1. Nurs 340 – Community Health Nursing Sexually Transmitted Disease: A Problem for Kent County Nursing
Spring 2013
Group Project
Anthony Peltier
William Berlin
Cheryl Veres
Catherine Drzewiecki
Lynn Bingham

2. Sexually Transmitted Disease (STD) in Kent County: Chlamydia, Gonorrhea, & Syphilis
Kent County experiences an elevated incidence of these STDs related to:
Social Factors
Racial and ethnic disparities. African American, Hispanics, and American Indian/Alaska Native populations have elevated rates of STDs compared to whites.
Economic Factors
STDs disproportionately affect poor and disenfranchised people.
Behavioral Factors
High risk behavior, men having sex with men, IV drug use are significant risk factors for STDs.

3. Cost of STDs
The total estimated burden of the nine million new cases of these STDs that occurred among year-olds in 2000 was $6.5 billion.
Not all cost are associated with Chlamydia, Gonorrhea, and/or Syphilis, in fact, HIV and HPV are the two most costly STDs to treat.
Viral STDs accounted for 94% of the total burden ($6.2 billion), and non-viral STDs accounted for 6% of the total burden ($0.4 billion).
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4. Position Statement / Community Problem Diagnosis
Elevated incidence of sexually transmitted disease (STD) in Kent County related to deficient modifiable lifestyle behaviors and ineffective STD education…
As Evidenced By……

5. Chlamydia: Kent County Vs. U.S. Rates

6. 2011 Kent County Statistics: Chlamydia
Kent county data supports an increased risk and incidence in the 15 – 24 year old demographic
Kent county data further supports an increased risk in the female 15 – 24 year old demographic

7. Gonorrhea: Kent County Vs. U.S. Statistics

8. 2011 Kent County Statistics: Gonorrhea
Kent county data supports an increased risk and incidence in the 15 – 24 year old demographic
Kent county data further supports an increased risk in the female 15 – 24 year old demographic

9. Syphilis: Kent County Vs. U.S. rates
In contrast to the rates of syphilis and gonorrhea, Kent County has for the most part had a lower incidence of syphilis than the US. In 2011, the rate was almost 40% lower in Kent County, and over the past ten years, only twice was it higher than the national average, although it has still been significantly higher than the Healthy People 2010 goal.

10. 2011 Kent County Statistics: Syphilis
In this case the data does not support elevated rates in the 15 – 24 year old demographic. The highest rates are observed in the 25 – 44 year old demographic
Also, the data does not support the higher rates in females. Higher rates are seen in males.
As you can see from the chart, syphilis again differs from chlyamida and gonorrhea in that most patients are between the ages of 25 and 44, not Rates were also higher in males than in females, another difference from the other two.

11. Highest Incidence is Seen in Young People (15 – 24) for These STDs
Young people aged 15–24 years acquire nearly half of all new STDs.
Sexually active adolescents aged 15–19 years and young adults aged 20–24 years are at higher risk of acquiring STDs for a combination of behavioral, biological, and cultural reasons.
The higher prevalence may reflect multiple barriers to accessing quality STD prevention services, including lack of health insurance or ability to pay, or a lack of transportation
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Individuals who are between the ages of 15 and 24 are more likely to contract STD’s than any other age group. This is for a number of reasons, including being more likely to engage in high risk behaviors, denial (It won’t happen to me), not having health insurance, money to pay for services, or the ability to get to a health care provider for treatment.

12. Review of the Data Supports
Integration of cultural competence.
Increased funding for free STD testing to all citizens in this demographic.
Public health experts lecturing at High Schools and Community Colleges in Kent County.
Our approach will include:
A review of the data supports our position that an STD outreach campaign focused on testing and education in the 15 – 24 year old demographic would provide the most value in reducing STDs in Kent County.
After reviewing the data, we decided to focus on the year old demographic. This plan will hopefully reduce STD rates in Kent County by increasing the cultural awareness of health dept staff, having presentations at area high schools and community college, and increasing funding for STD testing for people in this demographic.

13. Healthy People 2020: Emerging Issues
There are several emerging issues in STD prevention:
Address system-level barriers to implementation of expedited partner therapy.
Data demographics and behavioral variables are integral to epidemiology and prevention.
Coordinate prevention efforts for leverage of new developments provided by health reform legislation.
Innovative strategies in communication are critical.
> Each State needs to address system-level barriers to the implementation of expedited partner therapy for the treatment of chlamydia and gonorrheal infections.
> Innovative communication strategies are critical for addressing issues of disparities, and normalizing perceptions of sexual health and STD prevention, particularly as they help reduce health disparities
> Enhanced data collection on demographic and behavioral variables, such as the sex of an infected person’s sex partner(s), is essential to understanding the epidemiology of STDs and to guiding prevention efforts.
> It is necessary to coordinate STD prevention efforts with the health care delivery system to leverage new developments provided by health reform legislation.

