Running head: HEALTH POLICY 1

Health Policy Plan for Binge Drinking in Pinellas County, FL

Marielle Briones

University of South Florida

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Health Policy Plan for Binge Drinking in Pinellas County, FL

The purpose of this paper is to identify a health priority issue in one specific county and

develop a health care plan/policy that, if implemented, could affect the issue and improve the

health of the population. This will be done by looking at health data on the county, narrowing

down a health issue and a targeted population, and discussing evidence-based preventions. The

paper will look at the county of Pinellas, FL and focus on how a secondary intervention could

decrease rates of binge drinking.

Overview of Pinellas County.

Pinellas County is located on the west coast of central Florid and creates a peninsula.

Major cities within this county include St. Petersburg and Clearwater, both of which are key

cities within the Tampa Bay area. The county has a combination of both urban and rural areas

but is mainly urban. The top employer within Pinellas is Raymond James, hiring over 4,000 local

employees (Pinellas County Economic Development [PCED], n.d.). Several companies tie for

second place, hiring over 2,000 local employees. These companies include Home Shopping

Network, Tech Data Corp, and Spectrum (PCED, n.d.). Major health care systems within the

county include BayCare, Hospital Corporation of America [HCA], and Community Health

Systems [CHS]. The following paragraph lists different statistics to compare Pinellas County

with the state of Florida.

Comparison of Local vs. State Populations

Nine percent of families living in Pinellas County live below the poverty line compared

to an estimated 11.1% in the state of Florida (U.S. Census Bureau, 2017). Seventy-eight percent

of individuals 25 years or older have a high school diploma, which is the same percentage rate of

the state (CHR&R, 2017). Two percent of individuals in Pinellas do not speak English
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proficiently, lower compared to the state with is 6% (CHR&R, 2017). In Pinellas County, one

primary care physician on average has about 1,090 patients, compared to the state of Florida in

which one physician has on average 1,380 patients (CHR&R, 2017).

Analysis and Interpretation of Data

This portion of the paper will go more in-depth on the population of Pinellas County.

Strengths and weaknesses will be identified with statistics compared to the state’s. Looking at

these strengths and weaknesses will help to detect a priority health issue.

Identified Strengths

Pinellas County scored 96% on access to exercise opportunities, which was higher than

the state who scored 87% (CHR&R, 2017). Percentages represent the number of individuals who

live close to areas where they can exercise, such as parks, gyms, or recreation centers like the

YMCA (CHR&R, 2017). High percentage in this category indicates that the county has made

efforts to provide exercise opportunities to its citizens. Increased opportunities can mean less

factors that would keep individuals from exercising, thus improving community health. Being

close to areas where individuals can exercise regularly is very beneficial for overall health and

can help reduce risks for several different conditions such as “cardiovascular disease[s], type 2

diabetes, and some cancers” (Population Health Collaborative, 2016).

The county also scored 87% on diabetes monitoring, which was higher than the state who

scored 86% (CHR&R, 2017). This percentage indicates the diabetic individuals with Medicare

who have received the HbA1c test (CHR&R, 2017). Monitoring blood sugar not only indicates if

treatment is still effective but also can prevent diabetic complications. The county has trended

upwards in this category over the past several years.

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Lastly, Pinellas County has less particle matter, 6.9, compared to the state, 7.4 (CHR&R,

2017). This measure indicates the “average daily density of fine particulate matter in micrograms

per cubic meter” (CHR&R, 2017). Although it may not be at the forefront when people think

about maintaining good health, air pollution can negatively affect the human body overtime.

Reports show that air pollution plays a role in 6.4 million deaths per year (Environmental

Defense Fund, n.d.). It is important that the community does its best to lower pollution in the air.

Identified Weaknesses

Pinellas County had a higher percentage of adults who currently smoke, 17%, compared

to the state of Florida, 15% (CHR&R, 2017). Smoking is a leading cause of lung cancer and

other respiratory illnesses. Reports show that cigarette smoking causes over 480,000 deaths per

year in the U.S. (Centers for Disease Control, 2018). Although smoking rates have decreased in

the country for several decades, it is important to still encourage smoking cessation in the

community.

