Examining the Health of Monroe County

FOREWORD

The Monroe County Building Healthy Communities Coalition and its members are pleased to present the 2015 Health Assessment of our community. This comprehensive FOREWO Community Health Assessment provides a “snap shot” of where Monroe County residents currently stand in terms of their well-being as well as their health habits. Additionally, the local data provides a comparison with regional, state and national data. Because the statistics found in this report provide a clearer, more complete view of our collective health, the report can serve as a call to action for our residents, health professionals, employers, policy makers, community and religious leaders.

This document will be used by the Monroe County Building Healthy Communities Coalition in collaboration with multiple community partners to complete a Health Improvement Plan for Monroe County. The Health Improvement Plan will prioritize strategies to strengthen the local health system and support individuals in becoming and staying healthy. Through the Mobilizing for Action, Planning and Partnerships (MAPP) process, the Health Improvement Plan will be developed. The MAPP process comes from National Association of County & City Officials (NACCHO).

The Building Healthy Communities Coalition is committed to its vision of empowering Monroe County residents to live healthy lifestyles and its mission of improving the health of Monroe County residents by promoting physical activity, healthy eating and safe environments through community collaboration. This report offers assistance in identifying areas of opportunity to make Monroe County a healthier place to live, work and play.

We would like to thank the partnerships and agencies (list follows) that worked on this RD project and especially the residents who answered the survey. Without all of you, this comprehensive health assessment would not have been possible.

We also encourage you to use this report in planning and collaboration with partners to improve the health of our community.

Sincerely,

Kim Comerzan Annette Philips Health Officer/Director President Monroe County Health Department ProMedica Monroe Regional Hospital

Funding for the Monroe County Health Assessment Provided by:

Monroe County Health Plan

Member Organizations of the Monroe County Building Healthy Communities Coalition:

Mercy Memorial Hospital Health System City of Monroe Monroe County Health Department Area Agency on Aging Monroe County Health Plan United Way of Monroe Monroe County Substance Abuse Coalition Relay For Life Human Services Collaborative Network Great Start Collaborative American Cancer Society of SE Michigan Monroe County Family YMCA Monroe County Mental Health Authority Monroe County Community College Monroe County Head Start/Early Head Start Family Medical Center of Michigan Child Advocacy Network (CAN) Council Monroe Center for Healthy Aging Monroe County Planning Commission Department of Human Services Monroe County Board of Commissioners Community Foundation Catholic Charities of Southeast Michigan Monroe Public Schools Bedford Public Schools Jefferson Public Schools Ida Public Schools Dundee Public Schools Mason Consolidated Public Schools Summerfield Public Schools Whiteford Public Schools American Heart Association Monroe County Intermediate School District (ISD) American Red Cross Monroe County Commission on Aging Michigan State Police Monroe County MSU Extension Human Services Collaborative Network

Contact Information

Jamie R. Dean, B.S., M.S.Ed. Monroe County Health Department 2353 South Custer Rd. Monroe, MI 48161 Phone: (734)240-7909 [email protected]

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

Hospital Council of Northwest Ohio

Britney L. Ward, MPH Margaret Wielinski, MPH Director of Community Health Assistant Director of Community Health FOREWO Improvement Improvement

Michelle Von Lehmden Tessa Elliott Health Assessment Coordinator Graduate Assistant

Derick Sekyere Anna Crisp Graduate Assistant Undergraduate Assistant

Data Collection & Analysis

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

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

To see Monroe 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.

TABLE OF CONTENTS

EXECUTIVE SUMMARY PAGES 5-15 TREND SUMMARY PAGES 16-18

Adult Health (Ages 19 and Over)

HEALTH STATUS PERCEPTIONS PAGES 19-20 HEALTH CARE COVERAGE PAGES 21-23 HEALTH CARE ACCESS AND UTILIZATION PAGES 24-25 CARDIOVASCULAR HEALTH PAGES 26-31 CANCER PAGES 32-36 DIABETES PAGES 37-39 ASTHMA PAGES 40-42 ARTHRITIS PAGES 43-44 WEIGHT STATUS PAGES 45-47 TOBACCO USE PAGES 48-53 ALCOHOL CONSUMPTION PAGES 54-61 DRUG USE PAGES 62-64 WOMEN’S HEALTH PAGES 65-69 MEN’S HEALTH PAGES 70-73 PREVENTIVE MEDICINE AND HEALTH SCREENINGS PAGES 74-76 SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES PAGES 77-83 QUALITY OF LIFE PAGES 84-86 SOCIAL CONTEXT AND SAFETY PAGES 87-89 MENTAL HEALTH AND SUICIDE PAGES 90-93 ORAL HEALTH PAGES 94-95 PARENTING PAGE 96

Youth Health (Ages 12-18)

WEIGHT CONTROL PAGES 97-100 TOBACCO USE PAGES 101-103 ALCOHOL CONSUMPTION PAGES 104-107 DRUG USE PAGES 108-110 SEXUAL BEHAVIOR AND TEEN PREGNANCY OUTCOMES PAGES 111-114 MENTAL HEALTH AND SUICIDE PAGES 115-117 YOUTH SAFETY PAGES 118-119 YOUTH VIOLENCE ISSUES PAGES 120-122

Appendices

HEALTH ASSESSMENT INFORMATION SOURCES APPENDIX I PAGES 123-126 LIST OF ACRONYMS AND TERMS APPENDIX II PAGES 127-128 WEIGHTING METHODS APPENDIX III PAGES 129-131 SCHOOL PARTICIPATION APPENDIX IV PAGE 132 DEMOGRAPHIC PROFILE APPENDIX V PAGE 133 DEMOGRAPHICS AND HOUSEHOLD INFORMATION APPENDIX VI PAGES 134-141

EXECUTIVE

EXECUTIVE SUMMARY

This executive summary provides an overview of health-related data for Monroe County

adults (19 years of age and older) and youth (grades 6-12) who participated in a county-wide health assessment survey during spring 2015. The findings are based on self-administered surveys using structured questionnaires. 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 Behavioral Surveillance System (YRBSS). 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 and youth within Monroe 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

Two survey instruments were designed and pilot tested for this study. As a first step in the design process, health education researchers from the University of Toledo and staff members 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 youth.

The investigators decided to derive the majority of the adult survey items from the BRFSS and YRBSS. SUMMARY 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 Monroe County. During these meetings, banks of potential survey questions from the BRFSS and YRBSS surveys were reviewed and discussed. Based on input from the Monroe County planning committee, the Project Coordinator composed a draft survey containing 115 items for the adult survey and 76 items for the youth 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 Monroe 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 Monroe County. There were 106,973 persons ages 18 and over living in Monroe 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 383 adults was needed to ensure this level of confidence. The random sample of mailing addresses of adults from Monroe County was obtained from Allegra Marketing Services in Louisville, KY.

SAMPLING | Adolescent Survey

There were 15,972 persons ages 12 to 18 years old living in Monroe County. A sample size of 375 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.

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PROCEDURE | Adult Survey

Prior to mailing the survey to adults, an advance letter was mailed to 1,200 adults in Monroe County. This advance letter was personalized, printed on Building Healthy Communities Coalition stationery and was signed by John Kibble, Vice President, ProMedica Monroe Regional Hospital, and Kim Comerzan, Health Officer, Monroe County Health Department. 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 Building Healthy Communities Coalition 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 38% (n=444: CI=+4.64). 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 92% (n=456: CI=+4.52)

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 Monroe 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.

LIMITATIONS

As with all county assessments, it is important to consider the findings in light of all possible limitations. First, the Monroe 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 Monroe 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, the adult data collection method differed. CDC adult 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.

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EXECUTIVE

Data Summary

HEALTH PERCEPTIONS

In 2015, over half (55%) of the Monroe County adults rated their health status as excellent or very good. Conversely, 12% of adults, increasing to 19% of those over the age of 60, described their health as fair or poor.

Monroe County Adult Health Perceptions*

100% 0% 12% 11% 14% 13% 10% 22% 19% 22% 80% 36% 33% 36% 31% 36%

60% 38% 33%

40% 78% 55% 53% 55% 51% 54% 43% 45% 20%

0% Total Males Females Under 30 30-59 years 60 & Older Income Income <$25K $25K Plus 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?”

SUMMARY

HEALTH CARE COVERAGE

The 2015 Health Assessment data has identified that 9% of Monroe County adults were without health care coverage. Those most likely to be uninsured were adults ages 30-59, those with an income level under $25,000, and females. In Monroe County, 12.9% of residents live below the poverty level (Source: U.S. Census, American Community Survey 1 Year Estimate, 2013).

Uninsured Monroe County Adults 20%

13% 12% 12%

10% 9% 9% 8%

6%

2%

0% Total Males Females Under 30 30-59 years 60 & Older Income Income <$25K $25K Plus

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HEALTH CARE ACCESS

The 2015 Health Assessment project identified that 64% of Monroe County adults had visited a doctor for a routine checkup in the past year. 63% of adults went outside of Monroe County for health care services in the past year.

CARDIOVASCULAR HEALTH Monroe County The 2015 Monroe County Health Assessment Leading Types of Death found that 6% of adults had survived a heart 2013 attack and 3% had survived a stroke at some time in their life. Nearly one-third (32%) of Total Deaths: 1426

Monroe County adults had been diagnosed 1. Cancer (26% of all deaths) with high blood pressure, 35% had high blood 2. Heart Disease (25%) cholesterol, 31% were obese, and 14% were 3. Chronic Lower Respiratory Diseases (6%) smokers, four known risk factors for heart 4. Accidents, Unintentional Injuries (6%) disease and stroke. Heart disease (25%) and 5. Stroke (5%) stroke (5%) accounted for 30% of all Monroe County adult deaths in 2012 (Source: MDCH, Vital (Source: MDCH, Vital Statistics, updated 1-18-15) Statistics).

CANCER Monroe County In 2015, 12% of Monroe County adults had Incidence of Cancer, 2011 been diagnosed with cancer at some time in their life. Michigan Department of Community All Types: 642 cases

Health statistics indicate that from 2008-2012, . Lung and Bronchus: 114 cases (18%) a total of 1,571 Monroe County residents died . Prostate: 94 cases (15%) from cancer, the second leading cause of . Breast: 89 cases (14%) death in the county. The American Cancer . Colon and Rectum: 53 cases (8%) Society advises that not using tobacco products, maintaining a healthy weight, In 2012, there were 332 cancer deaths in adopting a physically active lifestyle, eating Monroe County. more fruits and vegetables, limiting alcoholic (Source: Michigan Community Health Information – beverages and early detection may reduce Cancer) overall cancer deaths.

DIABETES

In 2015, 13% of Monroe County adults had been diagnosed with diabetes.

ARTHRITIS

According to the Monroe County survey data, 38% of Monroe County adults were diagnosed with arthritis. According to the 2013 BRFSS, 31% of Michigan adults and 25% of U.S. adults were told they have arthritis.

ASTHMA

In 2015, 17% of Monroe County adults had been diagnosed with asthma.

ADULT WEIGHT STATUS

The 2015 Health Assessment identified that 73% of Monroe County adults were overweight or obese based on Body Mass Index (BMI). Nearly one-third (31%) of Monroe County adults were obese. The 2013 BRFSS indicates that 32% of Michigan and 29% of U.S. adults were obese by BMI. More than half (53%) of adults were trying to lose weight.

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EXECUTIVE

Monroe County Adult BMI Classifications

100% 8% 31% 28% 33% 29% 29% 80% 37% 41%

60% 50% 32% 44% 42% 47% 53% 39% 40% 44% 35% 20% 34% 26% 23% 24% 27% 19% 15% 0% Total Male Female Under 30 30-59 Years 60 & Older Income < Income $25K $25K 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, 14% of Monroe County adults were current smokers and 31% were considered former smokers. In 2014, 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 SUMMARY 8 million. (Source: Cancer Facts & Figures, American Cancer Society, 2014)

Monroe County Adult Smoking Behaviors

100%

80% 37% 47% 40% 55% 53% 54% 61% 60% 85% 26%

40% 47% 40% 31% 31% 24% 35% 20% 4% 37% 16% 14% 13% 15% 11% 13% 11% 0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus 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?”

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ADULT ALCOHOL CONSUMPTION

In 2015, the Health Assessment indicated that 12% of Monroe County adults were considered frequent drinkers (drank an average of three or more days per week, per CDC guidelines). 40% 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.

Monroe County Adult Drinkers Who Binge Drank in Past Month* 60%

52%

46% 43% 41% 40% 40% 40% 40%

27%

20%

0% Total Males Females Under 30 30-59 Years 60 & Older Income Income

<$25K $25K Plus

*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.

ADULT MARIJUANA AND OTHER DRUG USE

In 2015, 7% of Monroe County adults had used marijuana during the past 6 months. 11% 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.

