Running head: SEXUALLY TRANSMITTED INFECTIONS 1

Sexually Transmitted Infections in Hillsborough County

Kelly Cullinan

University of South Florida

SEXUALLY TRANSMITTED INFECTIONS 2

Sexually Transmitted Infections in Hillsborough County

This paper examines the strengths and weaknesses of Hillsborough County, Florida in

regard to health status and outcomes. Upon examination of this county, sexually transmitted

infections were found to be one of the top health concerns compared to the rest of the state of

Florida. The purpose of this paper is to explore why there is such an epidemic of sexually

transmitted infections in Hillsborough County, the health implications resulting from these

infections, and why comprehensive sex education and condom availability programs are

necessary in order to reduce the occurrence.

Overview of Hillsborough County

Hillsborough County is located near the middle of the state along the west coast of

Florida. Hillsborough, the states 19th county, was first explored by the Spanish in the 16th

century and was later ruled by France, Great Britain, Spain, and the United States (Hillsborough

County History, n.d.). Back then, the current counties of Manatee, Polk, Sarasota, Charlotte,

Pinellas, Hardee, DeSoto, Highlands, and part of Glades and Lee County, were all a part of

Hillsborough with a population of just 836 people (Hillsborough County History, n.d.).

Today, Hillsborough County has a substantial population of 1,316,298 people and is the

4th most populated county in Florida (County Health Rankings & Roadmaps, 2014). While the

county is mostly urban, there is a small percentage of the population that is rural. The top three

employers within the county are the School District of Hillsborough County, MacDill Air Force

Base, and the Hillsborough County Government (Tampa Hillsborough Economic Development

Corporation, 2011). The major health care systems within the county include HCA (Hospital

Corporation of America), BayCare, Florida Hospital System, H Lee Moffitt Cancer Center and

Tampa General Hospital (Hillsborough County, n.d.). Hillsborough County is a highly populated
SEXUALLY TRANSMITTED INFECTIONS 3

and diverse area with many businesses and places of healthcare that are easily accessible to

residents.

Comparison of Local vs. State Findings

In Hillsborough County, the percentage of families that live below the poverty line is

15% which is equal to the state average (Community Atlas, 2011). Poverty is defined as not

having enough income to afford life necessities such as food, clothing, and shelter (Community

Atlas, 2011). The United States Census Bureau has created guidelines on calculating the income

that constitutes poverty according to the number of people in the family. The percentage of

residents over age 25 with a high school diploma is 87.1% compared to the state average of

86.5% (United States Census Bureau, 2014). Within the population of people equal or greater to

age 5, approximately 27.2% speak a language other than English at home compared to the entire

state average of 27.8% (Office of Economic and Demographic Research, 2015).

The total number of hospital beds in Hillsborough is 329.9 per 100,000 people compared

to the state average of 320.6 per 100,000; the number of total licensed physicians is 280.1 per

100,000 people in the county and 300.6 per 100,000 people in the state (Florida Health, 2011).

While the county has better access to hospitals, the number of physicians as well as the number

of nursing home beds in the county is less than the state average. Overall, there is not an

overwhelming shortage of accessibility to health care in Hillsborough County.

Analysis and Interpretation of Data

Of Hillsborough Countys total population, 51.6% are non-Hispanic white, 26.5% are

Hispanic, 15.8% are non-Hispanic African American, 4.0% are Asian, 0.6% are American Indian

and Alaskan Native, and 0.1% are Native Hawaiian or other pacific islander (County Health

Rankings & Roadmaps, 2014). People below 18 years of age make up 23.2% of the county
SEXUALLY TRANSMITTED INFECTIONS 4

population and 13.1% of people in Hillsborough County are age 65 and older (County Health

Rankings & Roadmaps, 2014). The population is 49% male and 51% female (County Health

Rankings & Roadmaps, 2014).

Identified Strengths

A major strength of Hillsborough County is the accessibility of exercise opportunities.

