Running Head: PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES 1

Prevention of STIs Through Educational Resources

Michelle Bartholet
University of South Florida

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

Prevention of STIs Through Educational Resources

Health policies are put in place in order to achieve a specific target goal related to public
health. It can define an issue, create a goal, and outline the interventions required to achieve the
overall goal. Health policies are created with the sole intent to influence the overall health of our
entire nation and create healthier individuals. The county that will be the focus in the
development of a health policy in this paper is Hillsborough County. After reviewing the health
statistics of Hillsborough County, it is evident that the presence and growing rates of sexually
transmitted diseases are a remaining problem. The health policy to be implemented will focus on
prevention and the availability of STD treatment for the affected individuals.
The United States Census Bureau defines an urban area as one central place and the
adjacent densely settled surrounding territory that together have a minimum of 50,000 persons
(2010 Census, 2010). Hillsborough County is located in the Tampa Bay area.
Hillsborough is the largest county making up the bay area with a total population of 1.292
million people, while Tampa as a whole consists of 19.98 million, making it an urban area of
Florida (2010 Census, 2010). Being such a populated area, there is a wide range of
employment opportunities available. In Hillsborough County the three major employers consist
of the Hillsborough County School Board, MacDill Air Force Base, and Hillsborough County
Government. Being an urbanized area also requires many healthcare resources to keep up with
the population demand. In Hillsborough County, the three major health care systems available to
the public include Tampa General Hospital, Moffitt Cancer Center, and Florida Hospital- Tampa
(Briefing, 2012).
Hillsborough County is the fourth largest county in all of Florida in population. With a
community that is constantly expanding, one can only expect to find a wide range of cultures,

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

ethnicities, trades, and socioeconomic statuses in its inhabitants. In Hillsborough, 17.2% of the
population lives below the federal poverty level. However, in all of Florida, 16.7% of the
population is below the poverty level. Despite the larger percentage being from the county level,
the level of education for individuals living in Hillsborough County versus Florida as a whole
were not considerably different. In Hillsborough, 85.8% of individuals age 25 and up had high
school diplomas, while in Florida as a whole it was 85.3% of individuals 25 and up. Large
populations also imply a diverse culture among its citizens, which can often include different
languages spoken as well. Out of the entire population of Florida 27.4% of people over the age
of five speak a language other than English in their home. However, the numbers for
Hillsborough County were unexpected at only 3.8% of people over five in the population not
speaking English. In most numbers, Hillsborough County matched, or was remarkably close, to
the statistics seen in the state of Florida (Florida Charts, 2016).
According to County Health Ranking & Roadmaps, Hillsborough County is ranked 22nd
out of 67 counties in Florida in the overall health factors ranking. There are many different
categories that go into the overall ranking of the county health factors. After analyzing the
different categories, it is clear where Hillsborough County is ranked well, and where they fall
short. Three strengths of Hillsborough include the ratio of primary care providers to population,
the percentage of population with adequate access to locations for physical activity, and the
percentage of individuals who have completed at least some college. The ratio or primary care to
population in this county is 1,280:1, which is in the top 6 counties in all of Florida (Florida
Health Rankings, 2015). It is important that every individual has the opportunity to access
primary care physicians if required. Primary care is crucial in first hand preventative care. In
Hillsborough 95% of the population has access to locations for activity, which is heavily

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

associated with reducing the risk of obesity and many related health complications. There is a
recognized link to higher education and overall positive health outcomes (Zimmerman, Woolf, &
Haley, 2015).. With 63.6% of its population completing some college, more individuals will have
the resources for healthy living (Florida Health Rankings, 2015). Hillsborough County
also had some negative health outcomes, including the number of newly diagnosed sexually
transmitted infections, the percentage of uninsured individuals, and the percentage of children in
poverty. The statistics for the number of sexually transmitted infections was based off the
number of chlamydia cases since chlamydia is the most common STI in North America and can
lead to many complications including ectopic pregnancy, and pelvic inflammatory disease. In
Hillsborough County there are currently a total of 7,098 cases of chlamydia, the third highest
total in all the Florida counties. Of all individuals under the age of 65 living in Hillsborough
County, 22% are uninsured. Inadequate healthcare coverage, or lack thereof, is a major barrier in
individual and population health. It prevents people from being able to seek care when required
and can therefore increase the number of chronic illnesses and lower quality of life. Lack of
insurance could be related to low socioeconomic status and overall poverty. This county has 24%
of children under the age of 18 in poverty. As discussed previously, poverty can lead to increased
risk of diseases and mortality (Florida Health Rankings, 2015). Based on the statistic
information provided, the priority health issue and focus is the number of sexually transmitted
infections, and the growing rate, in Hillsborough County.
The determinants of health model include five categories listed where they influence each
other from the top down. In other words, there are several different levels of health and each
determinant influences another, which influences the individuals overall health. The categories
from the top to bottom include policymaking, social factors, health services, individual behavior,

