Running head: STI REDUCTION 1

Methods for Sexually Transmitted Infection Reduction in Whatcom County

Kalen Jordan, RN, Janet Palmer, RN, Lacey Ruby, RN

Western Washington University

NURS 432 Community-based Care for Vulnerable Populations

William Lonneman DNP, RN

June 6th, 2017

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Methods for Sexually Transmitted Infection Reduction in Whatcom County

The Whatcom County Health Department has noticed an upward trend in the sexually

transmitted infection (STI) rates for those between the ages of 18 and 24. Bellingham,

Washington, is known by many of the locals as a transient town with a high population of college

aged youth, especially with its multiple post-secondary institutions, including Western

Washington University (WWU). Due to this city's high population of young adults, as well as

newly emerging methods of communication, especially through technology, it is no surprise that

means of obtaining sexual health information have begun to change in our modern age. With

these increasing rates, the Whatcom County Health department inquired with the nursing

students at WWU to acquire possible strategies to better reach this age group and intervene with

these increasing trends.

After communicating with the facilitating staff from the Whatcom County Health

Department, the frame of this group's project was expanded to include health and educational

institutions who work with this specific demographic.

Assessment

When we were approached by Whatcom County Health Department about the scope of

our project, they provided local statistics that they had gathered on common STIs. The number of

local gonorrhea cases had gone from 61 cases in 2015 to 101 cases in 2016, nearly doubling in

one year. Chlamydia had not had such a sharp yearly increase in cases, but showed an upward

trend over the last two years with 692 cases reported in Whatcom County in 2016. For both of

these diseases, the age group with the most cases when the data was sorted by age, was the 20 to

24 year-old age group. 41% of chlamydia cases fell within this age range in 2016 (Hankinson &

Hensley, 2017).
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Primary Assessment: Survey and Interviews

In our initial assessment, we did a windshield survey to look at the area within a one mile

radius of the Whatcom County Health Department and noticed that this area included a variety of

neighborhoods and amount of access to needs. Age and economic standing of the people in this

area differs greatly, race of people predominantly white. Sites for the elderly, for the young,

homeless, mentally ill, are all found within this 1 mile radius (Jordan, Palmer, & Ruby, 2017).

This area had some areas that were in a food desert - no place to purchase groceries - while

others included local farmer markets such as Young Stocks. There were not, however, multiple

places to access sexual health care needs in this area. WWU had a health clinic, Planned

Parenthood was in the area, and Family Care Network (FCN), as well as Unity Care, had

providers available in the area.

We chose to look at the three secondary education campuses in town as a way to reach

our target population. WWU has 15,500 students enrolled with nearly 3000 of them being

incoming freshmen (About Western | Western Washington University, 2015.). Whatcom

Community College (WCC) has 11,000 student enrolled annually with a little over 4000 of them

at full time equivalent. Of their students, 68% are 18-24 years old and 76% of those are from

Whatcom county (Whatcom Community College: About Whatcom, n.d.). Bellingham

Technical College (BTC) is the smallest campus in the county with nearly 2300 full time

equivalent students in 2015-2016. This campus also has an average age of enrolled students at 32

years old (BTC Facts, n.d.).

Secondary Assessment: Literature Review

We performed a literature review through One Search utilizing keywords young adults,

sexual health, college students, communication, and sexual transmitted infections. We

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narrowed our search with the following parameters: must be in English language, peer reviewed,

and must be from 2000 or more recent.

Rittenour and Booth-Butterfield (2006) discuss that sexual activity and sexual health in

young adults is of particular concern when discussing overall health. According to these authors,

less than 25% of youth consistently use condoms, even when engaging with new sexual partners.

In examining the question of why these youth engage in sexually risky-behaviors, they point at a

gap in the literature regarding the role of peer-to-peer communication and sexual health.

Lamber, Kahn & Apple (2003) investigating college students' perceptions of "hooking

up" ("when two people agree to engage in sexual behavior for which there is no future

commitment," p. 129). Interestingly, the college students in their findings believed that their

peers were more comfortable with these interactions than they themselves were reportedly being.

