Defiance County Community Health Status Assessment 2015

Examining the Health of Defiance County

FOREWORD

Once again on behalf of the POWER Defiance County Coalition, I am pleased to present the FOREWO 2015 Defiance County Community Health Assessment Report. This report is the fifth community health assessment conducted by various social service, business, and government organizations in Defiance County in an effort to collect data reporting the health and health behaviors of Defiance County residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio.

Monitoring the health of local residents to identify community health problems is an essential public health service. This health status assessment should be used as a guide for strategic planning and decision making. It can help our communities identify new health concerns, measure the impact of current community improvement efforts, and guide the judicious use of local resources. However, this is only one planning tool. A true plan of action for community improvement will require taking a closer look at these survey results; seeking additional information from community residents, service providers, and others; identifying populations at risk for specific health conditions, and choosing effective strategies that will truly improve the health of Defiance County residents when put into action.

This report would not have been possible without the help of members of the Power Defiance County Coalition as well as the groups who contributed financially. Both are acknowledged on the following pages. It is vital that assessments such as this continue so that scarce resources are used in the most advantageous ways. All contributions whether financial or expertise is greatly appreciated. RD

Addressing the needs of the Defiance County community will take further collaborations and partnerships of many individuals and agencies. The work of public health is more a system than a single agency. Working together we can achieve a healthier Defiance County.

Sincerely,

Kimberly J. Moss, MPH, BSN Health Commissioner Defiance County General Health District

This report has been funded by:

Four County ADAMhs Board City of Defiance Community Memorial Hospital Defiance County Commissioners Defiance County General Health District Mercy Defiance Hospital ProMedica Defiance Regional Hospital United Way of Defiance County

This report has been commissioned by POWER Defiance County: Promoting Overall Wellness and Empower Residents:

City of Defiance Community Memorial Hospital Defiance Area Foundation Defiance Area YMCA Defiance City School Defiance County Commissioners Defiance County General Health District Defiance County Help Me Grow- Early Intervention Defiance County Juvenile Court Defiance County Ohio State University Extension Office Defiance Development and Visitors Bureau Family and Children First Council Four County ADAMhs Board Four County Family Center Hicksville Village Mercy Defiance Hospital Ministerial Association Northwestern Ohio Community Action Commission ProMedica Defiance Regional Hospital Recovery Services of Northwest Ohio United Way of Defiance County

Project Management, Secondary Data, Data Collection, and Report Development

ACKNOWLEDGEMENTS Hospital Council of Northwest Ohio Britney L. Ward, MPH Margaret Wielinski, MPH Director of Community Health Assistant Director of Community Health Improvement Improvement

Michelle Von Lehmden Selena Coley Health Assessment Coordinator Community Health Improvement Assistant

Tessa Elliott Derick Sekyere Graduate Assistant Graduate Assistant

Anna Crisp Undergraduate Assistant

Data Collection & Analysis

James H. Price, Ph.D., MPH Joseph A. Dake, Ph.D., MPH Emeritus Professor of Health Education Professor and Chair of Health Education University of Toledo University of Toledo

Timothy R. Jordan, Ph.D., M.Ed. Professor of Health Education University of Toledo

To see Defiance County data compared to other counties, please visit the Hospital Council of Northwest Ohio’s Data Link website at http://www.hcno.org/community/data-indicator.html.

The 2015 Defiance County Health Assessment is available on the following websites:

Defiance County General Health District http://defiancecohealth.org/defiance-county-public-health/

Hospital Council of Northwest Ohio http://www.hcno.org/community/reports.html

Contact Information

Kimberly J. Moss, MPH, BSN Health Commissioner Defiance County General Health District 1300 E. Second St., Ste 100 Defiance, Ohio 43512 [email protected] (419)784-3818

TABLE OF CONTENTS

EXECUTIVE SUMMARY PAGES 5-17 TREND SUMMARY PAGES 18-23

Adult Health (Ages 19 and Over)

HEALTH STATUS PERCEPTIONS PAGES 24 HEALTH CARE COVERAGE PAGES 25-27 HEALTH CARE ACCESS AND UTILIZATION PAGES 28-30 CARDIOVASCULAR HEALTH PAGES 31-36 CANCER PAGES 37-41 DIABETES PAGES 42-45 ASTHMA AND OTHER RESPIRATORY DISEASE PAGES 46-48 WEIGHT STATUS PAGES 49-51 TOBACCO USE PAGES 52-57 ALCOHOL CONSUMPTION PAGES 58-64 DRUG USE PAGES 65-71 WOMEN’S HEALTH PAGES 72-75 MEN’S HEALTH PAGES 76-80 PREVENTIVE MEDICINE AND HEALTH SCREENINGS PAGES 81-84 SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES PAGES 85-89 QUALITY OF LIFE PAGES 90-91 SOCIAL CONTEXT AND SAFETY PAGES 92-99 MENTAL HEALTH AND SUICIDE PAGES 100-101 ORAL HEALTH PAGES 102-104 PARENTING TEENS PAGES 105

Youth Health (Ages 12-18)

WEIGHT CONTROL PAGES 106-109 TOBACCO USE PAGES 110-112 ALCOHOL CONSUMPTION PAGES 113-116 DRUG USE PAGES 117-119 SEXUAL BEHAVIOR AND TEEN PREGNANCY OUTCOMES PAGES 120-123 MENTAL HEALTH AND SUICIDE PAGES 124-126 YOUTH SAFETY PAGES 127-128 YOUTH VIOLENCE ISSUES PAGES 129-131

Child Health (Ages 0-11)

HEALTH AND FUNCTIONAL STATUS PAGES 132-135 HEALTH INSURANCE, ACCESS, UTILIZATION, AND MEDICAL HOME PAGES 136-137 EARLY CHILDHOOD (0-5 YEARS) PAGES 138-139 MIDDLE CHILDHOOD (6-11 YEARS) PAGES 140-141 FAMILY FUNCTIONING, NEIGHBORHOOD & COMMUNITY CHARACTERISTICS PAGES 142-145 PARENT HEALTH PAGE 146

Appendices

HEALTH ASSESSMENT INFORMATION SOURCES APPENDIX I PAGES 147-151 LIST OF ACRONYMS AND TERMS APPENDIX II PAGES 152-153 WEIGHTING METHODS APPENDIX III PAGES 154-156 SCHOOL PARTICIPATION APPENDIX IV PAGE 157 DEMOGRAPHIC PROFILE APPENDIX V PAGE 158 DEMOGRAPHICS AND HOUSEHOLD INFORMATION APPENDIX VI PAGES 159-166

EXECUTIVE EXECUTIVE SUMMARY

This executive summary provides an overview of health-related data for Defiance County adults (19 years of age and older), youth (ages 12 through 18), and children (ages 0-11) who participated in a county-wide health assessment survey during January 2015 through April 2015. The findings are based on self-administered surveys using a structured questionnaire. The questions were modeled after the survey instruments used by the Centers for Disease Control and Prevention for their national and state Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System (YRBSS) and the National Survey of Children’s Health (NSCH) developed by the Child and Adolescent Health Measurement Initiative. The Hospital Council of Northwest Ohio collected the data, guided the health assessment process and integrated sources of primary and secondary data into the final report.

Primary Data Collection Methods

DESIGN

This community health assessment was cross-sectional in nature and included a written survey of adults, adolescents, and parents within Defiance County. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment.

INSTRUMENT DEVELOPMENT

Three survey instruments were designed and pilot tested for this study: one for adults, one for adolescents in grades 6-12, and one for parents of children ages 0-11. As a first step in the

design process, health education researchers from the University of Toledo and staff members SUMMARY from the Hospital Council of NW Ohio met to discuss potential sources of valid and reliable survey items that would be appropriate for assessing the health status and health needs of adults and adolescents. The investigators decided to derive the majority of the adult survey items from the BRFSS. The majority of the survey items for the adolescent survey were derived from the YRBSS. The majority of the survey items for the parents of children 0-11 were derived from the NSCH. This decision was based on being able to compare local data with state and national data.

The Project Coordinator from the Hospital Council of NW Ohio conducted a series of meetings with the planning committee from Defiance County. During these meetings, banks of potential survey questions from the BRFSS, YRBSS, and NSCH surveys were reviewed and discussed. Based on input from the Defiance County planning committee, the Project Coordinator composed drafts of surveys containing 115 items for the adult survey, 75 items for the adolescent grades 6-12 survey, and 81 items for the 0-11 survey. The drafts were reviewed and approved by health education researchers at the University of Toledo.

SAMPLING | Adult Survey

Adults ages 19 and over living in Defiance County were used as the sampling frame for the adult survey. Since U.S. Census Bureau age categories do not correspond exactly to this age parameter, the investigators calculated the population of those 18 years and over living in Defiance County. There were 29,434 persons ages 18 and over living in Defiance County. The investigators conducted a power analysis to determine what sample size was needed to ensure a 95% confidence level with a corresponding margin of error of 5% (i.e., we can be 95% sure that the “true” population responses are within a 5% margin of error of the survey findings.) A sample size of at least 379 adults was needed to ensure this level of confidence. The random sample of mailing addresses of adults from Defiance County was obtained from Allegra Marketing Services in Louisville, KY.

SAMPLING | Adolescent Survey

A sample size of 349 adolescents was needed to ensure a 95% confidence interval with a corresponding 5% margin of error. Students were randomly selected and surveyed in the schools.

SAMPLING | 0-11 Survey

Children ages 0-11 residing in Defiance County were used as the sampling frames for the surveys. Using U.S. Census Bureau data, it was determined that 6,340 children age 0-11 reside in Defiance County. The investigators conducted a power analysis based on a post-hoc distribution of variation in responses (70/30 split) to determine what sample size was needed to ensure a 95% confidence level with corresponding confidence interval of 5% (i.e., we can be 95% sure that the “true” population responses are within a 5% margin of error). Because many of the items were identical between the 0-5 and 6-11 surveys, the responses were combined to analyze data for children 0-11. The sample size required to generalize to children ages 0-11 was 362. The random sample of mailing addresses of parents of children 0-11 from Defiance County was obtained from Allegra Marketing Services in Louisville, KY.

PROCEDURE | Adult Survey

Prior to mailing the survey to adults, an advance letter was mailed to 1,200 adults in Defiance County. This advance letter was personalized, printed on Live Smart Defiance County Health Partners stationery and was signed by Kimberly Moss, Health Commissioner, Defiance County General Health District. The letter introduced the county health assessment project and informed the readers that they may be randomly selected to receive the survey. The letter also explained that the respondents’ confidentiality would be protected and encouraged the readers to complete and return the survey promptly if they were selected.

Three weeks following the advance letter, a three-wave mailing procedure was implemented to maximize the survey return rate. The initial mailing included a personalized hand signed cover letter (on Live Smart Defiance County Health Partners stationery) describing the purpose of the study; a questionnaire printed on colored paper; a self-addressed stamped return envelope; and a $2 incentive. Approximately three weeks after the first mailing, a second wave mailing included another personalized cover letter encouraging them to reply, another copy of the questionnaire on colored paper, and another reply envelope. A third wave postcard was sent three weeks after the second wave mailing. Surveys returned as undeliverable were not replaced with another potential respondent.

The response rate for the mailing was 49% (n=552: CI=± 4.13). This return rate and sample size means that the responses in the health assessment should be representative of the entire county.

PROCEDURE | Adolescent Survey

The survey was approved by all superintendents. Schools and grades were randomly selected. Each student in that grade had to have an equal chance of being in the class that was selected, such as a general English or health class. Classrooms were chosen by the school principal. Passive permission slips were mailed home to parents of any student whose class was selected to participate. The response rate was 95% (n=390: CI=± 4.7).

PROCEDURE | Children 0-5 and 6-11 EXECUTIVE

Prior to mailing the survey to parents of 0-11 year olds, an advance letter was mailed to 1,700 parents in Defiance County. This advance letter was personalized, printed on Live Smart Defiance County Health Partners stationery and was signed by Kimberly Moss, Health Commissioner, Defiance County General Health District. The letter introduced the county health assessment project and informed the readers that they may be randomly selected to receive the survey. The letter also explained that the respondents’ confidentiality would be protected and encouraged the readers to complete and return the survey promptly if they were selected.

DATA ANALYSIS

Individual responses were anonymous and confidential. Only group data are available. All data was analyzed by health education researchers at the University of Toledo using SPSS 17.0. Crosstabs were used to calculate descriptive statistics for the data presented in this report. To be representative of Defiance County, the adult data collected was weighted by age, gender, race, and income using 2010 Census data. Multiple weightings were created based on this information to account for different types of analyses. For more information on how the weightings were created and applied, see Appendix iii.

SUMMARY LIMITATIONS

As with all county assessments, it is important to consider the findings in light of all possible limitations. First, the Defiance County adult assessment had a high response rate. However, if any important differences existed between the respondents and the non-respondents regarding the questions asked, this would represent a threat to the external validity of the results (the generalizability of the results to the population of Defiance County). If there were little to no differences between respondents and non-respondents, then this would not be a limitation.

Second, it is important to note that, although several questions were asked using the same wording as the CDC questionnaires and the NSCH questionnaire, the adult and parent data collection method differed. CDC adult data and NSCH child data were collected using a set of questions from the total question bank and adults were asked the questions over the telephone rather than as a mail survey. The youth CDC survey was administered in schools in a similar fashion as this county health assessment.

Finally, this survey asked parents questions regarding their young children. Should enough parents feel compelled to respond in a socially desirable manner which is not consistent with reality, this would represent a threat to the internal validity of the results.

Data Summary

HEALTH PERCEPTIONS

In 2015, half (51%) of the Defiance County adults rated their health status as excellent or very good. Conversely, 12% of adults, increasing to 15% of those over the age of 65, described their health as fair or poor.

Defiance County Adult Health Perceptions* 100% 0% 12% 13% 11% 15% 10% 13% 15% 20% 17% 26% 80%

38% 37% 34% 37% 35% 34% 37% 34% 60% 51%

40% 74% 51% 52% 51% 48% 53% 51% 49% 46% 20% 34%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance years <$25K $25K Plus 2008 2012 Excellent/Very Good Good Fair/Poor

*Respondents were asked: “Would you say that in general your health is excellent, very good, good, fair or poor?”

HEALTH CARE COVERAGE

The 2015 Health Assessment data has identified that 6% of Defiance County adults were without health care coverage. Those most likely to be uninsured were adults under age 30 and those with an income level under $25,000. In Defiance County, 15.0% of residents live below the federal poverty level (Source: U.S. Census, American Community Survey 3 Year Estimate, 2013).

Uninsured Defiance County Adults 30%

20% 20% 16%

12% 10% 10% 7% 6% 6% 6% 4% 1% 0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

HEALTH CARE ACCESS EXECUTIVE

The 2015 Health Assessment project identified that 59% of Defiance County adults had visited a doctor for a routine checkup in the past year. 57% of adults went outside of Defiance County for health care services in the past year.

CARDIOVASCULAR HEALTH Defiance County Heart disease (17%) and stroke (3%) Leading Types of Death accounted for 20% of all Defiance County 2013 (Preliminary) adult deaths in 2013 (Source: ODH Information Warehouse, 2013 Preliminary Data). The 2015 Total Deaths: 328

Defiance County Health Assessment found 1. Heart Disease (17% of all deaths) that 5% of adults had survived a heart attack 2. Cancer (13%) and 3% had survived a stroke at some time in 3. Chronic Lower Respiratory Diseases (6%) their life. Over one-third (36%) of Defiance 4. Alzheimer’s disease (5%) County adults were obese, 32% had been 5. Stroke (3%) diagnosed with high blood pressure, 32% were sedentary, 27% had high blood (Source: ODH Information Warehouse, 2013) cholesterol, and 15% were smokers, five known risk factors for heart disease and stroke.

CANCER Defiance County In 2015, 8% of Defiance County adults had Incidence of Cancer, 2007-2011 been diagnosed with cancer at some time in their life. The Centers for Disease Control and All Types: 1,049 cases

Prevention (CDC) indicates that from 2009- . Prostate: 179 cases (17%)

2013, a total of 455 Defiance County residents . Breast: 130 cases (12%) died from cancer, the leading cause of SUMMARY . Lung and Bronchus: 169 cases (16%) death in the county. The American Cancer . Colon and Rectum: 106 cases (10%) Society advises that not using tobacco products, maintaining a healthy weight, In 2013, there were 70 cancer deaths in adopting a physically active lifestyle, eating Defiance County. more fruits and vegetables, limiting alcoholic (Source: Ohio Cancer Incidence Surveillance System, beverages and early detection may reduce ODH Information Warehouse, Updated 1/9/2014) overall cancer deaths.

DIABETES

In 2015, 9% of Defiance County adults had been diagnosed with diabetes.

ASTHMA

In 2015, 9% of Defiance County adults had been diagnosed with asthma.

ADULT WEIGHT STATUS

The 2015 Health Assessment identified that 70% of Defiance County adults were overweight or obese based on Body Mass Index (BMI). More than one-third (36%) of Defiance County adults were obese. The 2013 BRFSS indicates that 30% of Ohio and 29% of U.S. adults were obese by BMI. More than two-fifths (43%) of adults were trying to lose weight.

Defiance County Adult BMI Classifications

100%

80% 36% 34% 38% 25% 42% 35% 35% 35% 40% 40%

60% 33% 24% 32% 34% 20% 39% 40% 43% 36% 39% 39%

35% 20% 36% 36% 31% 27% 23% 24% 24% 20% 17% 0% Total Male Female Under 30 30-64 65 & Over Income < Income Defiance Defiance Years $25K $25K 2008 2012 Plus Normal Overweight Obese

(Percentages may not equal 100% due to the exclusion of data for those who were classified as underweight)

ADULT TOBACCO USE

In 2015, 15% of Defiance County adults were current smokers and 21% were considered former smokers. In 2015, the American Cancer Society (ACS) stated that tobacco use was the most preventable cause of death worldwide, and is responsible for the deaths of approximately half of long-term users. Each year, tobacco use is responsible for almost 6 million premature deaths, 80% of which are in low-and middle-income countries, and by 2030, this number is expected to increase to 8 million (Source: Cancer Facts & Figures, American Cancer Society, 2015).

Defiance County Adult Smoking Behaviors

100%

80% 50% 56% 63% 57% 59% 60% 64% 63% 69% 60% 86%

40% 29% 25% 26% 21% 21% 21% 30% 24% 20% 17% 5% 15% 16% 16% 18% 14% 16% 18% 21% 9% 11% 0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012 Current smoker Former smoker Never smoked

Respondents were asked: “Have you smoked at least 100 cigarettes in your entire life? If yes, do you now smoke cigarettes every day, some days or not at all?”

ADULT ALCOHOL CONSUMPTION EXECUTIVE

In 2015, the Health Assessment indicated that 10% of Defiance County adults were considered frequent drinkers (drank an average of three or more days per week, per CDC guidelines). 44% of adults who drank had five or more drinks (for males) or 4 or more drinks (for females) on one occasion (binge drinking) in the past month. Four percent of adults drove after having perhaps too much to drink.

Defiance County Adult Drinkers Who Binge Drank in Past Month* 80%

59% 60% 54%

44% 45% 41% 40% 35% 36% 32% 26% 24%

20%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

*Based on adults who have drunk alcohol in the past month. Binge drinking is defined as having five or more drinks (for males) or four or more drinks (for females) on an occasion. Adults must have reported drinking five or more drinks (for SUMMARY males) or four or more drinks (for females) on an occasion at least once in the previous month.

ADULT MARIJUANA AND OTHER DRUG USE

In 2015, 4% of Defiance County adults had used marijuana during the past 6 months. 3% of adults had used medication not prescribed for them or took more than prescribed to feel good or high and/or more active or alert during the past 6 months.

Defiance County Adult Marijuana Use in Past 6 Months 10%

5% 5% 5% 5% 4% 4% 4% 4% 4%

1% 1%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

WOMEN’S HEALTH

In 2015, nearly two-thirds (66%) of Defiance County women over the age of 40 reported having a mammogram in the past year. 57% of Defiance County women ages 19 and over had a clinical breast exam and 43% had a Pap smear to detect cancer of the cervix in the past year. The Health Assessment determined that 4% of women survived a heart attack and 3% survived a stroke at some time in their life. Almost one-third (31%) had high blood pressure, 30% had high blood cholesterol, 38% were obese, and 16% were identified as smokers, known risk factors for cardiovascular diseases.

Defiance County Women's Health Exams Within the Past Year

100%

75% 66% 62% 59% 57% 58% 59% 58% 59% 53% 55% 53% 50% 45% 45% 50% 41% 43% 38% 38% 38% 29%

25%

0% 0% Total Under 40 40 & Older Income <$25K Income >$25K Defiance 2008 Defiance 2012

Mammogram Breast Exam Pap Smear

MEN’S HEALTH

In 2015, 50% of Defiance County males over the age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases (heart disease and stroke) accounted for 33% and cancers accounted for 27% of all male deaths in Defiance County from 2011-2013. The Health Assessment determined that 4% of men survived a heart attack and 3% survived a stroke at some time in their life. Nearly one-third (32%) of men had been diagnosed with high blood pressure, 25% had high blood cholesterol, and 16% were identified as smokers, which, along with obesity (34%), are known risk factors for cardiovascular diseases.

PREVENTIVE MEDICINE AND HEALTH SCREENINGS

Over half (58%) of adults ages 65 and over had a pneumonia vaccination at some time in their life. More than half (51%) of adults ages 50 and over had a colonoscopy/sigmoidoscopy within the past 5 years.

ADULT SEXUAL BEHAVIOR & PREGNANCY OUTCOMES

In 2015, more than three-fifths (63%) of Defiance County adults had sexual intercourse. Four percent of adults had more than one partner. Prevalence estimates suggest that young people aged 15-24 years acquire half of all new STDs and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papilloma virus (HPV) (Source: CDC, STDs in Adolescents and Young Adults, 2014 STD Surveillance).

QUALITY OF LIFE

In 2015, 39% of Defiance County adults were limited in some way because of a physical, mental or emotional problem.

SOCIAL CONTEXT EXECUTIVE

In 2015, 7% of Defiance County adults were threatened and 7% were abused in the past year (including physical, sexual, emotional, financial, and verbal abuse). 58% of adults reported having

firearms in and around their homes.

MENTAL HEALTH AND SUICIDE

In 2015, 4% of Defiance County adults considered attempting suicide. 14% of adults had a period of two or more weeks when they felt so worried, tense or anxious nearly every day that they stopped doing usual activities.

ORAL HEALTH

The 2015 Health Assessment project has determined that more than three-fifths (65%) of Defiance County adults had visited a dentist or dental clinic in the past year. The 2012 BRFSS reported that 67% of U.S. adults and 68% of Ohio adults had visited a dentist or dental clinic in the previous twelve months. More than three-fourths (76%) of Defiance County youth in grades 6-12 had visited the dentist for a check-up, exam, teeth cleaning, or other dental work in the past year (2013 YRBS reported 75% for Ohio).

PARENTING

The 2015 Health Assessment project identified that 82% of parents discussed dating and relationships with their 10-to-18 year-old in the past year.

YOUTH WEIGHT STATUS

The 2015 Health Assessment identified that 18% of Defiance County youth were obese, according

to Body Mass Index (BMI) by age. When asked how they would describe their weight, 32% of SUMMARY Defiance County youth reported that they were slightly or very overweight. 75% of youth were exercising for 60 minutes on 3 or more days per week. 94% of youth were involved in extracurricular activities.

Defiance County Youth BMI Classifications 4% 4% 4% 6% 3% 3% 9% 5% 100%

80% 62% 57% 59% 67% 58% 60% 71% 59% 74%

40%

23% 19% 16% 11% 19% 20% 9% 18% 13% 19% 18% 16% 15% 19% 17% 14% 15% 0% Total Male Female 13 or 14 to 16 17 & Older Defiance Defiance younger Total 2008 Total 2012 Obese Overweight Normal Weight Underweight

YOUTH TOBACCO USE

The 2015 Health Assessment identified that 8% of Defiance County youth in grades 6-12 were smokers, increasing to 13% of those ages 17 and older. Nearly three-fourths 73% of Defiance County youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days. In the past week, two-thirds (66%) of all Defiance County youth were in a home or car with someone who was smoking.

Defiance County Youth Who Are Current Smokers 30%

20%

13% 12% 11% 11%

10% 8% 8% 6% 4%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

YOUTH ALCOHOL CONSUMPTION

In 2015, the Health Assessment results indicated that 50% of Defiance County youth in grades 6-12 had drank at least one drink of alcohol in their life, increasing to 69% of youth seventeen and older. 35% of those 6th-12th graders who drank, took their first drink at 12 years or younger. 20% of all Defiance County 6th-12th grade youth and 34% of those over the age of 17 had at least one drink in the past 30 days. Nearly half (48%) of the 6th-12th grade youth who reported drinking in the past 30 days had at least one episode of binge drinking. 2% of all youth drivers had driven a car in the past month after they had been drinking alcohol.

Defiance County Youth Current Drinkers Binge Drinking in Past Month* 100%

80%

56% 60% 54% 48% 50% 48% 46% 46% 45%

40%

20%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

*Based on all current drinkers. Binge drinking is defined as having five or more drinks on an occasion.

YOUTH MARIJUANA AND OTHER DRUG USE EXECUTIVE

In 2015, 9% of Defiance County 6th-12th grade youth had used marijuana at least once in the past 30 days, increasing to 15% of high school youth. 9% of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life, increasing to 15% of those over the age of 17.

Defiance County Youth Lifetime Drug Use 15%

10% 8% 7%7% 6% 6%

5% 4% 3% 3% 3% 3% 2% 2% 2% 2% 2% 1% 1% 1%1% 1% <1% 1% 1% 1% 0% 0% Cocaine Heroin Meth Steroids Inhalants

Total Male Female Defiance Total 2008 Defiance Total 2012

SUMMARY

YOUTH SEXUAL BEHAVIOR & PREGNANCY OUTCOMES

In 2015, nearly one-quarter (23%) of Defiance County youth have had sexual intercourse, increasing to 42% of those ages 17 and over. 22% of youth had participated in oral sex and 7% had participated in anal sex. 22% of youth participated in sexting. Of those who were sexually active, 53% had multiple sexual partners. One Defiance County school did not ask sexual behavior questions.

Defiance County Youth Who Had Sexual Intercourse 75%

50% 42%

28% 23% 24% 24% 24% 25% 21%

3% 0% Total Male Female 13 or 14 to 16 17 & Defiance Defiance Younger Older Total 2008 Total 2012

YOUTH MENTAL HEALTH AND SUICIDE

In 2015, the Health Assessment results indicated that 15% of Defiance County 6th-12th grade youth had seriously considered attempting suicide in the past year and 5% admitted actually attempting suicide in the past year.

Defiance County Youth Who Felt Sad or Hopeless Almost Every Day for Two Weeks or More in a Row 50%

40% 29% 28% 30% 23% 25% 23% 22% 18% 18% 20%

10%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

YOUTH SAFETY

In 2015, 13% of youth had ridden in a car driven by someone who had been drinking alcohol in the past month and 2% of youth drivers had driven after drinking alcohol. 43% of youth drivers texted while driving. 18% of youth reported that they had suffered a blow or jolt to the head while playing with a sports team which caused them to get “knocked out,” have memory problems, double or blurry vision, headaches or “pressure” in the head, or nausea or vomiting, increasing to 24% of high school youth and 27% of those ages 17 and older.

YOUTH VIOLENCE

In Defiance County, 26% of youth had been involved in a physical fight in the past year. 11% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months. 49% of youth had been bullied in the past year and 31% had been bullied on school property.

Defiance County Youth Involved in a Physical Fight in the Past Year 50%

40% 33% 31%

27% 28% 30% 26% 26%

18% 17% 20%

10%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

CHILD HEALTH AND FUNCTIONAL STATUS EXECUTIVE

In 2015, 23% of children were classified as obese by Body Mass Index (BMI) calculations. 78% of Defiance County parents had taken their child ages 0-11 to the dentist in the past year. 7% of Defiance County parents reported their child ages 0-11 had been diagnosed with asthma. 6% of parents reported their child had been diagnosed with ADD/ADHD.

CHILD HEALTH INSURANCE, ACCESS & UTILIZATION

In 2015, 1% of Defiance County parents reported their 0-11 year old did not have health insurance. 22% of parents reported they had taken their child to the hospital emergency room in the past year. 72% of parents had taken their child to the doctor for preventive care in the past year.

EARLY CHILDHOOD (0-5 YEARS OLD)

The following information was reported by parents of 0-5 year olds. 90% of mothers got prenatal care within the first three months during their last pregnancy. 6% of mothers smoked during their last pregnancy. 61% of parents put their child to sleep on his/her back. 25% of mothers never breastfed their child.

MIDDLE CHILDHOOD (6-11 YEARS OLD)

The following information was reported by Defiance County parents of 6-11 year olds. In 2015, 67% of Defiance County parents reported their child always feels safe at school. 44% of parents reported their child was bullied at some time in the past year. 85% of parents reported their child participated in extracurricular activities. 23% of parents reported their child had an email or a social network account.

FAMILY FUNCTIONING, NEIGHBORHOOD AND COMMUNITY CHARACTERISTICS SUMMARY

In 2015, 71% of Defiance County parents reported their 0-11 year old child slept 10-11 hours per night. 95% of parents reported their neighborhood was always or usually safe enough for their child to go out and play. 1% of parents reported there was an unlocked and loaded firearm in their home. 8% of parents reported they received benefits from the SNAP/food stamps program.

PARENT HEALTH

In 2015, 10% of Defiance County parents were uninsured. 38% of parents were overweight and 31% were obese. Parents missed work an average of 2.2 days per year due to their child being ill or injured.

