Running head: LUNG CANCER DEATHS 1

Lung Cancer Deaths In Brevard County

Marc-Allen Dy

University of South Florida

LUNG CANCER DEATHS 2

Lung Cancer Deaths in Brevard County

In the recent years, the United States has been battling with one of the most dangerous

cancers: lung cancer. In the year 2016, it was estimated that almost 30 percent of people would

die from lung cancer (American Lung Association, 2016). The high mortality rate is due to the

bleak prognosis rates. Early stage lung cancer has an approximate 50% 5-year survival rate,

while end stage can be lower than 5% (Mayo Clinic Staff, 2014). Brevard County was chosen

due to the consistent annual rates of lung cancer deaths. Although other counties have had high

rates of lung cancer deaths, the statistics fluctuate and in some years it is below the state average.

However, in Brevard County lung cancer deaths continue to follow an upward trend (Florida

Health Charts, 2015d).

Overview of Brevard County

Brevard County is a boot-shaped county that is approximately 1000 square miles in size

and is located on the eastern peninsula of Florida (United States Census Bureau, 2015b). On the

east lies the Atlantic Sea, while Orange and Osceola County are located to the west. On the

northern border lies Volusia County, and underneath is Indian River County (Cole, 2017).

Notable landmarks include the Kennedy Space Center, which is located northeast of the county

on Merritt Island.

Based on the U.S., Brevard County is considered an urban county. (Florida Department

of Health, n.d.). The total population in Brevard County is approximately 540,000 people

(Suburban Stats, 2017). The population mainly consists of Caucasian individuals, which account

for 83.7% of the county’s population. Minorities in the county include Black or African

American at 10.7%, Hispanic at 9.7%, Asian at 3.0%, and Native American at 0.5% (United

States Census Bureau, 2015a). The number one employer in Brevard County is the Brevard
LUNG CANCER DEATHS 3

County School Board. This board contains almost 9000 employees, which is considered the

largest company with the most employees. In addition to the education board, Eastern Florida

State College and the Florida Institute of Technology are major contributors to employment.

Major healthcare systems found in Brevard County include Health First, Health Management

Associates, and Parrish Medical Center (Curri, 2016).

Comparison of Local vs. State Populations

On average, families in Brevard County are not below the poverty level. In 2015, the

percentage of the population in Brevard County below the poverty line was 14%, while the state

average was 16.7% (Florida Health Charts, 2015c). Although Brevard County may be lower

than the state average, it was slightly above the national average of 13.5% (Center for Poverty

Research, 2016).

The previous statistic may be due to the education level of the population. According to

the Bureau of Labor Statistics, unemployment rates are higher and weekly earnings are lower

without a high school degree or equivalent (Bureau of Labor Statistics, 2016). In the year 2015,

the percentage of adults in Brevard County older than 25 with a high school degree was 53.1%.

The county’s percentage is slightly higher than the state rate which was approximately 51%

(Statistical Atlas, 2015).

The preceding statistics could be influenced by high number of English speakers and a

low percentage of those who do not. According to statistics from 2015, the percentage of people

in the county over the age 5 who do not speak English well only equated to 3.3%. This percent

was much lower than the state average, which was at 11.7%. According to statistics, the trend

has consistently stayed lower than the state rate. (Florida Health Charts, 2015c).
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All of the previous factors influence healthcare making decisions. Individuals who are

below the poverty line, speak little to no English, and make meager wages are less likely to

obtain adequate healthcare (Calvo & Hawkins, 2015). Although healthcare services are

abundant in Brevard County, the statistics demonstrate that accessibility is limited. In 2016, the

average rate was for accessing healthcare services in Brevard County was 37.4%, while the

national rate was 35%. Although patients reported difficulty accessing healthcare, they reported

an easier time finding a primary physician. According to data from 2016, the county rate was

12.1%, while the national rate was 8.7%. (Professional Research Consultants, 2016).

