Академический Документы
Профессиональный Документы
Культура Документы
Health Policy: Infant Mortality Among Pinellas County African American Population
Brooke Fortner
Health Policy: Infant Mortality Among Pinellas County African American Population
Infant mortality is defined as death within the first year of life. The causes of these deaths
include birth defects, preterm birth, maternal pregnancy complications, Sudden Infant Death
Syndrome (SIDS), and injuries (Centers for Disease Control and Prevention [CDC], 2016). With
this information, health policies can be created to decrease infant mortality rates, beginning in
Pinellas County is located on the western coast of Florida. This county encompasses a
span of 280-square miles that became its own county, separate from Hillsborough County, in
1912 (Pinellas County Florida, 2016). The estimated county population for 2015 was 949,827
(United States Census Bureau [USCB], 2016). With a population of over 50,000, Pinellas
County is classified as an urban area (United States Census Bureau [USCB], 2015). Pinellas
employing 3,500 people; Home Shopping Network and Bright House Networks complete the list
of this countys top three employers with 2,800 and 2,000 employees, respectively (Pinellas
County Economic Development, 2016). Major health systems in this county include Bayfront
Health, BayCare throughout various Morton Plant Hospitals in the county, and the Adventist
Health System including Florida Hospital locations (BayCare Health System, 2017; Bayfront
Data for the years 2010 to 2014 indicated that the percentage of families below the
poverty level in Pinellas County was 9.7 (Florida Health, 2015). This was less than the state
percentage of 12.2 (Florida Health, 2015). Compared to Floridas overall percentage of 86.9, the
INFANT MORTALITY 3
percentage of persons 25 years of age and older that have a high school diploma in Pinellas
County is 90.0% (USCB, 2016). In Pinellas County, 5.3% of the population ages five and older
do not speak English well, which is lower than Floridas percentage of 11.7 (Florida Health,
2015). According to the County Health Rankings (2016), 22% of persons under the age of 65 in
Pinellas County were uninsured in the year 2016 versus Floridas uninsured percentage of 24
(County Health Rankings, 2016). In Pinellas County, the ratio of primary care physicians to
population showed that for every 1,120 persons, there was one primary care physician (County
Health Rankings, 2016). This reflects more primary care physicians available to the population
in this county than overall in Florida, as the states ratio is 1,390:1 (County Health Rankings,
2016).
Identified Strengths
Three strengths in the health of Pinellas County include: 57.1% ages 50 and older
received sigmoidoscopy or colonoscopy in the last five years, 7.2% of adults currently have
asthma, and 79.2% of those with diabetes had a yearly eye exam completed (Florida Health,
2015). These are strengths of the county as the numbers reported for each of these are more
favorable than the averages in Florida. Overall in Florida, only 55.3% of adults ages 50 and older
received a sigmoidoscopy or colonoscopy in the past five years, 8.3% of adults currently have
asthma, and only 69.7% of those living with diabetes had an annual eye exam (Florida Health,
2015).
Identified Weaknesses
Three weaknesses in the health of Pinellas County include health behaviors and
outcomes. In Pinellas, 51.6% of women ages 40 to 74 received a mammogram in the past year;
INFANT MORTALITY 4
for every 1,000 black members of the population, 218.0 have heart disease; for every 1,000
births among the black population, there are 12.8 infant deaths (Florida Health, 2015). These are
weaknesses of the county as the numbers reported for each of these are less favorable than the
in the past year, the heart disease rate among the black population was 164.7, and only 6.1 infant
Healthy People 2020 selected infant death as a high-priority health issue, setting a target
of reducing the baseline 6.7 infant deaths to 6.0 infant deaths per 1,000 live births (Office of
Disease Prevention and Health Promotion [ODPHP], 2014c). Healthy People 2020 determined
that in 2009 the African American population had 2.8 times more infant deaths than the
population with the lowest rates (ODPHP, 2014b). In 2013, the African American population
still had 2.7 times more infant deaths than the group with the lowest rates (ODPHP, 2014b).
Therefore, the African American population continued to have more than double the risk of
The five leading causes of infant death, in order by rank, among African Americans are:
disorders related to preterm gestation and low birth weight, congenital and chromosomal
abnormalities, maternal complications, Sudden Infant Death Syndrome (SIDS), and accidents
(Mathews, MacDorman, & Thoma, 2015). Preterm birth occurs when delivery occurs prior to 37
weeks gestation. This is a major contributor to infant mortality and although efforts have been
made to decrease the rate of preterm births in the United States, there was an increase from
13.23% in 2014 to 13.39% in 2015 among the non-Hispanic black population (Hamilton, Martin,
& Osterman, 2016). In Pinellas County, between the years of 2013 and 2015, 12.5% of births
INFANT MORTALITY 5
among the black population were under 2500 grams, or low birth weight (Florida Health, 2015).