Adult І TREND SUMMARY

Defiance Defiance Defiance Ohio U.S. Adult Variables County County County 2013 2013 2008 2012 2015 Health Status Rated health as excellent or very good 53% 49% 51% 50% 52% Rated general health as fair or poor 13% 17% 12% 18% 17% Health Care Coverage Uninsured 12% 10% 6% 14% 17% Arthritis, Asthma, & Diabetes Has been diagnosed with diabetes 12% 12% 9% 11% 11% Has been diagnosed with asthma 3% 12% 9% 14% 14% Cardiovascular Health Had angina 2% 2% 1% 5% 4% Had a heart attack 4% 5% 5% 5% 4% Had a stroke 2% 2% 3% 4% 3% Has been diagnosed with high blood pressure 18% 34% 32% 34% 31% Has been diagnosed with high blood cholesterol 18% 24% 27% 38% 38% Had blood cholesterol checked within the past 5 76% 75% 70% 78% 76% years Cancer Diagnosed with skin cancer (melanoma or other N/A 4% 2% 6% 6% skin cancers) Diagnosed with any type of cancer, other than skin N/A 11% 6% 7% 7% cancer Weight Status Overweight 32% 39% 34% 35% 35% Obese 35% 35% 36% 30% 29% Ate 5 or more servings of fruits/vegetables per day N/A 8% 6% 21%*** 23%*** Alcohol Consumption Had at least one alcoholic beverage in past month 52% 53% 49% 53% 55% Binged in past month (5 or more drinks in a couple 20% 20% 23% 17% 17% of hours on an occasion) Tobacco Use Current smoker (currently smoke some or all days) 21% 18% 15% 23% 19% Former smoker (smoked 100 cigarettes in lifetime & 29% 26% 21% 25% 25% now do not smoke) Drug Use Adults who used marijuana in the past 6 months 5% 4% 4% N/A N/A Adults who misused prescription drugs in the past 6 1% 7% 3% N/A N/A months Adults who used other recreational drugs in the 6% 5% <1% N/A N/A past 6 months N/A - not available * 2012 BFRSS Data ***2009 BRFSS Data

Defiance Defiance Defiance Ohio U.S. Adult Variables County County County 2013 2013

2008 2012 2015

Preventive Medicine TREND Had a pneumonia vaccine (ages 65 and older) N/A N/A 58% 71% 70% Had a flu vaccine in the past year (ages 65 and N/A N/A 76% 63% 63% over) Had a clinical breast exam in the past two years 74% 66% 73% 75%** 77%** (ages 40 and older) Had a mammogram in the past two years 69% 67% 80% 74%* 74%* (ages 40 and older) Had a pap smear in the past three years 79% 74% 73% 78%* 78%* Had a digital rectal exam within the past year 33% 22% 15% N/A N/A Had a PSA test within the past year 32% 28% 22% N/A N/A Quality of Life Limited in some way because of physical, mental 25% 37% 39% 21% 20% or emotional problem Mental Health Considered attempting suicide in the past year 3% 2% 4% N/A N/A

Two or more weeks in a row felt sad or hopeless 11% 13% 16% N/A N/A SUMMARY Oral Health Adults who have visited the dentist in the past year 64% 65% 65% 68%* 67%* N/A - not available * 2012 BFRSS Data **2010 BRFSS Data

Youth І TREND SUMMARY

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Variables 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th) Weight Control Obese 14% 15% 18% 20% 13% 14% Overweight 18% 13% 16% 14% 16% 17% Described themselves as slightly or very 29% 29% 32% 33% 28% 31% overweight Trying to lose weight 45% 48% 46% 49% 47% 48% Exercised to lose weight 50% 52% 49% 53% 61%‡ 61%‡ Ate less food, fewer calories, or foods lower in 27% 34% 33% 39% 43%‡ 39%‡ fat to lose weight Went without eating for 24 hours or more 4% 7% 7% 7% 10% 13% Took diet pills, powders, or liquids without a 1% 2% 2% 3% 5% 5% doctor’s advice Vomited or took laxatives 2% 2% 2% 2% 5% 4% Ate 1 to 4 servings of fruits and vegetables N/A 83% 85% 86% 85%‡ 78%‡ per day Physically active at least 60 minutes per day 31% 34% 31% 30% 26% 27% on every day in past week Physically active at least 60 minutes per day 53% 59% 55% 56% 48% 47% on 5 or more days in past week Did not participate in at least 60 minutes of 11% 8% 11% 13% 13% 15% physical activity on any day in past week Watched TV 3 or more hours per day 36% 30% 23% 21% 28% 33% Unintentional Injuries and Violence Rarely or never wore a seatbelt 9% 10% 7% 7% 8% 8% Carried a weapon in past month 11% 13% 13% 13% 14% 18% Been in a physical fight in past year 27% 26% 26% 20% 20% 25% Did not go to school because felt unsafe 4% 4% 4% 3% 5% 7% Bullied on school property in past year N/A 36% 31% 21% 21% 20% Bullied in past year 51% 51% 49% 43% N/A N/A Electronically/cyber bullied in past year 8% 15% 13% 14% 15% 15% Physically forced to have sexual intercourse 3% 7% 4% 3% 8% 7% Hit, slapped, or physically hurt on purpose by 5% 6% 4% 5% 7% 9%‡ their boyfriend or girlfriend in past year Alcohol Consumption Ever tried alcohol 54% 57% 50% 62% 71%* 66% Current drinker 19% 24% 20% 28% 30% 35% Binge drinker (of all youth) 11% 14% 10% 14% 16% 21% Drank for the first time before age 13 23% 14% 16% 13% 13% 19% (of all youth) Rode with someone who was drinking 18% 13% 13% 10% 17% 22% Drank and drove (of youth drivers) 5% 3% 2% 3% 4% 10% Obtained the alcohol they drank by 62% 39% 24% 28% 38% 42% someone giving it to them * Comparative YRBS data for Ohio and U.S. is 2011, ‡ Comparative YRBS data for Ohio is 2007 and U.S. is 2009 N/A – Not available

Defiance Defiance Defiance Defiance Ohio U.S. County County County County

Youth Variables 2013 2013 2008 2012 2015 2015 th th th th th th th th th th th th (9 -12 ) (9 -12 ) (6 -12 ) (6 -12 ) (6 -12 ) (9 -12 ) TREND Tobacco Use Ever tried cigarettes 30% 31% 23% 33% 52%* 41% Current smokers 12% 11% 8% 13% 15% 16% Tried to quit smoking 46% 51% 52% 56% 56%* 48% (of those youth who smoked in the past year) Smoked cigarettes on 20 or more days during 4% 2% 2% 3% 7% 6% the past month (of all youth) Smoked a whole cigarette for the first time 11% 7% 4% 3% 14%* 9% before the age of 13 (of all youth) Used chewing tobacco or snuff in the past 6% 5% 3% 5% 9% 9% month Sexual Behavior Ever had sexual intercourse 24% 28% 23% 35% 43% 47% Used a condom at last intercourse 66% 64% 61% 68% 51% 59% Used birth control pills at last intercourse 28% 32% 24% 29% 24% 19% Did not use any method to prevent 19% 13% 13% 10% 12% 14% pregnancy during last sexual intercourse

Had four or more sexual partners SUMMARY 4% 5% 6% 8% 12% 15% (of all youth) Had sexual intercourse before age 13 4% 3% 3% 2% 4% 6% (of all youth) Drank alcohol or used drugs before last sexual 17% 18% 18% 16% 18% 22% intercourse Drug Use Youth who used marijuana in the past month 8% 8% 9% 15% 21% 23% Ever used methamphetamines 3% 1% <1% 0% 6%‡ 3% Ever used cocaine 2% 3% 2% 3% 4% 6% Ever used heroin 2% 1% 1% 0% 2% 2% Ever used steroids 2% 4% 2% 1% 3% 3% Ever used inhalants 7% 8% 6% 4% 9% 9% Ever used ecstasy/MDMA N/A 2% 2% 2% N/A 7% Ever misused medications 7% 12% 9% 13% N/A 18% Ever been offered, sold, or given an illegal drug by someone on school property in the 16% 5% 4% 6% 20% 22% past year Preventive Care Suffered a blow or jolt to the head N/A N/A 18% 24% 12% N/A Visited a dentist for a check-up within the past N/A 75% 76% 78% 75% N/A year Ever told by a doctor or nurse they had 20% 20% 18% 18% N/A 21% asthma Mental Health Youth who had seriously considered 11% 15% 15% 14% 14% 17% attempting suicide in the past year

Youth who had attempted suicide in the past 7% 5% 5% 3% 6% 8% year Youth who felt sad or hopeless almost every 22% 25% 23% 24% 26% 30% day for 2 or more weeks in a row * Comparative YRBS data for Ohio and U.S. is 2011, ‡ Comparative YRBS data for Ohio is 2007 and U.S. is 2009 N/A – Not available

Child І TREND SUMMARY

Defiance Defiance Ohio U.S. Ohio U.S. County County 2011/12 2011/12 2011/12 2011/12 Child Comparisons 2015 2015 Ages Ages Ages Ages Ages Ages 0-5 0-5 6-11 6-11 0-5 6-11 Health and Functional Status Rated health as excellent or very 94% 89% 86% 92% 86% 83% good Dental care visit in past year 53% 50% 54% 89% 92% 88% Diagnosed with asthma 2% 6% 6% 9% 10% 10% Diagnosed with ADHD/ADD 2% N/A 2%* 8% 12% 9% Diagnosed with behavioral or 0% N/A 2%** 3% 5% 4% conduct problems Diagnosed with vision problems 0% N/A <1% 4% N/A 2% that cannot be corrected

Diagnosed with bone, joint, or 1% N/A 1% 2% N/A 2% muscle problems Diagnosed with epilepsy 0% N/A <1% <1% N/A 1% Diagnosed with a head injury 1% N/A <1% 1% N/A <1% Diagnosed with diabetes 0% N/A N/A <1% N/A <1% Diagnosed with depression 0% N/A <1%* 2% N/A 2% Health Insurance, Access, Utilization and Medical Home Had public insurance 27% 40% 44% 19% 34% 37% Been to doctor for preventive 86% 94% 90% 64% 86% 82% care in past year 2 or more visits to the ER 10% 8%* 8%* 8% 6%* 4%* Received all the medical care 88% 99%* 99%* 89% 98%* 98%* they needed Have a personal doctor or nurse 80% 91% 91% 74% 93% 90% N/A – Not available *2007 National Survey of Children’s Health ** Ages 2-5

Defiance Defiance Ohio U.S. Ohio U.S. County County 2011/12 2011/12 2011/12 2011/12 Child Comparisons 2015 2015 Ages Ages Ages Ages TREND Ages Ages 0-5 0-5 6-11 6-11 0-5 6-11 Family Functioning Parent reads to child every 19% 53% 48% N/A N/A N/A day Never breastfed their child 25% 29% 21% N/A N/A N/A Child did not miss any days of school because of illness or N/A N/A N/A 27% 16%* 22%* injury Child missed school 11 days or more because of illness or N/A N/A N/A <1% 8%* 5%* injury Parent felt child was N/A N/A N/A 96% 96% 94% usually/always safe at school Family eats a meal together 50% 63% 61% 40% 45% 47% every day of the week

Child never attends religious SUMMARY 5% N/A N/A 12% 22% 18% services Neighborhood is usually or 96% 88% 86% 95% 86% 86% always safe Parent Health Mother’s mental or emotional 1% 7% 7% 5% 10% 8% health is fair/poor

Father’s mental or emotional 11% N/A 3% 2% 7% 5% health is fair/poor N/A – Not available *2007 National Survey of Children’s Health ‡ Children ages 4months-5 years

Adult І HEALTH STATUS PERCEPTIONS

Key Findings Adults Who Rated General Health In 2015, half (51%) of the Defiance County adults rated Status Excellent or Very Good their health status as excellent or very good. Conversely, . 12% of adults, increasing to 15% of those over the age of Defiance County 51% (2015) . 65, described their health as fair or poor. Ohio 50% (2013) . U.S. 52% (2013)

General Health Status (Source: BRFSS 2013 for Ohio and U.S.)

. In 2015, half (51%) of Defiance County adults rated their health as excellent or very good. Defiance County adults with higher incomes (53%) were most likely to rate their health as excellent or very good, compared to 46% of those with incomes less than $25,000.

. 12% of adults rated their health as fair or poor. The 2013 BRFSS has identified that 18% of Ohio and 17% of U.S. adults self-reported their health as fair or poor.

. Defiance County adults were most likely to rate their health as fair or poor if they:  Had been diagnosed with diabetes (27%)  Were widowed (27%)  Had an annual household income under $25,000 (20%)  Had high blood cholesterol (20%) or high blood pressure (18%)

The following graph shows the percentage of Defiance County adults who described their personal health status as excellent/very good, good, and fair/poor. Examples of how to interpret the information include: 51% of all Defiance County adults, 74% of those under age 30, and 34% of those ages 65 and older rated their health as excellent or very good.

Defiance County Adult Health Perceptions* 100% 0% 12% 13% 11% 15% 10% 13% 15% 20% 17% 26% 80% 38% 37% 34% 37% 35% 34% 37% 34% 60% 51%

40% 74% 51% 52% 51% 48% 53% 51% 49% 46% 20% 34%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance years <$25K $25K Plus 2008 2012 Excellent/Very Good Good Fair/Poor

*Respondents were asked: “Would you say that in general your health is excellent, very good, good, fair or poor?”

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Rated health as excellent or very good 53% 49% 51% 50% 52% Rated health as fair or poor 13% 17% 12% 18% 17%

HEALTH CARE C

Adult І HEALTH CARE COVERAGE

Key Findings Defiance County and Ohio Medicaid Statistics

The 2015 Health Assessment Average Defiance Ohio data has identified that 6% of Members Per County Residents Defiance County adults were Year Residents Enrolled in without health care coverage. Enrolled in Medicaid Those most likely to be uninsured 2010 Medicaid were adults under age 30 and 4,077 1,159,095 those with an income level Ages 0-18 (58%) (55%) under $25,000. In Defiance County, 15.0% of residents live 2,570 787,749 Ages 19-64 below the federal poverty level (36%) (38%) (Source: U.S. Census, American Community Survey 3 Year Estimate, Ages 65 and 395 155,896 2013). Over (6%) (7%) 7,042 2,102,740 Total General Health Coverage (100%) (100%) *(Percent of Members Enrolled = Total Enrollment/Population per . In 2015, 94% Defiance County U.S. Census Bureau) adults had health care (Source: Ohio Department of Job & Family Services, Defiance coverage, leaving 6% who County 2008-2011 Profile, were uninsured. The 2013 BRFSS http://jfs.ohio.gov/county/cntypro/pdf11/Defiance.pdf) reports uninsured prevalence rates for Ohio (14%) and the U.S. (17%).

. In the past year, 6% of adults were uninsured, increasing to 16% of those under the age of 30 and 20% of those with incomes less than $25,000.

. 10% of adults with children did not have healthcare coverage, compared to 5% of those who did not have children living in their household. OVERAGE . The following types of health care coverage were used: employer (45%), someone else’s employer (20%), Medicare (14%), self-paid plan (6%), Medicaid or medical assistance (6%), multiple-including private sources (4%), multiple-including government sources (1%), military or VA (1%), and other (2%).

6% of Defiance County adults were uninsured.

. Defiance County adult health care coverage includes the following: medical (98%), prescription coverage (91%), preventive care (73%), immunizations (73%), dental (70%), outpatient therapy (67%), their spouse (65%), vision (63%), mental health (54%), their children (52%), mental health counseling (48%), alcohol and drug treatment (40%), home care (27%), skilled nursing (27%), their partner (26%), long-term care (26%), and hospice (26%).

. The top reasons uninsured adults gave for being without health care coverage were: 1. They lost their job or changed employers (43%) 2. They could not afford to pay the insurance premiums (22%) 3. They became a part-time/temporary employee (17%)

(Percentages do not equal 100% because respondents could select more than one reason)

The following graph shows the percentages of Defiance County adults who were uninsured by demographic characteristics. Examples of how to interpret the information in the graph includes: 6% of all Defiance County adults were uninsured, 20% of adults with an income less than $25,000 reported being uninsured and 16% of those under age 30 lacked health care coverage. The pie chart shows sources of Defiance County adults’ health care coverage.

Uninsured Defiance County Adults 30%

20% 20% 16% 12% 10% 10% 7% 6% 6% 6% 4% 1%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

20 % of Defiance County adults with incomes less than $25,000 were

uninsured.

Source of Health Coverage for Defiance County Adults

Medicaid 6% Medicare Self-purchased 14% 6% Other 2% Employer Someone Else's 46% Employer

20%

Military 1% Multiple- Multiple-private govt. sources sources 4% 1%

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Uninsured 12% 10% 6% 14% 17%

Healthy People 2020 HEALTH CARE C Access to Health Services (AHS)

Defiance Healthy Ohio U.S. Objective County People 2020 2013 2013 2015 Target

84% age 20-24 79% age 18-24 76% age 18-24 AHS-1.1: Persons 94% age 25-34 76% age 25-34 74% age 25-34 under age of 65 93% age 35-44 87% age 35-44 80% age 35-44 100% years with health 97% age 45-54 86% age 45-54 84% age 45-54 care insurance 93% age 55-64 88% age 55-64 87% age 55-64

*U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2013 BRFSS, 2015 Defiance County Health Assessment)

The following chart shows what is included in Defiance County adults’ insurance coverage Don’t Health Coverage Includes: Yes No Know Medical 98% <1% 2% Prescription Coverage 91% 5% 4% Preventive Health 73% 5% 22% Immunizations 73% 7% 20% Dental 70% 27% 3% Outpatient Therapy 67% 3% 30% Their Spouse 65% 26% 9% Vision 63% 31% 6% Mental Health 54% 10% 36% Their Children 52% 37% 11% OVERAGE Mental Health Counseling 48% 11% 41% Alcohol and Drug Treatment 40% 7% 53% Home Care 27% 12% 61% Skilled Nursing 27% 11% 62% Their Partner 26% 44% 30% Long-Term Care 26% 22% 52% Hospice 26% 9% 65%

Ohio Medicaid Assessment Survey

. More than 2.3 million Ohioans were enrolled in Medicaid in December 2012. . An estimated 1.5 million Ohioans do not have health insurance, and most of them are from working families. . In Ohio, 593,912 residents were uninsured with incomes below 138 percent of poverty in 2010, and 5,309 of these residents were from Defiance County. . Medicaid plays a critical role in protecting the health of low-income Ohioans, but it leaves out many people. Like many states, Ohio does not extend Medicaid coverage to adults unless they have children or are disabled.

(Source: Office of Health Transformation, Extend Medicaid Coverage and Automate Enrollment, 1/31/2013, from: http://healthtransformation.ohio.gov/LinkClick.aspx?fileticket=oid6Wo-y0gs%3D&tabid=160)

Adult І HEALTH CARE ACCESS AND UTILIZATION

Key Findings Health Care Access among Employed and

Unemployed Adults The 2015 Health Assessment project identified that 59% of Defiance County . In 2009–2010, 48.1% of unemployed adults aged adults had visited a doctor for a routine 18–64 years had health insurance compared with checkup in the past year. 57% of adults 81.4% of employed adults. went outside of Defiance County for health . The unemployed were less likely to receive care services in the past year. needed prescriptions due to cost than the employed in all insurance categories. Health Care Access . Unemployed adults in 2009–2010 were more likely to have fair or poor health than employed adults . Almost half (46%) of adults rated their across all categories of insurance coverage.

satisfaction with their overall health care (Source: CDC, Access to Health Care, 2012, as excellent or very good. Conversely, http://www.cdc.gov/nchs/fastats/access_to_health_care.htm) 11% of adults rated their satisfaction with their health care as fair or poor, increasing to 24% of those with no health care coverage.

. Nearly three-fifths (59%) of Defiance County adults visited a doctor for a routine checkup in the past year, increasing to 81% of those over the age of 65.

. 69% of adults had seen a physician assistant or nurse practitioner for their health care needs in the past year.

. 29% of adults visited the emergency room in the past year, increasing to 41% of those with incomes less than $25,000.

. 89% of Defiance County adults reported they had one particular place they usually went if they were sick or needed advice about their health.

. Reasons for not having a usual source of medical care included: had not needed a doctor (34%), had two or more usual places (22%), cost/no insurance (8%), previous doctor unavailable/moved (8%), do not like/trust/ believe in doctors (5%), did not know where to go (2%), multiple reasons (2%), and other reasons (12%).

. Adults visited the following places for health care services: doctor’s office (74%), urgent care center (8%), multiple places- including doctor’s office (7%), Internet (3%), public health clinic or community health department (3%), hospital emergency room (3%), multiple places- not including a doctor’s office (1%), Department of Veterans Affairs (VA) (1%), in-store health clinic (<1%), and some other kind of place (1%). <1% of adults indicated they had no usual place for health care services.

. The following might prevent Defiance County adults from seeing a doctor if they were sick, injured, or needed some kind of health care: cost (35%), difficult to get an appointment (17%), hours not convenient (10%), could not get time off work (8%), worried they might find something wrong (3%), frightened of the procedure or doctor (3%), difficult to find/no transportation (3%), do not trust or believe doctors (2%), and some other reason (3%).

. Defiance County adults had the following problems when they needed health care in the past year: could not get appointments when they wanted them (13%), did not have enough money to pay for health care or insurance (8%), could not find a doctor to take them as a patient (7%), had to change doctors because of their healthcare plan (5%), could not find a C HEALTH doctor they were comfortable with (4%), did not have insurance (3%), did not have transportation (2%), too busy to get the healthcare they needed (1%), healthcare plan did not allow them to see doctors in Defiance County (1%), too embarrassed to seek help (1%), did not have child care (<1%), did not get health services because they were concerned about their confidentiality (<1%), did not get health services because of discrimination (<1%), and other problems that prevented them from getting health care (1%).

. Defiance County adults did not get the following major or preventive care because of cost: medications (7%), mammograms (6%), Pap smears (6%), lab testing (6%), colonoscopies (5%), surgery (4%), weight loss program (3%), PSA tests (2%), mental health services (2%), immunizations (2%), smoking cessation (1%), family planning services (1%), and alcohol or drug treatment (1%).

. 57% of adults went outside of Defiance County for the following health care services in the past year: specialty care (26%), dental services (17%), primary care (11%), cardiac care (5%), obstetrics/gynecology/NICU (4%), pediatric care (3%), orthopedic care (2%), cancer care (2%), pediatric therapies (2%), mental health care (1%), counseling (1%), addiction services (<1%), developmental disability services (<1%), and other services (8%).

. Defiance County adults had the following issues regarding their healthcare coverage: ARE deductibles were too high (44%), co-pays were too high (27%), premiums were too high (25%), high HSA account deductible (10%), could not understand their insurance plan (7%), working with their insurance company (7%), limited visits (7%), service is no longer covered (6%), opted out of certain coverage because they could not afford it (6%), provider is no longer covered (5%), service not deemed medically necessary (4%), difficulty navigating the Marketplace (3%), and opted out of certain coverage because they did not need it (1%).

. Defiance County adults had the following transportation issues when they needed health services: no car (3%), no driver’s license (3%), could not afford gas (3%), disabled (3%), limited public transportation available or accessible (2%), no car insurance (1%), car did not work A (1%), no transportation before or after 8 a.m.- 4:30 p.m. (1%), no public transportation available or accessible (1%), and other car issues/expenses (1%). CCESS . Defiance County adults preferred to obtain information about their health or healthcare services from: their doctor (71%), a family member or friend (11%), Internet searches (9%), newspaper articles or radio/television news stories (2%), advertisings or mailings from hospitals, clinics or doctor’s offices (2%), text messages (1%), and Facebook (<1%).

Availability of Services

. 5% of Defiance County adults have looked for a program to assist in care for the elderly (either in-home or out-of-home) for either themselves or a loved one. Of those who looked, 26% looked for in-home care, 19% looked for an assisted living program, 19% looked for out-of- home placement, and 4% looked for end-of-life care. 33% of adults looked for multiple types of elderly care programs.

. Defiance County adults reported they had looked for the following programs for themselves or a loved one: family planning (5%) and alcohol or drug abuse/addiction (1%).

Defiance County Adults Able to Access Assistance Programs/Services Defiance County adults Defiance County adults Types of Programs who have looked but who have looked and (% of all adults who looked for the have NOT found a specific have found a specific programs) program program Family Planning 5% 95% (5% of all adults looked) Alcohol or Drug Abuse/Addiction 0% 100% (1% of all adults looked)

Health Care Access and Utilization among Young Adults Ages 19-25

. From January through September 2011, 77.9% of women ages 19–25 had a usual place for health care compared with 62.5% of men in the same age group. . Among adults ages 19–25, those with public health coverage were more likely to have had an emergency room visit in the past 12 months than those with private coverage or the uninsured. . In 2011, 57.9% of Hispanic persons ages 19–25 had a usual place for health care. This was significantly less than non-Hispanic white (74.9%) and non-Hispanic black (68.4%) persons. . In the first 9 months of 2011, adults ages19–25 who were poor (67.2%) and those who were near poor (63.0%) were less likely than those who were not poor (76.0%) to have had a usual place for health care. . 28% of uninsured adults ages 19–25 delayed or did not get needed medical care due to cost compared with 7.6% of those with private health insurance and 10.1% of those with public coverage.

(Source: CDC, Health Care Access and Utilization among Young Adults Aged 19-25, 2012, http://www.cdc.gov/nchs/data/nhis/earlyrelease/Young_Adults_Health_Access_052012)

Adult І CARDIOVASCULAR HEALTH

CARDIOVASCULAR Key Findings Defiance County

Leading Types of Death Heart disease (17%) and stroke (3%) 2013 (Preliminary) accounted for 20% of all Defiance County adult deaths in 2013 (Source: ODH Information Total Deaths: 328 Warehouse, 2013 Preliminary Data). The 2015 Defiance County Health Assessment found 1. Heart Disease (17% of all deaths) that 5% of adults had survived a heart attack 2. Cancer (13%) and 3% had survived a stroke at some time in 3. Chronic Lower Respiratory Diseases (6%) their life. Over one-third (36%) of Defiance 4. Alzheimer’s disease (5%) 5. Stroke (3%) County adults were obese, 32% had been diagnosed with high blood pressure, 32% were (Source: ODH Information Warehouse, 2013) sedentary, 27% had high blood cholesterol, and 15% were smokers, five known risk factors for heart disease and stroke. Ohio Leading Types of Death Heart Disease and Stroke 2013 (Preliminary)

. In 2015, 5% of Defiance County adults Total Deaths: 110,001

reported they had survived a heart attack 1. Heart Disease (17% of all deaths) (myocardial infarction), increasing to 8% of 2. Cancers (15%) those over the age of 65. 3. Chronic Lower Respiratory Diseases (5%)

4. Stroke (4%) . 64% of adults who had survived a heart 5. Accidents, Unintentional Injuries (3%) attack were receiving treatment as a result of their heart attack. (Source: ODH Information Warehouse, 2013)

. 5% of Ohio and 4% of U.S. adults reported they had a heart attack or myocardial infarction in 2013 (Source: 2013 BRFSS).

. 3% of Defiance County adults reported they had survived a stroke, increasing to 5% of those over the age of 65.

. 9% of adults who had survived a stroke were receiving treatment as a result of their stroke.

. 4% of Ohio and 3% of U.S. adults reported having had a stroke in 2013 (Source: 2013 BRFSS).

. 8% of adults reported they had angina or coronary heart disease, increasing to 15% of those over the age of 65.

. 66% of adults with angina or coronary heart disease were receiving treatment for their angina or heart disease.

. 5% of Ohio and 4% of U.S. adults reported having had angina or coronary heart disease in 2013 (Source: 2013 BRFSS).

High Blood Pressure (Hypertension)

. Almost one-third (32%) of adults had been diagnosed with high blood pressure. The 2013 BRFSS reports hypertension prevalence rates of 34% for Ohio and 31% for the U.S.

. 88% of adults with high blood pressure were receiving treatment for their high blood pressure.

. 82% of adults had their blood pressure checked within the past year.

. Defiance County adults diagnosed with high blood pressure were more likely to: o Have been age 65 years or older (65%) o Have been classified as obese by Body Mass Index-BMI (48%) o Have rated their overall health as fair or poor (48%)

High Blood Cholesterol

. More than one-fourth (27%) of adults had been diagnosed with high blood cholesterol. The 2013 BRFSS reported that 38% of both Ohio and U.S. adults have been told they have high blood cholesterol.

. 75% of adults with high blood cholesterol were receiving treatment for their high blood cholesterol.

. More than two-thirds (70%) of adults had their blood cholesterol checked within the past 5 years. The 2013 BRFSS reported 78% of Ohio and 76% of U.S. adults had their blood cholesterol checked within the past 5 years.

. Defiance County adults with high blood cholesterol were more likely to: o Have been age 65 years or older (60%) o Have rated their overall health as fair or poor (44%) o Have been classified as obese by Body Mass Index-BMI (36%)

The following graph demonstrates the percentage of Defiance County adults who had major risk factors for developing cardiovascular disease (CVD). Defiance County Adults with CVD Risk Factors

50%

36% 32% 32%

27%

25%

15%

0% Obesity High Blood Sedentary High Blood Smoking Diabetes Pressure Cholesterol

(Source: 2015 Defiance County Health Assessment)

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had angina 2% 2% 1% 5% 4% Had a heart attack 4% 5% 5% 5% 4% Had a stroke 2% 2% 3% 4% 3% Had high blood pressure 18% 34% 32% 34% 31% Had high blood cholesterol 18% 24% 27% 38% 38%

The following graphs show the number of Defiance County adults who have been diagnosed with high blood pressure, high blood cholesterol and cardiovascular disease prevalence. Examples of how to interpret the information on the first graph include: 32% of all Defiance County adults have been diagnosed with high blood pressure, 32% of all Defiance County males, 31% of all females, CARDIOVASCULAR and 65% of those 65 years and older.

Diagnosed with High Blood Pressure*

80%

65%

60%

38% 40% 32% 32% 33% 34% 34% 31% 18% 20% 7%

0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012 *Does not include respondents who indicated high blood pressure during pregnancy only.

Diagnosed with High Blood Cholesterol 80%

60% 60%

40% 33% 30% 30% 27% 29% 25% 24% 18% 20% 5%

0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Cardiovascular Disease Prevalence

10%

5% 5% 4% 5% 3%

0% Heart Attack Stroke Defiance 2015 Ohio 2013

(Source: 2015 Defiance Health Assessment and 2013 BRFSS)

The following graphs show the age-adjusted mortality rates per 100,000 population for heart disease and stroke.

. When age differences are accounted for, the statistics indicate that the 2010 Defiance County heart disease mortality rate was lower than the figure for the state and the U.S. figure, but higher than the Healthy People 2020 target.

. The Defiance County age-adjusted stroke mortality rate for 2010 was lower than the state and the U.S. figure. The Defiance County age-adjusted stroke mortality rate for 2010 was equal to the Healthy People 2020 target objective.

. From 2005-2013, the Defiance County age-adjusted heart disease mortality rate has decreased for both sexes.

Age-Adjusted Heart Disease and Stroke Mortality Rates

300

250 192 180 200 150 150 101

100 34 42 42 34 50

Rate Rate per population 100,000 0 Heart Disease Stroke

Defiance 2010 Ohio 2010 U.S. 2009 HP 2020 Target*

*The Healthy People 2020 Target objective for Coronary Heart Disease is reported for heart attack mortality. (Source: ODH Information Warehouse, updated 5-23-12, Healthy People 2020)

Defiance County Age-Adjusted Heart Disease Mortality Rates by Gender 400

300 263 219 209 200 196 172 173 population

Rate per per 100,000 Rate 154 142 100 138

0 2005-2007 2008-2010 2011-2013

Defiance Total Defiance Male Defiance Female

(Source: CDC Wonder, Underlying Cause of Death, 2005-2013)

The following graph shows the age-adjusted mortality rates per 100,000 population for stroke by gender.

. From 2005-2013, the Defiance County stroke mortality rate was higher for males than for CARDIOVASCULAR females.

Age-Adjusted Stroke Mortality Rates by Gender

59 54 47 48 47 48 45

Rate Rate per population 100,000 Total Male Female

Defiance 2005 - 2007 Defiance 2008 - 2010 Defiance 2011 -2013

(Source: CDC Wonder, About Underlying Cause of Death, 2005-2013)

Healthy People 2020 Objectives Heart Disease and Stroke (HDS)

Defiance Survey 2013 Healthy People Objective Population U.S. Baseline* 2020 Target Baseline 31% HDS-5: Reduce proportion of adults 32% Adults age 18 27% with hypertension (2015) and up HDS-6: Increase proportion of adults 76% who had their blood cholesterol 70% Adults age 18 82% checked within the preceding 5 (2015) & up years 38% HDS-7: Decrease proportion of 27% Adults age 20 adults with high total blood 14% (2015) & up with cholesterol (TBC) TBC>240 mg/dl *All U.S. figures age-adjusted to 2000 population standard. (Source: Healthy People 2020, 2013 BRFSS, 2015 Defiance County Health Assessment)

Stroke Warning Signs and Symptoms

F.A.S.T. is an easy way to remember the sudden signs and symptoms of a stroke. When you can spot the signs, you'll know quickly that you need to call 9-1-1 for help. This is important because the sooner a stroke victim gets to the hospital, the sooner they'll get treatment. Being prompt can make a remarkable difference in their recovery. F.A.S.T is:

. Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile.

. Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

. Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?

. Time to call 911: If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

Beyond F.A.S.T- Other Symptoms to Know

. Sudden confusion or trouble understanding . Sudden numbness or weakness of the leg . Sudden severe headache with no known cause . Sudden trouble seeing in one or both eyes . Sudden trouble walking, dizziness, loss of balance or coordination

(Source: American Heart Association, Stroke Warning Signs and Symptoms, 2013, http://strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and- Symptoms_UCM_308528_SubHomePage.jsp)

Adult І CANCER

Key Findings Defiance County

Incidence of Cancer, 2007-2011 In 2015, 8% of Defiance County adults had been diagnosed with cancer at some time in All Types: 1,049 cases their life. The Centers for Disease Control and . Prostate: 179 cases (17%) Prevention (CDC) indicates that from 2009- . Breast: 130 cases (12%) 2013, a total of 455 Defiance County residents died from cancer, the leading cause of . Lung and Bronchus: 169 cases (16%) . Colon and Rectum: 106 cases (10%) death in the county. The American Cancer Society advises that not using tobacco

In 2013, there were 70 cancer deaths in CANCER products, maintaining a healthy weight, Defiance County. adopting a physically active lifestyle, eating (Source: Ohio Cancer Incidence Surveillance System, more fruits and vegetables, limiting alcoholic ODH Information Warehouse, Updated 1/9/2014) beverages and early detection may reduce overall cancer deaths.

8% of Defiance County adults had been diagnosed with cancer at some time in their life.

Adult Cancer

. 8% of Defiance County adults were diagnosed with cancer at some point in their lives.

. Of those diagnosed with cancer, they reported the following types: breast (28%), prostate (25%), other skin cancer (24%), cervical (11%), endometrial (6%), head and neck (5%), bladder (5%), melanoma (3%), thyroid (3%), liver (3%), colon (3%), and other types of cancer (8%).

Cancer Facts

. The Centers for Disease Control and Prevention (CDC) indicates that from 2009-2013, cancers caused 25% (455 of 1,843 total deaths) of all Defiance County resident deaths. The largest

percent (30%) of cancer deaths were from lung and bronchus cancer (Source: CDC Wonder).

. The American Cancer Society reports that smoking tobacco is associated with cancers of the mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), pharynx (throat), and esophagus (swallowing tube). Also, smoking has been associated with cancers of the lung, colorectal, stomach, pancreas, kidney, bladder, uterine cervix, ovary (mucinous) and acute myeloid leukemia. The 2015 health assessment project has determined that 15% of Defiance County adults were current smokers and many more were exposed to environmental tobacco smoke, also a cause of heart attacks and cancer.

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Diagnosed with skin cancer* N/A 4% 2% 6% 6% Diagnosed with any type of N/A 11% 6% 7% 7% cancer, other than skin cancer N/A – Not available *Melanoma and other skin cancers are included for “diagnosed with skin cancer”

A current smoker is defined as someone who has smoked over 100 cigarettes in their lifetime and currently smokes some or all days.

Lung Cancer

. The CDC reports that lung cancer (n=78) was the leading cause of male cancer deaths from 2009- 2013 in Defiance County, followed by prostate cancer (n=23) and cancer of the colon (n=12) (Source: CDC Wonder).

. In Defiance County, 16% of male adults were current smokers and 44% had stopped smoking for one or more days in the past 12 months because they were trying to quit (Source: 2015 Defiance County Health Assessment).

. The CDC reports that lung cancer was the leading cause of female cancer deaths (n=57) in Defiance County from 2009-2013 followed by breast (n=33) and colon (n=17) cancers (Source: CDC Wonder).

. Approximately 16% of female adults in the county were current smokers and 64% had stopped smoking for one or more days in the past 12 months because they were trying to quit (Source: 2015 Defiance County Health Assessment).

. According to the American Cancer Society, smoking causes 90% of lung cancer deaths in the U.S. Men and women who smoke are about 25 times more likely to develop lung cancer than nonsmokers (Source: American Cancer Society, Facts & Figures 2015).

16% of Defiance County male adults and 16% of female adults were current smokers.

Breast Cancer

. In 2015, 57% of Defiance County females reported having had a clinical breast examination in the past year.

. 66% of Defiance County females over the age of 40 had a mammogram in the past year.

. The 5-year relative survival for women diagnosed with localized breast cancer (cancer that has not spread to lymph nodes or other locations outside the breast) is 99%. However, only 61% of breast cancer cases are diagnosed early at a localized stage (Source: American Cancer Society, Facts & Figures 2015).

