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Running Head: PASCO COUNTY

Pasco County: Preventing the Dangers of Melanoma


Shannon OShea
University of South Florida

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

Pasco County: Preventing the Dangers of Melanoma


As the ninth most populated county, in the fourth most populated state in the United
States, Pasco is an excellent area to be studied. Between the large population and the harsh
Florida environment several health concerns are on the rise in Pasco county. After researching
the population of Pasco and the overall health of the county, data and information shows that the
area has several health needs that are not properly being met. Through the data gathered
important procedures and policies can be implemented to improve the health of the county, and
decrease disparities.
Pasco county is located on the western coast of Florida, and is centrally located within the
state. The county is considered both rural and urban. The western portion of Pasco county
includes suburbs, retirement communities and businesses. The eastern portion however, is made
up of mostly forest areas and agricultural land. Although this has been changing in recent years,
and the land is becoming more urban with suburban developments popping up. According to the
census estimates the population of Pasco county is approximately 485,331 people which makes it
Floridas twelfth most populated county (US Census Bureau, n.d.b). At 89.4 percent, majority of
people living in the county are white (US Census Bureau, n.d.b). In regards to age, 57 percent of
residents in Pasco County are between age 18 and 65 (US Census Bureau, n.d.b). The largest
employer within the county is the Pasco County School district which employees about ninetyseven hundred people. This employer is followed by HCA Healthcare which employees around
twenty-six hundred people. The third largest employer within the county is the Pasco
government system which employs twenty-two hundred individuals (Pasco County Economic
Development Council, 2015). The county has various healthcare systems operating within their

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

limits, these include HCA Healthcare, Baycare health systems, Florida Hospital and Bayfront
health (Pasco County Economic Development Council, 2015).
Census data shows that approximately 14.7 percent of people in Pasco county live in
poverty, this is slightly lower than the Florida poverty statistic which is 16.5 percent of people
living in poverty. Also, the percent of children living in poverty is about 18.7 percent. The
average family income in the county is approximately 54,330 which is lower than the state
average which is 57,176. Pasco county does have a higher percentage of individuals who have
received their high school diploma by age 25 at 87.5 percent than the state average, which is just
slightly lower at 86.5 percent. Compared to the state of Floridas high rate of individuals over
the age of five that do not speak English as a primary language at home at 27.8 percent, Pasco
county data shows approximately 14.2 percent of residents dont primarily speak English at
home (US Census Bureau, n.d.a).
One strength of Pasco County is their resources for disabled individuals. These resources
include help ranging from support systems to medical care. One main resource is the Deaf
Service Bureau of West Central Florida which offers services such as employment services,
interpreting, hearing aid assistance and more to deaf individuals throughout the county (Pasco
County Health Department (PCHD), 2012). Another strength of Pasco County are sexual health
and family planning clinics. Pasco has numerous locations throughout the county that offer
assistance to those with HIV/AIDS and STDs. They also have a prenatal program and teen clinic
which assists pregnant women, families and children. A third strength of Pasco county is their
availability for transportation for those needing medical care. Majority of the hospitals and
outpatient centers in the area provide transportation for patients. The American Cancer Society

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

also provides transportation to patients who are in need of cancer treatments, radiation and
chemotherapy (PCHD, 2012).
A large system that needs improvement in Pasco county is the need for cancer screenings.
The county is thirty to forty percent below the state average on cancer screenings having only
approximately 50.7 percent of the population receiving screenings, including those for breast,
colon and cervical cancers (Hoover, 2013). A second issue that needs improvement is the flu
shot compliance rates in the county. Currently, Florida in general is below the national average
compliance for flu shots. As of now Pasco county is twenty-six percent lower than the goals set
by Healthy People 2020 (Hoover, 2013). Lastly, lack of health insurance is a huge issue in Pasco
County that needs to be improved. Recent data shows that the rate of uninsured individuals in
Pasco County was approximately 25.2 percent (US Census Bureau, n.d.b).
As discussed cancer is a priority health issue in Pasco county, especially lung, colon,
cervical and skin cancers. These specific cancers all have a higher rate than the state average,
and are not performing at the goals set by Healthy People 2020 (PCHD, 2012). This topic is
important to discuss because of the major impacts it has on the health of the population. Due to
the lack of knowledge on screenings for cancer, individuals are catching the cancer at later
stages, which increases the risk of them dying from their cancer diagnosis. The focus of the
policy will be on the most dangerous form of skin cancer which is melanoma. In a study on
Pasco County it shows that the incidence rate of individuals affected with melanoma continues to
climb, and the death rate is at 2.8 compared to the Healthy People 2020 goal of 2.4 (PCHD,
2012). This form of cancer is especially important to prioritize because it can go undetected for
a long time before diagnosed. Education for melanoma should begin early in life due to the fact
that risks for developing this form of skin cancer can occur as early as childhood.

