Running head: HILLSBOROUGH COUNTY 1

Reducing Sexually Transmitted Infections in Hillsborough County

Addelyn Villalobos

University of South Florida

HILLSBOROUGH COUNTY 2

Reducing Sexually Transmitted Infections in Hillsborough County

In this section you will write a paragraph describing the purpose of the paper.

The introductory paragraph tells the reader why the paper was written. For example, typically

authors may describe what drew them to study a particular county or why they chose to focus on

a specific health issue. You may follow this demonstration of headings and content but be sure

to adapt, if needed, to your county and remove all blue highlighting - blue is for your

information.

Overview of Hillsborough County

Hillsborough county is located in southwest Florida along the gulf coast and is the fourth

largest county in Florida by population (United States Census Bureau, 2017). It is home to the

third largest city according to population size in Florida; Tampa (United States Census Bureau,

2017). Hillsborough county has a vast variety of living environments ranging from city living, to

rural living to waterside living. The population of Hillsborough county according to race is fifty

percent white, twenty-seven percent Hispanic, fifteen percent African-American and four percent

Asian (Data USA, 2016).

Regarding education, 32 percent have a Bachelor’s degree or higher education (United

States Census Bureau, 2010). According to the Census Bureau, 18 percent of adults in this

county do not have health insurance. The largest employer in this county is the School District

of Hillsborough County followed by HCA West Florida and MacDill Airforce Base (Suncoast

Employers, 2016). The major healthcare systems in this county are Advent Health (formerly

Florida Hospital), Baycare facilities and HCA West Florida (Florida Hospital Association, 2019).

Hillsborough county compares well to some state measures but does have weaknesses in some

areas which will be further examined.

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Comparison of Local vs. State Populations

Poverty is a concerning issue in Hillsborough county, 15.5 percent of people in this county

live below the poverty line compared to 14 percent in the whole state of Florida (United States

Census Bureau, 2010). Education level is another important factor to analyze prior to any

implementation; 88.2 percent of the population age 25 and older has a high school diploma

compared to 87.6 percent in the state population of Florida (United States Census Bureau, 2010).

Since Florida has a prevalent population of immigrants (1 in 5), language is a potential barrier to

making changes in Florida counties (American Immigration Council, 2017). Hillsborough

county’s percentage of people over age five that speak a language other than English at home is

similar to the Florida state average, both at 28 percent (United States Census Bureau, 2010).

Access to healthcare is also somewhat limited across Florida as well as Hillsborough county, the

ratio of population to primary care physicians is 1,190: to 1 in the county compared to 1,380 to 1

in Florida (University of Wisconsin Population Health Institute, 2018).

Analysis and Interpretation of Data

The following subsections will describe aspects of health data from Hillsborough county

interpreted as strengths and weaknesses of the county. This data will be compared to the state of

Florida rankings to demonstrate why it is a strength or weakness. Data for the following section

was gathered from the Hillsborough county health profile.

Identified Strengths

According to county health rankings, Hillsborough county does fare better in some areas

compared to the state of Florida. Approximately 92 percent of residents of Hillsborough county

have adequate access to an exercise facility or exercise support compared to 87 statewide

(University of Wisconsin Population Health Institute, 2018). The United States Department of
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Health and Human Services found that adults need at least 150 minutes of moderate intensity

aerobic activity, or exercise, per week to promote quality of life and disease prevention

(American Heart Association, 2018). Having adequate access to an exercise facility or support

for exercise can increase a populations ability to reach these physical activity recommendations.

In addition to this, the physical inactivity percentage is also lower than the state average at 23

percent compared to 24, and this number is trending down for Hillsborough county (University

of Wisconsin Population Health Institute, 2018). Physical activity plays an important role in

maintaining a healthy lifestyle and can help to improve numerous health conditions.

Hillsborough county has improving statistics for areas related to physical activity and proves to

be a strength for the county.

A third strength of Hillsborough county is safety. Reported violent crimes in

Hillsborough county per 100,000 is 339 compared to 500 statewide (University of Wisconsin

Population Health Institute, 2018). The number of violent crimes for Hillsborough county is

even trending down. The number of homicides and firearm fatalities are also lower than state

averages (University of Wisconsin Population Health Institute, 2018).

Identified Weaknesses

Hillsborough county does have a few weaknesses on a number of health related issues,

the first being teen pregnancy. The rate of teens (ages 15-19) giving birth is 29 per 1,000

compared to 25 state average (University of Wisconsin Population Health Institute, 2018).

Another weakness is sexually transmitted infections, specifically chlamydia, newly diagnosed at

a much higher rate than the state (University of Wisconsin Population Health Institute, 2018).

An additional identified weakness of Hillsborough county is alcohol related problems. County

officials found that 20 percent of residents report excessive drinking compared to 18 percent for
HILLSBOROUGH COUNTY 5

Florida (University of Wisconsin Population Health Institute, 2018). Excessive or heavy

drinking is considered more than four drinks on one day or fourteen per week for men and more

than three drinks on one day or more than seven per week for women (National Institute on

Alcohol Abuse and Alcoholism, n.d.). Heavy drinking can lead to a number of short term health

risks such as risky sexual behavior, including unprotected sex which increases the risk of

acquiring a sexually transmitted infection (STI) (Centers for Disease Control and Prevention,

2018). Heavy drinking also increases the risk of miscarriage or fetal alcohol spectrum disorders

(FADSs) in pregnant women (Centers for Disease Control and Prevention, 2018).