Rittenour and Booth-Butterfield (2006) question if these skewed perceptions of sexual behavior

amongst their peers possibly stem from peer conversation, and if further conversation may

clarify these misunderstandings, thus improving sexual health. These authors focused their

attention on answering the following three questions:

1) Which sexual health-related topics do college students discuss with their peers?
2) How comfortable are college students with discussing sexual health-related topics with

their peers?
3) Does gender affect college students feelings of comfort discussing sexual health-related

topics

The findings of their research shows that generally college students encourage one

another to engage in healthy sex practices. In general, lack of condom use may be due to feelings

of embarrassment, or not wanting to convey feelings of distrust. Furthermore, they continue with

the possibility that those who are discussing condoms are also more likely to engage in condom
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use. STIs and birth control were also found to be topics that peers discussed frequently; though

the authors state that though college students discuss the risk of STIs as potential outcomes in

risky sexual behaviors, the young adults may not recognize themselves as highly at risk

(Rittenour & Boothfield, 2006).

Eisenberg et. al (2014) point out differences in health behavior between students at two

and four-year college campuses. Students who attend two year college have poorer health

practices than those who are enrolled in four year colleges in areas like smoking, nutrition, and

physical activity. The only area in which four-year college students had worse health practices

was in the area of alcohol use; thus unprotected sex, STI rates, and rates of unplanned

pregnancies were all higher at two-year colleges but having sex while intoxicated was more

likely to happen at a four-year university. This study also points out that this data correlates with

previous sexual health research that discuss the prevalence of condom use and socioeconomic

status. Those with higher socioeconomic status are more likely to use condoms with sex and

more likely to get tested for STIs.

Interventions

The interventions possible ranged wildly due to the fact that each partner agency had

different resources already available and the needs of the populations that they each served. Each

of the college campuses are unique in what they can do for their student population and we also

considered the clinical side faced by the physicians or providers at FCN. The following

paragraphs discuss our recommendations for each community partner.

WWU has a wide range of resources available to students seeking STI testing and offers a

good selection of sexual health education methods. Our recommendations for this resource heavy

campus was to expand communication with the student body on these topics. We suggested
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offering sexual health updates to students via text message or school email broadcast. WWU

already offers text message alerts to students for safety and weather related school closures.

Eathington (2013) suggests that text messaging can be an effective way to target our age range to

change sexual health behaviors.

Because Whatcom Community College (WCC) never responded to our attempts to

contact them, we were unable to discuss the need for interventions with the staff there;

nevertheless, we will include possible recommendations for that campus here. This campus has a

nursing program which generally has 60 students enrolled, as well as a student nurse

organization on campus. This nursing program also hosts a yearly health fair for a variety of

topics chosen by the nursing students. Our recommendation is that the Whatcom Health

Department work with these nursing students to tailor these topics to focus on local issues, such

as the rising rates of chlamydia and gonorrhea in the county. We also suggest the formation of

volunteer student sexual health mentors such as those seen on WWUs campus and WWUs

Prevention and Wellness Services leader has stated a willingness to help support the other local

colleges in their starting a program of volunteer sexual health mentors.

BTC, while they serve a generally older student body than our target population, were

very enthusiastic about possible health promotion activities on their campus. They too offer a

nursing program as well as many other health services academic specialities, but no resources for

healthcare are located on their campus. Our recommendations for this campus include starting a

yearly health fair for students utilizing students enrolled in the schools health science courses.

FCN is a network of clinics and providers in Whatcom County. Our recommendation for

them is to provide a sexual health screening tool to patients in this age group at every office visit
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regardless of the medical reason for the visit and then to provide sexual health education and

offer testing based on the sexual health needs identified in the screening tool.

Final Intervention with Deliverable

Our chosen intervention was a small pamphlet which would assist with opening the

channels of communication between agencies, as well as providing the current statistics on STI

rates amongst this population, in Whatcom County. The rationale behind this, being that the only

long-term intervention in reducing STI rates is through education and communication. By

providing recent statistics to the educational institutions, and providing community contacts to

themselves and the health agencies we met with, we may hope that each individual agency may

use this information to educate their clientele, while also being kept up-to-date on future STI

statistics in the future.

Method of Evaluation

Because getting information and education to this patient population is likely to increase

the number of tests and reported STIs, our recommendation is to evaluate by the increase in

testing or reported STIs for the first year to see if the interventions are effective; and then within

five years evaluate if the trend of STIs in this age range has decreased overall.

Summary

There is a large increase in STI rates among Whatcom County residents aged 20-24

years. WWUs RN-to-BSN students and Whatcom County Health Department worked together

to find methods to decrease the rates of STIs during Spring Quarter of 2017. The three students

assigned to this project found that the people in this age range prefer technology and peers for

communication and education and do not often seek medical help; also found was the limited

local resources for sexual health awareness, screening, and treatment. FCN was interested in how
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to reach this population demographic but admitted to needing better screening and education for

their providers. BTC had almost no health services available to their students but were interested

in ways to include their academic programs into building a health fair to educate their students.

