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Victoria Clayton
The purpose of this paper was to highlight a particular health threat to Pasco County,
Florida. The number of domestic violence cases in Pasco County is significantly higher
compared to the state of Florida. Domestic violence interferes with quality of life and prevents
victims from succeeding and maintaining good health outcomes. Evidence-based interventions
have been put in place, yet health policy needs to be continuously monitored and revised to target
this detrimental issue. The overarching goal of this paper is to provide an overview of the county,
explore strengths and weakness of the county, propose levels of prevention for the given issue
Pasco County, Florida is located just north of Hillsborough County, and considered a part
of the greater Tampa Bay area. It serves as a suburb of the city of Tampa and includes many
residential areas as well as new emergent businesses and agriculture industries. Located on the
coast of the Gulf of Mexico, Pasco Countys largest city is New Port Richey and the county seat
Pasco County is considered diverse in that it has many rural, farming areas, but also has
several major road systems (US Highway 19) and its proximity to Tampa Bay give it a partially
urban name as well. Pasco County is 746.89 square miles in geographic size. Major employers
include management and professional businesses, accounting for 34.9% of employers (2014);
sales and office employment at 24.4%, and service occupations at 19.2%. The largest industries
include educational and health services (23.4%); retail (14.5%); and management,
administration, waste management, scientific and professional department (11.6%). The county
is also full of a multitude of health care systems and resources. Since 15.8% of the population is
DOMESTIC VIOLENCE AS A HEALTH ISSUE 3
uninsured, there are many free clinics, like Good Samaritan Clinic and the Mobile Medical Unit.
There are also low pricing clinics such as Premier Clinic. There are also many larger hospitals
including, Medical Center of Trinity Hospital, Florida Hospital Zephyrhills, Florida Hospital
Wesley Chapel, Bayonet Point, Bay Care Centers and many others. Most of the major hospitals,
Pasco County has a population of 492,513 people (Florida Charts 2015). Several
important factors in understanding the population and socioeconomic factors include poverty
level, education status, and access to health care services. In order to have a full picture of the
status of health in Pasco County, it is important to compare to state benchmarks and then using
that comparison to a healthcare model and the goals of Healthy People 2020.
In Pasco County, 9.9% of families live below the poverty level. In the states of Florida as
a whole, 11.9% of families are considered to be below the poverty level. Living in poverty, for a
family of four is considered making close to $24,000 or less and individually making about
As far as educational status and literacy two important markers are the number of
individuals who have a high school diploma and the percentage of the population who can
proficiently speak English. In Florida, 13.5% of the population aged 25 and older are without a
high school diploma, compared to 12.5% in Pasco County. One staggering difference in
benchmarks in the population that does not speak English very well. Across Florida, 11.7% are
considered to not be proficient in understanding and speaking English, whereas in Pasco County
that number is 4.4%, significantly lower. Language is a large barrier between receiving health
One last benchmark to compare to state findings is the health care services and access.
While Pasco County generally has similar numbers compared to state numbers, the number of
physicians per 100,000 is lower. The number of licensed physicians per 100,000 of the
population in Pasco County is 153.5 versus 259.3 in Florida. There are also significantly less
OBGYNs (4.7 per 100,000 versus 19.1 per 100,000) and pediatricians (7.0 per 100,000 versus
18.7 per 100,000). This puts women and children at risk for not receiving either timely or quality
In the following summary, Pasco Countys strengths and weaknesses will be identified
and discussed. Chosen strengths include the high number of screenings. This is evidenced by the
amount of people that have had cholesterol screenings within the past five years, the amount of
prenatal testing, and the low incidence of breast cancer. Identified weaknesses in Pasco County,
home to 492,513, include many poor lifestyle and behavioral choices. The amount of
hospitalizations, adult smokers, binge drinking and domestic violence are higher than state
averages. The focal point of this discussion will target how domestic violence is a priority health
Identified Strengths
As far as healthy living, health screenings and activity status, many citizens of Pasco County
exceed the state benchmarks. For example, 85% of the population of Pasco County received
cholesterol screenings within the past five years versus 79.9% on a state level. Though a small
difference, it is evident that Pasco County health department and its population value the ideals
DOMESTIC VIOLENCE AS A HEALTH ISSUE 5
of early screening. Unchecked, chronic high cholesterol is one of the leading causes of
Another area of strength in Pasco County is in prenatal testing. Eighty-two per cent of
mothers began prenatal testing during the first trimester in Pasco County versus 79.8% in the
state of Florida. Prenatal testing is critical in reducing infant mortality and complications during
Lastly, new incidence of breast cancer is significantly lower in Pasco County than in the
state as a whole. The new incidence percentage of breast cancer in Pasco County is 66.8% versus
79% in the state of Florida. This could perhaps indicate that women are receiving timely, early
screenings like mammograms (Florida Charts, 2011-2013). Through these strengths, it is evident
that Pasco County is meeting state benchmarks in regards to chronic illnesses and screening and
Identified Weaknesses
While chronic diseases seem well managed from the statistics, many lifestyles and