. For women in their 20s and 30s, a clinical breast exam should be done at least once every 3 years. Mammograms for women in their 20s and 30s are based upon increased risk (e.g., family history, past breast cancer) and physician recommendation. Otherwise, annual mammography is recommended beginning at age 40 (Source: American Cancer Society, Facts & Figures 2015).

Nearly two-thirds (66%) of Defiance County females over the age of 40 had a mammogram in the past year.

Colon and Rectum Cancer

. More than half (51%) of adults ages 50 and over had a colonoscopy or sigmoidoscopy in the past 5 years.

. The CDC statistics indicate that colon, rectum, and anus cancer deaths accounted for 9% of all male and female cancer deaths from 2009-2013 in Defiance County.

. The American Cancer Society reports several risk factors for colorectal cancer including: age; personal or family history of colorectal cancer, polyps, or inflammatory bowel disease; obesity; physical inactivity; a diet high in red or processed meat; alcohol use; long-term smoking; and possibly very low intake of fruits and vegetables.

CANCER . In the U.S., 90% of colon cancers occur in individuals over the age of 50. Because of this, the American Cancer Society suggests that every person over the age of 50 have regular colon cancer screenings. In 2015, 70% of Defiance County adults over the age of 50 reported having been screened for colorectal cancers at some time in their life and 51% had been screened in the past 5 years.

The leading types of cancer diagnoses for Defiance County adults were: breast (28%), prostate (25%), and other skin cancer (24%).

Prostate Cancer

. CDC statistics indicate that prostate cancer deaths accounted for 9% of all male cancer deaths from 2009-2013 in Defiance County.

. Incidence rates for prostate cancer are 60% higher in African Americans than in whites and they are twice as likely to die of prostate cancer. In addition, about 56% of prostate cancers occur in men over the age of 65, and 97% occur in men 50 and older. Other risk factors include strong familial predisposition, diet high in processed meat or dairy foods, and obesity. African American men and Caribbean men of African descent have the highest documented prostate cancer incidence rates in the world (Source: American Cancer Society, Facts & Figures 2015).

2015 Cancer Estimations

. In 2015, about 1,658,370 new cancer cases are expected to be diagnosed. . The World Cancer Research Fund estimates that about one-quarter to one-third of the new cancer cases expected to occur in the U.S. in 2015 will be related to overweight or obesity, physical inactivity, and poor nutrition, and thus could be prevented. . About 589,430 Americans are expected to die of cancer in 2015. . In 2015, about 171,000 cancer deaths will be caused by tobacco use. . In Ohio, 65,010 new cases of cancer are expected, and 25,260 cancer deaths are expected. . The Ohio female new breast cancer cases are expected to be 8,950. . About 15% of all new cancer cases in Ohio are expected to be from lung and bronchus cancers. . About 5,430 (8%) of all new cancer cases in Ohio are expected to be from colon and rectum cancers. . The Ohio male, new prostate cancer cases are expected to be 8,150 (13%).

(Source: American Cancer Society, Facts and Figures 2015, http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf)

The following graph shows the Defiance County, Ohio and U.S. age-adjusted mortality rates (per 100,000 population, 2000 standard) for all types of cancer in comparison to the Healthy People 2020 objective. The graph indicates:

. When age differences are accounted for, Defiance County had a lower cancer mortality rate than the U.S., but a higher rate than Ohio and the Healthy People 2020 target objective.

. The percentage of Defiance County males who died from all cancers is higher than the percentage of Defiance County females who died from all cancers.

Healthy People 2020 Objective

and Age-Adjusted Mortality Rates for All Cancers

206 250 191 187 161 200

150

100

Rate Rate per population 100,000 0

Defiance 2010 Ohio 2010 U.S. 2010 HP 2020 Target

(Source: ODH Information Warehouse, updated 10-27-14; Healthy People 2020)

Cancer As Percent of Total Deaths in Defiance County by Gender, 2009-2013

20%

13% 15% 11%

10%

0% Male Female

(Source: CDC Wonder, 2009-2013)

Defiance County Incidence of Cancer 2007-2011

Percent of Total Type of Cancer Number of Cases Incidence of Cancer Prostate 179 17%

Lung and Bronchus 169 16% Breast 130 12% Colon and Rectum 106 10% Other/Unspecified 91 9% Bladder 54 5% Non-Hodgkins Lymphoma 44 4% Melanoma of Skin 38 4% CANCER Pancreas 32 3% Cancer and Corpus Uteri 32 3% Kidney and Renal Pelvis 30 3% Leukemia 20 2% Oral Cavity & Pharynx 16 1% Multiple Myeloma 15 1% Stomach 13 1% Esophagus 13 1% Brain and CNS 13 1% Thyroid 10 <1% Larynx 10 <1% Ovary 9 <1% Liver and Bile Ducts 9 <1% Hodgkins Lymphoma 7 <1% Testis 6 <1% Cancer of Cervix Uteri 3 <1%

Total 1,049 100% (Source: Ohio Cancer Incidence Surveillance System, ODH Information Warehouse, Updated 1/9/2014)

Adult І DIABETES

Key Findings Diabetes Facts

In 2015, 9% of Defiance County adults had . Nearly 30 million children and adults in the been diagnosed with diabetes. United States have diabetes. . 86 million Americans have prediabetes. . 1.7 million Americans are diagnosed with Diabetes diabetes every year. . . The 2015 health assessment project has Nearly 10% of the entire U.S. population has identified that 9% of Defiance County diabetes, including over 25% of seniors. adults had been diagnosed with . As many as 1 in 3 American adults will have diabetes, increasing to 25% of those diabetes in 2050 if present trends continue. age 65 and older. The 2013 BRFSS . The economic cost of diagnosed diabetes reports an Ohio and U.S. prevalence of in the U.S. is $245 billion per year. 11%. . 8.1 million Americans have undiagnosed diabetes . 88% of adults with diabetes were . Diabetes kills more Americans every year receiving treatment for their diabetes. than AIDS and breast cancer combined. . Diabetes is the primary cause of death for . More than one-fourth (27%) of adults 69,071 Americans each year, and with diabetes rated their health as fair or contributes to the death of 231,051 poor. Americans annually.

(Source: American Diabetes Association, 2014 Fast Facts, . Defiance County adults diagnosed with http://professional.diabetes.org/admin/UserFiles/0%20- diabetes also had one or more of the %20Sean/14 fast facts june2014 final3.pdf) following characteristics or conditions: o 88% were obese or overweight o 76% had been diagnosed with high blood pressure o 68% had been diagnosed with high blood cholesterol

Defiance County Adults Diagnosed with Diabetes 30% 25%

19% 20%

12% 11% 12% 10% 9% 10% 8% 8%

0% 0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Diagnosed with diabetes 12% 12% 9% 11% 11%

Diabetes Symptoms

The most common symptoms of type 1 and type 2 diabetes are:

TYPE 1 DIABETES

. Frequent urination . Unusual thirst . Extreme hunger . Unusual weight loss . Extreme fatigue and irritability DIABETES TYPE 2 DIABETES

. Any of the type 1 symptoms . Blurred vision . Tingling/numbness in hands or feet . Recurring skin, gum, or bladder infections . Cuts/bruises that are slow to heal . Frequent infections

(Source: American Diabetes Association, Diabetes Basics, Symptoms, http://www.diabetes.org/diabetes- basics/symptoms/)

Who is at Greater Risk for Type 2 Diabetes

. People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) . People over age 45 . People with a family history of diabetes . People who are overweight or obese

. People who do not exercise regularly . People with low HDL cholesterol or high triglycerides, high blood pressure . Certain racial and ethnic groups (e.g. Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives) . Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

(Source: American Diabetes Association, Diabetes Basics, Your Risk: Who is at Greater Risk for Type 2 Diabetes, http://www.diabetes.org/diabetes-basics/prevention/risk-factors)

The following graphs show prevalence of diabetes by gender and the age-adjusted mortality rates from diabetes for Defiance County and Ohio residents with comparison to the Healthy People 2020 target objective.

. In 2010, the prevalence of diabetes was equal among males than females in Defiance County.

. From 2009 to 2011, Defiance County’s age-adjusted diabetes mortality rate was less than the Ohio, the national rate, and the Healthy People 2020 target objective.

Defiance County Prevalence of Diabetes by Gender, 2010

15%

11% 11%

10%

Percentage per 100,000 population 100,000 per Percentage Male Female

(Source: Network of Care: Health Indicators, Public Health Assessment and Wellness)

Healthy People 2020 Objectives and Age-Adjusted Mortality Rates for Diabetes

69.1 80 66

40 26.1 21.7 20 Rate Rate per population 100,000 0 Defiance 2009-2011 Ohio 2009-2011 U.S. 2012 HP 2020 Target

(Source: Network of Care: Health Indicators, CDC, and Healthy People 2020)

The following graph shows the Ohio prevalence of diabetes and prediabetes by BMI weight status category. The following graph shows:

. The chance of developing diabetes and prediabetes increases relative to increases in BMI weight status category.

2011 Ohio Prevalence of Diabetes and Prediabetes by BMI Weight Status Category

25% 2.1% 20% DIABETES

15%

19.4% 10% 0.9%

0.8% 5% 8.5% 0.1% 3.6% 0% 1.5% Underweight Normal Weight Overweight Obese

Diabetes Prediabetes

Overweight and Obese Type 2 Diabetes Risk by Sex in Ohio

Category Increase in Risk Overweight Men 2.4

Overweight Women 3.9 Obese Men 6.7

Obese Women 12.4

(Source: ODH, Obesity and Diabetes in Ohio 2013, from http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/diabetes/Obesity_Diabetes_Supp_2013.ashx)

Adult І ASTHMA AND OTHER RESPIRATORY DISEASE

Key Findings

According to the Defiance County survey data, 9% of adults had been diagnosed with asthma.

Asthma and Other Respiratory Disease

. In 2015, 9% of Defiance County adults had been diagnosed with asthma.

. 14% of both Ohio and U.S. adults have ever been diagnosed with asthma (Source: 2013 BRFSS).

. There are several important factors that may trigger an asthma attack. Some of these triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergens, pets, mold, smoke from burning wood or grass, infections linked to the flu, colds, and respiratory viruses (Source: CDC, 2013).

. Chronic lower respiratory disease was the 3rd leading cause of death in Defiance County and in Ohio, in 2013 (Source: ODH, Leading Causes of Death: 2013 Preliminary Data).

Defiance County Adults Diagnosed with Asthma 20%

12% 10% 10% 10% 9% 10% 8% 8% 6% 6%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had been diagnosed with asthma 3% 12% 9% 14% 14%

The following graphs demonstrate the lifetime and current prevalence rates of asthma by gender for Ohio and U.S. residents.

Adult Lifetime Asthma Prevalence Rates By Gender

20% 16.5% 16.3%

15% 11.8% 11.7% - Reported

10%

5% ASTHMA

Self Percentage 0% Males Females

Ohio Lifetime U.S. Lifetime

Adult Current Asthma Prevalence Rates By Gender

15% 12.4% 11.3%

- Reported 10% 6.8% 6.7%

Self Percentage 0% Males Females

Ohio Current U.S. Current

(Source for graphs: 2013 BRFSS)

Asthma Facts

. The number of Americans with asthma grows every year. Currently, 26 million Americans have asthma.

. Asthma mortality is almost 4,000 deaths per year.

. Asthma results in 456,000 hospitalizations and 2.1 million emergency room visits annually.

. Patients with asthma reported 13.9 million visits to a doctor’s office and 1.4 million visits to hospital outpatient departments.

. Effective asthma treatment includes monitoring the disease with a peak flow meter, identifying and avoiding allergen triggers, using drug therapies including bronchodilators and anti-inflammatory agents, and developing an emergency plan for severe attacks.

(Source: American College of Allergy, Asthma, & Immunology, Asthma Facts, from: http://acaai.org/news/facts- statistics/asthma)

What Causes an Asthma Attack?

. Tobacco Smoke: People should never smoke near you, in your home, in your car, or wherever you may spend a lot of time if you have asthma. Tobacco smoke is

unhealthy for everyone, especially people with asthma. If you have asthma and you smoke, quit smoking.

. Dust Mites: If you have asthma, dust mites can trigger an asthma attack. To prevent attacks, use mattress covers and pillowcase covers to make a barrier between dust mites and yourself. Do not use down-filled pillows, quilts, or comforters. Remove stuffed animals and clutter from your bedroom.

. Outdoor Air Pollution: This pollution can come from factories, automobiles, and other sources. Pay attention to air quality forecasts to plan activities when air pollution levels will be low.

. Cockroach Allergens: Get rid of cockroaches in your home by removing as many water and food sources as you can. Cockroaches are often found where food is eaten and crumbs are left behind. Cockroaches and their droppings can trigger an asthma attack, so vacuum or sweep areas that might attract cockroaches at least every 2 to 3 days.

. Pets: Furry pets can trigger an asthma attack. If you think a furry pet may be causing attacks, you may want to find the pet another home. If you can’t or don’t want to find a new home for a pet, keep it out of the person with asthma’s bedroom.

. Mold: Breathing in mold can trigger an asthma attack. Get rid of mold in your home to help control your attacks. Humidity, the amount of moisture in the air, can make mold grow. An air conditioner or dehumidifier will help keep the humidity level low.

. Smoke from Burning Wood or Grass: Smoke from burning wood or other plants is made up of a mix of harmful gases and small particles. Breathing in too much of this smoke can cause an asthma attack. If you can, avoid burning wood in your home.

. Other Triggers: Infections linked to influenza (flu), colds, and respiratory syncytial virus (RSV) can trigger an asthma attack. Sinus infections, allergies, breathing in some chemicals, and acid reflux can also trigger attacks. Physical exercise, some medicines, bad weather, breathing in cold air, some foods, and fragrances can also trigger an asthma attack.

(Source: Centers for Disease Control, Vital Signs, Asthma, updated November 18, 2014, http://www.cdc.gov/asthma/faqs.htm)

Adult І WEIGHT STATUS

Key Findings

The 2015 Health Assessment identified that 70% of Defiance County adults were overweight or ADULT WEIGHT obese based on Body Mass Index (BMI). More than one-third (36%) of Defiance County adults were obese. The 2013 BRFSS indicates that 30% of Ohio and 29% of U.S. adults were obese by BMI. More than two-fifths (43%) of adults were trying to lose weight.

Adult Weight Status

. In 2015, the health assessment indicated that more than two-thirds (70%) of Defiance County adults were either overweight (34%) or obese (36%) by Body Mass Index (BMI). This puts them at elevated risk for developing a variety of diseases.

. More than two-fifths (43%) of adults were trying to lose weight, 33% were trying to maintain their current weight or keep from gaining weight, and 3% were trying to gain weight.

. Defiance County adults did the following to lose weight or keep from gaining weight: exercised (47%), ate less food, fewer calories, or foods low in fat (46%), ate a low-carb diet (11%), participated in a prescribed dietary or fitness program (2%), smoked cigarettes (2%), used a weight loss program (1%), took diet pills, powders or liquids without a doctor’s advice (1%), took prescribed medications (1%), went without eating 24 or more hours (<1%), and vomited or took laxatives (<1%).

36% of Defiance County adults are obese.

Physical Activity

. In Defiance County, 50% of adults were engaging in some type of physical activity or exercise for at least 30 minutes 3 or more days per week. 30% of adults were exercising 5 or more days per week. Nearly one-third (32%) of adults were not participating in any physical activity in the past week, including 4% who were unable to exercise.

. Defiance County adults spent the most time doing the following physical activities in the past year: walking (41%), multiple types (17%), exercise machines (7%), running/jogging (7%), strength training (3%), cycling (1%), swimming (<1%), and other activities (7%). 17% of adults did not exercise at all, including 2% who were unable to do so.

In Defiance County, 50% of adults were engaging in some type of physical

activity or exercise for at least 30 minutes 3 or more days per week.

. Reasons for not exercising included: time (29%), weather (24%), too tired (18%), laziness (17%), chose not to exercise (12%), pain or discomfort (9%), could not afford a gym membership (8%), no gym available (3%), no walking or biking trails (2%), did not have child care (2%), safety (1%), no sidewalks (1%), did not know what activities to do (1%), doctor advised them not to exercise (1%), and other reasons (3%).

. The CDC recommends that adults participate in moderate exercise for at least 2 hours and 30 minutes every week or vigorous exercise for at least 1 hour and 15 minutes every week. Whether participating in moderate or vigorous exercise, CDC also recommends muscle- strengthening activities that work all major muscle groups on 2 or more days per week (Source: CDC, Physical Activity for Everyone).

Nutrition

. In 2015, 6% of adults were eating 5 or more servings of fruits and vegetables per day. 90% were eating between 1 and 4 servings per day. The American Cancer Society recommends that adults eat at least 2 ½ cups of fruits and vegetables per day to reduce the risk of cancer and to maintain good health. The 2009 BRFSS reported that only 21% of Ohio adults and 23% nationwide were eating the recommended number of servings of fruits and vegetables.

. Defiance County adults reported the following reasons they chose the types of food they ate: taste (61%), enjoyment (54%), cost (49%), ease of preparation (38%), availability (37%), healthiness of food (36%), food they were used to (29%), time (28%), what their spouse prefers (22%), nutritional content (21%), calorie content (18%), what their child prefers (7%), if it is organic (7%), if it is genetically modified (5%), gluten free (3%), health care provider’s advice (3%), other food sensitivities (3%), and other reasons (1%).

. Adults ate out in a restaurant or brought home take-out food an average of 2.3 times per week.

More than two-fifths (43%) of Defiance County adults were trying to lose

weight.

The following graph shows the percentage of Defiance County adults who are overweight or obese by Body Mass Index (BMI). Examples of how to interpret the information include: 27% of all Defiance County adults were classified as normal weight, 34% were overweight, and 36% were obese.

Defiance County Adult BMI Classifications 100%

80% 36% 34% 38% 25% 42% 35% 35% 35% 40% 40%

60% 33% 24% 32% 34% 20% 39% 40% 43% 36% 39% 39% 35% 20% 36% 36% 31% 27% 23% 24% 24% 20% 17% 0% Total Male Female Under 30 30-64 65 & Over Income < Income Defiance Defiance Years $25K $25K 2008 2012 Plus

Normal Overweight Obese

(Percentages may not equal 100% due to the exclusion of data for those who were classified as underweight)

The following graph shows the percentage of Defiance County adults who are obese compared to Ohio and U.S.

Obesity in Defiance County, Ohio, and U.S. Adults

60% ADULT WEIGHT

36% 40% 30% 29%

20%

0% Defiance County Ohio U.S.

(Source: 2015 Defiance County Health Assessment and 2013 BRFSS)

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Obese 35% 35% 36% 30% 29% Overweight 32% 39% 34% 35% 35%

Obesity Facts

. More than one-third of U.S. adults (34.9%) are obese. . Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. . The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. . Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%).

(Source: CDC, Adult Obesity Facts, updated September 9, 2014,

http://www.cdc.gov/obesity/data/adult.html)

Adult І TOBACCO USE

Key Findings

In 2015, 15% of Defiance County adults were current smokers.

Adult Tobacco Use Behaviors

. The 2015 health assessment identified that more than one-in-seven (15%) Defiance County adults were current smokers (those who indicated smoking at least 100 cigarettes in their lifetime and currently smoke some or all days). The 2013 BRFSS reported current smoker prevalence rates of 23% for Ohio and 19% for the U.S.

. More than one-fifth (21%) of adults indicated that they were former smokers (smoked 100 cigarettes in their lifetime and now do not smoke). The 2013 BRFSS reported former smoker prevalence rates of 25% for both Ohio and the U.S.

. Defiance County adult smokers were more likely to: o Have been separated (40%) or divorced (33%) o Have rated their overall health as fair or poor (22%) o Were ages 30-64 (18%)

. Defiance County adults used the following tobacco products in the past year: cigarettes (24%), chewing tobacco (7%), e-cigarettes (6%), cigars (3%), snuff (2%), hookah (2%), Black and Milds (1%), little cigars (1%), snus (1%), swishers (1%), flavored cigarettes (1%), and pipes (1%).

. 53% of current smokers responded that they had stopped smoking for at least one day in the past year because they were trying to quit smoking.

. Defiance County adults had the following rules/practices about smoking in their home: never allowed (71%), not allowed when children are present (8%), allowed anywhere (6%), and allowed in certain rooms (4%).

. Defiance County adults had the following rules/practices about smoking in their car: never allowed (76%), allowed with windows open (10%), allowed anywhere (4%), and not allowed when children are present (3%).

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Current smoker 21% 18% 15% 23% 19% Former smoker 29% 26% 21% 25% 25%

The following graph shows the percentage of Defiance County adults who used tobacco. Examples of how to interpret the information include: 15% of all Defiance County adults were current smokers, 21% of all adults were former smokers, and 64% had never smoked.

Defiance County Adult Smoking Behaviors ADULT TOBACCO

100%

80% 50% 56% 63% 57% 59% 60% 64% 63% 69% 60% 86%

40% 29% 25% 26% 24% 21% 21% 21% 30% 20% 17% 5% 15% 16% 16% 18% 14% 16% 21% 18% 9% 11% 0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012 Current smoker Former smoker Never smoked

If yes, do you now smoke cigarettes every day, some days or not at all?” Respondents were asked: “Have you smoked at least 100 cigarettes in your entire life?

53 % of current smokers responded that they had stopped smoking for at least one day in the past year because they were trying to quit smoking.

Smoke-free Living: Benefits & Milestones

According to the American Heart Association and the U.S. Surgeon General, this is how your body starts to recover: . In your first 20 minutes after quitting: your blood pressure and heart rate recover from the cigarette-induced spike. . After 12 hours of smoke-free living: the carbon monoxide levels in your blood return to normal. . After two weeks to three months of smoke-free living: your circulation and lung function begin to improve. . After one to nine months of smoke-free living: clear and deeper breathing gradually returns as coughing and shortness of breath diminishes; you regain the ability to cough productively instead of hacking, which cleans your lungs and reduce your risk of infection. . One year after quitting smoking, a person’s risk of coronary heart disease is reduced by 50 percent. . Five to 15 years after quitting smoking, a person’s risk of stroke is similar to that of a nonsmoker. . After 10 years of smoke-free living, your lung cancer death rate is about half that of a person who has continued to smoke. The risk of other cancers, such as throat, mouth, esophagus, bladder, cervix and pancreas decreases too.

(Source: AHA, Smoke-free Living: Benefits & Milestones, 2012, from: http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/QuittingSmoking/Smoke-free-Living-Benefits- Milestones_UCM_322711_Article.jsp)

Electronic Cigarettes Facts

. Electronic cigarettes (e-cigarettes) are a type of electronic smoking device, resembling cigarettes. They can also look like pipes, pens, or USB memory sticks.

. E-cigarettes cost approximately $30-60, and refill cartridges cost $7-$10. More recently, disposable e-cigarettes that “last up to two packs” are being sold for under $10 in local and national convenience stores.

. Cartridges generally contain 10-20 mg of nicotine. However, as e-cigarettes are unregulated by the Food and Drug Administration (FDA), their contents and the level of these contents can be highly variable.

. Ever use of e-cigarettes is highest among current cigarette smoking adults in the U.S. and increased from 9.8% in 2010 to 21.2% in 2011 to 32% in 2012.

. Early studies by the FDA found varying levels of nicotine and other potentially harmful ingredients, including cancer-causing substances and di-ethylene glycol, which is found in anti- freeze. However, these substances were found at much lower levels than in traditional cigarettes.

. The awareness and use of electronic cigarettes are increasing. In 2011, 6 of 10 U.S. adults were aware of electronic cigarettes with 21% of smokers having ever used an electronic cigarette.

. Nicotine is found in both inhaled and exhaled vapor of electronic cigarettes. Studies have also found heavy metals, silicates, and cancer-causing compounds in exhaled e-cigarette vapor.

(Source: Philadelphia Department of Public Health, “Electronic Cigarette Fact sheet,” published February 2014, from: http://www.smokefreephilly.org/smokfree_philly/assets/File/Electronic%20Cigarette%20Fact%20Sheet_2_27_14.pdf & Legacy for Health, Tobacco Fact Sheet, May 2014, from: http://www.legacyforhealth.org/content/download/582/6926/file/LEG- FactSheet-eCigarettes-JUNE2013.pdf)

21% of Defiance County adults indicated that they were former smokers.

The following graph shows Defiance County, Ohio, and U.S. adult cigarette smoking rates. The BRFSS rates shown for Ohio and the U.S. were for adults 18 years and older. This graph shows:

. Defiance County adult cigarette smoking rate was lower than the Ohio and U.S. rates, and higher than the Healthy People 2020 Goal.

Healthy People 2020 Objective & Cigarette Smoking Rates

40% 23% 30% 19% 15% 12% 20%

10%

0% Defiance County Ohio 2013 U.S. 2013 HP 2020 Target 2015

(Source: 2015 Defiance County Health Assessment, 2013 BRFSS and Healthy People 2020)

The following graphs show Defiance County, Ohio, and U.S. age-adjusted mortality rates per 100,000 population for chronic lower respiratory diseases (formerly COPD) in comparison with the Healthy People 2020 objectives and the percentage of Defiance County and Ohio mothers who smoked during pregnancy. These graphs show: ADULT TOBACCO . From 2010-2012, Defiance County’s age-adjusted mortality rate for chronic lower respiratory disease was higher than the Ohio and the U.S. rate, but lower than the Healthy People 2020 target objective.

. Disparities existed by gender for chronic lower respiratory disease mortality rate. The 2010- 2012 Defiance County male rates were higher than the Defiance County female rates.

Age-Adjusted Mortality Rates for Chronic Lower Respiratory Diseases (Formerly COPD)

200

150 99 82 100 55 51 58 48 42 38 47 38 50

Rate Rate per population 100,000 0 Total Male Female

Defiance 2010-2012 Ohio 2010-2012 U.S. 2010-2012 HP 2020 Target* (Source: ODH Information Warehouse and Healthy People 2020) * Healthy People 2020’s target rate and the U.S. rate is for adults aged 45 years and older. **HP2020 does not report different goals by gender.

Defiance County and Ohio Births to Mothers Who Smoked During

Pregnancy 50%

40% 28% 28% 30% 23% 21% 19% 20% 19% 19% 19% 18% 20% 10%

0% 2006 2007 2008 2009 2010

Defiance Mothers Ohio Mothers

(Source: ODH Information Warehouse)

The following graphs show Defiance County, Ohio, and U.S. age-adjusted mortality rates per 100,000 population for lung and bronchus cancer in comparison with the Healthy People 2020 objectives and Defiance County mortality rates by gender. These graphs show:

. Disparities existed by gender for Defiance County lung and bronchus cancer age-adjusted mortality rates.

. The 2007-2011 Defiance County lung and bronchus cancer mortality rates for males were substantially higher than the Defiance County female rates.

Age-Adjusted Mortality Rates for

Lung and Bronchus Cancer

100

80 59 57 50 46 60 40 20

0 Rate Rate per population 100,000

Defiance 2006-2010 Ohio 2006-2010 U.S. 2010 HP 2020 Target*

*Healthy People 2020 Target data is for lung cancer only (Sources: Healthy People 2020, National Cancer Institute, ODH Information Warehouse, updated 2014)

Age-Adjusted Mortality Rates by Gender for

Lung and Bronchus Cancer

90 100 80 60 39 40 20 0

Rate Rate per population 100,000 Defiance Males 2007-2011 Defiance Females 2007-2011

(Source: ODH Information Warehouse, updated 2014)

U.S. Adult Smoking Facts

. The percentage of American adults who smoke decreased from (20.9%) in 2005 to (19.3%) in 2010. . About 1 in 5 (46.6 million) adults still smoke. . 443,000 Americans die of smoking or exposure to secondhand smoke each year. . More men (about 22%) than women (about 17%) smoke. . Adults living below poverty level (29%) are more likely to smoke than adults living at or above poverty level (18%). . Smoking rates are higher among people with a lower education level.

(Source: CDC, Vital Signs, Tobacco Use: Smoking & Secondhand Smoke, September 2011, http://www.cdc.gov/VitalSigns/AdultSmoking/#LatestFindings)

Cigarette Expenditures, Percent of Total Expenditures, National Rank by Tract, Nielsen 2011

ADULT TOBACCO

(Source: Community Commons, updated 2/4/2015)

Adult І ALCOHOL CONSUMPTION

Key Findings

49% of Defiance County adults had at least one alcoholic drink in the past month.

Adult Alcohol Consumption

. In 2015, 49% of the Defiance County adults had at least one alcoholic drink in the past month, increasing to 56% of males and 64% of those under the age of 30. The 2013 BRFSS reported current drinker prevalence rates of 53% for Ohio and 55% for the U.S.

. One-in-ten (10%) adults were considered frequent drinkers (drank on an average of three or more days per week).

. Of those who drank, Defiance County adults drank 2.5 drinks on average, increasing to 2.9 drinks for those with incomes less than $25,000.

. Almost one-quarter (23%) of Defiance County adults were considered binge drinkers. The 2013 BRFSS reported binge drinking rates of 17% for both Ohio and for the U.S.

. 44% of those current drinkers reported they had five or more alcoholic drinks (for males) or 4 or more drinks (for females) on an occasion in the last month and would be considered binge drinkers by definition.

. 4% of adults reported driving after having perhaps too much to drink.

. Defiance County adults drove the following after having 5 or more alcoholic beverages: motor vehicle (3%), ATV (1%), and other (2%). No one reported driving a boat, watercraft, snowmobile, or motorcycle after having 5 or more alcoholic beverages.

. Defiance County adults reported that as a result of drinking, they or a family member repeatedly: placed themselves or a family member in dangerous situations (3%), had legal problems (3%), failed to fulfill obligations at home (2%), and failed to fulfill obligations at work (1%).

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Drank alcohol at least once in past month 52% 53% 49% 53% 55% Binge drinker (drank 5 or more drinks for males and 4 or more for females on an 20% 20% 23% 17% 17% occasion)

The following graphs show the percentage of Defiance County adults consuming alcohol and the amount consumed on average. Examples of how to interpret the information shown on the first

graph include: 45% of all Defiance County adults did not drink alcohol, 37% of Defiance County males did not drink, and 52% of adult females reported they did not drink.

Average Number of Days Drinking Alcohol in the Past Month ADULT 100%

90% 15% 26% 35% 80% 27% 7% 33% 33% 31% 39% 38% 70% 40%

60% 16% 24% 17% 15% 16% 17% 50% 12% 17% 40% 24% 75%

30% 52% 48% 47% 48% 45% 45% 43% 20% 37% 28% 10% 0% Total Male Female Under 30 30-64 65 & Income Income Defiance Defiance

Years Over <$25K $25K 2008 2012 ALCOHOL Plus Did not drink any 1-2 days 3 or more days Percentages may not equal 100% as some respondents answered “don’t know”

10% of Defiance County adults were considered frequent drinkers (drank on an average of three or more days per week).

Adults Average Number of Drinks Consumed Per Drinking Occasion 4

2.9 2.8 3 2.7 2.5 2.5 2.5 2.4 2.5 2.3

1.9 2

Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

The following graphs show the percentage of Defiance County drinkers who binge drank in the past month and a comparison of Defiance County binge drinkers with Ohio and U.S.

Defiance County Adult Drinkers Who Binge Drank in Past Month* 80%

59% 60% 54%

44% 45% 41% 40% 35% 36% 32% 26% 24%

20%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012 *Based on adults who have drunk alcohol in the past month. Binge drinking is defined as having five or more drinks (for males) or four or more drinks (for females) on an occasion. Adults must have reported drinking five or more drinks (for males) or four or more drinks (for females) on an occasion at least once in the previous month.

4% of Defiance County adults reported driving after having perhaps too much to drink.

Adult Binge Drinkers* 40%

30% 23%

20% 17% 17%

10%

0% Defiance 2015 Ohio 2013 U.S. 2013

(Source: 2013 BRFSS, 2015 Defiance County Health Assessment) *Based on all adults. Binge drinking is defined as males having five or more drinks on an occasion, females having four or more drinks on one occasion.

The following table shows the city of Defiance, Hicksville, Defiance County, and Ohio motor vehicle accident statistics. The table shows:

. 28% of all fatal injury crashes in Defiance County were alcohol-related compared to 29% in Ohio.

ADULT

City of City of Defiance Ohio Hicksville Defiance County 2014 2014 2014 2014

Total Crashes 74 532 1,149 271,341

Alcohol-Related Total Crashes 3 18 50 11,954

Fatal Injury Crashes 0 0 7 901

Alcohol-Related Fatal Crashes 0 0 2 263

Alcohol Impaired Drivers in Crashes 3 19 51 11,833

Injury Crashes 9 95 198 67,320

Alcohol-Related Injury Crashes 1 6 23 4,847 ALCOHOL

Property Damage Only 65 437 944 203,120 Alcohol-Related Property Damage 2 12 25 6,844 Only Deaths 0 0 8 988

Alcohol-Related Deaths 0 0 2 289

Total Non-Fatal Injuries 13 134 291 96,77

Alcohol-Related Injuries 1 7 32 6,719 (Source: Ohio Department of Public Safety, Crash Reports, Updated 2/6/2015, Traffic Crash Facts)

Caffeinated Alcoholic Beverages

. Excessive alcohol consumption is responsible for about 88,000 deaths and 2.5 million years of potential life lost (YPLL) in the United States each year.

. Drinkers who consume alcohol mixed with energy drinks are 3 times more likely to binge drink than drinkers who do not report mixing alcohol with energy drinks.

. Drinkers who consume alcohol with energy drinks are about twice as likely as drinkers who do not report mixing to report being taken advantage of sexually, to report taking advantage of someone else sexually, and to report riding with a driver who was under the influence of alcohol.

