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Running head: EVIDENCE-BASED COMMUNITY INTERVENTION

Evidence-Based Community Intervention: Maternal and Early Childhood Health Among African
Americans in Hillsborough County, Florida
Taylor Kelly
University of South Florida College of Nursing

EVIDENCE-BASED COMMUNITY INTERVENTION

Evidence-Based Community Intervention: Maternal and Early Childhood Health Among African
Americans in Hillsborough County, Florida
After further research of the Hillsborough county, Florida 2014 Health Profile, strengths
and weaknesses of the public health system were identified. Amongst the areas in need of
improvement, the priority health issue is the prevalence of decreased maternal and early
childhood health among the African American population.
Hillsborough county is located in the central-western part of the of state of Florida; the
size of Hillsborough county is approximately 1,136 square miles, with a 2010 population of
1,229,226 residents ("County Information", 2012). Hillsborough county consists primarily of an
urban city surrounded by suburban neighborhoods, and businesses. Major employers of the area
include: Baycare Health System, Inc., Publix Super Markets, Home Shopping Network,
University of South Florida, WellCare, and Tampa General Hospital ("Major Employers", 2016).
According to the 2014 Hillsborough County Health Profile, 16.8% of the population
living in Hillsborough county live below 100% of the federal poverty line, compared to 16.3% of
individuals at the state level. Also, 7% of the population of Hillsborough county is unemployed,
and an average per capita income of $27,149 2014 (Hillsborough County Health Profile, 2014).
Additionally, 85.8% of the population of Hillsborough county over the age of twenty-five have
received a high school diploma, similar to the Florida state level of 85.3% (Hillsborough County
Health Profile, 2014).
After analyzing the data provided in the 2014 Hillsborough County Health Profile, three
main strengths in the county and three main weaknesses were determined. The three strengths of
the county include: smoking cessation, immunizations, and cholesterol awareness among
individuals residing in Hillsborough county. According to the 2014 Hillsborough County Health

EVIDENCE-BASED COMMUNITY INTERVENTION

Profile regarding Behavioral Risk Factors, the number of adults in Hillsborough county in which
are smokers that have recently tried to quit smoking at least once in the past year has steadily
increased from 56.2% in 2002, to 68.7% in 2013 (Behavioral Risk Factors, 2014). This increase
in smokers that have attempted to quit smoking may be attributed to the Tobacco Free Florida
campaign, in which free resources such as information on nicotine replacement therapy, and
online support is provided. The second health related strength of the Hillsborough county is
immunization history; the amount of adults that have ever received a pneumococcal vaccine
nearly doubled from 2002 (17%) to 2013 (31%) (Behavioral Risk Factors, 2014). Similarly, the
amount of adults that have received a flu shot in the past year increased from 23.3% in 2002, to
30.5% in 2013 (Behavioral Risk Factors, 2014). The final strength of identified is cholesterol
awareness among adults; according to the 2014 Hillsborough County Health Profile, more adults
are aware of their cholesterol status. The percentage of adults in Hillsborough county that have
had their cholesterol levels check in the past two years increased from 73.8% in 2002 to 74.8%
in 2013 (Behavioral Risk Factors, 2014).
On the contrary, there were also three health related weaknesses that need
improvement identified including: Sexually transmitted disease prevalence, the frequency of
adults that are obese and inactive, and maternal and child health, specifically among African
Americans in Hillsborough county. According to the 2014 Reportable and Infectious Diseases of
Hillsborough county chart, the total three-year rate per 100,000 individuals with gonorrhea,
chlamydia, and infectious syphilis was 738.0 in Hillsborough county, versus 531.5 in the state
(Reportable and Infectious Diseases, 2014). Second, according to the 2014 Hillsborough County
Health Profile, the percentage of adults that are obese in Hillsborough county is significantly
higher than at the state level, additionally the percentage of adults that are inactive in

