Running head: PINELLAS COUNTY: BREASTFEEDING RATES

Pinellas County: Breastfeeding Initiation and Continuation Rates

Kristina Nealy

University of South Florida

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Pinellas County: Breastfeeding Initiation and Continuation Rates

The purpose of this paper is to identify community health strengths and weaknesses in

Pinellas County in Florida and then hone in on a particular issue. Upon researching community

health concerns in Pinellas County, it was evident that breastfeeding continuation rates were

quite low. This paper will discuss why breastfeeding discontinuation is so common in Pinellas

County, what can be done to encourage mothers to continue, and increase the breastfeeding rates

within the recommended length of time (for the first year of a childs life).

Overview of Pinellas County

Pinellas county is a peninsula located on the west coast of Florida; home to many of the

most beautiful gulf beaches in the state. It is considered a part of the Tampa Bay area, Pinellas

use to be a part of Hillsborough until it became its own county on January 1, 1912 (Pinellas

County Florida, 2016). Pinellas county is a compact county crammed full of residents within

twenty-four cities; it is actually the second smallest and sixth most heavily populated county in

the state of Florida spanning only thirty-eight miles long and fifteen miles wide (Pinellas County

Florida, 2016). Pinellas is also accommodating to millions of vacationers as it is a very popular

tourist attraction.

Pinellas County is definitely considered an urban area with its small size and dense

population; there is a population of 938,098 out of approximately twenty million residents in the

state of Florida (County Health Rankings and Roadmaps, 2016). As heavily populated the

county is, there is no surprise that there are over forty thousand businesses in Pinellas county

(Pinellas County Florida, 2016). According to the Pinellas County Economic Development, the

top three largest targeted industry employers are Raymond James Financial, Home Shopping
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Network, and Bright House Networks. There is a massive amount of healthcare accessibility in

Pinellas in regards to doctors offices, urgent care centers and hospitals but the major healthcare

systems within Pinellas county that many of these are affiliated with include Bay Care and

Hospital Corporation of America (HCA). These findings correlate to determining specific

statistics in Pinellas County as compared to the state of Florida such as the poverty rates, high

school diplomas percentages, how many people do not speak English, and how much access

there is to healthcare.

Comparison of Local vs. State Findings

In order to have a good understanding of statistics in Pinellas County you need to have a

brief background on the entire state of Florida to have something to compare it to. According to

the United States Census Bureaus most recent report in 2016, Floridas poverty rate was 16.6%

and in Pinellas County it was 15.2%. The high school diploma attainment percentages for

persons aged twenty-five or older are decent at 89.4% for Pinellas and 86.5% in Florida (Florida

Legislature Office of Economic and Demographic Research, 2016). In Pinellas County, only

5.3% of the population aged five years or older cannot speak English well compared to 11.7% in

Florida overall (Florida Charts, 2014). Access to healthcare is an identified strength in Pinellas

county; there is a large number of providers including eight hundred and thirty primary care

physicians with a county ratio of 119,1:1 and state ratio of 1,390:1 (County Health Rankings and

Roadmaps, 2016).

Analysis and Interpretation of Data

According to the Florida Health Pinellas County Community Health Assessment, in 2010

the majority of the population consisted of middle-aged adults 40-60 years of age with the

average age being 46.3 years old. The diversity of Pinellas county is not very broad as its
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population of non-Hispanic Caucasians is currently 75.4%, non-Hispanic African Americans

10.4%, Hispanic 8.8% and Asian 3.4%. The current female population is slightly higher than

males at 52.1% (County Health Rankings and Roadmaps, 2016). Community and public health

play an important role in Pinellas county and is the main source of identifying the specific

strengths, weaknesses, and issues in regards to the health of the population that may need

improvement.

Identified Strengths in Pinellas County

According to the Pinellas County Health Profile on the County Health Rankings and

Roadmaps, there are a few strengths in comparison to the state and nation, with the number one

strength being access to exercise opportunities at 100% which is certainly in the 90th percentile

ranking. This ranking also improved the amount of physical inactivity in Pinellas residents.

Another strength in Pinellas County is the access to healthcare, there is a vast number of

providers including eight hundred and thirty primary care physicians with a county ratio of

119,1:1 (County Health Rankings and Roadmaps, 2016). Although there is great access to

healthcare, this does not mean that everyone can afford it or that the access is being utilized. A

third strength that is a very important factor in the community for social and economic factors in

Pinellas county is the amount of higher education institutions and the accessibility to residents,

interns, and new graduates. 63.6% of adults aged 25-44 have some form of post-secondary

education which is more than half of that age population (County Health Rankings and

Roadmaps, 2016).

Identified Weaknesses in Pinellas County

Naturally, there are weaknesses to every and state county in regards to community and

public health. Fortunately, Pinellas Countys ranking is 20 out of 67 which is decent but there are
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areas that need improvement (County Health Rankings and Roadmaps, 2016). The trend of

sexually transmitted diseases (STDs) in Pinellas county is getting worse; it is currently at 442.8

cases per 100,000 residents (County Health Rankings and Roadmaps, 2016). This may be an

indication that there is lack of access to/knowledge of safe sex education amongst the population.

