Community Assessment of Chlamydia

Running head: COMMUNITY ASSESSMENT OF CHLAMYDIA 1
Community Assessment of Chlamydia Among 15-24 Year Olds in Kent County Michigan
Tina Bombe, Kimberly Cox, Angela Ekema,
M. Susan Nason, Rachael Seiter, and Mark Witteveen
Ferris State University

COMMUNITY ASSESSMENT OF CHLAMYDIA 2
Abstract
Chlamydia infections could be considered a national epidemic. By far the ages most affected by
this health problem are 15 to 24 years olds. People infected with chlamydia may remain
asymptomatic, which increases the risk of spreading the infection as well as decreases the chance
of seeking medical screening and treatment. Risk factors identified with chlamydia include
unprotected sex, education deficit regarding STDs, and lack of affordable and private healthcare.
In Michigan, Kent County ranks third in the state for chlamydial infection rates, only behind
Wayne County and Oakland County respectively and has seen a rise in infection rates since
1994. Without intervention, these numbers could continue to rise to epidemic numbers.
Considering the health problems that untreated chlamydia can cause and the fact that it is easily
treated with a course of antibiotics, it is a noticeable problem to tackle with community nursing
interventions. Education based upon the Health Belief Model about prevention, condom use
tutorials, increasing access to healthcare and antibiotics, and education about the lack of
symptoms and the long-term health problems associated with infection are necessary to solve
this problem for the community of Kent County.

