Running head: CAPSTONE PAPER

Capstone Paper Formative

Nina Wilczynski
The University of South Florida College of Nursing

CAPSTONE PAPER

Introduction: Geographic and Socioeconomic Data for Hillsborough County

The geographic location of Hillsborough County is in central Florida. The area spans
approximately 1020 square miles with a population of 1.316 million (The United States Census
Bureau, 2014). It encompasses a number of different urban and rural cities and subsections
including parts of Lutz, Tampa, Temple Terrace, Brandon and more. Three major employers in
the area include Baycare Health Systems, Publix, and the University of South Florida (Tampa
Bay Partnership, 2015). Healthcare systems in the area include Baycare Health Systems. Baycare
is a not-for profit health care system that connects clients to thirteen hospitals and other
outpatient centers throughout Tampa bay and central Florida. Other healthcare systems include
Wellcare (a health insurance company), Tampa General Hospital, Moffit Cancer and Research
Center, Florida Hospital, and the James A Haley Veterans Hospital (Tampa Bay Partnership,
2015). Approximately 14.2 percent of the population in Hillsborough County lives below the
poverty level, as compared to 13.8 percent of the state population (Florida Department of Health,
2013). Moreover 14.2 percent of the population greater than age 25 in Hillsborough County does
not have a high school diploma. This statistic compares to 14.7 percent of the state population
greater than age 25 that does not have a high school diploma (Florida Department of Health,
2013). In Hillsborough County, 10.2 percent of the population greater than age 5 speaks English
less than very well as compared to 11.8 percent of the state population (Florida Department of
Health, 2013). Further analysis of the County Health Profile reveals strengths and weaknesses of
the Hillsborough County area in regards to health status of the population. One particular
weakness is that Hillsborough County has a high percentage of obese adults as compared to the
entire United States (US). This analysis of the County Health Profile is found in the next section.

CAPSTONE PAPER

Analysis of Data: Strengths and Weakness of the Community

According to the County Health Profile, 95% of the population of Hillsborough County
has adequate access to locations for physical activity. This statistic is compared to only 93% of
the state population. Top US counties ranking in the 90th percentile for access to exercise
opportunities average at 92% (County Health Rankings and Roadmaps, 2015). These statistics
suggest that Hillsborough County provides more access to physical exercise for its population
than that found in over 90% of the counties nationwide. Another strength of Hillsborough
County is that the ratio of population to primary care physicians is 1280:1 as compared to the
state ratio of 1423:1 (County Health Rankings and Roadmaps, 2015). Lastly, the ratio of
population to mental health providers in Hillsborough County is 644:1 as compared to the state
ratio of 744:1 (County Health Rankings and Roadmaps, 2015). These statistics suggest that the
availability of primary care physician and mental health providers is greater in Hillsborough
County than in the overall state of Florida. These statistics were chose as the strengths for
Hillsborough County because they indicate the great accessibility the population has in
promoting health through exercise and availability of healthcare providers.
Weaknesses in the Hillsborough county area include the percentage of the adult
population that is obese (26%). In the state of Florida, 26% of the adult population is also obese.
Nationwide, the average percentage of the adult population reporting obesity in counties
reporting the highest levels of adult obesity is 25% (County Health Rankings and Roadmaps,
2015). These statistics suggest that Hillsborough County, along with the state of Florida, has one
of the highest levels of adult obesity in the nation. In an index of factors contributing to a healthy
food environment, with 0 being the worst and 10 being the best, Hillsborough county ranks a 6.8
compared to the state of Florida which ranks a 7. Nationwide, the counties ranking highest in the

CAPSTONE PAPER

index average an 8.4 (County Health Rankings and Roadmaps, 2015). These statistics suggest
that Hillsborough County ranks lower than the state of Florida and other counties in the nation in
regards to availability of a healthy food environment. Approximately 40% of Hillsborough
County is used for agriculture, yet it still ranks low in the availability of a healthy food
environment (Hillsborough County Agriculture Industry Development Program, 2011). Lastly,
the percentage of adults over the age of 20 reporting no physical activity in Hillsborough County
is 22% as compared to 23% in the state of Florida (County Health Rankings and Roadmaps,
2015). Hillsborough County has one of the highest levels of physical inactivity in the state of
Florida.
The levels of obesity in the Hillsborough County area are alarmingly high. Obesity rates
in the US have been increasing over the last few decades. Currently, one third of the adult
population and 17% of the youth population are obese (Ogden et al., 2014). Obesity is linked to
multiple health conditions, such as heart disease, stroke and type 2 diabetes. These conditions are
some of the leading causes of preventable death nationwide (US Department of Health and
Human Services, 1998, p 12). Moreover, obesity leads to an increase in medical costs for
civilians. In 2008, the estimated annual medical cost of obesity related illness was $147 billion
(Finkelstein et al., 2009). The increased medical and financial burden of obesity is notably high,
and the prevalence of this disease has been on the rise. Health policies should focus on obesity
care and prevention.
Obesity and the Determinants of Health
The range of personal, social, economic and environmental factors that influence health
are known as the determinants of health. These determinants include policymaking, social
factors, health services, individual behavior and biology and genetics (Office of Disease