14. Recommendation of Behavior Counseling for Prevention of STDs
The U.S. Preventative Services Task Force (USPSTF) (2008) recommends high-intensity behavior counseling to prevent sexually transmitted diseases for all sexually active adolescents and for adults at increased risk for STDs.
Importance
Sexually transmitted diseases are still an significant cause of morbidity and mortality in the United States.
Recognition of Behavior
Primary care clinicians and health care teams can identify adolescents and adults who are at an increased risk.
Effectiveness of Counseling
Targets sexually active adolescent and adults at an increased risk and reduces incidence 6 to 12 months after counseling.
Population of non-sexually-active adolescents and adults needs further research in effectiveness.
Evidence of Harm
No significant evidence showing behavioral or biological harm from this counseling.
> Evidence is showing that high-intensity behavior counseling can reduce rates of STDs.
> This is important because, in spite of advances in screening, diagnosis, and treatment of sexually transmitted diseases, they are still a significant cause of morbidity and mortality in the United States.
> There can be recognition of behaviors with behavior counseling. Primary care clinicians and health care teams can identify adolescents and adults who are at an increased risk.
> High-intensity behavior counseling is effective. There is convincing evidence that high-intensity behavioral counseling interventions are able to target sexually active adolescent and adults who are at an increased risk for developing STD’s showing a reducing in incidence 6 to 12 months after counseling.
USPSTF did identify a gap in the literature regarding evidence on behavioral counseling interventions that are directed towards non-sexually-active adolescents and adults not at an increased risk for STD’s, so further research in this area in recommended.
> There is no significant evidence to support resultant behavioral or biological harm from behavioral counseling about risk reduction.

15. Role of Kent County Health Department (KCHD) and Public Health Nurses
Continually assessing the health of the community and ensuring that certain services are available and accessible for its citizens.
Investigating the causes of disease, epidemics, morbidity and mortality, environmental health hazards using vital and health statistics for epidemiological studies. KCHD also plans and implements public education and enforces public health laws.
Assuring the provision of certain core programs in sexually transmitted diseases.
Surveillance: The ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementation, and evaluation of public health practice.
The Kent county health department and public health nurses will play a major role in this project. Efforts will include making sure clients are able to access needed services, determining the causes, as well as other factors and statistics for epidemiological studies, educating clients and helping to implement programs vital to the project’s success. Finally, information collected by the health department will be used to determine the effectiveness of the inititave
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16. CDC STD Prevention Guidelines
The CDC recommends the following strategies to reduce STD risks:
Testing
Condom use
Reduced number of sexual partners
Mutual Monogamy
Vaccination (available for HPV and Hepatitis B)
Abstinence
The CDC recommends these strategies to reduce the rates of STD’s. These include mostly behavior based tactics, such as abstinence, reducing the number of sexual partners and using condoms. Vaccines are available for HPV and Hep B. Testing is a major factor in preventing STDs, as patients can receive treatment before infecting others.

17. Existing Resources - Community Strengths
*Personal Health Services: Clinic offering counseling, testing, treatment, and follow-up testing for Gonorrhea, Chlamydia and Syphilis. Notification of sexual partners.
Surveillance program, published data, interment availability.
*The Healthy Kent 2010 Sexually Transmitted Infection Implementation Team: Focuses on teens and minority populations.
Reducing the Risk: Research- based curriculum targeting ages 14 to 18. Focuses on abstinence or reducing sexual interactions. Promotes use of condoms and contraception.
*Presentations: For youth, parents, teachers, and other audiences. Can be tailored to meet specific populations needs.
Free condoms
Active public health department (KCHD)
> Kent County Health Department is very involved and active in all aspects of STD prevention, detection, and treatment.
> Personal Health Services: Clinic offering no-fee counseling, testing, treatment, and 3 month follow-up testing for Chlamydia, Gonorrhea, and Syphilis. Notification of sexual partners.
> There is a surveillance program that was initiated with published data, and is available via the internet.
> The Healthy Kent 2010 Sexually Transmitted Infection Implementation Team promotes STD prevention in the community focusing on teens and minority populations.
> Reducing the Risk : A sixteen session research- based curriculum geared towards youth 14 to 18. This program focuses on abstaining from or decreasing sexual interactions and promoting the use of condoms and contraception.
> Presentations on communicable diseases: These are available to youth, parents, teachers, and other audiences, and can be delivered in various settings. Presentations can be tailored to meet the needs of specific populations.
> Free condoms are also available.

18. Elevated levels of low income/poverty
Community Barriers
High population of minorities
Inadequate monetary resources
Elevated levels of low income/poverty
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These are some of the barriers that could reduce the effectiveness of our initative. Kent County has a high population of minorities and people of low socioeconomic status, both of which are important social factors in health disparities. Funding could also potentially be an issue.