The county also had a higher percentage of individuals who excessively drank, 21%,

compared to the state, 18% (CHR&R, 2017). Drinking excessively can result in very deadly

conditions such as alcohol poisoning/intoxication. In addition, Pinellas has more alcohol-

impaired deaths, 28%, compared to the state, 26% (CHR&R, 2017). Not only does drunk driving

put the intoxicated individual at risk for death but also other individuals on the road. Being

responsible with alcohol is a topic that should be continuously taught within communities to

stress the importance of preventing alcohol-related illnesses and deaths.

Identification of a Priority Health Issue

The priority health issue that I have chosen to focus on is alcohol abuse. This issue relates

to excessive drinking and alcohol-impaired deaths, both of which are weaknesses I’ve identified
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above. Substance abuse, which includes alcohol abuse, is one of the topics in Health People

2020’s leader health indicators (United States Department of Health and Human Services [HHS],

Healthy People 2020, 2016). This issue is one of priority because multitudes of people across the

United States consume alcohol and run the risk of abusing or misusing the substance if not

responsible. According to the National Survey on Drug Use and Health, in 2017, 140.6 million

individuals had consumed alcohol within a 30-day span (Substance Abuse and Mental Health

Services Administration [SAMHSA], 2018).

Discussion and Application of Community Health Models

Community health models are important because they are tools used to guide the making

of interventions and policies. The Social Determinants of Health Model (SDOH) displays several

different environmental and social factors that can impact an individual’s health and influences

the health issues of communities (Savage, 2016). Because this model shows all the various

conditions, those developing interventions can research how these conditions might influence the

health issue and create intervention that overcome these factors. Many different SDOH factors

can impact and influence a person to abuse alcohol. Specifically, in Pinellas county, economic

stability is one of them. Data shows that having a higher income correlates to more alcohol use

as 25.1% of Pinellas residents who heavy or binge drink make $50,000 or more whereas only

15.9% make less than $25,000 (Florida Health Department [FHD], 2016).

On the flip side, less education correlated with higher chances of binge drinking as more

individuals who binged drink received less than high school education or received their high

school diploma/GED, 27.6% and 28.1% (FHD, 2016). This is ten percentages higher compared

to those who have more education after high school, 17.8% (FHD, 2016). Social cohesion is one

SDOH factor that can influence people to binge drink. That factor ties in with the individual’s
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environment. Living in an environment where alcohol is easily accessible, and/or being around

other binge drinkers, can increase one’s likelihood to binge drink as well.

Population Diagnosis

Young adults are at risk for developing alcohol-related conditions and disease due to

excessive use of alcohol.

Community/Population-based Interventions

This section will discuss different levels of evidence-based interventions of the primary

health issue. The three levels of interventions consist of primary, secondary, and tertiary

prevention. Each intervention will mention applicable principles of the Intervention Wheel

Model, a list of values used by public health nurses to improve the health of whoever they’re

serving, whether at individual, community, or systems level (Savage, 2016).

Primary Level of Prevention

A primary level intervention would be to educate individuals while they’re young, in

middle and high school. One evidence-based intervention is having mentoring programs, like Big

Brother/Big Sister, geared towards adolescents. In some RCT’s testing this intervention, it was

found that mentoring reduced rates of adolescents initiating alcohol use (Thomas, Lorenzetti, &

Spragins, 2011). Principles that apply to this intervention are counseling and health teaching. The

level of recipient is individual. This intervention educates on making good decisions and

promotes mental health (ex: teaching ways to handle stress, talking about emotions, etc.) which

may reduce an adolescent’s desire to start drinking. Community members are stakeholders who

would be affected by the intervention and program staff as well as partners of the programs are

stakeholders involved in the intervention. Mentorship programs like Big Brother/Big Sister are

mainly non-profit organizations that receive funding through donations or partnerships with
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companies or other organizations. The role of the community health nurse for this intervention

would be to refer adolescents to the mentor programs and/or help promote to the community so

youths would want to get involved.