Monroe County Adult Marijuana Use in Past 6 Months 20%

15% 15% 12%

10% 9% 8% 7% 7% 7% 6% 5%

0% Total Males Females Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

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EXECUTIVE

WOMEN’S HEALTH

In 2015, more than half (54%) of Monroe County women over the age of 40 reported having a mammogram in the past year. 64% of Monroe County women ages 19 and over had a clinical

breast exam and 56% had a Pap smear to detect cancer of the cervix in the past year. The Health Assessment determined that 2% of women survived a heart attack and 3% survived a stroke at some time in their life. More than one-quarter (26%) had high blood pressure, 34% had high blood cholesterol, 33% were obese, and 15% were identified as smokers, known risk factors for cardiovascular diseases.

Monroe County Women's Health Exams Within the Past Year

100%

72% 68% 68% 75% 64% 59% 57% 56% 54% 57% 48% 50% 40% 50% 37% 39%

25% 4%

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

Mammogram Breast Exam Pap Smear

SUMMARY

MEN’S HEALTH

In 2015, 60% of Monroe County males over the age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases (heart disease and stroke) accounted for 28% and cancers accounted for 30% of all male deaths in Monroe County in 2013. The Health Assessment determined that 12% of men survived a heart attack and 2% survived a stroke at some time in their life. Nearly two-fifths (39%) of men had been diagnosed with high blood pressure, 37% had high blood cholesterol, and 13% were identified as smokers, which, along with obesity (28%), are known risk factors for cardiovascular diseases.

PREVENTIVE MEDICINE AND HEALTH SCREENINGS

More than half (55%) of adults ages 65 and older had a pneumonia vaccination at some time in their life. Three-fifths (61%) of adults ages 50 and older had a colonoscopy/sigmoidoscopy within the past 5 years.

ADULT SEXUAL BEHAVIOR & PREGNANCY OUTCOMES

In 2015, over two-thirds (70%) of Monroe County adults had sexual intercourse. Six 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 papillomavirus (HPV) (Source: CDC, STDs in Adolescents and Young Adults, 2014 STD Surveillance).

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QUALITY OF LIFE

In 2015, 20% of Monroe County adults were limited in some way because of a physical, mental or emotional problem.

SOCIAL CONTEXT

In 2015, 9% of Monroe County adults were threatened or abused in the past year. 50% of adults kept a firearm in or around their home.

MENTAL HEALTH AND SUICIDE

In 2015, 3% of Monroe County adults considered attempting suicide. 9% of adults had a period of two or more weeks when they felt so sad or hopeless nearly every day that they stopped doing usual activities.

ORAL HEALTH

The 2015, four-fifths (80%) of Monroe 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 Michigan adults had visited a dentist or dental clinic in the previous twelve months. More than three-quarters (79%) of Monroe 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.

PARENTING

The 2015 Health Assessment project identified that 78% of parents discussed bullying with their 6-to-17 year-old in the past year. More than four-fifths (83%) of parents indicated their child was physically active for at least 60 minutes 3 or more days per week.

YOUTH WEIGHT STATUS

The 2015 Health Assessment identified that 17% of Monroe County youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 30% of Monroe County youth reported that they were slightly or very overweight. 68% of youth were exercising for 60 minutes on 3 or more days per week. 89% of youth were involved in extracurricular activities.

Monroe County Youth BMI Classifications 2% 1% 2% 4% 3% 1% 100%

80%

70% 69% 71% 67% 66% 60% 81%

40%

15% 10% 12% 9% 20% 16%

17% 21% 8% 18% 21% 11% 7% 0% Total Male Female 13 or younger 14 to 16 17 & Older

Obese Overweight Normal Weight Underweight

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EXECUTIVE

YOUTH TOBACCO USE

The 2015 Health Assessment identified that 7% of Monroe County youth in grades 6-12 were smokers, increasing to 17% of those ages 17 and older. Of those 6th -12th grade youth who

currently smoked, 68% had tried to quit.

Monroe County Youth Who Are Current Smokers 30%

20% 17%

10% 8% 7% 6% 5%

2% 0% Total Male Female 12 to 13 14 to 16 17 & Older

YOUTH ALCOHOL CONSUMPTION

In 2015, the Health Assessment results indicated that 48% of Monroe County youth in grades 6-12

had drank at least one drink of alcohol in their life, increasing to 68% of youth seventeen and older. SUMMARY 27% of those 6th-12th graders who drank, took their first drink at 12 years or younger. 21% of all Monroe County 6th-12th grade youth and 41% of those over the age of 17 had at least one drink in the past 30 days. Half (50%) of the 6th-12th grade youth who reported drinking in the past 30 days had at least one episode of binge drinking.10% of all youth drivers had driven a car in the past month after they had been drinking alcohol.

Monroe County Youth Current Drinkers Who Binge Drank in Past

Month*

100%

80% 59% 60%

60% 50% 50%

38% 39% 40%

20%

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

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

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YOUTH MARIJUANA AND OTHER DRUG USE

In 2015, 12% of Monroe County 6th-12th grade youth had used marijuana at least once in the past 30 days, increasing to 27% of those ages 17 and older. 6% of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life.

Monroe County Youth Lifetime Drug Use 15%

10%

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

Total Male Female

YOUTH SEXUAL BEHAVIOR & PREGNANCY OUTCOMES

In 2015, just over one-quarter (26%) of Monroe County youth have had sexual intercourse, increasing to 57% of those ages 17 and over. 30% of youth had participated in oral sex and 5% had participated in anal sex. 23% of youth participated in sexting. Of those who were sexually active, 58% had multiple sexual partners. Four Monroe County schools did not ask sexual behavior questions.

Monroe County Youth Who Had Sexual Intercourse 75%

57%

50%

32% 26%

25% 20% 15%

1%

0% Total Male Female 13 or Younger 14 to 16 17 & Older

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EXECUTIVE

YOUTH MENTAL HEALTH AND SUICIDE

In 2015, the Health Assessment results indicated that 11% of Monroe County 6th-12th grade youth had seriously considered attempting suicide in the past year and 6% admitted actually attempting suicide in the past year.

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

40% 33% 32%

30% 23% 20% 19% 20% 14%

10%

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

YOUTH SAFETY

SUMMARY In 2015, 19% of youth had ridden in a car driven by someone who had been drinking alcohol in the past month and 10% of youth drivers had driven after drinking alcohol. 32% of youth drivers texted while driving.

YOUTH VIOLENCE

In Monroe County, 21% of youth had been involved in a physical fight in the past year. 5% of youth had been threatened or injured with a weapon on school property in the past year. 44% of youth had been bullied in the past year and 28% had been bullied on school property.

Monroe County Youth Bullied in the Past Year 75%

53% 50% 44% 50% 41% 38% 34%

25%

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

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Adult І TREND SUMMARY

Monroe Michigan U.S. Adult Variables County 2013 2013 2015

Health Status

Rated health as excellent or very good 55% 51% 52%

Rated general health as fair or poor 12% 18% 17%

Average days that physical health not good in past month 3.0 3.6* 3.7**

Average days that mental health not good in past month 3.1 3.7* 3.5**

Health Care Coverage

Uninsured 9% 14% 17%

Arthritis, Asthma & Diabetes

Has been diagnosed with diabetes 13% 11% 11%

Has been diagnosed with asthma 17% 17% 14%

Cardiovascular Health Had a heart attack 6% 5% 4%

Had a stroke 3% 4% 3% Has been diagnosed with high blood pressure 32% 35% 31%

Has been diagnosed with high blood cholesterol 35% 41% 38% Had blood cholesterol checked within the past 5 years 81% 79% 76%

Alcohol Consumption Had at least one alcoholic beverage in past month 54% 57% 55%

Binged in past month (5 or more drinks in a couple of hours on an 21% 19% 17% occasion) Tobacco Use

Current smoker (currently smoke some or all days) 14% 21% 19%

Former smoker (smoked 100 cigarettes in lifetime & now do not smoke) 31% 27% 25%

Preventive Medicine Had a pneumonia vaccine in lifetime (age 65 and older) 55% 69% 70%

Had a flu vaccine in the past year (ages 65 and over) 76% 57% 63% Had a clinical breast exam in the past two years 76% 80%** 77%** (age 40 and older) Had a mammogram in the past two years 72% 77%* 74%* (age 40 and older)

Had a pap smear in the past three years 84% 80%* 78%* Had a PSA test within the past two years (age 40 & over) 58% 48%* 45%*

Weight Status Overweight 42% 35% 35%

Obese 31% 32% 29% Quality of Life

Limited in some way because of physical, mental or emotional problem 20% 23% 20%

Oral Health

Adults who have visited the dentist in the past year 80% 68%* 67%*

Adults who have had one or more permanent teeth removed 35% 45% 43%

N/A- not available *2012 BRFSS Data ** 2010 BFRSS Data

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Youth І TREND SUMMARY Monroe Monroe Michigan U.S. County County Youth Variables 2013 2013

2015 2015 TREND (9th-12th) (9th-12th) (6th-12th) (9th-12th) Alcohol Consumption Ever tried alcohol 48% 58% 60% 66% Current drinker 21% 28% 28% 35%

Binge drinker (of all youth) 11% 14% 17% 21%

Drank for the first time before age 13 (of all youth) 12% 12% 14% 19%

Rode with someone who was drinking 19% 22% 20% 22% Drank and drove (of youth drivers) 10% 10% 6% 10% Obtained the alcohol they drank by someone giving it to 33% 40% 33% 42% them Tobacco Use Ever tried cigarettes 24% 31% 36% 41%

Current smokers 7% 9% 12% 16%

Tried to quit smoking (of smokers) 68% 54% 52% 48%

Smoked cigarettes on 20 or more days during the past 2% 2% 4% 6% month (of all youth) SUMMARY Smoked a whole cigarette for the first time before the 5% 5% 8% 9% age of 13 (of all youth) Sexual Behavior Ever had sexual intercourse 26% 35% 38% 47% Used a condom at last intercourse 57% 58% 61% 59% Used birth control pills at last intercourse 35% 37% 22% 19% Did not use any method to prevent pregnancy during 11% 11% 9% 14% last sexual intercourse Had four or more sexual partners (of all youth) 8% 11% 8% 15%

Had sexual intercourse before age 13 (of all youth) 3% 4% 3% 6% Drug Use Youth who used marijuana in the past month 12% 16% 18% 23% Ever used methamphetamines 1% 1% 3% 3% Ever used cocaine 2% 3% 4% 6% Ever used heroin 1% 2% 3% 2% Ever used steroids 2% 3% 3% 3% Ever used inhalants 4% 4% 7% 9% Ever misused medications 6% 8% 16% 18% Ever used ecstasy/MDMA 2% 2% N/A 7% Ever been offered, sold, or given an illegal drug by 8% 11% 24% 22% someone on school property in the past year Mental Health Youth who had seriously considered attempting suicide 11% 11% 16% 17% in the past year Youth who had attempted suicide in the past year 6% 5% 9% 8%

Suicide attempt resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse 1% 1% 3% 3% (of all youth) Youth who felt sad or hopeless almost every day for 2 or 23% 25% 27% 30% more weeks in a row

N/A – Not available

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Monroe Monroe Michigan U.S. County County Youth Variables 2013 2013 2015 2015 (9th-12th) (9th-12th) (6th-12th) (9th-12th)

Weight Control

Obese 17% 19% 13% 14%

Overweight 12% 13% 16% 17%

Described themselves as slightly or very overweight 30% 30% 29% 31%

Trying to lose weight 46% 46% 45% 48%

Went without eating for 24 hours or more 3% 4% 13% 13% Took diet pills, powders, or liquids without a doctor’s 2% 3% 6% 5% advice

Vomited or took laxatives 2% 2% 5% 4% Physically active at least 60 minutes per day on every day 25% 27% 27% 27% in past week Physically active at least 60 minutes per day on 5 or more 48% 50% 50% 47% days in past week

Did not participate in at least 60 minutes of physical 13% 14% 15% 15% activity on any day in past week Watched TV 3 or more hours per day 22% 23% 27% 33%

Unintentional Injuries and Violence Carried a weapon in past month 12% 13% 16% 18%

Carried a weapon on school property in past month 3% 3% 4% 5%

Been in a physical fight in past year 21% 18% 22% 25%

Been in a fight on school property in past year 7% 6% 7% 8%

Threatened or injured with a weapon on school property 5% 5% 7% 7% in past year Did not go to school because felt unsafe 5% 5% 7% 7%

Electronically/cyber bullied in past year 10% 11% 19% 15% Bullied in past year 44% 40% N/A N/A

Bullied on school property in past year 28% 22% 25% 20% Hit, slapped, or physically hurt on purpose by their 4% 3% 9% 10% boyfriend or girlfriend in past year

Preventive Care Used an indoor tanning device in past year 8% 11% N/A 13%

N/A – Not available

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HEALTH PERCEPTIONS Adult І HEALTH STATUS PERCEPTIONS

Key Findings Adults Who Rated General Health In 2015, over half (55%) of the Monroe County adults Status Excellent or Very Good rated their health status as excellent or very good. Conversely, 12% of adults, increasing to 19% of . Monroe County 55% (2014) those over the age of 60, described their health as . Michigan 51% (2013) fair or poor. . U.S. 52% (2013)

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

. In 2015, more than half (55%) of Monroe County adults rated their health as excellent or very good. Monroe County adults with higher incomes (54%) were most likely to rate their health as excellent or very good, compared to 45% 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 Michigan and 17% of U.S. adults self-reported their health as fair or poor.