Pinellas County is known to have a very large homeless population which is a definite weakness.

According to the Department of Children and Families, in 2015 Pinellas had the 2nd largest

homeless population in the state after Miami-Dade with 3,387 homeless people. A third

weakness or issue that could use improvement in Pinellas County is breastfeeding initiation and

continuation. The breastfeeding initiation in Pinellas in 2015 was 78.8% compared to the state of

Florida at 84%. It has very slowly increased as years have gone by but not by much since 2006

(Florida charts, 2015).

Priority Health Issue

Breastfeeding may not be a topic that people think about often but it is not unnoticed that

it has become a much more popular issue overtime in our society. Not everyone is aware of the

wonderful benefits from breastfeeding for both the child and the mother; the resources are out

there but people may not know where or how to access them so they resort to formula feeding.

This is not to say formula feeding is bad because fed is best, but there are many great health

aspects that come along with breastfeeding. Benefits to breastfeeding are short-term and long-

term for both mommy and baby and there is also no financial burden for the family!

Breastfeeding is recommended and encouraged for the first six months of an infants life

and it is even more beneficial to continue for at least the first year of life (Wiley, 2015). In 2012,

the population of infants in Pinellas County was 4,258 and only 11.1% of infants were fully

breastfed and 14.1% were partially breastfed (USDA/FNS Supplemental Food Programs
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Division, 2012), these are very low continuation rates! According to the statistics, it seems as

though moms stop breastfeeding mainly when they go back to work and this could be because of

many different factors. Overall, breastfeeding initiation in Pinellas in 2015 was 78.8% (Florida

Charts, 2015); this means that 22.2% of mothers did not even decide to try breastfeeding which

indicates a weakness in knowledge of breastfeeding and that more teaching needs to be done

with parents in Pinellas County.

Impact of Community Health Model

Community health models are utilized to help healthcare workers develop a better

understanding of how the community is doing as a whole and what factors are involved in

overall health status. The Determinants of Health Model is a model based off of several different

factors such as biological, environmental, health services, and lifestyle factors. It is used to

examine the status of both healthy and unhealthy individuals and form interventions based on the

priority health issues related to each factor and helping the people live healthier lives (Healthy

People 2020, 2016).

According to Healthy People 2020, the biological determinants of health factors are age,

sex, family history, specific conditions, HIV history, and etcetera. The biological factors that

impact breastfeeding would be sex (only women can breastfeed), the mothers HIV status, or if

the baby has a condition that does not allow him or her to tolerate breastfeeding such as classic

galactosemia or lactose intolerance (American Academy of Pediatrics). Environmental

determinants of health would be social support, discrimination, social norms, resources, and

education; all of the above have huge influences on breastfeeding mothers. Lifestyle factors in

accordance to the Determinants of Health Model are the basic health choices including diet,

physical activity, drugs and alcohol use, and smoking. It is recommended that the mother quit
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smoking cigarettes if she is going to breastfeed but it is not contraindicated; if she would like to

have an occasional alcoholic beverage she should then pump and dump to avoid giving the

baby any alcohol that may be in her system (American Academy of Pediatrics). Finally, health

service determinants related to breastfeeding can be lack of health insurance (maybe their

insurance wont cover a breast pump or they do not have insurance at all), language barriers if

the mother and family do not speak English, and unmet health needs.

Population Diagnosis

Infants under one-year-old in Pinellas County are at risk for decreased immunity due to

mothers discontinuing breastfeeding before the recommended length of time as evidenced by

numerous studies and better outcomes for those who are breastfed versus those who are formula

fed.

Community/Population-based Interventions

Community health models assist in developing appropriate interventions and policies for

health issues and concerns among communities. According to the Minnesota Department of

Health, the Intervention Wheel model is a model including several different interventions which

are divided by systems or stakeholders. The Levels of Prevention Model is a community health

model that involves primary, secondary, and tertiary levels or prevention (Institute for Work and

Health).

Primary Level of Prevention

Primary prevention addresses the main issue in a more direct fashion. Primary

prevention in regards to breastfeeding continuation is considered health promotion; it is directed

towards mothers and would involve the health care provider (nurse, doctor, lactation consultant,

etc.) providing education to mothers about breastfeeding, encouraging them, and providing
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support throughout their breastfeeding journey. Parents with babies in the NICU need to be

informed that they are still able to breastfeed their baby and encouragement is needed. There is

an abundance of resources, lactation consultants, and breastfeeding support groups in Pinellas

County that it is important to inform mothers about (Florida Health, 2016). There are many

stakeholders involved in breastfeeding education and advocating which include the parents, the

child, and health care providers. It is very important for the nurse to provide education,

encouragement, and coaching on breastfeeding must be completed so that the mother will begin

and continue breastfeeding her child until he or she is at least one year of age and for both she

and her child to have the best experience possible.

