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Health Policy Capstone Paper
Health Policy Capstone Paper
Health Policy Capstone Paper
Kelly Cullinan
This paper examines the strengths and weaknesses of Hillsborough County, Florida in
regard to health status and outcomes. Upon examination of this county, sexually transmitted
infections were found to be one of the top health concerns compared to the rest of the state of
Florida. The purpose of this paper is to explore why there is such an epidemic of sexually
transmitted infections in Hillsborough County, the health implications resulting from these
infections, and why comprehensive sex education and condom availability programs are
Hillsborough County is located near the middle of the state along the west coast of
Florida. Hillsborough, the states 19th county, was first explored by the Spanish in the 16th
century and was later ruled by France, Great Britain, Spain, and the United States (Hillsborough
County History, n.d.). Back then, the current counties of Manatee, Polk, Sarasota, Charlotte,
Pinellas, Hardee, DeSoto, Highlands, and part of Glades and Lee County, were all a part of
Hillsborough with a population of just 836 people (Hillsborough County History, n.d.).
Today, Hillsborough County has a substantial population of 1,316,298 people and is the
4th most populated county in Florida (County Health Rankings & Roadmaps, 2014). While the
county is mostly urban, there is a small percentage of the population that is rural. The top three
employers within the county are the School District of Hillsborough County, MacDill Air Force
Base, and the Hillsborough County Government (Tampa Hillsborough Economic Development
Corporation, 2011). The major health care systems within the county include HCA (Hospital
Corporation of America), BayCare, Florida Hospital System, H Lee Moffitt Cancer Center and
Tampa General Hospital (Hillsborough County, n.d.). Hillsborough County is a highly populated
SEXUALLY TRANSMITTED INFECTIONS 3
and diverse area with many businesses and places of healthcare that are easily accessible to
residents.
In Hillsborough County, the percentage of families that live below the poverty line is
15% which is equal to the state average (Community Atlas, 2011). Poverty is defined as not
having enough income to afford life necessities such as food, clothing, and shelter (Community
Atlas, 2011). The United States Census Bureau has created guidelines on calculating the income
that constitutes poverty according to the number of people in the family. The percentage of
residents over age 25 with a high school diploma is 87.1% compared to the state average of
86.5% (United States Census Bureau, 2014). Within the population of people equal or greater to
age 5, approximately 27.2% speak a language other than English at home compared to the entire
The total number of hospital beds in Hillsborough is 329.9 per 100,000 people compared
to the state average of 320.6 per 100,000; the number of total licensed physicians is 280.1 per
100,000 people in the county and 300.6 per 100,000 people in the state (Florida Health, 2011).
While the county has better access to hospitals, the number of physicians as well as the number
of nursing home beds in the county is less than the state average. Overall, there is not an
Of Hillsborough Countys total population, 51.6% are non-Hispanic white, 26.5% are
Hispanic, 15.8% are non-Hispanic African American, 4.0% are Asian, 0.6% are American Indian
and Alaskan Native, and 0.1% are Native Hawaiian or other pacific islander (County Health
Rankings & Roadmaps, 2014). People below 18 years of age make up 23.2% of the county
SEXUALLY TRANSMITTED INFECTIONS 4
population and 13.1% of people in Hillsborough County are age 65 and older (County Health
Rankings & Roadmaps, 2014). The population is 49% male and 51% female (County Health
Identified Strengths
Of the total county population, 95% of people live within a practicable distance from a park or
recreational facility which is equal to the state average of 95% (County Health Rankings &
physical exercise can decrease the risk of developing cardiovascular disease, hypertension,
cancer, Type 2 Diabetes, and stroke (County Health Rankings & Roadmaps, 2014).
A second strength of this county is the rate of uninsured residents which is only 20%
compared to the state average of 24% (County Health Rankings & Roadmaps, 2014). This
means there is a lower percentage of uninsured people in Hillsborough County under the age of
65 compared to the state of Florida. A lack of health insurance can prevent people from
A third strength of this county is at least 64% of residents, between the ages of 25 and 44,
have some post-secondary education compared to the state average of 61% (County Health
Rankings & Roadmaps, 2014). Education is important because there is a well known correlation
of higher education and improved health outcomes (County Health Rankings & Roadmaps,
2014). According to Cutler and Lleras-Muney (2007), people who are educated have lower rates
of morbidities from common diseases such as heart disease and diabetes, and are less likely to
Identified Weaknesses
SEXUALLY TRANSMITTED INFECTIONS 5
A weakness of Hillsborough County is the rate of adult obesity, which is 28% compared
to the state benchmarks of 25% (County Health Rankings & Roadmaps, 2014). Adult obesity is
defined as having a BMI of 30 or more (County Health Rankings & Roadmaps, 2014).