During this same time period, there were 27 documented cases of infant deaths from congenital
and chromosomal abnormalities (Florida Health, 2015). In Pinellas County, there have been zero
infant deaths due to SIDS since 2009 (Florida Health, 2015). Accidental causes of death include
unintentional injury from suffocation and strangulation in bed; from 2013 to 2015, there were 20
deaths due to these types of accidents in Pinellas County (Florida Health, 2015).
A weakness which health policy could target for positive outcomes is the increased infant
mortality among the black population in Pinellas County due to preterm births and low birth
weight as this was the major cause of death to those less than one year old. As previously
mentioned, for every 1,000 births among this population, there are 12.8 infant deaths (Florida
Health, 2015). This is not only higher than the average infant death rate in Florida, but also
higher than both white and Hispanic races. For every 1,000 births among each population, there
were only five infant deaths among the white population and 7.3 in the Hispanic population
(Florida Health, 2015). Therefore, differences in factors that cause this increased rate among the
The Social Determinants of Health model is a framework of five key social factors and
physical conditions that affect health and quality of life (Savage, Kub, & Groves, 2016; ODPHP,
2014a). These five determinants include economic stability, education, health and health care,
social and community context, and the neighborhood and built environment (Savage et al.,
2016). Examples of these determinants include: availability of resources, access to health care
services, transportation options, public safety, social attitudes and support, socioeconomic
conditions, and literacy (ODPHP, 2014d). This model is useful in identifying how various
INFANT MORTALITY 6
environments and settings influence health outcomes and risks, which can then be used to
develop health policies and interventions that target the social conditions to improve health
In applying the Social Determinants of Health model to Pinellas County where African
Americans are a minority, there are various social factors and physical conditions that influence
infant mortality outcomes and risks among African American mothers. This population of
Rosenthal et al. (2015), in black women who experienced discrimination, there was an increase
Tanner (2012) stated that anxiety during pregnancy was associated with shorter gestation while
exposure to racism and symptoms of depression were associated with infants low in birth weight.
(Giurgescu, 2017). A systematic review by Nowak and Giurgescu (2017) suggested that a poor-
quality neighborhood is related to negative birth outcomes due to increased stress and symptoms
of depression. Among women without postsecondary education, those who reported living in
the various racial demographics of Pinellas County should be noted. The areas with the largest
percentages of African Americans include south Saint Petersburg, east Tarpon Springs, and north
Greenwood (Florida Health, 2012). These locations are also considered to be three of the five at-
risk communities who face barriers to health care due to economic, cultural, or linguistic factors
(Florida Health, 2012). The other two locations within Pinellas County include central
INFANT MORTALITY 7
Clearwater and Largo (Florida Health, 2012). Within these five communities, the Pinellas
County Economic Impact of Poverty report found that there were not only higher unemployment
rates, but also that the number of births to teenage females was double the average rate (Florida
Health, 2012). During the time period from 2013 to 2015, for every 1,000 females there were
42.4 births to mothers ages 15 to 19 in Pinellas County (Florida Health, 2015). In comparison,
this was more than double the rate of births to white mothers in the same age group, whose rate
was 15.2 (Florida Health, 2015). Births to teenage females are associated with a greater risk of
complications (Florida Health, 2012). A lack of access to care is also evident in the statistics of
prenatal care use in the black population. In Pinellas County, 69.8% of births to African
American females had prenatal care begun in the first trimester of pregnancy (versus 82.3% in
births to white females), while 6.7% of births had late or no prenatal care (versus 4% in births to
Population Diagnosis
African Americans in Pinellas County are at risk for increased infant mortality due to
Primary prevention to reduce infant mortality aims to prevent death by preventing illness.
vaccinations at the individual level. Infants less than six months old are most at risk for
include pneumonia, apnea, and death, which can be prevented by administering the diphtheria,
tetanus, and acellular pertussis (DTaP) vaccine (Wisner, 2017). Vaccinations should be given to
INFANT MORTALITY 8
all mothers during pregnancy (Wisner, 2017). Females vaccinated during pregnancy develop
antibodies that cross the placenta and provide passive immunity to the infant until they can
receive the first DTaP vaccination at two months of age (Barber, Muscoplat, & Fedorowicz,
2017). By vaccinating mothers as part of routine prenatal care, this can decrease the risk of
infants dying from pertussis within the first few months of life. Stakeholders toward whom the
intervention is geared include community members who will come in contact with the infant,
county officials who oversee implementation of government funding of vaccinations, and health
care providers who will administer the vaccinations. Funding will occur through private
insurance and government-funded programs such as Medicaid and Medicare. The community
health nurses role in this intervention is two-fold: adequate patient education on the importance
of the vaccine as well as the vaccination schedule and administration of the vaccine to the
patients.