. Monroe County adults were most likely to rate their health as fair or poor if they:  Had been diagnosed with diabetes (37%)  Had high blood pressure (24%) or high blood cholesterol (19%)  Had an annual household income under $25,000 (22%)  Were divorced (21%)  Were 60 years of age or older (19%)

Physical Health Status

. In 2015, 21% of Monroe County adults rated their physical health as not good on four or more days in the previous month.

. Monroe County adults reported their physical health as not good on an average of 3.0 days in the previous month. Michigan and U.S. adults reported their physical health as not good on an average of 3.6 days and 3.7 days, respectively, in the previous month (Source: 2010 BRFSS).

. Monroe County adults were most likely to rate their physical health as not good if they:  Were over the age of 60 (25%)  Were female (23%)

Mental Health Status

. In 2015, 20% of Monroe County adults rated their mental health as not good on four or more days in the previous month.

. Monroe County adults reported their mental health as not good on an average of 3.1 days in the previous month. Michigan and U.S. adults reported their mental health as not good on an average of 3.7 days and 3.5 days, respectively in the previous month (Source: 2010 BRFSS).

. One-in-five (20%) adults reported that poor mental or physical health kept them from doing usual activities such as self-care, work, or recreation.

. Monroe County adults were most likely to rate their mental health as not good if they:  Were ages 30-59 (26%)  Were female (23%)

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The following graph shows the percentage of Monroe County adults who described their personal health status as excellent/very good, good, and fair/poor. Examples of how to interpret the information include: 55% of all Monroe County adults, 78% of those under age 30, and 43% of those ages 60 and older rated their health as excellent or very good. The table shows the percentage of adults with poor physical and mental health in the past 30 days.

Monroe County Adult Health Perceptions* 100% 0% 12% 11% 14% 13% 10% 22% 19% 22% 80% 36% 33% 36% 31% 36% 60% 38% 33%

78% 40% 55% 53% 55% 51% 54% 45% 20% 43%

0% Total Males Females Under 30 30-59 years 60 & Older Income Income $25K <$25K Plus

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?”

8 or More Health Status No Days 1-3 Days 4-5 Days 6-7 Days Days Physical Health Not Good in Past 30 Days* Males 68% 8% 7% 3% 10% Females 60% 8% 7% 4% 12% Total 64% 8% 7% 3% 11% Mental Health Not Good in Past 30 Days* Males 70% 6% 4% 1% 12% Females 56% 9% 4% 0% 14% Total 63% 8% 4% 1% 13% *Totals may not equal 100% as some respondents answered “Don’t know/Not sure”.

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Rated health as excellent or very good 55% 51% 52% Rated health as fair or poor 12% 18% 17% Average days that physical health not good in 3.0 3.6* 3.7* past month Average days that mental health not good in 3.1 3.7* 3.5* past month *2010 BRFSS data

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HEALTH CARE C Adult І HEALTH CARE COVERAGE

Key Findings Monroe County The 2015 Health Assessment data Medicaid Health Plan Enrollees has identified that 9% of Monroe Residents County adults were without health Enrolled in Health Plans of Enrollees care coverage. Those most likely to Medicaid be uninsured were adults ages 30-59, those with an income level under McLaren Health Plan, Monroe $25,000, and females. In Monroe Meridian Health Plan of Michigan, County Molina Healthcare of Michigan, County, 12.9% of residents live below 16,838 June & the poverty level. (Source: U.S. Census, 2014 United Healthcare Community American Community Survey 1 Year Estimate, Plan, Inc. 2013) McLaren Health Plan, Monroe Meridian Health Plan of Michigan, General Health Coverage County Molina Healthcare of Michigan, 17,529 July & . In 2015, 91% of Monroe County 2014 United Healthcare Community adults had health care coverage, Plan, Inc. leaving 9% who were uninsured. The 2013 BRFSS reports uninsured (Source: Michigan Department of Community Health, Medicaid Health Plan Enrollees, 2014, from: prevalence rates for Michigan http://www.michigan.gov/documents/mdch/JE02072014_462792_7. (14%) and the U.S. (17%). pdf)

. In the past year, 9% of adults were uninsured, increasing to 12% of those with incomes less than $25,000 and those ages 30-59, and 13% of females.

. 16% of adults with children did not have healthcare coverage, compared to 6% of those who did not have children living in their household.

. The following types of health care coverage were used: employer (45%), someone else’s employer (16%), multiple-including private sources (12%), Medicaid or medical assistance

(9%), Medicare (8%), self-paid plan (4%), multiple-including government sources (3%), Health OVERAGE Insurance Marketplace (1%), military, CHAMPUS, TriCare, or VA (1%), and other (1%).

9% of Monroe County adults were uninsured.

. Monroe County adult health care coverage includes the following: medical (100%), prescription coverage (95%), immunizations (83%), dental (81%), preventive care (75%), their spouse (73%), outpatient therapy (73%), vision (72%), mental health (71%), their children (62%), County physicians (59%), alcohol and drug treatment (47%), home care (35%), their partner (33%), skilled nursing (31%), long-term care (30%), and hospice (29%).

. The top reasons uninsured adults gave for being without health care coverage were: 1. They lost their job or changed employers (60%) 2. They could not afford to pay the insurance premiums (16%) 3. They became a part-time or temporary employee (15%) 4. They could not afford to pay the exchange premiums (10%)

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

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The following graph shows the percentages of Monroe County adults who were uninsured by demographic characteristics. Examples of how to interpret the information in the graph includes: 9% of all Monroe County adults were uninsured, 12% of adults with an income less than $25,000 reported being uninsured and 8% of those under age 30 lacked health care coverage. The pie chart shows sources of Monroe County adults’ health care coverage.

Uninsured Monroe County Adults 20%

13% 12% 12%

10% 9% 9% 8% 6%

2%

0% Total Males Females Under 30 30-59 years 60 & Older Income Income <$25K $25K Plus

12% of Monroe County adults with incomes less than $25,000 were

uninsured.

Sources of Health Coverage for Monroe County Adults

Self-purchased 4% Other Medicare Medicaid 9% 1% 8%

Someone Else's Employer 16% Employer 45% Multiple-Including Private 12% Military 1%

Health Insurance Marketplace Multiple-govt. 1% sources 3%

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Uninsured 9% 14% 17%

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HEALTH CARE C The following chart shows what is included in Monroe County adults’ insurance coverage.

Don’t Health Coverage Includes: Yes No Know Medical 100% 0% <1% Prescription Coverage 95% 3% 1% Immunizations 83% 4% 13% Dental 81% 19% 0% Preventive Health 75% 4% 21% Their Spouse 73% 24% 3% Outpatient Therapy 73% 2% 25% Vision 72% 23% 5% Mental Health 71% 4% 25% Their Children 62% 34% 5% County Physicians 59% 5% 36% Alcohol and Drug Treatment 47% 5% 48% Home Care 35% 10% 55% Their Partner 33% 46% 21% Skilled Nursing 31% 11% 58% Long-term Care 30% 15% 55% Hospice 29% 10% 61%

Healthy People 2020 Access to Health Services (AHS) OVERAGE Healthy Monroe County Michigan U.S. Objective People 2020 2015 2013 2013 Target

89% age 20-24 78% age 18-24 76% age 18-24 AHS-1.1: Persons under 88% age 25-34 75% age 25-34 74% age 25-34 age of 65 years with 86% age 35-44 82% age 35-44 80% age 35-44 100% health care insurance 86% age 45-54 85% age 45-54 84% age 45-54 95% age 55-64 91% 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 Monroe County Health Assessment)

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Adult І HEALTH CARE ACCESS AND UTILIZATION

Key Findings Monroe County Health Care Statistics

The 2015 Health Assessment project identified . In 2014, Monroe County was ranked 35th that 64% of Monroe County adults had visited of 82 Counties in Michigan for Health a doctor for a routine checkup in the past Outcomes Rank. year. 63% of adults went outside of Monroe . In 2014, 11% of Monroe County residents County for health care services in the past could not see a doctor because of cost. year. . In 2014, 11,961 (13%) of all Monroe County residents age 18 to 65 years were Health Care Access uninsured.

(Source: Community Health rankings and Roadmaps, . Nearly two-thirds (64%) of Monroe County from: (http://www.countyhealthrankings.org/) adults visited a doctor for a routine checkup in the past year, increasing to 76% of those over the age of 60.

. More than half (57%) of Monroe County adults reported they had one person they thought of as their personal doctor or healthcare provider. 32% of adults had more than one person they thought of as their personal healthcare provider, and 11% did not have one at all.

. 67% of Monroe County adults reported having a usual source of medical care.

. Reasons for not having a usual source of medical care included: had two or more usual places (34%), had not needed a doctor (24%), no insurance (7%), cost (6%), did not know where to go (3%), previous doctor unavailable/moved (3%), no place available/close enough (2%), do not like/trust/ believe in doctors (1%), not accepting new patients (1%), and other reasons (7%).

. 13% of adults reported there was a time in the past year they needed to see a doctor but could not because of cost, increasing to 26% of those with incomes less than $25,000.

. Monroe County adults did not get medical care for the following reasons: no need to go (10%), cost/no insurance (8%), multiple reasons (2%), office is not open when they could get there (1%), too long of a wait in the waiting room (<1%), distance (<1%), and other reasons (1%).

. 63% of adults went outside of Monroe County for health care services for the following reasons: better quality program (14%), service not locally available (8%), multiple reasons (8%), used to live there (6%), insurance restriction (5%), word of mouth (3%), bad experience locally (3%), work there (2%), inconvenient hours (1%), confidentiality/anonymity (<1%), and other reasons (14%).

. Adults usually visited the following places for health care services: doctor’s office (70%), urgent care center (3%), Internet (2%), public health clinic or community health department (1%), in- store health clinic (1%), chiropractor (1%), hospital emergency room (<1%), and some other kind of place (2%). 18% of adults reported multiple places and 4% had no usual place for health care services.

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. Monroe County adults had the following issues regarding their healthcare coverage:

deductibles were too high (32%), co-pays were too high (23%), premiums were too high (22%), HEALTH C high HSA account deductible (8%), opted out of certain coverage because they could not afford it (5%), working with their insurance company (5%), could not understand their insurance plan (4%), service not deemed medically necessary (4%), service is no longer covered (3%), pre-existing conditions (3%), limited visits (3%), opted out of certain coverage because they did not need it (2%), and provider is no longer covered (2%).

Availability of Services

. 21% of adults used a program or service to help themselves or a loved one with depression, anxiety, or emotional problems.

. Reasons for not using a program or service to help with depression, anxiety, or emotional problems included: could not afford to go (6%), had not thought of it (4%), fear (4%), stigma of seeking mental health services (4%), co-pay/deductible was too high (3%), did not know how to find a program (2%), transportation (2%), did not feel the services they had received were good (1%), could not get to the office or clinic (1%), other priorities (1%), and other reasons (3%). 61% of adults indicated this type of program was not needed.

Health Care Access and Utilization among Young Adults Aged 19-25 ARE

. From January through September 2011, 77.9% of women aged 19–25 had a usual place for health care compared with 62.5% of men in the same age group. . Among adults aged 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 aged 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 aged 19–25 who were poor (67.2%) and those A 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 aged 19–25 delayed or did not get needed medical care CCESS 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)

Health Care Access among Employed and Unemployed Adults

. In 2009–2010, 48.1% of unemployed adult’s ages 18–64 years had health insurance compared with 81.4% of employed adults. . The unemployed were less likely to receive needed prescriptions due to cost than the employed in all insurance categories.

. Unemployed adults in 2009–2010 were more likely to have fair or poor health than employed adults across all categories of insurance coverage.

(Source: CDC, Access to Health Care, 2012, http://www.cdc.gov/nchs/fastats/access_to_health_care.htm)

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Adult І CARDIOVASCULAR HEALTH

Key Findings Monroe County Leading Types of Death The 2015 Monroe County Health Assessment 2013 found that 6% of adults had survived a heart attack and 3% had survived a stroke at some Total Deaths: 1,426 time in their life. Nearly one-third (32%) of Monroe 1. Cancer (26% of all deaths) County adults had been diagnosed with high 2. Heart Disease (25%) blood pressure, 35% had high blood cholesterol, 3. Chronic Lower Respiratory Diseases (6%) 31% were obese, and 14% were smokers, four 4. Accidents, Unintentional Injuries (6%) known risk factors for heart disease and stroke. 5. Stroke (5%) Heart disease (25%) and stroke (5%) accounted for 30% of all Monroe County adult deaths in (Source: MDCH, Vital Statistics, updated 1-8-15) 2013 (Source: MDCH, Vital Statistics).

