Running head: PASCO PRIORITY HEALTH ISSUSE 1

Pasco Priority Health Issue: Nonfatal Hospitalizations from Self-inflicted Injuries in Adolescents

Victoria Arriaga

University of South Florida

 PASCO PRIORITY HEALTH ISSUE 2

Pasco Priority Health Issue: Nonfatal Hospitalizations from Self-inflicted Injuries in Adolescents

Pasco County is one of 67 counties found within the state of Florida. A priority health

issue that must be addressed in Pasco County is the increased number of nonfatal hospitalized

self-inflicted injuries between the ages of 12-18. The wellbeing of these adolescents is very

important as they are in a stressful part of their life in which they are approaching early

adulthood, which encompasses many big life changes (University of Minnesota, n.d.). Stress on

an individual can lead to negative behaviors such as self-harm and possible suicide attempts if

not dealt with appropriately. Therefore, it is important to address the issue of increased

incidences of nonfatal self-inflicted injuries to ultimately decrease the amount of suicide attempts

and completions in the adolescent population.

Overview of Pasco County

Pasco County is located on the Gulf of Mexico and is in the Tampa Bay area. With the

county being 91% urban and 9% rural, approximately 503,541 people live in Pasco County

which has a total of 742 square miles (City Data, n.d.). This results in a high population density

of about 652 people per square mile (Pasco County Florida, n.d.). Regarding the type of people

residing in Pasco County, 30.6% of the population is over the age of 60 and 80.1% of the

population classify themselves as white non-Hispanic (Pasco County Florida, n.d.). The top

three employers in Pasco County include the Pasco County School District with 10,728

employees, the Pasco County Government with 3,851 employees, and HCA Healthcare with

2,825 employees (Pasco EDC, 2017). Some major health care systems present in Pasco County

include Baycare hospitals such as Morton Plant North Bay Hospital, Florida Hospital with

locations in Wesley Chapel and Zephyrhills, Florida Medical Clinic, and HCA healthcare (Pasco

EDC, 2017). With Pasco County considered a high population density area with an increasing
 PASCO PRIORITY HEALTH ISSUE 3

percentage of older adults, it is important to compare how well Pasco’s population is compared

to the State population in regards to poverty, education, and healthcare.

Comparison of Local vs. State Populations

Compared to the state population, Pasco County has a lower percentage of

families below poverty level. According to data collected in 2015, the percent of families

considered below the poverty level statewide was 12% of the Florida population, however the

percent in Pasco County was 9.9% (Florida Department of Health, 2015a). Pasco County also

succeeds at having a lower percent of its population 25 years and over with no high school

diploma. In 2015, Pasco had 12% of the local population that did not have a high school

diploma, while statewide the percent was 13.1% (Florida Department of Health, 2015a). The

percent of the Pasco population over the age of 5 that does not speak English was 4.4%, which

was less than half the percent for the entire population of Florida with a percent of 11 .5%

(Florida Department of Health, 2015a). Regarding healthcare, 83.8% of Pasco’s population had

any type of health care insurance coverage in 2015, while statewide the percentage was 77.1%

(Florida Department of Health, 2015b). Adults unable to see a doctor at least once within the

past year due to costs, lack of insurance, or inability to commute in Pasco County was 15.5%

compared to 20.8% statewide (Florida Department of Health, 2015c). Comparing to the Florida

state population, Pasco does exceptionally well in staying below the state percentages and is

ranked 21st for social and economic factors, 26th for clinical care, and 28th for quality of life in

the state (County Health Rankings, 2017). After comparing the socioeconomic indicators of the

Pasco County population to the state population, it is also important to compare the health status

between the populations by identifying specific strengths and weaknesses unique to this county.
 PASCO PRIORITY HEALTH ISSUE 4

Analysis and Interpretation of Data

Identified Strengths

Compared to the statewide population, Pasco County had lower levels of bacterial STDs

reported in 2015. In Pasco County, the rate of occurrence in 100,000 people was 338.9, while

state wide was 614.1 (Florida Department of Health, 2015a). A second health strength that

