Running head: CANCER IN PINELLAS COUNTY

Cancer in Pinellas County

Heidi Bosmans
University of South Florida
November 22, 2015

CANCER IN PINELLAS COUNTY

Pinellas County is a beautiful county in west central Florida. It is an extremely diverse

county with many people groups. Despite its diversity, Pinelas County residents have several
things in common. Included in the commonalities are many deficits in regards to health.
Although the county has many health resources, those resources are counterbalanced by
unhealthy lifestyles that are prevalent throughout the county. These unhealthy lifestyles choices,
such as tobacco use, excessive alchohol use and obesity, are reflected in the county's high rate of
cancer deaths. The purpose of the paper is to analyze the county's strengths and weaknesses
regarding health and lifestyles, and take a public health approach to improving health and
reducing risk for cancer.
Pinellas Counties Geographic Location and Data
Pinellas is a county located on the west coast of central Florida. According to the U.S.
Census Bureau, there are 273.80 square miles of land, making it the second smallest county in
Florida. With 916,542 people at the 2010 census, there are 3,347.5 people per square mile (U.S.
Census Bureau, 2013). Pinellas County boasts of its beautiful beaches, including Clearwater
Beach, a very popular tourist attraction. Major employers in Pinellas county include the Pinellas
County School District with over 13,000 employees, the Home Shopping Network with
approximately 4,000 employees, and the Pinelas County Government with approximately 4,000
employees (Largest Employers on the West Coast of Florida, 2011). There are several
hospitals in Pinellas county. These include hospitals from systems such as Hospital Corporation
of America, BayCare, and Florida Hospital. Other hospitals include All Childrens Hospital which
is under Johns Hopkins, a trauma center Bayfront, and several other smaller centers.
In Pinellas county, the percent of families below the poverty line is 9.5, which is slightly
better than the state percentage of 11.9 (Florida Department of Health). The percentage of

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residents who are older than twenty-five and have a highschool diploma is 88.9, compared to the
slightly lower state-wide percent of 86.1 (U.S. Census Bureau, 2013). The percent of the labor
force which is unemployed is 10.5%. The percentage of the population who are older than age
five and do not speak English very well is 5.3, compared to the state which is 11.7 (Florida
Department of Health, 2013). Statistics such as these give public health nurses insight into the
popluation's needs. They indicate health factors such as access to care and resources, and health
literacy.
Pinellas County Strength and Weakness
Pinellas county has several strengths regarding healthcare. The first strength is the
availability of hospital beds. In Pinellas county, there are 429.4 hospital beds per 100,000 people,
which is significantly more than the state of Florida which is 317.3 per 100,000 people. The
second strength is the number of physicians. There are 350.9 physicians per 100,000 people in
Pinellas county, compared to only 275.7 per 100,000 in the state of Florida (Florida Department
of Health, 2013). The last strength is in regards to health insurance. In Pinellas county, the
percent of adults with any type of health care insurance coverage is 80.2%, as of 2013. Statewide that percent is slightly lower, at 77.1% (Florida Department of Health, 2013). These are
strengths of the county because they reflect accessability of healthcare.
Although Pinellas county has strengths in regards to number of hospital beds, physicians,
and health insurance, there are several weakeness which can lead to poor health for the
community. Unhealthy behaviors are prevalent in Pinellas County. In 2013, 19.4% of the
popluation are current smokers, compared to the state of Florida with have 16.8% of the
population as current smokers (Florida Department of Health, 2013). Although this is not a
vast difference, when looking at the trends it is concerning. Between 2007 and 2013, the state of

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Florida has seen a slow but steady decreasing percent of current smokers. Meanwhile, in Pinellas
county, the percent has seen an increase. Another promininent weakness is that 61.1% of adults
in Pinellas county are overweight or obese (Florida Department of Health, 2013). Both tobacco
use and being overweight/obese are modifiable risk factors for developing several types of
cancer. The mortality rate for deaths from cancer is 160.2 per 100,000 residents of the county,
compared to 158.1 overall in the state (Florida Department of Health, 2013).
Cancer is an important topic because deaths can be prevented by first making lifestyle
changes to decrease one's risk of developing cancer, and secondly by being treated early to
prevent the cancer from metastizing and becoming fatal. In the United States, 582,607 people
died of cancer in 2012 (Center for Disease Control, 2015). Because many of the cancer deaths
can be preventable, it is important to educate the public and make moves to improve the public's
health.
Determinants of Health Model
The determinants of health model is a ways to assess and understand a population's
health. The models looks at mutiple factors that affect a population's health. According to WHO,
the determinants of health are the social and economic environment, the physical environment,
and the persons individual characteristics and behaviours (The determinants of health, n.d).
Many factors fall under these categories, such income, access to health services, genetics and
gender to name a few. A public health nurse looks at these determinants in the community and
assesses what needs to be done in order to improve the community's health. The range of impact
for the determinants of health model is large. The nurse can assess how each of these
components affect an individual patient, and use that to guide the plan of care. On a larger scale,

