Running head: OKEECHOBEE COUNTY CONTRIBUTES 1

Okeechobee County Contributes to a Rise in Teen Birth Rates

Taylor Brown

University of South Florida

OKEECHOBEE COUNTY CONTRIBUTES 2

Okeechobee County Contributes to a Rise in Teen Birth Rates

Okeechobee County in Florida is all but landlocked on one side and may seem small in

comparison to others; nonetheless, numerous conclusions about community health and its

disparities can be drawn from its statistical data. Teen birth rates were previously declining for

over a decade before the recent national rise beginning around 2006 (CDC, 2007). This countys

isolated data will allow us to explore the different causes, related factors and develop solutions

by creating new health care policy and interventions towards prevention. Healthcare policy must

be created effectively to target adolescent females at risk for becoming pregnant by improving

sex education, providing easily accessible contraceptives, and providing effective healthcare to

teen mothers and their newborns.

Overview of Okeechobee County

The lower third of Florida contains the county of Okeechobee, named for its southern

border of Lake Okeechobee. According to the United States Census Bureau, the most recent

population estimate for this county was about 40,314 people in the 768.91 square mile area. A

breakdown of the population by gender and age is as follows: 46.4% female gender, 18.3%

elderly (65 years and older), 22.4% adolescents (under 18 years old), and 6.2% children (under 5

years old). These numbers almost identically correlate with the state average except Okeechobee

has about a 4% decrease in females and a 4% increase in the elderly (US Census Bureau, 2016).

This is important to consider when drawing conclusions about a specific county, as it may shed

light on statewide and national health topics.

Of this population, it is estimated that about 32.5% of the county is considered rural. The

most urbanized concentrated area is the town of Okeechobee (County Health, 2017). In the

working force, there is estimated to be about 19,189 people aged 16 and above or 47.6% of the
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population (US Census Bureau, 2016). Three main occupations dominate this workforce with

18.9% in trade, transportation and utilities, 18.6% in education and health services, and 18.1% in

government (Florida Legislature, 2017). Understanding how this county feeds and takes care of

its children and families is vital in making connections between data. Comparing these facts

with the state population can also help determine how the county can be improved.

Comparison of Local vs. State Populations

Different socioeconomic factors can affect the overall wellness of a population. Poverty,

education, minority populations, and healthcare access can indicate the health of a specific

population, especially when compared to Florida as a whole. The US Census Bureaus most

recent estimate of families living below the poverty line in Okeechobee County was 23.2%. This

number may seem healthy for a small, rural county but the average for Florida is a mere 15.7%

(2016). Poverty may limit a familys access to vital health care, medications as well as healthy

food options.

Education is also a fundamental piece of every healthy society. In Okeechobee, only

70.3% of people aged 25 years and older have a high school diploma, whereas Florida State

boosts one of the highest percentages of high school graduates 86.9% (US Census Bureau,

2016). The United States conducted an experiment that compared the correlation between

education and health. The result was simply the greater amount of education received, the

greater your health (Savage, Kub, & Groves, 2016, p. 168).

The US Census Bureau estimates that 87.3% of the entire population is of the white race

(2016). Although Okeechobee County is dominated by the white race, minority health is

important factor in every community setting. Thus, the 23.7% of the population older than 5

years of age that are non-English speaking are especially considered at risk. This is lower than
OKEECHOBEE COUNTY CONTRIBUTES 4

the Florida average of 28.1% (US Census Bureau, 2016). The health of minority populations can

speak to how successful and culturally sensitive the healthcare systems in the area are.

Finally, the health of Okeechobee County is greatly affected by the populations access to

satisfactory healthcare. A primary care provider is often the first bridge between a person and

healthy living. These physicians usually know the extensive history of a specific patient and can

provide an ample amount of health education including health screenings, physicals,

vaccinations, nutrition, exercise, etc. For every 1,960 people in Okeechobee, there is one

primary care provider. The Florida average ratio is 1,380 people per one provider (County

Health, 2017). This population is below average in terms of providing primary care services.