Secondary prevention to reduce infant mortality aims to prevent death by screening for
based on the Baby Behavioral Educational Enhancement of Pregnancy (Baby BEEP) study that
provided support to low-income, pregnant women through weekly telephone conversations that
may screen for infant mortality risk factors (Evans & Bullock, 2017). Stakeholders toward
whom the intervention is geared include community members who utilize the intervention,
county officials who oversee implementation of government funding of the intervention, hospital
administrators who collaborate in sponsoring the intervention, and health care providers engaged
in the telephone conversation. Funding will occur through private insurance and government-
funded programs such as Medicaid and Medicare, and through hospital systems that sponsor the
INFANT MORTALITY 9
use of the program in exchange for referrals to their health services when needed. The
community health nurses role in this intervention is to conduct the telephone intervention to
build rapport and trust with the patient, provide counseling, and perform risk assessments.
Tertiary prevention to reduce infant mortality aims to prevent death in those at high risk
of death within the first year of life. An example of an intervention at this level would be
providing training to individuals, specifically Neonatal Intensive Care Unit (NICU) patients
caregivers, prior to discharge. This hospital-based program would provide caregivers with
hands-on training in cardiopulmonary resuscitation (CPR) in the event that an emergency occurs
at home (Murray & Joseph, 2016). Continuing practices performed at Nemours Alfred I. duPont
Hospital for Children, the training will be tailored to the caregivers needs and teach-back
methods will be utilized (Murray & Joseph, 2016). Stakeholders toward whom the intervention
sponsoring the intervention, American Heart Association instructors, and health care providers
engaged in referring caregivers to, and teaching, the CPR program. Funding will occur through
the hospital system that implements this program. The community health nurses role in this
intervention is to provide referrals to this program, complete training through the American
Health policy seeks to create positive goals and outcomes through the health care system
and interventions. The focus of this health policy proposal is to reduce infant mortality among
Pinellas County African Americans by utilizing secondary intervention. This policy proposes the
Pregnancy (Baby BEEP) study that provides support to low-income, pregnant women through
weekly telephone conversations (Evans & Bullock, 2017). The Baby BEEP study delivered
social support to this vulnerable population of women in the midwestern region of the United
States who experience disparities in access to adequate care (Evans & Bullock, 2017). Peplaus
theory of Interpersonal Relations served as the basis for the therapeutic nurse-patient interactions
The telephone conversation would include screening for maternal health factors and
practices that increase infant mortality risk. Signs and symptoms of pregnancy complications,
nutritional deficiencies, and tobacco use will be assessed. In order to reach the five at-risk
and Snapchat applications opened on devices with location services identifying the device is
within five miles of the zip codes of these communities. As the program reaches success and
toward whom the intervention is geared include female community members who utilize the
device application advertisement administrators, and the baccalaureate-prepared nurses who will
engage with patients in the telephone conversation. Funding will occur through private
insurance and government-funded programs such as Medicaid and Medicare, and through
hospital systems that sponsor the use of the program in exchange for referrals by the nurses to
Supporters of this health policy include female community members who utilize the
Additionally, private insurance companies and government-funded programs will support this
policy as it decreases health risk and health care costs. Opposing forces of the health policy
include fiscally conservative community members who believe that this program is an inefficient
The first step toward presenting the health policy is to form a committee in support of the
policy including other nurses and health care providers. The committee will draft a final
proposal to be presented first at city council meetings across Pinellas County. The goal of
presenting at city council meetings is to garner the support of mayors and city managers to create
a stronger momentum to then move forward and seek the support of government funding
agencies and hospital administrators. Local news networks will be contacted in order to create
This health policy addresses the needs of the underserved populations throughout five
specific communities in Pinellas County. Advertisement efforts will focus on these communities
to raise awareness of the programs availability to pregnant women who are most at risk of
lacking access to adequate prenatal care. The policy proposal can enhance this populations
health by providing a relatively less expensive access point to healthcare information. Trained
nurses will provide patients with therapeutic communication and social support. Additionally,
pregnant women will be provided with screenings covering various topics such as intimate
partner violence, depression risk, and maternal health complications. This provides vital health
care to women who may otherwise not have received care. Valuable information on prenatal
complications will be provided to enhance the health of the women during pregnancy.
INFANT MORTALITY 12
Ultimately, this policy proposal will decrease infant mortality rates among the Pinellas County
Conclusion
Infant mortality rates among the African American population remain higher than other
racial groups in Pinellas County and above goals set by Healthy People 2020. Failure to
adequately address this racial disparity through previous interventions creates the need for a
health policy that can serve this population. A telephone intervention program that has the
ability to reach low-income, pregnant women who lack access to other means of health care can
be the difference for infants who otherwise would not survive their first year of life.