Identification of a Priority Health Issue

The spread of sexually transmitted infections, such as chlamydia, is a community health

issue that has never been fully eradicated and chlamydia is spreading at a much more rapid rate

nationally (American Sexual Health Association, 2018). This infection is not only a health

priority but also a community health priority because of how easily it can be spread from one

person to another, with or without knowledge of having the infection. Hillsborough county has

on average 577 newly diagnosed cases of chlamydia per 100,000 compared to 455 statewide and

that number is trending poorly for Hillsborough (University of Wisconsin Population Health

Institute, 2018). A diagnosis of chlamydia can affect not only physical health but mental health

as well and can be spread to persons of any age. This is a priority health concern that needs to be

addressed in Hillsborough county because untreated STI’s can lead to an array of more serious

health problems including infertility, organ damage and even death (Centers for Disease Control

and Prevention, 2018).

Discussion and Application of Community Health Models

HILLSBOROUGH COUNTY 6

Prior to improving a community’s overall health, planning interventions is an important

part of the public health process in order to have effective and practical interventions.

Community health models aid in planning which health issues need improvement as well as how

to address those health issues among populations. One example of a predominant model is the

Social Determinants of Health Model. The Social Determinants of Health Model was created

along with the four Healthy People 2020 overreaching goals (United States Department of

Health and Human Services (HHS), Healthy People 2020, 2019). The model highlights the

social aspects that have the power to impact health status. There are five social determinants of

health according to Healthy People 2020 and the Social Determinants of Health Model;

economic status, education, social and community context, health and health care, and

neighborhood and built environment (HHS, Healthy People 2020, 2019). The Social

Determinants of Health Model is a useful tool in identifying which social aspects in a population

could be poorly affecting the health of the population, and aids to correct these areas with

planned interventions to promote better health for the population of focus.

Healthy People 2020 states that access to healthcare and poverty are social factors that

contribute to the risk of acquiring a STI (HHS, Healthy People 2020, 2019). Hillsborough

County has a 1,190:1 population to primary care physician ratio and 15% of the population is

uninsured and lives in poverty (County Health Rankings & Roadmaps, 2018). The

aforementioned facts are worse than the national averages and are indicative of limited access to

healthcare as well as poverty in Hillsborough County (County Health Rankings & Roadmaps,

2018). It is also indicated that a population’s level of health literacy (LHL) is correlated to STI

prevalence; a higher LHL is linked to a lower prevalence of STI’s (Mendonca et al., 2016). The
HILLSBOROUGH COUNTY 7

majority of Hillsborough County has a low LHL, which could be contributing to higher STI rates

compared to the state of Florida (The University of North Carolina at Chapel Hill, 2014).

Population Diagnosis

People between the ages of 15 and 24 living in Hillsborough County are at higher risk for

acquiring a sexually transmitted infection due to lesser access to health care and lower health

literacy levels.

Community/Population-based Interventions

Evidence based interventions to reduce STI rates will now be discussed according to the

Levels of Prevention Model. The main STI’s that the following interventions target are the

human papilloma virus, gonorrhea and chlamydia. Interventions will be categorized into

primary, secondary and tertiary levels of prevention.

Primary Level of Prevention

According to the Levels of Prevention Model, primary interventions prevent the illness or

event before it physically occurs (Institute for Work and Health, 2015). The human papilloma

virus (HPV) vaccine is an effective, individualized and population targeted, evidence based

practice primary intervention to reduce HPV (Rosen et al., 2017). If left untreated, HPV can

advance to various forms of cancer and since the introduction of the vaccine in 2006, HPV

related cancer rates have sharply declined according to the Centers for Disease Control and

Prevention (CDC) (Rosen et al., 2017). Stakeholders for this intervention are health care

professionals administering and supplying the vaccine as well as parents of minors receiving the

vaccine. Since the HPV vaccine is recommended for children ages eleven to twelve, the parents

and guardians of this population determine if they receive the vaccine and play a major role

(Rosen et al., 2017). A main concerns with the HPV vaccine is cost; each dose of the HPV
HILLSBOROUGH COUNTY 8

vaccine costs approximately $250 when not covered by insurance or some type of assistance

program (Planned Parenthood, 2019). A community health nurse would be responsible for

administering the vaccine and educating the population about the vaccine.

