UF nursing researchers to study Florida’s public health role in STD control and prevention
Florida’s public health officials are worried.
Sexually transmitted diseases remain one of the most preventable yet highly prevalent types of disease in Florida, but the state-run STD clinics, which provide low-cost diagnosis and treatment services, are seeing fewer patients. What’s more, Duval County has the highest rate of adolescent STD reinfections in Florida.
In order to determine problems associated with diagnosis and reinfection of STDs in Florida, University of Florida nurse researchers are conducting two studies examining the behaviors, attitudes and motivations of selected Florida community members relative to STDs. The studies are funded by a $160,000 contract grant from the Florida Department of Health’s State Bureau of STD Prevention and Control.
According to the State Bureau’s 2001 report, the number of cases of infectious STDs detected in Florida clinics has declined over the last five years, while the number of cases overall has remained constant. In the first study, researchers will work in Broward, Duval, St. Lucie and Palm Beach counties to gauge people’s perceptions of the communities’ STD clinics.
“It’s a big concern because we do not know where these people are going to be treated or if they are even being treated at all,” said Sharleen Simpson, Ph.D., A.R.N.P., director of the studies and an associate professor at the UF College of Nursing. “We can’t assume that all of these patients are going to the private sector for care, where oftentimes it is more expensive and requires medical insurance, which patients may not possess.”
According to a 2000 report from the Centers for Disease Control and Prevention, more than 65 million people were living with an incurable STD, and 15 million new STD cases are discovered each year, one-fourth of which are contracted by teenagers. However, STDs are one of the most underrecognized health problems in the country today, Simpson said.
While common, STDs are difficult to track. First, most can be “silent,” causing no noticeable symptoms, leaving testing as the only means of diagnosis. Unfortunately, routine screenings are not widely available. Social stigma and lack of public awareness concerning STDs often inhibit frank discussions between health-care providers and patients about disease risk and the need for testing. Therefore, most STDs go undiagnosed, and those that are diagnosed frequently are not reported and counted, Simpson said.
Simpson and co-investigator Kay Hood, a doctoral student at the UF College of Nursing, in conjunction with Karla Schmitt, Ph.D., M.P.H., A.R.N.P., chief of the Florida State Bureau of STD Prevention and Control, will attempt to address attitudes and behaviors of different groups within four communities in Broward, Duval, St. Lucie and Palm Beach counties. They will conduct in-depth interviews and focus groups, in addition to collecting existing information such as census data and health records, to assess why people are not visiting state-run STD clinics and if they are obtaining treatment elsewhere.
“We want to interact with a variety of people in the community, including clinical patients and staff, community and educational leaders, and community citizens,” Simpson said. “We have to reach beyond the boundaries of these clinics to see who is not visiting them and why. The principal goal is to make sure that patients are being seen and adequately treated.”
During 2000, STD reinfections in Duval County adolescents accounted for 20 percent of adolescent male reinfections and 12.5 percent of adolescent female reinfections in Florida. Although prior research has focused on the demographics of reinfected STD clients, there is little information on the underlying individual, relationship or societal factors that may contribute to subsequent infections and even less information on the potential contributory socioeconomic factors. The researchers’ second study will be a collaboration with the State Bureau of STD Prevention and Control and the CDC. Working with investigators from both of these institutions, Simpson and her team will try to address these research gaps.
Simpson and Cheryl McGhan, another UF nursing doctoral student, will conduct in-depth interviews with adolescent males and females between the ages of 14 and 19 who attend the Duval County Health Department STD Clinic and have been reinfected with chlamydia or gonorrhea within the previous 12 months. The study will attempt to uncover the behaviors that lead to repeated STD infections in adolescents. The long-term goal is to develop more effective ways to intervene with this population.
Information gained from both studies will be used to evaluate current services and to assist in planning for improved access and provision of care. Results are expected in 2003.