Full Report: PDF
Report Contents
Health Unit Profiles
Case Studies
Supporting Documents
Initial Report on Public Health
Case Studies

A board of health survey was conducted in November 2008 to collect both data and examples of local best practices. Case studies were sought to showcase local initiatives, unique programming or innovation, or demonstrate the success of boards of board of health in addressing local needs.

Suggested categories for case studies included:

  • integration of public health with local health care system;
  • program delivery to address local health determinants;
  • working with priority populations (i.e. First Nations, homeless people);
  • improving access to programs (i.e. overcoming language barriers);
  • community partnerships; and
  • knowledge exchange.

The following is a list of case studies that appear throughout the Initial Report on Public Health.

Addressing Poverty - Grey Bruce Health Unit
Best Start's Primary Care Strategy - City of Hamilton Health Unit
Building Internal Evaluation Capacity - Leeds, Grenville and Lanark District Health Unit
Collaboration with First Nations - Peterborough County-City Health Unit
Crystal Meth Task Force - Perth District Health Unit
First Nations Children's Oral Health Initiative - Northwestern Health Unit
First Nations, Métis and Inuit Diabetes Network - City of Ottawa Health Unit
Food Security - Peterborough County-City Health Unit / Huron County Health Unit
Guelph Inclusiveness Alliance -Wellington-Dufferin-Guelph Health Unit
Healthy Menus for Arenas - Durham Regional Health Unit
Knowledge Exchange - Peel Regional Health Unit / Waterloo Health Unit
Operation Hairspray - City of Ottawa Health Unit
SPARK Youth Website - Huron County Health Unit
Teen Sexual Health - Middlesex-London Health Unit / Kingston, Frontenac and Lennox
The Health Bus - Niagara Regional Area Health Unit
The Low-Wage Worker Project - Sudbury and District Health Unit
Toronto Cancer Prevention Coalition - City of Toronto Health Unit
Working with Correctional Facilities - Halton Regional Health Unit

In addition to those case studies included in the report, the following is a broader selection of case studies submitted by health units. The text of each case study appears as submitted by the health unit. Case studies are organized by category and some may appear several times where the case study pertains to more than one category.

Addressing Poverty - Grey Bruce Health Unit

Grey Bruce Health Unit's Moving Forward program focuses on breaking the cycle of poverty by addressing systemic barriers that prevent marginalized individuals from obtaining adequate education and employment. Targeting high-risk young families, the program uses motivational interviewing to help clients recognize their readiness to change and to develop an action plan to achieve specific goals. Set-backs and relapses are common throughout the change process. Public health professionals support clients to evaluate their goals and reaffirm their action plans.

Grey Bruce Health Unit also provides tangible support through the provision of transportation, access to adequate childcare and by helping clients purchase affordable, appropriate interview clothing. All these elements increase the client's opportunities for employment and education.

Moving Forward works on many levels to address and improve determinants of health associated with poverty and access to education and employment opportunities.

Best Start's Primary Care Strategy - City of Hamilton Health Unit

Healthy development during a child’s first years significantly impacts the health and well being of that individual later in life. The Best Start initiative, funded through the Ministry of Children and Youth Services, is designed to improve early identification and resource networking at the community level throughout Ontario, and public health units have been active participants in these projects.

As an example, City of Hamilton Public Health Services worked with primary care, public health and Ontario Early Years Centre (OEYC) representatives to form a sub-committee under Hamilton’s Best Start Network. A team that included a physician opinion leader, public health nurse and OEYC facilitator delivered presentations on early identification and the availability of community resources to primary care practitioners. Where possible, practitioners were invited to the neighbourhood OEYC, which reinforced the availability of local Early Years services. Other presentations were held in group practices, and physician rounds.

Attendees received an information package that included multiple copies of the Nipissing District Developmental Screen™ (NDDS), Rourke Well Baby Record, an article on the 18-month visit, and a flowchart of local early years services with contact information. In addition, a continuing medical education accreditation event provided more in-depth understanding of child development. Project evaluation demonstrated an increase in referrals to community services.

Building Internal Evaluation Capacity - Leeds, Grenville and Lanark District Health Unit

The Leeds, Grenville and Lanark District Health Unit has developed a plan to build organizational capacity for program evaluation and evidence-based public health practice. The goal is to integrate the planning and evaluation function into all public health professional job functions within the health unit and thus build an organizational culture of continuous quality improvement.