Secondary Level of Prevention

Early detection is important with STI’s in order to prevent the infection from progressing

and being spread, and detection is considered a component of the secondary level of prevention

(Institute for Work and Health, 2015). School based screening for STI’s has been implemented

before and has been shown effective in early detection of gonorrhea and chlamydia in students

grades nine through twelve (CDC, 2014). There was a significant drop in gonorrhea and

chlamydia cases amongst students following the initial screenings, successfully lowering the

rates of STI’s among this population (CDC 2014). The students, parents of these students, and

county health department are all stakeholders in this community based intervention. The

students and parents must consent to participate and the county health department of the schools

location must supply the staff and resources to accomplish the screenings. A partnership with

the school nurse whom the students are already familiar with, as well as additional community

health nurses to help carry out the screenings could be beneficial to this type of intervention and

creates an open line of communication between the students and the nurses. Funding would be

dependent on the county’s health department and could be an issue if there is not enough funding

to carry out screenings across all of the high schools in Hillsborough County.

Tertiary Level of Prevention

The CDC recommends a program called Expedited Partner Therapy (EPT) to target STI’s

at the tertiary level of prevention (CDC, 2018). This program treats, counsels and educates

sexual partners with an active STI and was found effective in preventing re-infection among
HILLSBOROUGH COUNTY 9

couples (Shiely, 2010). Healthcare providers and the individuals receiving the therapy are the

main stakeholders for this type of therapy. The partners undergoing therapy are responsible for

cost, which could be an issue for people living in poverty or those that are uninsured.

Community health nurses are often the first line of contact in the clinical setting, and will aid in

creating a comfortable, communication friendly environment for partners and healthcare

providers as well as education.

Development of Health Policy

Early detection of chlamydia and gonorrhea in adolescents ages 15-19 living in

Hillsborough County in order to prevent further spread of infection will be the focus of this

health policy. Early detection will occur via mandated high school based screenings so that the

infected students can be informed and referred to treatment in order to prevent further spread.

This policy is a secondary level of infection prevention because only the screening will be

mandated, not the treatment that students will be referred to. It is required by law that children

attend school and by implementing these screenings in a school environment, the target

population of adolescents age 15-19 is being reached. The screenings can be done more

efficiently on high school campuses across Hillsborough County so that parents or guardians of

this population will not have to transport to a separate location, set up appointments or take time

off work for a doctors visit to be screened. Screening all students will allow students to remain

anonymous and not be singled out. It has also been shown that population based STI screening

can aid in reducing sexual risk behavior in youth that test positive (Sznitman et al., 2010).

The ideal outcome of this health policy is that students that test positive for a STI will be

referred to an educator to inform the student of treatment options and future safe sex practices;

therefor preventing further spread of infection. In order to implement this policy, initial
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coordination would have to occur between the county health department, school board and

school nursing staff. Involving the schools’ Parent Teacher Association (PTA) or similar

governing body would be beneficial also, there may be some backlash from parents about the

health policy that will need to resolved. The policy would need to first be presented to the

Hillsborough County Health Department and School Board simultaneously to gain approval and

funding from the health department. If the health department agrees to budget the program, the

school board would also need to agree to implement the policy into all high schools in

Hillsborough County. The last step would be acquiring staff to carryout the screenings,

specifically community health nurses. School nurses could take the lead for each high school,

but additional nursing staff would be necessary and could be pulled from the county health

department, rotating through the high schools.

Since this health policy involves the school board, there are multiple stakeholders to be

included. The primary stakeholders are school board administrators, county health department

legislation, the community members who are involved in the schools governing bodies, and the

parents of the students attending the schools that would need to be the ones to provide consent

for the screenings since most high school students are under the age of 18. Funding would come

primarily from the county health department for the screening resources and staff. This health

policy may take a few years to implement so that a budget can be planned accordingly if the

school board agrees to accept the policy. This health policy could face potential scrutiny, parents

may object to their children being screened or it may be viewed as taboo. However, this type of

program has been shown to be very effective when implemented properly and community

members and parents need to be well informed in order to prevent this possible opposition. If
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parents choose to oppose this policy, they may not consent for their child to be screened which

would have a negative impact on the effectiveness of this population aimed screening strategy.

Conclusion

Hillsborough County is home to one of the largest cities in the country, and the health of

this county has some improvements to be made. By targeting a specific population early on to

prevent one of the most prevalent health concerns in Hillsborough county, STI rates, the overall

health of the area can begin to improve. STI’s affect both men and women and can lead to lasting

health problems if left untreated in all ages. By screening a younger, targeted population of

adolescents (age 15-19) in a setting where all members of this age group can participate,

prevention interventions can begin to occur to prevent further spread of infection. While this

policy may be controversial, the overall health of the population can benefit from the policy

implementation.

As a nurse, we have to consider all sides of an implemented change, especially ones that

involve multiple parties. While I fully support this health policy from a healthcare worker

prospective, I can see why parents may not agree with it. My mother is a Physician Assistant, so

my personal experience with sex education was done very objectively. While blatant, a lot of the

time this approach is best, especially with teenagers. I have incorporated this into my nursing

practice. An important part of any nurses job is education, and judging whether to be blatant or

whether to be gentle with it. When it comes to STI prevention, it is much more about the bigger

picture and the lasting effects of STI’s and I have always used a direct approach. This health

policy is very much a direct approach, one that could highly benefit the health of Hillsborough

county in the long run.

HILLSBOROUGH COUNTY 12

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