Running head: PROPOSED HEALTH POLICY 1

Proposed Health Policy for Pinellas County Regarding Sexually Transmitted Infections Among

Adolescents

Wendy M. Keil

University of South Florida

PROPOSED HEALTH POLICY 2

Proposed Health Policy for Pinellas County Regarding Sexually Transmitted Infections Among

Adolescents

Pinellas County is home to 970,637 people as of July 1, 2017 (U.S. Census Bureau, 2018)

and, 593 out of 100,000 residents are newly diagnosed with sexually transmitted infections

(STIs) each year according to the Department of Health of the State of Florida (2018). The

Florida Department of Health reports that the incidents of STIs increase each year in Pinellas

County, and this is concerning. The health of Pinellas County is important for longevity and

quality of life of its residents. Early education and early access to healthcare are important

interventions to combat the rising incidents of STIs in Pinellas County. The proposed health

policy will reduce the number of STIs in Pinellas County which will reduce health costs and

improve overall health.

Overview of Pinellas County.

Pinellas County is a peninsula situated between the Gulf of Mexico and Tampa Bay on

the western coast of Florida with a population of 970,637 as of July 1, 2017 (U.S. Census

Bureau, 2018). The largest city within the county is St. Petersburg and the entire county is

densely populated with little to no rural areas. The U.S. Census Bureau reports the majority

ethnic group is white at 82.7% followed by African American at 11.1% (2018). Additional

statistics include 24.2% of the population is over the age of 65, and 16.5% is under the age of 18.

High school graduates make up 90.4% of the population, and 29.5% have a bachelor’s degree or

higher. The median annual household income is $47,090, and 13.3% of the population are at the

poverty level. In regard to healthcare, 13.9% of the population report being without healthcare

insurance (U.S. Census Bureau, 2018). The three largest employers in the county are the

Pinellas County School District with 13,905 employees, the Home Shopping Network (HSN)
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with 4,000 employees, and Pinellas County Government with 4,000 employees (Suncoast Jobs,

LLC, 2018). Bay Care is the largest health care system within Pinellas County and the

surrounding areas with 15 hospitals and a network of outpatient facilities (Bay Care Medical

Group, 2018). Pinellas County ranks above average the state average in overall health outcomes,

but still has a way to go to be in the top 10% (County Health Rankings & Roadmaps, 2018).

Comparison of Local vs. State Populations

When comparing Pinellas County to the State of Florida, Pinellas County ranks 26th of 67

counties in health outcomes (County Health Rankings & Roadmaps, 2018). The percentage of

families below the poverty level is only slightly better with Pinellas County reporting 13.3% as

compared to the state of Florida at 14.0%. (U.S. Census Bureau, 2018). According to Sally

Murray in a 2016 article, poverty and health are intertwined because financial resources directly

influence availability of healthy foods, safe home and work environments, and healthcare.

Families in poverty may not be able to afford food at all, or they purchase foods that are highly

processed, high in fats and sugars, and not balanced in nutrients because they are cheaper. Safe

homes are often unaffordable and working environments of the underpaid hold risks that can lead

to illness or injury (Murray, 2016). Healthcare is accessed less frequently which could be a

result of financial resources, lack of health insurance, or lack of education (Murray, 2016).

Pinellas County also ranks higher than the state with 94.4% of the population greater than

25 years old obtaining a high school diploma or higher while the state reports 87.2% (U.S.

Census Bureau, 2018). According to Cutler and Lleras-Muney, the mortality rate for persons

ages 25-64 who didn’t obtain a high school diploma is double the mortality rate for persons with

some college as reported by the National Vital Statistics Reports in 2001 (2006). The

undereducated have less health-promoting knowledge of prevention or treatment of injuries or

PROPOSED HEALTH POLICY 4

illnesses (Murray, 2016). This leads to unhealthy lifestyle habits, the lack of preventative care,

and seeking care late in the disease process (Murray, 2016).

There are less foreign speaking homes in Pinellas County at 13.7% as compared to the

state at 28.3% (U.S. Census Bureau, 2018). Lack of effective communication between

healthcare workers and patients can result in medical errors which could be life-threatening

(Meuter, Gallois, Segalowitz, Ryder, & Hocking, 2015). In order to support good health

outcomes, interpreters and/or other forms of communication are essential.