As a nurse entering the profession in 2017, the possibilities to make a difference in the
healthcare field are infinite. With a prospective interest in labor and delivery nursing, I can
advocate for a program that would create more positive outcomes for my patients in Pinellas
County. If I choose another field of nursing, this policy may still be relevant as specialty fields
observe the success of this program using telephone access to care and choose to implement
References
Barber, A., Muscoplat, M. H., & Fedorowicz, A. (2017). Coverage with tetanus, diphtheria, and
acellular pertussis vaccine and influenza vaccine among pregnant women- Minnesota,
March 2013- December 2014. Morbidity and Mortality Weekly Report (MMWR), 66(2),
http://www.bayfrontstpete.com/bayfront-health-st-petersburg/hospitals.aspx
BayCare Health System. (2017). Morton plant hospital. Retrieved from https://baycare.org/mph
Centers for Disease Control and Prevention. (2016). Infant mortality. Retrieved from
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
http://www.countyhealthrankings.org/app/florida/2016/rankings/pinellas/county/factors/o
verall/snapshot
Evans, E. C., & Bullock, F. C. (2017). Supporting rural women during pregnancy: Baby beep
doi:10.1097/NMC.0000000000000305
Florida Health. (2012). Pinellas County community health assessment. Retrieved from
http://www.floridahealth.gov/provider-and-partner-resources/community-
partnerships/floridamapp/state-and-community-reports/pinellas-
county/_documents/pinellas-cha.pdf
Florida Health. (2015). County health profile 2015 [Data set]. Retrieved from
http://www.flhealthcharts.com/charts/CountyHealthProfile.aspx?county=52&reportYear=
2015&tn=23
INFANT MORTALITY 14
Florida Hospital North Pinellas. (2017). Careers at north pinellas. Retrieved from
https://www.floridahospital.com/north-pinellas/careers
Giurgescu, C. (2017). Social determinants of maternal health and birth outcomes. MCN, The
doi:10.1097/NMC.0000000000000303
Hamilton, B. E., Martin, J. A., & Osterman, M. (2016). Births: preliminary data for 2015.
https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_03.pdf
Mathews, T. J., MacDorman, M. F., & Thoma, M. E. (2015). Infant mortality statistics from the
2013 period linked birth/infant death data set. National Vital Statistics Reports, 64(9), 1-
Murray, C. H., Joseph, R. A. (2016). Transition from NICU to home: are the parents ready to
doi:10.1891/0730-0832.35.3.151
Nowak, A. L., & Giurgescu, C. (2017). The built environment and birth outcomes: A systematic
doi:10.1097/NMC.0000000000000299
Office of Disease Prevention and Health Promotion. (2014a). Determinants of health. Retrieved
from https://www.healthypeople.gov/2020/about/foundation-health-
measures/Determinants-of-Health
Office of Disease Prevention and Health Promotion. (2014b). Disparities overview by race and
https://www.healthypeople.gov/2020/data/disparities/summary/Chart/4825/3
INFANT MORTALITY 15
Office of Disease Prevention and Health Promotion. (2014c). Maternal, infant, and child health.
infant-and-child-health/objectives
Office of Disease Prevention and Health Promotion. (2014d). Social determinants of health.
determinants-of-health
Pinellas County Economic Development. (2016). Largest target industry employers. Retrieved
from http://pced.site-ym.com/?page=Pinellas_Employers
http://www.pinellascounty.org/about_pinellas.htm
Rosenthal, L., Earnshaw, V. A., Lewis, T. T., Reid, A. E., Lewis, J. B., Stasko, E. C., ... Ickovics,
postpartum: Age differences and consequences for mental health. American Journal of
Savage, C. L., Kub, J. E., & Groves, S. L. (2016). Public health science and nursing practice:
Schetter, D.C., & Tanner, L. (2012). Anxiety, depression, and stress in pregnancy: implications
for mothers, children, research, and practice. Current Opinion in Psychiatry, 25(2), 141-
148. doi:10.1097/YCO.0b013e3283503680
Sealy-Jefferson, S., Giurgescu, C., Helmkamp, L., Misra, D. P., & Osypuk, T. L. (2015).
Perceived physical and social residential environment and preterm delivery in African-
https://doi.org/10.1093/aje/kwv106
INFANT MORTALITY 16
United States Census Bureau. (2015). 2010 Census urban and rural classification and urban
2010.html
United States Census Bureau. (2016). QuickFacts [Data set]. Retrieved from
https://www.census.gov/quickfacts/table/PST045216/12103,12
Wisner, K. (2017). Protecting newborns from pertussis. MCN, The American Journal of