WWU had the best sexual health screening, as well as a clinic, multiple councilors, and a peer

sexual health mentor program; WWU voiced interest in helping other local colleges with

building programs of their own. WCC did not reply to the students and thus no further

communication was available, even with multiple attempts. Whatcom County Health Department

sends out local statistics to providers in the area and are willing to send that information out to

schools and possibly participate in health fairs when invited. It is believed that with these

recommendations and interventions implemented there will be an increase in STI testing and

treatment and with time a decline in overall STI rates in Whatcom County.

When working on this project, I learned things about how our community partners

functioned within the community and how slow the process of change can be. We spent a lot of

our time trying to get a contact within the partners we wanted to more fully assess. Some of the

contacts were provided to us and therefore easier to get ahold of, but some we had to contact on

our own. It took several weeks for Bellingham Technical college to get back to us and I e-mailed

3 different people in that time. While we were ultimately successful in meeting with them, the

time it took was surprising. I also got a good idea how small changes can have a large effect. Our

hope was to encourage small changes at each community partner site to effect a larger change in

how STIs are handled in our community (Palmer, 2017).

What I found most interesting was how many community partners were eager for a

change. I had never realized how hard it was for older generations to communicate with young

adults or how very different generations can be from each other in worldview, communication
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preferences, or how and when they access healthcare. With so many people looking for answers

and ways to address this patient population, we found there was motivation to make some form

of change even though each community partner had a different plan and rationale for their

choice. At this point, I can simply hope that if everyone does their part then a different can be

made and there will be a decrease in STIs and an increase in STI testing. (Ruby, 2017).

Attempting to brainstorm ways in which we could communicate the seriousness of sexual

health to the younger generation was a particular dilemma that was difficult for me to set aside.

Understanding that this demographic largely varies in level of education, perspective, and life

experience, it began clear that what we were dealing with was not simply a problem of

increasing STI rates, but a larger issue of communication (in this case, delivering information to

a recipient, who may not be mature, focused, or prepared, to absorb the message you are

delivering). This project was a reminder that not every problem can be faced head on, and at

times we have to be happy with small victories. The silver lining within this project for myself,

was seeing the level of commitment in our community leaders, even when faced with problems

much larger than themselves or the power they wield. I very much enjoyed hearing the political

discussions during our meetings with the Whatcom County Health Department, and the strive for

social equality and better health they each have for our community. (Jordan, 2017).

Conclusion

The primary means of reducing the risk of sexual health information is based on the

quality of communication and education provided. It is clear that the community mentors and

leaders in Whatcom County are strong advocates for the health of their community, and with a

steady flow of information between these agencies and these active leaders at hand, we may hope

that the rising rates of reported STIs amongst our youth may steadily decline.
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Appendix

Graphs from Whatcom County Health Department (Hankinson & Hensley, 2017).
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STI REDUCTION
Community Partners
Whatcom Health Department
Western Washington University
Resources
Current up-to-date statistics and
monitoring of STI rates
Partner treatment program
Peer-to-Peer Sexual Mentors
Health Clinic on campus
Strong and modern sexual health
screening
Willingness to help other
colleges
12
Recommendations
Update community partners with
information and offer support in
training peer mentors or
participation in health fairs.
Keep peer mentors and health
clinic up-to-date with STI
demographics; assist other local
colleges in starting peer
mentorship programs. Perhaps
use technology (via email or
texting) to reach out with current
health statistics or information.
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Whatcom Community College
Strong nursing program Assign topics for the nursing
Health Fair students in the health fair projects
Student Nurses of Whatcom club based off of Health Department
information; start a peer sexual
health mentor program.

Bellingham Technical College Strong programs Start having a health/wellness fair

Willingness to work within
community
that includes multiple programs
(all things relate to health); begin
a peer sexual health mentorship;
invite Health Department to be
involved in health fair.

Family Care Network Providers
Informed professionals
Access to testing and treatments
Willingness to learn new
methods
Start having a more thorough
sexual health screening form that
is given to anyone between 20-24
each visit. Reach out to colleges
to be included in their community
health resources or health fairs.
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Lonneman, Interviewer)

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