A public health nurse plans to assess a community using the CHANGE model. According to this model, which of the following steps should the nurse take first?

Choice A: "When the Exposure is Decreased or Eliminated, the Risk of Disease Declines or is Eliminated."
This statement accurately describes the concept of cessation of exposure in establishing causation. According to the Bradford Hill criteria, if a factor is truly causal, reducing or eliminating exposure to that factor should lead to a decrease in the incidence of the disease. This principle helps to confirm the causal relationship between the exposure and the disease.

Choice B: "The Exposure Must Come Before the Disease Develops."
This statement refers to the temporal relationship criterion in the Bradford Hill criteria, which states that for an exposure to be considered causal, it must precede the onset of the disease. While this is an important aspect of establishing causation, it does not specifically address the concept of cessation of exposure.

Choice C: "A Relationship is Biologically Possible, and it Makes Sense."
This statement pertains to the biological plausibility criterion, which suggests that the observed association between an exposure and a disease should be consistent with existing biological and medical knowledge. While biological plausibility is crucial for establishing causation, it does not directly relate to the cessation of exposure.

Choice D: "Increased Exposure Increases the Risk of Developing the Disease."
This statement describes the dose-response relationship, another criterion in the Bradford Hill framework. It indicates that a greater level of exposure to a risk factor should correspond to a higher risk of developing the disease. Although this is an important aspect of causation, it does not specifically address the cessation of exposure.

Choice A Reason:
Posting the analyzed findings on the health department section of the city's website is important for transparency and public awareness. It allows the community to access the information and understand the health issues identified. However, this action alone does not directly address the health issues identified in the assessment. It is more of a communication strategy rather than an intervention.

Choice B Reason:
Educating members of a vulnerable population about available public health services is a crucial step in ensuring that these populations can access the services they need. This action helps in bridging the gap between the health department and the community. However, it is a part of the implementation phase rather than the planning phase. The primary goal of the assessment is to identify issues and plan interventions.

Choice C Reason:
Conducting focus groups with local residents to discuss their usage of public health services is a valuable method for gathering qualitative data and understanding community needs and behaviors. This can provide deeper insights into the issues identified in the assessment. However, like choice B, this is more of a data collection method rather than a direct action plan to address the identified health issues.

Choice D Reason:
Preparing a plan to address a health issue in a specific area of the city is the most direct and actionable step that aligns with the core function of assessment. The purpose of conducting a community health assessment is to identify health issues and develop strategies to address them. This choice involves creating a targeted intervention plan based on the findings, which is the ultimate goal of the assessment process.