Of the total county population, 95% of people live within a practicable distance from a park or

recreational facility which is equal to the state average of 95% (County Health Rankings &

Roadmaps, 2014). Access to exercise opportunities is extremely important because increased

physical exercise can decrease the risk of developing cardiovascular disease, hypertension,

cancer, Type 2 Diabetes, and stroke (County Health Rankings & Roadmaps, 2014).

A second strength of this county is the rate of uninsured residents which is only 20%

compared to the state average of 24% (County Health Rankings & Roadmaps, 2014). This

means there is a lower percentage of uninsured people in Hillsborough County under the age of

65 compared to the state of Florida. A lack of health insurance can prevent people from

accessing the health care that they need.

A third strength of this county is at least 64% of residents, between the ages of 25 and 44,

have some post-secondary education compared to the state average of 61% (County Health

Rankings & Roadmaps, 2014). Education is important because there is a well known correlation

of higher education and improved health outcomes (County Health Rankings & Roadmaps,

2014). According to Cutler and Lleras-Muney (2007), people who are educated have lower rates

of morbidities from common diseases such as heart disease and diabetes, and are less likely to

smoke cigarettes and be overweight or obese.

Identified Weaknesses
SEXUALLY TRANSMITTED INFECTIONS 5

A weakness of Hillsborough County is the rate of adult obesity, which is 28% compared

to the state benchmarks of 25% (County Health Rankings & Roadmaps, 2014). Adult obesity is

defined as having a BMI of 30 or more (County Health Rankings & Roadmaps, 2014).

According to Centers for Disease Control and Prevention (2016), obesity puts people at risk of

many debilitating diseases including heart disease, stroke, and type 2 diabetes.

Another weakness of this county is the number of alcohol impaired driving deaths which

are at a rate of 33% compared to the state average of 29% (County Health Rankings &

Roadmaps, 2014). This statistic means that 33% of the total driving deaths in Hillsborough

County were due to alcohol impaired driving (County Health Rankings & Roadmaps, 2014). In

addition to fatalities, alcohol impaired driving crashes are associated with increased costs for

drivers, victims or their families, and taxpayers (Centers for Disease Control and Prevention).

A third weakness is the rate of sexually transmitted infections which is 560.9 per 100,000

people compared to the state average of 415.1. Hillsborough County is ranked 8th out of the 64

counties in Florida for highest rates of sexually transmitted infections (Davies, 2013). There are

560.9 newly diagnosed sexually transmitted infections per 100,000 people in the county (County

Health Rankings & Roadmaps, 2014).

Priority Health Issue

The rate of sexually transmitted infections is very high at 560.9 per 100,000 people which

is much higher compared to the state benchmark of 415.1 (County Health Rankings &

Roadmaps, 2014). Between 2013 and 2015, 567.3 per 100,000 people in Hillsborough County

were diagnosed with Chlamydia compared to the state benchmark of 433.8 per 100,000 people

and 151 per 100,000 people were diagnosed with Gonorrhea compared to the state benchmark of

112.1 per 100,000 people (Florida Department of Health, 2016). Along with the inconvenience
SEXUALLY TRANSMITTED INFECTIONS 6

of the associated symptoms, sexually transmitted infections can cause infertility, health issues for

the unborn baby, pelvic inflammatory disease, infection in other parts of the body, organ damage,

certain types of cancer, and even death, in women (Office on Womens Health, 2014). Men are

put at risk of testicular infections, infertility, organ damage, and death (Alberta Health Services

Calgary Zone, 2013).

Impact of Community Health Model

Community health models assist the nurse and other healthcare professionals in assessing

the community and environment in which the patients live in. It is important to accurately assess

patients environments to ensure that everything they need to survive, stay healthy and maintain a

decent quality of life is readily accessible to them. The Determinants of Health Model helps to

identify factors beyond what one may normally think that can affect individual or community

health such as social factors, biology and genetics, policy making, health services, and individual

behavior (Truglio-Londrigan & Lewenson, 2011). By utilizing this tool, nurses will be better

able to educate patients on the harmful implications of sexually transmitted infections on both

individuals and within the community.

