Running head: DOMESTIC VIOLENCE AS A HEALTH ISSUE 1

Domestic Violence as a Health Issue in Pasco County

Victoria Clayton

University of South Florida

DOMESTIC VIOLENCE AS A HEALTH ISSUE 2

Domestic Violence as a Health Issue in Pasco County

The purpose of this paper was to highlight a particular health threat to Pasco County,

Florida. The number of domestic violence cases in Pasco County is significantly higher

compared to the state of Florida. Domestic violence interferes with quality of life and prevents

victims from succeeding and maintaining good health outcomes. Evidence-based interventions

have been put in place, yet health policy needs to be continuously monitored and revised to target

this detrimental issue. The overarching goal of this paper is to provide an overview of the county,

explore strengths and weakness of the county, propose levels of prevention for the given issue

and explore necessary health policy to be implemented.

Overview of Pasco County

Pasco County, Florida is located just north of Hillsborough County, and considered a part

of the greater Tampa Bay area. It serves as a suburb of the city of Tampa and includes many

residential areas as well as new emergent businesses and agriculture industries. Located on the

coast of the Gulf of Mexico, Pasco Countys largest city is New Port Richey and the county seat

of Pasco County is Dade City.

Pasco County is considered diverse in that it has many rural, farming areas, but also has

several major road systems (US Highway 19) and its proximity to Tampa Bay give it a partially

urban name as well. Pasco County is 746.89 square miles in geographic size. Major employers

include management and professional businesses, accounting for 34.9% of employers (2014);

sales and office employment at 24.4%, and service occupations at 19.2%. The largest industries

include educational and health services (23.4%); retail (14.5%); and management,

administration, waste management, scientific and professional department (11.6%). The county

is also full of a multitude of health care systems and resources. Since 15.8% of the population is
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uninsured, there are many free clinics, like Good Samaritan Clinic and the Mobile Medical Unit.

There are also low pricing clinics such as Premier Clinic. There are also many larger hospitals

including, Medical Center of Trinity Hospital, Florida Hospital Zephyrhills, Florida Hospital

Wesley Chapel, Bayonet Point, Bay Care Centers and many others. Most of the major hospitals,

however, are clustered together on the coast.

Comparison of Local vs. State Findings

Pasco County has a population of 492,513 people (Florida Charts 2015). Several

important factors in understanding the population and socioeconomic factors include poverty

level, education status, and access to health care services. In order to have a full picture of the

status of health in Pasco County, it is important to compare to state benchmarks and then using

that comparison to a healthcare model and the goals of Healthy People 2020.

In Pasco County, 9.9% of families live below the poverty level. In the states of Florida as

a whole, 11.9% of families are considered to be below the poverty level. Living in poverty, for a

family of four is considered making close to $24,000 or less and individually making about

$11,000 or less (Florida charts, 2014).

As far as educational status and literacy two important markers are the number of

individuals who have a high school diploma and the percentage of the population who can

proficiently speak English. In Florida, 13.5% of the population aged 25 and older are without a

high school diploma, compared to 12.5% in Pasco County. One staggering difference in

benchmarks in the population that does not speak English very well. Across Florida, 11.7% are

considered to not be proficient in understanding and speaking English, whereas in Pasco County

that number is 4.4%, significantly lower. Language is a large barrier between receiving health

care, health insurance or utilizing resources (Florida Charts, 2014).

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One last benchmark to compare to state findings is the health care services and access.

While Pasco County generally has similar numbers compared to state numbers, the number of

physicians per 100,000 is lower. The number of licensed physicians per 100,000 of the

population in Pasco County is 153.5 versus 259.3 in Florida. There are also significantly less

OBGYNs (4.7 per 100,000 versus 19.1 per 100,000) and pediatricians (7.0 per 100,000 versus

18.7 per 100,000). This puts women and children at risk for not receiving either timely or quality

treatment (Florida Charts, 2014).