Pasco County has is the percentage of the population that is overweight. From the data collected

in 2013, Pasco County had 32.4% of the population considered to be overweight, which was

below the state percentage of 36.4% (Florida Department of Health, 2015a). This data

encompasses all ages and is considered a strength because Pasco is successfully promoting

healthy weight. A third strength that Pasco County has is regarding smoking. The percentage of

adults in Pasco County that were currently still smoking in 2015 was 15.9%, while the state

percentage was 16.8% (Florida Department of Health, 2015a). These three statistics are

considered strengths because with lower rates and percentages of STDs, being overweight, and

smoking, the lower the risk of certain complications and worse diagnoses from these health

statuses. For example, STDs can lead to pregnancy complications and infertility, being

overweight can lead to type 2 diabetes and hypertension, and smoking can cause health

complications such as peripheral arterial disease and even lung cancer (Mayo Clinic, 2016;

National Institute of Health, 2017; National Institute of Health, 2016).

Identified Weaknesses

Compared to the statewide population, Pasco County has a higher rate of diabetes death

rates as of 2015. The percentage of deaths caused by diabetes was a rate of 28.8 per 100,000

people, compared to 19.5 statewide (Florida Department of Health, 2015a). Secondly, the rate of

Melanoma incidences across all ages in Pasco County is also very high compared to statewide.
 PASCO PRIORITY HEALTH ISSUE 5

The rate was 29.9 per 100,000 people, while the state rate was 18.0 in 2015 (Florida Department

of Health, 2015a). Regarding adolescents between the ages of 12-18, Pasco County had high

levels of non-fatal hospitalizations for self-inflicted injuries with a rate of 133.8 per 100,000

people in 2013 and Statewide the rate was 94. All three of these statistics are considered

weaknesses because they each involve health conditions or situations that could have been

prevented with proper interventions and policies .

Identification of a Priority Health Issue

A priority health issue that requires intervention is the high level of nonfatal

hospitalizations for self-inflicted injuries among adolescents between the ages of 12-18. It is

important to address this issue because although the rate is for nonfatal injuries, if not addressed

the rate of fatal self-inflicted injuries and suicide can ultimately increase. Self-harm through

cutting, burning, hitting, etc. is one of the strongest predictors of suicide, however it is important

to note that not all self-inflicted injuries are suicide attempts (Ougrin, 2012). Even if the

adolescent currently self-harming has no intention to attempt suicide, the risk for suicide is 50%

higher for those who have self-harmed compared to the general adolescent population (Carrol et

al., 2016). Also, 15% of those who are hospitalized by self-inflicted injuries whether considered

fatal or nonfatal, attempt and complete suicide within a year (Carrol et al., 2016). Adolescents

are also often overlooked to be a priority health issue as they are often considered healthy,

however mental health is just as important as physical health (People to People Health

Foundation, 2015). Therefore, the high rate of nonfatal hospitalization due to self-inflicted

injuries among adolescents becomes a priority health issue to prevent future self-induced

premature deaths by these individuals.

 PASCO PRIORITY HEALTH ISSUE 6

Discussion and Application of Community Health Models

Factors that have the potential to influence health status among an individual or

population are known as determinants of health and before an intervention can improve a certain

health issue in the population, one must identify these determinant factors which include social,

biological, economic, environmental, and lifestyle factors (Savage, Kub, & Groves, 2016). Since

interrelationships exist among these factors, for an intervention to be effective it must address

more than one factor (Office of Disease Prevention and Health Promotion, n.d.). The

determinants of health factors that contribute to the priority health issue presented are social,

economic, and environmental factors. Examples of factors that have the potential to influence

the health of adolescents include economic status, insurance coverage, availability and access to

mental health resources and experts, social norms, stigma, culture, social support, family

structure, quality schools, and type of neighborhoods (Ontario Centre of Excellence for Child

and Youth Mental Health, n.d.).