(Source: CDC, Alcohol and Public Health, Fact Sheets, Caffeinated Alcoholic Beverages, November 2014, http://www.cdc.gov/alcohol/fact-sheets/cab.htm)

Alcohol Beverage Expenditures, Percent of Total Expenditures, National Rank by Tract, Nielsen 2011

(Source: Community Commons, updated 2/6/2015)

Bars and Drinking Establishments, Rate (Per 100,000 Pop.) by Zip Code Tract Area, Census Business Patterns 2012

ADULT

ALCOHOL

(Source: Community Commons, updated 2/6/2015)

Beer, Wine and Liquor Stores, Rate (Per 100,000 Pop.) by County, Census Business Patterns 2012

(Source: Community Commons, updated 2/6/2015)

Adult І DRUG USE

Key Findings ADULT

Adult Drug Use

. 4% of Defiance County adults had used marijuana in the past 6 months, increasing to 5% of those with incomes more than $25,000.

. <1% of Defiance County adults reported using other recreational drugs in the past six months such as cocaine, synthetic marijuana/K2, heroin, LSD, inhalants, Ecstasy, bath salts, and methamphetamines.

. When asked about their frequency of marijuana and other recreational drug use in the past six months, 24% of Defiance County adults who used drugs did so almost every day, and 14% did so less than once a month.

DRUG USE . 3% of adults had used medications not prescribed for them or they took more than prescribed to feel good or high and/or more active or alert during the past 6 months, increasing to 7% of those over the age of 65.

. When asked about their frequency of medication misuse in the past six months, 6% of Defiance County adults who used these drugs did so 3 to 4 days a week, and 22% did so less than once a month.

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Adults who used marijuana in the 5% 4% 4% N/A N/A past 6 months Adults who used other recreational drugs in the past 6 6% 5% <1% N/A N/A months Adults who misused prescription 1% 7% 3% N/A N/A drugs in the past 6 months

N/A – Not available

The following graphs are data from the 2015 Defiance County Health Assessment indicating adult marijuana use in the past six months and medication misuse in the past six months. Examples of how to interpret the information include: 4% of all Defiance County adults used marijuana in the past six months, 4% of adults under the age of 30 were current users, and 1% of adults with incomes less than $25,000 were current users.

Defiance County Adult Marijuana Use in Past 6 Months

10%

5% 5% 5% 5% 4% 4% 4% 4% 4%

1% 1%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Defiance County Adult Medication Misuse in Past 6 Months

10%

7% 7%

5% 4% 4%

3% 3% 3%

2% 1%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

The following graph shows Defiance County accidental deaths due to drug overdose from

January 1, 2013 to August 4, 2015. The graph shows that:

• There were a total of 13 accidental deaths due to drug overdose in Defiance County from

2013 to 2015. ADULT

Defiance County Accidental Deaths Due to Drug Overdose

9 10

8 4 6 4

of Fatalities Number 2

0 2013 2014 2015*

*There were 5 deaths in 2015 attributed to drug overdoses, with 4 more probable deaths pending toxicology results.

DRUG USE (Source: Defiance County General Health District Vital Statistics, Death Certificate Data)

Heroin

. Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. . In 2011, 4.2 million Americans aged 12 or older had used heroin at least once in their lives. . It is estimated that about 23% of individuals who use heroin become dependent on it. . Heroin overdoses frequently involve a suppression of breathing. This can affect the amount of oxygen that reaches the brain, a condition called hypoxia. . Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV. . Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease.

(Source: National Institute on Drug Abuse, Drug Facts: Heroin, October 2014, from: http://www.drugabuse.gov/publications/drugfacts/heroin)

The following graphs are data from the Ohio Automated Prescription Reporting System indicating Defiance County and Ohio opiate and pain reliever doses per patient, as well as opiate and pain reliever doses per capita.

Defiance County and Ohio Number of Opiate and Pain Reliever Doses Per Patient

350 284 282 287 280 300 258 238 236 212 250 205 210

200

150 Doses per Patient Patient per Doses 100

0 2010 2011 2012 2013 2014 Defiance Ohio

Defiance County and Ohio Number of Opiate and Pain Reliever Doses Per Capita

80 67.6 68.6 67.3 67.2 64.8 70 56.3 56.3 55.1 60 55.2 55.5 50 40 30

Capita per Doses 20 10 0 2010 2011 2012 2013 2014

Defiance Ohio

(Source: Ohio Automated Rx Reporting System, April 22, 2015, from: https://www.ohiopmp.gov/portal/docs.aspx)

Unintentional Drug Overdose Death Rates

. The average age-adjusted unintentional drug overdose death rate was 9.1 deaths per 100,000 in Defiance County from 2008-2013. ADULT . The average age-adjusted unintentional drug overdose death rate was 15.0 deaths per 100,000 in Ohio from 2008-2013.

DRUG USE

(Source: Ohio Department of Health, Office of Vital Statistics, Unintentional Drug Overdose Death Rates for Ohio Residents by County, obtained from: http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/injury%20prevention/CountyDrugData2013.pdf)

Prescription Analgesic Doses Per Capita

. In 2012, the statewide average per capita dosage rate was 66.7 doses per person.

. The average per capita dosage rate was 52.4.0 doses per person in Defiance County in 2012.

(Source: Ohio Mental Health and Addiction Services, Doses Per Capita September 2013, obtained from: http://mha.ohio.gov/Portals/0/assets/Research/Maps/Ohio_OARRS_Opioids_2012_v2.pdf)

Felony Cases and Drug Arrests January – June 2015

. Ohio State Highway Patrol (OSHP) investigated a wide range of felony offenses during the first half of 2015, including vice (1,820); assault (717); larceny (292); false pretense (100); property crimes (77); homicide/death (16); robbery/burglary (7); and various other types of felony ADULT offenses (150).

. OSHP Troopers made 6,256 total drug arrests during the first 6 months of 2015 – a 10% increase compared to 2014 and a 30% increase compared to the previous 3-year average (2012- 2014).

. Of the 6,256 drug arrests, over one-quarter (1,720 or 27%) included one or more felony drug charges. This represents a 36% increase over the previous 3-year average (2012-2014).

DRUG USE

(Source: Ohio State Highway Patrol, Felony Cases and Drug Arrests, January – June 2015, from http://statepatrol.ohio.gov/)

Adult І WOMEN’S HEALTH

Key Findings Defiance County Female Leading Types of Death, 2011– 2013 In 2015, nearly two-thirds (66%) of Defiance County women over the age of 40 reported having a 1. Heart Diseases (23% of all deaths) mammogram in the past year. 57% of Defiance 2. Cancers (21%) County women ages 19 and over had a clinical 3. Stroke (8%) breast exam and 43% had a Pap smear to detect 4. Chronic Lower Respiratory Diseases (7%) 5. Alzheimer’s (6%) cancer of the cervix in the past year. The Health Assessment determined that 4% of women (Source: CDC Wonder, 2011-2013) survived a heart attack and 3% survived a stroke at some time in their life. Almost one-third (31%) had high blood pressure, 30% had high blood Ohio Female cholesterol, 38% were obese, and 16% were Leading Types of Death, 2011 – 2013 identified as smokers, known risk factors for cardiovascular diseases. 1. Heart Diseases (23% of all deaths) 2. Cancers (21%) Women’s Health Screenings 3. Chronic Lower Respiratory Diseases (7%) 4. Stroke (6%) . In 2015, 67% of women had a mammogram at 5. Alzheimer’s disease (5%)

some time and two-fifths (41%) had this (Source: CDC Wonder, 2011-2013) screening in the past year.

. Nearly two-thirds (66%) of women ages 40 and over had a mammogram in the past year and 80% had one in the past two years. The 2012 BRFSS reported that 74% of women 40 and over in both Ohio and the U.S., had a mammogram in the past two years.

. Most (93%) Defiance County women have had a clinical breast exam at some time in their life and 57% had one within the past year. Nearly three-fourths (73%) of women ages 40 and over had a clinical breast exam in the past two years. The 2010 BRFSS reported that 75% of women 40 and over in Ohio and 77% in the U.S., had a clinical breast exam in the past two years.

. This assessment has identified that 93% of Defiance County women have had a Pap smear and 43% reported having had the exam in the past year. 73% of women had a pap smear in the past three years. The 2012 BRFSS indicated that 78% of both Ohio and U.S. women had a pap smear in the past three years.

. Defiance County women completed an average of 4.2 self-breast exams in the past year, increasing to 5.6 for those ages 40 and older.

Pregnancy

. 16% of Defiance County women had been pregnant in the past 5 years.

. Thinking back to their last pregnancy: 43% of women wanted to be pregnant then, 33% did not want to be pregnant then or any time in the future, 15% wanted to be pregnant sooner, 7% wanted to be pregnant later, and 4% of women did not recall.

. During their last pregnancy, Defiance County women: got a prenatal appointment in the first 3 months (95%), took a multi-vitamin (86%), took folic acid during pregnancy (41%), took folic acid pre- pregnancy (22%), smoked cigarettes (16%), experienced perinatal depression (8%), consumed alcoholic beverages (5%), and used marijuana (5%).

Women’s Health Concerns

. From 2011-2013, major cardiovascular diseases (heart disease and stroke) accounted for 31% of all female deaths in Defiance County (Source: CDC Wonder, Underlying Cause of Death).

. Women used the following as their usual source of services for female health concerns: WOMEN’S general or family physician (40%), private gynecologist (28%), nurse practitioner/physician’s assistant (10%), multiple places (4%), family planning clinic (3%), community health center (3%), and health department clinic (2%). 11% indicated they did not have a usual source of services for female health concerns.

. In 2015, the health assessment determined that 4% of women had survived a heart attack and 3% had survived a stroke at some time in their life.

. Major risk factors for cardiovascular disease include smoking, obesity, high blood cholesterol, high blood pressure, physical inactivity, and diabetes. In Defiance County, the 2015 Health Assessment has identified that:  62% were overweight or obese (60% Ohio, 58% U.S., 2013 BRFSS)  31% were diagnosed with high blood pressure (32% Ohio, 30% U.S., 2013 BRFSS)  30% were diagnosed with high blood cholesterol (36% Ohio, 37% U.S., 2013 BRFSS)  16% of all women were current smokers (23% Ohio, 17% U.S., 2013 BRFSS)  11% had been diagnosed with diabetes (12% Ohio, 12% U.S., 2013 BRFSS)

The following graph shows the percentage of Defiance County female adults that had various health exams in the past year. Examples of how to interpret the information shown on the graph include: 41% of Defiance County females had a mammogram within the past year, 57% had a clinical breast exam, and 43% had a Pap smear.

Defiance County Women's Health Exams Within the Past Year

100%

75% 66% 62% 59% 57% 58% 59% 58% 59% HEALTH 53% 55% 53% 50% 45% 45% 50% 41% 43% 38% 38% 38% 29% 25%

0% 0% Total Under 40 40 & Older Income <$25K Income >$25K Defiance 2008 Defiance 2012

Mammogram Breast Exam Pap Smear

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had a clinical breast exam in the past 74% 66% 73% 75%* 77%* two years (age 40 & over) Had a mammogram in the past two 69% 67% 80% 74%** 74%** years (age 40 & over) Had a pap smear in the past three 79% 74% 73% 78%** 78%** years N/A – Not Available *2010 BRFSS Data **2012 BRFSS Data

The following graphs show the Defiance County and Ohio age-adjusted mortality rates per 100,000 population for cardiovascular diseases. The graphs show:

. From 2009-2011, the Defiance County and Ohio female age-adjusted mortality rate was lower than the male rate for heart disease.

. The Defiance County female heart disease mortality rate was lower than the Ohio female rate from 2009 to 2011.

Defiance County Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2009-2011 300

250 209

200 135 Male 150 Female

100 48 54

Rate Rate per population 100,000 0 Heart Disease Stroke

Ohio Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2009-2011

300

240 250

200 153 Male Female 150

100 42 41 Rate per population 100,000 50

0 Heart Disease Stroke

(Source: Health Indicators Warehouse, 2009-2011)

The following graphs show the Defiance County age-adjusted cancer mortality rates per 100,000 population for women with comparison to Healthy People 2020 objectives when available. The graphs show:

. From 2009-2013, the Defiance County age-adjusted mortality rate for female lung cancer WOMEN’S mortality rate was less than the Ohio rate.

. The Defiance County breast cancer and colon/rectum mortality rates were greater than the Ohio rate.

Defiance County Female Age-Adjusted Cancer Mortality Rates 60

50 43.6 42.0

40 27.0 30 23.5 20.6

population 17.1 20 14.0 Rate per per 100,000 Rate 10

0 Lung Cancer Colon/Rectum Cancer Breast Cancer

Defiance 2009-2013 Ohio 2009-2013 HP 2020 Target*

(Source: CDC Wonder 2009-2013 and Healthy People 2020)

*Note: Healthy People 2020 target rates are not gender specific; Healthy People 2020 Targets may not be available for all diseases.

HEALTH Human Papilloma Virus (HPV and Vaccine)

. Approximately 79 million Americans are infected with human papillomavirus (HPV); approximately 14 million people will become newly infected each year. . Some HPV types can cause cervical, vaginal, and vulvar cancer among women, penile cancer among men, and anal and some oropharyngeal cancers among both men and women. . Other HPV types can cause genital warts among both sexes. Each year in the United States an estimated 27,000 new cancers attributable to HPV occur, 17,600 among females (of which 10,400 are cervical cancer) and 9,300 among males (of which 7,200 are oropharyngeal cancers). . There are, however, two HPV vaccines available (Gardasil® and Cervarix®) which protect against the types of HPV infection that cause most cervical cancers (HPV types 16 and 18). Both vaccines should be given as a three-shot series. Clinical trials and post- licensure monitoring data show that both vaccines are safe. . CDC recommends HPV vaccination for the prevention of HPV infections responsible for most types of cervical cancer.

(Sources: Centers for Disease Control and Prevention, Vaccine Safety, Human Papillomavirus (HPV) Vaccine, updated January 26, 2015, from http://www.cdc.gov/vaccinesafety/vaccines/HPV/Index.html)

Adult І MEN’S HEALTH

Key Findings Defiance County Male In 2015, 50% of Defiance County males over Leading Types of Death, 2011 – 2013 the age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases 1. Cancers (27% of all deaths) (heart disease and stroke) accounted for 33% 2. Heart Diseases (24%) and cancers accounted for 27% of all male 3. Chronic Lower Respiratory Diseases (9%) deaths in Defiance County from 2011-2013. 4. Stroke (6%) 5. Accidents, Unintentional Injuries (5%) The Health Assessment determined that 4% of men survived a heart attack and 3% survived (Source: CDC Wonder, 2011-2013) a stroke at some time in their life. Nearly one- third (32%) of men had been diagnosed with high blood pressure, 25% had high blood Ohio Male cholesterol, and 16% were identified as Leading Types of Death, 2011 – 2013 smokers, which, along with obesity (34%), are 1. Heart Diseases (25% of all deaths) known risk factors for cardiovascular diseases. 2. Cancers (24%) Men’s Health Screenings and 3. Chronic Lower Respiratory Diseases (6%) 4. Accidents, Unintentional Injuries (6%) Concerns 5. Stroke (4%)

(Source: CDC Wonder, 2011-2013) . More than one-third (37%) of Defiance County males had a Prostate-Specific Antigen (PSA) test at some time in their life and 22% had one in the past year.

. 76% of males age 50 and over had a PSA test at some time in their life, and 50% had one in the past year.

. 51% of men had a digital rectal exam in their lifetime and 15% had one in the past year.

. From 2011-2013, major cardiovascular diseases (heart disease and stroke) accounted for 33% of all male deaths in Defiance County (Source: CDC Wonder).

. In 2015, the health assessment determined that 4% of men had a heart attack and 3% had a stroke at some time in their life.

15% of Defiance County males had a digital rectal exam in the past year.

. Major risk factors for cardiovascular disease include smoking, obesity, high blood cholesterol, high blood pressure, physical inactivity, and diabetes. In Defiance County the 2015 health assessment has identified that: o 77% were overweight or obese (71% Ohio, 71% U.S., 2013 BRFSS) o 32% were diagnosed with high blood pressure (36% Ohio, 34% U.S., 2013 BRFSS) o 25% were diagnosed with high blood cholesterol (40% Ohio, 40% U.S., 2013BRFSS) o 16% of all men were current smokers (24% Ohio, 22% U.S., 2013 BRFSS) o 8% had been diagnosed with diabetes (10% Ohio, 10% U.S., 2013 BRFSS)

. From 2011-2013, the leading cancer deaths for Defiance County males were lung, prostate, and colon and rectum cancers. Statistics from the same period for Ohio males show lung, prostate, and colon and rectum cancers as the leading cancer deaths (Source: ODH Information Warehouse).

The following graph shows the percentage of Defiance County male adults that had various health exams in the past year. Examples of how to interpret the information shown on the graph include: 22% of Defiance County males had a PSA test within the past year and 15% had a digital rectal exam.

Defiance County Men's Health Exams Within the Past Year 60% 50%

40%

33% 33% MEN’S 32% 28% 26% 22% 22% 18% 20% 15% 14% 11% 5% 5%

0% Total Under 50 50 & Older Income Income Defiance Defiance <25K >25K 2008 2012

Prostate-Specific Antigen Digital Rectal

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had a digital rectal exam within 33% 22% 15% N/A N/A the past year HEALTH Had a PSA test within the past year 32% 28% 22% N/A N/A N/A – Not Available

The following graphs show the Defiance County and Ohio age-adjusted mortality rates per 100,000 population for cardiovascular diseases by gender. The graphs show:

. From 2009-2011, the Defiance County and Ohio male age-adjusted mortality rate was higher than the female rate for heart disease.

. The Defiance County male age-adjusted mortality rate was lower than the female rate for stroke in 2009-2011.

. The Defiance County male age-adjusted heart disease mortality rate was lower than the Ohio male rate.

Defiance County Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2009-2011

300

250 209

200 Male 135 Female 150

100 48 54 50 Rate Rate per population 100,000 0 Heart Disease Stroke

Ohio Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2009-2011

300

240 250

200 153 Male Female 150

100 42 41 Rate Rate per population 100,000 50

0 Heart Disease Stroke

(Source: Health Indicators Warehouse, 2009-2011)

The following graph shows the Defiance County age-adjusted cancer mortality rates per 100,000 population for men with comparison to Healthy People 2020 objective. The graph shows:

. From 2009-2013, the Defiance County age-adjusted mortality rate for male lung cancer was higher than the Ohio average.

. The Defiance County colon/rectum cancer age-adjusted mortality rate for males was lower than the Ohio rates for 2009-2013.

. The age-adjusted prostate cancer mortality rate in Defiance County for 2009-2013 was higher than the Ohio rate and the Healthy People 2020 objective. MEN’S

Defiance County Male Age-Adjusted Cancer Mortality Rates

100

72.3 80 68.8

40 24.9

population 20.5 20.9 21.2

18.8

Rate per per 100,000 Rate 20

Lung Cancer Colon/Rectum Cancer Prostate Cancer HEALTH Defiance 2009-2013 Ohio 2009-2013 HP 2020 Target*

*Note: the Healthy People 2020 target rates are not gender specific. (Source: CDC Wonder 2009-2013 and Healthy People 2020)

Men’s Health Data

. Approximately 12% of adult males ages 18 years or older reported fair or poor health. . 21% of adult males in the U.S. currently smoke. . Of the adult males in the U.S., 31% had 5 or more drinks in 1 day at least once in the past year. . Only 54% of adult males in the U.S. met the 2008 federal physical activity guidelines for aerobic activity through leisure-time aerobic activity. . 35% of men 20 years and over are obese. . There are 19% of males under the age of 65 without health care coverage. . The leading causes of death for males in the United States are heart disease,

cancer and accidents (unintentional injuries).

(Source: CDC, National Center for Health Statistics, Men’s Health, Fast Stats, July 14, 2014, from http://www.cdc.gov/nchs/fastats/mens_health.htm)

Cancer and Men

. Every year, more than 300,000 men in America lose their lives to cancer.

. The most common kinds of cancer among men in the U.S. are skin cancer, prostate cancer, lung cancer, and colorectal cancer.

. Skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light from the sun and tanning devices.

. More men in the U.S. die from lung cancer than any other type of cancer, and cigarette smoking accounts for 90% of lung cancer deaths.

. Smoking increases the risk of developing the following types of cancer: esophagus, pancreas, pharynx, larynx, lip, oral cavity, kidney, bladder, stomach, colorectal, and acute myeloid leukemia.

. In men, the following cancers are associated with being overweight: colorectal cancer, esophageal adenocarcinoma (a type of cancer of the tube that connects your throat to your stomach), and cancer of the kidney and pancreas. Adopting a lifestyle that includes healthy eating and regular physical activity can help lower the risk for several types of cancers.

. Prostate cancer is the most frequently diagnosed cancer in men aside from skin cancer. For unclear reasons, incidence rates are 63% higher in African Americans than in whites. It is the second most common cause of cancer death in men.

(Source: Center for Disease Control and Prevention, Cancer Prevention and Control, June 9, 2015, http://www.cdc.gov/features/cancerandmen/, and American Cancer Society, Cancer Facts & Figures 2015, http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf)

PRE

Adult І PREVENTIVE MEDICINE AND ENVIRONMENTAL HEALTH

Key Findings Skin Cancer Prevention Recommendations VENTIVE MEDICINE Over half (58%) of adults ages 65 and over had a pneumonia vaccination at some . Seek shade, especially during midday hours. time in their life. More than half (51%) of . Wear clothing to protect exposed skin. adults ages 50 and over had a . Wear a hat with a wide brim to shade the colonoscopy/sigmoidoscopy within the face, head, ears, and neck. past 5 years. . Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays Preventive Medicine as possible. . Use sunscreen with sun protective factor . Half (50%) of Defiance County adults (SPF) 15 or higher, and both UVA and UVB had a flu vaccine during the past 12 protection. months. . Avoid indoor tanning.

(CDC, Skin Cancer Prevention, Updated 5/29/2014, . Of those who had a flu vaccine, 96% http://www.cdc.gov/cancer/skin/basic_info/prevention.htm) had the shot and 4% had the nasal spray.

. 76% of Defiance County adults ages 65 and over had a flu vaccine in the past 12 months. The 2013 BRFSS reported that 63% of U.S. and Ohio adults ages 65 and over had a flu vaccine in the past year.

. More than one-fourth (27%) of adults have had a pneumonia shot in their life, increasing to 58% of those ages 65 and over. The 2013 BRFSS reported that 71% of Ohio and 70% of U.S. adults ages 65 and over had a pneumonia shot in their life.

. Defiance County adults have had the following vaccines: tetanus booster (including Tdap) in the past 10 years (50%), pneumonia vaccine in their lifetime (27%), Zoster (shingles) vaccine in their lifetime (16%), pertussis vaccine in the past 10 years (7%), and human papillomavirus vaccine in their lifetime (3%).

Preventive Health Screenings and Exams

. More than half (51%) of adults ages 50 and over had a colonoscopy or sigmoidoscopy in the past 5 years.

. In the past year, 66% of Defiance County women ages 40 and over have had a mammogram.

. In the past year, half (50%) of men ages 50 and over have had a PSA test.

. See the Women and Men’s Health Sections for further prostate, mammogram, clinical breast exam, and Pap smear screening test information for Defiance County adults.

Environmental Health

. 46% of Defiance County adults used a septic tank for wastewater. Of those who had a septic tank, 41% had it pumped within the past 5 years, and 20% never had it pumped. 24% did not know the last time their septic tank had been pumped.

. 47% of Defiance County adults had a private water source for drinking water. Of those who had a private water source, 20% had it tested within the past year, and 24% have never had it tested. 18% did not know the last time their water source had been tested.

. Defiance County households had the following disaster preparedness supplies: cell phone (91%), working flashlight and working batteries (88%), 3-day supply of nonperishable food for everyone in the household (64%), working battery-operated radio and working batteries (53%), 3-day supply of prescription medication for each person who takes prescribed medicines (53%), 3-day supply of water for everyone in the household (1 gallon of water per person per day) (41%), communication plan (12%), and a disaster plan (8%).

. 11% of adults reported their household was well-prepared to handle a large-scale disaster or emergency, and 21% felt their household was not prepared at all.

. Defiance County adults indicated the following as their main method or way of getting information from authorities in a large-scale disaster or emergency: television (63%), radio (44%), internet (36%), neighbors (13%), print media (6%), and other methods (2%).

. Defiance County adults thought the following threatened their health in the past year.

 Mold (8%)  Excess medications in home (1%)

 Insects (7%)  Plumbing problems (1%)

 Moisture issues (3%)  Radon (1%)

 Rodents (3%)  General living conditions (1%)

 Temperature regulation (3%)  Safety hazards (<1%)

 Chemicals found in products (2%)  Sanitation issues (<1%)

 Unsafe water supply/wells (2%)  Bed bugs (<1%)

 Sewage/waste water problems (1%)  Cockroaches (<1%)

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had a pneumonia vaccination N/A N/A 58% 71% 70% (ages 65 and over) Had a flu vaccine in the past N/A N/A 76% 63% 63% year (ages 65 and over)

N/A – Not available

PRE

Defiance County Adults Having Discussed Healthcare Topics With Their Healthcare Professional in the Past 12 Months

Total HEALTHCARE TOPICS 2015 Physical Activity or Exercise 29% Weight, Dieting or Eating Habits 28%

Self-Breast or Self-Testicular Exam 24% VENTIVE MEDICINE Immunizations 23% Significance of Family History 17% Depression, Anxiety, or Emotional Problems 15% Quitting Smoking 6% Alternative Pain Therapy 6% Sexual Practices Including Family Planning, STDs, AIDS, & Condom 4% Use Injury Prevention Such As Safety Belt Use & Helmet Use 4% Alcohol Use 4% Alcohol Use When Taking Prescription Drugs 3% Domestic Violence 1% Illicit Drug Abuse 1%

Defiance County Adult Health Screening Results GENERAL SCREENING RESULTS Total Sample Diagnosed with High Blood Pressure 32% Diagnosed with High Blood Cholesterol 27% Diagnosed with Diabetes 9% Diagnosed with a Heart Attack 5% Diagnosed with a Stroke 3%

(Percentages based on all Defiance County adults surveyed)

Healthy People 2020 Immunization and Infectious Diseases (IID) - Pneumonia Vaccination Healthy Defiance Ohio U.S. People Objective County 2013 2013 2020 2015 Target IID-13.1: Increase the percentage of non-institutionalized high-risk adults aged 65 years and older who are 58% 71% 70% 90% vaccinated against pneumococcal disease

*U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2013 BRFSS, 2015 Defiance County Health Assessment)

Basic Disaster Supplies Kit

A basic emergency supply kit could include the following recommended items: . One gallon of water per person per day for at least three days, for drinking and sanitation.

. At least a three-day supply of non-perishable food. . A working battery operated radio and working batteries. . Flashlight and extra batteries. . First aid kit. . Whistle to signal for help. . Dust mask to help filter contaminated air. . Moist towelettes, garbage bags and plastic ties for personal sanitation. . Cell phone with chargers, inverter or solar charger. . Manual can opener for food.

(Source: Federal Emergency Management Agency (FEMA), Ready: Prepare. Basic Disaster Supplies Kit, Updated 6/10/2014, from: http://www.ready.gov/basic-disaster-supplies-kit)

Who Should Get a Yearly Flu Shot?

The following groups are recommended to get a yearly flu vaccine: . All persons aged 6 months and older should be vaccinated annually. . When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons who: • Are aged 6 months through 4 years. • Are aged 50 years and older. • Have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus). • Are or will be pregnant during the influenza season. • Are American Indians/Alaska Natives. • Are morbidly obese (body-mass index is 40 or greater. • Are health-care personnel. • Are household contacts and caregivers of children aged younger than 5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged younger than 6 months. • Are household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

(Source: CDC, Seasonal Influenza (Flu), Who Should Get Vaccinated Against Influenza, Updated in 2014, from: http://www.cdc.gov/flu/protect/whoshouldvax.htm)

Adult І SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES

Key Findings HIV in the United States SEXUAL BEHAVIOR

. More than 1.2 million people in the United In 2015, more than three-fifths (63%) of States are living with HIV infection, and Defiance County adults had sexual almost 1 in 7 (14%) are unaware of their intercourse. Four percent of adults had more infection. than one partner. Prevalence estimates . By race, African Americans face the most suggest that young people aged 15-24 years severe burden of HIV. acquire half of all new STDs and that 1 in 4 . The estimated incidence of HIV has sexually active adolescent females have an remained stable overall in recent years, at STD, such as chlamydia or human papilloma about 50,000 new HIV infections per year. virus (HPV) (Source: CDC, STDs in Adolescents and . In 2012, an estimated 47,989 people were Young Adults, 2014 STD Surveillance). diagnosed with HIV infection in the United Adult Sexual Behavior States. In that same year, an estimated 27,928 people were diagnosed with AIDS.

. Since the epidemic began, an estimated 4% of adults reported they had 1,170,989 people in the United States have intercourse with more than one partner in been diagnosed with AIDS the past year, increasing to 8% of those . An estimated 13,834 people with an AIDS under the age of 30. diagnosis died in 2010, and approximately 648,459 people in the United States with . Defiance County adults used the an AIDS diagnosis have died since the following methods of birth control: epidemic. vasectomy (21%), tubes tied (17%), they or their partner were too old (16%), birth (Source: CDC, HIV in the United States: At a Glance, 11/25/2014, from: control pill (13%), hysterectomy (11%), http://www.cdc.gov/hiv/statistics/basics/ataglance.html) condoms (10%), withdrawal (7%), abstinence (4%), infertility (4%), rhythm method (3%), IUD (2%), diaphragm (1%), and shots (1%).

. 11% of Defiance County adults were not using any method of birth control.

. Defiance County adults did not use birth control for the following reasons:  They or their partner had a hysterectomy/vasectomy/tubes tied (42%)  They or their partner were too old (20%)  They did not think they or their partner could get pregnant (6%)  They did not want to use birth control (6%)  They wanted to get pregnant (4%)  They did not care if they or their partner got pregnant (3%)

 Their partner did not want to use birth control (3%)  They or their partner did not like birth control/fear of side effects (2%)  They or their partner were currently pregnant (2%)  They could not pay for birth control (2%)  No regular partner (2%)  They had a problem getting birth control when they needed it (1%)  They or their partner had just had a baby (1%)  They or their partner were currently breast feeding (1%)  Lapse in use of method (1%)  Religious preferences (1%)

. Defiance County adults were treated for the following sexually transmitted diseases in the past five years: genital herpes (1%), multiple STDs (1%), and human papilloma virus (HPV) (<1%).

. 19% of adults have been tested for HIV as part of a blood donating process, and 13% of adults have been tested for HIV not as part of a blood donating process.

. 4% of Defiance County adults reported being forced to have sexual activity when they didn’t want to, increasing to 8% of females.

The following graph shows the sexual activity of Defiance County adults. Examples of how to interpret the information in the graph include: 59% of all Defiance County adults had one sexual partner in the last 12 months and 4% had more than one, and 54% of males had one partner in the past year.

Number of Sexual Partners in the Past Year

100%

30% 28% 29% 31% 29% 37% 42% 80% 47% 2% 61% 4% 67% 4% 7% 4% 60% 4% 4% 8% 40% 4% 67% 62% 66% 70% 66% 59% 54% 45% 20% 33% 35%

0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

One More than one None

Respondents were asked: “During the past 12 months, with how many different people have you had sexual intercourse?”

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Had more than one sexual partner 7% 4% 4% N/A N/A in past year N/A – Not available

The following graphs show Defiance County chlamydia disease rates per 100,000 population updated June 27, 2014 by the Ohio Department of Health. The graphs show:

. Defiance County chlamydia rates fluctuated from 2009 to 2013. Defiance County rates remained below the Ohio rates.

SEXUAL BEHAVIOR . In 2012, the U.S. rate for new chlamydia cases was 456.7 per 100,000 population (Source: CDC, STD Trends in the U.S., 2014).

Chlamydia Annualized Disease Rates for Defiance County and Ohio 600 500

400 456.4 461.8 462.0 420.2 443.7 300 339.5 349.0

200 245.6

181.9 100 166.5 Rate Rate per Population 100,000 0 2009 2010 2011 2012 2013 Defiance Ohio

Annualized Count of Chlamydia Cases for Defiance County 200

150

132 135 100 95 50 64 71

Number of Number reported cases 0 2009 2010 2011 2012 2013

(Source for graphs: ODH, STD Surveillance, data reported through 6-27-14)

The following graphs show Defiance County gonorrhea disease rates per 100,000 population updated June 27, 2014 by the Ohio Department of Health. The graphs show:

. The Defiance County gonorrhea rate increased from 2009 to 2011, then decreased from 2011 to 2013. The Defiance County gonorrhea rate remained below the Ohio rate.

. The Ohio gonorrhea rate fluctuated from 2009 to 2013.

. In 2012, the U.S. rate for new gonorrhea cases for the total population was 107.5 per 100,000 population (Source: CDC, STD Trends in the U.S., 2014).

. The Healthy People 2020 objective for gonorrhea is 257 new female and 198 new male cases per 100,000 population.

Gonorrhea Annualized Disease Rates for Defiance County and Ohio 200

150

139.2 143.3 145.0 143.4 144.4

100

50 64.3

Rate Rate per population 100,000 13 49.9 41 23.3 0 2009 2010 2011 2012 2013 Defiance Ohio

Annualized Count of Gonorrhea Cases for Defiance County 30 25 25

20 18 16 15 9 10 5 5

Number of Number reported cases 0

2009 2010 2011 2012 2013

(Source for graphs: ODH, STD Surveillance, data reported through 6-27-2014)

The following graph shows Defiance County HIV/AIDS rates per 100,000 population updated December 31, 2013 by the Ohio Department of Health. The graph shows:

. From 2009-2013, the number of people living with HIV/AIDS in Defiance County increased.

SEXUAL BEHAVIOR Living with HIV/AIDS in Defiance County

30 24 24 25 22 19 20 16 15

NumberCases of Reported 0 2009 2010 2011 2012 2013

(Source for graphs: ODH HIV/AIDS Surveillance Program, Updated 12-31-13)

Pregnancy Outcomes *Please note that the pregnancy outcomes data includes all births to adults and adolescents.

