Running head: TOBACCO IN BREVARD 1

Tobacco Related Deaths in Brevard County, Florida

Nicki Shaw

University of South Florida

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Tobacco Related Deaths in Brevard County, Florida

In Brevard County, Florida, there were 232 tobacco-related deaths per 100,000 people

over the age of 35 years old. For the entire state of Florida, the average was 172 deaths in 2015

and decreasing annually. These statistics show a problem that Brevard is facing and the

population is suffering from. This paper will discuss ways to combat the issue of tobacco use in

Brevard through three levels of prevention and a proposed health policy.

Overview of Brevard County

According to the United States Census Bureau, Brevard County had an estimated

population of 579,130 people in 2016. Brevard County is a combination of urban and rural

communities, encompassing a wide variety of cityscapes and countrysides along 72 miles of

Florida’s east coast. Brevard neighbors Volusia County to the north, Indian River County to the

south, and Orange and Osceola counties to the west.

Brevard County is also known as the “Space Coast”, as it is home to the John F. Kennedy

Space Center. The Kennedy Space Center is one of the top employers in Brevard, as well as

Harris Corporation and the cruise lines at Port Canaveral. The Health First Health Plans

headquarters are located in Brevard County, and they one of the major providers of healthcare to

the surrounding population. They operate several hospitals, clinics, and centers around the

county. Another large health care system in Brevard is the Department of Health located in

Central Brevard.

Comparison of Local vs. State Populations

According to Florida Health Charts, Brevard County has a 14% rate of total population

below the poverty line, compared to the state percentage of 16.5%. The percentage of families

below the poverty level in Brevard is 9.9%, whereas the state statistic is 12%. The estimated
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percentage of individuals over the age of 25 with a high school diploma is 90.7% in Brevard and

86.9% in the state. The Brevard County percentage of those over the age of five that do not

speak English well is 3.3%, compared to the state of Florida percentage of 11.7% (Florida Health

Charts, 2016). The percentage of Brevard’s population that has access to a primary care provider

is 74.8%, whereas the state rate is 73.2% (Florida Department of Health, 2016).

Analysis and Interpretation of Data

Identified Strengths

According to Florida Health Charts (2016), the percentage of families below the poverty

line in Brevard County is 9.9%, compared to the state statistic of 12%. This shows Brevard has a

small amount of its population that is unable to meet or afford basic needs such as food, shelter,

and water. This is considered a strength for Brevard as it is below the state average and has been

since the 1990’s (Florida Health Charts, 2016).

Another strength of Brevard County is that 90.7% of the population over 25 years old is

thought to have their high school diplomas (Florida Health Charts, 2016). This is over the state

percentage of 86.9%. This can be used as a strength for Brevard because the educated

population may have a better understanding of healthcare, as well as a better chance of being

able to pay for it.

The county of Brevard also shows a strength in that the rate of AIDS cases in 2016 was

less than half of that in the overall state of Florida. Brevard had 5.1 cases per 100,000 citizens

whereas Florida had 12.2 cases (Florida Health Charts, 2016). This is indicative of health in

Brevard as it may represent the population’s ability to prevent disease as well as the county

health department’s ability to teach the individuals about healthcare. In conclusion, these

strengths strongly indicate that much of the population in Brevard County is educated, living

above poverty, and well educated on disease prevention and care.

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Identified Weaknesses

According to the Florida Health Charts (2016), Brevard County had 232 tobacco-related

deaths per 100,000 citizens over the age of 35 in 2016. This is over the state of Florida’s average

of 172 deaths. This is identified as a weakness because Brevard county citizens are dying from

preventable disease at a higher rate than the entire state of Florida. Also, this statistic does not

show the others affected by the tobacco industry, such as those under the age of 35 or even the

children that may be impacted by secondhand smoke.

Brevard County, in 2015, had 7,700 premature deaths, whereas the state of Florida had

6,700 on average (County Health Rankings). Premature death is the death of an individual under

the age of 75, and can be related to countless health, socioeconomic, and other factors.

According to County Health Rankings, the state of Florida is trending down in this category but

the county of Brevard has no trend.

Another weakness of Brevard County is the high rate of deaths related to coronary heart

disease. Per Florida Health Charts (2016), the county had 111.4 deaths on average 100,000

people when the state of Florida only had 98.7 deaths. This statistic of Brevard County is a

negative indicator of health.

Identification of a Priority Health Issue

As seen earlier in this paper, Brevard County had a significantly higher average of

tobacco-related deaths than the state of Florida. In 2015 alone, Brevard had approximately 232

tobacco-related deaths per 100,000 citizens, whereas Florida’s rate was an average of 172 deaths.