The ratio of the population to primary care physicians is 1,090:1 in Pinellas County while

the state ratio is 1,380:1 (County Health Rankings & Roadmaps, 2018). Pinellas County comes

close to the top 10% (1030:1) of the United States in healthcare availability. Easily accessible

healthcare is necessary for the health of a community because people are less likely to seek care

if there are too many obstacles.

Analysis and Interpretation of Data

Pinellas county is ranked 16th in health factors and 26th in health outcomes out of the 67

counties in Florida according to the County Health Rankings & Roadmaps (2018). There are

many factors that affect health and most of those are intertwined which makes the assessment of

health factors complicated. The following analysis will look at individual health factors within

the county.

Identified Strengths

Three strengths identified in Pinellas County are access to healthcare, access to exercise,

and physical inactivity (County Health Rankings & Roadmaps, 2018). These strengths represent

health behaviors that promote overall general health and the prevention of many diseases. The

access to healthcare in Pinellas County is better than the state of Florida as demonstrated by the
PROPOSED HEALTH POLICY 5

ratio of people to primary care physicians with Pinellas County at 1,090:1 and the state at

1,380:1 (County Health Rankings & Roadmaps, 2018). Ninety-six percent of Pinellas County

has access to exercise which is above the state at 87% and the national top performers at 91%

(County Health Rankings & Roadmaps, 2018). Physical inactivity reported in Pinellas County is

23% which is better than the state at 24% but is lower than the national top performers at 20%.

Healthy People 2020 reports that 34% of the U.S. population is obese and includes nutrition,

physical activity, and obesity as a leading health indicator (U.S. Department of Health and

Human Services, 2018).

Identified Weaknesses

Three weaknesses identified in Pinellas County are sexually transmitted infections (STI),

excessive drinking, and teen births (County Health Rankings & Roadmaps, 2018). These

weaknesses represent health behaviors that do not promote health and are risk factors in many

disease processes. Pinellas County had 593 cases of newly diagnosed STIs per 100,000

population which is better than the state at 455 cases but considerably worse than the national top

performers at 145 cases (County Health Rankings & Roadmaps, 2018). Excessive drinking is

reported at 21% which is above the state at 18% and the national top performers at 13% (County

Health Rankings & Roadmaps, 2018). The county also has a teen birth rate of 25 births per 1000

females between the ages of 15-19 which is equal to the state but higher than the national top

performers at 15 cases (County Health Rankings & Roadmaps, 2018). Healthy People 2020

reports that an estimated 19 million people contract a STI each year and includes reproductive

and sexual health as a leading health indicator (U.S. Department of Health and Human Services,

2018).
PROPOSED HEALTH POLICY 6

Identification of a Priority Health Issue

With 19 million people contracting an STI each year according to the U.S. Department of

Health and Human Services (2018), 455 out of 100,000 of newly diagnosed cases of STIs in

Pinellas County is priority health issue (County Health Rankings & Roadmaps, 2018). The

County Health Rankings limits the data to cases of chlamydia (2018), but the Department of

Health State of Florida (2017) reports 1065 cases per 100,000 in Pinellas County as compared to

the 593 cases in Florida of all reportable STIs. The other two weakness identified are also

indicators that there’s a health issue regarding STIs because teen births demonstrate the lack or

misuse of birth control, and excessive alcohol results in risky behaviors such as unprotected sex

and multiple sexual partners.

Discussion and Application of Community Health Models

A Community Health Model is important because it establishes a framework that

promotes health within a community while allowing for different approaches based on the

community’s needs. The social determinates of health model outlines seven distinct disparities

that affect the health of a community including natural biological variation, health-damaging

behavior, and inadequate access to healthcare (Savage, Kub, & Groves, 2016). In Pinellas

County, the amount of newly diagnosed cases of STIs indicates a disparity in health-damaging

behavior and limited access to healthcare. Once the disparity is identified, solutions can be

established. Education is the easiest and most cost-effective way to combat health-damaging

behaviors while access to care is more complex.

Population Diagnosis

Sexually active adolescents in Pinellas County are at risk for sexually transmitted

infections due to lack of education.

