RUNNING HEAD: SARASOTAS SILENT KILLER 1

High Blood Cholesterol: Sarasotas Silent Killer

Tatyana Boytsan

University of South Florida, College of Nursing

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High Blood Cholesterol: Sarasotas Silent Killer

This paper was written to shed light on one of Sarasotas weaknesses, the rising amount

of adults diagnosed with high blood cholesterol. It will take a look at what can be done to

improve the statistics and assist the population. It will expand upon this priority health issue, the

multiple levels of prevention that can be applied, and the development of a health policy that can

assist in decreasing the rate of adults in Sarasota county with high blood cholesterol.

Overview of Sarasota County

Sarasota is a county found in southwest Florida, about 573 square miles in size (Urban

and Rural Setting, 2016). According to the United States Census Bureau, as of the last estimate

in 2015, the population of Sarasota is about 405,550 people (U.S. Census Bureau, 2015). Since a

part of it is on the coast, it is known for its beaches and is a common tourist stop.

Some of that population finds themselves employed by the largest employers in Sarasota

County. The school board of Sarasota county and Sarasota Memorial health care are the top two

largest employers in Sarasota county with Publix, a private employer, trailing closely behind

(Notable Employers in Sarasota County, 2016). As aforementioned, Sarasota Memorial Health

Care is one of the top employers, but is it also the major health care system with different

hospitals, offices, and clinics found throughout the Sarasota area. Much of the population

receives care at these locations, all with different socioeconomic statuses.

Comparison of Local vs State Findings

The percent of families below poverty level in Sarasota county is 8%, as opposed to the

state of Florida which is 11.9%, meaning the poverty rate in the county is lower than that of the

state as a whole (Florida Charts, 2013). When it comes to education, Sarasota comes out ahead

once again. The percent of the population over the age of 25 years old that has at least a high
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school diploma is a little over 90, where as the state percentage sits at 86 (Sarasota County

Government, 2012). The percent of the population over the age of five in the county that does

not speak English well is 5%, where as the population of the state that doesnt speak English well

is 11.7%. (Florida Charts, 2013). The amount of health care providers and facilities available to

Sarasota county is above the state average across the board (Florida Charts, 2014).

Analysis and Interpretation of Data

In this section, the population of Sarasota county will be explored in more depth. The

strengths and weaknesses will not only be compared among the two, but evaluated and the

statistics will be interpreted. The strengths and weaknesses, or needs, will be taken from the

county health profile, Florida Charts.

Identified Strengths

When it comes to comparing the county of Sarasota to the state of Florida that it is in, a

few things stand out. One of them is the amount of reported STD and AIDS cases. When it

comes to reported STD (including the total gonorrhea, chlamydia, infectious syphilis) and AIDS

cases, the rate is lower across the board in the county compared to the state. An example of this

is that the rate of AIDS cases is about 30% less in Sarasota compared to the state of Florida as a

whole (Florida Charts, 2013). Although poverty is still a fight being fought everywhere, luckily

Sarasotas strengths is the poverty rate. In the county the rate of both individuals and families

below poverty level is less than the rate of poverty in both individuals and families in the state

(Florida Charts). And yet another one is the rate of death from diabetes. The rate has always

been and is still currently lower in Sarasota than the rate of diabetes related deaths in Florida

(Florida Charts, n.d.).

Identified Weakness
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As there is always something to improve upon, Sarasota unfortunately is not doing better

than Florida in all things. One weakness that Sarasota has is the amount of current smokers. That

rate has been decreasing from 22.6 in 2007 to 18.4 in 2013 in the county; however, even with

that decrease the county has still consistently been above the state average within the span of

those seven years (Florida Charts, n.d.). In relation to smoking, there is also the consumption of

alcohol which is another weakness of Sarasota county. Although 2002 through 2007 statistically

shows that Sarasota county had a lower rate of adults who engage in heavy or binge drinking

compared to the state percentages, 2010-2013 shows a rising trend of adult binge drinkers in

Sarasota county, now above the Florida state average (Florida Charts, n.d.).

Now turning away from behavioral risk factors and toward medical risk factors; one

weakness of Sarasota compared to Florida is the rate of high blood cholesterol. Looking at 2002

through 2013, there is a rising rate of adults who have ever been told they have high blood

cholesterol in Sarasota county, and the rate has consistently been above the state. When taking a

deeper look, it is noticeable that in 2002 that percent of adults who have ever been told that they

have high blood cholesterol was 37.8 in Sarasota county, as opposed to the states rate of 35.2

(Florida Charts, 2002). Then in 2013 it is seen that the percent had risen to 44.9 in the county,

and 33.4 in the state. The countys rates have risen, while the states rates have lowered. So

much so, that in 2013 Sarasota county was about 10% above the Florida state average (Florida

Charts, 2013).