Heart Disease and Stroke Michigan Leading Types of Death . In 2015, 6% of Monroe County adults 2013

reported they had survived a heart attack or Total Deaths: 92,463 myocardial infarction, increasing to 12% of those over the age of 60. 1. Heart Disease (26% of all deaths) 2. Cancers (22%) . 5% of Michigan and 4% of U.S. adults 3. Chronic Lower Respiratory Diseases (6%) reported they had survived a heart attack or 4. Stroke (5%) myocardial infarction in 2013 (Source: 2013 5. Accidents, Unintentional Injuries (5%) BRFSS). (Source: MDCH, Vital Statistics, updated 1-8-15)

. 3% of Monroe County adults reported they had survived a stroke, increasing to 6% of those over the age of 60.

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

. 6% of adults reported they had angina or coronary heart disease, increasing to 16% of those over the age of 60.

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

High Blood Pressure (Hypertension)

. Nearly one-third (32%) of adults had been diagnosed with high blood pressure. The 2013 BRFSS reports hypertension prevalence rates of 35% for Michigan and 31% for the U.S.

. 8% of adults were told they were pre-hypertensive/borderline high.

. 92% of adults had their blood pressure checked within the past year.

. Monroe County adults diagnosed with high blood pressure were more likely to: o Have rated their overall health as fair or poor (64%) o Have been age 60 years or older (55%) o Have been classified as obese by Body Mass Index-BMI (44%)

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High Blood Cholesterol

. More than one-third (35%) of adults had been diagnosed with high blood cholesterol. The 2013 CARDIOVASCULAR BRFSS reported that 41% of Michigan adults and 38% of U.S. adults have been told they have high blood cholesterol.

. Four-fifths (81%) of adults had their blood cholesterol checked within the past 5 years. The 2013 BRFSS reported 79% of Michigan and 76% of U.S. adults had their blood cholesterol checked within the past 5 years.

. Monroe County adults with high blood cholesterol were more likely to: o Have been age 60 years or older (61%) o Have rated their overall health as fair or poor (57%) o Have been classified as obese by Body Mass Index-BMI (50%)

The following graph demonstrates the percentage of Monroe County adults who had major risk factors for developing cardiovascular disease (CVD).

Monroe County Adults with CVD Risk Factors

50%

35% 32% 31%

24%

25% 14% 13%

0% High Blood High Blood Obesity Sedentary Smoking Diabetes Cholesterol Pressure (Source: 2015 Monroe County Health Assessment)

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Had angina 6% 5% 4% Had a heart attack 6% 5% 4% Had a stroke 3% 4% 3% Had high blood pressure 32% 35% 31% Had high blood cholesterol 35% 41% 38% Had blood cholesterol checked within past 5 81% 79% 76% years

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The following graphs show the number of Monroe 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 Monroe County adults have been diagnosed with high blood pressure, 39% of all Monroe County males, 26% of all females, and 55% of those 60 years and older.

Diagnosed with High Blood Pressure*

80%

55% 60% 42% 39% 40% 32% 34% 28% 26%

20%

0% 0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus *Does not include respondents who indicated high blood pressure during pregnancy only.

Diagnosed with High Blood Cholesterol

80% 61% 60% 49%

35% 37% 40% 34% 34% 32%

20% 7%

0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

Cardiovascular Disease Prevalence

10%

6% 5% 4% 5% 3%

0% Heart Attack Stroke

Monroe 2015 Michigan 2013

(Source: 2015 Monroe Health Assessment and 2013 BRFSS)

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

CARDIOVASCULAR . When age differences are accounted for, the statistics indicate that the 2011-2013 Monroe County heart disease mortality rate was higher than the figure for the state, the U.S. figure and the Healthy People 2020 target.

. The Monroe County age-adjusted stroke mortality rate for 2011-2013 was higher than the state, U.S. figure, and the Healthy People 2020 target objective.

Age-Adjusted Heart Disease and Stroke Mortality Rates

300 250 203 200 170.5 200

150 101

100 39 37 36.9 34 50

0 Rate Rate per population 100,000 Heart Disease Stroke

Monroe 2011-2013 Michigan 2011-2013 U.S. 2012 HP 2020 Target*

*The Healthy People 2020 Target objective for Coronary Heart Disease is reported for heart attack mortality. (Source: MDCH, Vital Statistics, updated September 2014, Healthy People 2020)

Monroe County Age-Adjusted Heart Disease Mortality Rates by

Gender 400

300 275 259 267 237 220 220 202 202 196 200 192

population 179 165 156 163 Rate per per 100,000 Rate 149 100

0 2009 2010 2011 2012 2013

Monroe Total Monroe Males Monroe Females

(Source: MDCH, Vital Statistics, updated 1-8-15)

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

. Disparities exist for stroke mortality rates by gender in Michigan.

. The age-adjusted stroke mortality rate has decreased from 2011 to 2013.

Age-Adjusted Stroke Mortality Rates by Gender

39 39 37 36 37 37 38 36 35

Rate Rate per population 100,000 Total Male Female

Michigan 2011 Michigan 2012 Michigan 2013

(Source: MDCH, Vital Statistics, 2013)

Healthy People 2020 Objectives Heart Disease and Stroke (HDS) Monroe Survey 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 older (2011) HDS-6: Increase proportion of adults 76% who had their blood cholesterol 81% Adults age 18 82% checked within the preceding 5 (2015) & older years (2011) 38% HDS-7: Decrease proportion of Adults age 20 35% adults with high total blood & older with 14% (2015) cholesterol (TBC) TBC>240 mg/dl (2011)

*All U.S. figures age-adjusted to 2000 population standard.

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

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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 CARDIOVASCULAR 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 or arm . 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)

Heart Attack Warning Signs and Symptoms

Heart attacks can be sudden and intense, but most start with mild pain or discomfort. Even if you are unsure if it is a heart attack, have it checked out. Here are signs that can indicate a heart attack is happening:

. Chest discomfort. Most discomfort for heart attacks comes in the center of the chest and lasts for more than a few minutes or goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. . Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. . Shortness of breath with or without chest discomfort. . Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

(Source: American Heart Association, Warning Signs of a Heart Attack, 2015, http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a- Heart-Attack_UCM_002039_Article.jsp)

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Adult І CANCER

Key Findings Monroe County Incidence of Cancer, 2011 In 2015, 12% of Monroe County adults had been All Types: 642 cases diagnosed with cancer at some time in their life. Michigan Department of Community Health . Lung and Bronchus: 114 cases (18%) statistics indicate that from 2008-2012, a total of . Prostate: 94 cases (15%) 1,571 Monroe County residents died from . Breast: 89 cases (14%) cancer, the second leading cause of death in . Colon and Rectum: 53 cases (8%) the county. The American Cancer Society advises that not using tobacco products, In 2012, there were 332 cancer deaths in maintaining a healthy weight, adopting a Monroe County. physically active lifestyle, eating more fruits and (Source: Michigan Community Health Information – vegetables, limiting alcoholic beverages and Cancer) early detection may reduce overall cancer deaths.

Adult Cancer

. 12% of Monroe County adults were diagnosed with cancer at some point in their lives, increasing to 26% of adults over the age of 60.

. Of those diagnosed with cancer, they reported the following types: other skin cancer (29%), prostate (28%), cervical (24%), melanoma (7%), head and neck (7%), endometrial (4%), colon (4%), breast (4%), bladder (4%), multiple types (4%), thyroid (2%), Hodgkin’s lymphoma (2%), and other types of cancer (11%).

12% of Monroe County adults had been diagnosed with cancer at some time in their life.

Cancer Facts

. The Michigan Department of Community Health (MDCH) vital statistics indicate that from 2008- 2012, cancers caused 24% (1,571 of 6,586 total deaths) of all Monroe County resident deaths. The largest percent (30%) of cancer deaths were from lung and bronchus cancer (Source: MDCH Vital Statistics).

. 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 14% of Monroe County adults were current smokers and many more were exposed to environmental tobacco smoke, also a cause of heart attacks and cancer.

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015

Diagnosed with skin cancer 4%* 5% 6% Diagnosed with any type of cancer, other 8% 8% 7% than skin cancer *Melanoma and other skin cancers are included for “diagnosed with skin cancer”

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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 Michigan Department of Community Health reports that lung cancer was the second leading cause of male invasive cancer incidence from 2009-2011 in Monroe County, with a per year average of 52 cases for males.

. In Monroe County, 13% of male adults were current smokers and 64% of them had stopped smoking for one or more days in the past 12 months because they were trying to quit (Source: 2015 Monroe County Health Assessment). CANCER . The Michigan Department of Community Health reports that lung cancer was the second leading cause of female invasive cancer incidence from 2009-2011 in Monroe County, with a per year average of 49 cases for females.

. Approximately 15% of female adults in the county 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 Monroe County Health Assessment).

. According to the American Cancer Society, smoking causes 87% of lung cancer deaths among men and 70% of lung cancer deaths among women in the U.S. The risk of developing lung cancer is about 23 times higher in male smokers and 13 times higher in female smokers, compared to lifelong nonsmokers (Source: American Cancer Society, Facts & Figures 2015).

13% of Monroe County male adults and 15% of female adults were current smokers.

Breast Cancer

. In 2015, 64% of Monroe County females reported having had a clinical breast examination in the past year.

. 54% of Monroe 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% (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).

0

More than half (54%) of Monroe County females over the age of 40 had a mammogram in the past year.

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Colon and Rectum Cancer

. The American Cancer Society recognizes any cancer involving the esophagus, stomach, small intestine, colon, rectum, anus (anal canal and anorectum), liver, gallbladder or pancreas as a digestive cancer.

. In Monroe County, colorectal cancer was the third leading cause of male and female invasive cancer incidence from 2009 to 2011, with a per year average of 29 new invasive cancer cases for females and 30 for males.

. 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.

. In 2015, 79% of Monroe County adults over the age of 50 reported having been screened for colorectal cancers at some time in their life and 61% had been screened in the past 5 years. 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 age 50 and older have regular colon cancer screenings.

Prostate Cancer

. In Monroe County, prostate cancer was the leading cause of male invasive cancer incidence from 2009 to 2011, with an average of 74 cases per year.

. 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 60% 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 Michigan, 57,420 new cases of cancer are expected, and 20,920 cancer deaths are expected. . The Michigan female new breast cancer cases are expected to be 7,780. . About 8,350 (15%) of all new cancer cases in Michigan are expected to be from lung and bronchus cancers. . About 4,190 (7%) of all new cancer cases in Michigan are expected to be from colon and rectum cancers. . The Michigan male, new prostate cancer cases are expected to be 8,110 (14%).

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

34

Monroe County Number of Cancer Cases 2002-2011 Colon & Year All Sites Breast Lung Prostate Rectum 2002 613 74 87 96 89 2003 576 76 69 85 74 2004 766 97 87 115 97 2005 624 76 70 119 62 2006 581 74 61 102 60 2007 794 104 81 138 107 2008 721 92 73 125 86 CANCER 2009 642 88 71 104 52 2010 611 83 51 86 75 2011 642 89 53 114 94

Monroe County Number of Cancer Deaths 2002-2011 Colon & Year All Sites Breast Lung Prostate Rectum 2002 256 16 27 70 12 2003 243 24 22 79 15 2004 304 20 31 64 16 2005 286 14 32 102 11 2006 316 17 28 100 18 2007 284 11 31 99 12 2008 321 16 33 95 11 2009 325 40 32 96 14 2010 303 15 27 92 9

2011 290 21 27 77 10 (Source for tables: MDCH, Cancer Statistics updated 4-11-14)

35

The following graphs show the Monroe County, Michigan 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 and cancer as a percentage of total deaths by gender. The graph indicates:

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

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

Healthy People 2020 Objective and Age-Adjusted Mortality Rates for All Cancers

250 183 175 169 161 200

150

100

50

Rate Rate per population 100,000 0

Monroe 2012 Michigan 2012 U.S. 2011 HP 2020 Target

(Source: MDCH, Vital Statistics, updated 1-8-15; Healthy People 2020)

Cancer As Percent of Total Deaths in Monroe County by Gender, 2012

30% 35%

30% 23%

25%

20%

15%

10%

5%

0% Male Female

(Source: MDCH, Vital Statistics, updated 1-8-15)

36

Adult І DIABETES

Diabetes Facts

Key Findings

. Nearly 30 million children and adults in the In 2015, 13% of Monroe County adults had United States have diabetes. been diagnosed with diabetes. . 86 million Americans have prediabetes.

. 1.7 million Americans are diagnosed with Diabetes diabetes every year.