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Community/Population-based Interventions

There are many different levels of interventions. According to the Intervention Wheel

Model, there are 17 public health interventions that can be focused at the individual, community,

or system level (Savage, Kub, & Groves, 2016). One of the primary focuses of the Intervention

Wheel is health education, but it also takes in consideration education disparities. The Levels of

Prevention Model focuses its interventions based on prevention, screening, and treatment

(Savage, Kub, & Groves, 2016). The Institute for Work & Health defines these levels of

treatment as primary, secondary, and tertiary levels of prevention (2015). Primary prevention

aims to prevent disease or injury before they happen through legislation, education, and

immunization. Secondary prevention aims to detect and mitigate disease or injury through

medical exams, medical screenings, medications, dietary changes, and exercise programs.

Tertiary prevention aims to lessen the impact of complex health problems and debilitating

injuries through rehabilitation programs, support groups, and medical management (The Institute

for Work & Health, 2015). With all interventions, evidence-based practices should be utilized

for the best outcomes.

Primary Level of Prevention

Sexually Transmitted infections are very prominent in Pinellas County with a rate of 443

compared to the state rate of 145 (Ewan, Hillsborough County, 2018). The primary level of

prevention will focus on the community and enhance awareness of safe sex practices. A concept

map for STIs identified 7 areas: General sex education, support and empowerment, testing and

treatment, community involvement and awareness, prevention and protection, parental

involvement in sex education, and media (Ewan, McLinden, Biro, DeJonckheere, & Vaughn,

2016). These concept maps were able to identify key stakeholders and strategies at multiple
PROPOSED HEALTH POLICY 8

social ecological levels. The intervention suggested was to improve education about safe sex

practices and to offer free preventative supplies. This can be embedded within currently

established clinics in the county, but government funding will be needed to support the need for

increased staff and supplies. Key stakeholders that need to support the intervention are

government leaders at the state and local levels, healthcare workers, social work, school

employees and parents. The role of school nurses will be to offer education to students and to

offer supplies as needed if parental permission is provided.

Secondary Level of Prevention

Secondary level of prevention will be screening for STIs within the community.

Screening is an important tool for the patient to be properly treated and educated on the disease

process. According to Grieb et. al, methods to increase privacy were effective for increasing

screening (2018). The methods included using apps for scheduling appointments, completing

paperwork, and self-test kiosks where that patient can drop off their specimen. This intervention

would be a community wide intervention because it would need to be implemented throughout

the community and available for all citizens. Funding will be needed for additional staff,

supplies and testing centers. Key stake holders requiring buy in are government officials,

healthcare workers, school officials, social workers and parents. These stakeholders are essential

because they can grant funding and are experts on what resources would be needed. The role of

the school nurse will be to provide education on resources available and coordinate follow-up

care with the parents.

Tertiary Level of Prevention

Treatment for STIs is the tertiary level of prevention and needs to be a community wide

intervention. Time to treatment is an issue in the healthcare system. A study conducted in the
PROPOSED HEALTH POLICY 9

school system in Chicago revealed that time to treatment was significantly reduced with

embedded school treatment clinics (Sabharwal, Masinter, & Weaver, 2018). This model can be

used in the Pinellas County school system as well as be developed as free standing STI clinics

for adults. The key stakeholders for this intervention will need government officials, school

officials, healthcare professionals, social worker officials and parents. Funding will be needed to

support the additional staff and the need for more facilities and supplies. The school nurse role

will be to screen the student and refer them to the school STI clinic immediately for treatment

once the STI is identified as well as provide needed education and parental support.