Analysis and Interpretation of Data

Identified Strengths

The amount of violent crime, or lack there of, is a strength in Okeechobee County. The

County Health Organization estimates that there are 421 reported crimes for every 100,000

people, while Florida sits at 500 (2017). Safety is a top concern of any community population,

without safety, health cannot even be determined.

An additional strength is the amount of sexually transmitted infections reported and

treated in Okeechobee. For every 100,000 people, 333.1 infections were reported in

Okeechobee, but 430.6 in Florida (County Health, 2017). Sexual health can affect many aspects

of a persons wellness, including their mental health and interpersonal relationships.

The last strength noted in this county may seem like a small win, but the health of

newborns is detrimental to continue a functional population. The percentage of newborns with

low birth weights was reported as 8% and 9% in Okeechobee county and Florida, respectively

(County Health, 2017). A healthy start is a great determinant of the future.

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Identified Weaknesses

Smoking tobacco is detrimental to health, and is in fact a priority goal for Healthy People

2020. The goal is to reduce the percentage of adults who smoke down to 12% by the year 2020

(Office of Disease, 2015). This is important to consider when 31.6% of adults in Okeechobee

use tobacco, compared to 16.8% average in Florida (Department of Health, 2015).

An additional weakness is the amount of children eligible for free or reduced cost of

lunch. In Okeechobee, it is a 75% of children, almost a quarter increase from Floridas average

of 58% (County Health, 2017). This statistic not only speaks to poverty levels, but also to the

nutritional status and availability to children in Okeechobee.

Finally, Okeechobee County contributes to the rising rates of teen births in Florida and

the United States. The amount of births per 1,000 females, aged 15 to 19 years old, is double in

this county in comparison to state averages: 63 in Okeechobee and 31 in Florida as a whole

(County Health, 2017).

Identification of a Priority Health Issue

Identifying and solving community health problems start at the community level, and in

this case, the county level. The rate of teen births is a priority issue when you consider that the

World Health Organization (WHO) recognizes that pregnancy and complications during birth are

the second leading cause of death in adolescent women (2014). Teen births not only emotionally

and financially straining for the individual, but is even associated with an increased chance of

obesity later in life (Chang, Choi, Richardson & Davis, 2013). Obesity is a risk factor for many

other disease processes, and these teens may already be predisposed to other risk factors before

becoming pregnant. If a teen is obese before becoming pregnant, her risk of preeclampsia and

eclampsia increase with the teens BMI (Aliyu, Luke, Kristensen, Alio, & Salihu, 2010), this
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puts both the mother and their fetus at risk for complications. This problem could be addressed

in many different influential forms, including sex education and contraceptive options to avoid

pregnancy, and encouraging healthy diet and exercise options to obese adolescent women. Since

Okeechobee County has one of the highest rates, if improvement can be reached here, Florida

and the United States can achieve a lower rate of teen pregnancy.

Discussion and Application of Community Health Models

Community health is one of the greatest insights into the health of our citizens because if

the community is flourishing, the people are flourishing. Healthy People 2020 strive to provide

resources to advance society towards greater health: they develop realistic, specific goals for the

country in many topics. In order for the country to reach these goals, it begins in smaller

communities, like Okeechobee County. The Determinants of Health Model provides a list of the

five categories that go into determining a societies health. By defining the parts of the system

that need to be addressed, the community is able to establish specific interventions to reach their

goals (Healthy People, 2017). Although biological factors cannot be changed after birth, puberty

and fertility are two recognizable contributors to a pregnancy. One study of Native American,

black and white women showed some difference perceptions of what it means to become a teen

mother. This study concluded that Native American placed high value on fertility and fulfilling

the feminine role of a nurturing mother. Black women found early pregnancy undesirable but

were not negatively affected by peers within their culture. Lastly, it was highly undesirable for

white women to become pregnant as a teenager (Horn, 2014). An environmental factor is what

is placed upon individual simply because of where they are. In Okeechobee County this may be

a rural setting, poverty-stricken family, or lack of available education, all related to the facts

listed above. Lifestyle factors are one of the biggest influences in teen pregnancy. Different
OKEECHOBEE COUNTY CONTRIBUTES 7

religions may influence the perception of teen pregnancy. Catholics, for example, are specifically

strict on premarital sex and having a child before marriage is considered a sin. Additional

lifestyle choices may be earlier sexual activity or the decision to get an abortion. Lastly, the

health care system can influence teen birth rates. Sexual education, the availability of

contraceptive options, and screening options for sexually active teens are some of these

determining factors.