. Nearly 10% of the entire U.S. population has . The 2015 health assessment project diabetes, including over 25% of seniors. has identified that 13% of Monroe DIABETES . As many as 1 in 3 American adults will have County adults had been diagnosed diabetes in 2050 if present trends continue. with diabetes, increasing to 19% of . The economic cost of diagnosed diabetes in those over the age of 60 and those the U.S. is $245 billion per year. with incomes less than $25,000. The . 8.1 million Americans have undiagnosed 2013 BRFSS reports a prevalence of diabetes 11% for both Michigan and the U.S. . Diabetes kills more Americans every year than AIDS and breast cancer combined. . 4% of adults had been diagnosed with . pre-diabetes. Diabetes is the primary cause of death for 69,071 Americans each year, and contributes to the death of 231,051 . Adults with diabetes were using the Americans annually. following to treat their diabetes: diabetes pills (77%), checking blood (Source: American Diabetes Association, 2014 Fast Facts, sugar (71%), diet control (63%), http://professional.diabetes.org/admin/UserFiles/0%20- %20Sean/14_fast_facts_june2014_final3.pdf) checking A1C (51%), exercise (47%), insulin (37%), taking a class (13%), and nothing (6%).

. More than one-third (37%) of adults with diabetes rated their health as fair or poor.

. Monroe County adults diagnosed with diabetes also had one or more of the following characteristics or conditions:

o 92% were obese or overweight o 73% had been diagnosed with high blood pressure o 71% had been diagnosed with high blood cholesterol

Monroe County Adults Diagnosed with Diabetes

30%

19% 19% 20% 16% 14% 13% 11% 11% 10%

0% 0% Total Males Females Under 30 30-59 Years 60 & Older Income Income $25K <$25K Plus

37

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Diagnosed with diabetes 13% 11% 11%

Diabetes Symptoms

Many people with type 2 diabetes never show any signs, but some people do show symptoms caused by high blood sugar. The most common symptoms of type 2 diabetes are:

TYPE 1 DIABETES

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

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)

38

The following graphs show age-adjusted mortality rates from diabetes for Monroe County and

Michigan residents with comparison to the Healthy People 2020 target objective.

. Monroe County’s age-adjusted diabetes mortality rate decreased from 2005 to 2013.

. From 2011 to 2013, the Monroe County age-adjusted diabetes mortality rate was higher than the state rate, but less than the national rate and the Healthy People 2020 target objective.

Diabetes Age-Adjusted Mortality Rates

50 DIABETES

40 31.2 30.2 26.7 26.7 30 24.4 23.6

20

10

Rate Rate per Population 100,000 0 2005-2007 2008-2010 2011-2013

Monroe Michigan

(Source: MDCH, Vital Statistics, updated 1-8-15)

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

69 80 66

60

40 27 24 20 Rate Rate per population 100,000 0 Monroe 2011-2013 Michigan 2011-2013 U.S. 2012 HP 2020 Target

(Source: MDCH, Vital Statistics, updated 1-8-15 and Healthy People 2020, CDC)

39

Adult І ASTHMA AND OTHER RESPIRATORY DISEASE

Key Findings

According to the Monroe County survey data, 17% of adults had been diagnosed with asthma.

Asthma and Other Respiratory Disease

. In 2015, 17% of Monroe County adults had been diagnosed with asthma, increasing to 31% of those under the age of 30.

. 17% of Michigan and 14% of U.S. adults had ever been diagnosed with asthma (Source: 2013 BRFSS).

. There are several important factors that may trigger an asthma attack. Some of these triggers are secondhand 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, 2012).

. Chronic lower respiratory disease was the 3rd leading cause of death in Monroe County and in Michigan, in 2012 (Source: MDCH, Vital Statistics).

Monroe County Adults Diagnosed with Asthma 40%

31%

30%

19% 19% 20% 17% 16% 15% 15% 12% 10%

0% Total Males Females Under 30 30-59 Years 60 & Over Income Income <$25K $25K Plus

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015

Had been diagnosed with asthma 17% 17% 14%

40

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

Adult Lifetime Asthma Prevalence Rates By Gender

25% 18.7% 20% 16.3% 14.3% - Reported 11.7% 15%

10%

5%

Percentage Self Percentage 0% Males Females

Michigan Lifetime U.S. Lifetime ASTHMA

Adult Current Asthma Prevalence Rates By Gender

20%

14.2%

15% 11.3%

- Reported 8.6% 10% 6.7%

5%

Percentage Self Percentage 0%

Males Females

Michigan Current U.S. Current

(Source for graphs: 2013 BRFSS)

Asthma Statistics

. The number of people with asthma continues to grow. One in 12 people (about 25 million, or 8% of the U.S. population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001.

. From 2008–2010, the prevalence of asthma was higher among children than adults.

. The prevalence of asthma was higher among multiple-race, black, and American Indian or Alaska Native persons than white persons from 2008-2010.

. Asthma costs the U.S. about $3,300 per person with asthma each year from 2002 to 2007 in medical expenses, missed school and work days, and early deaths.

. Asthma was linked to 3,447 deaths (about 9 per day) in 2007.

. More than half (53%) of people with asthma had an asthma attack in 2008.

(Source: American Academy of Allergy, Asthma, and Immunology, Asthma Statistics 2013, from: http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx)

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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)

42

Adult І ARTHRITIS

Key Findings

According to the Monroe County survey data, 38% of Monroe County adults were diagnosed with arthritis. According to the 2013 BRFSS, 31% of Michigan adults and 25% of U.S. adults were told they have arthritis.

Arthritis

. More than one-third (38%) of Monroe County adults were told by a health professional that they had some form of arthritis, increasing to 61% of those over the age of 60.

. According to the 2013 BRFSS, 31% of Michigan adults and 25% of U.S. adults were told they ARTHRITIS have arthritis.

38% of Monroe County adults were told by a health professional that they had some form of arthritis, increasing to 61% of those over the age of 60.

. An estimated 52.5 million U.S. adults (about 1 of 5) report having doctor-diagnosed arthritis. As the U.S. population ages, the number of adults with arthritis is expected to increase sharply to 67 million by 2030. (Source: CDC, Arthritis at a Glance 2014).

. Adults are at higher risk of developing arthritis if they are female, have genes associated with certain types of arthritis, have an occupation associated with arthritis, are overweight or obese, and/or have joint injuries or infections (Source: CDC).

Arthritis Prevalence Increases With Body Weight

50%

40% 29% 30% 20% 16% 20%

10%

0% Healthy Weight BMI <25 Overweight BMI 25-29.9 Obese BMI >30

(Source for graph: CDC Arthritis, Morbidity and Mortality Weekly Report 2013; 62(44);869-873

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015

Diagnosed with arthritis 38% 31% 25%

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20% of Monroe County adults were limited in some way because of a physical, mental or emotional problem. Among those who were limited in some way, 39% were limited because of arthritis.

Arthritis-Attributable Activity Limitations Increase with Weight in the U.S.

70%

60% 45% 50% 38% 37% 40%

30% 20%

10% 0% Healthy Weight Overweight BMI 25-29.9 Obese BMI >30

(Source for graph: CDC Arthritis, Morbidity and Mortality Weekly Report 2010; 62(44);869-873

Arthritis: Key Public Health Messages

Early diagnosis of arthritis and self-management activities can help people decrease their pain, improve function, and stay productive.

Key self-management activities include the following: Be Active –Research has shown that physical activity decreases pain, improves function, and delays disability. Make sure you get at least 30 minutes of moderate physical activity at least 5 days a week. You can get activity in 10 minute intervals. Watch your weight –The prevalence of arthritis increases with increasing weight. Research suggests that maintaining a healthy weight reduces the risk of developing arthritis and may decrease disease progression. A loss of just 11 pounds can decrease the occurrence (incidence) of new knee osteoarthritis and a modest weight loss can help reduce pain and disability. See your doctor –Although there is no cure for most types of arthritis, early diagnosis and appropriate management is important, especially for inflammatory types of arthritis. For example, early use of disease-modifying drugs can affect the course of rheumatoid arthritis. If you have symptoms of arthritis, see your doctor and begin appropriate management of your condition. Protect your joints –Joint injury can lead to osteoarthritis. People who experience sports or occupational injuries or have jobs with repetitive motions like repeated knee bending have more osteoarthritis. Avoid joint injury to reduce your risk of developing osteoarthritis.

(Source: Centers for Disease Control and Prevention, Arthritis: Key Public Health Messages, www.cdc.gov/arthritis/basics/key.htm, updated January 2015)

44

Adult І WEIGHT STATUS

Key Findings

The 2015 Health Assessment identified that 73% of Monroe County adults were overweight or obese based on Body Mass Index (BMI). Nearly one-third (31%) of Monroe County adults were obese. The 2013 BRFSS indicates that 32% of Michigan and 29% of U.S. adults were obese by BMI. WEIGHT More than half (53%) of adults were trying to lose weight.

Adult Weight Status

. In 2015, the health assessment indicated that nearly three-fourths (73%) of Monroe County adults were either overweight (42%) or obese (31%) by Body Mass Index (BMI). This puts them at elevated risk for developing a variety of diseases.

. More than half (53%) of adults were trying to lose weight, 31% were trying to maintain their current weight or keep from gaining weight, and 4% were trying to gain weight.

. Monroe County adults did the following to lose weight or keep from gaining weight: exercised (56%), ate less food, fewer calories, or foods low in fat (55%), ate a low-carb diet (17%), smoked cigarettes (5%), took diet pills, powders or liquids without a doctor’s advice (4%), took prescribed medications (2%), went without eating 24 or more hours (2%), participated in a prescribed dietary or fitness program (2%), took laxatives (1%), used a weight loss program (1%), bariatric surgery (<1%), and vomited after eating (<1%).

31% of Monroe County adults are obese.

STATUS Physical Activity

. In Monroe County, 54% of adults were engaging in some type of physical activity or exercise for at least 30 minutes 3 or more days per week. 31% of adults were exercising 5 or more days per week. Nearly one-fourth (24%) of adults were not participating in any physical activity in the past week, including 5% who were unable to exercise.

. Reasons for not exercising included: time (19%), too tired (18%), weather (17%), laziness (13%), pain/discomfort (13%), chose not to exercise (8%), could not afford a gym membership (5%), no sidewalks (4%), no childcare (3%), no walking/biking trails (3%), safety (2%), did not know what activity to do (2%), no gym available (1%), doctor advised them not to exercise (<1%), and other reasons (4%).

. 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).

. On an average day, adults spent time doing the following: 2.7 hours watching television, 1.4 hours on their cell phone 1.2 hours on the computer outside of work, , and 0.3 hours playing video games.

More than half (53%) of Monroe County adults were trying to lose weight.

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Nutrition

. In 2015, 6% of adults were eating 5 or more servings of fruits and vegetables per day. 88% 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 23% of Michigan and U.S. adults were eating the recommended number of servings of fruits and vegetables.

. Monroe County adults reported the following reasons they chose the types of food they ate: taste (63%), cost (49%), enjoyment (48%), healthiness of food (46%), ease of preparation (41%), availability (39%), time (34%), nutritional content (29%), food they were used to (25%), what their spouse prefers (24%), calorie content (22%), what their child prefers (14%), if the food is organic (11%), if the food is genetically modified (10%), health care provider’s advice (5%), and other reasons (2%).

. Adults reported the following barriers to consuming fruits and vegetables: too expensive (13%), did not like the taste (7%), did not know how to prepare (3%), no variety (2%), transportation (1%), and other barriers (2%).

. Monroe County adults reported that they ate most of their food at: home (83%), multiple places (12%), work (3%), restaurants (1%), fast food (1%), and other places (<1%).

. Adults ate out in a restaurant or brought home take-out food an average of 2.2 times per week.

. Monroe County adults had access to a wellness program through their employer or spouse’s employer with the following features: health risk assessment (13%), free/discounted gym membership (12%), lower insurance premiums for participation in wellness program (7%), gift cards or cash for participation in wellness program (7%), on-site fitness facility (6%), on-site health screenings (6%), free/discounted weight loss program (4%), free/discounted smoking cessation program (3%), healthier food options in vending machines or cafeteria (3%), lower insurance premiums for positive changes in health status (3%), on-site health education classes (2%), gift cards or cash for positive changes in health status (1%), and other (2%).

. 36% of Monroe County adults did not have access to any wellness programs, and 15% had access to more than one wellness program.

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)

46

The following graphs show the percentage of Monroe County adults who are overweight or obese by Body Mass Index (BMI). Examples of how to interpret the information include: 26% of all Monroe

County adults were classified as normal weight, 42% were overweight, and 31% were obese.

Monroe County Adult BMI Classifications

100%

8% 31% 28% 33% 29% 29% WEIGHT 80% 37% 41%

60% 50% 32% 44% 42% 47% 53% 39% 40% 44%

35% 20% 34% 26% 23% 24% 27% 19% 15% 0% Total Male Female Under 30 30-59 Years 60 & Older Income < Income $25K $25K 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 Monroe County adults who are obese compared to Michigan and U.S.

Obesity in Monroe County, Michigan, and U.S. Adults STATUS

60%

40% 31% 32% 29%

20%

0% Monroe County Michigan U.S.

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

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Obese 31% 32% 29% Overweight 42% 35% 35%

47

Adult І TOBACCO USE

Key Findings

In 2015, 14% of Monroe County adults were current smokers and 31% were considered former smokers. In 2014, 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)

In 2015, 14% of Monroe County adults were current smokers.