CANCER IN PINELLAS COUNTY

by assessing the status of the determinants of health in the community, it can be used to direct
policy changes and community programs.
There are many factors that contribute to development of cancer. Lifestyle plays a major
part. Tobacco use is a major risk factor for development of lung, mouth, larynx, esophagus,
stomach, pancreas, colon, pancreas, cervix, kidney, and bladder cancers (Stein & Colditz, 2004).
Tobacco use is not the only modifiable risk factor for cancer. Obesity is also a significant
problem is the United States. According to the Center for Disease Control, more than one third of
adults in the United States are obese (Adult Obesity Facts). Obesity is linked to many cancers
such as colorectal, renal, endometrial, postmenopausal breast, and esophageal cancer (Stein &
Colditz, 2004). Alcohol use is linked to cancer development as well. According to the Florida
Department of Health, the percent of adults in Pinellas County who engaged in heavy of binge
drinking in 2013 was 19.6, which is higher than the state percent (Florida Department of
Health, 2013). Excessive alchohol use can increase the risk of developing cancers such as oral,
esophageal, breast, colorectal and liver. The CDC recommends not to exceed one drink per day
for women and two drinks per day for men (Center for Disease Control, 2015). Other risk factors
include diet, genetics, and unsafe sexual practices.
Population Diagnosis
In the Pinellas County's population, there is increased risk for cancer because of the high
rates of tobacco use, being overweight/obese, and heavy alcohol use. This is evidenced by a
mortality rate of deaths from cancer of 160.2, compared to 158.1 overall in the state of Florida
(Florida Department of Health, 2013).

CANCER IN PINELLAS COUNTY

Community Based Intervention

Community health nurses play a integral part in the primary prevention of cancer. The
purpose of primary prevention to act now to stop problems before they occur. Many of the risk
factors for cancer are modifiable, therefore education is key to prevention. Recipients of this
intervention would be both for individual and community. The first step should be to promote
healthy behaviors in children and adolescents. Programs should be initiated in schools to
decrease the amount of youths who start smoking (Stein & Colditz, 2004). Emphasis should also
be put on healthy eating habits. A diet that is high in fiber from foods such as fruits and
vegetables reduces the risk of cancers such as colorectal (Chan & Giovannucci, 2010). Health
care providers must assess individuals and determine their risk factors, and subsequently educate
as necessary.
Secondary prevention will address clients who already have risk factors for cancer.
Recipients of this intervention would also be individuals and the community. The purpose is to
decrease their risk of developing and/or dying from cancer. A major part of this is cessation of
tobacco use for those that already smoke. Although tobacco use has a devastating effect on the
body, quitting leads to a significant reduction of risk. According to the American Cancer Society,
ten years after quitting the risk of dying from lung cancer is 50% less than that of someone who
is still smoking (When smokers quit what are the benefits over time?). There are many
methods to smoking cessation. One recent randomized controlled trial showed that when
information on cessation programs was distributed to employees of a company, the group of
employees who received information which included financial incentives for completing the
program were significantly more likely to quit smoking than those who did not receive financial
incentives (Volpp et al 2009). This might be an effective plan to roll out in some college

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campuses or companies if evidence showed there were high rates of smoking there. Another
potentially beneficial way to decrease the number of current smokers is to increase the tobacco
excise tax. In addition to promoting healthier lifestyle, a significant part of secondary prevention
is promotion of regular screenings for cancer. By catching signs of cancer and treating it early,
the risk of dying can be significantly reduced. For some cancers such as colorectal and cervical,
premalignant conditions can be caught be frequent screening (Stein & Colditz, 2004).
The purpose of tertiary prevention is to reduce the severity of an illness and prevent
complications. The recipient of this intervention would be an individual who has been diagnosed
with a malignancy or pre-malignant condition. It is imperative to treat early to prevent mortality
if possible. Psychological support is also an important aspect that can improve symptoms such
as fatigue and depression during treatment (Jacobsen & Andrykowski, 2015). After treatment, it
is essential for the patient to have follow up exams to check for metastasis or recurrences, and to
have proper rehabilitation. The role of the community health nurse in all this is to assess the
client's ability to have access to such resources. Although in Pinellas County 80.2% of adults
have some type of healthcare coverage, that number is on the decline. Between 2010 and 2013
that number saw a 8.4% drop (Florida Department of Health, 2013). Additionally, with some
types of health insurance many things may not be covered. If necessary, the nurse can direct the
client to more financially available resources.
Health Policy Proposal
Health policy guides public health interventions for the community. Health policies are
guidelines set in order to reach goals for a healthier community. One of the major risk factors for
several types of cancers is tobacco use. Because 19.4% of the population of Pinellas County is a
current smoker, an important step would to be promote smoking cessation (Florida Department