Stigma and poor economic status and accessibility to mental health resources are crucial

determinants of health in particular and they can prove to be the biggest barriers to treatment

regarding mental health. Negative stigma surrounding mental health in a community can result

in adolescents becoming fearful or shameful and therefore unlikely to seek help from family or

other adults (People to People Health Foundation, 2015). Low economic status and

inaccessibility to local mental health clinics can also make it difficult for individuals to seek help

even if they wish for guidance (People to People Health Foundation, 2015). It is important to

recognize major determinants of health to implement a successful health policy for the

community.
 PASCO PRIORITY HEALTH ISSUE 7

Population Diagnosis

Pasco County had high levels of non-fatal hospitalizations for self-inflicted injuries with

a rate of 133.8 per 100,000 people in 2013 and Statewide the rate was 94. Therefore, adolescents

aged 12-18 in Pasco County are at risk for increased nonfatal hospitalizations of self-inflicted

injuries due to lack of mental health screenings and parents unaware of the signs and symptoms

of major mental illnesses such as depression.

Community/Population-based Interventions

Primary Level of Prevention

Primary prevention is conducted to prevent injury or disease in the population and is

geared towards people at risk (Savage, Kub, & Groves, 2016). In this situation, the recipient of

the primary level would be the individual adolescent and their family. To reduce the risk of

hospitalizations from self-inflicted injuries and possible suicide, it would be beneficial to

promote health teaching regarding self-harm and suicide prevention education to students and

family members. The stakeholders would include all parents, adolescents, teachers, health care

providers, and the school board. The education presented to the stakeholders will address the

risks of self-harm as well as inform about signs and symptoms of mental illness, which can aid

guardians and school employees in identifying risk factors early (Georgia Tech, n.d.). Possible

funding concerns involve how the education and information will be provided to the public .

Possible routes include media or in person seminars in classrooms, however proper staffing and

scheduling will be required. The community health nurse would play a large role in this

intervention by promoting the spread of education to all individuals and families that exhibit risk

factors that could lead an adolescent to complete self-harming behaviors.

 PASCO PRIORITY HEALTH ISSUE 8

Secondary Level of Prevention

Secondary prevention is typically aimed at creating interventions that will detect early

signs of disease or injury and typically involves screenings and possible treatment (Savage, Kub,

& Groves, 2016). The stakeholders would include, parents, teachers, and health care providers.

Once the stakeholders are informed and educated about the risks of self-harm and the signs and

symptoms of mental health, they should then be shown how to follow the Question, Persuade,

and Refer (QPR) suicide prevention model that promotes asking the individual if they exhibit

signs of mental illness, possibly persuading the individual to seek help, and aiding the individual

to find resources to an appropriate health care provider to aid in their recovery (Georgia Tech,

n.d.). Parents and teachers are important stakeholders in this prevention because due to their

close involvement with adolescent lives they can identify and screen adolescents that exhibit

signs and symptoms of self-harm or mental illness and refer them to proper health care providers

before the situation worsens. Health care providers as well as the community health nurse then

play the role of treating the adolescent with therapy or pharmacotherapy to stop the progression

of mental illness and self-harm. The potential issues with the intervention involve financial

concerns regarding payment for health services and referrals .

Tertiary Level of Prevention

The tertiary level of prevention involves aiding those who have been affected by the

undesirable outcome and therefore needs to be monitored and aided with the consequences

(Savage, Kub, & Groves, 2016). For example, if an adolescent becomes hospitalized due to self-

harm, it would then turn into a tertiary level of prevention in which the goal would be to

reinforce compliance with treatment, monitor treatment effects, and prevent rehospitalization

through continued counseling, pharmacotherapy, and support groups (Georgia Tech, n.d.). The
 PASCO PRIORITY HEALTH ISSUE 9

stakeholders would include health care providers as it will be their job to reinforce treatments,

education, and compliance to the individual and family members involved . The community

health nurse would also play a huge role in monitoring the progress of the individual and

continuing treatment. Funding concerns may present as a problem as there may prove difficult

for the family of the adolescent to pay for the mental health services and continued treatment .