Adult Tobacco Use Behaviors

. The 2015 health assessment identified that one-in-seven (14%) Monroe 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 21% for Michigan and 19% for the U.S.

. Nearly one-third (31%) 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 27% for Michigan and 25% for the U.S.

. Monroe County adult smokers were more likely to: o Have been divorced (42%) o Have rated their overall health as poor (40%) o Have incomes less than $25,000 (37%)

. Monroe County adults used the following tobacco products in the past year: cigarettes (20%), e- cigarettes (8%), cigars (6%), hookah (3%), Black and Milds (3%), roll-your-own (2%), chewing tobacco (2%), pipes (2%), little cigars (1%), swishers (1%), cigarillos (1%), and snuff (1%).

. 52% 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.

. 89% of adults reported they believe that secondhand tobacco smoke is harmful to themselves and their family’s health.

. Monroe adults reported they would support an ordinance to ban smoking in the following places: vehicle with a minor present (74%), college/university campuses (57%), parks or ball fields (52%), fairgrounds (47%), and other places (9%). 21% of adults reported they would not support an ordinance to ban smoking anywhere.

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Current smoker 14% 21% 19%

Former smoker 31% 27% 25%

48

The following graph shows the percentage of Monroe County adults who used tobacco. Examples of how to interpret the information include: 14% of all Monroe County adults were current smokers,

31% of all adults were former smokers, and 55% had never smoked.

Monroe County Adult Smoking Behaviors

100%

TOBACCO 80% 40% 37% 47% 54% 55% 61% 53% 60% 85% 26% 40% 47% 40% 31% 31% 24% 35% 20% 4% 37% 16% 14% 13% 15% 11% 13% 11% 0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus 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?”

52% 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. USE . 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 reduces 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)

49

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)

31% of Monroe County adults indicated that they were former smokers.

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

. Monroe County adult cigarette smoking rate was lower than the Michigan and U.S. rates, and higher than the Healthy People 2020 goal.

Healthy People 2020 Objective & Cigarette Smoking Rates

40% 23% 20% 30% 14% 12% 20%

10%

0% Monroe County 2015 Michigan 2012 U.S. 2012 HP 2020 Target

(Source: 2015 Monroe County Health Assessment, 2012 BRFSS and Healthy People 2020)

50

The following graphs show Monroe County, Michigan, 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 Monroe County and Michigan mothers who smoked during pregnancy. These graphs show:

. In 2013, Monroe County’s age-adjusted mortality rate for Chronic Lower Respiratory Disease was similar to the Michigan rate and lower than the Healthy People 2020 target objective, but

higher than the U.S. rate. TOBACCO

. The 2013 male age-adjusted mortality rate for Chronic Lower Respiratory Disease was higher than the female rate during the same time period.

. In 2013, the percentage of mothers who smoked during pregnancy in Monroe County was lower than the Michigan rate.

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

200

150 103

100 60 53 46 47 42 47 43 38 38 50

Rate per population 100,000 0 Total Male Female Monroe 2013 Michigan 2013 U.S. 2012 HP 2020 Target*

(Source: MDCH, Vital Statistics and Healthy People 2020) * Healthy People 2020’s target rate and the U.S. rate are for adults aged 45 years and older. **HP2020 does not report different goals by gender.

USE

Monroe County and Michigan Births to Mothers Who Smoked During Pregnancy, 2013

50%

40% 18% 20% 30%

20% 10%

0%

Monroe Mothers Michigan Mothers

(Source: MDCH, Vital Statistics, 2012)

51

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

. In 2012, the Monroe County age-adjusted mortality rate for lung cancer was higher than the state, national, and Healthy People 2020 target objective.

. Disparities existed by gender for Monroe County lung cancer age-adjusted incidence rates from 2009-2011.

Age-Adjusted Mortality Rates for

Lung Cancer

100

64 80 50 47 46 60 40 20

0 Rate Rate per population 100,000

Monroe 2012 Michigan 2012 U.S. 2010 HP 2020 Target*

(Source: Healthy People 2020, MDCH, updated 4-11-14)

Age-Adjusted Incidence Rates by Gender for Lung Cancer

100 67 80 52 60

40

20

0

Rate Rate per population 100,000 Monroe Males 2009-2011 Monroe Females 2009-2011

(Source: MDCH Information updated 4-11-14)

U.S. Adult Smoking Facts

. The percentage of American adults who smoke decreased from (21%) in 2005 to (18%) in 2013. . About 1 in 5 (42.1 million) adults still smoke cigarettes. . Cigarette smoking is the leading cause of preventable death in the United States, accounting for more than 480,000 deaths, or one of every five deaths, each year. . More men (about 21%) than women (about 15%) smoke. . More than 16 million Americans suffer from a disease caused by smoking. . Adults living below poverty level (29%) are more likely to smoke than adults living at or above poverty level (16%). . Smoking rates are higher among people with a lower education level.

(Source: CDC, Adult Cigarette Smoking in the United States: Current Estimates, January 23, 2015, from: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/)

52

Cigarette Expenditures, Percent of Total Expenditures, National Rank by Census Tract, Nielsen 2014

TOBACCO

USE

(Source: Community Commons 5/18/15)

53

Adult І ALCOHOL CONSUMPTION

Key Findings

In 2015, the Health Assessment indicated that 12% of Monroe County adults were considered frequent drinkers (drank an average of three or more days per week, per CDC guidelines). 40% 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.

54 % of Monroe County adults had at least one alcoholic drink in the past

month.

Adult Alcohol Consumption

. In 2015, 54% of the Monroe County adults had at least one alcoholic drink in the past month, increasing to 67% of those under the age of 30. The 2013 BRFSS reported current drinker prevalence rates of 57% for Michigan and 55% for the U.S.

. Approximately one-in-eight (12%) adults were considered frequent drinkers (drank on an average of three or more days per week).

. Of those who drank, Monroe County adults drank 2.7 drinks on average, increasing to 2.9 drinks for males and those under the age of 30.

. One-fifth (21%) Monroe County adults were considered binge drinkers. The 2013 BRFSS reported binge drinking rates of 19% for Michigan and 17% for the U.S.

. 40% of 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 alcohol to drink.

. Monroe County adults experienced the following in the past six months: drank more than they expected (6%), spent a lot of time drinking (2%), continued to drink despite problems caused by drinking (2%), tried to quit or cut down but could not (2%), drank more to get the same effect (1%), gave up other activities to drink (1%), failed to fulfill duties at home or work (1%), and drank to ease withdrawal symptoms (1%).

. 6% of adults used a program or service to help themselves or a loved one with alcohol problems.

. Reasons for not using a program or service to help with alcohol problems included: had not thought of it (2%), could not afford to go (1%), fear (1%), stigma of seeking alcohol services (<1%), did not want to miss work (<1%), and other reasons (3%). 92% of adults indicated this type of program was not needed.

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Drank alcohol at least once in past month 54% 57% 55% Binge drinker (drank 5 or more drinks for males and 4 or 21% 19% 17% more for females on an occasion)

54

The following graphs show the percentage of Monroe County adults consuming alcohol and the ALCOHOL CONSUMPTION amount consumed on average. Examples of how to interpret the information shown on the first graph includes: 44% of all Monroe County adults did not drink alcohol, 31% of Monroe County males did not drink, and 55% of adult females reported they did not drink.

Average Number of Days Drinking Alcohol in the Past Month 100% 90% 22% 30% 80% 38% 38% 41% 44% 47% 37% 70% 17%

60% 14% 12% 50% 16% 13% 15% 40% 18% 30% 61% 30% 55% 48% 44% 44% 38% 20% 31% 26% 10% 0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

Did not drink any 1-2 days 3 or more days

Percentages may not equal 100% as some respondents answered “don’t know”

12% of Monroe County adults were considered frequent drinkers (drank on an average of three or more days per week).

Adults Average Number of Drinks of Alcohol Consumed Per Drinking Occasion 4

2.9 2.9 2.9 2.8 3 2.7 2.4 2.4 2.3

2

1

0 Total Males Females Under 30 30-59 Years 60 & Older Income Income $25K <$25K Plus

55

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

Monroe County Adult Drinkers Who Binge Drank in Past Month* 60%

52%

46% 43% 41% 40% 40% 40% 40%

27%

20%

0% Total Males Females Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus *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 Monroe County adults reported driving after having perhaps too

much to drink.

Adult Binge Drinkers* 40%

30%

21% 19% 20% 17%

10%

0% Monroe 2015 Michigan 2013 U.S. 2013

(Source: 2013 BRFSS, 2015 Monroe 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.

56

The following table shows the city of Monroe, Monroe County, and Michigan motor vehicle ALCOHOL CONSUMPTION accident statistics.

City of Monroe Michigan Monroe County 2013 2013 2013

Total Crashes 636 3,892 289,061

Alcohol-Related Total Crashes 31 203 9,828

Fatal Crashes 1 28 881

Alcohol-Related Fatal Crashes 0 9 284

Alcohol Impaired Drivers in Crashes 31 196 9,828

Injury Crashes 122 693 51,949

Alcohol-Related Injury Crashes 13 80 3,765

Property Damage Only 513 3,171 236,231 Alcohol-Related Property Damage 18 114 5,806 Only

Deaths 1 28 951 Alcohol-Related Deaths 0 9 284

Total Non-Fatal Injuries 158 978 71,031

Alcohol-Related Injuries 25 122 5,242

(Source: Michigan Office of Highway Safety Planning Crash Reports, 2013 Traffic Crash Facts)

Impaired Driving

. Every day, almost 30 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This amounts to one death every 51 minutes.

. The annual cost of alcohol-related crashes totals more than $59 billion.

. In 2012, 10,322 people were killed in alcohol-impaired driving crashes, accounting for nearly one-third (31%) of all traffic-related deaths in the United States.

. Of the 1,168 traffic deaths among children ages 0 to 14 years in 2012, 239 (20%) involved an alcohol-impaired driver.

. In 2010, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics.

(Source: CDC, Injury Prevention & Control: Motor Vehicle Safety, January 13, 2015, http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html)

57

Motor Vehicle Accidents

The following graphs show number of Monroe County deaths due to motor vehicle accidents and

Monroe County percentage of fatal crashes with drinking involvement.

. From 2009-2013, there were a total of 86 motor vehicle deaths.

Monroe County Number of Motor Vehicle Deaths from 2009-2013 N=86 30 26

23

20 17

14

10 6 No. of reported deaths No. reported of

0

2009 2010 2011 2012 2013

(Source: MTCF, Michigan Traffic Crash Facts)

Monroe County Percentage of Fatal Crashes With Drinking

Involvement from 2009-2013

60% 50% 46% 50% 43%

40% 32% 28% 30%

20%

10%

0% 2009 2010 2011 2012 2013

(Source: MTCF, Michigan Traffic Crash Facts)

58

Alcoholic Beverage Expenditures, Percent of Total Expenditures, National Rank by ALCOHOL CONSUMPTION

Census Tract, Nielsen 2011

(Source: Community Commons updated 3/4/15)

59

Beer, Wine and Liquor Stores, Rate (Per 100,000 Population) by ZCTA, CBP 2012

ZCTA – ZIP Code tabulation area CBP – County Business Patterns, U.S. Census Bureau

(Source: Community Commons updated 3/4/15)

60

Bars and Drinking Establishments, Rate (Per 100,000 Population) by ZCTA, ALCOHOL CONSUMPTION

CBP 2012

ZCTA – ZIP Code tabulation area CBP – County Business Patterns, U.S. Census Bureau

(Source: Community Commons updated 3/4/15)

61

Adult І DRUG USE

Key Findings

In 2015, 7% of Monroe County adults had used marijuana during the past 6 months. 11% 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.

Adult Drug Use

. 7% of Monroe County adults had used marijuana in the past 6 months, increasing to 15% of those under the age of 30.

. 2% of Monroe County adults reported using other recreational drugs 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, 28% of Monroe County adults who used drugs did so almost every day, and 41% did so less than once a month.

. 11% of adults had used medication 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 16% of those under the age of 30.

. When asked about their frequency of medication misuse in the past six months, 23% of Monroe County adults who used these drugs did so almost every day, and 31% did so less than once a month.

. Monroe County adults obtained these medications from the following: primary care physicians (77%), bought from friend of family member (18%), free from friend or family members (10%), multiple doctors (5%), and ER or urgent care doctor (3%).

. 4% of Monroe County adults have used a program or service to help with drug problems for either themselves or a loved one. Reasons for not using such a program included: had not thought of it (2%), stigma of seeking drug services (1%), did not want to get in trouble (1%), did not want to miss work (1%), could not afford to go (1%), and other reasons (1%). 94% of adults indicated they did not need a program or service to help with drug problems.

. Monroe County adults indicated they did the following with their unused prescription medication: took as prescribed (40%), threw it in the trash (22%), kept it (20%), flushed it down the toilet (18%), took it to the Medication Collection program (16%), disposed in RedMed Box, Yellow Jug, etc. (6%), gave it away (1%), sold it (<1%), and some other destruction method (3%).

