Running head: SEXUALLY TRANSMITTED DISEASES 1

Sexually Transmitted Diseases as an Evidence-Based Practice for Pinellas County

Brittaney Bures
University of South Florida















SEXUALLY TRANSMITTED DISEASES 2
Sexually Transmitted Diseases as an Evidence-Based Practice for Pinellas County
Pinellas County is a county located in central Florida on the western coast of the state.
According to the County Health Profile, in 2012 there was a total population of 918,061. While
Pinellas County is the second smallest county in Florida, it is actually the most densely populated
county in the state, with 3,347 people per square mile (Pinellas County, 2014).
Pinellas County is an urban setting, including major cities such as Clearwater and St.
Petersburg. The county is 38 miles long and 15 miles wide, at its broadest point. It totals up to
280 square miles with 588 miles making up the coastline. The major employers of Pinellas
County, starting from the largest, include the Home Shopping Network, Raymond James
Financial, and Bright House Network. Health care systems in the county include BayCare
Health Systems, Largo Medical Center, and Bay Pines VA hospital. Other health and
community services available to residents within the county are benefits for veterans, burial
program information, dental services, disability advocates, and emergency home assistance for
seniors. There is also a mobile medical home that covers primary, non-emergent care for
uninsured or homeless community members that even offers prescription assistance (Pinellas
County, 2014).
Socioeconomic factors largely influence the population within the county. For example,
according to the County Health Profile, from 2006-2010, 8.1% of families were below the
poverty level for Pinellas County compared to the state as a whole at 9.9%, and only 5.5% of the
population greater than age five years old did not speak English, compared to the state average at
11.8%.
Strengths and weaknesses of the county can easily be identified using the research
collected from the County Health Profile. When providing strengths of the county, the
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percentage population for adults greater that 25 years old without a high school diploma (or
equivalency) is 11.7% compared to 14.5% for the rest of the state. Another strength for Pinellas
County includes the comparison of adults who have adopted sedentary lifestyles. Only 22.1% of
the population in the county is sedentary, while 25.4% of the state has a sedentary lifestyle. This
can be attributed to the involvement of active lifestyles that many embrace within the county.
Additionally, the percentage of adults who have health care insurance coverage is higher for the
county at 88.6% compared to the state at 83.0% (Florida Charts, 2014).
Three areas that need to be addressed in the county are domestic violence, alcohol-related
motor vehicle incidents, and the reported number of STDs. The amount of crime and domestic
violence in the county, averaging over three years, was higher than the state. Domestic violence,
specifically, ranked on average at 722.9 for the county, compared to the state at 586.5. Alcohol-
related motor vehicle incidents were also significantly higher for the county than the state, with
the county averaging 128.4 for alcohol-related car crashes compared to the state at 97.2.
Furthermore, the average number of injuries associated with alcohol-related car crashes was 79
for the county and 67.1 for the state (Florida Charts, 2014).
The amount of reported sexually transmitted diseases (STDs) in the county, specifically
chlamydia, gonorrhea, infectious syphilis, and HIV, were considerably higher than the state. On
average, between the years of 2010-2012, there were 418.4 cases of chlamydia in the county
compared to the state with 402.4. Gonorrhea cases for the county were 123.2 compared to the
state at 104.6. Infectious syphilis was ranked least favorable with an average of 6.7 for both the
county and state. HIV also ranked least favorable with an average of 21.0 per 100,000 between
the years of 2010-2012 (Florida Charts, 2014).
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Based on the statistical data from the County Health Profile, the priority health issue that
raises the highest concern for the county is the amount of STDs reported. This health issue is
most concerning because STD prevention and awareness seems to lack importance when
compared to other health issues. The severity and potential harm resulting from STDs is often
overlooked. Some STDs, including HIV, may be fatal, so taking initiative and implementing an
intervention that focuses on prevention and patient education should be emphasized.
When developing a health policy proposal to address a population health issue such as
STDs, the community health nurse can use the Determinants of Health model. This model
covers a range of biological, economic, environmental, and social factors that influence health. It
also addresses the relationship between five areas, including policymaking, health status and
biology, individual behavior, health services, and other social factors (Healthy People 2020,
2014).
It is important to note that STDs are acquired by having unprotected sex with an infected
partner. Often times, theres no way of knowing once a STD has been contracted. STDs usually
do no present with signs or symptoms. It can take time, sometimes years, to recognize any
significant changes or clinical health problems. During that time, STDs can be spread to other
sexual partners without the infected person being aware that he or she is doing so. Typically,
once infected, women suffer more frequent and serious STD complications, and even have the
ability to pass it on to a child if becoming pregnant. Additionally, sexually active adolescents,
between the ages of 15-19 and young adults 20-24, are at higher risk of getting an STD (Healthy
People 2020, 2014).
The accumulation of reported STDs is also associated with other social, economic, and
lifestyle factors. These factors may negatively influence STD prevention due to their impact
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on social and sexual networks, access to high quality health care, willingness to seek care,
and social norms regarding sex and sexuality (Healthy People 2020, 2014). For example,
certain ethnic and racial groups have higher rates of STDs. Race and ethnicity may be correlated
