Running head: PINELLAS COUNTY HEALTH

Pinellas County Health

Brian J. Poirier
University of South Florida

PINELLAS COUNTY HEALTH

Pinellas County, Florida, is a densely populated and mostly urban county on the West
Coast of Florida which borders Tampa Bay and the Gulf of Mexico. The area was discovered in
1528 and formally established in 1912 from a collection of rural communities and orange groves.
Pinellas County quickly became one of the most densely populated counties in Florida, and is
now the most densely populated county in Florida with over 900,000 residents over 280 square
miles of land, or 3,347 people per square mile (Pinellas County Government, 2014). Three
private corporations serve as the largest employers of the county: the Home Shopping Network,
a consumer goods provider which broadcasts nationally, Raymond James Financial, and Bright
House Networks, a cable and internet service provider. These three corporations employ over
7,000 residents in Pinellas County (Pinellas County Economic Development, 2012). Three
networks of hospitals and outpatient facilities provide medical care to the residents of Pinellas
County: Baycare Health Systems, Bayfront Health Systems and the Hospital Corporation of
America.
The demographics of Pinellas County, when compared to identical demographic
identifiers at the state level show an aging but relatively healthy and socioeconomically
comfortable population; 8.1% of families in Pinellas County are below the poverty line
compared to 9.9% at the state level. The population of Pinellas County also has a rate of 11.9%
of residents over 25 with a high school diploma compared to 14.7% at the state level although
only 5.5% of the countys population over five does not speak English compared to 11.8% of the
states population (Florida Department of Health, 2012). Health literacy, level of education, and
the ability to speak and comprehend the English language all affect the ability of a given
population to find and receive healthcare in order to prevent and manage negative health
outcomes. After comparing similar demographic data when viewed in the light of perceived

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strengths and weaknesses in health outcomes at the state and county level, three areas of strength
and three areas of need can be addressed to provide evidence for the need of a change in
community health policy. According to the Robert Wood Johnson Foundations (2014) county
health rankings across the nation, three areas of strength within Pinellas County that can be
considered positive indicators of the communitys health when compared to the state average
are: a lower percentage inactivity (20% in Pinellas County compared to 24% in Florida),
meaning adults are more active in Pinellas County than at the state level, 95% of the population
in Pinellas County has access to locations for physical activity compared to the states
significantly lower 78%, and the percentage of Pinellas County residents who are uninsured
(23%) is lower than the states level (24%) of uninsured. While these indicators suggest healthy
residents in Pinellas County, there are areas of where improvement is needed. In the same
rankings, three areas of need can be delineated: 20% of the population in Pinellas County are
smokers compared to the state average of 18%, there are 1,307 more premature deaths per
100,000 Pinellas County residents than the state level, and a small spike in Sexually Transmitted
Infections (STIs) results in 422 cases per 100,000 in Pinellas County compared to 399 per
100,000 at the state level. These areas of weakness in the county are significant since each
indicator is preventable. Of these low scoring indicators, smoking cessation and STI prevention
are easily preventable through education and minimal need of resources to provide maximum
benefit to the health of a community. This report will discuss evidenced based prevention
techniques and guidelines to support a health policy change which can be implemented in the
community to decrease the prevalence and incidence of sexually transmitted infections in
Pinellas County.