The plan involves implementing a comprehensive strategy of policies, supportive environments, infrastructure development, and staff education and training. The goal of plan is to enhance the skills of public health professionals in the foundations of effective, evidence-based public health practice. The strategy includes the launch of a learning series to enhance knowledge and skills, and the creation of an Evaluation Community of Practice, which is an informal network supporting the exchange of ideas and experiences in program evaluation.

Ultimately, building organizational capacity for program evaluation will enhance accountability to stakeholders and the quality of public health programs delivered to the community.

Collaboration with First Nations - Peterborough County-City Health Unit

As an example of inclusion at the governance level, the Peterborough County-City Board of Health (PCCHU) has signed an agreement with Curve Lake First Nation and Hiawatha First Nation for comprehensive public health services.

Both communities contribute their share of the 25% local funding, and the council of each band appoints one of its members to the board of health for one, two, or three years. Curve Lake First Nation and Hiawatha First Nation also may jointly appoint a representative. In Peterborough, Curve Lake First Nation Chief Keith Knott has served as a Board Member since 2002, including a term as Chair in 2004. The relationship with these two communities continues to evolve and PCCHU continues to act as a resource, a facilitator, an educator, a trainer, and an advocate as needs arise.

PCCHU has partnered with staff at the Curve Lake First Nation Health Centre on a youth tobaccoprevention strategy. Curve Lake First Nation and Hiawatha First Nation are partners in the Health Canada funded smoking cessation project and also have partnered with PCCHU on a proposal to the Canadian Tobacco Control Research Initiative.

Services offered by the health unit, such as HBHC home-visiting, food handler training and certification, parenting groups (such as Nobody’s Perfect), and food security initiatives, such as "Come Cook with Me" enhance the programs that already exist within the First Nation. Child care is provided, so parents can have some time for themselves, forge new friendships, and learn new skills.

Crystal Meth Task Force - Perth District Health Unit

As new health concerns emerge in a community, public health units use their knowledge and skills to respond with creative community engagement strategies. For example, in 2005, The Toronto Star labelled Perth County the "Crystal Meth Capital" of Ontario. A series of methamphetamine lab discoveries and rising substance misuse rates had leaders scrambling to deal with this problem.

In response, the Perth District Health Unit became involved with the formation of the Perth County Task Force on Crystal Meth, which formed in 2005. By 2008, it had grown to a 40-member committee, including public health, police, politicians, fire, EMS, health-care providers, addiction counsellors, social services, pharmacies, and agriculture associations. The Director of Health Protection from the Perth District Health Unit and the Mayor of Stratford co-chair the committee.

The Task Force is tackling the crystal meth problem on four fronts:

  • enforcement
  • health protection
  • prevention and education
  • treatment

Through its leadership on the Task Force, the Perth District Health Unit is able to ensure that crystal meth use is addressed using a comprehensive, best-practices approach. In 2008, the Task Force implemented nine programs across the four areas of focus. Public health unit programs have focused on youth development and engagement to prevent substance misuse, and health protection measures related to drug labs.

To date, the program has experienced successes resulting in:

  • a decrease in meth lab discoveries
  • major enforcement successes
  • improved addiction treatment services
  • better informed youth through the impact of widespread, multifaceted education measures
First Nations Children's Oral Health Initiative - Northwestern Health Unit

Many health units are working in innovative ways with First Nations communities to address local health needs and build collaborative partnerships that will support improved communication and planning.

For example, in September 2004 the Northwestern Health Unit (NWHU) partnered with Health Canada to enrol five new First Nations communities in the Children's Oral Health Initiative (COHI), pilot program, and to date 19 communities are involved. The initiative addresses the high rates of preventable dental disease in First Nations and Inuit communities in Canada.

Under the program the NWHU provides diversified oral health promotion activities, such as: education, oral health assessments, screenings, fluoride varnish, sealants, scaling, and oral hygiene instruction. Yearly baseline epidemiological data are collected and used to implement and evaluate the program and determine trends in oral disease.

This strategy has broken down the federal/provincial/First Nations jurisdictional barriers and ties in nicely with other tripartite initiatives across Canada, enabling health unit staff to provide desperately needed services to children under federal jurisdiction.

The ultimate goal is to empower communities to provide these services themselves.