According to Centers for Disease Control and Prevention (2016), obesity puts people at risk of
many debilitating diseases including heart disease, stroke, and type 2 diabetes.
Another weakness of this county is the number of alcohol impaired driving deaths which
are at a rate of 33% compared to the state average of 29% (County Health Rankings &
Roadmaps, 2014). This statistic means that 33% of the total driving deaths in Hillsborough
County were due to alcohol impaired driving (County Health Rankings & Roadmaps, 2014). In
addition to fatalities, alcohol impaired driving crashes are associated with increased costs for
drivers, victims or their families, and taxpayers (Centers for Disease Control and Prevention).
A third weakness is the rate of sexually transmitted infections which is 560.9 per 100,000
people compared to the state average of 415.1. Hillsborough County is ranked 8th out of the 64
counties in Florida for highest rates of sexually transmitted infections (Davies, 2013). There are
560.9 newly diagnosed sexually transmitted infections per 100,000 people in the county (County
The rate of sexually transmitted infections is very high at 560.9 per 100,000 people which
is much higher compared to the state benchmark of 415.1 (County Health Rankings &
Roadmaps, 2014). Between 2013 and 2015, 567.3 per 100,000 people in Hillsborough County
were diagnosed with Chlamydia compared to the state benchmark of 433.8 per 100,000 people
and 151 per 100,000 people were diagnosed with Gonorrhea compared to the state benchmark of
112.1 per 100,000 people (Florida Department of Health, 2016). Along with the inconvenience
SEXUALLY TRANSMITTED INFECTIONS 6
of the associated symptoms, sexually transmitted infections can cause infertility, health issues for
the unborn baby, pelvic inflammatory disease, infection in other parts of the body, organ damage,
certain types of cancer, and even death, in women (Office on Womens Health, 2014). Men are
put at risk of testicular infections, infertility, organ damage, and death (Alberta Health Services
Community health models assist the nurse and other healthcare professionals in assessing
the community and environment in which the patients live in. It is important to accurately assess
patients environments to ensure that everything they need to survive, stay healthy and maintain a
decent quality of life is readily accessible to them. The Determinants of Health Model helps to
identify factors beyond what one may normally think that can affect individual or community
health such as social factors, biology and genetics, policy making, health services, and individual
behavior (Truglio-Londrigan & Lewenson, 2011). By utilizing this tool, nurses will be better
able to educate patients on the harmful implications of sexually transmitted infections on both
unprotected sexual activity, having multiple partners, being under 25 years old, alcohol use,
illicit drug use, prostitution, using only birth control for prevention of conception, already having
a sexually transmitted infection, and living in a community with a high prevalence of sexually
transmitted diseases (Boskey, 2016). Young people between the ages of 15 to 24 account for half
of all newly diagnosed sexually transmitted diseases despite this age group only representing
25% of the sexually active population (Office of Disease Prevention and Health Promotion,
2016). A study done in a Midwestern pediatric emergency department found that 1 in 10 sexually
SEXUALLY TRANSMITTED INFECTIONS 7
active adolescents presenting to the emergency department for reasons other than reproductive
complaints tested positive for 1 or more sexually transmitted infections (Miller, Dowd, Harrison,
Population Diagnosis
Adolescents and young adults are at an increased risk of acquiring a sexually transmitted
infection in Hillsborough County due to high-risk behaviors and possible lack of safe sex
education.
Community/Population-based Interventions
infections. This can be done by educating the community as a whole on safe sex, the dangers of
high-risk behaviors, and available vaccines such as the Human papillomavirus vaccine.
Comprehensive safe sex education should be taught in public schools before adolescents begin to
engage in these behaviors. Nurses can help achieve this by lobbying through the American
Nurse Association (ANA), calling or writing to the policy makers, and meeting with local
government and school boards to propose adding more sex education in schools (Truglio-
Londrigan & Lewenson, 2011). In addition to lobbying for these changes, it is also very
important for nurses to educate their patients on an individual level on the risk factors of sexually
transmitted infections and recognizing the symptoms of these infections so they can seek
Secondary levels of prevention target individual patients who are diagnosed with a
sexually transmitted infection. The goal of secondary prevention is to reduce the number of
complications associated with sexually transmitted infections by early detection and prompt
treatment. The nurse should be able to assist in properly identifying and treating sexually
SEXUALLY TRANSMITTED INFECTIONS 8
transmitted infections to prevent further complications. Some sexually transmitted infections are
asymptomatic or produce very few signs or symptoms and often go untreated due to this nature
(Office of Disease Prevention and Health Promotion, 2016). It is important for the nurse to
stress the importance of regular testing and screening for sexually transmitted infections and
inform the patient on places in the community that offer free testing. The nurse should also
educate the patient who already has an infection on safe sex and reduction of high-risk behaviors
to prevent reoccurrence in the future and further spread of the infection. It is also the
responsibility of the nurse to encourage the patient to notify any sexual partners the patient
recently had so they are able to get checked and explain the importance of reporting.