behavioral factors do not meet state benchmarks. Smoking, heavy/binge drinking and domestic
violence cases are higher in Pasco County than across the states of Florida. For instance, Pasco
County has higher rates of adult smokers with 24% compared to 16% on a state level (Florida
Charts, 2013). Smoking has a vast array of negative impacts on health. From chronic lung
diseases, to the effects of second hand smoke in others, smoking is a huge health indicator and
100,000 people, 955.2 people are hospitalized versus 805.2 in the state of Florida (Florida
DOMESTIC VIOLENCE AS A HEALTH ISSUE 6
Charts, 2012-2014). The amount of hospitalizations is indicative of either how many individuals
The percentage of people who engage in heavy/binge drinking is 18.1% in Pasco County
versus 12.2% in Florida (Florida Charts, 2013). Heavy/binge drinking is largely associated and
linked to mental health issues like addiction and violence in the home. Heavy drinking can lead
to liver failure and a number of other chronic illnesses. Additionally, heavy drinking and
addiction to alcohol can lead to destructive and sometimes violent behaviors. Thus heavy
One last area of weakness to be discussed is in the amount of total domestic violence
cases in Pasco County. The number of total cases in 2015 was 760.2 versus 542.1 in the state of
Florida. Domestic violence encompasses physical, emotional, sexual and verbal abuse across all
age groups. Elder abuse, child abuse and partner abuse all pose detrimental effects on the health
A priority health issue for Pasco County, FL is in the high number of domestic
violence cases. Domestic violence includes willful intimidation, physical abuse, sexual abuse,
emotional abuse, battery and any other form of violent or aggressive control that a perpetrator
exerts on a victim. Though victims can be anyone, they are most often an individuals partner,
child, friend or family member. Domestic violence falls under the Injury and Violence health
indicator category for Healthy People 2020. Injury and violence is a major health indicator that
reveals quality of life in the home. Injury and violence as a health indicators encompass
homicides, suicides, motor vehicle accidents, intentional and unintentional overdoses. Deaths
caused by accidents and violence are among the top 15 killers in the United States, making it a
DOMESTIC VIOLENCE AS A HEALTH ISSUE 7
critical public health issue (Healthy People 2020). According to Johnson-Reid, Kohl and Drake
(2012), there is also a link to significant mental health issues for children that were abused.
Domestic violence is a risk factor for future abusive relationships and even homicide. Reducing
the amount of injury-related deaths and homicides is a significant Healthy People 2020 goal.
Research by Johnson-Reid, Kohl and Drake (2012) found the effects of domestic violence
abuse in children can produce lasting effects. It is found that many children who were abused
often continue the cycle of abuse in their own home. Additionally, mental illnesses, such as
additions, substance abuse, and suicidal tendencies, as well as brain injuries and sexually
transmitted infections are common place amongst children of abuse (Johnson-Reid, Kohl &
Drake, 2012). Domestic violence and abuse decreases quality of life and health for all age
groups. Research and studies are conducted to discover the best way to address family violence
encompassing child abuse, elder abuse and partner abuse (Gear et al., 2012). It is vital to
approach this issue to find ways to reduce the incidence of domestic violence to improve the
Social determinants of health are important to consider when exploring the topic of
domestic violence. Biological factors, environmental factors, lifestyle factors and health care
systems all play a part in why domestic violence occurs, in what settings and how health care is
involved. The World Health Organizations definition of the social determinants of health include
income and social status, education, physical environment, social support networks, genetics,
health services and gender. Factors that are most applicable to domestic violence include income
and social status, education, physical environment, social support networks and gender. Though
DOMESTIC VIOLENCE AS A HEALTH ISSUE 8
domestic abuse is inconsistent across social economic status, domestic abuse and violence is
slightly more prevalent in those of lower economic and educational status. (more) In regards to
social support, it is more common for the perpetrator of abuse to be related to the victim. Thirty
per cent of women have been victimized and abused by an intimidate partner, versus 7% per cent
that have experienced non-intimate partner violence (CDC, 2016). Thus victims of domestic
violence struggle with social support if their once trusted support are the very ones who are
abusive. Lastly, gender and age are additional factors to consider. The elderly population, women
and children are most at risk to domestic violence. One in seven children will experience some
form of domestic violence. Twenty-two per cent of women and sixteen per cent of men will
Population Diagnosis
Women, especially in their teens and early twenties, in Pasco County are at an increased
risk for domestic violence due to their gender and age, physical environments of lower
Community/Population-based Interventions
One-quarter to one-half of women will experience sexual abuse in their lifetime (Rowe,
Jouriles, & McDonald, 2015). The response of the community and health care professionals is
vital in combatting the detrimental effects of all types of domestic violence abuse. Evidence-
based interventions that have been studied and implemented include screening tools, follow-up
A primary level of prevention to reduce the incidence of IPV and domestic violence
amongst adolescent and college aged women includes education and prevention programs. These
DOMESTIC VIOLENCE AS A HEALTH ISSUE 9
can be implemented in high schools, colleges, and other extra-curricular activities. These
programs are intended to increase awareness, empower women and connect them to resources.