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

The determinants of health model show us how different factors around us can shape our
health status. The determinants can include environmental, social, personal and economic
factors (Determinants of Health, n.d.). In regards to the risk of developing melanoma there are
three large determinant factors. The first is an individuals lifestyle, which can highly impact the
development of melanoma. Lifestyle choices may include wearing sunscreen, wearing
protective clothing when outdoors and going to tanning beds for an artificial tan. A second factor
in the risks for developing melanoma is family history. Those individuals who have had family
members diagnosed with skin cancer are at a higher risk for developing the cancer. In regards to
biology, those individuals diagnosed with xeroderma pigmentosum, which is where the body is
unable to repair UV damage to the DNA are at a very high risk of developing melanoma
(Horrell, Wilson & DOrazio, 2015). People with nevi on their skin, whether congenital or
dysplastic, are at a higher risk (Horrell, Wilson & DOrazio, 2015). The last, and possibly most
important risk factor is an individuals environment. Melanoma risks greatly increase when
someone has constant exposure to UV radiation. This can occur from being outside in the sun,
those who live closer to the equator and those who use artificial UV rays in a tanning bed. All of
these factors can leave people at a higher risk for developing melanoma.
A population diagnosis that would fit this priority health issue could be, school aged
children are at risk for developing melanoma due to their increased exposure to environmental
UV radiation without protection.
A primary level of prevention that could be put into effect for my health issue would be
aimed towards school systems. The policy would promote healthy lifestyle changes for school
age children that could help reduce the risk of developing melanoma. Within the policy there
would be standards for the schools to follow which may include allowing and promoting students

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

to wear hats and wear sunscreen, protective clothing, sunglasses, etc. when they are participating
in activities outdoor. The policy should also include a mandate stating that schools shouldnt
schedule outdoor activities during peak sun hours, and that adequate shaded hours should be
provided for students to take a break. These interventions should be geared towards school aged
children and their parents. Unless shaded areas needed to be built in these outdoor areas there
should be no funding concerns with this policy. A community health nurse could develop an
information manual for schools to provide to parents explaining how they can prepare their
children and send them with the proper equipment for these outdoor times.
A plan that could be developed as a secondary level of prevention for melanoma is a
screening system performed before a child enters middle school. This prevention would be
aimed towards individual students, and screenings could be performed during their physical and
immunization doctors appointment needed before they enter middle school. The screening
would be a simple skin check performed by the students pediatrician, who would look for any
new moles or lesions and assess them using the ABCDE method. The physician can then
document any existing moles on the skin and start a skin record for the patient. This would allow
for earlier discovery of skin changes, and possibly earlier detection of melanoma, which could
allow for treatment and decrease the risk of death. This stage of prevention also should not have
any funding need because it would simply include having physicians performing a skin
assessment. The only change in funding may occur when a patient needs to be treated, but in the
long run could save the health care system money because if the disease is caught early the
treatment needed may be less extreme. The role of the community nurse in this level would be
follow up care. The nurse would be alerted if any child was found to have no moles or skin
changes, and help the patient to schedule a more in depth skin assessment with a dermatologist.