Risk factors contributing to the transmission of sexually transmitted infections are

unprotected sexual activity, having multiple partners, being under 25 years old, alcohol use,

illicit drug use, prostitution, using only birth control for prevention of conception, already having

a sexually transmitted infection, and living in a community with a high prevalence of sexually

transmitted diseases (Boskey, 2016). Young people between the ages of 15 to 24 account for half

of all newly diagnosed sexually transmitted diseases despite this age group only representing

25% of the sexually active population (Office of Disease Prevention and Health Promotion,

2016). A study done in a Midwestern pediatric emergency department found that 1 in 10 sexually
SEXUALLY TRANSMITTED INFECTIONS 7

active adolescents presenting to the emergency department for reasons other than reproductive

complaints tested positive for 1 or more sexually transmitted infections (Miller, Dowd, Harrison,

Mollen, Selvarangan, & Humiston, 2015).

Population Diagnosis

Adolescents and young adults are at an increased risk of acquiring a sexually transmitted

infection in Hillsborough County due to high-risk behaviors and possible lack of safe sex

education.

Community/Population-based Interventions

A primary level of prevention is aimed at reducing the incidence of sexually transmitted

infections. This can be done by educating the community as a whole on safe sex, the dangers of

high-risk behaviors, and available vaccines such as the Human papillomavirus vaccine.

Comprehensive safe sex education should be taught in public schools before adolescents begin to

engage in these behaviors. Nurses can help achieve this by lobbying through the American

Nurse Association (ANA), calling or writing to the policy makers, and meeting with local

government and school boards to propose adding more sex education in schools (Truglio-

Londrigan & Lewenson, 2011). In addition to lobbying for these changes, it is also very

important for nurses to educate their patients on an individual level on the risk factors of sexually

transmitted infections and recognizing the symptoms of these infections so they can seek

treatment and prevent any further transmission.

Secondary levels of prevention target individual patients who are diagnosed with a

sexually transmitted infection. The goal of secondary prevention is to reduce the number of

complications associated with sexually transmitted infections by early detection and prompt

treatment. The nurse should be able to assist in properly identifying and treating sexually
SEXUALLY TRANSMITTED INFECTIONS 8

transmitted infections to prevent further complications. Some sexually transmitted infections are

asymptomatic or produce very few signs or symptoms and often go untreated due to this nature

(Office of Disease Prevention and Health Promotion, 2016). It is important for the nurse to

stress the importance of regular testing and screening for sexually transmitted infections and

inform the patient on places in the community that offer free testing. The nurse should also

educate the patient who already has an infection on safe sex and reduction of high-risk behaviors

to prevent reoccurrence in the future and further spread of the infection. It is also the

responsibility of the nurse to encourage the patient to notify any sexual partners the patient

recently had so they are able to get checked and explain the importance of reporting.

A tertiary level of prevention targets individual patients that already have the disease and

are experiencing complications such as such as pelvic inflammatory disease, cancer, and

infertility. It focuses on decreasing effects of the complications from the sexually transmitted

infections and making sure the patient complies with the prescribed treatment to prevent any

further complications from happening. The nurse should provide supportive care to the patients

that are experiencing complications and monitor how the patient is responding to the treatment to

prevent any further health complications from the infection. After the patient is already

diagnosed with a sexually transmitted infection, it is imperative that the nurse educates the

patient on abstinence of sex while infection is present and practicing safe sex after the infection

is gone to prevent reoccurrence or transmission to their partners.

Development of Health Policy

Health policies promote changes in the overall health of a community by reducing or

eliminating the unhealthy conditions or by promoting activities that contribute to the health of

the community as a whole. To decrease the occurrence of sexually transmitted infections in

SEXUALLY TRANSMITTED INFECTIONS 9

adolescents, a primary level of prevention would be most effective. This will be done by making

comprehensive sex education and condom availability programs mandatory in schools.