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

and biology and genetics (Determinants of Health, 2016). The environmental factors,
including social and physical factors of the community, can directly affect the number of
individuals with sexually transmitted infections. Some examples of social and physical factors of
the environment include social support, exposure to crime or social disorder, socioeconomic
conditions, quality schools, transportation available, available housing, and natural environment
(Determinants of Health, 2016). With the focus on STIs, low socioeconomic status of
the community environment can directly influence the individuals overall health and increase
their exposure to these infections. Individual behavior and social factors can also contribute to
the health issue of sexually acquired infections (Determinants of Health, 2016). In the
case of STIs use of condoms or other protective barriers and other personal habits can influence
the individuals risk of acquiring the infection.
This health policy is based on the following diagnosis: risk of sexually transmitted
infections among individuals in Hillsborough County Florida with low socioeconomic status
related to lack of available economic resources or programs. The focus of this health policy will
be on the individual primary level of prevention of sexually transmitted infections by using risk
factor modification techniques. This intervention will be geared towards both community
members and health care providers. Since the target is the low socioeconomic bracket, education
is the most important part of the intervention process. Male condoms are important in reducing
the risk of transmitting and contracting a sexually transmitted disease. Condoms are regularly
tested, regulated like other medical devices, and when used correctly provide an essentially
impermeable barrier to STD pathogens (Fact Sheet for Public Health Personnel,
2013). According to the CDC, the failure of condoms to protect against STD transmission or
unintended pregnancy usually results from inconsistent or incorrect use rather than condom

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

breakage (Clinical Prevention Guidance, 2011). Therefore, the intervention will focus
on the education of sexually active individuals on the correct usage of condoms as well as the
resources available to them. This process should have very little funding concerns as its main
focus is on education and demonstration requirements. Both physicians and nurses will be
required to participate in this intervention, so the only cost to them is time in preparation for
future patients. The community health nurse is a vital component of this process. It is the
responsibility of the community health nurse to not only assist in carrying out the intervention
but also to make sure that each individual that is sexually active receives all the information
required at the end of the visit. While the focus of this policy is on primary prevention, it is
important to realize there are different levels of prevention in health policy making. In this case
of sexually transmitted infections, the secondary component of prevention would be the
screening and treatment of sexually transmitted infections at each primary care visit, and the
tertiary level of prevention would include preventing the spread of sexually transmitted
infections and following the treatment pattern of the infected individuals.
The health policy proposal will be for each clinic or primary care facility in which a
sexually active individual receives care will be required to provide information on the use of
condoms, including the correct way in which to use it, and provide information on clinics or
facilities that offer free condoms to the public. The goal of this policy is to improve education
related to condom usage, provide accurate information to individuals at risk for STIs, and
increase the number of individuals using condoms. There should be little to no funding concerns
since the priority of this policy is on education. Clinical staffs are already trained in screening of
individuals during a healthcare visit, and in education on many healthcare concerns. The only
requirement for a clinic or facility is to do research on correct usage in order to demonstrate the