. From 2010-2014, there was an average of 400 live births per year in Defiance County.

Defiance County Total Live Births

600 477 481

445 500 388

400

300 211

200

100 Number of Live Births Live of Number 0

2010 2011 2012 2013** 2014**

(Source for graphs: ODH Information Warehouse Updated 8-4-14)

** Indicates preliminary data that may change

Adult І QUALITY OF LIFE

Key Findings Simple Tips for Healthy Eyes

In 2015, 39% of Defiance County adults were Follow these simple guidelines for maintaining limited in some way because of a physical, healthy eyes: mental or emotional problem. . Have a comprehensive dilated eye exam. . Know your family’s eye health history. Impairments and Health Problems . Eat right to protect your sight. . Wear sunglasses to protect your eyes from . In 2015, nearly two-fifths (39%) of Defiance the sun’s ultraviolet rays. County adults were limited in some way . Give your eyes a rest. because of a physical, mental or . Quit smoking or never start. emotional problem (21% Ohio, 20% U.S., . Clean your hands and your contact lenses 2013 BRFSS). properly.

(Source: CDC, Vision Health Initiative, 2012, from: . Among those who were limited in some http://www.cdc.gov/visionhealth/basic_information/eye_he way, the following most limiting problems althtips.htm) or impairments were reported: back or neck problems (43%), arthritis/rheumatism (35%), stress, depression, anxiety, or emotional problems (18%), walking problems (17%), high blood pressure (13%), diabetes (12%), hearing problems (11%), fractures, bone/joint injuries (10%), lung/breathing problems (9%), heart problems (8%), eye/vision problems (8%), tobacco dependency (8%), cancer (3%), stroke- related problems (2%), and a learning disability (<1%).

. Defiance County adults had fallen in the past 6 months due to the following: same-level fall (slipping, tripping or stumbling) (14%), stairs (2%), shower (<1%), ladders (<1%), and some other way/place (3%).

. One-quarter (25%) of Defiance County adults 65 and older had fallen in the past 6 months due to the following: same-level fall (slipping, tripping or stumbling) (17%), stairs (1%), shower (1%), ladders (1%), and some other way/place (8%). 3% of Defiance County adults ages 65 and older have fallen more than once.

. Defiance County adults needed help with the following because of an impairment or health problem: household chores (3%), shopping (2%), finances (2%), getting around for other purposes (2%), doing necessary business (2%), bathing (1%), getting around the house (1%), dressing (<1%), and eating (<1%).

. Defiance County adults were responsible for providing regular care or assistance to the following: multiple children (12%), an elderly parent or loved one (7%), a friend, family member or spouse with a health problem (4%), grandchildren (3%), an adult child (2%), someone with special needs (2%), a friend, family member or spouse with dementia (2%), foster children (1%), and a friend, family member or spouse with a mental health issue (1%).

Defiance Defiance Defiance Adult Comparisons Ohio U.S County County County 2013 2013 2008 2012 2015

Limited in some way because of a physical, mental, or emotional 25% 37% 39% 21% 20% problem

The following graph shows the most limiting health problems of Defiance County adults who reported being limited by a physical, mental or emotional problem. Examples of how to interpret the information shown on the graph includes: 43% of Defiance County adults who had a limitation reported back and neck problems.

Defiance County Most Limiting Health Problems

QUALITYOF LIFE 60% 50% 43% 35% 40%

30% 18% 17% 20%

10% 0% Back and Neck Arthritis/Rheumatism Stress, Depression, Walking Problems Problems Anxiety, Emotional Problems

Healthy People 2020 Arthritis, Osteoporosis, and Chronic Back Conditions (AOCBC) Defiance Healthy Objective County People 2020 2015 Target

AOCBC-2: Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation 35% 36% in activity due to arthritis or joint symptoms *U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2015 Defiance County Health Assessment)

Hearing Loss in Older Adults

. Hearing loss is one of the most common conditions affecting older adults. Approximately 17 percent, or 36 million, of American adults report some degree of hearing loss. . There is a strong relationship between age and reported hearing loss: 18 percent of American adults 45-64 years old, 30 percent of adults 65-74 years old, and 47 percent of adults 75 years old, or older, have a hearing impairment. . Men are more likely to experience hearing loss than women. . People with hearing loss may find it hard to have a conversation with friends and

family. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms.

(Source: NIH Senior Health, Hearing Loss, http://nihseniorhealth.gov/hearingloss/hearinglossdefined/01.html)

Adult І SOCIAL CONTEXT AND

SAFETY Key Findings

In 2015, 7% of Defiance County adults were threatened and 7% were abused in the past year (including physical, sexual, emotional, financial, and verbal abuse). 58% of adults reported having firearms in and around their homes.

Social Context

. 7% of Defiance County adults were threatened in the past year. They were threatened by the following: a spouse or partner (74%), another family member (11%), a parent (8%), and someone else (37%).

. 7% of Defiance County adults were abused in the past year. They were abused by the following: a spouse or partner (57%), a parent (14%), another family member (9%), and someone else (40%).

7% of Defiance County adults were threatened, and 7% were abused in the past year.

. Defiance County adults experienced the following as a child: lived with someone who was a problem drinker or alcoholic (15%), a parent or adult in their home swore at, insulted, or put them down (14%), their parents became separated or were divorced (14%), lived with someone who was depressed, mentally ill, or suicidal (10%), someone at least 5 years older than them or an adult touched them sexually (8%), a parent or adult in their home hit, beat, kicked, or physically hurt them (7%), their parents or adults in their home slapped, hit, kicked, punched, or beat each other up (6%), lived with someone who used illegal stress drugs, or who abused prescription medications (4%), someone at least 5 years older than them or an adult tried to make them touch them sexually (4%), lived with someone who served time or was sentenced to serve time in prison, jail or other correctional facility (2%), someone at least 5 years older than them or an adult forced them to have sex (2%), and their parents were not married (1%).

. Defiance County adults experienced the following in the past year: had to choose between paying bills and buying food (8%), their food assistance was cut (3%), were worried they would run out of food (3%), a loss of income led to food insecurity issues (2%), went hungry/ate less to provide more food for their family (2%), and were hungry but did not eat because they did not have money for food (2%).

. Defiance County adults experienced the following stressful situations in the past 12 months: a close family member went to the hospital (35%), death of a family member or close friend (32%), had bills they could not pay (13%), someone in their household had their hours at work reduced (6%), moved to a new address (4%), someone in their household lost their job (4%), someone close to them had a problem with drinking or drugs (3%), someone in their household went to jail (3%), became separated or divorced (2%), had someone homeless living with them (2%), were involved in a physical fight (1%), their child was hit or slapped by their spouse or partner (<1%), and were hit or slapped by their spouse or partner (<1%).

. In the past month, 11% of adults needed help meeting their general daily needs, such as food, clothing, shelter or paying utility bills, increasing to 25% of those with incomes less than $25,000.

. Defiance County adults who needed help meeting their general daily needs sought assistance from the following: friend or family member (57%), social service agency (5%), church (3%), Welfare Department/Job & Family Services (3%), First Call for Help/2-1-1 (2%), and somewhere else (10%). SOCIAL CONTEXT . Defiance County residents reported the following concerns in their community: drug use (41%), unemployment (27%), distracted driving (26%), bullying (25%), youth substance abuse (22%), opiate/prescription drug abuse (17%), lack of affordable healthcare (16%), traffic (16%), school funding (16%), OVI (15%), senior/elder care (15%), sexting (15%), healthy eating (14%), physical fitness (14%), violence (12%), underemployment (12%), teen pregnancy (12%), parents hosting/allowing underage drinking (12%), nutrition (10%), homelessness (10%), suicide prevention (9%), tobacco use (9%), lack of affordable housing (8%), speeding (6%), lack of affordable transportation (6%), cancer prevention screenings (6%), lack of health education (5%), disaster preparedness (5%), chronic disease prevention (4%), discrimination based on race, ethnicity, sexual orientation, etc. (4%), bicycle safety (4%), cooking (4%), seat belt or restraint usage (3%), falls (3%), and gambling (3%).

Safety

. 58% of Defiance County adults had firearms in or around their home for the following reasons: hunting or sport (42%), protection (33%), work (2%), and some other reason (5%).

. Defiance County adults reported doing the following while driving: eating (53%), talking on hand-held cell phone (49%), talking on hands-free cell phone (19%), not wearing a seatbelt (15%), texting (14%), using internet on their cell phone (7%), being under the influence of alcohol (5%), checking Facebook on their cell phone (5%), reading (1%), being under the influence of drugs (1%), and other activities (such as applying makeup, shaving, etc.) (2%).

. 2% of adults reported they or a family member contacted the poison control hotline or had gone to the emergency room for a potential poisoning in the past year.

. Defiance County adults reported always wearing a helmet while riding the following: snowmobile (88%), motorcycle (20%), ATV (17%), and bike (7%).

. Defiance County adults reported never wearing a helmet while riding the following: bike (81%), ATV (51%), and motorcycle (33%).

Distracted Driving

. Distracted driving is driving while doing another activity that takes your attention away from driving. Distracted driving can increase the chance of a motor vehicle crash. . Each day, more than 9 people are killed and more than 1,060 people are injured in crashes that were reported to involve a distracted driver. . In 2011, 3,331 people were killed in crashes involving a distracted driver. An additional 387,000 people were injured in motor vehicle crashes involving a distracted driver in 2011 . 69% of drivers in the U.S. ages 18-64 reported that they had talked on their cell

phone while driving, and 31% reported that they had read or sent text messages or email messages while driving at least once within the last 30 days. . Nearly half of all U.S. high school students’ aged 16 years or older text or email while driving.

(Source: CDC, Distracted Driving, updated October 10, 2014, http://www.cdc.gov/motorvehiclesafety/distracted_driving/index.html)

The following graph shows the percentage of Defiance County adults that had a firearm in the home. Examples of how to interpret the information shown on the first graph include: 58% of all Defiance County adults kept a firearm in their home, 66% of males, and 57% of those ages 30-64 kept a firearm in their home.

Defiance County Adults With a Firearm in the Home 100%

80% 73% 66% 60% 58% 57% 57% 56% 60% 50% 50% 48%

40%

20%

0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Victims of Gun Violence in America

. More than 100,000 people are shot in murders, assaults, suicides, and suicide attempts, accidents or by police intervention in America in an average year.

o 31,537 people die from gun violence and 71,386 people survive gun injuries.

. Every day, an average of 282 people are shot in America. Of those 282 people, 86 people die and 196 are shot, but survive.

o Of the 282 people who are shot every day, an average of 50 are children and teens.

o Of the 86 people who die, 32 are murdered, 51 are suicides, 2 die accidently and 1 with an unknown intent.

o Of the 196 people who are shot but survive, 140 are from assault, 43 are shot accidently, 10 are suicide attempts, 2 are police interventions and 1 is of unknown intent.

(Source: Brady Campaign to Prevent Gun Violence, “There Are Too Many Victims of Gun Violence” fact sheet, retrieved from: http://www.bradycampaign.org/sites/default/files/GunDeathandInjuryStatSheet3YearAverageFINAL.pdf)

Ohio State Patrol Activity Statistics

. The table below shows activity that has been produced by the Ohio State Highway Patrol for Defiance County from 1/1/2015 through 8/2/2015. SOCIAL CONTEXT

. The table also shows a previous year comparison for the same time frame.

Year to Date Activity 2014 2015

Enforcement Stops 2,734 2,476

Non-Enforcement Activity 3,425 3,933

Warnings 2,194 2,527

Motorist Assists 925 1,082

Crashes Investigated 328 269

OVI Enforcement 87 94

Driving Under Suspension Enforcement 75 97

Seat Belt Enforcement 424 434

Commercial Vehicle Enforcement 133 90

Felony Arrests 4 14

Felony Warrants Served 1 1

Misdemeanor Summons Issued 31 54

Misdemeanor Warrants Served 3 4

Drug Violations 19 36

Identity Theft Enforcements 0 0

Resisting Arrest Violations 0 2

Weapons Violations 0 1 (Source: Ohio State Highway Patrol Statistics, Defiance County Activity Statistics, Updated 8/2/2015, obtained from: http://www.statepatrol.ohio.gov/statistics/statspage.asp?Area1=26&B2=Submit)

(Source: Ohio State Highway Patrol Statistics, Defiance County Fatal Traffic Crash Statistics, Updated 6/30/2015, obtained from: http://www.statepatrol.ohio.gov/statistics/statspage.asp?Area1=26&B2=Submit)

Ohio State Highway Patrol Statistics

. Below are the yearly activity summaries and officer complaints from 2009-2013.

SOCIAL CONTEXT . In 2013 there were 64,468 total crashes in the state of Ohio.

5 Year Crashes Investigated 2009 2010 2011 2012 2013 Total

Total Crashes 67,695 69,077 66,628 64,561 64,468 333,429 Fatal 494 514 499 535 468 2,510 Injury 20,271 20,741 20,118 19,498 18,586 99,214 Property/Unknown 46,930 47,822 46,011 44,528 46,414 231,705

5 Year Traffic Enforcement 2009 2010 2011 2012 2013 Total

Total Contacts 1,428,830 1,386,383 1,404,060 1,495,564 1,582,694 7,307,531 Enforcement 523,525 514,247 512,125 567,858 601,371 2,719,126 Non-Enforcement 915,305 872,136 891,935 927,706 981,323 4,588,405 OVI Arrests 24,254 22,090 23,747 24,529 24,128 118,748 Speed Citations 318,543 325,423 323,477 362,821 381,500 1,711,765 Safety Belt Citations 98,039 86,623 84,176 91,595 97,463 457,896 Driver License Citations 26,019 25,367 25,656 28,299 32,344 137,685 Traffic Warnings 410,659 371,085 367,739 409,029 440,349 1,998,861 Motorist Assists 324,906 308,573 312,104 304,293 291,837 1,541,713

5 Year Crime Enforcement 2009 2010 2011 2012 2013 Total

Cases 11,191 11,209 9,040 9,244 9,975 50,659 Stolen Vehicles Recovered 673 676 653 735 654 3,391 Drug Arrests 5,327 5,665 6,164 7,644 9,628 34,428 Illegal Weapon Arrests 315 332 362 395 568 1,972 Resisting Arrests 733 682 726 721 731 3,593

(Source: OSHP Computer-Aided Dispatch (CAD) System and DPS Electronic Crash Record System. Updated: 01/30/2014)

Traffic Stop Data

. This data is compiled from all traffic stops in which a citation, inspection, warning, or vehicle defect notice was issued by Ohio State Highway Patrol Troopers in 2013.

Crime Enforcement Asian Black Hispanic White Unknown Total Traffic Stop Contracts 13,558 131,805 21,701 818,994 4,278 991,001

(Source: OSHP Computer-Aided Dispatch (CAD) System and DPS Electronic Crash Record System. Updated: 01/30/2014)

Crime Data

. In 2013, the total population in Defiance County was 38,649.

. There were a total of 641 property crimes and 36 violent crimes in 2013.

Total Number of Crimes in Defiance County in 2013

700

600 502 500

400

300

200 137

100 17 15 6 3 2 1

0 Larceny- Burglary Aggravated Forcible Arson Robbery Motor Vehicle Murder Theft Assault Rape Theft

(Source: Office of Criminal Justice Services, Crime Statistics and Crime Reports, 2013, from http://www.ocjs.ohio.gov/crime_stats_reports.stm)

Arrests/Incarceration Data

. In 2014, the total inmate population in the state of Ohio was 50,403.

. In FY 2015, the total budget is $1,619,085,171. The budget has increased $55,986,365 since FY 2013.

. The average daily cost per inmate in 2014 was $62.57, and the annual budget was $22,836.34.

Ohio Department of Rehabilitation and Correction Counts 2014 Inmates Under 18 Years of Age 38 Inmates Over 50 Years of Age 8,071

Pregnant Females 53 Mothers/Babies in the ABC Nursery 9 Inmates Serving Life Without Parole (LWOP) 531

Age Range of Offender Population 2014

Male 37.09 years Female 35.11 years

Average Stay in Prison 2.26 years (Source: Ohio Department of Rehabilitation and Correction, Fact Sheet, July 2015, from http://www.drc.ohio.gov/web/Reports/FactSheet/July%202015.pdf)

The following graphs show the Ohio inmate population in 2014 by gender and race. These graphs show:

. The percentage of Ohio males who are incarcerated is extremely higher than the percentage of females. SOCIAL CONTEXT

. More than half (53%) of the Ohio population that is incarcerated is White, followed by African Americans at 45%.

Inmate Population by Gender, 2014

92% 100%

75%

50%

25% 8%

0% Male Female

Inmate Population by Race, 2014

53% 75% 45%

50%

2% 25%

0% White Black Other

(Source: Ohio Department of Rehabilitation and Correction, Fact Sheet, July 2015, from http://www.drc.ohio.gov/web/Reports/FactSheet/July%202015.pdf)

Adult І MENTAL HEALTH AND SUICIDE

Key Findings Suicide Facts In 2015, 4% of Defiance County adults considered . 38,364 people in the U.S. died from attempting suicide. 14% of adults had a period of two suicide, and 959,100 people attempted or more weeks when they felt so worried, tense or suicide in the 2010. anxious nearly every day that they stopped doing usual activities. . Every 13.7 minutes an average of one person kills themselves, and every 32 Adult Mental Health seconds a person attempts suicide in the United States.

. In the past year, 14% of Defiance County adults . Suicide is the 10th ranking cause of had a period of two or more weeks when they felt death in the U.S. so worried, tense or anxious nearly every day that . For every female death by suicide, there they stopped doing usual activities. are 3.7 male deaths.

. In 2010, there were 1,439 suicide deaths . 16% of adults had a period of two or more weeks in Ohio. when they felt sad, blue or depressed nearly every day, increasing to 24% of those with . The leading suicide methods included: incomes less than $25,000. • Firearm suicides (50.5%) • Suffocation/Hanging (24.7%) . 4% of Defiance County adults considered • Poisoning (17.2%) attempting suicide in the past year. • Cutting/Piercing (1.8%) • Drowning (1.1%)

. One percent (1%) of adults reported attempting (Sources: American Association of Suicidology, suicide in the past year. Statistics, September 21, 2012, from: http://www.suicidology.org/resources/facts-statistics- current-research/suicide-statistics) . 16% of Defiance County adults looked for a program or service to help with depression, anxiety or emotional problems. Of those who looked, 87% found a program, and 13% did not find a program to help with depression, anxiety or emotional problems.

. Defiance County adults reported they or a family member had been diagnosed with or treated for the following mental health issues: depression (41%), anxiety or emotional problem (29%), anxiety disorder (27%), attention deficit disorder (17%), bipolar (11%), developmental disability (7%), illicit drug abuse (5%), psychotic disorder (5%), post-traumatic stress disorder (5%), life adjustment disorder (4%), and another mental health disorder (4%). 25% of adults indicated they or a family member had taken medication for a mental health issue, and 8% had been hospitalized for a mental health issue.

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015

Two or more weeks in a row felt 11% 13% 16% N/A N/A sad or hopeless

Considered attempting suicide in 3% 2% 4% N/A N/A the past year

N/A – Not available

100

The following graph shows Defiance County adults who felt sad or hopeless for two or more weeks in a row in the past year. Examples of how to interpret the information in the graph include: 16% of all Defiance County adults felt sad or hopeless for two or more weeks in a row, 15% of males, and 19% of females.

Defiance County Adults Feeling Sad or Hopeless for MENTAL Two or More Weeks in a Row 35%

30%

24% 25% 19% 19% 19% 20% 16% 15% 15% 13% 13% 11% 9% 10%

0% Total Male Female Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25,000 >$25,000 2008 2012

Warning Signs for Suicide

More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular: . Major depression

. Bipolar depression . Schizophrenia HEALTH . Drug abuse & dependence . Alcohol abuse & dependence . Post-Traumatic Stress Disorder (PTSD) . Eating disorders . Personality disorders

The core symptoms of major depression are a “down” or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as: . Changes in sleeping patterns . Change in appetite or weight . Intense anxiety, agitation, restlessness . Fatigue or loss of energy . Decreased concentration, indecisiveness, or poorer memory . Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt . Recurrent thoughts of suicide

Prevention: Take it Seriously

Fifty to 75% of all suicides give some warning of their intentions to a friend or family member. Recognize the Imminent Dangers: . Threatening to hurt or kill oneself . Talking or writing about death, dying, or suicide . Looking for ways to kill oneself (weapons, pills, or other means) . Has made plans or preparations for a potentially serious attempt

(Source: American Foundation for Suicide Prevention, When You Fear Someone May Take Their Life, https://www.afsp.org/)

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Adult and Youth І ORAL HEALTH

Key Findings

The 2015 Health Assessment project has Defiance County determined that more than three-fifths (65%) of Dental Care Resources – 2012 Defiance County adults had visited a dentist or dental clinic in the past year. The 2012 BRFSS . Number of licensed dentists- 15 reported that 67% of U.S. adults and 68% of Ohio . Number of primary care dentists- 12 adults had visited a dentist or dental clinic in the . Ratio of population per dentist- 2,578:1 previous twelve months. Over three-fourths(76%) of . Number of dentists who treat Medicaid Defiance County youth in grades 6-12 had visited patients- 3 the dentist for a check-up, exam, teeth cleaning, . Ratio of Medicaid population per dentist or other dental work in the past year, increasing to who treats Medicaid patients- 2,853:1

81% of those ages 17 and older (2013 YRBS (Source: ODH Ohio Oral Health Surveillance System, 2012) reported 75% for Ohio).

Access to Dental Care

. In the past year, 65% of Defiance County adults had visited a dentist or dental clinic, decreasing to 56% of adults with annual household incomes less than $25,000.

. The 2012 BRFSS reported that 67% of U.S. adults and 68% of Ohio adults had visited a dentist or dental clinic in the previous twelve months.

. Nearly three-fourths (72%) of Defiance County adults with dental insurance have been to the dentist in the past year, compared to 63% of those without dental insurance.

. When asked the main reason for not visiting a dentist in the last year, 29% said cost, 27% had no oral health problems, 12% indicated multiple reasons, 8% said fear, apprehension, nervousness, pain, and dislike going, 5% had not thought of it, 3% could not get to the office, 2% did not have/know a dentist, 1% said their dentist did not accept their medical coverage, 1% could not find a dentist to who took Medicaid, 1% had other priorities, and 1% could not find a dentist who treats special needs clients.

. Defiance County youth last saw a dentist for a check-up, exam, teeth cleaning, or other dental work: less than a year ago (76%), 1 to 2 years ago (11%), 2 or more years ago (2%), never (1%), and do not know (10%).

What You Can Do to Maintain Good Oral Health

. Drink fluoridated water and use fluoride toothpaste. Fluoride's protection against tooth decay works at all ages. . Take care of your teeth and gums. Thorough tooth brushing and flossing to reduce dental plaque can prevent gingivitis—the mildest form of gum disease. . Avoid tobacco. In addition to the general health risks posed by tobacco, smokers have 4 times the risk of developing gum disease compared to non-smokers.

. Limit alcohol. Heavy use of alcohol is a risk factor for oral and throat cancers. . Eat wisely. Adults should avoid snacks full of sugars and starches. . Visit the dentist regularly. Check-ups can detect early signs of oral health problems and can lead to treatments that will prevent further damage, and in some cases, reverse the

problem.

(Source: CDC: Oral Health for Adults, July 2013, from: http://www.cdc.gov/OralHealth/publications/factsheets/adult_oral_health/adults.htm)

102

The following graphs provide information about the frequency of Defiance County adult and youth dental visits. Examples of how to interpret the information on the first graph include: 65% of all Defiance County adults had been to the dentist in the past year, 75% of those under the age of 30, and 56% of those with incomes less than $25,000.

Defiance County Adults Visiting a Dentist in the Past Year HEALTH ORAL 100%

75% 80% 68% 65% 63% 65% 65% 64% 65% 58% 56% 60%

40%

20%

0% Total Males Females Under 30 30-64 65 & Over Income Income Defiance Defiance Years <$25K $25K Plus 2008 2012

Defiance County Youth Visiting a Dentist in the Past Year 100%

81% 76% 77% 76% 75% 80% 72% 75% 69%

60%

40%

20%

0% Total Males Females 13 or 14-16 17 or older Defiance Defiance younger 2008 2012

103

Within Within Within 5 or

the Past the Past the Past More Never Adult Oral Health Year 2 Years 5 Years years Time Since Last Visit to Dentist/Dental Clinic Males 63% 11% 10% 14% <1% Females 65% 13% 9% 10% 0% Total 65% 12% 9% 12% <1% Totals may not equal 100% as some respondents answered do not know.

Defiance Defiance Defiance Ohio U.S. Adult Comparisons County County County 2013 2013 2008 2012 2015 Adults who have visited the dentist 64% 65% 65% 68%* 67%* in the past year *2012 BRFSS Data

Oral Health in Older Adults

. Older adults are at risk for getting cavities, gum disease and mouth cancer – and these may not cause any pain or discomfort until they are advanced. . Everyone needs to see their dentist for a checkup at least once a year – preferably more often. . People without natural teeth are at risk for mouth cancer as well as gum problems. Denture wearers need to have their mouth and their dentures checked at least once a year. . As with many other cancers, older adults are more likely to get mouth cancer than younger people. . Everyone is at a greater risk of getting mouth cancer if they use tobacco, drink alcohol a lot, or are repeatedly exposed to the sunlight. . Severe gum disease has also been associated with pneumonia in long-term care patients, heart disease, stroke, and poor diabetic control. . Periodontal disease can be prevented by: • Cleaning your teeth and gums thoroughly every day. • Getting regular checkups from your dentist. • Following the advice of your dentist and dental hygienist.

(Source: American Dental Association: Oral Longevity Questions and Answers, from: http://www.ada.org/en/)

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Adult І PARENTING TEENS

Key Findings Talking to your teen about drinking

82% of parents discussed dating and . Be honest and direct. relationships with their 10-to-18 year-old in . Encourage your teen to talk to you about the past year and 47% discussed negative drinking, remain calm when listening. effects of alcohol. . Try not to judge or criticize. Make it PARENTING comfortable for your teen to talk honestly. . Parenting Remind your teen that drinking comes with serious risks. . Emphasize that your teen should never . Parents discussed the following sexual drink and drive or ride with a driver who health and other health topics with their has been drinking. 10-to-18 year-old in the past year:  Dating and relationships (82%) (Source: MedlinePlus, Talking to your teen about drinking  Screen time (51%) http://www.nlm.nih.gov/medlineplus/ency/patientinstruc tions/000505.html, May 14, 2014)  Abstinence/refusal skills (51%)  Eating habits (48%)  Negative effects of alcohol (47%)  Negative effects of tobacco (47%)  Negative effects of marijuana and other drugs (47%)  Safe sex/STD prevention (43%)  Body image (42%)  Birth control/use of condoms (35%)  Sexually transmitted infections (32%)  HIV infections/AIDS (30%)  Reproduction (24%)  Refusal skills (24%)  Anatomy (19%)

Tips for Parents – Ideas to Help Children Maintain a Healthy Weight

. Encourage healthy eating habits by providing fruits, vegetables, whole grains, low-fat or non- fat dairy products, and lean meats and proteins for your family.

. Find ways to make your family’s favorite dishes in a healthier way.

. Limit or reduce the consumption of calorie-rich, sugary and/or saturated fat in your home.

. Adding physical activity into the family’s routine will lead to it becoming a healthy habit. Some examples of moderate intensity physical activity include brisk walking, playing tag, jumping rope, playing soccer, swimming and dancing.

. Encourage fun activities to reduce the amount of sedentary time watching TV, playing video games or on the computer.

. The goal is to reduce the rate of weight gain in overweight and obese children and teens while still accounting for normal growth and development. Children and teens should not be placed on a diet without consulting a doctor.

(Source: CDC, Healthy Weight, “Tips for Parents – Ideas to Help Children Maintain a Healthy Weight”, http://www.cdc.gov/healthyweight/children/index.html, November 25, 2014)

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Youth І WEIGHT STATUS

Key Findings

The 2015 Health Assessment identified that 18% of Defiance County youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 32% of youth reported that they were slightly or very overweight. 75% of youth were exercising for 60 minutes on 3 or more days per week. 94% of youth were involved in extracurricular activities.

Youth Weight Status

. BMI for children is calculated differently from adults. The CDC uses BMI-for-age, which is gender and age specific as children’s body fatness changes over the years as they grow. In children and teens, BMI is used to assess underweight, normal, overweight, and obese.

. In 2015, 18% of youth were classified as obese by Body Mass Index (BMI) calculations (2013 YRBS reported 13% for Ohio and 14% for the U.S.). 16% of youth were classified as overweight (2013 YRBS reported 16% for Ohio and 17% for the U.S.). 62% were normal weight, and 4% were underweight.

18% of Defiance County youth were classified as obese.

. 32% of youth described themselves as being either slightly or very overweight (2013 YRBS reported 28% for Ohio and 31% for the U.S.).

. Nearly half (46%) of all youth were trying to lose weight, increasing to 60% of Defiance County female youth (compared to 32% of males) (2013 YRBS reported 47% for Ohio and 48% for the U.S.).

. Defiance County youth reported doing the following to lose weight or keep from gaining weight in the past 30 days:  49% of youth exercised.  42% of youth drank more water.  33% of youth ate less food, fewer calories, or foods lower in fat.  29% of youth ate more fruits and vegetables.  14% of youth skipped meals.  7% reported going without eating for 24 hours or more (2013 YRBS reported 10% for Ohio and 13% for the U.S.).  2% reported taking diet pills, powders, or liquids without a doctor’s advice (2013 YRBS reported 5% for Ohio and the U.S.).  2% vomited or took laxatives (2013 YRBS reported 5% for Ohio and 4% for the U.S.).  2% reported smoking to lose weight.

Nutrition

. 12% of Defiance County youth ate 5 or more servings of fruits and vegetables per day. 85% ate 1 to 4 servings of fruits and vegetables per day.

. Defiance County youth reported eating out in a restaurant or bringing food home to eat an average of 2.3 times in a typical week.

. In the past month, youth reported they went to bed hungry because there was not enough food in their home: sometimes (7%), most of the time (2%), and always (1%). 90% of youth reported they rarely or never went to bed hungry.

106

Physical Activity

. 75% of Defiance County youth participated in at least 60 minutes of physical activity on 3 or more days in the past week. 55% did so on 5 or more days in the past week (2013 YRBS reports 48% for Ohio and 47% for the U.S.), and 31% did so every day in the past week (2013 YRBS reports 26% for Ohio and 27% for the U.S.). 11% of youth did not participate in at least 60

minutes of physical activity on any day in the past week (2013 YRBS reports 13% for Ohio and

15% for the U.S.). YOUTH

. The CDC recommends that children and adolescents participate in at least 60 minutes of physical activity per day. As part of their 60 minutes per day; aerobic activity, muscle strengthening, and bone strengthening are three distinct types of physical activity that children should engage in, appropriate to their age. Children should participate in each of these types of activity on at least three days per week.

. Defiance County youth spent an average of 3.4 hours on their cell phone, 1.6 hours watching TV, 1.8 hours on their computer/tablet and .09 hours playing video games on an average day of the week.

. Nearly one-quarter (23%) of youth spent 3 or more hours watching TV on an average day (2013 YRBS reported 28% for Ohio and 33% for the U.S.).

. 94% of youth participated in extracurricular activities. They participated in the following: sports or intramural programs (62%), exercising (outside of school) (49%), school club or social organization (36%), church youth group (35%), church or religious organization (33%), part-time job (23%), caring for siblings after school (19%), volunteering in the community (17%), babysitting for other kids (15%), caring for parents or grandparents (4%) or some other WEIGHT organized activity (Scouts, 4H, etc.) (17%).

Defiance County 6th-12th Grade Youth did the following to lose weight in the past 30 days: Percent Exercised 49% Drank more water 42% Ate less food, fewer calories, or foods lower in fat 33% Ate more fruits and vegetables 29% Skipped meals 14% Went without eating for 24 hours 7% Took diet pills, powders, or liquids without a doctor’s advice 2% Vomited or took laxatives 2% Smoked cigarettes 2%

107

The following graph shows the percentage of Defiance County youth who were classified as obese, overweight, normal weight or underweight by Body Mass Index (BMI). Examples of how to interpret the information in the first graph include: 62% of all Defiance County youth were classified as normal weight, 18% were obese, 16% were overweight, and 4% were underweight for their age and gender.

Defiance County Youth BMI Classifications 9% 4% 4% 4% 6% 3% 3% 5% 100%

80% 62% 57% 59% 67% 58% 60% 71% 59% 74%

40%

Physical Activity Facts

. Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. . The U.S. Department of Health and Human Services recommends that young people ages 6–17 years participate in at least 60 minutes of physical activity daily. . The percentage of high school students who attended physical education classes daily decreased from 42% in 1991 to 25% in 1995 and remained stable at that level until 2011 (31%). . Regular physical activity: • Helps build and maintain healthy bones and muscles. • Helps reduce the risk of developing obesity and chronic diseases, such as diabetes, cardiovascular disease, and colon cancer. • Reduces feelings of depression and anxiety and promotes psychological well- being. • May help improve students’ academic performance, including academic achievement and academic behavior.

