Running

head: PREVENTION OF SEXUALLY TRANSMITTED DISEASES

Preventing Sexually Transmitted Diseases in Hillsborough County

Anthony Cline
University of South Florida

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

Preventing Sexually Transmitted Diseases in Hillsborough County

Hillsborough County is the fourth largest county by population in the state of
Florida. The county is comprised of Riverview, Temple Terrace, Plant City and a few
other cities but the largest city by a large margin is Tampa that contains almost 30% of
the countys 1,195,317 residents. Most of the residents of Hillsborough County live in an
urban or suburban setting (Florida Department of Health, 2011). Hillsborough County
has multiple hospital systems to include St Josephs Hospital, South Florida Baptist,
which are a part of Baycare Health System, Florida Hospital, and Tampa General
Hospital to name a few. The largest employers of the county are Baycare Health System,
Publix, and the University of South Florida (Tampa Bay Partnership, 2015).
Hillsborough County has a higher percentage of families that live below the
poverty line at 19.1% when compared to the state average of 16.3%. Even with the large
farms in Plant City that is largely inhabited by immigrants the county only has 9.3% of
the population that does not speak English, which is lower than the state average. 85% of
the countys population over 25 has a high school diploma. Only 45% of households have
married couples and 13.5% are single mothers (Florida Department of Health, 2011). The
purpose of this paper is to synthesize data related to the population of Hillsborough
County, FL and use the findings to determine a prevention plan and health policy
proposal.
Analyze, Interpret and Prioritize
In Hillsborough County, FL there are three health indicators that the county does
well which are access to primary care providers, age adjusted stroke death rate and good
air quality. The county has 94.7 physicians per 100,000 residents which is much higher

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

than the national average of 48. Being able to make a needed appointment with your
health care provider is very important for individual health. The aged adjusted stroke
death rate of 38.5 per 100,000 is also better than the national average of 46 per 100,000.
The measurement is age adjusted due to some areas having a higher percentage of
geriatrics, who are more likely to have a stroke. The goal for Healthy People 2020 is to
have the death rate below 34.8 per 100,000, so Hillsborough County is headed in the right
direction. The last strength of the county is how well they keep the air clean. This metric
is measured in particulate matter 2.5 micrometers or smaller (PM2.5). Hillsborough is able
to keep the air clean with a PM2.5 8.8 g/m3 compared to the national average of
10.7g/m3. This health indicator is important because this particulate matter can lead to
respiratory complications and is the most dangerous form because the particulate matter
is so small. (Centers for Disease Control and Prevention, 2015a).
Some of the weaknesses of health indicators in Hillsborough County are the
sexually transmitted disease (STD) rates, to include gonorrhea, chlamydia and
HIV/AIDS, students graduating from high school on time, and the percentage of people
underinsured. The Hillsborough County infection rate for gonorrhea, chlamydia, and
HIV/AIDS are 169.7, 559.9 and 543.5 per 100,000 and compared to the US national
averages of 30.5, 280.6, and 105.5 per 100,000, respectively. These health indicators are
very alarming because it is so much higher than the national average. While only the
gonorrhea and chlamydia infections are curable, all three are preventable by education
and use of contraception. The on-time graduation rate for high school students is also
well below the national average. Only 69% of students graduate on time compared to the
US average of 83.8%. This statistic is important because education is a key because it

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

leads to better lifestyle choices, higher education and better job choices. The last
determinants of health concern is the amount of underinsured which is 23.3% compared
to 17.7% nationwide. This is concerning because lack of access to health care can
severely impact the health of an individual and family. (Centers for Disease Control and
Prevention, 2015a)
STD prevention is an important topic because it can be very easily prevented.
Casual contact or even just being in the same area as another person transmits most
communicable diseases. STDs on the other hand are mostly passed by intimate contact
such as oral sex, anal sex or vaginal sex. Half of all new cases nationwide are in the
population aged 15-24 years old (Centers for Disease Control and Prevention, 2015b).
Some young people say that performing anal sex or oral sex is still being abstinent and do
not realize these acts can transmit STDs (Florida Health, 2015).
Comprehend, Discuss, and Apply Community Health Models
The Determinants of Health Model is a range of personal, social, economic, and
environmental factors that influence the health status of the population, community and
individual. Interventions should be geared towards improving or changing more than one
determinant to best improve the health issue (Office of Disease Prevention and Health
Promotion, 2015). This will assist the nurse because with proper prevention because the
nurse will need to provide less secondary level care to treat the health issue.
The main factors that contribute to the priority health issue of STD transmission
are biological differences, environment and lifestyle. Environmental factors including
quality schools and lack of health education are two key points of concern (Riegelman &
Garr, 2011). Lifestyle, access to health care and lack of signs and symptoms are also

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shown to be a large factors in the transmission of STDs due to improper and inconsistent
use of contraceptives by teens, lack of parental input about sexual activity and the push to
abstain from sex until older age (Commendador, 2010). An appropriate negative nursing
diagnosis would be: Hillsborough County population aged 15-24 years old at risk for
contracting sexually transmitted diseases related to low sexual health education and low
access to health care as evidenced by population diagnosed with sexually transmitted
diseases higher than national average.
Community/Population-based Interventions
Primary Intervention
Primary intervention is designed to prevent further spread of STDs at the
community level. Stakeholders include students, teachers, school nurses, faculty, and
family of students. According to Commendador (2010), New policies should be targeted
to strengthening family functions through family members in their roles as parents One
specific recommendation is that both mothers and daughters need to be included into
programs. Schools can implement a mother/daughter night out where communication
between mothers and daughters can be established. This change in mother daughter
relationship can impact the STD rate and while only targets females, it can reduce the
instances where STDs are transmitted. From a nursing standpoint the school nurse is
typically the sole healthcare provider at a school and will prepare information for the
community. The nurse should work with teachers and faculty to implement a program
that is inviting and educational to all members involved. This program can also be used to
model something similar for males but include a different event geared towards a father
and son. The main source of sexual health education material will be the responsibility of