CAPSTONE PAPER

Prevention and Health Promotion, 2014). These determinants of health can be applied on a
broader population aspect. Influencing a specific population is the focus of a community health
nurse. Addressing multiple levels of the determinants of health increases the effectiveness of a
community health nurses interventions.
Multiple determinants of health influence obesity. Genetic heritability influences ones
predisposition for obesity (Choquet & Meyre, 2011). The environment one lives in and their
personal lifestyle also play a big role in the likelihood of weight gain and obesity (Bouchard,
2010). Lastly, the health systems available to a population provide a foundation for which to
influence levels of obesity care and prevention (Gortmaker et al., 2011). The population of
Hillsborough County has an increased risk of obesity related health illness (such as Type 2
diabetes, heart disease and stroke) due to the high levels of adult obesity in the area as evidenced
by the Florida charts statistics showing the county to have one of the highest levels of obesity
nationwide.
Primary, Secondary and Tertiary Obesity Interventions
Interventions focused on combating obesity can occur on a primary, secondary and
tertiary level. The following are examples of interventions on each of the stated levels.
Primary prevention of obesity beings with promoting awareness of the physical exercise
programs and services available in the Hillsborough County community. The lower Hillsborough
Wilderness Preserve provides access to bike trails free to the community. Getting the word out
into the community about this resource incorporates the Intervention Wheel Models
interventions of advocacy and social marketing of the resource. This intervention would be
community wide and focused on letting the public know about the bike trail availability.
Increased physical exercise has been shown to reduce levels of obesity (Jimenez-Pavon, Kelly,

CAPSTONE PAPER

Reilly, 2010). Increasing awareness of a resource would increase the likelihood of the resources
use and thus increase health promotion and physical activity within the community. The risk
factor of a sedentary lifestyle within the community would be modified with an increased
promotion of physical exercise. Healthcare providers and public officials could increase verbal
promotion of the use of this resource by community members. The community health nurse
would have to be aware of the resource as well in order to promote physical activity among the
overweight population within the Hillsborough community.
A secondary prevention strategy for obesity focuses on treatment of the illness at the
community level. This prevention strategy works to implement community based exercise and
weight loss programs. Case studies of community based behavioral weight loss interventions and
exercise programs have been shown to be effective in reducing levels of obesity (Hillier-Brown
et al., 2014). The stakeholders of this prevention strategy would include community members,
whom the intervention is geared towards, public officials, whom would create the community
based exercise programs, and funding sources, whom would fund the exercise programs. The
community health nurse would need to use the Intervention Wheel Models tool of screening to
identify overweight and obese patients that could benefit from the programs. The tools of
referral to the programs would also be utilized by the community Health nurse as well as
follow up to check the progress of the patient toward their weight loss goals.
Tertiary prevention for obesity would have a system-wide focus and would look to deal
with the consequences of, and prevent further negative impacts on, health due to the excess
weight. This intervention would make use of multidisciplinary clinics in the monitoring and
treatment of illness occurring secondary to obesity, such as Type 2 diabetes, stroke and heart
disease. The stakeholders of this intervention would include the community members who are

CAPSTONE PAPER

suffering from secondary diseases related to obesity and the healthcare providers who would
need to treat the community members with secondary illnesses. The community health nurse
would provide multiple services in this prevention strategy. Examples include monitoring blood
glucose levels in patients with Type 2 diabetes and providing education for the proper use of
medications needed in management of Type 2 diabetes, stroke and heart disease prevention.
Policymaking
Health policy determines the distribution of resources for the implementation of
interventions. These resources expand access to, improve quality and safety of, and reduce costs
of care (Truglio-Londrigan & Lewenson, 2013, p 202). A primary prevention policy focused on
deterring obesity within Hillsborough County could include the installation of a bike rental
agency near the bike trails of the Lower Hillsborough Wilderness Preservation. The wilderness
preservation is one of the largest contiguous recreational areas within Hillsborough County and
spans an area of 16,000 acres. This characteristic makes the wilderness preservation a suitable
area for the promotion of exercise through bike riding. Currently, four of the seven parks contain
bike trails. However, bikes are not provided in the area. The inclusion of a bike rental business
near the trails would promote their usage and promote physical activity within the Hillsborough
County community. The stakeholders affected by the proposed policy include the Southwest
Florida Water Management District that owns the Lower Hillsborough Wilderness Preservation.
Other stakeholders would include the community members that would benefit from the bike
rental service and funding sources that would need to fund the initial installation of the rental
business. Potential opposition may initially originate from the Southwest Florida Water
Management District due to possible concerns of the negative impact of increased usage of the
wilderness preservation. However, charging a fee for bike rentals could provide fiscal profit for