Secondary Level of Prevention

The purpose of secondary preventions is to detect and treat conditions as early as

possible; tools like screening help with that aim. One evidence-based intervention is screening in

primary care settings for unhealthy use of alcohol (US Preventive Services Task Force, 2018).

The principle that applies to this intervention is screening. The level of recipient would be

community and would be a considered screening intervention. Community members, in this case

primary care clients, are stakeholders who would be affected by the intervention. Health care

providers are stakeholders involved in the intervention as they are the ones who will see the

responses of their patients to the screening instrument. Funding for screenings may come from

the government or from organizations that focus on a specific health issue. For this intervention,

funding may come from local or state health departments and/or organization like the National

Institute of Alcohol Abuse and Alcoholism, NIAAA. Community health nurses may be the ones

handing on the screenings to clients if they work in or with the primary care facility. The

intervention could also be given in other settings.

Tertiary Level of Prevention

Tertiary interventions are designed to help individuals with complex and more long-term

issues to prevent further disability and improve their quality of life. One evidence-based

intervention is the community reinforcement approach, a 24-week outpatient therapy that uses a

variety of “recreational, familial, social, and vocational reinforcers, along with material

incentives” as rewards for sobriety (National Institute on Drug Abuse [NIDA], 2018). Principles
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that apply to this intervention include collaboration, referral & follow up, health teaching, and

counseling. The level of recipient would be individual. This intervention monitors compliance

and prevents further negative impact on health. Community members, in this case recovering

alcoholics enrolled in this program, are stakeholders who would be affected by the intervention.

Those working in and with the therapy facility, providers, nurses, counselors, and partnered

businesses are stakeholders involved in the intervention involved with carrying out the

intervention. Funding for this type of therapy may come from local or state government. Local

businesses may also develop deals and partnerships with the facility to offer material incentives

for the clients as charity. The community health nurse has the potential to play many different

roles. They may give clinic-monitor disulfiram therapy to the patients or help lead the weekly

counseling session (NIDA, 2018).

Development of Health Policy

The objective of the health policy is to reduce the rate of excessive alcohol use by

implementing screenings to detect early onset of unhealthy alcohol use. This secondary

intervention is the focus of the health policy. It will address the needs of the underserved

population by targeting screenings towards young adults so that furthers interventions can be put

in place if an individual shows early signs of alcoholism. Lowering rates of binge drinking will

enhance the general health of the population by decreasing the chances of alcohol-related

diseases and deaths within the community.

The main goal with the proposed health policy is to implement the screening in various

settings and train those who will conduct the screenings on further interventions if needed. The

screening instrument that will be used is the Alcohol Use Disorders Identification Test–

Consumption (AUDIT-C), a 3-item tool that asks the person how often they drink, how many
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drinks a day they typically have, and how often they have 6 or more drinks (US Preventive

Services Task Force, 2018). If an individual’s scores indicate a positive screening, follow-up

assessments that are more in-depth should be conducted to confirm their excessive alcohol use

and develop a plan of care (US Preventive Services Task Force, 2018). Further assessment by

clinicians may include longer screening instruments such as the AUDIT, which is the AUDIT-C

but includes an additional 7 questions that would indicate if the client shows signs of alcohol

dependency and if they have any of the common problems that are linked with heavy alcohol use

(US Preventive Services Task Force, 2018). It would be up to the clinician on what interventions

or next steps in care should be implemented. Behavioral counseling interventions in the form of

personalized normative feedback sessions have been reported to be commonly used (US

Preventive Services Task Force, 2018).

The general plan of the health policy would be to implement the screening in clinics

across Pinellas County. Advisory committees within the Florida/Pinellas County Department of

Health would be beneficial to approach first for feedback and funding. The next part would be

developing a list of clinics within Pinellas and then meeting with the directors or personnel in

charge and discuss with them the possibility of employing the screening into their practice. Since

there are several hundreds of clinics within the county, there would be a team of people working

on this step of the plan and it would be dealt with one city/area at a time as to not overwhelm the

team. Health organizations, especially those who’s focus is on alcoholism recovery and

prevention, will be contacted as well for possible support and funding.