According to Florida Health Charts, this statistic is continuously trending up for Brevard, but not

the state of Florida. According to Healthy People 2020, the use of tobacco is the leading

preventable cause of death in America. Additionally, tobacco use, and the health issues it
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causes, are to blame for billions of America’s healthcare costs annually (Henry, 2012). For this

reason, tobacco use is a major priority of health.

Discussion and Application of Community Health Models

One example of a community health model, the Determinants of Health Model, is a

diagram used to visualize the different factors that influence health. In the model, social and

physical factors such as education, healthcare, environment, and others are addressed to work

towards effectively improving the populations’ health (Healthy People, 2017). Environmental,

lifestyle, and healthcare factors may contribute to the issue of tobacco use and related deaths.

Environmental factors, such as the locations of stores, may affect this health problem as tobacco

products would be readily available and easy to obtain. The proximity of stores selling tobacco

products around schools showed a correlation to adolescent smoking (Gwon, DeGuzman,

Kulbok, & Jeong, 2017). This study showed that the availability of the product did indeed have

an impact on the prevalence of its use in the surrounding community.

Population Diagnosis

The population of Brevard County over the age of 18 years old is at risk for poor health

and higher rates of mortality related to tobacco use. This can be seen within the statistic of

tobacco-related deaths, asthere were 232 deaths per 100,000 citizens in Brevard compared to the

average of 172 deaths in the state of Florida.

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Community/Population-based Interventions

Primary Level of Prevention

This intervention will be directed at the entire population of Brevard County, specifically

those who have not started using tobacco. Adolescents as well as adults are at risk for beginning

or continuing to use tobacco products. Interventions to prevent tobacco use and promote the

health of the community would include continuing to educate the populations about the dangers

of tobacco use. At the primary level, these interventions would include informative signs, health

pamphlets, and warning labels. As seen in the research by Gwon, DeGuzman, Kulbok, and

Jeong, the location of tobacco-selling stores had an impact on their lifestyle choices. Using this

information, interventions would be directed towards those more at risk depending on the

location and proximity to stores supplying tobacco. Addressing these locations and putting forth

preventative measures to remind people of the harm of tobacco will continue to promote health.

This primary intervention will be geared mostly toward community members. These

community members are considered stakeholders as they are directly affected by the dangers of

tobacco use, such as personal use or even secondhand smoke. The funding concerns related to

these interventions would be how to delegate the responsibility of informing the public.

Informative signs and such could be sanctioned by local government, volunteer organizations, or

the business owners themselves. Another alternative would be to have local healthcare

businesses support the interventions with any donations or allotted budget. The public health

nurse would have the role of organizing and implementing these interventions. They might

coordinate with local schools, businesses, and community members to create the informative

environment. The nurse may also follow up and see how the new interventions are reaching the

citizens.
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Secondary Level of Prevention

This level of prevention would again be geared towards the county wide population of

Brevard. This secondary level of prevention would entail finding individuals that use tobacco

and screening them for any tobacco related health issues. Diseases related to tobacco could

include heart disease, lung disease, and many types of cancers (Healthy People 2020). If

diagnosed with any of these issues, this level of prevention would also include attempting to treat

said issues.

As with the primary level of prevention, these steps would also be aimed towards

community members and health care providers. Community members are affected by these

illnesses, so this level of prevention will attempt to catch problems before they grow. Health

care providers are also stakeholders in these interventions as they will be the driving force

behind screening tests, treatment, and care. There are significant funding concerns for these

interventions as they call for time, shelter, and staff. Funds may be supplied by community

donations or local healthcare businesses possibly. The community health nurse may have the

responsibility of finding others to help organize the event and identifying individuals in the

community who need to be screened.

Tertiary Level of Prevention

The tertiary level of prevention would be directed towards those in the community

affected by tobacco use. Tertiary prevention consists of monitoring the population and assessing

for compliance within the treatments they are receiving. Specifically, for this health issue of

tobacco use, the interventions would include observing those in the community affected by

tobacco use and following up on whatever guidelines they should be carrying out. Compliance

would include complete cessation of tobacco products and following any treatment protocols.
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This level would also include further education on the importance of continuing on the current

path of a tobacco free road.

The stakeholders in this level of prevention would be community members and health

care providers. As with the other levels, members of the Brevard community are largely affected

by tobacco use and, subsequently, these steps of prevention. Health care providers also have a

big part in this as they will be providing teaching, following up with care, and monitoring

compliance. Funding concerns stay the same throughout these proposed community changes.