Analysis and Interpretation of Data

Identified Strengths

As described in the previous paragraphs, Brevard County has many strengths and

weaknesses. Additional strengths found in the county include a decreased rate of adults

diagnosed with diabetes, decreased teen births, and a decreased number of AIDS cases.

A strength found in Brevard County is the decreased number of individuals diagnosed

with diabetes in the ages of 45 to 64. The rate in Brevard County in 2013 was 10.7, while the

rate in Florida was 11.6 (Florida Health Charts, 2013b). Possible contributions could be due to

decreased obesity, sufficient moderate activity and adequate consumption of daily fruits and

vegetables. All three of these factors combined reduces the risk of developing diabetes type 2

(Asif, 2014). The rate in 2013 for obesity was 25.7, while the state rate was 30.3. In terms of

weekly moderate activity, the rate was 46.5 and Florida’s rate was 35.7. Furthermore, the rate in

2013 for Brevard County for adequate fruit and vegetable consumption was 16.8, as opposed to

the rate in Florida which was 17.5 (Florida Health Charts, 2013a). Although Brevard County has
LUNG CANCER DEATHS 5

not exceeded for Florida for every contribution, improvements can still be made to further reduce

the deaths from diabetes.

Another strength found in Brevard County are decreased teen births from the age ranges

of 15 to 19. The rate for teen births in 2015 from this range age was 19.2, as opposed to Florida

which had a rate of 20.3 (Florida Health Charts, 2015b). Contributing factors may include an

overall decrease of teen births in the country and implemented interventions in the county to

decrease teen pregnancy. According to CNN, in the last 5 years teen pregnancy in this age group

has decreased significantly in the U.S. In 2013, the rate decreased by 8% and in the subsequent

year by 9% (Storrs, 2016). Additionally, Brevard County has implemented a clinic to prevent

teenage pregnancies in response to the Teenage Pregnancy Reduction Program instituted by

Florida. This clinic decreases teen pregnancy by educating teens about contraceptives while also

giving them the resources to pursue protected sex (Heshmati, 2015). Both factors contribute to

the decreased teen pregnancy rates in this age group. In order to support the downward trend,

additional interventions must be made to further decrease the rates.

Furthermore, Brevard County has a strength many other counties do not have. As

opposed to other counties, Brevard County has decreased AIDS rates in the age groups of 50-59.

According to statistics from 2013, individuals in this age group accounted for more than a

quarter of AIDS cases in the U.S (Center for Disease Control and Prevention, 2017a). The rate

in Brevard County was 7.5, while the rate in Florida was 17.5. Possible factors related to the

decrease include lower transmission rates between injection drug users, heterosexual individuals,

and homosexual or bisexual males. According to previous statistics, decreased rates have been

found in all groups, and HIV rates in the U.S. have dropped almost 20 percent in a span of six

years (Center for Disease Control, 2017b). Additionally, interventions have been implemented
LUNG CANCER DEATHS 6

in Brevard County to reduce the transmission of AIDS. The county has a Risk Reduction

program that provides free testing, confidential counseling, and additional resources for anyone

who may have AIDS (Florida Health Brevard County, 2017). If further interventions are made,

Brevard County may be able to meet the to meet the Healthy People 2020 goal rate of 3.5 (Office

of Disease Prevention and Promotion 2017c).

Identified Weaknesses

On the contrary, weaknesses of Brevard County include increased salmonellosis cases,

suicide rates, and lung cancer deaths. As previously stated, salmonellosis or food poisoning is

one the major weaknesses found in Brevard County. Brevard has one of the highest rates of

salmonellosis in the state. Compared to Florida, which had a rate of 29.8 in 2015, Brevard

County had a rate of 49.0, which was almost double the state rate (Florida Health Charts, 2015d).

Possible factors that affect the rate are poor hygiene habits related to handling raw meat and

proper handwashing. According to an article by Bay News 9, salmonellosis cases were reported

and were traced back to Brevard County in 2013 (Bay News 9, 2013). Public health workers

identified the illness and discovered it originated from a chicken farm. (Brevard Times 2013).