62

The following graphs are data from the 2015 Monroe 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: 7% of all Monroe County adults used marijuana in the

past six months, 15% of adults under the age of 30 were current users, and 12% of adults with incomes less than $25,000 were current users.

Monroe County Adult Marijuana Use in Past 6 Months 20%

15% 15%

12% DRUG USE

10% 9% 8% 7% 7% 7% 6%

5%

0% Total Males Females Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

Monroe County Adult Medication Misuse in Past 6 Months 20%

16%

15% 12% 11% 11% 11% 11% 10% 10%

6%

5%

0% Total Males Females Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

63

Abuse of Prescription (Rx) Drugs

. Young adults (age 18 to 25) are the biggest abusers of prescription (Rx) opioid pain relievers, ADHD, stimulants, and anti-anxiety drugs.

. Reasons for abusing these drugs include: getting high, relieving pain, studying better, dealing with problems, losing weight, feeling better, increasing alertness, and having a good time with friends.

. In 2010, almost 3,000 young adults died from prescription drug (mainly opioid) overdoses. This was a 250% increase from 1999.

. Among young adults, for every death due to Rx drug overdose, there were 17 treatment admissions and 66 emergency room visits.

(Source: National Institute on Drug Abuse, Abuse of Prescription (Rx) Drugs Affects Young Adults Most, June 2013, from: http://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-rx-drugs-affects-young-adults-most)

Bath Salts

. “Bath salt” stimulant products are sold in powder form in small plastic or foil packages of 200 and 500 milligrams under various brand names. Mephedrone is a fine white, off-white, or slightly yellow-colored powder. It can also be found in tablet and capsule form. MDPV is a fine white or off-white powder.

. “Bath salts” are usually ingested by sniffing/snorting. They can also be taken orally, smoked, or put into a solution and injected into veins.

. People who abuse these substances have reported agitation, insomnia, irritability, dizziness, depression, paranoia, delusions, suicidal thoughts, seizures, and panic attacks. Users have also reported effects including impaired perception of reality, reduced motor control, and decreased ability to think clearly.

. Cathinone derivatives act as central nervous system stimulants causing rapid heart rate (which may lead to heart attacks and strokes), chest pains, nosebleeds, sweating, nausea, and vomiting.

(Source: U.S. Department of Justice : DEA Briefs & Background, Drug Fact Sheets, June 2012, from: http://www.justice.gov/dea/druginfo/factsheets.shtml)

64

Adult І WOMEN’S HEALTH

Key Findings WOMEN’S Monroe County Female Leading Types of Death, 2013 In 2015, more than half (54%) of Monroe County women over the age of 40 reported 1. Heart Diseases (25% of all deaths) having a mammogram in the past year. 64% 2. Cancers (23%) of Monroe County women ages 19 and over 3. Stroke (6%) had a clinical breast exam and 56% had a 4. Chronic Lower Respiratory Diseases (6%) Pap smear to detect cancer of the cervix in 5. Unintentional Injuries (5%) the past year. The Health Assessment (Source: MDCH, updated 1-8-15) determined that 2% of women survived a heart attack and 3% survived a stroke at some time in their life. More than one-quarter Michigan Female (26%) had high blood pressure, 34% had high Leading Types of Death, 2013 blood cholesterol, 33% were obese, and 15% were identified as smokers, known risk factors 1. Heart Diseases (25% of all deaths) for cardiovascular diseases. 2. Cancers (21%) 3. Chronic Lower Respiratory Diseases (6%) Women’s Health Screenings 4. Stroke (6%) 5. Alzheimer’s disease (5%)

. In 2015, 71% of women had a (Source: MDCH, updated 1-8-15) mammogram at some time and more than one-third (37%) had this screening in the past year.

. More than half (54%) of women ages 40 and over had a mammogram in the past year and 72% had one in the past two years. The 2012 BRFSS reported that 74% of women 40 and over in the U.S. and 77% in Michigan, had a mammogram in the past two years.

. Most (92%) Monroe County women have had a clinical breast exam at some time in their life and 64% had one within the past year. Three-fourths (76%) of women ages 40 and over had a HEALTH clinical breast exam in the past two years. The 2010 BRFSS reported that 77% of women 40 and over in the U.S. and 80% in Michigan, had a clinical breast exam in the past two years.

. This assessment has identified that 96% of Monroe County women have had a Pap smear and 56% reported having had the exam in the past year. 84% of women had a pap smear in the past three years. The 2012 BRFSS indicated that 78% of U.S. and 80% of Michigan women had a pap smear in the past three years.

. Monroe County women completed an average of 4.3 self-breast exams in the past year, increasing to 4.7 for those ages 40 and older.

Pregnancy

. 32% of Monroe County women had been pregnant in the past 5 years.

. During their last pregnancy, Monroe County women: got a prenatal appointment in the first 3 months (66%), took a multivitamin (64%), took folic acid during pregnancy (45%), took folic acid pre-pregnancy (39%), experienced perinatal depression (7%), and smoked cigarettes

(2%).

65

Women’s Health Concerns

. In 2013, major cardiovascular diseases (heart disease and stroke) accounted for 31% of all female deaths in Monroe County (Source: MDCH, Vital Statistics).

. In 2015, the health assessment determined that 2% 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 Monroe County the 2015 Health Assessment has identified that:  65% were overweight or obese (58% U.S., 61% Michigan, 2013 BRFSS)  34% were diagnosed with high blood cholesterol (37% U.S., 38% Michigan, 2013 BRFSS)  26% were diagnosed with high blood pressure (30% U.S. and 32% Michigan, 2013 BRFSS)  15% of all women were current smokers (17% U.S., 18% Michigan, 2013 BRFSS)  14% had been diagnosed with diabetes (12% U.S., 11% Michigan, 2013 BRFSS)

The following graph shows the percentage of Monroe County female adults that had various health exams in the past year. Examples of how to interpret the information shown on the graph includes: 37% of Monroe County females had a mammogram within the past year, 64% had a clinical breast exam, and 56% had a Pap smear.

Monroe County Women's Health Exams Within the Past Year

100%

72% 68% 68% 75% 64% 59% 57% 56% 54% 57% 48% 50% 40% 50% 37% 39%

25% 4%

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

Mammogram Breast Exam Pap Smear

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015

Had a clinical breast exam in the past two 76% 80%* 77%* years (age 40 & over)

Had a mammogram in the past two years 72% 77%** 74%** (age 40 & over)

Had a pap smear in the past three years 84% 80%** 78%**

*2010 BRFSS Data **2012 BRFSS Data

66

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

. In 2013, the Monroe County and Michigan female age-adjusted mortality rate was lower than the male rate for both heart disease. WOMEN’S

. The Monroe County female heart disease mortality rate was higher than the Michigan female rate in 2013.

Monroe County Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2013

300

220 250

200 165 Male 150 Female

100 36 37 50

Rate Rate per population 100,000 0 Heart Disease Stroke

Michigan Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2013 HEALTH

300 251 250

200 160 Male Female 150

100 37 35 50 Rate Rate per population 100,000

0 Heart Disease Stroke

(Source for graphs: MDCH, Vital Statistics, updated 1-8-15)

67

The following graph shows the Monroe 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 2007-2011, the Monroe County age-adjusted mortality rate for female lung cancer was higher than the Michigan rate.

. From 2007-2011, the Monroe County age-adjusted breast cancer mortality rate was less than the Michigan rate but higher than the Healthy People 2020 target objective.

Monroe County Female Age-Adjusted Cancer Mortality Rates 60

44.5 50 43.4

40

30 21.4 23.4 population 20.6

15.8 Rate per per 100,000 Rate 20 13.7 10

0 Lung Cancer Colon/Rectum Cancer Breast Cancer

Monroe 2007-2011 Michigan 2007-2011

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

(Source: Michigan Cancer Surveillance Program, updated 5-13-14, and Healthy People 2020)

Binge Drinking: A Serious, Under Recognized Problem among Women and Girls

. Binge drinking for women is defined as consuming 4 or more alcohol drinks (beer, wine, or liquor) on an occasion.

. Binge drinking is a dangerous behavior but is not widely recognized as a women’s health problem.

. Drinking too much results in about 23,000 deaths in women and girls each year.

. Binge drinking increases the chances of breast cancer, heart disease, sexually transmitted diseases, unintended pregnancy, and many other health problems.

. If women binge drink while pregnant, they risk exposing their developing baby to high levels of alcohol, increasing the chances the baby will be harmed by the mother’s alcohol use.

. Drinking alcohol during pregnancy can lead to sudden infant death syndrome and fetal alcohol spectrum disorders.

. About 1 in 8 women aged 18 years and older and 1 in 5 high school girls binge drink. Women who binge drink do so frequently – about 3 times a month – and have about 6 drinks per binge.

(Sources: Centers for Disease Control and Prevention, Binge Drinking, January 2013, http://www.cdc.gov/vitalsigns/BingeDrinkingFemale/index.html)

68

Human Papilloma Virus (HPV and Vaccine)

. Approximately 79 million Americans are infected with human papillomavirus (HPV), and approximately 14 million people will become newly infected each year. WOMEN’S

. 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)

Breast Cancer in Young Women

. Most breast cancers are found in women who are 50 years old or older, but breast cancer also affects younger women. . About 11% of all new cases of breast cancer in the United States are found in women younger than 45 years of age.

. In 2010, 206,966 women and 2,039 men in the United States were diagnosed with breast

cancer. 40,996 women and 439 men in the United States died from breast cancer. HEALTH . Some young women are at a higher risk for getting breast cancer at an early age compared with other women their age. If you are a woman under age 45, you may have a higher risk if:

• You have close relatives (parents, siblings, or children) who were diagnosed with breast or ovarian cancer when they were younger than 45, especially if more than one relative was diagnosed or if a male relative had breast cancer. • You have changes in certain breast cancer genes (BRCA1 and BRCA2), or have close relatives with these changes. • You were treated with radiation therapy to the breast or chest during childhood or early adulthood. • You have been told that you have dense breasts on a mammogram. • You have had breast cancer or certain other breast health problems such as lobular carcinoma in situ(LCIS), ductal carcinoma in situ (DCIS), atypical ductal hyperplasia, or atypical lobular hyperplasia.

. You can help lower your risk of breast cancer in the following ways: • Get screened for breast cancer regularly. • Know how your breasts normally look and feel. • Keep a healthy weight.

• Exercise regularly (at least four hours a week). • Breastfeed your babies, if possible. • If you plan to have children after 30, talk to your doctor about your cancer risk. • Talk to your doctor if you have a family history of breast or ovarian cancer or other risk factors.

(Source: CDC, Breast Cancer, May 8, 2014, http://www.cdc.gov/cancer/breast/young_women/)

69

Adult І MEN’S HEALTH

Key Findings Monroe County Male In 2015, 60% of Monroe County males over the Leading Causes of Death, 2013 age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases (heart disease 1. Cancers (30% of all deaths) and stroke) accounted for 28% and cancers 2. Heart Diseases (24%) accounted for 30% of all male deaths in Monroe 3. Chronic Lower Respiratory Diseases (7%) County in 2013. The Health Assessment 4. Accidents, Unintentional Injuries (7%) determined that 12% of men survived a heart 5. Diabetes Mellitus (4%) attack and 2% survived a stroke at some time in (Source: MDCH, updated 1-8-15) their life. Nearly two-fifths (39%) of men had been diagnosed with high blood pressure, 37% had high blood cholesterol, and 13% were identified as Michigan Male smokers, which, along with obesity (28%), are Leading Types of Death, 2013 known risk factors for cardiovascular diseases. 1. Heart Diseases (25% of all deaths) Men’s Health Screenings and Concerns 2. Cancers (23%) 3. Chronic Lower Respiratory Diseases (6%) . More than two-fifths (42%) of Monroe County 4. Accidents, Unintentional Injuries (6%) 5. Stroke (4%) males had a Prostate-Specific Antigen (PSA) test at some time in their life and 31% had one (Source: MDCH, updated 1-8-15) in the past year.

. 50% of men had a digital rectal exam in their lifetime and 20% had one in the past year.

. 79% of males age 50 and over had a PSA test at some time in their life, and 60% had one in the past year.

. Monroe County males completed an average of 1.0 self-testicular exam in the past year, increasing to 1.4 exams for those ages 50 and older.

. In 2012, major cardiovascular diseases (heart disease and stroke) accounted for 28% of all male deaths in Monroe County (Source: MDCH, Vital Statistics).

. In 2015, the health assessment determined that 12% of men had a heart attack and 2% had a stroke at some time in their life.

31% of Monroe County males had a PSA test in the past year.