19. Dorothy E. Johnson’s Behavioral System Model
Johnson’s Behavioral system has broad application in this area of nursing as negative/high risk behavior can be rooted in early environmental interactions. Johnsons model states that:
Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them.
Individual as a behavioral system is composed of seven subsystems: the subsystems of attachment, or the affiliative, dependency, achievement, aggressive, ingestive-eliminative and sexual.
Disturbances in these causes nursing problems
Dorothy Johnson, creator of the behavioral system model, felt that nursing was concernened w/ man as a whole, including physical and social well being and illness.
She believed that humans had two systems-medicine was responsible for the biological system and nursing’s focus is on the behavioral system.
The behavioral system has 7 subsystems that function to protect the individual from noxious influences, promote a nurturing environment and stimulate growth.
Nursing’s role is to assist the client to correct imbalances in subsystems.
Johnsons theory considers the importance of a secure, safe, and consistent, environment while growing up. Disturbances can lead to negative outcomes, one of which could be high risk sexual behaviour, another might be drug abuse.

20. Interventions- Who, What, When, Why, How
Abstinence pledges.
Make condoms available at convenient locations.
Screening, testing, and high-intensity behavior counseling.
Presentation to area high schools and colleges highlighting reduction of high risk behaviors, encouraging safe sex practices.
Risk reduction workshops.
STD prevention endorsements from community figures.
Multimedia campaign aimed at utilizing CDC recommendations by target age group (Facebook, TV, billboards, radio etc.).
> The most successful health communication campaigns utilize a multi-approach. Combing multiple mass media like Facebook, TV, radio, print, and changing community norms through community outreach programs, positively impacts the community.
> Presentations at area high schools and colleges that highlight education of high risk behaviors (like Risk Reduction workshops), encouraging safe sex practices, discussing abstinence pledges, and making condoms available at convenient locations can reduce STD incidence rates.
> Screening, testing, and high-intensity behavior counseling are the current recommendations. STD prevention endorsements from community leaders can inspire and motivate others and provide a public opinion leader to identify with.

21. Interventions There are resources currently in place.
Interventions selected for Kent County have been taken from the CDC and based on similar statistical findings, all recommendations can be tailored to fit the area being served.
CDC estimates that half of all newly diagnosed STDs are among young people ages
There are resources currently in place.
Facilitates a decrease in dollars spent with an increase in community health
Permission needed by KCHD and presentation sites.
> The CDC estimates that half of all newly diagnosed STDs are among young people ages
> Interventions selected for Kent County have been taken from the CDC and based on similar findings, all recommendations can be tailored to fit the area being served.
> Kent County currently has some resources in place to carry out and facilitate implementation of these interventions.
> These interventions would serve community interests by decreasing health care dollars spent on STDs and improving the communities overall health.
> Permission for these interventional programs would be granted by the Kent county Health Department and the sites, agencies, or facilities where it is presented.

22. Outcomes Goals Increase In : Decrease In:
STD screening and testing, abstinence, and safe sex behaviors in year olds.
Knowledge of STDs.
Identification of high risk behaviors.
Decrease In:
STD prevalence in year olds.
Practice of high risk behaviors.
We are hoping that following the implementation of our interventions, the following will occur.
Kent County will see an increase in STD screening, and reported safe sex behaviors, knowledge of STDs and high risk behaviors in the identified demographic.
Kent County will see a decrease in STD prevelance in the target age group and a reduction in reported high risk behaviors.

23. Evaluation Monitoring of STD rates in 15-24 year olds
Survey given before, immediately after, 1, 6 and 12 months after presentation
Assess individual’s knowledge/feelings about STDs, prevention and high risk behaviors
Is the individual applying information to personal life?
How effective was the presentation?
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Using data collected by the health department, we will evaluate the effectiveness of our initative in 2 ways.
1. Monitioring STD rates in the targeted age group
2. A survey will be sent out immeadiately after, 1, 6 and 12 months after presentation to attendees asking the following
- knowledge based questions about STDs, how to prevent them and how to reduce risky behaviors
- is the information that was presented being applied to the client’s personal life?
-Finally, was the presentation able to get the information across in a way that was understandable?

24. References
Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance.
Retrieved from:
Blandfor, J.M., Chesson, H.W., & Gift, T.L. (2004). The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, Perspectives on Sexual and Reproductive Health. 36 (1) Retrieved from
PubMed Health. Chlamydia. Retrieved from:
Centers for Disease Control and Prevention. Program Operations Guidelines for STD prevention: Community and Individual Behavior Change Interventions. Retrieved from:
On behalf of Tony, Cheryl, Lynne and Catherine, I’d like to thank you all for listening and we look forward to hearing your comments.