A tertiary level of prevention targets individual patients that already have the disease and
are experiencing complications such as such as pelvic inflammatory disease, cancer, and
infertility. It focuses on decreasing effects of the complications from the sexually transmitted
infections and making sure the patient complies with the prescribed treatment to prevent any
further complications from happening. The nurse should provide supportive care to the patients
that are experiencing complications and monitor how the patient is responding to the treatment to
prevent any further health complications from the infection. After the patient is already
diagnosed with a sexually transmitted infection, it is imperative that the nurse educates the
patient on abstinence of sex while infection is present and practicing safe sex after the infection
eliminating the unhealthy conditions or by promoting activities that contribute to the health of
adolescents, a primary level of prevention would be most effective. This will be done by making
Comprehensive sex education not only promotes abstinence but also includes information about
the use of condoms and contraception versus abstinence only education. Research shows
comprehensive sex education is more effective in preventing teen pregnancy and sexually
transmitted infections while abstinence-only programs have shown to be ineffective and may
actually promote an increase in these (Carter, 2012). While comprehensive sex education may
be controversial in parents, evidence shows it does not encourage adolescents to become sexually
active or increase the amount of sexual activity. It does increase the use of condoms and
contraceptives while decreasing the frequency of sexual activity and high-risk behavior including
having multiple sexual partners (Advocates for Youth, n.d.). Douglas Kirby, a researcher for the
National Campaign to End Teenage Pregnancy, examined many studies on sex education
programs and found that 60% of these programs reduced unprotected sex and 13 of the 23
immunodeficiency virus, and teenage pregnancy in the participants (Kirby, 2007). In addition,
14 of those 23 programs increased the use of condoms in the participants that were sexually
active (Advocates for Youth, n.d.). Many adolescents have barriers to obtaining condoms
access to protection, it would be beneficial for the nurse to address law makers and lobby for
schools and colleges to be required to provide good quality condoms for students. According to
the American Academy of Pediatrics, the most effective way to encourage adolescents to use
condoms is through school programs including education on condom use and condom
47% decrease in the occurrence of Gonorrhea and Chlamydia combined in males and a 2.5%
Visintainer, & Pinkston-Koenigs, 2011). While there was not a large difference in the prevention
of sexually transmitted infections in females, the results in males were very significant. Overall,
comprehensive sex education and condom availability programs would most likely significantly
To put this health policy into place, the nurse would first need to reach out to the
community and educate the people on why this policy is so important to acquire more supporters.
The nurse and supporters would then need to contact their local legislators and public officials to
present the case of how sex education and condom availability programs in schools will decrease
the state of Florida requires all students to complete one-half of a credit in life management
skills which must include education on the prevention of HIV/AIDS, sexually transmitted
diseases, the benefits of abstinence, and the consequences of teenage pregnancy (Florida
Department of Education, 2016). Unfortunately, not only is one-half of a credit a very minimal
education but there is an opt-out policy where parents can remove their child from any sex
education programs. According to the Florida House of Representatives (2016), there was a bill
proposed in 2008 called the Florida Healthy Teens Act that would require comprehensive sex
education but failed to be heard in the House and subsequently died. While some may be
apprehensive and concerned about funding, President Obama signed the Patient Protection and
Affordable Care Act in 2010 which created the Personal Responsibility Education Program
(Sexuality Information and Education Council of the United States, n.d.). This program funds a
total of $75 million in age appropriate and medically accurate sex education for young people
SEXUALLY TRANSMITTED INFECTIONS 11
(Sexuality Information and Education Council of the United States, n.d.). Comprehensive sex
education and condom availability programs would decrease the rates of sexually transmitted
infections in adolescents; therefore, the community would be healthier as a whole and experience
Conclusion
Community health plays a vital role in nursing to promote the health of not only our
patients but the entire community. I believe public health is a large and important aspect in the
role of a nurse that is often overlooked. In my nursing practice, I will ensure that my patients
needs outside of the hospital will be met as well as promote healthy behaviors that contribute to
the overall health of the community. As an emergency room nurse, I will expect to see
adolescents with sexually transmitted infections in the acute care setting. I will educate these
patients on prevention and treatment in hopes of reducing the rate of sexually transmitted
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