EVIDENCE-BASED COMMUNITY INTERVENTION

Hillsborough county is also greater than at the state level (Hillsborough County Health Profile,
2014); this information is concerning due to the correlation between inactivity and heart disease.
Lastly, the 2014 Hillsborough County Health Profile also revealed that prevalence of infant
deaths, including neonatal deaths (0-27 days) and postneonatal deaths (28-364 days), among
African Americans in Hillsborough county is much greater than any other race in the county. It is
also evident that more African American babies are born at a low birth weight than any other
race in the county (Maternal & Child Health, 2014).
The priority health issue identified by the 2014 Hillsborough County Health Profile is
maternal and child health among African Americans, specifically infant death rates, low birth
weight deliveries, and children born to African American mothers aged fifteen to nineteen. This
is a particularly concerning issue because it illustrates a major health discrimination within
Hillsborough county that is detrimental to African American mothers, and their babies. With
public health programs set into place to increase maternal and child health among African
Americans in Hillsborough county, the prevalence of infant deaths and low birth weight infants
will decrease, allowing costs related to hospitalizations and other medical costs will decrease as
well.
According to the 2014 Hillsborough County Health Profile, infant deaths among African
Americans in Hillsborough county is 12.3%, compared to 5.8% of Caucasians, and 8.6% of
Hispanics; also, this 12.3% is approximately double what the infant death rate is across the state
of Florida, 6.1% (Maternal & Child Health, 2014).Concurrently, live low birth weights (under
2,500 grams) among African American infants in Hillsborough county is 13.9%, while only 8.6%
at the state level (Maternal & Child Health, 2014).The staggering amount of low birth weight

EVIDENCE-BASED COMMUNITY INTERVENTION

African American babies born may be a contributing factor in the great amount of infant deaths
occurring within the same population.
Another confounding result of the 2014 Hillsborough County Health Profile is the
amount of African American mothers aged fifteen to nineteen, compared to other races in the
same county. African American mothers aged fifteen to nineteen account for 42.3% of mothers in
that category, whereas on 24.9% are Caucasian, and 32.5% are Hispanic (Maternal & Child
Health, 2014).
The Determinants-of-Health-Model is used to define the cause of certain health issues
among a population and allow for healthcare providers to form tailored interventions in order to
resolve said issues; this can be done by analyzing different factors of the population in question
that may cause the health issue, such as human biology, the healthcare system, environmental
factors, and the populations lifestyle.
For instance, The Determinants-of-Health-Model can be used to evaluate the priority
health issue of maternal and child health among African Americans, specifically infant death
rates, live low birth weight deliveries, and children born to African American mothers aged
fifteen to nineteen. Although human biology is not a modifiable risk factor, it is still important to
note that biological factors including fertility, genetic congenital anomalies, and some
complications of pregnancy can all lead to decreased maternal and child health. The healthcare
system can also directly contribute to maternal and child health. For example, access to prenatal
care and pediatrician follow up visits; pregnant mothers that do not receive prenatal care are
more likely to result in prematurity, stillbirth, early and late neonatal death, and infant death
(Partridge, Balayla, Holcroft, & Abenhaim, 2012).

EVIDENCE-BASED COMMUNITY INTERVENTION

Also, environmental factors can effect the health of pregnant mothers and their infants,
such as: socioeconomic factors that contribute to the ability to afford of care, the safety of the
mother and child, and cultural beliefs regarding healthcare. Similarly, lifestyle choices by
pregnant women can deeply change the outcome of their pregnancy. For instance, the use of
tobacco, alcohol, and drugs while pregnant can negatively effect the pregnancy and the infant,
stress can also contribute to preterm birth, and domestic violence among pregnant women can
have detrimental effects against mothers and their infants. Therefore, it is evident that African
Americans of Hillsborough county are at risk for poor maternal and early childhood health based
on evidence from the 2014 Hillsborough County Health Profile.
In order to correct this health difference among African Americans in Hillsborough
county, a population-based intervention must be put into place using the Levels of Prevention
Model. The Levels of Prevention Model uses three stages of prevention: primary, secondary and
tertiary. Primary prevention is used to prevent the health issue in its entirety through the use of
risk factor modification. The policy proposal will be focused on the primary level of prevention,
which includes providing greater access to prenatal care to pregnant African Americans residing
in Hillsborough county.
The population of the primary prevention policy is pregnant African Americans of
Hillsborough county. In order to prevent low birth weight infants and infant death among this
population, it is imperative that pregnant African American women receive affordable prenatal
care starting in their first trimester. Prenatal care will allow women to receive information and
guidance on healthy practices during pregnancy, early screenings of neonatal abnormalities, track
the progress of their pregnancy, and to early identify any risk factors of infant death or low birth
weight. Ideally, funding would be provided through state grants; therefore, the target