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

correct usage, and research on locations that provide free condoms. The CDC continuously
launches campaigns and funding for the prevention and treatment of HIV and other sexually
transmitted diseases and provides resources to all individuals who are interested in implementing
their own programs, including condom distribution programs (Condom Distribution,
2015). The Florida Department of Health in Hillsborough County also provides many family
planning services and clinics all over the county, including many clinics that offer STD
counseling and treatment, yearly exams, and free condoms to the public (Family Planning,
2016). Both of these supporters are highly influential and reputable in the nation, as well as the
state in which they reside. In order to get this policy into action, it is important to have reputable
health care providers and clinics willing to help represent this action. The first approach before
going to the government would therefore be to visit established clinics to recruit nurses,
physicians, and services and educate them on the upcoming policy. This also provides members
of the community that are familiar with the policy that can teach other health care workers when
the policy is implemented and mandatory. This policy focuses on individuals who are not only
sexually active, but also those of a low socioeconomic status because it requires the healthcare
team to refer the individual to additional resources that include free condoms. This ensures that
both education and financial status of the individual does not prevent them from receiving the
care they require and the prevention of sexually transmitted diseases. With Hillsborough County
being in the top 3 counties for most cases of sexually acquired infections, this policy is aimed at
reducing rate of growing cases by preventing new infections through the use of education and
allocation of resources. This will add to the overall population health by decreasing the
transmission from one individual to another and reduce the risk and incidence of STD-related
complications, such as pelvic inflammatory diseases. This policy will also allow members of the

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

community who are sexually active to feel safe when practicing sex, and to encourage healthy
sexual behaviors with their partners.
There are many factors that influence the overall health of a
community and its members. Socioeconomic status is often times directly
correlated to the individuals overall health, with those closer to poverty
experiencing poorer health. However, low income or educational status
should not put an individual at risk for contracting a sexually transmitted
disease. There are many things to be learned by every individual when it
comes to correct condom usage. For example, the CDC discourages the use
of oil based lubricants because they degrade the condom and can cause
them to be rendered useless in preventing STDs or break entirely (Clinical
Prevention Guidance, 2011). That is why education on use of condoms, and
providing resources for free condoms is essential in this health policy. When
used regularly and correctly, condoms reduce the risk of transmission of
sexually acquired infections, which can often lead to many long-term
complications. Although I have lived in Hillsborough County for most of my
life, I was surprised to see the different statistics and learn how prevalent
sexually transmitted infections are within this area of Tampa, and compared
to Florida as a whole. In my opinion, this health policy would have an
outstanding benefit on the community. This policy could help many
healthcare team members, as well as myself in my future nursing career, by
making it more acceptable to talk about sexually transmitted infections.
Often times, people are uncomfortable because they dont have the proper

PREVENTION OF STIS THROUGH EDUCATIONAL RESOURCES

training to discuss certain topics and dont know how to approach these
matters. I realized through this policy paper, that primary prevention through
education of simple topics is one of the simplest ways I can help clients in
the future.

References
Briefing: Floridas Top Ten Largest Public Employers By County. Florida Tax
Watch. (May 2012). Retrieved March 1, 2016, from
http://www.floridataxwatch.org/resources/pdf/jobsbriefing.pdf
2010 Census Urban Area FAQs. United States Census. (2010). Retrieved
March 1, 2016, from
https://www.census.gov/geo/reference/ua/uafaq.html
Florida Health Rankings. County Health Rankings & Roadmaps. (2015).
Retrieved March 1, 2016, from
http://www.countyhealthrankings.org/app/florida/2015/rankings/hillsbor
ough/county/factors/overall/snapshot
Florida Charts. Florida Department of Health. (2016). Retrieved March 1,
2016, from http://www.floridacharts.com/charts/SearchResult.aspx
Determinants of Health. Healthy People 2020. (2016). Retrieved March 1,
2016, from https://www.healthypeople.gov/2020/about/foundationhealth-measures/Determinants-of-Health
Fact Sheet for Public Health Personnel. Centers for Disease Control and
Prevention. (March 25, 2013). Retrieved March 1, 2016, from
http://www.cdc.gov/condomeffectiveness/latex.html

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Clinical Prevention Guidance: Sexually Transmitted Diseases Treatment

Guidelines. Centers for Disease Control and Prevention. (January 28,
2011). Retrieved March 1, 2016, from
http://www.cdc.gov/std/treatment/2010/clinical.htm
Condom Distribution as a Structural Level Intervention. Centers for Disease
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http://www.cdc.gov/hiv/programresources/guidance/condoms/index.ht
ml
Family Planning- Birth Control (Women and Men). Florida Health Hillsborough
County. (n.d.). Retrieved March 1, 2016, from
http://hillsborough.floridahealth.gov/programs-and-services/clinicalnutrition-services/family-planning-birth-control/index.html
Zimmerman, E. B., Woolf, S. H., & Haley, A. (2015, September). Population
Health: Behavioral and Social Science Insights. Retrieved March 01,
2016, from http://www.ahrq.gov/professionals/education/curriculumtools/population-health/zimmerman.html