CANCER IN PINELLAS COUNTY

of Health, 2013). A way this could be done would be to increase the excise tax for cigarettes
and other tobacco products. The stakeholders for this policy would be state legislators.
Supporters would be healthcare providers. Potential opponents of the policy might be community
members and businesses that sell tobacco products. The role of the community health nurse is to
presents the evidence, propose the policy to the legislators, and lobby for it. This policy should
impact the county by decreasing the percent of current smokers. It should, as well,
simultaneously discourage individuals from initiating smoking, therefore decreasing percentage
of smokers in the long run.
Conclusion
Pinellas County has high rates of cancer deaths, contributed to by high rates of unhealthy
behaviors such as tobacco use, heavy alcohol use, and being overweight or obese. These risk
factors are all modifiable, and therefore the best form of action against cancer is to reduce the
risk. This can be done a variety of ways, but a main focus should be reducing rates of childhood
obesity and initiation of teen smoking. Reduction of unhealthy behaviors such as smoking can be
done by smoking cessation programs and increasing of the tobacco excise tax. If it is a
established that an individual is at risk, it is essential for them to receive frequent cancer
screenings to ensure malignancies are caught early. Lastly, it is important to aid those diagnosed
with cancer by ensuring they have the resources for treatment, emotional support, and follow up
screenings. With these steps taken, Pinellas County will be able to promote increased health to
it's residents and decrease rates of cancer deaths.

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9
References

Adult Obesity Facts. (2015). Retrieved from http://www.cdc.gov/obesity/data/adult.html

Chan, A. T., & Giovannucci, E. L. (2010). Primary Prevention of Colorectal Cancer.
Gastroenterology, 138(6), 20292043.e10. http://doi.org/10.1053/j.gastro.2010.01.057
Florida Department of Health (2013) Major Causes of Death. Retrieved from:
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=52&reportYear=2014&tn=31
Florida Department of Health (2013) Behavioral Risk Factors. Retrieved from:
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=52&reportYear=2014&tn=31
Florida Department of Health (2013) Socioeconomic indicators. Retrieved from:
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=52&reportYear=2014&tn=31
Florida Department of Health (2013) Health Resource Availability. Retrieved from:
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=52&reportYear=2014&tn=31
Center for Disease Control (2015). Frequently Asked Questions. Retrieved from
http://www.cdc.gov/alcohol/faqs.htm

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Jacobsen, P., & Andrykowski, M. (2015). Tertiary prevention in cancer care: Understanding and
addressing the psychological dimensions of cancer during the active treatment period.
American Psychologist, 70(2), 134-145. doi:10.1037/a0036513.
Largest Employers on the West Coast of Florida. (2011). Retrieved from
http://suncoastemployers.com/#pinellas
Stein, C. J., & Colditz, G. A. (2004). Modifiable risk factors for cancer. British Journal of
Cancer, 90(2), 299303. http://doi.org/10.1038/sj.bjc.6601509
Center for Disease Control. (2015). Statistics for Different Kinds of Cancer. Retrieved from
http://www.cdc.gov/cancer/dcpc/data/types.htm
The determinants of health. (n.d.). Retrieved from http://www.who.int/hia/evidence/doh/en/
United States Census Bureau (2013) Retrieved from:
http://quickfacts.census.gov/qfd/states/12/12103.html
Volpp, K., Troxel, A., Pauly, M., Glick, H., Puig, A., Asch, D.,...Audrain-McGovern, J. (2009).
A Randomized Controlled Trial of Financial Incentives for Smoking Cessation. The New
England Journal of Medicine, 260(7), 699-709. doi:10.1056/NEJMsa0806819
When smokers quit what are the benefits over time? (2014). Retrieved from
http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-toquitting-smoking-benefits