2. 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

3. 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.

4. Cost of STDs The total estimated burden of the nine million new cases of these STDs that occurred among 15-24-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).

5. 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……

6. Chlamydia: Kent County Vs. U.S. Rates http://wonder.cdc.gov/std-std-race-age.html

7. 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 http://www.accesskent.com/Health/HealthDepartment/Publications/CD_reports_htm/2012/cd1212.html

8. Gonorrhea: Kent County Vs. U.S. Statistics http://wonder.cdc.gov/std-std-race-age.html http://www.accesskent.com/Health/HealthDepartment/Publicati ons/CD_reports_htm/2012/cd1212.html

9. 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 http://www.accesskent.com/Health/HealthDepartment/Publications/CD_reports_htm/2012/cd1212.html

10. Syphilis: Kent County Vs. U.S. rates http://www.accesskent.com/Health/HealthDepartment/Publications/CD_reports _htm/2012/cd1212.html http://wonder.cdc.gov/std-std-race-age.html

11. 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. http://www.accesskent.com/Health/HealthDepartment/Publications/CD_reports_htm/2012 /cd1212.html

12. 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

13. 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.

14. 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. http://www.healthypeople.gov/202 0/topicsobjectives2020/overview. aspx?topicid=37

15. 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. http://www.uspreventiveservicestaskfo rce.org/uspstf08/sti/stirs.htm

16. 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. http://www.accesskent.com/Health/HealthDepartment/ and http://www.accesskent.com/Health/HealthDepartment/

17. 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

18. 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) http://www.accesskent.com/Health/HealthDepartment/Publicatio ns/pdfs/h_cdrep3.pdf

19. Community Barriers High population of minorities Inadequate monetary resources Elevated levels of low income/poverty

20. 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 http://currentnursing.com/nursing_theory/introduction.html

21. 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.). http://www.cdc.gov/std/progr am/community.pdf

22. Interventions 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 15-24. 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.

23. Outcomes Goals : Increase In : STD screening and testing, abstinence, and safe sex behaviors in 15-24 year olds. Knowledge of STDs. Identification of high risk behaviors. Decrease In : STD prevalence in 15-24 year olds. Practice of high risk behaviors.

24. 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?

25. References Centers for Disease Control and Prevention. 2011 Sexually Transmitted Disease Surveillance. Retrieved from: http://www.cdc.gov/std/stats11/adol.htmhttp://www.cdc.gov/std/stats11/adol.htm Blandfor, J.M., Chesson, H.W., & Gift, T.L. (2004). The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, 2000. Perspectives on Sexual and Reproductive Health. 36 (1) Retrieved from http://www.guttmacher.org/pubs/journals/3601104.html PubMed Health. Chlamydia. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002321/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002321/ Centers for Disease Control and Prevention. Program Operations Guidelines for STD prevention: Community and Individual Behavior Change Interventions. Retrieved from: http://www.cdc.gov/std/program/community.pdf http://www.cdc.gov/std/program/community.pdf http://www.cdc.gov/std/prevention/default.htm