Chickens are natural carriers of the salmonellosis bacteria, and the bacteria is spread through

unwashed hands and contact with chickens (Bailey, 2013). If an individual has general poor

hygiene habits, then the illness is more likely to spread (University of Florida IFAS Extension,

2016). Education about proper handwashing and cooking of raw meats is essential in order to

decrease the extreme rates in the county.

Another weakness found in Brevard County was the suicide rates between the age ranges

of 45-64. According to statistics from 2015, suicide rates within this age group have been the

highest in the last 5 years (American Foundation for Suicide Prevention, 2015). Based on this
LUNG CANCER DEATHS 7

information, the data from 2015 showed that the rate in Brevard County was 22.3, while the rate

in Florida was 14.6 (Florida Health Charts, 2015f). Possible explanations for data may correlate

with high domestic violence and unemployment rate found in the county. According to a

statistic from 2016, domestic violence increases the risk of suicide by almost 25% (“All

Domestic Violence Survivors” 2016). In Brevard County, the domestic violence rate in 2015

was 595.5 compared to the state rate of 542.1. According to the American Foundation for

Suicide Prevention, chronic stressors such as unemployment is a risk factor for suicide

(American Foundation for Suicide Prevention, 2017). The unemployment rate in Brevard

County in 2015 was 12.1, meanwhile the state data demonstrated a rate of 10.9 (Florida Health

Rankings, 2015c). Both of these risk factors only represent a small fraction of factors that affect

the suicide rate. However, the county can initiate supplementary interventions to reduce these

risk factors to decrease the rate of suicide.

An additional weakness that is found in Brevard County is the increased mortality rate

related to lung cancer for men between the ages of 45 to 64. According to statistics from 2015,

the rate in Brevard County was 88.2, while the rate in Florida was 53.2 (Florida Health Charts,

2015d). A possible contribution to this increase may be due to the increased smoking rates

found for this population. The rate in Brevard County in 2013 was 22.3, and the state rate was

19.5 (Florida Health Charts, 2013a). According to the CDC, approximately 90% of cases are

linked to smoking and is the primary risk factor developing lung cancer. (Center for Disease

Control and Prevention, 2016). It is also the major contributor to lung cancer deaths as well.

Men that are currently smokers are approximately 20 times more likely to develop lung cancer

(American Lung Association, 2016). If unaddressed, lung cancer deaths are bound to trend

upward.
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Identification of a Priority Health Issue

A major health issue that must be solved within Brevard County are the increased

mortality rates related to lung cancer among men ages 45 to 64. As previously stated, the rate in

2015 for lung cancer deaths in Brevard County was 88.2, as opposed to Florida with a rate of

53.2 (Florida Health Charts, 2015d). On a national level, the rate in 2015 was 50.6. The county

rate almost doubles the rate in Florida and the national rate, despite the fact it is a preventable

cancer. According to the American Lung Association, lung cancer is the number one cancer that

leads to death. Based on a previous statistic from 2013, lung cancer almost accounts for 30

percent of cancer deaths. On a national scale, men are more vulnerable to death by lung cancer,

with a rate of 51.7. In addition, the prognosis for lung cancer is much lower than other cancers

with a 17.7% survival rate within 5 years. (American Lung Association, 2016). Although

treatment options are available, the 5-year survival rate declines as lung cancer advances. Even

at stage 1, lung cancer has approximately 50% 5-year survival rate. When the cancer progresses

to stage 4, the survival rate is approximately 1% (American Cancer Society, 2016a). Early

initiatives must be made in Brevard County to prevent lung cancer deaths. Initiatives based on

community health models must be used to construct a plan of care that accommodates the

individual’s unique circumstances. These initiatives will attempt to decrease the rate to

hopefully meet the Healthy People 2020 of 45.5 (Office of Disease Prevention and Promotion

2017b).

Discussion and Application of Community Health Methods

As stated previously, community health models are essential to developing interventions

because they view the circumstances surrounding an individual before creating a plan of care.