Community Assessment of Chlamydia Among 15-24 Year Olds in Kent County Michigan
Chlamydia poses a serious threat to public health in the United States. An estimated 2.8
million Americans are infected with chlamydia trachomatis each year making this infection a
silent epidemic (Centers for Disease Control, Morbidity and Mortality Report, 2009). Chlamydia
is insidious because those infected with it are often asymptomatic and inadvertently spread the
infection to their sexual partners placing people who have unprotected sex at greater risk for
contracting this sexually transmitted disease (STD). Recent studies have shown an alarming
increase in the incidence of chlamydia among 15-24 year old residents of Kent County,
Michigan. According to the statistical information obtained in the Epi Focus 2010 report from
the Kent County Health Department (2011), there were 3,225 cases of chlamydia reported to
KCHD [Kent County Health Department] in 2010 data from 2010 reveal that 72% of cases in
Kent County were between the ages of 15 and 24 years and 88% of cases were under the age of
30 (p. 5). The risk factors directly associated with chlamydia include unprotected sex, lack of
education related to STDs, and a lack of adequate health coverage and therefore access to
affordable care. Fortunately, all of these risk factors are preventable.
The Centers for Disease Control and Prevention (CDC) (2011) has identified several
health problems associated with chlamydia infection including infertility, ectopic pregnancy,
pelvic inflammatory disease, and cervical cancer. In order to reduce the incidence of chlamydia,
community interventions such as; STD education including proper condom use, STD screenings
in areas where infection rates are high, and free or low cost treatment options need to be
implemented in Kent County to improve the overall health of the community. These
interventions can be directly measured through statistical information from the Kent County
Health Department and the CDC or they can be indirectly measured by surveying the community
after the interventions have been implemented.
Problem Statement
Risk of chlamydia trachomatis and sequelae among 15-24 year old people in urban Kent
County regions related to:
a. lack of adequate access to free and private healthcare
b. lack of education about chlamydia prevention/screening/lack of symptoms
c. knowledge deficit regarding chlamydia-related long-term health problems
as demonstrated in
1. Kent County Health Departments reported prevalence of chlamydia
trachomatis in 15-24 year old people as compared to the reported national and
state prevalence data.
Data
According to statistical information provided by the Michigan Department of Community
Health, (see Appendix A) there were 3,225 cases of chlamydia reported in 2010 in Kent County.
The highest incidence of chlamydia was reported in the 15-19 and 20-24 age brackets, with
1,049 cases being in the 15-19 year age bracket. Among this age group, there were 245 males
and 804 females. This creates a female/male ratio of 3.3 (see Appendix A). In the 20-24 year old
age bracket, there were a reported 1,265 cases, and of those, 390 were male and 874 were female
which is a female/male ratio was 2.2 (see Appendix A). To get a better understanding of how
important it is to intervene in Kent County, it is necessary to compare local data to state and
national data.
Local Data Compared to Benchmarks
Chlamydia is the most frequently reported bacterial sexually transmitted disease in the
United States. In 2010 1,307,893 chlamydial infections were reported to the Centers for Disease
Control and Prevention (CDC) from the 50 states and the District of Columbia. Under-reporting
is substantial because most people with chlamydia are not aware of their infections and do not
seek testing (CDC, 2012, para. 2). National data points out the severity of the problem in Kent
County. According to the CDC (2011), Michigan ranked 10
th
in reported cases per rank of
100,000 in population in the United States for the year 2010 (see Appendix C) making this an
important health problem for intervention.
In 2010, the Michigan Department of Community Health reported 50,430 cases of
chlamydia trachomatis in the State of Michigan (see Appendix B). In 2010, Kent County ranked
third in Michigan for reported cases of chlamydia (see Appendix E), and considering that many
cases go untreated and therefore unreported, Kent County has a highly vulnerable population. At
6.4 percent of distribution in the state of Michigan, Kent County was only beaten by Wayne
County with 43.7 percent, and Oakland County with 7.3 percent (see Appendix E).
Unfortunately, there has been an increase in the reportable cases of chlamydia in Kent County,
on average from the year 2002-2011 there has been a steady growth of 95.6 cases per year (see
Appendix D), making this a health disparity that needs interventions aimed at specific risk
factors and vulnerable populations.
Health Belief Model
There are a variety of models that can be used to motivate people within a community to
change their behavior. The health belief model (HBM) was selected to describe, explain, or
predict prevention health behaviors (Harkness & DeMarco, 2012, p.76) and to determine the
best way to motivate the citizens of Kent County to change their behavior regarding the increase
incidence of chlamydia. The health belief model uses cues as an important way to remind
people of healthy behaviors and to promote these actions (Harkness & DeMarco, 2012, p.77).
The HBM attempts to explain and predict health behaviors based on four components 1) severity
of potential illness, 2) perceived susceptibility, 3) benefits of preventative action, and 4)
understanding barriers toward the goal of taking action of health promotion (Harkness &
DeMarco, 2012). When applying the HBM as it relates to the increased incidence in chlamydia,
the public health nurse (PHN) needs to determine 1) the opinion of 15-24 year olds contracting
Chlamydia, 2) their opinion of how serious a condition it is and the consequences associated with
the infection, 3) the benefits associated with the reduction of chlamydia, and 4) identify the
barriers associated with the reduction of incidence of chlamydia. The PHN also needs to identify
the cues needed to remind young adults of the benefits of STD prevention as well as to promote
the actions needed to reduce chlamydia. These cues can be accomplished through primary and
secondary prevention.
The primary prevention measures that can be used before the infection is present would
be the use of abstinence, increased and appropriate condom use, and programs aimed to prevent
chlamydia. According to the CDC (1993):
Behavioral changes that reduce the risk of acquiring or transmitting infection
should be promoted (e.g., delaying age at first intercourse, decreasing the
number of sex partners, partner selection, and the use of barrier contraception
{condoms}). Efforts to effect behavioral changes are not specific to chlamydia