with several health status determinants, including poverty, limited access to health care, fewer
attempts to get medical treatment, and living in communities with higher rates of STDs. In
communities with higher rates of STDs, high-risk sexual activity may be more common, while
education on STD prevention may not be sought out. Access to healthcare services for
screenings or treatment may also be compromised. Generally, groups with the highest rates of
STDs tend to be the same groups whose access to or use of health services is most limited
(Healthy People 2020, 2014).
A population diagnosis related to the amount of STDs reported can be developed using
the Determinants of Health model: Increased risk for sexually transmitted diseases among
adolescents and young adults in Pinellas County related to knowledge deficit as evidence by the
county statistics collected from the County Health Profile compared to the state as a whole. As
the Determinants of Health model states, there are factors that influence health, and knowledge
deficit is likely to be related to limited access to healthcare services and lack of educational
opportunities.
When developing a health policy proposal to reduce the amount of reported STDs, it is
necessary to analyze the intervention at a primary, secondary, and tertiary level. The primary
level of prevention is health promotion and education at an individual and community level, with
community members being the stakeholder the intervention is geared towards. Health promotion
includes patient education on different types of sexually transmitted diseases. Education should
also include different types of protection and other barrier methods that can be used to reduce the
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number of STD reported cases. At this level, the community health nurse can organize group
comprehensive education classes to adolescents, in schools or communities, to promote
behaviors that prevent or reduce the risk of STDs, including HIV, and pregnancy (Centers
for Disease Control and Prevention, 2012).
The secondary level of prevention includes screening for diseases. Screening may be
done at an individual level, with community members being the stakeholder the screenings will
be available for. Formative research reveals that much of the youth population is unaware
of the asymptomatic nature of STDs, and routine STD screening and youth-friendly services
are recommended (Friedman, 2014). The community nurse is responsible for engaging the
community in efforts to reach youth in order give them information and link them to testing
(Friedman, 2014). They should ensure that screenings are readily available and that follow up
with patients that test positive for sexually transmitted diseases is completed.
The tertiary level of prevention includes treating individuals in the community with
reported cases of being infected with an STD. Members of the community are the stakeholders
being treating. The community health nurse ensures that follow up takes place when monitoring
the compliance of medication and treatment in use. For some treatments, especially for HIV,
some of the drugs can cause serious side effects and don't work for everyone. The
community nurse should monitor how well the drugs are working, watch for side effects, and
have a plan in mind of the medication stops working (U.S. Department of Veterans Affairs,
2014).
After addressing all three levels of prevention, it is imperative that the focus for the
health policy proposal be at the primary level, which includes educating the community.
Community members would be affected by this proposed health policy. The proposal includes
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making sexual education more available, especially to adolescents and young adults. Offering
more sexual education classes in high schools increases awareness and prevention of sexually
transmitted diseases.
Community members, public officials, and health care providers would support this
proposed intervention of providing education in high schools. Promoting education and
awareness can reduce engagement in sexual activity, frequency of sexual activity, number of
partners, and frequency of unprotected sexual activity, and increase the amount of self-
reported use of protection against STDs and pregnancy (Centers for Disease Control and
Prevention, 2012). Government sources may oppose funding STD prevention and awareness
education. While prevention can reduce the amount of money spent by the healthcare system in
the long run, many feel that sexual education classes are inappropriate and unnecessary.
The initial step in presenting the health policy proposal includes identifying data to
support the proposal. The data would then be presented to county officials to discuss the impact
that sexual education courses in high schools could have on the amount of STDs reported in
Pinellas County.
This health policy proposal will impact the Florida and Pinellas County because it
addresses prevention in adolescents and young adults who may not be sexually active yet. STD
prevention and education can prevent behaviors that might lead to STDs or complications
related to STDs, HIV, and pregnancy. Preventing pregnancy in teens can also decrease the
amount of low-birth rate babies, an area that also ranked unfavorable for the county compared to
the state in the County Health Profile.


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References
Centers for Disease Control and Prevention (2012). HIV, other STD, and pregnancy prevention
education in public secondary schools- 45 states, 2008-2010. MMWR Morb Mortal Wkly
Rep, 61(13): 222-8.
Florida Charts (2012). Florida CHARTS. Retrieved June 18, 2014, from
http://www.floridacharts.com/charts/mapp_report.aspx
Friedman, A., Brookmeyer, K., Kachur, R. E., Ford, J., Hogben, M., Habel, M., . . . McFarlane, M.
(2014). An assessment of the GYT: get yourself tested campaign: an integrated
approach to sexually transmitted disease prevention communication. The Real
World of STD Prevention, 41(3): 151-157. doi: 10.1097/OLQ.0000000000000100
Healthy People 2020. (2014, June 18). Retrieved from http://healthypeople.gov

Pinellas County. (2014, June 18). Retrieved from http://www.pinellascounty.org/

U.S. Department of Veterans Affairs. (2014, June 18). HIV/AIDS. Retrieved from

http://www.hiv.va.gov