First Nations, Métis and Inuit Diabetes Network - City of Ottawa Health Unit

Another example of current work with First Nations is Ottawa Public Health’s work with the First Nations, Métis and Inuit Diabetes Network. With diabetes among Ontario Aboriginals three times higher than that in non-Aboriginal populations, the Ottawa Aboriginal community recognized the need for a more coordinated approach to diabetes education. Ottawa Public Health, working with Ottawa Aboriginal organizations, initiated the formation of a network that includes the Canadian Diabetes Association, Heart and Stroke Foundation, and the Diabetes Education Program of Ottawa.

The strength of the First Nations, Métis and Inuit Diabetes Network is its Aboriginal membership and its commitment to collectively engage, discuss, and arrive at a shared understanding on planning diabetes education while ensuring the efforts reflect the three distinct populations. As a result, the network has been able to move toward developing and sharing culturally relevant resources, training, and service approaches to diabetes prevention, as well as bring a focus to the prevention of other chronic diseases.

The First Nations, Métis and Inuit Diabetes Network is building on its interdisciplinary and intersectoral membership to attract new service, research, and academic partners to work together to reduce the burden of this preventable chronic disease among Ottawa’s approximately 60,000 Aboriginals.

Food Security - Peterborough County-City Health Unit / Huron County Health Unit

Having access to affordable healthy foods is an issue of public health concern, and Peterborough County-City Health Unit has been working to address this issue with its Food Security Community Partnership Project.

For more than a decade, the annual Nutritious Food Basket survey has identified that low-income residents in Peterborough City and County cannot afford an adequate diet once they have paid for housing and other basic needs. In response, the Peterborough County-City Health Unit rallied community partners to provide the Food Security Community Partnership Project (FSCPP), with a focus on community-based food programs and food skill development.

The FSCPP involves 5,000 adults and children living on low incomes in Peterborough City and County. The program targets priority populations, including those from: rural and First Nation communities, youth living independently, parents of young children, homeless and under-housed community members, and seniors living in isolated situations. The new partnerships allowed the program to expand its reach within these priority populations.

The project components include:

  • Advocacy for improved incomes for people receiving social assistance and low wages.
  • Come Cook with Us - Cooking sessions in which participants cook, enjoy a meal together, share healthy eating and food safety tips, and take home meals and a food voucher. Graduates are invited to join a monthly collective kitchen.
  • Food Box Programs - Monthly boxes of staples and/or produce with a subsidy for low income clients.
  • Cooking up Employment - Two community members work with the "Open Table Chef" to provide a free, nourishing meal to community members five days a week.
  • Frozen Meal Program. - The provision of nutritious meals, delivered to isolated rural community members in Peterborough County.

Evaluations of this initiative indicate that participants are making healthier food choices. Community response to the program has been remarkable, in both the numbers reached and in the stories from individuals whose lives have been impacted.

Another local example of work on food security is occurring in the Huron County Health Unit, with their Farm to Table Project. This network of community organizations, concerned about access to local, healthy food and the overall decline in agriculture in Huron and Perth Counties, aims to educate consumers about food, nutrition, and agricultural issues, and create new markets for local farmers.

Farm to Table’s central initiative is the monthly Huron Good Food Box program, which provides Huron County residents with a regular, affordable supply of local fresh fruits and vegetables. The program relies on volunteers, and annual sales volumes have grown since its inception in 2001, to more than 2,500 Good Food Boxes in 2007, to a customer base that included 25% of buyers with annual household incomes of less than $20,000. More than 60% of users of the Huron Good Food Box program report they have increased their consumption of fruits and vegetables.

Guelph Inclusiveness Alliance -Wellington-Dufferin-Guelph Health Unit

The Guelph Inclusiveness Alliance (GIA) is a multicultural coalition of more than 30 service provider organizations and persons focusing on making Guelph a more welcoming place for immigrants in need of support. The Wellington-Dufferin-Guelph Public Health (WDGPH) provides GIA with epidemiological expertise and brings a determinants-of-health perspective to the coalition's work.

The 2006 Census found that immigrants represent 21% of Guelph's population. In 2009, the Guelph Inclusiveness Alliance will buy customized, demographic information from Statistics Canada to provide more detailed immigrant profiles as a basis for identifying inequities and improving accuracy.