Priority Health Issue

While there are a few, one health indicator that is a priority health issue in Sarasota

county is the aforementioned high blood cholesterol. High blood cholesterol increases the risk of

cardiovascular disease (World Heard Federation, 2016). Therefore, an increased rate of high
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blood cholesterol could indicate a possible increase in the rate of cardiovascular disease in that

county. In fact, the percentage of adults who have ever had a heart attack, angina, or coronary

heart disease in Sarasota is about 14%, a little above the 10% of the overall Florida population

(Florida Charts, 2013). This is concerning, considering that death from heart disease is already

the second most common major cause of death in Sarasota county (Florida Charts, 2014).

Impact of Community Health Model

The Determinants-of-Health Model is something that Healthy People 2020 use to help

develop objectives that encourages disease prevention and health promotion (Healthy People

2020, 2016). The range of personal, social, economic, and environmental factors that influence

health status are known as determinants of health (Healthy People 2020, 2016). Using the

model helps develop interventions that are going to be most effective by creating interventions

that affect multiple determinants of the population based health issue.

Like many populations based health issues, the rising rate of high blood cholesterol in

Sarasota is affected by multiple factors. Biological factors, environmental factors, and lifestyle

factors contribute to this priority health issue. To begin, a biological factor that affects high

blood cholesterol is heredity. High blood cholesterol can be inherited; in fact, there is a

condition called familial hypercholesterolemia, which is an inherited genetic disorder that causes

a high level of low density lipoproteins that are difficult for the body to remove (Familial

Hypercholesterolemia Foundation, 2016). On the other hand, environmental factors and lifestyle

factors can contribute to this health issue equally. Being overweight, lacking physical activity,

and consuming a diet high in trans-fatty-acids can affect cholesterol levels (National Heart Blood

and Lung Institute, 2016). In relation to that, an overabundance of fast-food restaurants and
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insufficient amount of healthy food options and gyms could also contribute to the rising rate of

high blood cholesterol in the Sarasota county population.

Population Diagnosis

Adults in Sarasota County are at risk for cardiovascular disease due to the increasing rate

of high blood cholesterol among the population.

Community/Population-based Interventions

In this section, evidence based interventions will be presented using the Levels of

Prevention Model, in the form of primary, secondary, and tertiary levels of preventions. This will

also be done using the Intervention Wheel Model. The Intervention Wheel is population based,

and encompasses community, systems, and the individual (Keller, Lia-Hoagberg, Schaffer, &

Strohschein, 2004).

Primary Level of Prevention

As aforementioned in this paper, lifestyle factors like weight and physical activity affect

blood cholesterol levels. The primary prevention would be risk factor modification through the

use of education to the recipient, the community. The education would consist of understanding

the need to make lifestyle changes, like changing the diet and increasing physical activity, to

decrease high blood cholesterol levels. One specific thing that can be taught in knowing which

fat raise LDL cholesterol and which ones dont, so that patient can make diet modifications

(American Heart Association, 2014). The main stakeholders here would be community

members, as they are going to be the ones educated, and health care providers, as they are going

to be the ones doing the education. The role of the community nurse would be to carry out this

education. While primary care offices and hospitals can do education on lowing blood

cholesterol levels, a broader net may also be cast by creating a program that reaches out to the
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entire community, not just people who are patients already. This would however increase

funding concerns, as it would take more to finance than education in offices or hospitals would.

This would then also involve stakeholders like public officials or legislators because they would

be involved in the creation of a health policy that would need to be created to reach to entire

community.

Secondary Level of Prevention

Almost 80% of the adult population in Sarasota has had their cholesterol checked in the

past two years (Florida Charts, 2013). This means that health care professionals have direct

access to treat 80% of the adults in Sarasota. The recipient here would be an individual, a

patient, and the intervention would be treatment. Sometimes lifestyle modifications alone arent

enough to manage high blood cholesterol and cholesterol-lowering medications, like statins, are

necessary (National Heart, Lung, and Blood Institute, 2016). The interventions would be geared

toward stakeholders like the community as a whole, since anyone can have have high blood

cholesterol. Other stakeholders involved would be healthcare providers like specialists or

pharmacists since they would be the ones providing the treatment. There would not be funding

concerns toward the intervention for health care providers, since this falls under their job

description already, but the individual may have problems being able to afford the care and

medications. The role of the community nurse could be to assist the patient with finding the

right kind of resources to be able to afford the treatment, if the patient cannot afford the

medication. The community nurse could also be involved in providing education about the

medications, for example how the medication works and possible side effects.