Development of Health Policy

Reducing the incidents of sexually transmitted illnesses in adolescents of Pinellas County

by providing evidence-based education will be the focus of this health policy. The goal is to

prevent incidents of STIs, so primary level prevention will be utilized. Pinellas County currently

has 593:100,00 new cases of STIs and 25:1000 teen births each year (Department of Health State

of Florida, 2017). While the teen birth rate doesn’t correlate to the incidents of STIs, it does

provide insight on the practice of unprotected sex among adolescents. STIs are of concern at any

age, but this health policy focuses on adolescents because early education provides the best long-

term outcomes (Bakken, Brown, & Downing, 2017). The Florida Board of education requires

that abstinence be taught as one component but does not prohibit other concepts (Florida

Department of Education, 2018). The Pinellas County School Board is currently recommending

sexual abstinence as the expected standard in their health education curriculum (2018), but

Breuner et al. determined that promoting abstinence only increases the likelihood of adolescents

not using protection during sexual intercourse and decreases the number of adolescents who seek
 PROPOSED HEALTH POLICY
10

screenings for STIs (2017). Since adolescents are the future adults, reducing the number of STIs

in adolescents will promote a healthy community.

The goal of this health policy is to reduce the incidents of STIs in adolescents by 20%

each year. The first step is to implement a grassroots movement by educating the public on the

importance of sex education in the school system because the voice of the public will shape the

curriculum designed by the Pinellas County School Board. All of the board members are elected

officials who will determine the health education curriculum. If there is enough public support,

signed petitions could assist in getting the proposed health education curriculum changes on the

ballot for voters to decide. There are many ways to get the public involved such as Parent

Teacher Association meetings, Social Media, television/radio commercials. Focusing on the

curriculum for Pinellas County schools will reach more adolescents than any other platform.

The key stakeholders for this policy are community members, legislators, healthcare providers,

and funding sources. Currently there is federal funding for curriculums that support evidence-

based interventions that include delayed sexual activity, contraception, and reduced sexual

partners (Breuner, et al., 2016), and the reduction in health costs could be redirected to

educational programs. The surgeon general reports that the prevention of one case of HIV saves

$355,000 of treatment. Opposition for this health policy comes from individuals who do not

believe the school system should be involved in educating children about sexuality, but with the

right evidence, education of the opposition could result in a change.

Conclusion

Adolescents in Pinellas County are at risk for STIs and education is the key to prevention.

The data supports a significant number of incidents each year, and those numbers are trending

upward. Even though the county’s overall rankings are above the state averages in many
 PROPOSED HEALTH POLICY
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determinates of health, there is still much more room for improvement. Many determinates of

health are lacking country wide, so a comparison isn’t always the best measurement. STIs are

preventable, and in an ideal situation, STIs could be nearly, if not completely, eradicated with

accurate evidence-based education and 100% compliance. Every age group is at risk for

contracting an STI, but adolescents should be a priority. Evidence supports that early education

impacts positive health outcomes, and those adolescents are our future adults who will impact

policy and practice changes for our communities. Currently Pinellas County is focusing on

abstinence for prevention of STIs, but the expectation of all adolescents abstaining is not

practical. All options of prevention should be taught so adolescents can make informed

decisions. Early education is more cost effective than treatment of STIs, and the proposed health

policy affecting adolescents will reduce the incidents of STIs.

While writing this proposed health policy, I discovered how complex health policies can

be and increases in complexity at each level. There are also many factors that affect each topic

of concern. There is also no right answer to anything. While I considered including other

factors in this paper, I felt like I would be arguing my proposal in circles. I do believe that

starting small changes at local levels would be much less tedious. I chose STIs because they are

easily preventable, yet people continue to contract them. It was even more concerning when I

discovered that my county was trending upwards. I focused my health policy towards

adolescents even though I couldn’t find statistics by age. I did find that Pinellas County also had

a significant number of teen births so that led me to determine there was a significant number of

adolescents having unprotected sex.

As a current LPN and a future RN, this proposed health policy could affect my career in

many ways. I have considered becoming a school nurse, so educating teens on the prevention of
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STIs would be an educational priority. I have also managed an OBGYN clinic where I was

indirectly involved in prevention, screening, and treatment of STIs. During my time on the labor

and delivery ward, screening for STIs that would affect the health of the baby was also a priority.

Not only is prevention good for individual health, it is also good for the economy. If we can find

ways to reduce healthcare costs overall, then we can reallocate more money to the under

privileged until all of those other disparities are addresses. Everyone has the right to be in their

best health and receive healthcare. Prevention is always cheaper than treatment. I came into

healthcare to care for the sick and injured, but the healthcare system would be so much more

streamlined if we could get patients with preventable diseases out of the pipeline.
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edu/
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Topics