The community health nurse’s responsibilities may include seeking out those ready for this level

of prevention and assessing compliance.

Development of Health Policy

According to the American Public Health Association, health policies are created to

address current concerns in the health of the public. As seen earlier in this paper, tobacco use

and its associated dangers are especially a concern in Brevard. This policy regarding tobacco use

in Brevard County will be based on the secondary level of prevention. This policy will entail

prohibiting the use of tobacco products in public spaces, such as outside of stores, restaurants,

and parks. This may be carried out with the cooperation of local businesses and government

entities. The goal of this policy is to protect the populations’ health and limit the danger the

citizens are subjected to by reducing second-hand smoke and other harms.

Those affected by this proposed health policy would primarily be community members.

Those supporting this policy would be local businesses and the government at the city level that

would implement and enforce it. Healthcare providers in Brevard would assist by continuing to

teach the citizens the dangers of tobacco use and encourage them to discontinue use. Nurses are

the largest group of healthcare providers and usually spend the most face-to-face contact with the
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public, so nurses can help educate the public on the health policy (Peterson, Meyer, Sachs,

Bialous, & Cataldo, 2017). Those that may oppose this proposed health policy are some

community members who may not wish to be limited in their freedom, or local businesses that

profit from the support and presence of tobacco users. While the cooperation of the community

is important to this policy, there will always be a difference of opinions. As long as businesses

and local governments enforce the policy, the community should benefit in the long run.

Citizens may adapt to the policy and use their tobacco products in different locations or perhaps

be encouraged to start the process of quitting.

To bring this policy forth, local businesses and sponsors must be contacted to build a

strong foundation of sponsors of the policy. With a large base of supporters, the policy is more

likely to take hold and impact the community. In Brevard, there are many businesses, such as

Kennedy Space Center and Harris Corporation, that employ a large amount of the county’s

citizens. To promote the health of their employees and customers, these companies may help

kickstart the policy in their own locations, thus impacting a large amount of Brevard’s citizens.

To put this policy in motion, Health First Health Plans would be the first to be contacted. As the

major source of healthcare in Brevard, with many hospitals and clinics spread within the county,

Health First is a perfect sponsor and a perfect place to start.

This health policy will impact Brevard County by minimizing the dangers of tobacco use

on its citizens and helping set forth a way for those individuals to take control of their own

health. Prohibiting the use of tobacco in public places will help the public by not only protecting

the public but by giving current tobacco-users an incentive to discontinue their habits both in

public and at home. It will help overall by improving the health of Brevard County and

preventing tobacco-related deaths.

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Conclusion

This paper outlined the issue of tobacco-related deaths in Brevard County, Florida.

Brevard had more deaths per 100,000 citizens than the state of Florida average. To address this

issue and work to improve the health of Brevard’s population, a health policy was proposed to

prohibit the usage of tobacco in public spaces around the entire county.

The issue of tobacco use is relevant to my life and nursing career. I hope to work with

the general population, many of whom do use tobacco and are not always the best at keeping up

with their doctors’ appointments. This paper helps set forth a plan to help the public limit their

tobacco use and encourage them to take steps in the direction of overall cessation. Using the

research and information I found for this paper, I hope to better counteract the impacts of

tobacco in the community of Brevard and elsewhere.

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References:

American Public Health Association. (2017). Advocacy for public health. Retrieved from:

https://www.apha.org/policies-and-advocacy/advocacy-for-public-health

County Health Rankings & Roadmaps. (2017). Brevard (BV). Retrieved from:

http://www.countyhealthrankings.org/app/florida/2017/rankings/brevard/county/

outcomes/overall/snapshot

Florida Department of Health. (2016). Tobacco-related cancer deaths to persons 35 and over.

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DataViewer.aspx?cid=0268

Florida Health Charts. (2014). Brevard county-state profile. Retrieved from:

http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.Cou

ntyStateProfile

Gwon, S. H., DeGuzman, P. B., Kulbok, P. A., & Jeong, S. (2017). Density and proximity of

licensed tobacco retailers and adolescent smoking. The Journal of School Nursing, 33,

18-29. doi: 10.1177/1059840516679710

Healthy People 2020. (2017). Determinants of health. Retrieved from:

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Health.

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Henry, B. (2013). Impact of tobacco-control legislation. Clinical Journal of Oncology Nursing,

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Peterson, A.B., Meyer, B., Sachs, B.L., Bialous, S.A., & Cataldo, J.K. (2017). Preparing nurses
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to intervene in the tobacco epidemic: Developing a model for faculty development and

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United States Census Bureau. (2016). Brevard County, Florida. Retrieved from:

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