rates in small counties, so they lag behind current conditions. Small numbers make county rates unstable: a single crash with three deaths changes the rate substantially. Listening sessions reflect those who attend. For these reasons, the assessment relied on five-year combined rates, compared the county with the state rather than ranking small differences, and treated community views as one criterion among several rather than a vote.
Five Candidate Problems
Five problems stood out when county measures were compared with the state. The table summarizes the composite figures used in the ranking.
| Problem | County | State | Notes |
|---|---|---|---|
| Motor vehicle crash deaths, per 100,000 | 24 | 12 | Five-year rate; one in four deaths aged 15 to 20 |
| Adult obesity | 38% | 34% | Rising slowly; similar to rural counties statewide |
| Adults without health insurance | 12% | 8% | Concentrated among farmworker families |
| Adult smoking | 21% | 16% | Falling slowly |
| Suicide deaths, per 100,000 | 22 | 17 | Small numbers; mostly men over 45 |
Crash data added detail to the first problem. Over five years, the county recorded 46 motor vehicle deaths, 12 of them among people aged 15 to 20. Of those 12, nine occurred at night or on weekends, eight were unbelted, and seven crashes involved a teen driver with at least one teen passenger. Teens were also involved in 31 serious injury crashes. In listening sessions, parents raised teen driving more than any other concern, often naming a crash that had killed a student in recent years.
Scoring and Ranking
The team scored each problem from 1 to 5 on five criteria: size, the number of people affected; severity, including deaths and years of life lost; trend; disparity between groups; and changeability, whether evidence-based interventions exist that a county health department and its partners can deliver. Changeability and severity were weighted double, because the board's aim was measurable progress within three years. Community concern was used to break ties. Three nurses scored independently and then agreed on final scores through discussion.
| Problem | Size | Severity (x2) | Trend | Disparity | Changeability (x2) | Total |
|---|---|---|---|---|---|---|
| Teen crash deaths | 2 | 10 | 3 | 4 | 8 | 27 |
| Suicide | 2 | 10 | 4 | 3 | 6 | 25 |
| Uninsured adults | 3 | 6 | 3 | 5 | 6 | 23 |
| Adult smoking | 4 | 8 | 2 | 3 | 6 | 23 |
| Adult obesity | 5 | 6 | 3 | 2 | 4 | 20 |
Why Teen Crash Deaths Ranked First
Teen crash deaths scored highest because they combine severe consequences, the loss of most of a lifetime, with strong evidence for interventions a county can support. Graduated driver licensing, which restricts nighttime driving and teen passengers for new drivers, is associated with fewer fatal crashes among 16-year-olds; in a national analysis, states with stronger programs had about 26% fewer fatal crashes involving 16-year-old drivers than states without the key elements, though they also had somewhat more among 18-year-olds, suggesting that some teens delayed licensure and then drove without restrictions (Masten et al., 2011). A later review concluded that the benefits of these programs depend heavily on how well families understand and enforce the restrictions, and recommended parent involvement as a way to extend their effect (Williams, 2017).
That finding points to a clear public health nursing role. The county's crash data show that most teen deaths occurred at night, unbelted or with teen passengers, the very behaviors graduated licensing and parental agreements target. School nurses, public health nurses and the high schools' driver education program can reach every family of a new driver. Suicide ranked a close second and is not being set aside; the assessment recommends that the department join the state's existing suicide prevention coalition while leading on teen crash prevention.
Next Steps
The nursing division recommends forming a teen driving coalition with the schools, the sheriff's office, the hospital, parents and student leaders; setting a goal of zero teen crash deaths and a 30% reduction in teen serious injury crashes over three years; and monitoring belt use through an annual observational survey at high school parking lots. The next module's work will develop the intervention plan in detail.
Conclusion
This assessment combined standardized county measures, local crash and death records, emergency visit data and community voices to identify five problems and rank them with explicit criteria. Teen motor vehicle crash deaths ranked first because they are severe, concentrated in behaviors that evidence-based measures address, and a concern parents raised repeatedly. The ranking gives the board a clear recommendation and shows public health nurses using population data to decide where their work can save the most years of life.
References
Masten, S. V., Foss, R. D., & Marshall, S. W. (2011). Graduated driver licensing and fatal crashes involving 16- to 19-year-old drivers. JAMA, 306(10), 1098-1103. https://doi.org/10.1001/jama.2011.1277
Remington, P. L., Catlin, B. B., & Gennuso, K. P. (2015). The County Health Rankings: Rationale and methods. Population Health Metrics, 13, Article 11. https://doi.org/10.1186/s12963-015-0044-2
Williams, A. F. (2017). Graduated driver licensing (GDL) in the United States in 2016: A literature review and commentary. Journal of Safety Research, 63, 29-41. https://doi.org/10.1016/j.jsr.2017.08.010
How this N 680 Module 2 example is structured
Aspen does not publish N680 module prompts, so check your classroom for the exact instructions. This example describes the county, names each data source and its limits, compares five problems with state figures in a table, scores them on explicit weighted criteria, justifies the top priority with evidence, and sets next steps.
N680 Module 2 questions, answered
What does N680 Module 2 usually ask for?
Aspen's N680 description emphasizes using population data to assess, plan, monitor and evaluate, so a community assessment built from county data with priorities identified is a typical assignment. Check your classroom for the prompt.
How should I rank community health problems?
Use explicit criteria, such as size, severity, trend, disparity and whether effective interventions exist, score each problem, and explain any weighting. Methods such as the Hanlon method formalize this.
What if my county's numbers are small?
Use multiyear combined rates, compare with state figures rather than over-interpreting small differences, and state the limitation in the paper.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.