WDGPH uses census and postal code information to examine the spatial and temporal distribution of immigrants, mortality rates, emergency room visits, and hospitalizations, across 12 Guelph neighbourhoods. This work supports a powerful Geographic Information System (GIS) that includes advanced statistical analysis tools to help interpret health patterns within Guelph.

Through the GIA, Wellington-Dufferin-Guelph Public Health is attempting to identify and reduce health inequities among Guelph's diverse populations, tailor its programs and services to better meet local needs, and share its knowledge and expertise with community partners.

Healthy Menus for Arenas - Durham Regional Health Unit

In developing strategies to encourage healthy eating, health units are exploring ways to get beyond the use of broadcast messages to a whole population and are looking at strategies that address the specific locations where people eat meals away from home.

An innovative local approach led by the Durham Region Health Department is occurring whereby, where a Healthy Menus for Arenas program is currently operating in five Durham arenas. This program was based on the positive results of a 2007 pilot study, which found that arena users will make healthy food choices if options are available at arena concession stands.

Healthy menu options were developed by Public Health Nurses and Nutritionists in collaboration with the Heart and Stroke Foundation of Ontario, Canadian Cancer Society, Canadian Diabetes Association, Canadian Liver Foundation, FoodSense Vending Services, and local Municipal Recreation Facilities.

Further initiatives have also been introduced in support of healthy eating in other recreational facilities, including a communication campaign and a coaches' incentive program. Along with Health Department funding, financial support has also been received from the local Heart Health Coalition (Durham Lives!), the Public Health Agency of Canada's Diabetes Strategy, and the Canadian Cancer Society, Ontario Division.

Knowledge Exchange - Peel Regional Health Unit / Waterloo Health Unit

Developing methods of promoting and supporting knowledge exchange is an important aspect of ensuring that new knowledge is translated into practice and that current thinking on best practices is continually updated.

Peel Public Health has embarked on a ten year strategic direction setting process to enhance evidence informed decision making throughout the health unit. This multi-faceted strategy currently includes a review of library services, staff skill development, particularly in critical appraisal of the literature, a department wide communication plan, a project by one of the Associate Medical Officers of Health who has a fellowship through the CHSRF Executive Training for Research Application (EXTRA) program, and a post doctoral study on the change management process by a researcher at McMaster University. Additional activities include piloting the use of a knowledge broker role, contracting academics for selected literature reviews, a 12 month pilot of RefWorks (an online research management tool that manages on line information and generates citations and bibliographies) and formation of a critical appraisal club where staff can develop new skills and learn from each other.

Region of Waterloo Public Health approached this task by organizing a Research Pathways to Healthy Public Policy forum as a way to advance population health assessment, research, and evaluation activities. The forum is part of a program through which the health unit developed specific goals and objectives to guide its work with key stakeholder groups, including community organizations, the community at large and in particular vulnerable populations, professional partners and colleagues, decision makers and members of academia.

The Research Pathways to Healthy Public Policy one day forum attracted more than 80 participants from local academic institutions and key community groups. The event focused on three themes:

  • health and the built environment (community design)
  • environmental conditions affecting health (drinking water, air quality)
  • local healthy food system development

The day was organized into three sections:

  1. a general overview of the public health context, which outlined the Region of Waterloo Public Health's mandate and what Research Pathways had to offer researchers
  2. a large-group plenary section, which addressed expectations and concerns in partnering with Public Health and brainstormed how to overcome barriers to working together
  3. small-group break-out sessions covering the three themes

Each small-group sessions identified key issues for both academia and public health by theme area, discussed ways to continue communications on the issues, and identified the key contact people for each theme area. Since the session, public health staff have followed up on at least 10 potential research ideas, proposals, or discussions for projects with the academic attendees.

Operation Hairspray - City of Ottawa Health Unit

Ottawa Public Health has developed a health protection initiative that works with community members to provide health information to populations at risk. Operation Hairspray trains African and Caribbean hairdressers and barbers to deliver culturally appropriate information about HIV/AIDS prevention strategies to their customers and to members of local African and Caribbean communities.

Volunteers in Operation Hairspray are trained as peer educators and acquire the knowledge and skills needed to impart STI and HIV/AIDS prevention information while they are interacting with their clients. Over the course of 12 months, 19 peer volunteers were recruited and trained across Ottawa. In total, they made more than 14,000 contacts with clients and community members, sharing information and a variety of different written publications on basic HIV/AIDS prevention, and distributing more than 24,000 condoms. South East Ottawa Centre Healthy Communities created a database to house information collected by the peer volunteers.