Analysis and Interpretation of Data

In the following summary, Pasco Countys strengths and weaknesses will be identified

and discussed. Chosen strengths include the high number of screenings. This is evidenced by the

amount of people that have had cholesterol screenings within the past five years, the amount of

prenatal testing, and the low incidence of breast cancer. Identified weaknesses in Pasco County,

home to 492,513, include many poor lifestyle and behavioral choices. The amount of

hospitalizations, adult smokers, binge drinking and domestic violence are higher than state

averages. The focal point of this discussion will target how domestic violence is a priority health

issue in the county.

Identified Strengths

Overall, Pasco County has a number of strengths in regards to health indicators.

As far as healthy living, health screenings and activity status, many citizens of Pasco County

exceed the state benchmarks. For example, 85% of the population of Pasco County received

cholesterol screenings within the past five years versus 79.9% on a state level. Though a small

difference, it is evident that Pasco County health department and its population value the ideals
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of early screening. Unchecked, chronic high cholesterol is one of the leading causes of

atherosclerosis which leads to cardiovascular diseases (Florida Charts, 2013).

Another area of strength in Pasco County is in prenatal testing. Eighty-two per cent of

mothers began prenatal testing during the first trimester in Pasco County versus 79.8% in the

state of Florida. Prenatal testing is critical in reducing infant mortality and complications during

pregnancy (Florida Charts, 2011-2013).

Lastly, new incidence of breast cancer is significantly lower in Pasco County than in the

state as a whole. The new incidence percentage of breast cancer in Pasco County is 66.8% versus

79% in the state of Florida. This could perhaps indicate that women are receiving timely, early

screenings like mammograms (Florida Charts, 2011-2013). Through these strengths, it is evident

that Pasco County is meeting state benchmarks in regards to chronic illnesses and screening and

maternal and child health.

Identified Weaknesses

While chronic diseases seem well managed from the statistics, many lifestyles and

behavioral factors do not meet state benchmarks. Smoking, heavy/binge drinking and domestic

violence cases are higher in Pasco County than across the states of Florida. For instance, Pasco

County has higher rates of adult smokers with 24% compared to 16% on a state level (Florida

Charts, 2013). Smoking has a vast array of negative impacts on health. From chronic lung

diseases, to the effects of second hand smoke in others, smoking is a huge health indicator and

area of weakness in Pasco County.

Another area of weakness in Pasco County is in the number of hospitalizations. Per

100,000 people, 955.2 people are hospitalized versus 805.2 in the state of Florida (Florida
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Charts, 2012-2014). The amount of hospitalizations is indicative of either how many individuals

are hospitalized for chronic illness, mental illnesses or accidental injuries.

The percentage of people who engage in heavy/binge drinking is 18.1% in Pasco County

versus 12.2% in Florida (Florida Charts, 2013). Heavy/binge drinking is largely associated and

linked to mental health issues like addiction and violence in the home. Heavy drinking can lead

to liver failure and a number of other chronic illnesses. Additionally, heavy drinking and

addiction to alcohol can lead to destructive and sometimes violent behaviors. Thus heavy

drinking also has a tremendous impact on the health status of a community.

One last area of weakness to be discussed is in the amount of total domestic violence

cases in Pasco County. The number of total cases in 2015 was 760.2 versus 542.1 in the state of

Florida. Domestic violence encompasses physical, emotional, sexual and verbal abuse across all

age groups. Elder abuse, child abuse and partner abuse all pose detrimental effects on the health

and psychosocial status of the victim.

Priority Health Issue

A priority health issue for Pasco County, FL is in the high number of domestic

violence cases. Domestic violence includes willful intimidation, physical abuse, sexual abuse,

emotional abuse, battery and any other form of violent or aggressive control that a perpetrator

exerts on a victim. Though victims can be anyone, they are most often an individuals partner,

child, friend or family member. Domestic violence falls under the Injury and Violence health

indicator category for Healthy People 2020. Injury and violence is a major health indicator that

reveals quality of life in the home. Injury and violence as a health indicators encompass

homicides, suicides, motor vehicle accidents, intentional and unintentional overdoses. Deaths

caused by accidents and violence are among the top 15 killers in the United States, making it a
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critical public health issue (Healthy People 2020). According to Johnson-Reid, Kohl and Drake

(2012), there is also a link to significant mental health issues for children that were abused.