(Sources: CDC, Adolescent and School Health, Updated: 2/19/2013, from: http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm)

108

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th)

Obese 14% 15% 18% 20% 13% 14% Overweight 18% 13% 16% 14% 16% 17%

Described themselves as slightly or 29% 29% 32% 33% 28% 31% very overweight

Trying to lose weight 45% 48% 46% 49% 47% 48% YOUTH Exercised to lose weight 50% 52% 49% 53% 61%‡ 61%‡ Ate less food, fewer calories, or 27% 34% 33% 39% 43%‡ 39%‡ foods lower in fat to lose weight Went without eating for 24 hours 4% 7% 7% 7% 10% 13% or more Took diet pills, powders, or liquids 1% 2% 2% 3% 5% 5% without a doctor’s advice Vomited or took laxatives 2% 2% 2% 2% 5% 4% Ate 1 to 4 servings of fruits and N/A 83% 85% 86% 85%‡ 78%‡ vegetables per day Physically active at least 60 minutes per day on every day in 31% 34% 31% 30% 26% 27% past week

Physically active at least 60 minutes per day on 5 or more 53% 59% 55% 56% 48% 47% days in past week

Did not participate in at least 60

minutes of physical activity on any 11% 8% 11% 13% 13% 15%

day in past week WEIGHT Watched TV 3 or more hours per 36% 30% 23% 21% 28% 33% day N/A – Not available ‡ Comparative YRBS data for Ohio is 2007 and U.S. is 2009

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Youth І TOBACCO USE

Key Findings

The 2015 Health Assessment identified that 8% of Defiance County youth in grades 6-12 were smokers, increasing to 13% of those ages 17 and older. Nearly three-fourths (73%) of youth identified as current smokers were also current drinkers. In the past week, two-thirds (66%) of youth were in a home or car with someone who was smoking.

In 2015, 8% of Defiance County youth were current smokers, having

smoked at some time in the past 30 days.

Youth Tobacco Use Behaviors

. The 2015 health assessment indicated that 23% of Defiance County youth had tried cigarette smoking (2013 YRBS reported 41% for the U.S.).

. 10% of those who had smoked a whole cigarette did so at 10 years old or younger, and another 17% had done so by 12 years old. The average age of onset for smoking was 13.7 years old.

. 4% of all youth had smoked a whole cigarette for the first time before the age of 13 (2013 YRBS reported 9% for the U.S.).

. In 2015, 8% of youth were current smokers, having smoked at some time in the past 30 days, increasing to 13% of youth ages 17 and older (2013 YRBS reported 15% for Ohio and 16% for the U.S).

. 10% of current smokers smoked cigarettes daily.

. 2% of all youth smoked cigarettes on 20 or more days during the past month (2013 YRBS reported that 7% of youth in Ohio smoked cigarettes on 20 or more days during the past month and 6% for the U.S).

. Nearly three-fourths (73%) of youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days.

. 38% of youth smokers borrowed cigarettes from someone else, 26% indicated they bought cigarettes from a store or gas station (2013 YRBS reported 18% for the U.S.), 24% took them from a family member, 24% gave someone else money to buy them cigarettes¸ 10% said a person 18 years or older gave them the cigarettes, 5% got them on the internet and 14% got them some other way. No one reported buying them from a vending machine or taking them from a store.

. In the past 30 days, 3% of youth used chewing tobacco or snuff, (2013 YRBS reported 9% for both Ohio and the U.S.).

. Defiance County youth used the following forms of tobacco the most in the past year: e- cigarette (12%), cigarettes (12%), hookah (7%), Black and Mild’s (6%), cigars (5%), swishers (4%), chewing tobacco or snuff (4%), cigarillos (4%), flavored cigarettes (2%), snus (1%) and bidis (1%). No one reported using dissolvable tobacco products or little cigars.

. Over half (52%) of the youth who smoked in the past year had tried to quit smoking (2013 YRBS reported 48% for the U.S.).

. In the past week, two-thirds (66%) of all youth were in a home or car with someone who was smoking.

110

. In the past month, 35% of youth smokers bought cigarettes in a store. Of those who bought or attempted to buy cigarettes, three-quarters (75%) were asked to show proof of age, and one- quarter (25%) were not asked to show proof of age.

TOBACCO YOUTH The following graph shows the percentage of Defiance County youth who smoke cigarettes. Examples of how to interpret the information include: 8% of all Defiance County youth were current smokers, 11% of males smoked, and 6% of females were current smokers.

Defiance County Youth Who Are Current Smokers

30%

20%

13% 11% 12% 11%

10% 8% 8% 6% 4%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

Current smokers are those youth surveyed who have self-reported smoking at any time during the past 30 days.

73% of Defiance County youth identified as current smokers were also current drinkers.

Behaviors of Defiance County Youth Current Smokers vs. Non-Current Smokers Non- Current Youth Behaviors Current Smoker Smoker Participated in extracurricular activities 90% 94% Exposed to second hand smoke in the past week 80% 30% Have had sexual intercourse 76% 17% Have had at least one drink of alcohol in the past 30 days 73% 17% Have been bullied in the past 12 months 65% 48% Have used marijuana in the past 30 days 52% 5% Misused prescription medications in the past 30 days 40% 6% Attempted suicide in the past 12 months 13% 5%

111

Defiance Defiance Defiance Defiance Ohio U.S. County County County County 2013 2013 Youth Comparisons 2008 2012 2015 2015 (9th–12th) (9th–12th) (6th-12th) (6th-12th) (6th-12th) (9th–12th) Ever tried cigarettes 30% 31% 23% 33% 52%* 41%

Current smokers 12% 11% 8% 13% 15% 16%

Tried to quit smoking (of those youth who smoked in the past 46% 51% 52% 56% 56%* 48% year)

Smoked cigarettes on 20 or more days 4% 2% 2% 3% 7% 6% during the past month (of all youth)

Smoked a whole cigarette for the first time 11% 7% 4% 3% 14%* 9% before the age of 13 (of all youth)

Used chewing tobacco or snuff in the past 6% 5% 3% 5% 9% 9% month * Comparative YRBS data for Ohio is 2011

Electronic Cigarettes and Teenagers in the U.S.

. The percentage of U.S. middle and high school students who tried electronic cigarettes more than doubled from 2011 to 2012. . E-cigarettes look like regular cigarettes, but they are operated by battery. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled. . The percentage of high school students who had ever used e-cigarettes rose from 4.7% in 2011 to 10% in 2012. In the same time period, high school students using e- cigarettes within the past 30 days rose from 1.5% to 2.8%. . The percentage of middle school students who had ever used e-cigarettes also doubled from 1.4% to 2.7%. . Altogether, as of 2012 more than 1.78 million middle and high school students in the US had tried e-cigarettes. . 76% of current young e-cigarette users also smoked regular cigarettes. Some experts fear that e-cigarettes may encourage children to try regular cigarettes. . Nicotine is a highly addictive drug. Many teens that start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

(Source: CDC, Press Release, September 5, 2013, http://www.cdc.gov/media/releases/2013/p0905-ecigarette- use.html & ACS, Electronic Cigarette Use Doubles Among Teenagers, September 9, 2013, http://www.cancer.org/cancer/news/electronic-cigarette-use-doubles-among-teenagers)

112

Youth І ALCOHOL CONSUMPTION

Key Findings YOUTH In 2015, the Health Assessment results indicated that 50% of Defiance County youth in grades 6- 12 had drank at least one drink of alcohol in their life, increasing to 69% of youth seventeen and older. 20% of all youth were current drinkers, having had at least one drink in the past 30 days. Nearly half (48%) of youth who reported drinking in the past 30 days had at least one episode of binge drinking. 2% of all youth drivers had driven a car in the past month after they had been drinking alcohol.

In Defiance County in 2015, 20% of youth had at least one drink

in the past 30 days.

Youth Alcohol Consumption

. In 2015, the Health Assessment results indicated that half (50%) of all Defiance County youth (ages 12 to 18) had at least one drink of alcohol in their life, increasing to 69% of those ages 17 and older (2013 YRBS reports 66% for the U.S.).

. One-fifth (20%) of youth had at least one drink in the past 30 days, increasing to 34% of those ALCOHOL ages 17 and older (2013 YRBS reports 30% for Ohio and 35% for the U.S.).

. Of those who drank, 48% had five or more alcoholic drinks on an occasion in the last month and would be considered binge drinkers by definition.

. Based on all youth surveyed, 10% were defined as binge drinkers, increasing to 17% of those ages 17 and older (2013 YRBS reports 16% for Ohio and 21% for the U.S.).

. Over one-third (35%) of Defiance County youth who reported drinking at some time in their life had their first drink at 12 years old or younger; 27% took their first drink between the ages of 13 and 14, and 38% started drinking between the ages of 15 and 18. The average age of onset was 13.3 years old.

. Of all Defiance County youth, 16% had drunk alcohol for the first time before the age of 13 (2013 YRBS reports 13% of Ohio youth drank alcohol for the first time before the age of 13 and 19% for the U.S.).

. Defiance County youth drinkers reported they got their alcohol from the following: a parent gave it to them (29%), someone gave it to them (24%)(2013 YRBS reports 38% for Ohio and 42% for the U.S.), someone older bought it (14%), an older friend or sibling bought it (13%), gave someone else money to buy it (12%), took it from a store or family member (12%), a friend’s parent gave it to them (10%), bought it at a restaurant/bar/club (3%), bought it in a liquor store/ convenience store/gas station (1%), bought it at a public event (1%), bought it with a fake ID (1%), and some other way (24%).

. During the past month 13% of all Defiance County youth had ridden in a car driven by

someone who had been drinking alcohol (2013 YRBS reports 17% for Ohio and 22% for the U.S.).

. 2% of youth drivers had driven a car in the past month after they had been drinking alcohol (2013 YRBS reports 4% for Ohio and 10% for the U.S.).

113

The following graphs show the percentage of Defiance County youth who have drank in their lifetime and those who are current drinkers. Examples of how to interpret the information include: 50% of all Defiance County youth have drank at some time in their life: 53% of males and 48% of females.

Defiance County Youth Having At Least One Drink In Their Lifetime 100%

80% 69%

54% 57% 60% 53% 52% 50% 48%

33% 40%

20%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

Based on all Defiance County youth surveyed, 10% were defined as binge

drinkers.

Defiance County Youth Who Are Current Drinkers

60%

40% 34%

23% 24% 21% 20% 19% 19% 20% 11%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

114

The following graph shows the percentage of Defiance County youth who were binge drinkers. Examples of how to interpret the information include: 48% of current drinkers binge drank in the past month, 48% of males, and 46% of females had binge drank. The table shows differences in specific risk behaviors between current drinkers and non-current drinkers.

YOUTH

Defiance County Youth Current Drinkers Binge Drinking in Past

Month* 100%

80%

54% 56% 60% 50% 48% 48% 46% 46% 45%

40%

20%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

*Based on all current drinkers. Binge drinking is defined as having five or more drinks on an occasion. ALCOHOL

29% of Defiance County youth drinkers reported they got their alcohol from

a parent giving it to them.

Behaviors of Defiance County Youth Current Drinkers vs. Non-Current Drinkers Non- Current Youth Behaviors Current Drinker Drinker Participated in extracurricular activities 94% 95% Have been bullied in the past 12 months 52% 49% Have had sexual intercourse 48% 15% Misused prescription medications in the past 30 days 31% 2% Have used marijuana in the past 30 days 30% 3% Have smoked cigarettes in the past 30 days 28% 3% Attempted suicide in the past 12 months 14% 3% Current drinkers are those youth surveyed who have self -reported drinking at any time during the past 30 days.

Of all Defiance County youth, 16% had drunk alcohol for the first time

before the age of 13.

115

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th–12th) (9th–12th) (6th-12th) (6th-12th) (6th-12th) (9th–12th)

Ever tried alcohol 54% 57% 50% 62% 71%* 66% Current drinker 19% 24% 20% 28% 30% 35% Binge drinker (of all youth) 11% 14% 10% 14% 16% 21% Drank for the first time before age 13 23% 14% 16% 13% 13% 19% (of all youth) Rode with someone who was drinking 18% 13% 13% 10% 17% 22% Drank and drove 5% 3% 2% 3% 4% 10% (of youth drivers) Obtained the alcohol they drank by 62% 39% 24% 28% 38% 42% someone giving it to them * Comparative YRBS data for Ohio is 2011

Teen Binge Drinking: All Too Common

Risks Associated with Binging: . It is estimated that alcohol consumption is responsible for about 80,000 deaths in the US each year. . Binge drinking has also been associated with many health problems, including: • Heart disease • Stroke • Cancer • Liver disease • Chemical dependency • Pregnancy • STDs • Alcohol poisoning . MRI scans of the brains of teens that drank heavily showed damaged nerve tissue compared to those who did not. . Studies have shown that alcohol can cause long-term damage to the brain and impair memory, coordination and movement.

(Source: Psychology Today, Teen Angst, Teen Binge Drinking: All Too Common, 1/26/2013, from: http://www.psychologytoday.com/blog/teen-angst/201301/teen-binge-drinking-all-too-common

116

Youth І DRUG USE YOUTH

Key Findings Drug Facts: Drugged Driving

In 2015, 9% of Defiance County 6th-12th . Vehicle accidents are the leading cause grade youth had used marijuana at least of death among youth people aged 16 to once in the past 30 days. 9% of youth used 19. When teens’ relative lack of driving medications that were not prescribed for experience is combined with the use of them or took more than prescribed to get marijuana or other substances that affect high at some time in their life. cognitive and motor abilities, the results can be tragic. Youth Drug Use . According to the 2013 National Survey on Drug Use and Health (NSDUH), an . In 2015, 9% of Defiance County youth estimated 9.9 million people aged 12 or had used marijuana at least once in the older reported driving under the influence past 30 days, increasing to 15% of high of illicit drugs during the year prior to being school youth. The 2013 YRBS found a surveyed. prevalence of 21% for Ohio youth and a . After alcohol, THC (delta-9- prevalence of 23% for U.S. youth. tetrahydrocannabinol), the active ingredient in marijuana is the substance . 9% of youth used medications that were most commonly found in the blood of DRUG USE not prescribed for them or took more impaired drivers, fatally injured drivers, and than prescribed to feel good or get high motor vehicle crash victims. Studies in at some time in their lives, increasing to several localities have found that 15% of those over the age of 17. approximately 4 to 14 percent of drivers

who sustained injury or died in traffic . Youth who misused prescription accidents tested positive for THC. medications got them in the following ways: a friend gave it to them (37%), a (Source: National Institute on Drug Abuse, The Science of Drug Abuse & Addiction: Drug Facts: Drugged Driving, parent gave it to them (33%), they took http://www.drugabuse.gov/publications/drugfacts/drugg it from a friend or family member (23%), ed-driving, revised 12-14) bought it from a friend (16%), bought it from someone else (9%), got it on the internet (5%), and another family member gave it to them (2%),

. Defiance County youth had tried the following in their life: o 6% of youth used inhalants, (2013 YRBS reports 9% for both Ohio and U.S.) o 4% used posh/salvia/synthetic marijuana o 3% misused cough syrup o 3% misused over-the-counter medications o 3% used K2/spice o 2% used cocaine, (2013 YRBS reports 4% for Ohio and 6% for U.S.) o 2% used steroids, (2013 YRBS reports 3% for both Ohio and U.S.) o 2% used ecstasy/MDMA (2013 YRBS reports 7% for the U.S.) o 2% used Cloud 9 o 2% used liquid THC o 1% misused hand sanitizer o 1% used heroin, (2013 YRBS reports 2% for Ohio and U.S.) o 1% had been to a pharm party/used skittles o <1% used methamphetamines, (2013 YRBS reports 3% for the U.S.) o No one reported using GhB or bath salts.

. During the past year, youth reported that someone had offered, sold, or given them an illegal drug in the following places: at a party (11%), on school property (4%), (2013 YRBS reports 20% for Ohio and 22% for the U.S.), on public property (4%), close to school grounds, but on a nearby public street (2%), and at a school sporting event (2%).

117

The following graphs are data from the 2015 Defiance County Health Assessment indicating youth lifetime drug use and marijuana use in the past 30 days. Examples of how to interpret the information include: 2% of youth have used cocaine at some point in their lives, and 6% of youth have used inhalants at some point in their life.

Defiance County Youth Lifetime Drug Use

15%

10% 8% 7% 7% 6% 6%

5% 4% 3% 3% 3% 3% 2% 2% 2% 2% 2% 1% 1% 1%1% 1% <1% 1% 1% 1% 0% 0% Cocaine Heroin Meth Steroids Inhalants

Total Male Female Defiance Total 2008 Defiance Total 2012

9% of Defiance County youth had used marijuana in the past month.

Defiance County Youth Marijuana Use in Past Month 25%

20%

15% 12% 12% 11% 9% 10% 8% 8% 7%

5% 3%

0% Total Male Female 13 or 14 to 16 17 or older Defiance Defiance younger Total 2008 Total 2012

118

The following graph is data from the 2015 Defiance County Health Assessment indicating youth lifetime prescription medication abuse. Examples of how to interpret the information include: 9% YOUTH YOUTH of youth have misused medication at some point in their life.

Defiance County Youth Lifetime Prescription Medication Abuse 25%

20%

15% 15% 12%

9% 9% 9% 10% 8% 7%

5% 3%

Total Male Female 13 or 14 to 16 17 or older Defiance Defiance DRUG USE younger Total 2008 Total 2012

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th) Youth who used marijuana in the past 8% 8% 9% 15% 21% 23% month Ever used methamphetamines 3% 1% <1% 0% 6%‡ 3% Ever used cocaine 2% 3% 2% 3% 4% 6% Ever used heroin 2% 1% 1% 0% 2% 2% Ever used steroids 2% 4% 2% 1% 3% 3% Ever used inhalants 7% 8% 6% 4% 9% 9% Ever used ecstasy/MDMA N/A 2% 2% 2% N/A 7% Ever misused medications 7% 12% 9% 13% N/A 18% Ever been offered, sold, or given an illegal drug by someone on school 16% 5% 4% 6% 20% 22% property in the past year N/A – Not available ‡ Comparative YRBS data for Ohio is 2007

119

Youth І SEXUAL BEHAVIOR AND TEEN

PREGNANCY OUTCOMES

Key Findings

42% of Defiance County youth ages 17 and over have had sexual

intercourse

Youth Sexual Behavior

. One Defiance County school did not ask sexual behavior questions.

. Nearly one-quarter (23%) of Defiance County youth have had sexual intercourse, increasing to 42% of those ages 17 and over (The 2013 YRBS reports 43% for Ohio and 47% of U.S. youth have had sexual intercourse).

. 22% of youth had participated in oral sex, increasing to 46% of those ages 17 and over.

. 7% of youth had participated in anal sex, increasing to15% of those ages 17 and over.

. 22% of youth had participated in sexting, increasing to 36% of those ages 17 and over.

. 28% of youth had viewed pornography, increasing to 41% of males and 45% of those ages 17 and over.

. Of those youth who were sexually active in their lifetime, 47% had one sexual partner and 53% had multiple partners.

. 6% of all youth had 4 or more sexual partners (2013 YRBS reports 12% for Ohio and 15% for the U.S.).

. Of those youth who were sexually active, 27% had done so by the age of 13. Another 39% had done so by 15 years of age. The average age of onset was 14.8 years old.

. Of all youth, 3% were sexually active before the age of 13 (2013 YRBS reports 4% for Ohio and 6% for the U.S).

. 61% of youth who were sexually active used condoms to prevent pregnancy, 24% used birth control pills, 17% used the withdrawal method, 6% used a shot, patch or birth control ring, 3% used an IUD and 5% used some other method. 3% reported they were gay or lesbian. However, 13% were engaging in intercourse without a reliable method of protection and 12% reported they were unsure.

. Of the youth who were sexually active, 18% had drunk alcohol or used drugs before their last sexual encounter, (2013 YRBS reports 18% for Ohio and 22% for the U.S).

. Youth had experienced the following situations in the past 30 days: had received a text or e-mail with a revealing photo of someone (15%), had texted, e-mailed, or posted electronically a revealing or sexual photo of themselves (9%), and a revealing or sexual photo of themselves was texted, e-mailed, or posted electronically without their permission (2%).

120

The following graphs show the percentage of Defiance County youth who participated in sexual intercourse and oral sex. Examples of how to interpret the information include: 23% of all Defiance County youth had sexual intercourse, 24% of males, and 21% of females had sex.

Defiance County Youth Who Had Sexual Intercourse SEXUAL BEHAVIOR 75%

50% 42%

28% 23% 24% 24% 24% 25% 21%

3% 0% Total Male Female 13 or 14 to 16 17 & Older Defiance Defiance Younger Total 2008 Total 2012

13 % of Defiance County youth who were sexually active were not using a reliable method of protection to prevent pregnancy.

Defiance County Youth Who Participated in Oral Sex 75%

46% 50%

26% 22% 25% 20% 19%

0% Total Male Female 13 or Younger 14 to 16 17 & Older

121

The following graphs show the percentage of Defiance County youth who participated in anal sex and sexting. Examples of how to interpret the information include: 7% of all Defiance County youth participated in anal sex, 10% of males, and 4% of females.

Defiance County Youth Who Participated in Anal Sex 50%

25% 15%

10%

7% 5% 4% 2%

0% Total Male Female 13 or Younger 14 to 16 17 & Older

Defiance County Youth Who Participated in Sexting

75%

50% 36%

25% 22% 23% 22% 25%

0% Total Male Female 13 or Younger 14 to 16 17 & Older

122

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th–12th) (9th–12th) (6th–12th) (6th–12th) (6th–12th) (9th–12th) Ever had sexual intercourse 24% 28% 23% 35% 43% 47% SEXUAL BEHAVIOR Used a condom at last intercourse 66% 64% 61% 68% 51% 59% Used birth control pills at last 28% 32% 24% 29% 24% 19% intercourse Did not use any method to prevent pregnancy during last sexual 19% 13% 13% 10% 12% 14% intercourse Had four or more sexual partners 4% 5% 6% 8% 12% 15% (of all youth) Had sexual intercourse before age 13 4% 3% 3% 2% 4% 6% (of all youth) Drank alcohol or used drugs before last 17% 18% 18% 16% 18% 22% sexual intercourse

Sexual Risk Behavior

Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2013:

. 47% had ever had sexual intercourse . 34% had had sexual intercourse during the previous 3 months, and, of these

. 41% did not use a condom the last time they had sex . 15% had had sex with 4 or more people during their life

. Only 22% of sexually experienced students have ever been tested for HIV

Sexual risk behaviors place adolescents at risk for HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy:

. Approximately 10,000 young people aged 13–24 years were diagnosed with HIV infection in the United States in 2013 . Nearly half of the 20 million new STDs each year are among young people aged

15–24 years . In 2013, about 273,000 babies were born to teenage girls

(Source: CDC, Adolescent and School Health, updated 3/25/2015, from: http://www.cdc.gov/HealthyYouth/sexualbehaviors/)

123

Youth І MENTAL HEALTH AND SUICIDE

Key Findings 2013 Ohio Suicide Statistics for Youth Grades 9-12

In 2015, the Health Assessment results . 14% of Ohio youth seriously considered attempting indicated that 15% of Defiance County suicide in the 12 months prior to the survey. 6th-12th grade youth had seriously . 11% of Ohio youth made a plan about how they considered attempting suicide in the past would attempt suicide in the 12 months prior to the year and 5% admitted attempting suicide survey. in the past year. . 6% of youth had attempted suicide one or more Youth Mental Health times in the 12 months prior to the survey.

. 1% of youth had a suicide attempt that resulted in . In 2015, nearly one-quarter (23%) of an injury, poisoning, or an overdose that had to be youth reported they felt so sad or treated by a doctor or nurse in the 12 months prior hopeless almost every day for two to the survey. weeks or more in a row that they (Source: Centers for Disease Control and Prevention, Healthy Youth, stopped doing some usual activities, YRBS 2013) increasing to 29% of females (2013 YRBS reported 26% for Ohio and 30% for the U.S.).

. 15% of youth reported they had seriously considered attempting suicide in the past 12 months, increasing to 18% of females (2013 YRBS rate of 17% for U.S. youth and 14% for Ohio youth).

. In the past year, 5% of youth had attempted suicide, increasing to 9% of females. 3% of youth had made more than one attempt. The 2013 YRBS reported a suicide attempt prevalence rate of 8% for U.S. youth and a 6% rate for Ohio youth.

. 14% of Defiance County youth stated that they would be very likely to seek help if they were feeling depressed or suicidal. 11% reported that it would be very unlikely they would seek help.

. Defiance County youth reported the following causes of anxiety, stress and depression: academic success (46%), fighting with friends (40%), sports (37%), self-image (32%), fighting at home (32%), death of close family member or friend (30%), peer pressure (29%), breakup (29%), dating relationship (26%), being bullied (25%), parent divorce/separation (18%), poverty/no money (15%), caring for younger siblings (14%), alcohol or drug use at home (9%), ill parent (7%), parent lost their job (7%), not feeling safe at home (7%), parent with a mental illness (7%), not having enough to eat (6%), sexual orientation (6%), parent/caregiver with a substance abuse problem (5%), not having a place to live (4%), family member in the military (3%), not feeling safe in the community (3%), and other stress at home (26%).

. Defiance County youth reported the following ways of dealing with anxiety, stress, or depression: sleeping (48%), hobbies (42%), texting someone (38%), exercising (31%), praying (29%), talking to a peer (29%), talking to someone in their family (26%), eating (24%), using social media (18%), reading the Bible (13%), breaking something (12%), shopping (10%), writing in a journal (10%), self-harm (9%), talk to a counselor /teacher (7%), drinking alcohol (6%), using illegal drugs (5%), using prescribed medication (5%), smoking/using tobacco (4%), vandalism/violent behavior (4%), talking to a medical professional (4%), harming someone else (2%), gambling (1%), and using un-prescribed medication (1%). 14% of youth reported they did not have anxiety, stress, or depression.

. When Defiance County youth are dealing with feelings of depression or suicide, they usually talk to the following: best friend (28%), girlfriend/boyfriend (14%), parent/guardian (17%), brother/sister (8%), adult friend (6%), adult relative (5%), caring adult (5%), teacher (3%), professional counselor (3%), pastor/priest/religious leader (3%), school counselor (2%), youth minister (2%),Teen Line or First Call for Help (1%), and someone else (6%). 15% of youth reported they talked to no one.

124

The following graphs show the percentage of Defiance County youth who had felt sad or hopeless almost every day for two weeks or more in a row and attempted suicide in the past 12 months

(i.e., the first graph shows that 23% of all youth had felt sad or hopeless for two weeks or more, 18% of males and 29% of females).

MENTAL Defiance County Youth Who Felt Sad or Hopeless Almost Every Day for Two Weeks or More in a Row

50%

40%

29% 28% 30% 25% 23% 23% 22% 18% 18% 20%

10%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance

Total 2008 Total 2012

Defiance County youth reported the following leading causes of anxiety, stress and depression: academic success (46%), fighting with friends

(40%), sports (37%), fighting at home (32%) and self-image (32%). HEALTH

Defiance County Youth Who Attempted Suicide in Past 12 Months

15%

9% 10% 7% 7%

5% 5% 5%

5% 3%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

125

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th)

Youth who had seriously considered 11% 15% 15% 14% 14% 17% attempting suicide in the past year Youth who had attempted suicide in the past 7% 5% 5% 3% 6% 8% year Youth who felt sad or hopeless almost every 22% 25% 23% 24% 26% 30% day for 2 or more weeks in a row

Youth Suicide

Suicide affects all youth, but some groups are at a higher risk than others. Boys are more likely than girls to die from suicide. Girls, however, are more likely to report attempting suicide than boys. Several factors can put a young person at risk for suicide. However, having these risk factors does not always mean that suicide will occur.

Risk Factors Include: . History of previous suicide attempts . Family history of suicide . History of depression or other mental illness . Alcohol or drug abuse . Stressful life event or loss . Easy access to lethal methods . Exposure to the suicidal behavior of others . Incarceration

(Source: CDC 2014, Injury Center: Violence Prevention; Suicide Prevention; Youth Suicide http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

126

Youth І SAFETY

Key Findings Texting While Driving Statistics and Information

In 2015, 13% of youth had ridden in a car driven by someone who had been drinking . Be Smart: Don’t text and drive. No text alcohol in the past month and 2% of youth message is worth the distraction. SAFETY YOUTH drivers had driven after drinking alcohol. 43% . Be in Control: Remember it’s your phone. of youth drivers texted while driving. You decide if and when to send and read texts so take control. Consider Personal Safety turning your phone off, setting it to silent or even storing it in the glove box before

hitting the road. . 7% of Defiance County youth rarely or . Be Caring: Never send a text message to never wore a seatbelt when riding in a a friend that is driving to meet you, or to car driven by someone else (2013 YRBS anyone you know is likely behind the reported 8% for both Ohio and the U.S.). wheel. 54% reported they always wore a . Be a Friend: Friends don’t let each other seatbelt. text and drive.

. In the past 30 days, 13% of youth had (Source: Enough is Enough: Internet Safety 101, Texting and Driving, from: ridden in a car driven by someone who http://www.internetsafety101.org/textinganddriving.htm) had been drinking alcohol, (2013 YRBS reported 17% for Ohio and 22% for the U.S.) and 2% of youth drivers had driven a car themselves after drinking alcohol, (2013 YRBS reported 4% for Ohio and 10% for the U.S.).

. 9% of youth played the choking game.

. Defiance County youth drivers did the following while driving in the past month: wore a seatbelt (74%), talked on their cell phone (51%), ate (49%), texted (43%), used the internet on their cell phone (21%), used cell phone for other things (13%), checked Facebook on their cell phone (8%), played electronic games on cell phone (4%), applied makeup (4%), drank alcohol (3%), used illegal drugs (3%), read (2%) and misused prescription drugs (1%).

18% of Defiance County youth had suffered a blow or jolt to their head while playing with a sports team in the past year, increasing to 27% of

those ages 17 and older.

. Defiance County youth always wore a helmet when they rode the following in the past year: a motorcycle or dirt bike (13%), a snowmobile (10%), an ATV (8%), and a bicycle (3%)

. Defiance County youth never wore a helmet when they rode the following in the past year: a bicycle (58%), an ATV (19%), a motorcycle or dirt bike (11%) and snowmobile (6%).

. 18% of youth reported that they had suffered a blow or jolt to the head while playing with a

sports team which caused them to get “knocked out,” have memory problems, double or blurry vision, headaches or “pressure” in the head, or nausea or vomiting, increasing to 24% of high school youth and 27% of those ages 17 and older (2013 YRBS reported 12% for Ohio).

. More than two-thirds (69%) of Defiance County youth reported there was a firearm in or around their home. 1% of youth reported they were unlocked and loaded.

. 91% of youth had a Twitter, Instagram, facebook, online gaming, or other social network account.

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. Of those who had an account, they reported the following: o They knew all of “my friends” (45%) o Their account was currently checked private (44%) o Their parents had their password (23%) o They knew all of the people they play online (15%) o They had been asked to share personal info (15%) o They had been asked to meet someone they met online (10%) o They were bullied because of their accounts (10%) o Their friends had their password (8%) o They share personal information (7%) o They had problems as a result of their account (5%) o Their parents do not know they have an account (5%) o They had participated in sexual activity with someone they met online (2%)

. Over half (52%) of the youth who had a Twitter, Instagram, facebook, online gaming, or other social network account believed that sharing information online is dangerous.

Personal Health

. Over three-fourths (76%) of youth had been to the dentist for a check-up, exam, teeth cleaning or other dental work in the past year, increasing to 81% of those ages 17 and older (2013 YRBS reported 75% for Ohio).

. Defiance County youth had been told by a doctor or other health professional that they had: asthma (18%) (2013 YRBS reported 21% for the U.S.), needed to lose weight to improve their health (7%), high blood pressure (3%), diabetes (2%), high blood cholesterol (1%) and skin cancer (<1%).

. Youth reported they felt they were putting their health at a greater risk by doing the following: smoking cigarettes (84%), drinking and driving (83%), ride in a car with someone who had been drinking alcohol (83%), texting while driving (82%), drinking alcohol (78%), bullying others (74%), using marijuana (68%), carrying a weapon (65%), participating in other sexual activities (56%) and participating in sexual intercourse (55%).

. Youth reported they preferred to get information about their health from the following: parents (68%), the internet (36%), school (28%), friends (28%), siblings (13%), TV (11%), social media/facebook (11%) and the radio (4%).

Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th) Always wore a seatbelt 41% 42% 54% 55% N/A N/A Rarely or never wore a seatbelt 9% 10% 7% 7% 8% 8% Ridden with someone who had been 18% 13% 13% 10% 17% 22% drinking alcohol in past month Drove a car after drinking alcohol 5% 2% 2% 3% 4% 10% (of all youth drivers) Suffered a blow or jolt to the head N/A N/A 18% 24% 12% N/A Visited a dentist for a check-up within the N/A 75% 76% 78% 75% N/A past year Ever told by a doctor or nurse they had 20% 20% 18% 18% N/A 21% asthma N/A – Not available

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Youth І VIOLENCE ISSUES

Key Findings YOUTH

Violence-Related Behaviors

. In 2015, 13% of youth had carried a weapon (such as a gun, knife or club) in the past 30 days; increasing to 20% of males (2013 YRBS reported 14% for Ohio and 18% for the U.S.).

. 4% of youth did not go to school on one or more days because they did not feel safe at school or on their way to or from school (2013 YRBS reported 5% for Ohio and 7% for the U.S.).

. 49% of youth had been bullied in the past year. The following types of bullying were reported: o 36% were verbally bullied (teased, taunted or called harmful names) 29% were indirectly bullied (spread mean rumors about them or kept them out of a o “group”) VIOLENCE o 13% were cyber bullied (teased, taunted or threatened by e-mail or cell phone) (2013 YRBS reported 15% for Ohio and the U.S.). o 10% were physically bullied ( were hit, kicked, punched or people took their belongings) o 2% were sexually bullied (used nude or semi-nude pictures to pressure someone to have sex that did not want to, blackmail, intimidate, or exploit another person)

. In the past year, 31% of youth had been bullied on school property (2013 YRBS reported 21% for Ohio and 20% for the U.S.).

. In the past year, 26% of youth had been involved in a physical fight, increasing to 33% of males. 14% had been in a fight on more than one occasion (2013 YRBS reported 20% for Ohio and 25% for the U.S.).