Comprehensive sex education not only promotes abstinence but also includes information about

the use of condoms and contraception versus abstinence only education. Research shows

comprehensive sex education is more effective in preventing teen pregnancy and sexually

transmitted infections while abstinence-only programs have shown to be ineffective and may

actually promote an increase in these (Carter, 2012). While comprehensive sex education may

be controversial in parents, evidence shows it does not encourage adolescents to become sexually

active or increase the amount of sexual activity. It does increase the use of condoms and

contraceptives while decreasing the frequency of sexual activity and high-risk behavior including

having multiple sexual partners (Advocates for Youth, n.d.). Douglas Kirby, a researcher for the

National Campaign to End Teenage Pregnancy, examined many studies on sex education

programs and found that 60% of these programs reduced unprotected sex and 13 of the 23

programs studied revealed significant decreases in sexually transmitted infections, human

immunodeficiency virus, and teenage pregnancy in the participants (Kirby, 2007). In addition,

14 of those 23 programs increased the use of condoms in the participants that were sexually

active (Advocates for Youth, n.d.). Many adolescents have barriers to obtaining condoms

including confidentiality, embarrassment, finances, and transportation. To ensure students have

access to protection, it would be beneficial for the nurse to address law makers and lobby for

schools and colleges to be required to provide good quality condoms for students. According to

the American Academy of Pediatrics, the most effective way to encourage adolescents to use

condoms is through school programs including education on condom use and condom

availability programs (OBrien, 2013). A study done in Holyoke, Massachusetts demonstrated a

SEXUALLY TRANSMITTED INFECTIONS 10

47% decrease in the occurrence of Gonorrhea and Chlamydia combined in males and a 2.5%

decrease in females after the implementation of a condom availability program (Wretzel,

Visintainer, & Pinkston-Koenigs, 2011). While there was not a large difference in the prevention

of sexually transmitted infections in females, the results in males were very significant. Overall,

comprehensive sex education and condom availability programs would most likely significantly

decrease the rate of sexually transmitted infections in adolescents in Hillsborough County.

To put this health policy into place, the nurse would first need to reach out to the

community and educate the people on why this policy is so important to acquire more supporters.

The nurse and supporters would then need to contact their local legislators and public officials to

present the case of how sex education and condom availability programs in schools will decrease

the incidence of sexually transmitted infections in adolescents. Currently in order to graduate,

the state of Florida requires all students to complete one-half of a credit in life management

skills which must include education on the prevention of HIV/AIDS, sexually transmitted

diseases, the benefits of abstinence, and the consequences of teenage pregnancy (Florida

Department of Education, 2016). Unfortunately, not only is one-half of a credit a very minimal

education but there is an opt-out policy where parents can remove their child from any sex

education programs. According to the Florida House of Representatives (2016), there was a bill

proposed in 2008 called the Florida Healthy Teens Act that would require comprehensive sex

education but failed to be heard in the House and subsequently died. While some may be

apprehensive and concerned about funding, President Obama signed the Patient Protection and

Affordable Care Act in 2010 which created the Personal Responsibility Education Program

(Sexuality Information and Education Council of the United States, n.d.). This program funds a

total of $75 million in age appropriate and medically accurate sex education for young people
SEXUALLY TRANSMITTED INFECTIONS 11

(Sexuality Information and Education Council of the United States, n.d.). Comprehensive sex

education and condom availability programs would decrease the rates of sexually transmitted

infections in adolescents; therefore, the community would be healthier as a whole and experience

less complications due to these infections.

Conclusion

Community health plays a vital role in nursing to promote the health of not only our

patients but the entire community. I believe public health is a large and important aspect in the

role of a nurse that is often overlooked. In my nursing practice, I will ensure that my patients

needs outside of the hospital will be met as well as promote healthy behaviors that contribute to

the overall health of the community. As an emergency room nurse, I will expect to see

adolescents with sexually transmitted infections in the acute care setting. I will educate these

patients on prevention and treatment in hopes of reducing the rate of sexually transmitted

infections within the community.

SEXUALLY TRANSMITTED INFECTIONS 12

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