Population Diagnosis

Adolescent girls aged 15 to 19 years old in Okeechobee County are at risk for teen

pregnancy due to earlier sexual activity, non-availability of contraceptives, failed sexual

education and/or being born into a rural or poverty-ailed home.

Community/Population-based Interventions

Primary Level of Prevention

Education is a great way to promote health and prevent disease, or in this case prevent

teen pregnancy. Since adolescent girls aged 15-19 is our target for this education, it could easily

be formatted to fit into a high school health class. Since Okeechobees teen birth rate is double

of that in the state, it is apparent that current sexual education is not working. Currently,

government education is focused on an abstinence-based approach only, and in fact, under

federal funding these education programs cannot even teach students about contraceptive

options. A study on the effectiveness of abstinence-only based teaching programs was shown to

actually increase teen pregnancy (Stangler & Hall, 2011). In order to provide communities

useful sexual education and therefore lower teen birth rates, education representatives must

collaborate with healthcare professionals. Since the current failing programs are already

federally funded, communities just need to lobby the school boards for evidence-based education
OKEECHOBEE COUNTY CONTRIBUTES 8

programs that seek to promote safe sex. These education programs would simply consist of

improving the current course of action in sexual education and perhaps utilizing resources that

are already in community members hands like the school nurse. School nurses already know

the population of a specific school and could provide simple education, like the use of condoms

or oral contraceptives. This would benefit the teens themselves, as well as their families, peers,

and the school board of education. The school board would greatly benefit from more students

graduating on time and receiving their diploma, increasing their school funding and associated

resources in the community.

Secondary Level of Prevention

Secondary levels of prevention include encouraging adolescent girls, who are

biologically capable of getting pregnant, to use their knowledge of contraceptives effectively and

detecting pregnancy as soon as possible. If the teen is not pregnant, healthcare professionals in

the community can continue to encourage safe sex as well as screen for possible sexually-related

illnesses, such as STIs, in sexually active adolescents. These providers can also reach out to

schools or other places where teens gather to further inform them the effects of teen pregnancy

on an individual. The community should allocate money to develop programs where teens can

learn about safe sex and ask questions. If the teen is pregnant, than prenatal care should begin

immediately to promote to wellness of the fetus. Healthcare providers should be held

accountable to provide screening programs to sexually active teens. If teen births can be reduced

or if pregnant adolescents have all the best treatment options, the community will benefit in that

it has saved on the healthcare costs while promoting the health of a newborn baby. This is

especially important to consider when taxpayers paid at least $9.4 billion in healthcare costs for

teen pregnancy in 2010 (Teen Pregnancy, 2017). A community health nurse can be a vital
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member in developing screening programs for pregnancy and providing prenatal and/or

education on correct contraceptive use.

Tertiary Level of Prevention

Tertiary levels of prevention benefit the entire community. These interventions help

create a better future by providing all options for pregnant teens, whether that includes abortion,

adoption programs or just beginning prenatal education. The goals here is dealing with the effect

of their pregnancy and avoiding future teen pregnancies. Healthcare officials are responsible for

providing the best care they can and supporting a patients right to autonomy. Community

members also have a civil duty to care for the children in their community. Health insurance will

also become a major part of the pregnant teen and their unborn childs lives as they receive the

health care they need. Hospital funding must be allocated to supporting teen mothers and

providing their babies with the best opportunity for a healthy future. Community health nurses

will be a key part of a teens access to healthcare. These nurses must support a teen mothers

choice, assess their emotional reaction to the pregnancy, remind them of prenatal care routine,

perform newborn assessments and encourage compliance with monthly checkups (Meeting the

Needs, 2009).