Development of Health Policy

Health policies are plans that are developed to obtain specific health care goals for a

population and outlines a vision for the future (World Health Organization, n.d.). Decreasing the

number of nonfatal hospitalization from self-inflicted injuries in adolescents aged 12-18 in Pasco

County will be the goal of this health policy. To achieve this health policy proposal, it would be

beneficial to focus on the primary level of prevention to decrease the overall number of

hospitalizations of adolescents. As mentioned earlier, the primary level of prevention consists of

providing health education to the public regarding self-harm, mental illness, and suicide

prevention (Georgia Tech, n.d.). The stakeholders that would be targeted and affected by this

health policy would be the adolescents, parents, teachers, health care providers, and the school

board for funding and approval.

The parents can be seen as both a positive and negative stakeholder for this policy.

Parents and teachers would have a large influence since they are the ones who are engaged in an

adolescent’s life and therefore can ultimately benefit the most from the teaching to support and

care for the adolescents. The health care providers would also influence the policy by providing

support for the parents and offering valued opinions and added education about self-harm.

However, parents can also be considered a possible opposing force for this health policy because

the topic of mental health can be considered as a taboo subject and some parents may deny the
PASCO PRIORITY HEALTH ISSUE 10

necessity to educate their children on subjects of self-harm (Alliance of Natural Health, 2016).

Adolescents and the school board can also be possible opposing forces. Adolescents may not be

interested to sit and learn about mental health and may possibly feel peer pressured into not

receiving help or guidance (Teen Mental Health, n.d.). The school board may be opposed to the

proposal as the subject of mental health may need approval to be taught in classrooms during

class time where funding will be required for the material and time needed for the presentation

(Classroom Mental Health, n.d.). There would also have to be a waiver sent home for parents to

approve and permit their children to learn of such subjects if they allow.

The first steps that must be taken to put the policy into action is to first present the policy

to the school board to seek approval and funding. Once approved by the school board, the next

step would be to inform the teachers and staffs of the schools to inform them of the policy and

the necessity to dedicate set classroom time to promote this mental health awareness. It is

important to stress to teachers and schools that improving communication, reducing stigma, and

reducing stress are important goals to maintain in the classroom always (Classroom Mental

Health, n.d.). It would then be beneficial to hire a well renowned health care provider or

psychiatrist to present the information to the parents, teachers, and adolescents on set dates in

which the public can choose to attend. The education will consist on informing the public the

signs and symptoms of different mental illnesses, the risks of self-harm, and the consequences of

suicide. The health proposal will impact Pasco because it will help to address a very important

health topic that is often over looked. Mental health is just as important as physical health and if

addressed, can help to reduce deaths and illnesses across the county. If more adolescents,

parents, teachers, and health care providers are taught about the importance of mental health than

the number of adolescent hospitalizations due to self-inflicted injuries will surely decrease.
PASCO PRIORITY HEALTH ISSUE 11

Conclusion

There are 56,014 adolescents aged 18-20 in Pasco county, which takes up approximately

9% of the population in Pasco (Florida Department of Health, 2015a). Adolescents are in a

stressful part of their life in which they are approaching early adulthood which encompasses many

big life changes. Stress on an individual can lead to negative behaviors if not dealt with

appropriately. Although nonfatal self- inflicted injuries are not always suicide attempts, self-harm

is a major predictor of future suicide attempts. The rate of hospitalizations due to self-harm in

Pasco county adolescents is dangerously higher than the state average and therefore a health policy

must be enforced to reduce the possible suicide risks in Pasco adolescents. The policy is to

decrease the number of hospitalizations due to self-inflicted injuries in adolescents aged 12-18,

however to promote this policy the focus must begin in the primary level of prevention. Education

and mental health teaching must be promoted in schools and in the community so that adolescents,

parents, and teachers can all be educated on the signs and symptoms of mental illness, the risks of

self-harm, and the consequences of suicide. The higher the rate of mental health education in the

community, the lower the chances of self-harm acts and possible suicide attempts.