EVIDENCE-BASED COMMUNITY INTERVENTION

stakeholders for this health policy proposal would be public health officials. This program would
allow the state to save money on hospitalization and healthcare costs of at risk infants, by
preventing complications.
The secondary level of prevention aims to halt the progression of an already existing
health issue through early detection and immediate treatment. In the case of African American
maternal and early childhood health, the secondary intervention would provide resources for
pediatrician follow up care for at risk and low birth weight African American infants residing in
Hillsborough county in attempts to prolong or stop the development of future complications, or
infant death within the first year of life through ways of early detection. Community health
nurses and healthcare providers will focus on providing routine developmental screenings,
immunizations, referrals to specialists, and education to parents of at risk and low birth weight
African American infants. Again, this proposal would be state funded and be targeted towards
public health officials and legislators.
Lastly, the tertiary level of prevents strives to reduce the complications of any given
health issue or disease. In this case, the tertiary intervention would provide support groups for
African American parents that have experience infant death, or have an at-risk infant at home;
this would help soften the impact, and help parents deal with the consequences of having an at
risk infant. This program would be volunteer based, and therefore the policy would be geared
towards healthcare providers and community based nurses that are willing to volunteer their time
to lead weekly support groups for this population. By using volunteer healthcare providers, this
allows the group to be lead by a professional that is able to be adequate education regarding
prevention, and information on healthy coping mechanisms.

EVIDENCE-BASED COMMUNITY INTERVENTION

Generally, health policy tends to directly effect the type of healthcare a population is
eligible to receive. The health policy proposal discussed regarding African American maternal
and early childhood health in Hillsborough county aims to remove the current health disparity, in
order to allow for adequate healthcare opportunities among the at risk population. The primary
focus of the policy proposal will be at the level of primary prevention in order to achieve the goal
of dramatically decreasing the number of African American low birth weight infants, and to
reduce the incidence of African American infant deaths in Hillsborough county.
The general plan to put the proposal into action is present the policy to public health
officials and legislators in order to receive the adequate funding for the program. This health
policy proposal will impact Hillsborough county by reducing costs of the population with the
highest incidence of low birth weight infants and adjoining complications. In general, this health
policy will enhance the health of the population by allowing for a more effective allocation of
resources to focus on prevention and detection, rather than covering the copious amount of
funding a developed health issue.
In all, there were several strengths and weaknesses identified of the healthcare system of
Hillsborough county, Florida. Of those areas in need of improvement, the priority health issue is
the prevalence of decreased maternal and early childhood health among the African American
population. With added health policy focusing on primary prevention, the health disparity
amongst the African American population can be decreased. This is relevant to my nursing career
because it highlights the massive impact that policy has over the entire healthcare field. Health
policies are constantly evolving, and therefore it will be very important to be aware of changing
health policies within the field of healthcare that I chose as a career.

EVIDENCE-BASED COMMUNITY INTERVENTION

References
2014 Hillsborough County Health Profile. (2014). Retrieved March 08, 2016, from
http://www.hcwcfl.org
Behavioral Risk Factors. (2014). Retrieved March 09, 2016 from
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=29&reportYear=2014&tn=31
County Information. (2012). Retrieved March 08, 2016, from
http://www.hillsborough.communityatlas.usf.edu/general/?id=12057
Feijen-de Jong, E. I., Jansen, D. E., Baarveld, F., Boerleider, A. W., Spelten, E., Schellevis, F., &
Reijneveld, S. A. (2015). Original Research Quantitative: Determinants of prenatal
health care utilisation by low-risk women: A prospective cohort study. Women And Birth,
2887-94. doi:10.1016/j.wombi.2015.01.005
Major Employers. (2016). Retrieved March 08, 2016, from http://www.tampabay.org/site-s
election/major-employers
Maternal & Child Health. (2014). Retrieved March 09, 2016 from
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=29&reportYear=2014&tn=31
Partridge, S., Balayla, J., Holcroft, C. A., & Abenhaim, H. A. (2012). Inadequate Prenatal Care
Utilization and Risks of Infant Mortality and Poor Birth Outcome: A Retrospective
Analysis of 28,729,765 U.S. Deliveries over 8 Years. American Journal Of Perinatology,
29(10), 787-793 7p. doi:10.1055/s-0032-1316439
Reportable and Infectious Diseases. (2014). Retrieved March 09, 2016 from

EVIDENCE-BASED COMMUNITY INTERVENTION


http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=29&reportYear=2014&tn=31

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