The Determinants of Health Model is used to identify specific biologic, lifestyle, environmental
LUNG CANCER DEATHS 9

factors, in addition to accessibility to healthcare. These factors have various effects on the health

of a population and the individual when combined (Office of Disease Prevention and Promotion

2017a). Biologic factors that relate to lung cancer include the inheritance of chromosome 6 and

previous family history of lung cancer (American Cancer Society, 2016b). As described above,

major lifestyle factors include any variation of smoking, and risk increases with duration, pack

years, and an early onset of smoking (Cancer Australia, 2017). Environmental factors include

any exposure to secondhand smoking and environmental chemicals. According to research,

individuals exposed to secondhand smoke are at a higher risk for developing lung cancer. Any

additional exposure to radon, radiation, asbestos, arsenic, and air pollution also increase the risk

(Cancer Research UK, 2015). Lastly, accessibility to healthcare impacts the risk of lung cancer

deaths. According to a study, an individual from a low socioeconomic background or identifies

as African American is less likely to receive treatment for lung cancer. The study demonstrated

individuals who have a similar background are less likely to have surgery, despite the early

intervention for lung cancer being surgery (Lathan, 2015).

Population Diagnosis

Men between the age ranges of 45 to 64 with low socioeconomic status in Brevard

County are at an increased risk for death related to lung cancer due to increased smoking rates.

Community/Population-based Interventions

Primary Level of Prevention

A level of recipient that can benefit from early primary intervention are men between the

ages of 45-64 who smoke in Brevard County. A primary intervention that can be implemented

would be education about smoking cessation while incorporating a program like Tobacco Free

Florida. According to a study, smoking cessation is the only proven preventative measure for
LUNG CANCER DEATHS 10

lung cancer (Greenberg, Jorgensen, Tchou-Wong, Tsay, and Rom 2013). On their website, they

have tools such as phone helplines, support groups, web conferences, and additional resources

available for those who want to quit (Tobacco Free Florida, 2016). Regardless of an individual’s

readiness to quit, the patient should be informed of the risks of smoking. Stakeholders such as

public officials should be involved to educate the public on the importance of smoking cessation

and the prevention of lung cancer. Legislators must be approached to mandate universal

smoking education laws to all individuals who smoke. Families of smokers should be included

to encourage smoking cessation and act as support for those in the process. In addition,

healthcare workers should also be involved to act as an educator, supporter, advocate and

resource for patients who smoke or at risk for lung cancer (Bradley et. al. 2016). In terms of

funding, it would come from the Florida Health Department, which funds Tobacco Free Florida.

The role of the community health nurse would be to contact Tobacco Free Florida and devise a

campaign to educate patients in hospitals, clinics, healthcare agencies, and the community in

Brevard County.

Secondary Level of Prevention

A secondary level of prevention for this population stated above would be mandatory

annual low-dose CT screenings to diagnose and determine the stage of lung cancer. Based on

results from a previous study, those at risk for lung cancer who received a CT scan faced an

approximately 20 percent lower mortality rate than who had an X-ray (National Cancer Institute,

2014). In addition, results from a study showed that the screenings coupled with smoking

cessation education can decrease smoking rates (Georgetown University Medical Center, 2017).

If caught early at stage 1, treatment options such as surgery and additional chemotherapy are the

best chances for reducing lung cancer progression (American Cancer Society, 2017).
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Stakeholders involved should include legislators and public officials. Legislators should be

contacted to pass a law mandating annual CT screenings for high risk individuals. Public

officials should also be included to help integrate the previously stated laws into effect into the

county. Funding sources would come from the National Cancer Institute, due to their previous

study on CT screenings (National Cancer Institute, 2013a). In terms of screening cost, the

Affordable Care Act makes Medicare and private plans relatively cost free for those at high risk

for lung cancer (Gomez, 2016). The role of the community health nurse is to contact the

National Institute of Cancer and start a campaign or petition to advocate for mandatory annual

CT screening laws for those at risk for lung cancer.