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

The tertiary level of prevention for melanoma would also be geared toward the
individual. During this stage it would be the role of the community nurses to monitor for patient
compliance, and be sure they are following their treatment plans that were established in the
secondary stage. Long-term follow up by the community health nurse is important due to
recurrences and deaths often happening been five years of he initial diagnoses (Han et al., 2012).
The nurses would also help patients deal with any negative side effects due to the treatment, and
may even have to assess the patients for coping issues and make proper referrals for help or to
support groups.
Health policies have impacted health care by bringing new ideas and positive suggestions
to light which can lead to s healthier population. These policies are typically introduced by those
involved in the health care setting, so they are more aware of the needs to people the policy
affects.
The health policy I am proposing would include the primary level of prevention. The
policy would involve the schools of Pasco County, and the goal would be to prevent the risk of
children developing melanoma. The proposal would include the school system allowing children
to wear protective clothing, including hats and sunglasses. Children would also be encouraged to
wear sunscreen when outdoors, and the school will be required to schedule outdoor activities
around non peak hours of sun. Lastly, schools will need to provide shaded areas for students to
rest. The only funding that may need to be used is for schools that need to build appropriate
shaded areas for the students. Parents should be large supporters of this policy due to the fact it
will help reduce the amount of their childrens exposure to UV radiation. Any opposition that
may be present would be from the school if any scheduling issues may occur.

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

In order to put my policy in to action I would first bring my proposal to a group of


physicians who agree with my research and interventions and who would endorse my plans. I
would then approach the school board to discuss the benefits of the interventions, and how the
small changes within the policy can decrease the risk of children developing melanoma. This
policy proposal would assist Pasco county in particular because hopefully early education and
decrease of high risk factors could lower the incidence rate of melanoma, and in turn the health
rate from the cancer. In the case of melanoma, children are an underserved population and need
more focus, so this policy brings more positive attention to lowering the risks from this major
health issue. In general, this policy could help lower the death rate of melanoma and hopefully
bring to light the dangers of this cancer, and how important education and prevention is to
protect the population.
As mentioned throughout the paper the need for new health policies in Pasco County is a
major issue. The current issue with melanoma is one that can be prevented if effective policies
and procedures are put in place. Completing this paper has made an important impact on my
nursing career, as it shows how much thought and data needs to be put into creating a health
policy. The paper has also shown how incorporating policies and procedures into the counties
current health care could improve the health of the residents, and possibly reduce the amount of
mortality.

PASCO COUNTY: PREVENTING THE DANGERS OF MELANOMA

References
Han, D. Z. (2012). The unique clinical characteristics of melanoma diagnosed in children. Annals
of Surgical Oncology, 19 (12), 3888-3895.
Healthy People 2020. (n.d.). Determinants of Health. Retrieved March 7, 2016, from
https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-ofHealth
Hoover, P. S. (2013). Community Health Needs Assessment Final Report. Florida Hospital North
Pinellas.
Horrell, E. M. (2015). Epidemiology, Risk Factors, and the Role of Adaptive Pigmentation. In E.
M. Horrell, Melanoma - Current Clinical Management and Future Therapeutics.
Lexington, KY.
Pasco County Health Department. (2012, September). Community Health Assessment Report.
Retrieved March 7, 2016, from Pinellas County Health Department:
http://www.floridahealth.gov/provider-and-partner-resources/communitypartnerships/floridamapp/state-and-community-reports/pasco-county/_documents/pascocha.pdf
Pasco Economic Development Council. (2015, March 11). Largest Employers. Retrieved March
7, 2016, from http://www.pascoedc.com/Pasco-Data/Labor-Employment/LargestEmployers
Skin Cancer Foundation. (n.d.). Melanoma. Retrieved March 7, 2016, from
http://www.skincancer.org/skin-cancer-information/melanoma
US Census Bureau. (n.d.). Florida Quick Facts. Retrieved March 7, 2016, from
http://www.census.gov/quickfacts/table/PST045215/12
US Census Bureau. (n.d.). Pasco County, Florida Quick Facts. Retrieved March 7, 2016, from
http://www.census.gov/quickfacts/table/PST045215/12101

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