In 2008, Ottawa Public Health developed a successful partnership with Somerset West Community Health Centre to expand the reach of the project by recruiting and training an additional 20 peer volunteers. The AIDS Community Action Programme (ACAP) provided time-limited funding for Operation Hairspray, Phase 2: Spray the Word. To date, an additional seven peer volunteers have been recruited and trained.

SPARK Youth Website - Huron County Health Unit

Substance misuse prevention initiatives need to match both the community characteristics and the needs of the population being served. Huron County Health Unit, which is located in a rural region, has developed a web based intervention that is designed to reduce barriers that rural youth face in accessing health information such as distance, transportation, lack of anonymity, and a general lack of youth health and social services.

Since local rates of youth alcohol abuse are significantly higher than the provincial average, the youthspark website content focuses on alcohol and drug abuse, but also contains information on a variety of health topics, including healthy sexuality, relationships, and mental health. There is a strong evaluation component to this project to ensure this interactive, youth-led site is continually evolving to meet the needs of local youth.

By providing employment for 6 youth in the initial stages of the design and maintenance of the website itself and currently employing 1 SPARK youth ambassador, the SPARK youth website is designed to give at-risk youth in Huron County the opportunity to develop the skills to:

  • design and maintain a health-promotion website and
  • build the website into a reliable source of public health information for Huron County youth

The website, found at http://www.youthspark.ca includes personal stories, local information and announcements of events. It also has open forums for youth to find answers together, and to connect with health professionals who can answer questions anonymously.

Teen Sexual Health - Middlesex-London Health Unit / Kingston, Frontenac and Lennox

Many health units are addressing teens' sexual health needs by providing services in ways that are relevant to this client group.

For example, Kingston, Frontenac and Lennox & Addington Public Health offers its comprehensive school-based teen sexual health clinic program in partnership with the Limestone District School Board. A public health nurse visits various local high schools to increase the access local teens have to free, confidential sexual health services. Public health nurses work closely with the adolescent care worker at each school and facilitate physician referrals as required.

The teen sexual health clinic program is designed to decrease the rate of teen pregnancy and prevent the spread of sexually transmitted infections. Three local high schools currently are involved in the teen health clinic program. It is being extended to two additional high schools during 2009. One Teen Clinic occurs at an alternate education centre where many of the students are homeless or involved in prostitution. A Teen Clinic database is currently being developed to capture all relevant demographic information and sexual health services provided in order to evaluate the program's success.

Another approach is being used by the Middlesex-London Health Unit, which runs a one-day, interactive high school outreach program designed to enhance knowledge and engage youth. The Having a Baby Day program operates in conjunction with St. Joseph's Health Care, London, the Regional Sexual Assault and Domestic Violence Treatment Centre (RSADVTC), and the Thames Valley and London District Catholic school boards.

The program is offered quarterly and brings high school students and their teachers into St. Joseph's Health Care to learn about preparing for parenthood, achieving optimal pre-conception health, experiencing a healthy pregnancy, and having the healthiest newborn possible.

Students rotate through small-group discussion sessions on and site visits to:

  • the Family Birthing Centre (FBC)
  • the Neonatal Intensive Care Unit
  • Healthy Relationships
  • the Regional Sexual Assault and Domestic Violence Treatment Centre
  • Post-Partum Issues

The sessions include discussions by health care staff on topics such as antenatal, intra-partum, and post-partum care, implications of having a pre-term or ill infant, decisions about safer sex, resources on preventing abuse, and changes facing families with newborns.

The Health Bus - Niagara Regional Area Health Unit

The Health Bus began as a vision of the Niagara-based Wise Guys charity, which provided funding to allow Niagara Region Public Health to purchase a bus and convert it into a mobile health care facility for the homeless. The Health Bus is permanently staffed by a team leader and a public health nurse. In addition, staff from the sexual health program, the dental program and the mental health program provide services on a rotating or occasional basis.

The initial homeless target population has been expanded to include vulnerable, marginalized, and isolated populations. Niagara Region Public Health undertook extensive collaboration and consultation with community partners to determine the services required and the best locations at which to reach the target population, and works to keep community agencies abreast of Health Bus services and service locations.