Domestic violence is a risk factor for future abusive relationships and even homicide. Reducing

the amount of injury-related deaths and homicides is a significant Healthy People 2020 goal.

Therefore, the amount of domestic violence present in Pasco County is concerning.

Research by Johnson-Reid, Kohl and Drake (2012) found the effects of domestic violence

abuse in children can produce lasting effects. It is found that many children who were abused

often continue the cycle of abuse in their own home. Additionally, mental illnesses, such as

additions, substance abuse, and suicidal tendencies, as well as brain injuries and sexually

transmitted infections are common place amongst children of abuse (Johnson-Reid, Kohl &

Drake, 2012). Domestic violence and abuse decreases quality of life and health for all age

groups. Research and studies are conducted to discover the best way to address family violence

encompassing child abuse, elder abuse and partner abuse (Gear et al., 2012). It is vital to

approach this issue to find ways to reduce the incidence of domestic violence to improve the

community of Pasco County.

Impact of Community Health Model

Social determinants of health are important to consider when exploring the topic of

domestic violence. Biological factors, environmental factors, lifestyle factors and health care

systems all play a part in why domestic violence occurs, in what settings and how health care is

involved. The World Health Organizations definition of the social determinants of health include

income and social status, education, physical environment, social support networks, genetics,

health services and gender. Factors that are most applicable to domestic violence include income

and social status, education, physical environment, social support networks and gender. Though
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domestic abuse is inconsistent across social economic status, domestic abuse and violence is

slightly more prevalent in those of lower economic and educational status. (more) In regards to

social support, it is more common for the perpetrator of abuse to be related to the victim. Thirty

per cent of women have been victimized and abused by an intimidate partner, versus 7% per cent

that have experienced non-intimate partner violence (CDC, 2016). Thus victims of domestic

violence struggle with social support if their once trusted support are the very ones who are

abusive. Lastly, gender and age are additional factors to consider. The elderly population, women

and children are most at risk to domestic violence. One in seven children will experience some

form of domestic violence. Twenty-two per cent of women and sixteen per cent of men will

experience intimate partner violence in their lifetime (CDC, 2016).

Population Diagnosis

Women, especially in their teens and early twenties, in Pasco County are at an increased

risk for domestic violence due to their gender and age, physical environments of lower

socioeconomic status, and poor social support.

Community/Population-based Interventions

One-quarter to one-half of women will experience sexual abuse in their lifetime (Rowe,

Jouriles, & McDonald, 2015). The response of the community and health care professionals is

vital in combatting the detrimental effects of all types of domestic violence abuse. Evidence-

based interventions that have been studied and implemented include screening tools, follow-up

programs and domestic violence shelters.

Primary Level of Prevention

A primary level of prevention to reduce the incidence of IPV and domestic violence

amongst adolescent and college aged women includes education and prevention programs. These
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can be implemented in high schools, colleges, and other extra-curricular activities. These

programs are intended to increase awareness, empower women and connect them to resources.

Often, the target focus for this population is to first reduce victimization. Young women who

were victims of intimate partner violence are at risk for being recurrently victimized. Programs

that have been shown to be most effective are risk-reduction programs that discuss detailed ways

for young women to identify threatening situation and offers strategies for self-protection rather

than merely raising awareness. Stakeholders that would be involved include community

members, teachers, health care providers, and other educational and social services. The role of

the community health nurse includes providing resources to young women that are high school

and college-aged (Rowe, Jouriles, & McDonald, 2015).

Secondary Level of Prevention

A secondary level or prevention includes screenings. Screenings that aim to decrease

interpersonal violence and other types of domestic violence are applicable for social services,

health care providers, educators, and many other public relations jobs. Additionally, educators

and health care providers specifically can report suspected cases and provide resources for

treatment. Stakeholders include health care providers, educators, case managers, and social

services. Legislators may also be involved with the legal aspect of implementing screening and

reporting tools in schools and in hospitals. Funding concerns would be at the referral level and

follow-up with patients and students that are victims. Lastly, community health nurse may be

responsible for identifying victims, utilizing screening tools and making referrals and follow-up

treatment (Rowe, Jouriles, & McDonald, 2015).