Often, the target focus for this population is to first reduce victimization. Young women who
were victims of intimate partner violence are at risk for being recurrently victimized. Programs
that have been shown to be most effective are risk-reduction programs that discuss detailed ways
for young women to identify threatening situation and offers strategies for self-protection rather
than merely raising awareness. Stakeholders that would be involved include community
members, teachers, health care providers, and other educational and social services. The role of
the community health nurse includes providing resources to young women that are high school
interpersonal violence and other types of domestic violence are applicable for social services,
health care providers, educators, and many other public relations jobs. Additionally, educators
and health care providers specifically can report suspected cases and provide resources for
treatment. Stakeholders include health care providers, educators, case managers, and social
services. Legislators may also be involved with the legal aspect of implementing screening and
reporting tools in schools and in hospitals. Funding concerns would be at the referral level and
follow-up with patients and students that are victims. Lastly, community health nurse may be
responsible for identifying victims, utilizing screening tools and making referrals and follow-up
After abuse has been screened and reported, a tertiary level of prevention includes
support groups, counseling and domestic violence shelters. These level aims to help victims deal
with the traumatic event of the abuse, prevent further negative impact on health physically and
mentally. Keeping victims in programs such as support groups or shelters helps monitor victims
to prevent them from returning to perpetrators or move them into a safer environment. Funding
sources and concerns include funding domestic violence shelters and making treatment for these
victims affordable. It is imperative that community health nurses are prepared with resources for
Health policies include making legal regulations or mandates to address issues that often
require action. Health policies most of the time lead to the development of programs, which are
policies put into motion. Policies and programs are established to target issues and ensure that
action is being taken to either recognize an issue before it occurs, or take the proper steps into
treatment and ensuring it does not occur again. The topic of domestic violence, more particularly
subject with which to enforce health policy. A primary level of prevention program should be
implemented to reduce the incidence of interpersonal violence cases in Pasco County. One policy
that should be incorporated is a domestic violence prevention educational course offered or even
required for adolescent and college-aged men and women. Implementing a required educational
course of real life examples, risk factors, self-assessment and resources on domestic violence for
adolescents and young adults in Pasco County will be the focus of this health policy. This
education course would be required for any school, institution or university and would provide
insight into risk factors, self-assessments, and resources. The main stakeholders affected by this
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11
proposed policy would be educational leaders and health care providers. Any healthcare provider,
social service or educational member would be in support of this proposal, knowing the huge
burden domestic violence has on society. Opposing members may be any state organization who
would deem the funding for such a project to be difficult (World Health Organization, 2006).
The implementation of this health policy would be greatly beneficial to Pasco County, Fl.
Especially if the policy is implemented in health care and school settings, the program would
bring awareness to not only those most at risk, but others in the community as well. If successful,
the policy would empower both men and women to take ownership of their actions, recognize
Conclusion
Overall, the focus of this paper is to bring attention to a significant weakness in Pasco
County regarding the incidence of domestic violence. Primary, secondary and tertiary levels of
prevention has been explored to further reduce the incidence. Lastly, a proposed health policy
plan was explored to target the overarching issue of interpersonal violence amongst adolescents
This topic significantly impacts my nursing career. The first day I started my community
health clinical rotation, my first patient was a 21 year old female who was a victim of domestic
violence. She had a broken arm from her perpetrator and a bruised face. She was not empowered,
she was insecure and she stayed with a man who had all of the warning signs. Recognizing
victims of domestic violence, and recognizing those who are at risk for being in situations of
provider I have the right to help victims and potential victims report the violence. I also have the
ability to refer patients to valuable resources to help provide treatment and safety for them.
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Domestic violence is a significant health burden and hinders many individuals from obtaining
References
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Centers for Disease Control and Prevention. (2016). Intimate partner violence. Retrieved from
http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/index.html
Gear, C., Koziol-McLain, J., Wilson, D., Rae, N., Samuel, H., Clark, F., & McNeill, E. (2012).
Jonson-Reid, M., Kohl, P., & Drake, B. (2012). Child and adult outcomes of chronic child
Rowe, L. S., Jouriles, E. N., & McDonald, R. (2015). Reducing sexual victimization among
United States Census Bureau. (n.d.) Retrieved October 19, 2016 from
http://www.census.gov/quickfacts/table/PST045215/12101