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 reason: Studies show a minimal increase in confidence levels among mentored youth
While mentorship can have various benefits, the statement that it shows only a minimal increase in confidence levels is not entirely accurate. Research indicates that mentorship programs can significantly boost self-esteem and self-confidence among youth. However, this choice does not directly address the primary rationale for referring a disruptive student to a mentorship program.

Choice B reason: Students who are mentored are more likely to attain educational success
This statement is supported by extensive research. Mentorship programs have been shown to improve academic performance, increase high school graduation rates, and enhance overall educational aspirations. Mentored students often receive guidance, support, and motivation that help them succeed academically. This rationale aligns well with the goal of addressing disruptive behavior in school by providing positive role models and support systems.

Choice C reason: Mentored teens tend to recover better from bullying experiences
Mentorship can indeed help teens recover from bullying by providing emotional support and guidance. Mentors can offer a safe space for mentees to discuss their experiences and develop coping strategies. However, while this is a valid benefit of mentorship, it is not the primary rationale for referring a disruptive student to a mentorship program.

Choice D reason: Mentorship will help the child avoid social activities during the teen years
This statement is incorrect. Mentorship programs aim to encourage positive social interactions and engagement in constructive activities. They do not seek to isolate children from social activities but rather to guide them towards healthier and more productive social engagements. Therefore, this rationale does not support the referral for mentorship.

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.