Newaygo County

1. Newaygo County STDS Tessa Grewe, Ann Puruleski, GennaGorte, Ashley Snider, Ashley Albrecht, Abi Lee, Michelle Heim

2. Newaygo county has the highest prevalence of gonorrhea and chlamydia in District 10 (since 2005) • Overall rates of gonorrhea and chlamydia have decreased, but are still significant in Newaygo County • The age group that is primarily affected by the cases of gonorrhea and chlamydia are from 15-25 years of age • Health Belief Model: • -Four parts: severity of the potential illness, the level of which the illness can • be contracted, the benefit of preventing this illness, and what factors are • hindering the actions towards health promotion Review of Scholarly Paper

3. Review of Scholarly Paper (cont.) Contributing Factors: -Underutilized resources -Access to care -Patient to physician ratio -Poor quality of care -Lack of education Resources: -Family Planning (birth control, testing, counseling, and education) -WIC (breastfeeding counseling, screening, maternal infant health, immunizations) -STD Control Program (education on STD’s)

4. Problem Statement Who is at risk?: Males and females ages 15-25 in Newaygo County What they are at risk for?: Contracting the sexually transmitted diseases chlamydia and gonorrhea How it is related to certain changeable factors?: Lack of sex education, access to healthcare, Evidence of change that can be measured: Number of reported cases of gonorrhea and chlamydia, future reproductive health complications,

5. Review of the Evidence Relevant to the Proposed Intervention Gonorrhea: (2006-2010) (2011) Newaygo County - 8 cases 5 cases District 10 - 36 cases 30 cases Michigan - 16,256 cases 13,065 cases Chlamydia: (2006-2010) (2011) Newaygo County - 85 cases 89 cases District 10 - 449 cases 542 cases Michigan - 44,935 cases 50,052 cases

6. Interventions • Who? People 15-25 • What? Chlamydia and Gonorrhea • Where? Newaygo County • Why? Highest of any other county's in District #10 • How? Spread by sexual intercourse, oral sex

7. Smart Goals for Newaygo County • Provide teaching of STD’s and HIV to all high school students in Newaygo County by February 2014. • Prevent STD’s and HIV by implementing that all teens will always have access to condoms through out the year by August 1, 2014. • By December of 2014, At least 60 percent of women over the age of 16 will have had a pelvic exam done through a clinic provided by Newaygo County. • Have Screenings be more successful by having at least 2000 teens that have admitted to having sex tested for STD’s by March 30th 2014.

8. Interventions • Best Practices: • Teaching, recommended by the CDC. Students should learn about preventing STDs and HIV • Condoms- to prevent the spread of STD and HIV • Pelvic exams- to check females who may have been exposed • STD testing- since some may not have signs or symptoms, its recommended to get tested.

9. Interventions • Geopolitical: Does not differ, same community but a selected group of people • Differences won’t really influence interventions. Only ones it would influence is 15 year olds who may not be able to get to the clinic.

10. Interventions • EBP: STD testing, medication to treat symptoms

11. Interventions • Local Resources: • Through the Public Health Department in Newaygo, they offer to administer STD testing. These can be covered by Medicaid or on a sliding fee. • Medication can be prescribed to treat the STDs. • PHD wants to prevent the occurrence of these STDs so they offer a lot of help to treat patients who are infected. • Teaching: • This is important, especially for women who are pregnant so that they know they are advised not to give birth vaginally if it is active.

12. Interventions • What might be needed? • An additional resource that would be needed is to possibly have a clinic in the high school or junior high school to help prevent and educate students. Wexford County has this in place, and Newaygo would benefit from implementing this as well.

13. Interventions • This intervention of implementing a school clinic would help those people who are in high school still. It would seem to fit community interests because preventing the spread of STDs is easier to do than treating them once people are infected. This would lead them to gaining further knowledge about STDs and would help prevent further outbreaks. If people are educated at a young age about using protection, they will know the risks they are taking if what can happen if they decide not to use condoms.

14. Interventions • Permission would be needed from the State to provide funding, and support from the community and public health department.

15. What Local Factors are Relevant to the Success of the Proposed Intervention? Factors for Success: • Bringing in more health professionals into the area (physicians, nurses, etc) • Willingness of patients to travel to receive care • Willingness of patients to accept teaching and information about STD’s • Using new programs for teaching such as Get Yourself Tested (GYT) • Increase in support through the community (i.e. schools) • Encouraging prevention with use of updated information, supplies for safe sex, and support

16. What Change Modules are Relevant? Health Belief Model: • Severity of the potential illness • The level of which the illness can be contracted • The benefit of preventing this illness • What factors hindering the actions towards health promotion

17. Evaluation • The desired outcome would be for the cases of STD’s to decrease with in the first year of following the interventions listed above. After five years to see a big change and have more people compliant with screenings and education. • Some interim outcomes that may be important to track are seeing decrease numbers involving STD’s, Seeing a raise in attendance to screenings, and seeing a rise in the number of people getting education early • For this change to happen it would take a good five years to see a dramatic change. The first year we might see a slight change if the population responds well with the interventions. • The PHD does offer screening for STD’s from those screenings they post statistic rates to see what is effective among that age group and community

18. References • CDC Grand Rounds: Chlamydia Prevention: Challenges and Strategies for Reducing Disease Burden and Sequelae. (2011). MMWR: Morbidity & Mortality Weekly Report, 60(12), 370-373. • District Health Department, District 10. (2011). Appendix C-2011 Newaygo Chartbook. • Retrieved from website: http://www.dhd10.org/community-health-needs-assessment • Golden, M., William, H., Whittington, B., Handsfield, H., Hughes, J., Stamm, W., Hogben, M., Clark, A., Malinski, C., Helmers, J., Thomas, K., Holmes, K (2005). Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. The New England Journal of Medicine, 352(7), 675-685. • Haggerty, C., Gottlieb, S., Taylor, B., Low, N., Xu, F., Ness, R (2010). Risk of sequelae after chlamydia trachomatis genital infection in women. The Journal of Infectious Diseases, 201(2), 134-155. • Harkness, G. DeMarco, R. (2012). Community and public health nursing. Philadelphia, PA: Lippincott Williams & Wilkins. • HIV, Other STD, and Pregnancy Prevention Education in Public Secondary Schools - 45 States, 2008-2010. (2012). MMWR: Morbidity & Mortality Weekly Report, 61222-228. • Newaygo County Health Statistics Table. (2012). Sexually transmitted diseases. Retrieved from https://word.office.live.com/wv/WordView.aspx?FBsrc=https%3A%2F%2Fwww.face book.com%2Fdownload%2Ffile_preview.php%3Fid%3D675571759126447%26time %3D1374446405%26metadata&access_token=1263600054%3AAVIjZYHrGwJClc_n B7pnKs3efUvPYxNnTGwPahDKd_0ekQ&title=Analysis+of+Assessment+Findings+- +Newaygo.docx