Several stakeholders would be affected by the proposed health policy. Primary Care and

Family Practice clinics in the county will have the screenings in their facilities and implement

them however they feel is best (ex: handout questionnaire, the doctor directly asks, etc.). The
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screening may also be implemented in Pediatric care since many of these facilities still see

individuals until they are 21-years-old. One idea is to implement the screenings in a few primary

care facilities and then expand out to areas, like free clinics, that reach individuals who are

uninsured. The recipients of the screenings are the community members affected by this health

policy. The screening should be standardized and given to all clients. This should be mentioned

to the clients so as not to make them feel judged or embarrassed.

Other stakeholders that would be affected would be the Pinellas County Department of

Health and organizations like Operation PAR or Tranquil Shores since they are potential funding

sources and/or sponsors of the screening. These organizations and others that focus on helping

alcoholics recover from their addiction would most likely be in support of interventions that

could prevent individuals from going down the path of unhealthy alcohol use in the first place.

Their influence on the health policy would be to help in funding. Clinics that are supports would

allow enactment of the screening into their primary care exams. There weren’t any organizations,

facilities, or businesses that came to mind when thinking of oppositions to this health policy.

Some provider facilities and clinics may be hesitant to implement the screening at first.

However, reminding them about the benefits of the screening and how easy it is to execute can

persuade opposition to become a supporter.

Conclusion

In conclusion, excessive alcohol use amongst young adults is a priority health issue, as

rates are higher in Pinellas County compared to the state of Florida. There are several evidence-

based interventions at different levels of prevention that have been proven to reduce rates of

binge drinking amongst its tested demographic. I decided to focus on screenings, a secondary

intervention, as I developed a hypothetical health policy. This health policy involved a plan of
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implementing the screenings in clinic and primary care settings. The simple questionnaire has the

potential of notifying the provider or public health nurse conducting the screening if a client has

tendencies to binge drink and thus they can assess the individual even further and employ the

next steps of the intervention if necessary.

This paper was very closely tied with the public health course in general and definitely

opened my eyes to community nursing. It is relevant to my future nursing career because I hope

to work within the Pinellas County. It’s an area I’ve lived in for a very long time, but this paper

helped me to look at the county in a new light – from a health perspective. It also showed me

how interventions in the community level can prevent complications down the road that could

lead individuals to the hospital. I wasn’t too surprised at first seeing that alcohol related statistics

were higher in Pinellas county compared to the state. The certain parts of the county have a

drinking/party ambiance with the university campus in downtown St. Petersburg and the fact that

the county has tons of beaches; both areas have several bars and pubs. I think this is something to

keep in mind as I work in the community. This course and paper also taught me that nurses can

even influence legislation. This has inspired me to take on activism type roles once I am a nurse

and be a voice of change for my community.

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References

Centers for Disease Control. (2018). Smoking & tobacco use fast facts. Retrieved from

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index

County Health Rankings & Roadmaps. (2017). Pinellas County demographics. Retrieved from

http://www.countyhealthrankings.org/app/florida/2017/rankings/pinellas/county/factors/o

verall/snapshot

Environmental Defense Fund. (2019). Health impacts of air pollution. Retrieved from

https://www.edf.org/health/health-impacts-air-pollution

Florida Department of Health. (2016). Adults who engage in heavy or binge drinking. Retrieved

from: http://www.flhealthcharts.com/charts/Brfss/DataViewer.aspx?bid=10

National Institute on Drug Abuse. (2018). Community reinforcement approach plus vouchers

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https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-

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Pinellas County Economic Development. (n.d.). Largest target industry employers. Retrieved

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Savage, C.L. (2016). Public health science and nursing practice: Caring for populations [E-

reader version].
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Thomas, R.E., Lorenzetti, D., & Spragins, W. (2011) Mentoring adolescents to prevent drug and

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