. 4% of youth reported a boyfriend or girlfriend hit, slapped, or physically hurt them on purpose in the past 12 months (2013 YRBS reported 7% for Ohio).

. 11% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months.

. Defiance County youth had been forced to engage in the following: touched in an inappropriate sexual way (7%), sexual intercourse (4%), other sexual activity (3%), and oral sex (2%).

. In the past year, 15% of youth had purposefully hurt themselves one or more times without wanting to die, such as by cutting or burning themselves. 4% of youth had purposely hurt themselves 6 or more times.

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The following graph shows Defiance County youth involved in a physical fight in the past year. The graph shows the number of youth in each segment giving each answer (i.e., the graph shows that 26% of all youth had been in a fight in the past year, 33% of males and 18% of females).

Defiance County Youth Involved in a Physical Fight in the Past Year 50%

40% 33% 31%

30% 26% 27% 28% 26%

18% 20% 17%

10%

0% Total Male Female 12 to 13 14 to 16 17 & Older Defiance Defiance Total 2008 Total 2012

Types of Bullying Defiance County Youth Experienced in Past Year 14-16 13 or 17 and Youth Behaviors Total Male Female Years younger older old Verbally Bullied 36% 30% 41% 43% 41% 21%

Indirectly Bullied 29% 19% 39% 33% 30% 23%

Cyber Bullied 13% 8% 18% 13% 15% 11%

Physically Bullied 10% 12% 8% 13% 12% 3%

Sexually Bullied 2% 0% 4% 3% 2% 2%

Behaviors of Defiance Youth Bullied vs. Non-Bullied Non- Youth Behaviors Bullied Bullied Have drank alcohol in the past 30 days 22% 20%

Contemplated suicide in the past 12 months 22% 8%

Have smoked cigarettes in the past 30 days 11% 6%

Have used marijuana in the past 30 days 11% 7%

Misused prescription medications in the past 30 days 11% 6%

Attempted suicide in the past 12 months 10% 1%

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Defiance Defiance Defiance Defiance Ohio U.S. County County County County Youth Comparisons 2013 2013 2008 2012 2015 2015 (9th-12th) (9th-12th) (6th-12th) (6th-12th) (6th-12th) (9th-12th) YOUTH Carried a weapon in past month 11% 13% 13% 13% 14% 18% Been in a physical fight in past year 27% 26% 26% 20% 20% 25% Did not go to school because felt unsafe 4% 4% 4% 3% 5% 7% Bullied on school property in past year N/A 36% 31% 21% 21% 20% Bullied in past year 51% 51% 49% 43% N/A N/A Electronically/cyber bullied in past year 8% 15% 13% 14% 15% 15% Physically forced to have sexual 3% 7% 4% 3% 8% 7% intercourse Hit, slapped, or physically hurt on purpose 5% 6% 4% 5% 7% 9%‡ by their boyfriend or girlfriend in past year N/A – Not available ‡ Comparative YRBS data is for 2009

VIOLENCE

Understanding Bullying

. Bullying is a form of youth violence. CDC defines bulling as any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated.

. Bulling can result in physical injury, social and emotional distress, and even death. Victimized youth are at increased risk for depression, anxiety, sleep difficulties, and poor school adjustment. Youth who bully others are at increased risk for substance use, academic problems, and violence later in adolescents and adulthood.

. Some of the factors associated with a higher likelihood of bullying behavior include: . Externalizing problems such as defiant and disruptive behavior . Harsh parenting by caregivers . Attitudes accepting of violence

. Some of the factors associated with a higher likelihood of victimization include: . Poor peer relationships . Low self-esteem . Perceived by peers as different or quiet

(Source: CDC, Injury Center: Violence Prevention, Understanding Bullying Fact Sheet, January 2014, http://www.cdc.gov/violenceprevention/pub/understanding_bullying.html)

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Child І HEALTH & FUNCTIONAL STATUS

Key Findings National Survey of Children’s Health In 2015, 23% of children were classified as obese 2011/12 by Body Mass Index (BMI) calculations. 78% of Defiance County parents had taken their child . 6% of Ohio children ages 0-5 were ages 0-11 to the dentist in the past year. 7% of diagnosed with asthma, increasing Defiance County parents reported their child ages to10% of 6-11 year olds. 0-11 had been diagnosed with asthma. 6% of . 12% of Ohio children ages 6-11 were parents reported their child had been diagnosed diagnosed with ADD/ADHD. with ADD/ADHD. (Source: National Survey of Children’s Health, Health of Children Ages 0-11 2011/12, http://nschdata.org)

. In 2015, almost two-thirds (63%) of Defiance County parents of 0-11 year olds rated their child’s health as excellent. 1% of parents rated their child’s health as fair.

. About one-quarter (23%) of children were classified as obese by Body Mass Index (BMI) calculations. 17% of children were classified as overweight, 55% were normal weight, and 4% were underweight.

. Defiance County children ate the following for breakfast: cereal (85%), milk (74%), toast (47%), eggs (46%), fruit/fruit juice (36%), yogurt (33%), oatmeal (30%), bacon/ham/sausage (23%), Pop Tart/donut/pastry (34%), soda pop (1%), and other (8%). 6% of children ate at the school breakfast program.

. 11% of Defiance County children ate 5 or more servings of fruits and vegetables per day. 86% ate 1 to 4 servings of fruits and vegetables per day.

. Defiance County children spent an average of 2.2 hours watching TV, 1.4 hours on the computer/tablet/cellphone, and 0.9 hours playing video games an average day of the week.

. 78% of children had been to the dentist in the past year, increasing to 89% of 6-11 year olds.

. Parents gave the following reasons for not getting dental care for their child: child was not old enough to go to the dentist (13%), cost (4%), dentist would not see child yet because of their age (3%), no insurance (3%), treatment was ongoing (3%), could not find a dentist who accepted their insurance (2%), not available in area/transportation problems (1%), child refused to go (<1%), health plan problem (<1%), did not know where to go for treatment (<1%), and other (2%). No one reported the dentist did not know how to treat/provide care to child that they missed an appointment and was not allowed to go back to clinic, or dissatisfaction with dentist.

Children’s Dental Health

. Dental disease remains a common problem among Ohio’s children; 51% of children have experienced tooth decay by third grade. . Dental care remains the single most common unmet health care need for nearly 157,400 children in Ohio, regardless of family income. . Almost 486,000 (19%) of Ohio’s children are without dental insurance; this is four times the number of children without medical insurance. . Almost 340,000 children in Ohio have never been to the dentist. . The overall percentage of children in Ohio with dental sealants has increased; however, children in rural/non-Appalachian counties are significantly less likely to have dental sealants.

(Source: ODH, Oral Health Isn’t Optional, 2011, from: http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/ohs/oral%20health/ohioreport8_9.ashx)

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HEALTH & & HEALTH . Parents reported their child had the following allergies:  Pollen (7%)  Wheat (3%)  Eggs (1%)  Ragweed (7%)  Milk/dairy products (3%)  Soy (1%)  House dust mites (6%)  Horses (3%)  Fish (1%)  Grasses (6%)  Red dye (2%)  Kiwi (1%)  Dogs (4%)  Gluten (2%)  Shellfish (1%)  Cats (4%)  Fungi (2%)  Strawberries (1%)  Peanuts (3%)  Tree nuts (2%)  Watermelon (1%)  Mold (3%)  Bees (1%)  Other (5%)

. 1% of children had an epi-pen for their allergy.

. 18% of Defiance County children ages 0-11 years old had at least one health condition.

. A doctor told Defiance County parents their 0-11 year old child had the following conditions:  Asthma (7%)  Bone/joint/muscle problems (2%)  Dental problems (7%)  Head injury (1%) FUNCTION  Speech and language problems (6%)  Autism (1%)  ADD/ADHD (6%)  Depression problems (1%)  Developmental delay or physical  Intellectual disability/ mental impairment (5%) retardation (1%)  Anxiety problems (4%)  Other life threatening illness (1%)  Learning disability (4%)  Genetic disease (1%)  Birth defect (4%)  Cerebral palsy (1%)  Urinary tract infection (4%)  Appendicitis (1%)  Hearing problems (4%)  Diabetes (<1%)  Vision problems that cannot be corrected  Epilepsy (<1%) with glasses (3%)  Digestive tract infections (<1%)  Behavioral/conduct problem (2%)  Pneumonia (2%)

. 40% of parents reported their child had been tested for lead poisoning, and the results were within normal limits. <1% reported the levels were elevated and medical follow-up was needed. 46% of parents had not had their child tested for lead poisoning and 13% of parents

did not know if their child had been tested for lead. AL

. One-fifth (20%) of Defiance County children ages 0-11 had difficulties in the following areas: concentration (12%) emotions (9%), behavior (7%), and being able to get along with people (1%). Of those with difficulties, 60% were minor and 5% were severe.

. Difficulties were managed in the following ways: family and friends take care of it (53%), STATUS professional help (26%), school/day care (26%), help was not needed (26%), and unable to access help (1%).

. 1% of Defiance County parents reported their children usually felt unhappy, sad or depressed in the past month.

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Defiance Ohio U.S. Defiance Ohio U.S. County 2011/12 2011/12 County 2011/12 2011/12 Child Comparisons 2015 Ages Ages 2015 Ages Ages Ages 0-5 0-5 Ages 6-11 6-11 0-5 6-11 Rated health as excellent or 94% 89% 86% 92% 86% 83% very good

Dental care visit in past year 53% 50% 54% 89% 92% 88%

Diagnosed with asthma 2% 6% 6% 9% 10% 10%

Diagnosed with ADHD/ADD 2% N/A 2%* 8% 12% 9%

Diagnosed with behavioral or 0% N/A 2%** 3% 5% 4% conduct problems Diagnosed with vision problems that cannot be 0% N/A <1% 4% N/A 2% corrected Diagnosed with bone, joint, or 1% N/A 1% 2% N/A 2% muscle problems

Diagnosed with epilepsy 0% N/A <1% <1% N/A 1%

Diagnosed with a head injury 1% N/A <1% 1% N/A <1%

Diagnosed with diabetes 0% N/A N/A <1% N/A <1%

Diagnosed with depression 0% N/A <1%* 2% N/A 2% N/A – Not available * - Ages 2-5

Attention-Deficit / Hyperactivity Disorder (ADHD)

. 5% of school-aged children have ADHD. However, studies have estimated higher rates in community samples. . Parents report that approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011. . Parent-reported ADHD diagnosis in Ohio was 14.2% . Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5% per year from 2003 to 2007. . Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD. . Rates of ADHD diagnosis increased at a greater rate among older teens as compared to younger children.

. The highest rates of parent-reported ADHD diagnosis were noted among children

covered by Medicaid and multiracial children.

(Source: CDC, Attention-Deficit / Hyperactivity Disorder (ADHD), 12/10/2014, from: http://www.cdc.gov/ncbddd/adhd/data.html

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HEALTH & & HEALTH Asthma

The following graph shows that Defiance County has a lower percentage of children ages 0-5 and 6-11 who are diagnosed with asthma than both Ohio and the U.S.

Children Diagnosed with Asthma 30%

25%

20%

15% 10% 10% 9% 10% 6% 6%

5% 2% FUNCTION

0% Ages 0-5 Ages 6-11

Defiance 2015 Ohio 2011/12 U.S. 2011/12

Child Fatalities

The following graph shows Defiance County child fatality data for youth from birth to 18 years old, from January 1, 2012 to December 31, 2014. The table shows that:

. There were a total of 13 child fatalities in Defiance County from 2012 to 2014, averaging to 4 fatalities per year.

Defiance County Child Fatalities, 2012 to 2014

10 AL

8 5 6 4 4

4 STATUS

2 of Fatalities Number

0 2012 2013 2014

(Source: Defiance County General Health District Vital Statistics, Death Certificate Data)

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Child І HEALTH INSURANCE, ACCESS,

UTILIZATION AND MEDICAL HOME

Key Findings National Survey of Children’s Health In 2015, 1% of Defiance County parents reported their 2011/12 0-11 year old did not have health insurance. 22% of parents reported they had taken their child to the . 7% of 0-5 year old and 5% of 6-11 year hospital emergency room in the past year. 72% of old Ohio children were without parents had taken their child to the doctor for insurance at some time in the past year. preventive care in the past year. . 40% of 0-5 year old and 34% of 6-11 year old Ohio children had public Health Insurance insurance.

. 94% of 0-5 year old and 86% of 6-11 . 1% of parents reported that their child did not year old Ohio children had been to the currently have health insurance. doctor for preventive care in the past

year. . Defiance County children had the following types of health insurance: parent’s employer (64%), (Source: National Survey of Children’s Health, 2011/12 Medicaid, Healthy Start, or other public health http://nschdata.org) benefits (22%), someone else’s employer (16%), self-paid (2%), Insurance Marketplace (1%), Medicare (<1%), or some other source of insurance (<1%).

. Parents reported their child’s health insurance covered the following: doctor visits (98%), prescription coverage (96%), well visits (95%), hospital stays (95%), immunizations (92%), dental (85%), vision (75%), and mental health (72%).

Access and Utilization

. 17% of parents reported their child did not get all of the prescription medications they needed in the past year for the following reasons: their child did not need prescription medication (14%), no referral (2%), cost (1%), treatment is ongoing (1%), dissatisfaction with doctor (<1%), health plan problem (<1%), transportation problems (<1%), doctor did not know how to treat or provide care (<1%), and other reasons (1%). No one reported their child did not have insurance, they could not find a doctor to accept child’s insurance, they could not get an appointment, religious preference, or they did not know where to get treatment.

. 11% of parents reported their child did not get all of the medical care they needed in the past year. They reported the following reasons: cost (5%), no referral (3%), health plan problem (2%), inconvenient times/could not get an appointment (2%), treatment is ongoing (2%), no insurance (1%), not available in area/transportation problems (1%), doctor did not know how to treat or provide care (1%), could not find a doctor who accepted child’s insurance (<1%), not available in area (<1%), vaccine shortage (<1%), and other reasons (1%). No one reported that they did not like the doctor, they didn’t know where to go for treatment, there was a language barrier or that their child refused to go.

. 9% of Defiance County children received mental health care or counseling in the past year, increasing to 14% of those with incomes less than $25,000.

. Almost one-quarter (22%) of parents took their child to the hospital emergency room for health care in the past year, increasing to 37% of parents with incomes less than $25,000. 3% of children had been to the ER three or more times in the past year.

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C . 12% of parents reported their child needed the following special services in the past year: speech therapy (6%), counseling (4%), physical therapy (3%), occupational therapy (3%), special education (3%), respite care (<1%), out of home care(<1%), or medical equipment, such as a wheelchair (<1%). INSURANC HEALTH HILD

. 93% of Defiance County children had received all of their recommended vaccinations.

. 7% of children did not get all of their recommended vaccinations for the following reasons: child had received some, but not all recommended vaccinations (7%), parents chose to not vaccinate their child (3%), fear of negative effects (1%), religious or cultural beliefs (1%), alternate vaccination schedule used (<1%), and other reasons (1%).

. Of those parents who chose not to vaccinate their child, they did not get their child the following vaccines: Influenza (75%), Chickenpox (Varicella) (63%), Hepatitis A (56%), Hepatitis B (56%), Prevnar 13 (Pneumococcal Conjugate) (50%), MMR (measles, mumps, and rubella) (44%), HIB (Haemophilus) (44%), Polio (44%), and DtaP/Tdap (diphtheria, tetanus, and pertussis) (31%).

Medical Home

. 76% of parents reported they had one or more people they think of as their child’s personal doctor or nurse, decreasing to 64% of those with incomes less than $25,000.

. 72% of children had visited their health care provider for preventive care in the past year, increasing to 86% of 0-5 year olds.

. In 2015, 98% of Defiance County parents reported that their child had one particular place they usually went if they were sick or needed advice about their health. They reported the following places: a private doctor’s office (78%), an urgent care center (9%), a community health center (1%), a hospital emergency room (<1%), and some other kind of place (1%). 8% reported multiple places.

. Defiance County children have been referred to the following specialists: Ear, Nose, and Throat (ENT) doctor (18%), Allergist (6%), Cardiologist (heart doctor) (4%), Pediatric Ophthalmologist (4%), Psychiatrist (3%), Dermatologist (3%), Endocrinologist (diabetes doctor) (2%), Oncologist (cancer doctor) (<1%), and other specialist (12%).

Defiance Defiance Ohio U.S. Ohio U.S. County County Child Comparisons 2011/12 2011/12 2011/12 2011/12 2015 2015 Ages Ages Ages Ages Ages Ages 0-5 0-5 6-11 6-11 0-5 6-11 Had public insurance 27% 40% 44% 19% 34% 37% Been to doctor for preventive 86% 94% 90% 64% 86% 82% care in past year 2 or more visits to the ER 10% 8%* 8%* 8% 6%* 4%* Received all the medical care 88% 99%* 99%* 89% 98%* 98%* they needed Have a personal doctor or 80% 91% 91% 74% 93% 90% E nurse *2003 national and state data

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Child І EARLY CHILDHOOD

(0-5 YEAR OLDS)

Key Findings Progress on Childhood Obesity The following information was reported by parents of 0-5 year olds. 90% of mothers got prenatal care . 1 in 8 preschoolers is obese in the US. within the first three months during their last . Obesity among low-income preschoolers pregnancy. 6% of mothers smoked during their last declined, from 2008 through 2011, in 19 of pregnancy. 61% of parents put their child to sleep 43 states and territories. on his/her back. 25% of mothers never breastfed . Children who are overweight or obese as their child. preschoolers are 5 times as likely as normal weight children to be overweight Early Childhood or obese as adults.

(Source: CDC, Progress on Childhood Obesity, August . The following information was reported by 2013, from: Defiance County parents of 0-5 year olds. http://www.cdc.gov/vitalsigns/ChildhoodObesity/index. html)

. During their last pregnancy, mothers did the following: got prenatal care within the first 3 months (90%), took a multi-vitamin (88%), took folic acid during pregnancy (53%), took folic acid pre-pregnancy (34%), experienced depression during or after pregnancy (14%), smoked cigarettes (6%), and used alcohol (2%).

. When asked how parents put their child to sleep as an infant, 61% said on their back, 10% said on their side, 10% said in bed with them or another person, 8% said on their stomach, and 5% said various methods.

. Children were put to sleep in the following places: pack n’ play (56%), crib/bassinette without bumper, blankets, or stuffed animals (50%), crib/bassinette with bumper, blankets, or stuffed animals(47%), in bed with parent or another person (42%), swing (39%), car seat (31%), floor (15%), couch or chair (11%).

. Mothers breastfed their child: more than 9 months (28%), 4 to 9 months (15%), 7 weeks to 3 months (18%), 3 to 6 weeks (6%), 2 weeks or less (6%), still breastfeeding (2%), and never breastfed (25%).

. Parents reported they or someone in the family reads to their 0-5 year old child: every day (19%), almost every day (40%), a few times a week (27%), and a few times a month (7%). 3% reported never reading to their child due to lack of interest from the child.

. Children 0-5 years old were more likely than children 6-11 years old to:  Have visited a doctor for preventive care in the past year (86% compared to 64% of 6-11).  Have public insurance (27% compared to 19% of 6-11).  Have a personal doctor or nurse (80% compared to 74% of 6-11).

Defiance Ohio U.S. County Child Comparisons 2011/12 2011/12 2015 0-5 years 0-5 years 0-5 years

Parent reads to child every day 19% 53% 48%

Never breastfed their child 25% 29% 21%

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Breastfeeding

The following graph shows the percent of infants who have been breastfed or given breast milk EARLY CHILDHOOD from Defiance County, Ohio, and U.S.

. The U.S. has a larger percent of children who have been breastfed for any length of time, compared to Ohio and Defiance County.

Children Breastfed

100% 79% 75% 71% 80%

60%

40% 25% 29% 21%

20%

0% Never Breastfed Breastfed

Defiance 2015 Ohio 2011/12 U.S. 2011/12

(Source: National Survey of Children’s Health, Data Resource Center, and 2015 Defiance County Health Assessment)

Facts about Breastfeeding

. The percent of infants who were ever breastfed is 65% in Ohio, compared to 77% in the U.S. . Human milk provides virtually all the protein, sugar, and fat your baby needs to be healthy, and it also contains many substances that benefit your baby’s immune system, including antibodies, immune factors, enzymes, and white blood cells. These substances protect your baby against a wide variety of diseases and infections not only while he is breastfeeding but in some cases long after he has weaned. Formula cannot offer this protection. . With regard to allergy prevention, there is some evidence that breastfeeding protects babies born to families with a history of allergies, compared to those babies who are fed either a standard cow’s milk based formula or a soy formula. . Recent research even indicates that breastfed infants are less likely to b obese in adolescence and adulthood. They are also less vulnerable to developing both type 1 and type 2 diabetes. . The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.

(Source: CDC, Breastfeeding, July, 31, 2013, from: http://www.cdc.gov/breastfeeding/faq/index.htm & Healthy Children, Breastfeeding Benefits Your Baby’s Immune System, 5/11/2013, from: http://www.healthychildren.org/)

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Child І MIDDLE CHILDHOOD (6-11 YEARS OLD)

Key Findings National Survey of Children’s Health 2011/12

The following information was reported by Defiance . 10% of Ohio and 9% of U.S. parents of 6- County parents of 6-11 year olds. In 2015, 67% of 11 year olds reported their child watched Defiance County parents reported their child 4 or more hours of TV or played video always feels safe at school. 44% of parents reported games each day. their child was bullied at some time in the past year. . 83% of Ohio and 79% of U.S. parents of 6- 85% of parents reported their child participated in 11 year olds reported their child extracurricular activities. 23% of parents reported participated in one or more organized their child had an email or a social network activities outside of school account. . 96% of Ohio and 94% of U.S. parents of 6- 11 year olds reported they felt their child Middle Childhood was usually or always safe at school.

(Source: National Survey of Children’s Health, 2011/12, . The following information was reported by accessed from: http://nschdata.org) Defiance County parents of 6-11 year olds.

. Parents reported they had to contact the following agencies to help with problems with their child: child’s school (8%), mental health agency (6%), Board of Developmental Disabilities (<1%), Children’s Services (<1%), faith based agency (<1%), and law enforcement (<1%). No one reported contacting juvenile court. 88% of parents reported they have never called an agency for help with their child.

. 74% of parents of 6-11 year olds reported their child was physically active for at least 60 minutes on 3 or more days per week. 53% had done so on 5 or more days and 19% were physically active for at least 60 minutes every day per week. 1% reported no physical activity.

. 85% of parents reported their 6-11 year old child participated in extracurricular activities in the past year. Their child participated in the following: a sports team or sports lessons (71%), a religious group (39%), a club or organization such as Scouts (21%), Boys/Girls Club (2%), and some other organized activity (24%).

. Children missed school an average of 1.9 days per year because of illness or injury.

. Defiance County children 6-11 years old were enrolled in the following types of schools: public (87%), private (7%), home-schooled (4%), and charter (<1%). 1% of children were not enrolled in school.

. 67% of parents reported they felt their child was always safe at school. 29% reported usually, 1% reported sometimes, and 1% reported they felt their child was never safe at school.

. 44% of parents reported their child was bullied in the past year. The following types of bullying were reported:  32% were verbally bullied (teased, taunted or called harmful names)  11% were indirectly bullied (spread mean rumors about or kept out of a “group”)  8% were physically bullied (they were hit, kicked, punched or people took their belongings)  1% were cyber bullied (teased, taunted or threatened by e-mail or cell phone)

. 9% of parents reported they did not know if their child was bullied.

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. Almost one-quarter (23%) of parents of 6-11 year olds reported their child had an email, Facebook, Twitter, Instagram or other social network account. Of those who had an account,

they reported the following: they had their child’s password (86%), they knew all of the people in their child’s “my friends” (57%), their child’s account was checked private (50%), their child had a problem as a result of their account (5%), and their child’s friends had their passwords

(2%). 2% of parents reported they did not know if their child had a social network account. MIDDLE CHILDHOOD

. Parents reported they or someone in the family reads to their 6-11 year old child: every day (8%), almost every day (15%), a few times a week (20%), a few times a month (8%), and a few times a year (5%). 39% of parents reported their child read to him/herself, and 1% reported never reading to their child due to lack of interest from the child.

. Children 6-11 years old were more likely than children 0-5 years old to:  Have been diagnosed with asthma (9% compared to 2% of 0-5).  Have ADD or ADHD (8% compared to 2% of 0-5).  Have gone to the dentist in the past year (89% compared to 54% of 0-5).

. Defiance County parents reported they were concerned a lot with the following issues with their 6-11 year old child: having enough time with their child (9%), child’s academic achievement (8%), their relationship with their child (6%), how their child copes with stressful things (5%), learning difficulties with their child (4%), their child’s anxiety (4%), their child’s self- esteem (4%), their child being bullied by their classmates(4%), cell phone and technology use (3%), their child’s depression (3%), internet use (2%), violence in the home, school or neighborhood (2%), their child talking (1%), eating disorders (1%), their child walking or running (1%), their child getting along with others (1%) and substance abuse (1%).

Defiance Ohio U.S. County Child Comparisons 2011/12 2011/12 2015 6-11 Years 6-11 Years 6-11 Years Child did not miss any days of school 27% 16%* 22%* because of illness or injury Child missed school 11 days or more <1% 8%* 5%* because of illness or injury Parent felt child was usually/always 96% 96% 94% safe at school

*2007 National Survey of Children’s Health

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Child І FAMILY FUNCTIONING, NEIGHBORHOOD AND COMMUNITY CHARACTERISTICS

Key Findings National Survey of Children’s Health In 2015, 71% of Defiance County parents 2011/12 reported their 0-11 year old child slept 10-11 . 63% of Ohio and 61% of U.S. parents of 0-5 hours per night. 95% of parents reported their year olds reported their family ate a meal neighborhood was always or usually safe together every night of the week. enough for their child to go out and play. 1% of parents reported there was an unlocked . 29% of 0-5 year old and 34% of 6-11 year and loaded firearm in their home. 8% of old Ohio children lived in a household with parents reported they received benefits from someone who smokes. the SNAP/food stamps program. (Source: National Survey of Children’s Health, 2011/12 http://nschdata.org) Family Functioning

. Almost three-quarters (71%) of parents reported their child slept 10-11 hours per night. 22% reported their child slept 8-9 hours each night, <1% reported 5-7 hours, and 5% reported 12 or more hours a night.

. 1% of parents reported their child went to bed hungry at least one day per week because they did not have enough food.

. 43% of parents reported that every family member who lived in their household ate a meal together every day of the week. Families ate a meal together an average of 6.3 times per week.

. 30% of parents reported their child attended religious service one to three times per month and 58% reported four or more times per month. 12% reported their child has never attended a religious service. Parents reported their child attended religious services an average of 3.9 times per month.

. Parents reported their child regularly attended the following: elementary school (37%), child care outside of their home provided by a relative (30%), nursery school, pre-school, or kindergarten (22%), family-based child care outside of home (21%), child care in their home provided by a relative other than a parent/guardian (19%), child care center (8%), child care in their home provided by a baby sitter (7%), and Head Start or Early Start program (3%).

. Parents reported the following forms of discipline they used for their child: take away privileges (80%), time out (61%), grounding (40%), yelling (39%), spanking (32%), wash mouth out (3%) and other method (7%).

. Parents reported the following challenges they face in regards to the day-to-day demands of parenthood/raising children: demands of multiple children (44%), financial burdens (19%), being a single parent (9%), difficulty with lifestyle changes (3%), loss of freedom (3%), child has special needs (2%), post-partum depression (1%), alcohol and/or drug abuse (1%), and other challenges (7%).

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Child Safety Characteristics FAMILY FUNCTIONING

. Parents reported their neighborhood was: always safe (55%), usually safe (40%), sometimes safe (2%), and never safe (3%).

. Parents reported having the following safety items in their home: working smoke alarm/detector (96%), fire extinguisher (60%), carbon monoxide detector (58%), and Poison Control number by the phone (39%). 85% had more than one of these safety items in their home.

. 53% of parents reported they had a firearm in or around their home. 1% reported they were unlocked and loaded.

. 49% of parents reported their child always rode in a car seat/booster seat when a passenger in a car, decreasing to 29% of those children ages 6-11 years old.

. Parents reported their child spent the following unsupervised time after school on an average school day: no unsupervised time (72%), less than one hour (21%), 1-2 hours (6%), and 3-4 hours (1%).

. Parents reported their child always wore a helmet when riding the following: ATV (18%), a scooter/bike (14%), rollerblades/skates (3%), and a skateboard (3%).

. Parents reported their child never wore a helmet when riding the following: rollerblades/skates (12%), a scooter/bike (31%), a skateboard (12%), and an ATV (8%).

Neighborhood and Community Characteristics

. Defiance County parents had the following rules about smoking in their home: no one is allowed to smoke inside their home at any time (85%), smoking is not allowed when children are present (9%), smoking is allowed anywhere (3%), and smoking is allowed in some rooms only (2%).

. Defiance County parents had the following rules about smoking in their car: no one is allowed to smoke inside their car at any time (80%), smoking is not allowed when children are present (6%), smoking is allowed as long as a window is open (6%), and smoking is allowed anywhere (1%).

. In the past year, parents reported that someone in the household received the following: free or reduced cost breakfast or lunches at school (18%), SNAP/food stamps (8%), benefits from WIC program (7%), mental health treatment (5%), cash assistance from a welfare program (3%), Help Me Grow (1%), and subsidized childcare through Defiance County JFS (<1%).

. Defiance County parents reported their child experienced the following: had at least one other adult in their school, neighborhood, or community who knows him/her well and who he/she can rely on for advice or guidance (42%), their parents became separated or were divorced (14%), lived with someone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks (4%), lived with a parent/guardian who served time or was sentenced to serve time in prison or jail after they were born (4%), lived with someone who had a problem with alcohol or drugs (4%), seen or heard any parents or adults in their home hit, beat, kicked, or physically hurt each other (2%), lived with a parent/guardian who died (2%), were treated or judged unfairly because his/her ethnic group (1%), and been the victim of violence or witness violence in their neighborhood (<1%).

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Defiance Defiance Ohio U.S. Ohio U.S. County County 2011/12 2011/12 2011/12 2011/12 Child Comparisons 2015 2015 0-5 0-5 6-11 6-11 0-5 6-11 Years Years Years Years Years Years Family eats a meal together every day of the 50% 63% 61% 40% 45% 47% week Child never attends 5% N/A N/A 12% 22% 18% religious services Neighborhood is usually or 96% 88% 86% 95% 86% 86% always safe N/A – Not available

Family Dinners

The following graph shows the percent of Defiance County families that eat a meal together every day of the week along with the percent of Ohio families and the percent of U.S. families.

. U.S. families eat a meal together every day of the week more frequently than Defiance County and Ohio families.

Families that Eat Together Everyday of the Week

100%

80% 53% 60% 43% 34%

40%

20%

Defiance 2015 Ohio 2011/12 U.S. 2011/12

(Source: National Survey of Children’s Health & 2015 Defiance County Health Assessment)

Children and Sleep

. Children five to twelve years old need 10-11 hours of sleep. . Sleep problems and disorders are prevalent at this age. Poor or inadequate sleep can lead to mood swings, behavioral problems such as hyperactivity and cognitive problems that impact their ability to learn in school. . Sleep tips for school-aged children: . Teach school-aged children about healthy sleep habits . Emphasize need for regular and consistent sleep schedule and bedtime routine . Make child's bedroom conducive to sleep – dark, cool and quiet . Keep TV and computers out of the bedroom.

(Source: National Sleep Foundation, Children and Sleep; http://www.sleepfoundation.org/article/sleep- topics/children-and-sleep)

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Neighborhood Safety

FAMILY FUNCTIONING The following graph shows the percent of Defiance County, Ohio, and U.S. parents who feel their neighborhood is always or usually safe.

. Defiance County has the largest percent of parents for both the 0-5 age group and the 6-11 age group who feel that their neighborhood is always/usually safe as compared to Ohio and U.S. parents.

Parents Feel their Neighborhood is Always or Usually Safe 100% 96% 95%

88% 90% 86% 86% 86%

80%

70% Ages 0-5 Ages 6-11

Defiance 2015 Ohio 2011/12 U.S. 2011/12

(Source: National Survey of Children’s Health & 2015 Defiance County Health Assessment)

Child Passenger Safety Facts

. In the United States during 2011, more than 650 children ages 12 years and younger died as occupants in motor vehicle crashes, and approximately 148,000 were injured. . One CDC study found that, in one year, more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time. . More than two-thirds of fatally injured children were killed while riding with a drinking driver. . Restraint use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained. . Booster seats reduce the risk for serious injury by 45% for children ages 4 to 8 years. . Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddler’s ages 1 to 4 years. . Child restraint systems are often used incorrectly. One study found that 72% of nearly 3,500 observed car and booster seats were misused in a way that could be expected to increase a child’s risk of injury during a crash.

(Sources: CDC, Injury Prevention & Control: Motor Vehicle Safety, Updated: September 12, 2014, from: http://www.cdc.gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html)

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Child І PARENT HEALTH

Key Findings National Survey of Children’s Health 2011/2012 In 2015, 10% of Defiance County parents . 78% of mothers of 0-5 year olds and 70% of mothers were uninsured. 38% of parents were of 6-11 year olds in Ohio rated their mental and overweight and 31% were obese. emotional health as excellent or very good. Parents missed work an average of 2.2 days per year due to their child being ill . 83% of fathers of 0-5 year olds and 80% of fathers of 6-11 year olds in Ohio rated their mental and or injured. emotional health as excellent or very good. Parent Health . 7% of mothers of 0-5 year olds and 10% of mothers of 6-11 year olds in Ohio rated their mental and . Those filling out the survey had the emotional health as fair or poor. following relationship to the child: . 7% of fathers of 6-11 year olds in Ohio rated their mental and emotional health as fair or poor. mother (70%), father (28%), grandparent (1%), and other non- (Source: National Survey of Children’s Health, 2011/12, relative (<1%). http://nschdata.org)

. Almost three-quarters (75%) of parents rated their health as excellent or very good, decreasing to 55% of parents with incomes less than $25,000. 4% of parents had rated their health as fair or poor.