The Health Bus provides a wide range of health services, including:

  • treatment for minor medical conditions
  • general, mental, and sexual health counselling
  • foot care
  • immunizations
  • sexually transmitted disease testing and treatment
  • needle exchange
  • dental assessments and
  • referrals to appropriate medical and dental service providers

Despite demands to expand the coverage area, the Health Bus has been able to maintain its focus on providing access to the target population. One of the Health Bus's strengths is its visibility and the trust it has developed with the target population. The Health Bus has been successful in increasing client, community, and staff satisfaction in providing health care to a traditionally poorly served population.

The Low-Wage Worker Project - Sudbury and District Health Unit

Public health programming that directly addresses the underlying social factors associated with poor health outcomes is an important practice area for public health units. As an example, in 2003, the Sudbury & District Health Unit (SDHU) staff and its university partners launched a major project to understand the health and wellness issues facing low-wage worker populations in the City of Greater Sudbury and to identify interventions that could be taken to improve their health, safety, and well-being.

A literature review revealed that research on public health interventions to improve the lives and working conditions of working poor people is limited. This made a series of needs assessment interviews fundamental to understanding the challenges faced by low-income workers and the possible interventions to address those challenges. As a result, nine focus groups were conducted with 23 key informants and 65 low-wage workers. Recommendations from the interviews included calls for:

  • enhancement of existing health promotion, protection, and safety programs focused on the low-wage worker population
  • development of community partnerships to advocate for and implement policy changes
  • conducting more research on the needs of low-wage workers and the identification of interventions at the individual, workplace, community, and social policy levels.

These recommendations have implications for public health planners across Ontario. Full reports are available on the Sudbury & District Health Unit's website at http://www.sdhu.com.

Toronto Cancer Prevention Coalition - City of Toronto Health Unit

The Toronto Cancer Prevention Coalition was created in 1998 by Toronto Public Health and community partners and is North America's largest municipal cancer prevention coalition. In November 2002, City Council endorsed the Coalition Action Plan as the cornerstone of cancer prevention in the City of Toronto.

The strength of the coalition lies in its dedicated membership. For the first time in history, governments, universities, unions, health and environmental agencies, school boards, grassroots groups, activists and survivors have brought their individual expertise to the coalition and its comprehensive agenda for cancer prevention. The coalition's work has accomplished or influenced prevention work being done throughout Canada today.

In 2007, the Toronto Board of Health endorsed a policy statement for shade for the City of Toronto which was forwarded to City Managers for implementation and has since been a catalyst for additional pilot projects, activities and advocacy work in effectively reducing overexposure to ultraviolet radiation within the city's facilities.

Working with Correctional Facilities Case Study

The Halton Region Health Department’s Communicable Disease Control team has launched a program to assist and support health in the two "Super Jails" (Maplehurst and the Vanier Centre) within its jurisdiction. Maplehurst Correctional Complex, with a population of 1,182 and a turnover rate of 30 inmates per day, is the largest male correctional facility in Canada. The Vanier Centre for Women is a 333-bed medium- and maximum-security facility with an almost 100% turnover rate every 18 to 21 days and an 80% recidivism rate.

The Communicable Disease Control team provides program support to both facilities and works closely with the jail’s health services and administration to ensure routine admission testing, including testing for tuberculosis, and prompt reporting of communicable disease issues for appropriate follow-up and treatment. At both facilities, 95% of the workload is TB related, including latent TB infections (LTBIs), active disease follow-up, treatment and contact management.

In addition, the Food Safety team conducts regular compliance inspections of the kitchen facilities at both locations. One is a commercial-grade food-production facility that provides more than 9,000 meals daily to five other provincial institutions. The other provides the meals for inmates at both Maplehurst and Vanier. In both kitchens, inmates assist in the production and assembly of meals.

In this role, Halton Region Public Health has been involved in both investigating food-safety-related complaints and outbreaks, including those resulting from contaminated food products and intentional adulteration. As well, staff respond to environmental health issues, including mould and indoor air quality issues.

The health unit also runs a Sexual Health and Needle Exchange Program that provides Maplehurst and Vanier inmates with education and case management for those diagnosed with a sexually transmitted infection (STI), and general education on STIs, including HIV/AIDS and hepatitis A, B, and C.