PINELLAS COUNTY HEALTH

In order to develop and implement interventions to reduce the prevalence and incidence
of STIs, a model must be used to inspect influences and factors that may affect the prevalence of
STIs in the community. A Determinants of Health Model is used to examine the circumstances
and environmental elements that affect an individuals health. These determinants include a
persons socioeconomic status, the environment in which they inhabit, and each individuals
unique personality and behavior; determinants can then be grouped into several general
categories such as policymaking, social determinants, health services, individual behaviors, and
biology/genetic determinants (United States Department of Health and Human Services, 2014).
Once applicable determinants have been identified, a community nurse or other community
healthcare provider can implement interventions to target specific determinants in order to enact
a positive change in the overall goal of a health policy. For instance in an effort to reduce STIs
in Pinellas County, a public health policy proposal may target three determinants: social
determinants, such as a lack of education, health service determinants: a lack of insurance
coverage to seek medical treatment of an existing infection, and individual behavioral
determinants, such as substance abuse, which may increase risk taking behavior.
These associated determinants have been shown empirically to affect the prevalence and
incidence of STIs in a given population. Deogan, Cnattingius and Mnsdotter (2012), in a
survey of socio-economic, demographic, and lifestyle factors found that excessive alcohol
consumption resulted in a doubling of the previous rate of self-reported chlamydia cases. The
same survey also revealed education level as a social determinant. Participants who had only
graduated high school had a threefold increased risk of acquiring an STI than compared to those
with a college degree due to a lack of knowledge about STI transmission. The Center for Disease
Control (CDC) (2012) also stated that higher rates of STIs in adolescents may be the result of

PINELLAS COUNTY HEALTH

multiple obstacles to proper care, of which a lack of insurance, or the inability to pay, are labeled
as health service determinants.
As determinants are compiled for STI incidence and prevalence in Pinellas County, a
community diagnosis can be developed: sexually active residents of Pinellas County are at an
increased risk of transmission and contraction of STIs possibly related to a lack of education
concerning reproductive health, low socioeconomic standing and a lack of medical insurance
coverage, and individual behaviors that increase the risk of infection such as substance abuse, as
evidenced by the increased prevalence of sexually transmitted infections in Pinellas County
when compared to the state of Florida. Based on the community diagnosis, three levels of
prevention can be applied to three separate interventions which can be implemented to decrease
the prevalence of STIs in Pinellas County.
Primary prevention interventions are used to prevent a disease or disorder from
occurring. A high school sexual education lesson on proper condom use could be used to prevent
the incidence of STIs in Pinellas County. Dodge, Reece, and, Herbenick (2009) have reported
that males who participated in school-based condom education classes were almost 10% less
likely to contract an STI than men who had not received condom education in high school. This
individual level intervention with high school aged boys will teach proper condom use to modify
risk factors to potentially lower the incidence of STI transmission and contraction in Pinellas
County. Before the implementation, school teachers, parents and community health nurses must
be briefed and agree to the intervention. School teachers may be able to provide education after
training by healthcare providers, but registered nurses may be a more suitable option. Regional
Planned Parenthood affiliates may also provide educators to high schools. Funding for the
program may be acquired by allowing Planned Parenthood to present comprehensive sex

PINELLAS COUNTY HEALTH

education, or by contacting local hospitals, the school board may be able to set up a volunteer
task force of nurses to provide education at no cost to the schools. Community health nurses
would review evidenced based literature on proper condom use and develop a program to use in
each school and provide education to students.
Secondary preventions are implemented to stop or slow the progress of a newly acquired
disease. In addition to providing sex education, offering free or very low cost STD testing would
further reduce the incidence and prevalence of STIs in Pinellas County by diagnosing and
treating new infections thereby decreasing the transmission to others. Individual community
members of low socioeconomic may avoid STI screening and treatment due to the prohibitively
high cost of health insurance and treatment. Offering, and publically advertising, free or very low
cost STI testing to Pinellas County residents who cannot afford insurance at county health clinics
could dramatically reduce the prevalence of STIs. If the county health clinic cannot offer free
STI testing, a partnership with an organization such as the Aid Healthcare Foundation, which
does provide free testing, could be arranged to provide testing. Aside from community health
nurses already employed at clinics, this intervention would require assistance in a policy change
from public officials and legislators in office to provide funding, or guidance in a partnership
with a private non-profit organization.
Tertiary preventions assist in the management of long lasting, chronic disease or
afflictions by providing rehabilitation, support, or continued medical treatment to decrease the
damage and prevent further complications. In a 2007 survey on sexually transmitted diseases and
substance abuse, the United States Department of Health and Human Services found young
adults who drank heavily had a 3.1% rate of past year STI compared to 1.4% percent of young
adults who did not drink in the past month. Additionally, this same survey noted a 3.9% rate of