CAPSTONE PAPER

the Water Management District that could be used for the further preservation of the lands. Such
a fee could be five dollars per hour of rental. The fee would be financially affordable to the
public. Furthermore, the use of ones personal bicycle would not be banned from the wilderness
preservation should the community members not want to pay for the rental. The majority
supporters for the policy would be the community members who would benefit from the service.
More support would come from public officials and legislators concerned with health promotion
in the County. The first step toward putting this policy in action is to present it to the Southwest
Florida Water Management District. Arguments based on statistical and scholarly evidence in the
health promotion of the community due to the policy would need to be presented to the Water
Management District. Further arguments of the financial benefits of the policy would also need
to be provided to the District.
Conclusion
Thus, the promotion of a bike rental agency within the Lower Hillsborough Wilderness
Preservation would increase the accessibility of bicycles to the community members of
Hillsborough County. This increased accessibility would promote physical activity within the
community and serve as a primary prevention strategy for the deterrence of obesity.
Approximately 95% of the population of Hillsborough County has access adequate access to
locations for physical activity. This statistic indicates that the population of Hillsborough County
is already able to get to the Wilderness Preservation, as well other areas that promote physical
activity. However, these locations of physical activity do not necessarily provide all the resources
necessary for easy access of exercise to the community. Increasing the availability and
accessibility of bicycles in such a large area promotes actual exercise to take place.

CAPSTONE PAPER

9
References

Bouchard, C. (2010). Defining the genetic architecture of the predisposition to obesity: A

challenging but not insurmountable task. The American Journal of Clinical Nutrition, 91,
5-6. Retrieved from http://ajcn.nutrition.org/content/91/1/5.long
Choquet, H., Meyer, D., (2011). Genetics of obesity: What have we learned? Curative
Genomics, 12(3), 169-179. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc /articles/PMC3137002/
County Health Rankings and Roadmaps. (2015). Hillsborough [Data file]. Retrieved from
http://www.countyhealthrankings.org/app/florida/2015/rankings/hillsborough/county/outc
omes/overall/snapshot
Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., Dietz, W., (2009). Annual medical spending
attributable to obesity: Payer-and service-specific estimates. Health Affairs, 28, 822-823.
Retrieved from http://content.healthaffairs.org/content/28/5/w822.full.pdf+html
Florida Department of Health. (2013). Socioeconomic Indicators [Data file]. Retrieved from
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?county=29&reportYear=
2013&tn=31
Gortmaker, S. L., Swinburn, B. A., Levy, D., Carter, R. C., Mabry, P. L., Finegood, D. T.,
Moodie, M. L., (2011). Changing the future of obesity: Science, policy, and action. The
Lancet 378, 838-847. Retrieved from
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60815-5/abstract
Hillier-Brown, F. C., Bambra, C. L., Cairns, J. M., Kasim, A., Moore, H. J., Summerbell, C. D.,
(2014). A systematic review of the effectiveness of individual, community and societallevel interventions at reducing socio-economic inequalities in obesity among adults.

CAPSTONE PAPER

10

International Journal of Obesity, 38, 1483-1490. Retrieved from

http://www.nature.com/ijo/journal/v38/n12/full/ijo201475a.html
Hillsborough County Agriculture Industry Development Program. (2011). Hillsborough County
Agricultural Commodities 2011 [Data Set]. Retrieved from
http://www.hillsboroughcounty.org/DocumentCenter/View/6140
Jimenez-Pavon, D., Kelly, J., Reilly, J. J., (2010). Associations between objectively measured
habitual physical activity and adiposity in children and adolescents: Systematic review.
International Journal of Pediatric Obesity, 5(1), 3-18. Retrieved from
http://www.tandfonline.com/doi/abs/10.3109/17477160903067601
Office of Disease Prevention and Health Promotion. (2014). Determinants of Health.
Retrieved

from http://www.healthypeople.gov/2020/about/foundation-health-

measures/Determinants-of-Health
Ogden, C. L., Carroll, M. D., Kit, B. K., Flegal, K. M., (2014). Prevalence of childhood and adult
obesity in the United States, 2011-2012. The Journal of the American Medical
Association, 311(8), 806-814. Retrieved from
http://jama.jamanetwork.com/article.aspx?articleid=1832542#Discussion

Tampa

Bay Partnership. (2015). Major Employers [Data Set]. Retrieved from

http://www.tampabay.org/site-selection/major-employers
The United States Census Bureau. (2014). Hillsborough County, Florida [Data File].
Retrieved from http://quickfacts.census.gov/qfd/states/12/12057.html
Truglio-Londrigan, M., & Lewenson, S. (2013). Considerations of culture in the
health of the

public (2nd ed.). In M. Truglio-Londrigan & S. Lewenson (Eds.), Public health

nursing: Practicing population based care (p.202). Burlington, MA: Jones & Bartlett

CAPSTONE PAPER
Learning.

11