prevention but are also critical components in preventing sexual transmission of
the human immunodeficiency virus (HIV) and other sexually transmitted
diseases (STDs). Identify and treat persons with genital chlamydial infection
before they infect their sex partners, and for pregnant women before they infect
their babies. Efforts to detect chlamydial infection are essential to chlamydia
prevention. Identifying and treating chlamydial infections require active
screening and referral of sex partners of infected persons, since infections among
women and men are usually asymptomatic. (n.p.)
Secondary prevention is a planned effort to minimize the impact of disease and injury
once it is realized (Harkness & DeMarco, 2012, p.72). Such strategies would include
screenings, promotion of health care seeking behaviors, and treatment of both partners
once the infection has been recognized. When nurses engage in education, it is important
to fully understand what groups they are teaching and what risk factors are important to
assess for and then act to decrease.
Risk Factors and Identified Groups
The CDC has identified several risk factors associated with chlamydia infection.
According to the CDC (2010), risk factors include: adolescent, new or multiple sex partners,
history of STD, presence of another STD, oral contraceptive user, and lack of barrier
contraception (CDC, Epidemiology, para.1). In addition to acknowledging the risk factors for
chlamydia, it is important to note that there are several identified groups that have a higher
incidence of the STD. The KCHD Epi Focus Report (2010) states:
In 2010, the rate of reported chlamydia infection in Kent County African
Americans was 1,728 per 100,000 compared to 150 per 100,000 in Caucasians.
A gender disparity was also apparent among cases of chlamydia (727 per
100,000 in females vs. 338 per 100,000 in males). Due to the fact that up to 70%
of sexually active women with chlamydia infections are asymptomatic, many
infections go unreported and these numbers likely underestimate the true burden
of chlamydia in Kent County. (p. 5)
In 2010, the Michigan Department of Community Health reported 50,430 cases of
chlamydia trachomatis in the State of Michigan (see Appendix B); of those 20,320 were
identified in the 15-19 year old age group and 18,068 were identified in the 20-24 year old age
bracket. With the data showing high numbers in the 15-24 year old age group as well as the
racial and gender disparities, interventions must be tailored to ensure proper coverage.
Resources
The Kent County Health Department has addressed this problem in its clinic mapping
project (2005) which outlines a medical shortage area in which there is a less than proportionate
number of clinics per resident (see Appendix F). They also surveyed Kent County residents
utilizing the Healthy People initiatives as a reference point and report the findings periodically.
In their 2008 report, they addressed the problems of limited healthcare coverage and access to
healthcare, both of which contribute to the increase in chlamydia rates.
The Kent County Health Department offers a Reducing the Risk program that is a 16-
session research-based curriculum about the prevention of STDs, but anyone wishing to take this
course must come to the health department, something many young people may not be willing to
do or do not have transportation to the health department in order to participate. The health
department also has a public fact sheet (see Appendix G) that is easy to read and hand out to
vulnerable populations. The Kent County Health Department has one location located in Grand
Rapids for counseling, screening, treatment, retesting, and referrals. They also have limited open
hours and only take appointments on certain days. The health department cannot tackle this
community health problem alone; they need help in order to decrease the growing numbers of
chlamydia infections in Kent County.
Adequacy of Resources
Planned Parenthood is a nationwide organization that has come into Kent County to
promote and ensure sexual health (Planned Parenthood, 2012). There are two locations in Kent
County to assist with screening, treatment, retesting, and referrals. Part of the reason chlamydia
continues to be a problem in Kent County is because people ages 15 -24 lack adequate healthcare
coverage and access to healthcare providers. If a person does not have healthcare coverage, they
are referred to either Planned Parenthood or the Kent County Health Department. With a limited
number of sites and potential transportation issues, people are not getting the necessary
assessment, screening, and education to prevent the transmission of chlamydia. Kent County has
adequate resources available to educate on safe sex habits, transmission, long-term health effects
of an untreated infection, and where to get screenings and treatment (see Appendix G). However,
Kent County lacks the funds and the staff to distribute these resources, which is why chlamydia
continues to be a problem in Kent County. The nursing shortage could play a role in this health
problem. In 2002, the U.S. Department of Health and Human Services, Health Resources and
Services Administration (HRSA) projected that there would be a 1.7 percent yearly increase in
the demand for registered nurses and a 29 percent shortage in the national supply of registered
nurses by 2020 (The Michigan Center for Nursing, 2009, p. 3).
Kent County Underperformances
Kent County has many resources available to assist the community but they are limited
by their ability to reach the vulnerable populations. They have a need for more medical clinics in
the metropolitan area (see Appendix F). Because of this shortage, many high-risk Kent County
residents must use the public busing system to get to healthcare (often nights and weekends due
to their school hours) and clinics may be closed. There is also a need for increased STD
prevention education for adolescents in the area, and no staff is currently dedicated solely to this
cause in the urban area. Schools need a nursing presence in order to educate adolescents about
STD prevention. These educators need to find the youth of the area and search out teaching
opportunities as well as to be available for screenings and treatment.
Community Nursing Interventions
According to the Healthy People 2020 website, as stated in their sexually transmitted
disease topics and objectives, their goal is to, Promote healthy sexual behaviors, strengthen
community capacity, and increase access to quality services to prevent sexually transmitted
diseases (STDs) and their complications. In their weekly grand rounds regarding chlamydia
prevention, the CDC (2011), states that their goal is to increase awareness among adolescents
and young adults, to normalize conversations about STD prevention, and to promote sexual
health and STD testing. According to the CDC (2011), the direct medical costs for the treatment
of chlamydia infections and their associated infertility are estimated to be $701 million annually.