PINELLAS COUNTY HEALTH

past year STI among young adults who consumed alcohol and an illegal drug. Individuals being
screened for STIs should be assessed for substance abuse and referred to substance abuse
support groups such as alcoholics anonymous to prevent future sexual risk taking behavior due to
substance abuse. A policy change at all facilities that provide STI testing and diagnosis to
include screening for substance abuse when treating STIs could be developed and implemented
by community health nurses at each facility.
A health policy can be defined as the plans and interventions enacted at healthcare
facilities and administrations to guide and complete specific health goals. In short health policies
drive the decisions and actions of healthcare providers. In an effort to reduce STI incidence and
prevalence in Pinellas County, a primary intervention of educating boys enrolled in high school
in proper condom use and STI education should be implemented. A partnership between regional
Planned Parenthood affiliates and community health nurses employed by local hospitals will
offer one hour educational sessions on proper condom use and general information about
sexually transmitted diseases to high school boys. Planned Parenthood will provide the materials
and training to community health nurses who in turn will educate high school boys. Planned
Parenthood will provide a detailed report describing the material covered to the school board
who will distribute this information to parents of boys in high school for notification. Those in
opposition to the education session may opt their child out of the lecture. Foreseeable opposition
includes local conservative churches and their members. Community health nurses will be relied
upon to provide an evidenced based proposal for partnership with Planned Parenthood to provide
this education to decrease the prevalence and incidence of STIs in Pinellas County.
This proposal will utilize federal grant money and resources obtained from Planned
Parenthood and community health care nurses to provide education on proper condom use to

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lower the elevated rates of STIs in Pinellas County, thereby improving the overall health of the
county and state of Florida.

PINELLAS COUNTY HEALTH

References
Center for Disease Control and Prevention. (2012). STDs in adolescents and young adults.
Retrieved from http://www.cdc.gov/std/stats11/adol.htm.
Deogan, C., Cnattingius, S., & Mnsdotter, A. (2012). Risk of self-reported chlamydia
trachomatis infection by social and lifestyle factors a study based on survey data from
young adults in Stockholm, Sweden. The European Journal of Contraception and
Reproductive Health Care 17. p. 458467.
Dodge, B., Reece, M., & Herbenick, D. (2009). School-based condom education and its relations
with diagnoses of and testing for sexually transmitted infections among men in the
United States. American Journal of Public Health. 99 (12).
Florida Department of Health. County health profile. (2012). Retrieved from
http://www.floridacharts.com/charts/mapp_report.aspx
Pinellas County Economic Development. Pinellas County's largest private target industry
employers. (2012). Retrieved from
http://www.pced.org/demographics_data/subpage.asp?TopEmployers
Pinellas County Government. Facts about Pinellas. (2014). Retrieved from
http://www.pinellascounty.org/facts.htm.
Robert Wood Johnson Foundation. County health rankings and roadmaps, Pinellas County
snapshot. (2014). Retrieved from

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http://www.countyhealthrankings.org/app/florida/2014/rankings/pinellas/county/outcome
s/overall/snapshot
United States Department of Health and Human Services. (2014). Determinants of health.
Retrieved from
http://www.healthypeople.gov/2020/about/DOHAbout.aspx#policymaking
United States Department of Health and Human Services. (2007). Sexually transmitted diseases
and substance use. Retrieved from
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCoQFj
AB&url=http%3A%2F%2Fwww.samhsa.gov%2Fdata%2F2k7%2Fstd%2Fstd.pdf&ei=_
V-wU8vjJtaTqAazj4GIDA&usg=AFQjCNGjYHOVuNOAMJeiNmcA8FMYEj2Fg&sig2=CFZ5I6ZtoMHzujHihSanrA&bvm=bv.69837884,d.b2k.

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