Development of Health Policy

Health policy is a result of advocacy for better lifestyles choices that are carried out in

communities. The purpose is to address a specific area needing improvement while formulating

goals, targeting specific populations and advocating these changes to policy makers and

influential stakeholders of the problem. In Okeechobee County, teen pregnancy and birth rates

must be addressed before these women become pregnant, or by a primary intervention.

Education is best way to empower an individual to make better health care decisions. Since
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teenage adolescents aged 15-19 are more than likely enrolled in high school, providing education

at school about sexual health is the best way to reach this population. By reframing these

teachings to have realistic objectives, the already allocated resources will be expended

effectively. The goal is to improve the teen birth rate by improving current sex education in

public schools.

Stakeholders of a public policy on sexual education would include community members,

legislators, health care providers and funding sources. Firstly, community members can and will

support a better sexual education program because of the financial burden of early pregnancy and

its effects on these young womens education level. A 2013 study founded that as a result of

teen birth, these teens completed an estimated 0.7-1.9 fewer years of education (Kane, Morgan,

Harris, & Guilkey, 2013). Since Okeechobee already has 15% fewer high school graduates than

at the state level, keeping adolescent women in school is a priority (US Census Bureau, 2016).

Every community strives to have educated individuals that can contribute to society. Legislators

will also be affected by a change in sexual education policy. The supporters of evidence-based

teachings can advocate for a health care policy bill such as this one, whereas supporters of

abstinence-only teachings will most likely refute a new sex education plan. Therefore, the

evidence concluding that abstinence-based teaching actually increases teen pregnancy needs to

be presented to these legislators (Stangler & Hall, 2011). Health care providers can provide the

evidence for a new sexual health teaching plan as well as take fundamental roles in teaching

adolescents. Lastly, since sex education is already federally funded, the community would

simply have to allocate these resources more effectively in teaching that has shown to improve

knowledge and lower teen birth rates. Moreover, Okeechobee County would be receiving better
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education, targeting all populations, both the rural and urban teens as well as those living in

poverty.

To begin advocating for better, more effective sexual education, Okeechobee County

must initiate advocacy to people who have a significant influence in the state government or the

federal government. The first step would be drawing attention to the issue of teen birth rates, by

perhaps using social media, television media, and getting the facts and statistics into the eyes of

stakeholders for the issue. Using lobbyists or gathering groups of the communities individuals

to travel to local government areas of legislation, will begin shinning a light on the problem of

teen birth rates. These advocates must clearly and respectfully inform legislators of the issue, its

effects on the community, and provide solutions that are attainable and specific.

Okeechobee County would greatly benefit from an enhanced sexual education teachings

in public schools. This new education would reach the rural population as they attend school as

well as improve the health of adolescent teens that are biologically capable of becoming

pregnant. The social stigmas that affect women who become pregnant at a young age can effect

every aspect of their lives physically, mentally, emotionally and the lives of their children.

The entire community would benefit from a lower teen birth rate. The number of educated

individuals would increase, the number of people living in poverty would decrease as less

children are financially straining, and Okeechobee County will approach the goals set out by

Healthy People 2020 for better community health.

Conclusion

Teen births are financially, physically, emotionally and mentally straining not only for

the individual, but for the entire community. It is also a problem that is harder to fix after the

initial pregnancy, as there are many options to move forward with; this is why primary
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interventions are the strongest foundation of creating change. This change has to be adapted to

fit the needs and resources available in Okeechobee, including how to target the different

populations. Just like any other county, Okeechobee both excels and struggles in many different

aspects. By developing health care policy that targets the specific population affected by teen

pregnancy, it can empower the individuals to make better health care-related decisions now and

in the future.

As a student nurse, I can easily see the impact of having a child at a young age. Its hard

for me to say that if I had become pregnant in my adolescent years, that I would be where I am

today - fulfilling my dream in becoming a Registered Nurse. Speaking as a young woman

myself, I believe the greatest impact on these young teens is the emotional trauma associated

with becoming pregnant. They not only face bullying in school and other social settings, but

may even become the center of religious persecution by the ample amount of people who do not

support pre-marital sex. This paper has allowed me to take a glance into the life of a pregnant

teen in any community setting. It has better prepared me for delivering sexual education as well

as providing interventions appropriately.

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