With these staggering monetary statistics, and the human toll associated with this infection, it is
imperative that nurses intervene.
A key component necessary with this community intervention is education. Education is
a common theme throughout this community assessment document. According to Harkness and
Demarco (2012) a key role for a public health nurse is that of an educator. We are to, develop a
health education plan and teach clients and other caregivers and to role model those behaviors
to be learned (Harkness & DeMarco, 2012, p. 10). Considering the health problems that
untreated chlamydia can cause and the fact that it is easily treated with a course of antibiotics, it
is a perfect problem to tackle with community nursing interventions.
Disciplines
Patrick Lencioni of the Four Disciplines of Organizational Health states an organization
is healthy when its whole, consistent and complete, when its management, operations, strategy
and culture fit together and make sense. Health practices need a multidisciplinary group of
professionals to collaborate in preventing, assessing, and treating the community. Demographics,
education level, income, and social life are all important determinants of health to recognize
while assessing a community health problem.
Collaborative Approach
In order to solve this community health problem, many people from different disciplines
have to be involved. An influx of money will be necessary to hire and maintain the clinicians to
adequately staff the clinics where the education, testing, and treatment will take place. Medical
personnel are needed to participate in the testing and treatment of residents in high-risk areas
where there are low numbers of medical clinics. Multiple provider levels such as physician,
physician assistant, and nurse practitioner personnel are necessary for the ordering of tests and
antibiotic therapy when appropriate for treatment. Nurses are needed to assess for risk factors,
administer testing, and for their special relationship-focused care. Social workers are necessary
to assist area residents to solve the problems of their daily lives in order to make better decisions
as well as to apply for financial assistance when needed. Volunteers can answer phones, hand out
flyers, visit schools, and stock supplies. The only way to decrease the rates of chlamydia in Kent
County is to apply a multidisciplinary approach to the problem and utilize all available
community resources.
Resources Necessary for Change
The Department of Human Services would be a great asset in the fight against chlamydia.
They could provide financial assistant through programs like Medicaid, MIChild, or Medicare
for any unpaid medical expenses incurred. Another potential partner is The Rapids, which is the
public bus service that provides transportation in Kent County. It offers student discounts and
has specific routes outlined in pamphlets or online for increased access to clinic sites. The Kent
County Health Department would be an integral part of an intervention program as they already
have facilities for clinic sites as well as their education materials and programs on prevention of
sexually transmitted diseases would be important to any future program. It cannot be discounted
that the County Health Department already has a relationship with their community and it should
be used to its greatest advantage. When the County Health Department has helped a family with
one problem, they may be more likely to turn to them again.
Being a large metropolitan area, Kent County has a large pool of resources from which to
pull. An Internet search revealed programs that are already in place in the community that have a
focus of prevention of STDs or sexual education. These area programs would be a great asset to
any community nursing interventions aimed at decreasing chlamydia rates. Reaching out to them
and making alliances would be part of any good plan. These future partners are: Positive Youth
Development, Planned Parenthood, Spectrum Hospital, St. Marys Hospital, Metro Hospital, the
YWCA, Arbor Circle, D.A. Blodgett Services for Children and Families, and the Family
Outreach Center. Community interventions in Kent County will have some barriers to their
success, but if known ahead of time, planning may help to alleviate some of them.
Barriers to Community Nursing Intervention
The first barrier that most programs must overcome when planning a community
intervention is that of monetary resources. It can be very expensive to increase staff, supplies,
extend office hours, make pamphlets, and open new clinic sites. In this time of decreased
government spending, funding is a dilemma that creative grant writing will help to alleviate. We
also hope to have private donors and community partnerships to help carry some of the financial
burden.
Another barrier occurs when patients provide false information such as name, address or
phone number in order to maintain privacy or deter medical costs. Additionally, after a patient
has been diagnosed with chlamydia, they may not finish or even fill their prescription due to
financial hardships. It is also common with this age group to be embarrassed by the fact that
they are even having sex let alone that they may have an STD, and because of this, they may be
reluctant to speak to medical professionals. Due to the young age of our target group, they may
not be able to afford or know how to use condoms appropriately.
Because of age or financial constraints, the lack of transportation or knowledge of bus
services in Kent County to get to appointments could be another strong barrier. Privacy is a big
issue with this age group. Many young adults are afraid to go to their primary care physician for
STD screening because they fear that their medical information will be shared with their parents.
Perhaps the most dangerous barrier to intervention is that the person may have no signs or
symptoms of disease and believe they do not have it, or that it could not happen to them. This
belief system is common in young people and nursing education should acknowledge it.
Conclusion
The number of new cases of chlamydia in Kent County has consistently increased since
1994, with the rate of new cases among the teen and young adult populations significantly higher
than the rate for all of the other age groups. As of 1999, 74% of new cases of chlamydia in Kent
County were in 15-24 year old residents (see Appendix D). Without intervention, these numbers
could continue to rise to epidemic numbers. Considering the health problems that untreated
chlamydia can cause and the fact that it is easily treated with a course of antibiotics, it is a perfect
problem to tackle with community nursing interventions. Education based upon the Health Belief
Model regarding prevention, condom use tutorials, increasing access to healthcare and
antibiotics, and education about the lack of symptoms and long-term health problems associated
with the infection are necessary to solve this problem for the community of Kent County,
Michigan.