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

the nurse to ensure the most current evidence based practice is used. These events can
start as early as elementary school for other health related topics but should start to
transition to sexual health as early as middle school and continuing into high school to
have to biggest impact on the target population (Commendador, 2010).
Secondary Intervention
The school community and individuals will be the target for the secondary
interventions. The school nurse can make sure the students know they can come forward
if they have any questions or concerns about their sexual health. The nurse can provide
screening to students that suspect they have a STD to help with early detection. The nurse
can provide education on how to treat the disease and how the disease process affects
them. The nurse can also provide a place to get low-cost or free medications to treat the
disease. Also, giving medication for the sexual partner can prove to be effective as well
since some do not get tested and treated. Using Expedited Partner Therapy (EPT) the
nurse can provide treatment for the partner by giving the original patient medications for
their partner. This allows both people to get treatment (Shiely et al., 2010). The nurse will
be able to use surveillance data to know what group of students to target with the primary
interventions.
Tertiary Intervention
The individual will be the target for the tertiary intervention. The best tertiary
preventions are access to antiretroviral drugs and prevention of any co-infections such as
pneumonia and influenza. While this article concentrates on HIV/AIDS, the practices can
be applied to other STDs like herpes or genital warts since they are currently incurable.
The nurse can then provide education to help prevent a reoccurrence and spread of the

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

STD and also prevent further complications like pelvic inflammatory disease (PID). The
biggest focus is symptoms management and allowing the person to maintain a normal life
(Sahasrabuddhe & Vermund, 2009).
Policy Proposal
Policy proposals affect health care because policies determine how it is funded
and who will be involved as stakeholders. This policy proposal will be at the primary
level. The stakeholders are students, parents, school nurses, teachers, school board,
community, churches and funding sources. Supporters of this prevention will be parents,
communities, nurses and students. The parties who will oppose this policy are the school
board, funding sources, and churches.
The proposed plan seeks to have an agreement with Hillsborough County school
nurses and the Education Board to prevent the occurrences of STDs in our school aged
population. This agreement will require funding for educational tools, STD testing and
medications and will be used with the most current form of evidence based practice.
School nurses will have to work with county administrators and physicians to get funding
for the school-based programs. The goal of this policy is to prevent hospital visits and
missed class days while also increasing the graduation rate due to lower STD rates and
pregnancy. A team of nurses will need to be assembled to standardize the educational
materials to be distributed to the schools and create a basic model for the events to make
sure all information is covered.
The greatest threat to this proposal is legislators if they decide to not fund the
program so it is imperative the main focus of this program will save money in overall
healthcare costs negating any cost up front for the preventative measures. It addresses the

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

needs of an underserved population since most of the affected live in poverty or do not
have access to healthcare. Allowing the schools to manage the care it takes away any
differences in treatment due to the family upbringing. This proposal will lower the
occurrences of STDs in our adolescent population aged 15 to 24 years old who account
for 19 million yearly infections and $15.9 million in health care costs.
Conclusion
The ultimate goal of any is nurse to help others in any way possible. Most nursing
is focused on the acute care setting and it is easy to lose sight of the community
prevention interventions. With STD transmission being completely preventable, it should
be made a priority, especially when the diagnosis rates are so high in Hillsborough
County. By providing education about sexual health and keeping the parents involved,
STD rates can drop drastically in the population aged 15-24 years old and the benefits
would be a healthier population and lower hospital costs (Centers for Disease Control and
Prevention, 2015).

PREVENTION OF SEXUALLY TRANSMITTED DISEASES

References
Centers for Disease Control and Prevention. Hillsborough county, fl. (2015a). Retrieved
from
http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/FL/Hillsborough/#
Centers for Disease Control and Prevention. Reproductive and sexual health. (2015b).
Retrieved from http://www.healthypeople.gov/2020/leading-healthindicators/2020-lhi-topics/Reproductive-and-Sexual-Health
Commendador, K. (2010). Parental influences on adolescent decision making and
contraceptive use. Pediatric Nursing, 36(3), 147-170.
Florida Department of Health. 2010/2011 community health profile. (2011). Retrieved
from http://hillsborough.floridahealth.gov/programs-and-services/communityhealth-planning-services/status-reports/_documents/hchd2010-2011-communityhealth-profile-report-optimized.pdf
Florida Health. Sexually transmitted diseases. (2015). Retrieved from
http://www.floridahealth.gov/diseases-and-conditions/sexually-transmitteddiseases/index.html
Office of Disease Prevention and Health Promotion. Determinants of health. (2015, July
3). Retrieved from http://www.healthypeople.gov/2020/about/foundation-healthmeasures/Determinants-of-Health
Riegelman, R., & Garr, D. (2011). Healthy people 2020 and education for health.
American Journal of Preventive Medicine, 40(2), 203-206.

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Sahasrabuddhe, V., & Vermund, S. (2009, June 23). The future of HIV prevention: STI
control and circumcision interventions. Retrieved July 8, 2015.
Shiely, F., Hayes, K., Thomas, K., Kerani, R., Hughes, J., Whittington, W., . . . Golden,
M. (2010). Expedited partner therapy: A robust intervention. Sexually Transmitted
Diseases, 37(10), 602-607. doi:10.1097/OLQ.0b013e3181e1a296
Tampa Bay Partnership. Major employers. (2015, April 21). Retrieved from
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