. 76% of parents rated their mental and emotional health as excellent or very good. 4% rated their mental and emotional health as fair or poor.

. 1% of mothers and 11% of fathers of 0-5 year olds rated their mental and emotional health as fair or poor. 5% of mothers and 2% of fathers of 6-11 year olds rated their mental or emotional health as fair or poor.

. 10% of parents were uninsured, increasing to 19% of parents with incomes less than $25,000.

. 69% of parents were either overweight (38%) or obese (31%). 29% were normal weight, and 2% were underweight.

. 51% of Defiance County parents reported they were physically active for at least 30 minutes on 3 or more days per week. 26% had done so on 5 or more days and 9% were physically active for at least 30 minutes every day per week. 24% reported no physical activity.

. Parents missed work an average of 2.2 days per year due to their child being ill or injured.

Defiance Defiance Ohio U.S. Ohio U.S. County County 2011/12 2011/12 2011/12 2011/12 Child Comparisons 2015 2015 0-5 0-5 6-11 6-11 0-5 6-11 Years Years Years Years Years Years Mother’s mental or emotional 1% 7% 7% 5% 10% 8% health is fair/poor Father’s mental or emotional 11% N/A 3% 2% 7% 5% health is fair/poor

N/A – Not available

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Appendix I І DEFIANCE COUNTY HEALTH ASSESSMENT INFORMATION SOURCES

Source Data Used Website American Academy of Pediatrics . Safer Sex Guidelines www.lpch.org/Dise (AAP) aseHealthInfo/Healt APPENDIX hLibrary/adolescent /safesex.html American Association of . Suicide Facts www.suicidology.or Suicidology g/resources/facts- statistics-current- research/suicide- statistics American Cancer Society, . 2015 Cancer Facts, Figures, Cancer Facts and Figures 2015. and Estimates www.cancer.org Atlanta: ACS, 2015 . Nutrition Recommendations www.cancer.org/c American Cancer Society, ancer/news/electro . Electronic Cigarettes and Electronic Cigarette Use Doubles nic-cigarette-use- Teenagers in the U.S. Among Teenagers, 2013 doubles-among- teenagers http://acaai.org/ne American College of Allergy, . Asthma Facts ws/facts- Asthma & Immunology statistics/asthma www.ada.org/secti American Dental Association . Oral Health in Older Adults ons/publicResource s/pdfs/faq.pdf . Type 1 and 2 Diabetes American Diabetes Association . Risk Factors for Diabetes www.diabetes.org . Diabetes Facts American Foundation for Suicide . Warning Signs for Suicide www.afsp.org/ Prevention . Stroke Warning Signs and

American Heart Association, Symptoms www.heart.org/HEA 2013 . Smoke-free Living: Benefits & RTORG/

Milestones I

Arthritis at a Glance, 2012, Centers for Disease Control & www.cdc.gov/chro Prevention, Morbidity and nicdisease/resource . Arthritis Statistics Mortality Weekly Report 2010; s/publications/AAG 59(39):999-1003 & 59(39):1261- /arthritis.htm 1265 Behavioral Risk Factor Surveillance System, National Center for Chronic Disease . 2009 - 2013 Adult Ohio and Prevention and Health www.cdc.gov U.S. Correlating Statistics Promotion, Behavioral Surveillance Branch, Centers for Disease Control

147

Source Data Used Website www.bradycampai gn.org/sites/default Brady Campaign to Prevent Gun /files/GunDeathan . Victims of Gun Violence Violence dInjuryStatSheet3Ye arAverageFINAL.pd f www.caron.org/sig . Characteristics of New Caron Pennsylvania ns-of-pot-use- Marijuana Users 5827.html . Adverse Childhood Experiences (ACE) . Asthma Attacks . Binge Drinking Among Women . Caffeinated Alcohol Beverages . Cancer and Men . Distracted Driving . Electronic Cigarettes and Teenagers . Health Care Access Among Center for Disease Control and the Employed and www.cdc.gov Prevention (CDC) Unemployed . Health Care Access and Utilization . Healthy Eyes . HIV in the U.S. . Heart Health and Stroke Facts . Obesity Facts . Oral Health . Skin Cancer Prevention . Smoking facts . Tips for Parents . Yearly Flu Shots www.cdc.gov/heal CDC, Adolescent and School . Youth Physical Activity Facts thyyouth/physicala Health, 2013 ctivity/facts.htm www.cdc.gov/arthr CDC, Arthritis . Key Public Health Messages itis/basics/key.htm . Suicide Prevention CDC, Injury Center: Violence . Youth Suicide www.cdc.gov/viole Prevention 2014 . Understanding Bullying Fact nceprevention/pub Sheet . Leading Causes of Death in U.S. CDC, National Center for Health . Men’s Health www.cdc.gov/nchs Statistics . U.S. Female Fertility Rate /fastats/ . U.S. Births to Unwed Mothers . U.S. Low Birth Weight, Live Births

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Source Data Used Website www.cdc.gov/phys

CDC, Physical Activity for . Physical Activity icalactivity/everyon Everyone Recommendations e/guidelines/adults. html

www.cdc.gov/med

. Electronic Cigarettes and ia/releases/2013/p0 CDC, Press Release, 2013 Teenagers in the U.S. 905-ecigarette- use.html . U.S. Chlamydia and

Gonorrhea Rates APPENDIX CDC, Sexually Transmitted www.cdc.gov/std/s . STD’s in Adolescents and Diseases Surveillance, 2014 tats/ Young Adults . U.S. STD Surveillance Profile www.cdc.gov/vac CDC, Vaccine Safety, Human . Human Papillomavirus cinesafety/vaccine Papillomavirus (HPV) s/HPV/Index.html . About Underlying Cause of http://wonder.cdc. CDC, Wonder Death, 1999-2012 gov/ucd-icd10.html . Cigarette Expenditures . Alcohol Beverage Expenditures www.communityco Community Commons . Beer, Wine and Liquor Stores mmons.org/ . Bars and Drinking Establishments www.internetsafety Enough is Enough: Internet . Texting While Driving Statistics 101.org/textingand Safety 101 and Information driving.htm www.ready.gov/ba Federal Emergency . Basic Disaster Supplies Kit sic-disaster-supplies- Management Agency (FEMA) kit Health Indicators Warehouse . Age-Adjusted Mortality Rates www.healthindicat for Motor Vehicle Accidents ors.gov/Indicators/S . Heart Disease and Stroke election Mortality Rates . All Healthy People 2020 Healthy People 2020: U.S. Target Data Points www.healthypeopl

Department of Health & Human . Some U.S. Baseline Statistics e.gov/2020/topicso Services bjectives2020 . Predictors of Access to I Health Care

www.legacyforheal th.org/content/do wnload/582/6926/fil Legacy for Health . Tobacco Fact Sheet e/LEG-FactSheet- eCigarettes- JUNE2013.pdf http://statecance . Age-Adjusted Cancer National Cancer Institute profiles.cancer.gov Mortality Rates /index.html

149

Source Data Used Website

. Drug Facts: Heroin www.drugabuse.go National Institute on Drug Abuse . Drug Facts: Drugged Driving v

http://nihseniorhealt National Institute of Health, Senior h.gov/hearingloss/h . Hearing Loss Health earinglossdefined/01 .html www.cdc.gov/nchs/ National Vital Statistics Report . Live Birth Data data/nvsr/nvsr61/nvs r61_01.pdf#table01 http://Defiance.oh.n . Health Indicators etworkofcare.org/ph Network of Care . Age-Adjusted Mortality Rates /county- indicators.aspx#cat1 http://healthtransfor mation.ohio.gov/Lin . Ohio Medicaid Assessment Office of Health Transformation kClick.aspx?fileticket Survey =oid6Wo- y0gs%3D&tabid=160 www.ocjs.ohio.gov/ . Crime Statistics and Crime Office of Criminal Justice Services crime_stats_reports.s Reports tm . Obesity and Diabetes in Ohio . Defiance County and Ohio Mortality Statistics . Defiance County and Ohio Birth Statistics . Defiance County and Ohio Ohio Department of Health, Leading Causes of Death www.odh.ohio.gov/ Information Warehouse . Sexually Transmitted Diseases . Incidence of Cancer . HIV/AIDS Surveillance Program . Statistics: Access to Health Services . Teen Birth Rates http://publicapps.o Ohio Department of Health, Ohio . Defiance County Dental Care dh.ohio.gov/oralhea Oral Health Surveillance System Resources lth/default.aspx . Defiance County and Ohio http://jfs.ohio.gov/c Ohio Department of Job & Family Medicaid Statistics ounty/cntypro/pdf1 Services 1/Defiance.pdf . 2014 Defiance County and https://ext.dps.state. Ohio Crash Facts Ohio Department of Public Safety oh.us/crashstatistics/ . OSHP Computer-Aided CrashReports.aspx Dispatch (CAD) System

. Arrests/Incarceration Data www.drc.ohio.gov/ Ohio Department of . Inmate Population by Gender web/Reports/FactSh Rehabilitation and Correction and Race eet/July%202015.pdf

150

Source Data Used Website http://mha.ohio.gov . Opiate and Pain Reliever /Portals/0/assets/Res Ohio Mental Health and Doses Per Capita earch/Maps/Ohio_O Addiction Services . Opiate and Pain Reliever ARRS_Opioids_2012_ Doses Per Patient v2.pdf

. Compliant Data . Electronic Crash Records http://statepatrol.ohi Ohio State Highway Patrol . Felony Cases and Drug Arrests o.gov/ . Defiance County Activity Statistics APPENDIX www.ohiospf.org/co Ohio Suicide Prevention . Suicide Deaths by Gender and ntent.php?pageurl= Foundation Age Group ohio_statistics www.smokefreephill y.org/smokfree_phill Philadelphia Department of y/assets/File/Electron . Electronic Cigarette Factsheet Public Health ic%20Cigarette%20F act%20Sheet_2_27_1 4.pdf www.psychologytod . Teen Angst ay.com/blog/teen- Psychology Today, 2013 . Teen Binge Drinking: All Too angst/201301/teen- Common binge-drinking-all- too-common . American Community Survey 1 year estimate, 2013 . Ohio and Defiance County 2013 Census Demographic U. S. Department of Commerce, Information www.census.gov Census Bureau; Bureau of . Ohio and U.S. Health Insurance Economic Analysis Sources . Small Area Income and Poverty Estimates . Federal Poverty Thresholds www.lsc.state.oh.us/ U.S. Department of Health and fiscal/ohiofacts/sept Human Services, Ohio . Mental Health Services in Ohio 2012/health&human

Department of Mental Health services.pdf

Youth Risk Behavior Surveillance I

System, National Center for http://apps.nccd.cd Chronic Disease Prevention and . 2005 - 2013 youth Ohio and c.gov/YouthOnline/ Health Promotion, Division of U.S. correlating statistics App/Default.aspx Adolescent and School Health, Centers for Disease Control

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Appendix II І DEFIANCE COUNTY ACRONYMS AND TERMS

AHS Access to Health Services, Topic of Healthy People 2020 objectives Adult Defined as 19 years of age and older. Age-Adjusted Death rate per 100,000 adjusted for the age Mortality Rates distribution of the population. Adult Binge Drinking Consumption of five alcoholic beverages or more (for males) or four or more alcoholic beverages (for females) on one occasion. AOCBC Arthritis, Osteoporosis, and Chronic Back Conditions BMI Body Mass Index is defined as the contrasting measurement/relationship of weight to height. BRFSS Behavior Risk Factor Surveillance System, an adult survey conducted by the CDC. CDC Centers for Disease Control and Prevention. Current Smoker Individual who has smoked at least 100 cigarettes in their lifetime and now smokes daily or on some days. CY Calendar Year FY Fiscal Year HCNO Hospital Council of Northwest Ohio HDS Heart Disease and Stroke, Topic of Healthy People 2020 objectives HP 2020 Healthy People 2020, a comprehensive set of health objectives published by the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Health Indicator A measure of the health of people in a community, such as cancer mortality rates, rates of obesity, or incidence of cigarette smoking. High Blood Cholesterol 240 mg/dL and above High Blood Pressure Systolic >140 and Diastolic > 90 IID Immunizations and Infectious Diseases, Topic of Healthy People 2020 objectives N/A Data is not available. NSCH National Survey of Children’s Health ODH Ohio Department of Health OSHP Ohio State Highway Patrol

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Race/Ethnicity Census 2010: U.S. Census data consider race and Hispanic origin separately. Census 2010 adhered to the standards of the Office of Management and Budget (OMB), which define Hispanic or Latino as “a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.” Data are presented as “Hispanic or Latino” and “Not Hispanic or Latino.” Census 2010 reported five race categories including: White, Black or African American, American Indian & Alaska Native, Asian, Native Hawaiian and Other Pacific Islander. Data reported, “White alone” or “Black alone”, means the respondents reported only one race. APPENDIX Weapon Defined in the YRBSS as “a weapon such as a gun, knife, or club” Youth Defined as 12 through 18 years of age YPLL/65 Years of Potential Life Lost before age 65. Indicator of premature death. Youth BMI Underweight is defined as BMI-for-age < 5th percentile Classifications Overweight is defined as BMI-for-age 85th percentile to < 95th percentile. Obese is defined as > 95th percentile.

YRBSS Youth Risk Behavior Surveillance System, a youth survey conducted by the CDC

153

Appendix III І METHODS FOR

WEIGHTING THE 2015

DEFIANCE COUNTY

ASSESSMENT DATA

Data from sample surveys have the potential for bias if there are different rates of response for different segments of the population. In other words, some subgroups of the population may be more represented in the completed surveys than they are in the population from which those surveys are sampled. If a sample has 25% of its respondents being male and 75% being female, then the sample is biased towards the views of females (if females respond differently than males). This same phenomenon holds true for any possible characteristic that may alter how an individual responds to the survey items.

In some cases, the procedures of the survey methods may purposefully over-sample a segment of the population in order to gain an appropriate number of responses from that subgroup for appropriate data analysis when investigating them separately (this is often done for minority groups). Whether the over-sampling is done inadvertently or purposefully, the data needs to be weighted so that the proportioned characteristics of the sample accurately reflect the proportioned characteristics of the population. In the 2015 Defiance County survey, a weighting was applied prior to the analysis that weighted the survey respondents to reflect the actual distribution of Defiance County based on age, sex, race, and income.

Weightings were created for each category within sex (male, female), race (White, Non-White), Age (9 different age categories), and income (7 different income categories). The numerical value of the weight for each category was calculated by taking the percent of Defiance County within the specific category and dividing that by the percent of the sample within that same specific category. Using sex as an example, the following represents the data from the 2015 Defiance County Survey and the 2010 Census.

2015 Defiance Survey 2010 Census Weight Sex Number Percent Number Percent Male 228 44.53125 19,250 49.47187 1.11094729 Female 284 55.46875 19,661 50.52813 0.91092964

In this example, it shows that there was a slightly larger portion of females in the sample compared to the actual portion in Defiance County. The weighting for males was calculated by taking the percent of males in Defiance County (based on Census information) (49.47187%) and dividing that by the percent found in the 2015 Defiance County sample (44.53125%) [49.47187 / 44.53125 = weighting of 1.110947 for males]. The same was done for females [50.52813/ 55.46875% = weighting of 0.910930 for females]. Thus males’ responses are weighted heavier by a factor of 1.110947 and females’ responses weighted less by a factor of 0.910930.

154

This same thing was done for each of the 20 specific categories as described above. For example, a respondent who was female, White, in the age category 35-44, and with a household income in the $50-$75k category would have an individual weighting of 1.632445 [0.9109296 (weight for females) x 0.9409790 (weight for White) x 2.2546631 (weight for age 35-44) x 0.8446799 (weight for income $50-$75k)]. Thus, each individual in the 2015 Defiance County sample has their own individual weighting based on their combination of age, race, sex, and income. See next page for each APPENDIX specific weighting and the numbers from which they were calculated.

Multiple sets of weightings were created and used in the statistical software package (SPSS 21.0) when calculating frequencies. For analyses done for the entire sample and analyses done based on subgroups other than age, race, sex, or income – the weightings that were calculated based on the product of the four weighting variables (age, race, sex, income) for each individual. When analyses were done comparing groups within one of the four weighting variables (e.g., smoking status by race/ethnicity), that specific variable was not used in the weighting score that was applied in the software package. In the example smoking status by race, the weighting score that was applied during analysis included only age, sex, and income. Thus a total of eight weighting scores for each individual were created and applied depending on the analysis conducted. The weight categories were as follows:

1) Total weight (product of 4 weights) – for all analyses that did not separate age, race, sex, or income. 2) Weight without sex (product of age, race, and income weights) – used when analyzing by sex. 3) Weight without age (product of sex, race, and income weights) – used when analyzing by age. 4) Weight without race (product of age, sex, and income weights) – used when analyzing by race. 5) Weight without income (product of age, race, and sex weights) – used when analyzing by income.

6) Weight without sex or age (product of race and income weights) – used when analyzing by sex and age. 7) Weight without sex or race (product of age and income weights) – used when III analyzing by sex and race. 8) Weight without sex or income (product of age and race weights) – used when analyzing by sex and income.

155

Defiance 2010 Weighting Category % % Sample Census * Value

Sex: Male 228 44.53125 19,250 49.47187 1.110947 Female 284 55.46875 19,661 50.52813 0.910930

Age: 20-24 26 5.11811 2,396 8.46344 1.653626 25-34 35 6.88976 4,498 15.88838 2.306085 35-44 37 7.28346 4,649 16.42176 2.254663 45-54 77 15.15748 5,498 19.42070 1.281262 55-59 79 15.55118 3,002 10.60403 0.681879 60-64 83 16.33858 2,194 7.74991 0.474332 65-74 129 25.39370 3,224 11.38820 0.448466 75-84 42 8.26772 2,161 7.63335 0.923271 85+ 0 0 688 2.43024 NA

Race: White 477 92.98246 34,045 87.49454 0.940979 Non-White 36 7.01754 4,866 12.50546 1.782028

Household

Income: Less than $10,000 10 2.09644 1,037 6.82102 3.253628 $10k-$15k 20 4.19287 696 4.57804 1.091863 $15k-$25k 47 9.85325 1,639 10.78077 1.094133 $25k-$35k 78 16.35220 2,034 13.37894 0.818174 $35k-$50 73 15.30398 2,624 17.25975 1.127795 $50k-$75k 115 24.10901 3,096 20.36440 0.844680 $75k or more 134 28.09224 4,077 26.81708 0.954608 Note: The weighting ratios are calculated by taking the ratio of the proportion of the population of Defiance County in each subcategory by the proportion of the sample in the Defiance County survey for that same category. * Defiance County population figures taken from the 2010 Census.

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Appendix IV І DEFIANCE COUNTY SCHOOLS

The following schools were randomly chosen and agreed to participate in the 2015 Defiance County Health Assessment:

Ayersville Local Schools APPENDIX Ayersville Junior High/High School

Central Local Schools Fairview Middle School Fairview High School

Defiance City Schools Defiance Middle School Defiance High School

Hicksville Exempted Village Schools Hicksville Elementary Hicksville Middle School/High School

Northeastern Local Schools Tinora Junior High School Tinora High School

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Appendix V І DEFIANCE COUNTY

SAMPLE DEMOGRAPHIC

PROFILE* Defiance

County Census 2015 Survey Ohio Census Variable 2011-2013 Sample 2013 (3 year estimate)

Age

20-29 19.8% 11.5% 13.2% 30-39 16.3% 12.6% 11.9%

40-49 15.1% 11.6% 13.2% 50-59 19.6% 15.6% 14.7% 60 plus 24.2% 21.8% 21.3%

Race/Ethnicity

White 82.3% 91.8% 82.5% Black or African American 0.2% 1.8% 12.1% American Indian and Alaska Native 5.3% 0.3% 0.2%

Asian 1.6% 0.3% 1.8% Other 5.0% 4.5% 0.8% Hispanic Origin (may be of any race) 4.3% 9.4% 3.3%

Marital Status†

Married Couple 57.0% 53.8% 47.8%

Never been married/member of an unmarried couple 24.7% 26.4% 31.8% Divorced/Separated 10.6% 14.3% 14.0%

Widowed 4.0% 5.4% 6.4%

Education†

Less than High School Diploma 7.2% 11.7% 11.0% High School Diploma 29.2% 44.3% 34.2% Some college/ College graduate 63.1% 44% 54.8%

Income (Families)

$14,999 and less 13.5% 8.1% 8.7% $15,000 to $24,999 9.4% 7.8% 8.2% $25,000 to $49,999 24.4% 27.2% 23.4%

$50,000 to $74,999 17.9% 23.6% 20.3% $75,000 or more 25.8% 33.4% 39.4% * The percents reported are the actual percent within each category who responded to the survey. The data contained within the report however are based on weighted data (weighted by age, race, sex, and income). Percents may not add to 100% due to missing data (non-responses).

† The Ohio and Defiance County Census percentages are slightly different than the percent who responded to the survey. Marital status is calculated for those individuals 15 years and older. Education is calculated for those 25 years and older.

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Appendix VI І DEMOGRAPHICS AND

HOUSEHOLD INFORMATION

Defiance County Population by Age Groups and Gender U.S. Census 2010

Age Total Males Females

Defiance County 39,037 19,225 19,812 0-4 years 2,489 1,298 1,191 1-4 years 2,016 1,044 972 APPENDIX < 1 year 473 254 219 1-2 years 981 514 467 3-4 years 1,035 530 505 5-9 years 2,721 1,343 1,378 5-6 years 1,068 530 538 7-9 years 1,653 813 840 10-14 years 2,762 1,420 1,342 10-12 years 1,663 856 807 13-14 years 1,099 564 535 12-18 years 3,845 1,997 1,848 15-19 years 2,738 1,435 1,303 15-17 years 1,631 846 785 18-19 years 1,107 589 518 20-24 years 2,291 1,150 1,141 25-29 years 2,229 1,113 1,116 30-34 years 2,244 1,108 1,136 35-39 years 2,385 1,180 1,205 40-44 years 2,358 1,196 1,162 45-49 years 2,774 1,347 1,427 50-54 years 3,044 1,503 1,541 55-59 years 2,833 1,432 1,401 60-64 years 2,312 1,185 1,127 65-69 years 1,756 840 916 70-74 years 1,373 649 724 75-79 years 1,062 469 593 80-84 years 872 338 534 VI 85-89 years 505 165 340 90-94 years 222 46 176 95-99 years 63 8 55 100-104 years 4 0 4 105-109 years 0 0 0 110 years & over 0 0 0 Total 85 years and over 794 219 575 Total 65 years and over 5,857 2,515 3,342 Total 19 years and over 28,852 14,022 14,830

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DEFIANCE COUNTY PROFILE

General Demographic Characteristics (Source: U.S. Census Bureau, Census 2013)

2011-2013 ACS 3-year estimate

Total Population 2013 Total Population 38,794 2000 Total Population 39,500

Largest City-Defiance 2013 Total Population 16,836 100% 2000 Total Population 16,465 100%

Population By Race/Ethnicity Total Population 38,794 100% White Alone 35,600 91.8% Hispanic or Latino (of any race) 3,630 9.4% African American 683 1.8% Asian 120 0.3% Two or more races 681 1.8% Other 1,743 4.5% American Indian and Alaska Native 130 0.3%

Population By Age 2010 Under 5 years 2,489 6.4% 5 to 17 years 7,114 18.2% 18 to 24 years 3,398 8.7% 25 to 44 years 9,216 23.6% 45 to 64 years 10,963 28.1% 65 years and more 5,875 15.0% Median age (years) 39.1

Household By Type Total Households 15,152 100% Family Households (families) 10,912 72.0% With own children <18 years 4,076 26.9% Married-Couple Family Households 7,957 52.5% With own children <18 years 2,413 15.9% Female Householder, No Husband Present 1,892 12.5% With own children <18 years 1,179 7.8% Non-family Households 4,240 28.0% Householder living alone 3,619 23.9% Householder 65 years and > 1,199 7.9%

Households With Individuals < 18 years 4,708 31.1% Households With Individuals 65 years and > 3,945 26.0%

Average Household Size 2.51 people Average Family Size 2.91 people

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General Demographic Characteristics, Continued (Source: U.S. Census Bureau, Census 2013)

2011-2013 ACS 3-year estimate

Median Value of Owner-Occupied Units $106,400 Median Monthly Owner Costs (With Mortgage) $1,071 Median Monthly Owner Costs (Not Mortgaged) $394 Median Gross Rent for Renter-Occupied Units $646 Median Rooms Per Housing Unit 6.1

Total Housing Units 16,673 No Telephone Service 268 Lacking Complete Kitchen Facilities 116 Lacking Complete Plumbing Facilities 20 APPENDIX

Selected Social Characteristics (Source: U.S. Census Bureau, Census 2013)

2011-2013 ACS 3-year estimates

School Enrollment Population 3 Years and Over Enrolled In School 9,914 100% Nursery & Preschool 575 5.8% Kindergarten 604 6.1% Elementary School (Grades 1-8) 4333 43.7% High School (Grades 9-12) 2,163 21.8% College or Graduate School 2,239 22.6%

Educational Attainment Population 25 Years and Over 25,874 100% < 9th Grade Education 848 3.3% 9th to 12th Grade, No Diploma 2,183 8.4% High School Graduate (Includes Equivalency) 11,457 44.2% Some College, No Degree 4,841 18.7% Associate Degree 2,485 9.6% Bachelor’s Degree 2,630 10.2% Graduate Or Professional Degree 1,430 5.5%

Percent High School Graduate or Higher *(X) 88.3%

Percent Bachelor’s Degree or Higher *(X) 15.7% *(X) – Not available VI

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Selected Social Characteristics, Continued (Source: U.S. Census Bureau, Census 2013)

2011-2013 ACS 3-year estimate

Marital Status Population 15 Years and Over 31,021 100% Never Married 8,197 26.4% Now Married, Excluding Separated 16,695 53.8% Separated 554 1.8% Widowed 1,693 5.5% Female 1,459 4.7% Divorced 3,882 12.5% Female 1,944 6.3%

Veteran Status Civilian Veterans 18 years and over 3,061 10.4%

Disability Status of the Civilian Non-institutionalized Population Total Civilian Noninstitutionalized Population 38,489 100% With a Disability 5074 13.2% Under 18 years 9,371 100% With a Disability 587 6.3% 18 to 64 years 23,193 100% With a Disability 2,345 10.1% 65 Years and Over 5,925 100% With a Disability 2,142 36.2% Selected Economic Characteristics (Source: U.S. Census Bureau, Census 2013) 2011-2013 ACS 3-year estimate

Employment Status Population 16 Years and Over 30,644 100% In Labor Force 19,688 64.2% Not In Labor Force 10,956 35.8% Females 16 Years and Over 15,598 100% In Labor Force 9,321 59.8%

Population Living With Own Children <6 Years 2,804 100% All Parents In Family In Labor Force 2,090 74.5%

Class of Worker Employed Civilian Population 16 Years and Over 17,676 100% Private Wage and Salary Workers 14,842 84.0% Government Workers 1,744 9.9% Self-Employed Workers in Own Not Incorporated Business 1,041 5.9% Unpaid Family Workers 49 0.3%

Median Earnings Male, Full-time, Year-Round Workers Female, Full-time, Year-Round Workers $45,872 $32,529

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Selected Economic Characteristics, Continued (Source: U.S. Census Bureau, Census 2013) 2011-2013 ACS 3-year estimate

Occupations Employed Civilian Population 16 Years and Over 17,676 100% Production, Transportation, and Material Moving 4,425 25.0% Occupations Management, business, science, and art occupations 4,400 24.9% Sales and Office Occupations 4,005 22.7% Service Occupations 3,011 17.0% Natural Resources, Construction, and Maintenance 1,835 10.4% Occupations

Leading Industries Employed Civilian Population 16 Years and Over 17,676 100% APPENDIX Manufacturing 5,004 28.3% Educational, health and social services 3,621 20.5% Trade (retail and wholesale) 2,331 13.2% Arts, entertainment, recreation, accommodation, and food 1,471 8.3% services Professional, scientific, management, administrative, and 894 5.1% waste management services Transportation and warehousing, and utilities 556 3.1% Finance, insurance, real estate and rental and leasing 912 5.2% Other services (except public administration) 750 4.2% Construction 860 4.9% Public administration 672 3.8% Information 188 1.1% Agriculture, forestry, fishing and hunting, and mining 417 2.4%

Bureau of Economic Analysis (BEA) Per Capita Personal Income Figures

Income Rank of Ohio Counties BEA Per Capita Personal Income 2013 $36,232 41st of 88 counties BEA Per Capita Personal Income 2010 $32,687 41st of 88 counties BEA Per Capita Personal Income 2003 $28,401 25th of 88 counties BEA Per Capita Personal Income 2000 $26,282 29th of 88 counties

(BEA PCPI figures are greater than Census figures for comparable years due to deductions for retirement, Medicaid, VI Medicare payments, and the value of food stamps, among other things)

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Selected Economic Characteristics, Continued (Source: U.S. Census Bureau, Census 2013)

2011-2013 ACS 3-year estimate

Income In 2013 Households 15,152 100% < $10,000 1,101 7.3% $10,000 to $14,999 718 4.7% $15,000 to $24,999 1,668 11.0% $25,000 to $34,999 2,170 14.3% $35,000 to $49,999 2,258 14.9% $50,000 to $74,999 3,085 20.4% $75,000 to $99,999 2,113 13.9% $100,000 to $149,999 1,622 10.7% $150,000 to $199,999 225 1.5% $200,000 or more 192 1.3% Median Household Income $48,295

Income In 2013 Families 10,912 100% < $10,000 547 5.0% $10,000 to $14,999 332 3.0% $15,000 to $24,999 846 7.8% $25,000 to $34,999 1,335 12.2% $35,000 to $49,999 1,633 15.0% $50,000 to $74,999 2,575 23.6% $75,000 to $99,999 1,789 16.4% $100,000 to $149,999 1,490 13.7% $150,000 to $199,999 208 1.9% $200,000 or more 157 1.4%

Median Household Income (families) $56,470

Per Capita Income In 2011-2013 $22,485

Poverty Status In 2013 Number Below % Below Poverty Poverty Level Level Families *(X) 10.3% Individuals *(X) 15.0% *(X) – Not available

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Poverty Rates, 5-year averages 2009 to 2013

Category Defiance Ohio

Population in poverty 13.9% 15.8%

< 125% FPL (%) 18.3% 20.3%

< 150% FPL (%) 24.1% 24.9%

< 200% FPL (%) 34.5% 34.1% Population in poverty (1999) 5.6% 10.6%

(Source: The Ohio Poverty Report, Ohio Development Services Agency, January 2015, http://www.development.ohio.gov/files/research/P7005.pdf) APPENDIX

Employment Statistics Category Defiance Ohio Labor Force 19,300 5,785,700

Employed 18,400 5,487,600

Unemployed 1,000 298,100

Unemployment Rate* in June 2015 4.9 5.2

Unemployment Rate* in May 2015 4.9 4.9

Unemployment Rate* in June 2014 5.8 5.9 *Rate equals unemployment divided by labor force. (Source: Ohio Department of Job and Family Services, June 2015, http://ohiolmi.com/laus/current.htm)

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Estimated Poverty Status in 2013 90% 90% Confidence Age Groups Number Percent Confidence Interval Interval Defiance County All ages in poverty 4,278 3,477 to 5,079 11.4% 9.3 to 13.5 Ages 0-17 in poverty 1,556 1,231 to 1,881 17.3% 13.7 to 20.9 Ages 5-17 in families in 1,048 797 to 1,299 15.7% 12.0 to 19.4 poverty Median household $45,927 to $48,971 income $52,015 Ohio All ages in poverty 1,767,288 to 1,793,523 15.9% 15.7 to 16.1 1,819,758 Ages 0-17 in poverty 573,913 to 589,871 22.7% 21.1 to 23.3 605,829 Ages 5-17 in families in 384,850 to 398,690 20.8% 20.1 to 21.5 poverty 412,530 Median household $49,833 to $52,578 income $55,323 United States All ages in poverty 48,554,692 to 48,810,868 15.8% 15.7 to 15.9 49,067,044 Ages 0-17 in poverty 15,948,844 to 16,086,960 22.2% 22.0 to 22.4 16,225,076 Ages 5-17 in families in 10,860,529 to 10,958,232 20.8% 20.6 to 21.0 poverty 11,055,935 Median household $52,185 to $52,250 income $52,315 (Source: U.S. Census Bureau, Small Area Income and Poverty Estimates, http://www.census.gov/did/www/saipe/data/interactive/#)

Federal Poverty Thresholds in 2014 by Size of Family and Number of Related Children Under 18 Years of Age No One Two Three Four Five Size of Family Unit Children Child Children Children Children Children 1 Person <65 years $12,316 1 Person 65 and > $11,354 2 people $15,853 $16,317 Householder < 65 years 2 People $14,309 $16,256 Householder 65 and > 3 People $18,518 $19,055 $19,073 4 People $24,418 $24,817 $24,008 $24,091 5 People $29,477 $29,875 $28,960 $28,252 $27,820 6 People $33,869 $34,004 $33,303 $32,631 $31,633 $31,041 7 People $38,971 $39,214 $38,375 $37,791 $36,701 $35,431 8 People $43,586 $43,970 $43,179 $42,485 $41,501 $40,252 9 People or > $52,430 $52,685 $51,984 $51,396 $50,430 $49,101 (Source: U. S. Census Bureau, Poverty Thresholds 2014, http://www.census.gov/hhes/www/poverty/data/threshld/index.html)

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