Tertiary Level of Prevention

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After abuse has been screened and reported, a tertiary level of prevention includes

support groups, counseling and domestic violence shelters. These level aims to help victims deal

with the traumatic event of the abuse, prevent further negative impact on health physically and

mentally. Keeping victims in programs such as support groups or shelters helps monitor victims

to prevent them from returning to perpetrators or move them into a safer environment. Funding

sources and concerns include funding domestic violence shelters and making treatment for these

victims affordable. It is imperative that community health nurses are prepared with resources for

referrals for victims (Rowe, Jouriles, & McDonald, 2015).

Development of Health Policy

Health policies include making legal regulations or mandates to address issues that often

require action. Health policies most of the time lead to the development of programs, which are

policies put into motion. Policies and programs are established to target issues and ensure that

action is being taken to either recognize an issue before it occurs, or take the proper steps into

treatment and ensuring it does not occur again. The topic of domestic violence, more particularly

on the issue of interpersonal violence on adolescent and college-aged women, is a complicated

subject with which to enforce health policy. A primary level of prevention program should be

implemented to reduce the incidence of interpersonal violence cases in Pasco County. One policy

that should be incorporated is a domestic violence prevention educational course offered or even

required for adolescent and college-aged men and women. Implementing a required educational

course of real life examples, risk factors, self-assessment and resources on domestic violence for

adolescents and young adults in Pasco County will be the focus of this health policy. This

education course would be required for any school, institution or university and would provide

insight into risk factors, self-assessments, and resources. The main stakeholders affected by this
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proposed policy would be educational leaders and health care providers. Any healthcare provider,

social service or educational member would be in support of this proposal, knowing the huge

burden domestic violence has on society. Opposing members may be any state organization who

would deem the funding for such a project to be difficult (World Health Organization, 2006).

The implementation of this health policy would be greatly beneficial to Pasco County, Fl.

Especially if the policy is implemented in health care and school settings, the program would

bring awareness to not only those most at risk, but others in the community as well. If successful,

the policy would empower both men and women to take ownership of their actions, recognize

risk behaviors and know which resources to turn to.

Conclusion

Overall, the focus of this paper is to bring attention to a significant weakness in Pasco

County regarding the incidence of domestic violence. Primary, secondary and tertiary levels of

prevention has been explored to further reduce the incidence. Lastly, a proposed health policy

plan was explored to target the overarching issue of interpersonal violence amongst adolescents

and young adults.

This topic significantly impacts my nursing career. The first day I started my community

health clinical rotation, my first patient was a 21 year old female who was a victim of domestic

violence. She had a broken arm from her perpetrator and a bruised face. She was not empowered,

she was insecure and she stayed with a man who had all of the warning signs. Recognizing

victims of domestic violence, and recognizing those who are at risk for being in situations of

domestic violence is of utmost importance when working with my patients. As a healthcare

provider I have the right to help victims and potential victims report the violence. I also have the

ability to refer patients to valuable resources to help provide treatment and safety for them.
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Domestic violence is a significant health burden and hinders many individuals from obtaining

and maintaining quality of life.

References
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Centers for Disease Control and Prevention. (2016). Intimate partner violence. Retrieved from

http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/index.html

Florida Charts. (n.d.). Retrieved September 18, 2016, from floridacharts.com/charts/QASpecial

Gear, C., Koziol-McLain, J., Wilson, D., Rae, N., Samuel, H., Clark, F., & McNeill, E. (2012).

Primary healthcare response to family violence: a Delphi evaluation tool. Quality In

Primary Care, 20(1), 15-30.

Jonson-Reid, M., Kohl, P., & Drake, B. (2012). Child and adult outcomes of chronic child

maltreatment. Pediatrics, 129 (5) 839-845; DOI: 10.1542/peds.2011-2529

Rowe, L. S., Jouriles, E. N., & McDonald, R. (2015). Reducing sexual victimization among

adolescent girls: A randomized controlled pilot trial of My Voice, My Choice. Behavior

Therapy, 46(3), 315-327. doi:10.1016/j.beth.2014.11.003

United States Census Bureau. (n.d.) Retrieved October 19, 2016 from

http://www.census.gov/quickfacts/table/PST045215/12101