References
Access Kent County. (2012). Department of Human Services, The Rapids, Health Department.
Retrieved September 26, 2012 from
www.accessKent.com/CourtsandLawEnforcement/CollaborativePartnership/
Centers for Disease Control and Prevention. (2012). Chlamydia - CDC fact sheet. Retrieved on
September 18, 2012 from http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm
Centers for Disease Control and Prevention (2010). Chlamydia - CDC fact sheet. Retrieved
September 18, 2012 from http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm
Centers for Disease Control and Prevention. (2010). Epidemiology. Retrieved from
http://www2a.cdc.gov/stdtraining/self-study/chlamydia/chlamydia2.asp
Centers for Disease Control and Prevention. (2009). Chlamydia screening among sexually active
young female enrollees of health plansUnited States, 20002007. Morbidity and
Mortality Weekly Report, 58, 362365.
Centers for Disease Control and Prevention. (1993). Recommendations for the prevention and
management of Chlamydia trachomatis infections. Morbidity and Mortality Weekly
Report, 42, Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/00021622.htm
Harkness, G., & DeMarco, R. (2012). Community and public health nursing: evidence for
practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Kent County Health Department. (2011). Epi Focus 2010. Retrieved September 18, 2012 from
http://www.accesskent.com/Health/HealthDepartment/CD_Epid/pdfs/2011/EpiFocus201
0.pdf
Lencioni, Patrick. (2012). Four Disciplines of Organizational Health. Retrieved September 26,
2012 from
www.leadershipnow.com/leadingblog/2012/03/the_four_disciplines_of_organi_html
Morbidity and Mortality Weekly Report. (2011). CDC grand rounds: chlamydia prevention:
challenges and strategies for reducing disease burden and sequelae. CDC Publication.
Vol. 60, No. 12.
Planned Parenthood at a Glance. (2012). Planned Parenthood. Retrieved October 3, 2012
from http://www.plannedparenthood.org/west-northern-michigan/about-us-37248.htm
Sexually Transmitted Diseases. (n.d.). Retrieved October 1, 2012 from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=37
The Michigan Center for Nursing. (2009). A Profile of Michigans Nursing Workforce 2009.
Retrieved October 7, 2012 from
http://www.michigancenterfornursing.org/mimages/mi_nurse_profile09.pdf

Appendix A

Source: Michigan Sexually Transmitted Diseases Database, Sexually Transmitted Disease
Section, Division of HIV/AIDS-STD, Michigan Department of Community Health;
Table prepared by the Division for Vital Records and Health Statistics, Michigan
Department of Community Health.

Appendix B


Appendix C

Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention

Appendix D


Appendix E


Appendix F
Community clinics in the greater Grand Rapids area. The medical shortage area is outlined in
green.

Appendix G

Community Assessment of Chlamydia

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Community Assessment of Chlamydia

Uploaded by

Copyright:

Available Formats

Running head: COMMUNITY ASSESSMENT OF CHLAMYDIA 1

You might also like