The topic is relevant to nursing since education and teaching is an important task that all

nurses must complete in everyday work. As a future nurse, I consider this topic very important

since it deals with the wellbeing of a population in the community that is often considered healthy

and therefore often overlooked. As a nurse, one must not only treat the physical illnesses an

individual might have, but also the mental illnesses to promote overall health. It is also crucial as

a nurse to never forget the importance of patient education as it can ultimately save lives.
PASCO PRIORITY HEALTH ISSUE 12

References

Alliance of Natural Health. (2016). Let’s break the mental health taboo in 2016. Retrieved from

http://anhinternational.org/2016/01/06/lets-break-the-mental-health-taboo-in-2016/

Carrol, R., Thomas, K., Bramely, K., William, S., Griffin, L., Potokar, J., & Gunnell, D. (2016).

Brief Report: Self-cutting and risk of subsequent suicide. Journal of Affective Disorders,

1928-10. doi: 10.1016/j.jad.2015.12.007

City Data. (n.d.). Pasco county, florida (FL). Retrieved from

http://www.city-data.com/county/Pasco_County-FL.html

Classroom Mental Health. (n.d.). Your classroom climate. Retrieved from

https://www. classroommentalhealth.org/mental-health-in-the-classroom/classroom-

climate/

County Health Rankings. (2017). Florida: Pasco (PA). Retrieved from

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

overall/snapshot

Florida Department of Health. (2015a). County health profile. Retrieved from

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

tyHealthProfile

Florida Department of Health. (2015b). Adults with any kind of healthcare insurance coverage.

Retrieved from http://www.flhealthcharts.com/charts/Brfss/DataViewer.aspx?bid=0011

Florida Department of Health. (2015c). Adults who could not see a doctor at least once in the

past year. Retrieved from http://www.flhealthcharts.com/charts/Brfss/DataViewer

.aspx?bid=0013
PASCO PRIORITY HEALTH ISSUE 13

Georgia Tech. (n.d.). Levels of prevention. Retrieved from

http://endsuicide.gatech.edu /content/levels-prevention

Mayo Clinic. (2016). Sexually transmitted diseases: Symptoms and causes . Retrieved from

http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-

stds/symptoms-causes/dxc-20180596

National Institute of Health. (2016). Smoking and your heart: What are the risks of smoking?

Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/smo/risks

National Institute of Health. (2017). Overweight and obesity: Signs, symptoms, and

complications. Retrieved from

https://www.nhlbi.nih.gov/health/health-topics/topics/obe/signs

Office of Disease Prevention and Health Promotion. (n.d.). Determinants of health. Retrieved

from https://www.healthypeople.gov/2020/about/foundation-health-

measures/Determinants-of-Health

Ontario Centre of Excellence for Child and Youth Mental Health. (n.d.). Social determinants of

health. Retrieved from http://www.togethertolive.ca/social-determinants-health

Ougrin, D. (2012). Self-harm in adolescents: The best predictor of death by suicide? -reflections

on Hawton et al. (2012). Journal of child Psychology and Psychiatry, (12), 1220.

Pasco County Florida. (n.d.). About us. Retrieved from

http://www.pascocountyfl.net/index .aspx?NID=1376

Pasco EDC. (2017). Pasco county’s largest employers. Retrieved from

http://pascoedc.com/top-employers
PASCO PRIORITY HEALTH ISSUE 14

People to People Health Foundation. (2015). The forgotten chronic disease: Mental health

among teens and young adults. Retrieved from

http://healthaffairs.org/blog/2015/10/01/the-forgotten-chronic-disease-mental-health-

among-teens-and-young-adults/

Savage, C.L., Kub, J.E., Groves, S.L. (2016). Public health science and nursing practice: Caring

for populations. Philadelphia: F.A. Davis Company

Teen Mental Health. (n.d.). Understanding stigma. Retrieved from

http://teenmentalhealth.org /live/understanding-stigma/

University of Minnesota. (n.d.) Adolescent stress and depression. Retieved from http://www.

extension.umn.edu/youth/research/youth-issues/adolescent-stress-and-depression/

World Health Organization. (n.d.). Health policy. Retrieved from http://www.who.int/topics/

health_policy/en/