Secondary Level of Prevention

Breastfeeding can be very difficult for some mothers due to social norms and feeling

uncomfortable due to the societys portrayal. Many mothers tend to trail off on breastfeeding

when their maternity leave is over (usually 8-12 weeks) and they head back to work. The society

plays a pivotal role in breastfeeding now a day in both the work place and the community. There

have been reports of employers and employees stating that they are uncomfortable with women

breastfeeding or pumping at work and studies show that women who plan to go back to work are

less likely to continue breastfeeding (Rollins, 2016). The secondary level of prevention in this

case would be directed at employers to allow breastfeeding mothers the time they need to

breastfeed their children. The nurse can begin to implement this form of prevention by going

into the community and providing information sessions or seminars on the importance of

breastfeeding to employers from corporate companies or government facilities.

Tertiary Level of Prevention

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Tertiary prevention leads back to the individual, the mother in this case, who might have

attempted breastfeeding with a previous baby and did not succeed for the recommended period

of time. Studies show that if a mother failed at an attempt of breastfeeding in the past, they are

less likely to try again with their future children (Rollins et al, 2016). Encouragement, support,

and education will be needed to get the mom to try again and succeed the next time around.

Nurses can provide the family with resources to help them get through the journey and

understand the benefits that breastfeeding entitles. Since breastfeeding tends to be more difficult

upon returning to work, it may be beneficial for mothers to learn how to efficiently pump in a

timely manner so that their job is not in question due to taking too long.

Development of Health Policy

A public health policy is a type of legal mandate or action that addresses health concerns

in a society and is set by the government but involves multiple different parties. Public health

policies influence the general publics health regulates appropriate rules amongst establishes in

the community (Centers for Disease Control and Prevention, 2015). This health policy focuses to

increase breastfeeding rates for at least the first year of childrens lives in Pinellas County

through a form of secondary prevention.

Research shows that breastfeeding rates dwindle around the time that maternity leave is

usually over with mothers who go back to work (Rollins et al, 2016). The proposal for this

health policy is to begin with educating employers on the importance and outcomes of

breastfeeding so that they can support their breastfeeding employees to continue as they

transition back to work without the fear of being judged or losing their job because of doing what

is best for their babys health. The addition of lactation rooms and paid or unpaid nursing breaks

are to be considered within the proposal. Community members (co-workers, employers), health
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care providers, public officials, and funding sources such as breastfeeding advocate groups and

WIC will be affected by the proposed health policy.

Supporters from those who are affected by the health policy include health care providers

and funding sources especially because they will be providing the education and funds for

advocacy. Support is huge in a proposal regarding breastfeeding advocacy because it is can be

very difficult at times and it can be very easily given up on. There will always be many

opposing forces to breastfeeding due to social norms as stated previously but in the work place

they are specific to whether or not employers support breastfeeding. In some instances,

employers dont appreciate the time it takes for a mother to breastfeed because they are

responsible for finding someone else to cover that persons position for the time they are away

from their job. Perhaps in the future there could be some type of law implemented where it is

mandatory for employers to allow breastfeeding mothers fifteen minutes or so to pump since it

is providing nutrition for a child which is 100% necessary. It is possible that some employers

just arent understanding, breastfeeding makes them uncomfortable and they need to be educated

on the benefits of breastfeeding.

Presentation of the health policy involves a plan that introduces the proposal for

breastfeeding to government employers and establishments. By starting off with those whom are

at the government level, this will then bring the proposal to the attention of public officials and

legislatures that put the health policy into place. Breastfeeding advocates, lactation specialists,

health care providers, and WIC associates all within the community can be contacted to arrange

and provide the necessary information or seminar for these establishments.

Referring back to the statistics of low breastfeeding rates in Pinellas County, this is an

absolute necessary health policy proposal for the county to consider. Breastfeeding mothers do
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not get nearly the amount of positive attention and acknowledgement that they deserve and

infants obviously cant make the decision to be breastfed so these are both underserved

populations in regards to this issue. Health care is constantly advancing and changing; breast

milk is an ongoing research project that is found to have more and more benefits as years go on.

Breastfeeding has proven to reduce mortality rates in infants and children and has also been

found to save womens lives (Rollins et al, 2016). Not only is it good for the health of a child and

its mother but it is a great thing for the health care community. Breast milk is natural and free of

charge which relieves the stress of financial burdens, it improves the health of our future

generations and it is great for our environment with producing less pollution with cans and

product packaging (Rollins et al, 2016).

Conclusion

This paper builds a foundation on Pinellas County, identifies health issues and concerns

in the community and focuses in on the low continuation of breastfeeding rates in the first year

of a childs life. With the utilization of community health models, interventions were formed to

assist in improving breastfeeding rates and distinguish between different levels of prevention. It

concludes the many benefits of breastfeeding and comes up with a health policy proposal to

encourage breastfeeding for better health outcomes for children, mothers, families, and the

community.

My dream has always been to begin a career in nursing focused on children and womens

health. I wanted to write about a topic or issue that interests me and that I can use in my future

endeavors as a nurse; breastfeeding fits that criteria perfectly. While I do not have any children

of my own and I have not had the opportunity to breastfeed; I see and hear about the struggles

that mothers have while trying to breastfeed their baby and how people in our society make them
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feel and I really just want to make a difference. Breastfeeding is an amazing, beneficial, natural

part of life and I believe it is important for these voices to be heard.

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