Tertiary Level of Prevention

A tertiary level of prevention that could help this population would be to create a

program that creates a nurse case manager position catered to patients diagnosed lung cancer and

their families. Per an evidence-based study, nurse case managers function as the link between

facilities and healthcare providers in the community and produce positive patient results (Huber

and Joo, 2014). The role of the nurse case manager would assess and refer them to an

oncologist, pulmonologist, pain management, counselor, and palliative or hospice care if needed

(CancerCare, 2017). In addition, the nurse case manager would act as a facilitator and ease the

transition from each healthcare provider setting up appointments if possible (Grover, Kub, and

Savage 2016). The nurse case manager would also be responsible for obtaining the any

equipment or devices that the patient would need such oxygen and medications. Afterwards, the

community health nurse would be responsible for following up with the patient weekly to

monitor any new medication compliance, side effects of treatment, and implement emergency

interventions if necessary. Stakeholders involved would be the respective healthcare workers.

LUNG CANCER DEATHS 12

The other role of the community health nurse is to act a liaison with the respective healthcare

workers and gather the contact information and resources needed for referral. In addition, the

nurse would create a case manager position that hospitals and clinics can implement into their

system as a formal occupation. In regards to funding, the funds would come from the hospitals

and clinics supporting the developing of the position.

Development of Health Policy

Health policies are specific measures taken to achieve a targeted goal (World Health

Organization, 2017). A proposed policy would be to decrease the mortality rates of lung cancer

deaths among men ages 45 to 64 who smoke in Brevard County by increasing smoking

cessation. As stated previously, smoking cessation is the only method to prevent lung cancer

(Greenberg, Jorgensen, Tchou-Wong, Tsay, and Rom 2013). The driving force of the policy will

focus on primary prevention. The purpose of the policy is to implement a mandatory smoking

cessation program for all smokers. It will incorporate resources from Tobacco Free Florida as a

mandatory requirement in all Floridian hospitals, clinics, and healthcare agencies. The goal for

patients is to be educated on the risks of lung cancer, while having the resources to make

healthier decisions for themselves. The desired outcome of the health policy is to reduce the

current mortality rate of 88.2 to 60.0 in 3 years.

Stakeholders involved would be public officials, legislators, healthcare providers, and

funding sources. Supporters of the policy would include healthcare providers and funding

sources. Healthcare providers could advocate for the education program through

recommendations to the upper echelons of hospitals and clinics. Funding sources such as the

Florida Health Department would support the policy by providing the materials needed.

Stakeholders that would be against the policy would be legislators and community members.
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Legislators would oppose the policy by preventing the policy from becoming a state law. Some

members of the community may be against the policy because it may oppose their own self-

beliefs about smoking.

The first steps to advance the teaching program would be to contact the Florida Health

Department with the health policy proposal. A collaboration is needed to bring the smoking

cessation program to the local hospitals and clinics. A test run of the program combined with

Tobacco Free Florida can be formed into research studies to develop baseline material. The

results can be published and can be presented to a public official along with the policy. If

successful, the public official can then bring the health policy to the legislator, which can be

turned into a state law. The proposed policy addresses the necessities of an undeserved

population because all the resources on Tobacco Free Florida are free. All that is needed is a

phone call or text message to begin the journey to quit smoking. There are even in-person group

options for those who have limited access to the Internet (Tobacco Free Florida, 2017). The

policy enhances the general population because it prevents respiratory damage that makes them

prone to lung disease (John Hopkins Medicine, n.d.)

Conclusion

Brevard County has an array of strengths and weaknesses found in their community.

Despite the improvements made in many areas, there are still interventions that can be

implemented to improve the health of the population. With the health policy implemented, the

goal would be to reduce further deaths by lung cancer. In my future nursing career, I will use

this information to educate my patients who smoke and inform them of the risk that they face. I

can give them the education while also referring them to Tobacco Free Florida. In this manner,

they will have the extra resources and support available if they decide to quit.
LUNG CANCER DEATHS 14

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