Tertiary Level of Prevention

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This level of prevention affects a system-wide recipient. The interventions would relate

to monitoring compliance, monitoring the treatment effects, and preventing further negative

impact on health. This could be done by following up with patients in outpatient centers,

ensuring that the patient understood the education that was given to them and rechecking their

blood cholesterol levels to make sure the treatment, for example medications, is working for

them. A part of the education would be teaching patients that prescribing hypercholesterolemic

medications to achieve treatment goalsand accessing healthcare at least biannually could

improve concurrent risk factor control and coronary heart disease prevention (Egan, Li,

Qanungo, & Wolfman, 2013). Some patients are against the use of medications claiming that

they do not work, and unfortunately there are cases where the blood cholesterol wont get better

without medications. In this case, research may be shown to such patients, that shows that the

proportion of those with medication that successfully treated with cholesterol was significantly

higher than those who took medication that did not control their cholesterol level (Aekplakorn,

Fihn, Hasegawa, Lim, Mokdad, & Roth,2011). The stakeholders here are the community

members who have received the treatment, and the healthcare providers who are treating them.

There is no additional funding concern here. The role of the community nurse would be to call

patients and follow up over the phone, and follow up in outpatient settings. The follow up would

consist of checking blood cholesterol levels, possibly repeating education, and ensuring

medication adherence and compliance to the treatment plan.

Development of Health Policy

The general impact of health policy on health care is that health policy changes health

care, and the health of the population, in a good way. They are created to address the problems
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and provide guidance on how to improve outcomes. Implemented health policies can mean the

difference between a thriving population and a dying one.

The focus of this health policy proposal is on the primary level of prevention. As

aforementioned, education on risk factor modification is the general focus. The proposal would

be that the education be given in high schools, while the teenagers are not yet adults. A good

way to reduce the rate of high blood cholesterol is by ensuring that the teenagers soon entering

the adult population do not increase the rate. Educating high school students on risk factors for

high blood cholesterol, and how to alter their diet and lifestyle can reduce their risk or their

possibly already high blood cholesterol, and this is the goal. This would affect stakeholders like

the community members, the high school students receiving the education, and the health care

providers, who will likely be teaching the education, and those who would create the curriculum.

This will also affect legislators and public officials because they would be involved in the

creation of the policy and backing it up. Funding sources may also likely play a big role,

because of the funding that would be necessary to go into the creation of the curriculum and the

hiring of the educators. More than likely all the stakeholders would support the proposed health

policy, as it affects the students health and the countys health rates. However, some legislators

or public officials may be against it because of the challenge that is posed of how to bring that

education to the schools, passing state mandated exams, and the common challenge of funding.

At the end of the day they would want to know if it is worth it to take away from what other

education the students could have focused on instead during the time of the lesson.

The first step toward presenting the health policy proposal is to have advocates for it.

Advocates that support the policy proposal, and have the statistics to back up why the policy

should be implemented. Another important step would be to create a rough lesson plan for the
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education that would be implemented, so that the legislators know what is going to be taught and

why.

This health policy proposal can impact the Florida county of Sarasota by increasing the

amount of people who are educated on high blood cholesterol and everything that is involved in

it. This includes risk factors, treatments, and what high blood cholesterol can lead to. High

school students are underserved in this aspect, because while they receive a lot of education it is

not always about their personal health. This policy, if efficient, would enhance the population

health in general by decreasing the rate of adults diagnosed with high blood cholesterol and

subsequently possibly decreasing the rate of adults diagnosed with cardiac diseases.

Conclusion

High blood cholesterol is a health issue that affects half of the Sarasota county

population, which means that half of the county also has a high risk of cardiovascular disease.

Biological, lifestyle, and environmental factors affect a patients risk of having high blood

cholesterol but some of them can be reduced through a few lifestyle changes. Education, lifestyle

changes, and treatment with the use of medication can reduce high blood cholesterol. Education

specifically can be done even before the patient becomes an adult. The proposed health policy

touches on that, implying that education on risk factor modification in high schools can reduce

the overall rate of high blood cholesterol and increase the health of teenagers as well.

This paper affects my future in nursing because it is the heart of where I hope to live and

work in the future. Sarasota is a beautiful place, with beautiful people, and I want to make it my

home. And like any home-owner, I want to make sure that the flowers are being watered and the

picket fence has a fresh coat of white paint. What I mean by this is that when I live and work in

Sarasota, I want to take care of the people who have made it their home as well. And
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unfortunately, half of that population has high blood cholesterol. It is something that I know I

will come across often, and likely with a comorbidity. Therefore, I am passionate about reducing

high blood cholesterol, and cardiovascular disease risks, in Sarasota County.

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References

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