. Major risk factors for cardiovascular disease include smoking, obesity, high blood cholesterol, high blood pressure, physical inactivity, and diabetes. In Monroe County the 2015 health assessment has identified that: o 81% were overweight or obese (71% U.S., 71% Michigan, 2013 BRFSS) o 39% were diagnosed with high blood pressure (34% U.S., 37% Michigan, 2013 BRFSS) o 37% were diagnosed with high blood cholesterol (40% U.S., 44% Michigan, 2013 BRFSS) o 13% of all men were current smokers (22% U.S., 25% Michigan, 2013 BRFSS) o 11% had been diagnosed with diabetes (10% U.S., 11% Michigan, 2013 BRFSS)

. In 2013, cancer was the leading cause of death for Monroe County males (N=206 male resident deaths). Cancer was the second leading cause of death for Michigan males (N=10,647 male resident deaths) (Source: MDCH, Vital Statistics).

70

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

. In 2013, the Monroe County and Michigan male age-adjusted mortality rate was higher than the female rate for heart disease but lower than the female rate for stroke.

. The Monroe County male age-adjusted heart disease and stroke mortality rates were lower than the Michigan male rates.

Monroe County Age-Adjusted Heart Disease and Stroke MEN’S Mortality Rates By Gender, 2013

300

220 250

200 165 Male

150 Female

100 36 37 50 Rate Rate per population 100,000 0 Heart Disease Stroke

HEALTH Michigan Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, 2013

300 249

250

200 160

Male 150 Female 100 37 35

Rate Rate per population 100,000 50

0 Heart Disease Stroke

(Source for graphs: MDCH, Vital Statistics, updated 1-8-15)

71

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

. From 2007-2011, the Monroe County age-adjusted mortality rate for male lung cancer was higher than the Michigan rate.

. The age-adjusted prostate cancer mortality rate in Monroe County for 2007-2011 was lower than the Michigan rate and the Healthy People 2020 objective.

Monroe County Male Age-Adjusted Cancer Mortality Rates

100

80 68.7 66.3

60

40 20.5 19.0 18.3 21.0 21.2 population 20 per 100,000 Rate 0 Lung Cancer Colon/Rectum Cancer Prostate Cancer Monroe 2007-2011 Michigan 2007-2011 HP 2020 Target*

*Note: the Healthy People 2020 target rates are not gender specific. (Source: Michigan Cancer Surveillance Program, updated 5-13-14, and Healthy People 2020)

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015

Had a PSA test within the past two years (age 58% 48%* 45%* 40 & over)

*2012 BRFSS data

Men’s Health Data

. Approximately 12% of adult males aged 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, 2/6/2015 from http://www.cdc.gov/nchs/fastats/mens_health.htm)

72

Cancer and Men

. Every year, cancer claims the lives of nearly 300,000 men in America.

. More men in the U.S. die from lung cancer than any other type of cancer. The most important

thing you can do to prevent lung cancer is not to start smoking, or to quit if you smoke.

. Smoking causes cancers of the esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach, and acute myeloid leukemia.

. In men, the following cancers are associated with being overweight: colorectal cancer, MEN’S esophageal adenocarcinoma (a type of cancer of the tube that connects your throat to your stomach), and cancer of the kidney and pancreas.

. Prostate cancer is the most common cancer in men in the U.S., not counting skin cancer. It is the second most common cause of cancer death in men. While all men are at risk for prostate cancer, some factors increase risk. These include: o older age o family history of prostate cancer o being African American

. Colorectal cancer is the third leading cause of cancer deaths in America men. Screening tests can find precancerous polyps so they can be removed before they turn into cancer. Everyone should be tested for colorectal cancer regularly, starting at age 50.

(Source: Center for Disease Control and Prevention, National Cancer Institute, May 28, 2014, http://www.cdc.gov/features/cancerandmen/)

HEALTH Heart Health and Stroke Facts for Men

. Heart disease is the leading cause of death for men in the United States, killing 307,225 men in 2009—that’s 1 in every 4 male deaths. . Heart disease is the leading cause of death for men of most racial/ethnic groups in the United States, including African Americans, American Indians or Alaska Natives, Hispanics, and whites. For Asian American or Pacific Islander men, heart disease is second only to cancer. . About 8.5% of all white men, 7.9% of black men, and 6.3% of Mexican American men have coronary heart disease. . Half of the men who die suddenly of coronary heart disease have no previous symptoms. Even if you have no symptoms, you may still be at risk for heart disease. . Between 70% and 89% of sudden cardiac events occur in men . High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors. Several other medical conditions and lifestyle choices can also put people at higher risk for heart disease, including: • Diabetes • Physical inactivity • Excessive Alcohol Use • Poor diet • Overweight and obesity

(Source: CDC, Men and Heart Disease Fact Sheet, updated 8-26-13, from: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm)

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Adult І PREVENTIVE MEDICINE AND HEALTH SCREENINGS

Key Findings Reasons Some Adults Still Need Vaccines

More than half (55%) of adults ages 65 and older Some adults incorrectly assume that the had a pneumonia vaccination at some time in vaccines they received as children will their life. Three-fifths (61%) of adults ages 50 and protect them for the rest of their lives. older had a colonoscopy/sigmoidoscopy within Generally this is true, except that: the past 5 years. . Some adults were never vaccinated as children. Preventive Medicine . Newer vaccines were not available when some adults were children. . Nearly half (45%) of Monroe County adults had . Immunity can begin to fade over time. a flu vaccine during the past 12 months. . As we age, we become more susceptible to serious disease caused by common . Of those who had a flu vaccine, 99% had the infections (such as flu and shot and 1% had the nasal spray. pneumococcus).

(Source: CDC, Immunization Schedules, updated 9-18, . 76% of Monroe County adults ages 65 and 2014, http://www.cdc.gov/vaccines/schedules/easy-to- older had a flu vaccine in the past 12 months. read/adult.html) The 2013 BRFSS reported that 63% of U.S. and 57% of Michigan adults ages 65 and older had a flu vaccine in the past year.

. More than one-fifth (22%) of adults have had a pneumonia shot in their life, increasing to 55% of those ages 65 and older. The 2013 BRFSS reported that 70% of U.S. and 69% of Michigan adults ages 65 and older had a pneumonia shot in their life.

. Monroe County adults have had the following vaccines: tetanus booster (including Tdap) in the past 10 years (53%), pneumonia vaccine in their lifetime (22%), pertussis vaccine in the past 10 years (14%), Zoster (shingles) vaccine in their lifetime (7%), and human papillomavirus vaccine in their lifetime (5%).

Preventive Health Screenings and Exams

. Three-fifths (61%) of adults ages 50 and older had a colonoscopy or sigmoidoscopy in the past 5 years.

. Adults reported they were at risk of developing the following based on family history: high blood pressure (56%), heart disease (47%), cancer (46%), diabetes (38%), high blood cholesterol (32%), alcohol addiction (14%), Alzheimer’s disease (13%), mental illness (11%), drug addiction (5%), and unexplained sudden death (1%).

. 37% of adults have been screened by a doctor or other health professional for skin cancer.

. In the past year, 54% of Monroe County women ages 40 and older have had a mammogram.

. In the past year, 60% of Monroe County men ages 50 and older 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 Monroe County adults.

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PREVENTIVE MEDICINE

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Had a pneumonia vaccination 55% 69% 70% (ages 65 and older) Had a flu vaccine in the past year (ages 65 76% 57% 63% and older)

Monroe County Adult Health Screening Results

GENERAL SCREENING RESULTS Total Sample Diagnosed with High Blood Cholesterol 35% Diagnosed with High Blood Pressure 32% Diagnosed with Diabetes 13% Diagnosed with a Heart Attack 6% Diagnosed with a Stroke 3% (Percentages based on all Monroe County adults surveyed)

Healthy People 2020 Immunization and Infectious Diseases (IID) - Pneumonia Vaccination Healthy Monroe Michigan U.S. People Objective County 2013 2013 2020 2015 Target

IID-13.1: Increase the percentage of non-institutionalized high-risk adults aged 55% 69% 70% 90% 65 years and older who are vaccinated against pneumococcal disease

*U.S. baseline is age-adjusted to the 2000 population standard

(Sources: Healthy People 2020 Objectives, 2013 BRFSS, 2015 Monroe County Health Assessment)

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)

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Environmental Health

. Monroe County adults indicated the following as their main method or way of getting information from authorities in a large-scale disaster or emergency: television (73%), radio (48%), Internet (46%), Monroe County Emergency Alert System (37%), friends/family (35%), social media (28%), neighbors (26%), newspaper (14%), and other methods (2%).

. Monroe County households had the following disaster preparedness supplies: cell phone (88%), working flashlight and working batteries (87%), cell phone with texting (80%), 3-day supply of nonperishable food for everyone in the household (60%), 3-day supply of prescription medications for each person who takes prescribed medicines (56%), home land-line telephone (54%), working battery-operated radio and working batteries (51%), generator (48%), 3-day supply of water for everyone in the household (1 gallon of water per person per day) (47%), communication plan (22%), plan for their pets (14%), and a disaster plan (10%).

. 30% of Monroe County adults had a private water source for drinking water. Of those who had a private water source, 9% had it tested within the past year, and 17% have never had it tested. 31% did not know the last time their water source had been tested.

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

 Insects (11%)  Radon (1%)

 Unsafe water supply/wells (6%)  Safety hazards (1%)

 Mold (5%)  General living conditions (1%)

 Temperature regulation (4%)  Sewage/waste water problems (1%)

 Rodents (4%)  Bed bugs (1%)

 Plumbing problems (3%)  Excess medications in the home (1%)

 Lead paint (1%)  Lice (1%)

 Chemicals found in products (1%)  Cockroaches (<1%)

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Adult І SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES

Key Findings SEXUAL

In 2015, over two-thirds (70%) of Monroe County adults had sexual intercourse. Six 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 papillomavirus (HPV) (Source: CDC, STDs in Adolescents and Young Adults, 2014 STD Surveillance).

Adult Sexual Behavior

. Over two-thirds (70%) of Monroe County adults had sexual intercourse in the past year.

. 6% of adults reported they had intercourse with more than one partner in the past year, increasing to 17% of those with incomes less than $25,000 and 22% of those under the age of 30.

. Monroe County adults used the following methods of birth control: vasectomy (27%), they or their partner were too old (18%), hysterectomy (18%), tubes tied (16%), condoms (11%), birth control pill (11%), withdrawal (6%), abstinence (3%), IUD (2%), rhythm method (2%), infertility

(2%), diaphragm (1%), and contraceptive patch (<1%).

BEHAVIOR . 12% of Monroe County adults were not using any method of birth control.

. Monroe County adults did not use birth control for the following reasons:  They or their partner had a hysterectomy/vasectomy/tubes tied (40%)  They or their partner were too old (22%)  They wanted to get pregnant (7%)  They did not think they or their partner could get pregnant (6%)  They did not want to use birth control (4%)  They did not care if they or their partner got pregnant (3%)  No regular partner (3%)  They or their partner did not like birth control/fear of side effects (1%)  They or their partner were currently breastfeeding (1%)  Their partner did not want to use birth control (1%)  They had a same-sex partner (1%)  They could not pay for birth control (<1%)  Religious preferences (<1%)

. The following situations applied to Monroe County adults in the past year: had sex with someone they did not know (3%), tested for an STD (3%), had anal sex without a condom (2%), treated for an STD (1%), and used intravenous drugs (<1%).

. Adults indicated that HIV is transmitted in the following ways: unprotected sex (94%), sharing needles (94%), and infected blood (91%). 4% of adults did not know how HIV is transmitted.

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The following graph shows the sexual activity of Monroe County adults. Examples of how to interpret the information in the graph include: 64% of all Monroe County adults had one sexual partner in the last 12 months and 6% had more than one, and 59% of males had one partner in the past year.

Number of Sexual Partners in the Past Year

100% 22% 24% 30% 33% 28% 37% 80% 5% 53% 53% 5% 6% 4% 8% 60% 22% 1% 40% 17% 71% 67% 73% 64% 59% 47% 20% 41% 30%

0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

One More than one None

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

HIV in the United States

. More than 1.2 million people in the United States are living with HIV infection, and almost 1 in 7 (14%) are unaware of their infection. . By race, African Americans face the most severe burden of HIV. . The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year. . In 2012, an estimated 47,989 people were diagnosed with HIV infection in the United States. In that same year, an estimated 27,928 people were diagnosed with AIDS. Since the epidemic began, an estimated 1,170,989 people in the United States have been diagnosed with AIDS . An estimated 13,834 people with an AIDS diagnosis died in 2011, and approximately 648,459 people in the United States with an AIDS diagnosis have died since the epidemic.

(Source: CDC, HIV in the United States: At a Glance, 11/25/14, from: http://www.cdc.gov/hiv/statistics/basics/ataglance.html)

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The following graphs show Monroe County chlamydia disease rates per 100,000 population updated June 24, 2013 by the Michigan Department of Community Health. The graphs show:

. Monroe County chlamydia rates fluctuated from 2009 to 2013, but increased overall. Monroe County rates remained below the Michigan rates. SEXUAL . In 2013, the U.S. rate for new chlamydia cases was 446.6 per 100,000 population (Source: CDC, Reported STDs in the U.S., 2013).

Chlamydia Annualized Disease Rates for Monroe County and Michigan 600

500 487.4 510.6 507.0 493.1 400 455.7

300

200 239.4 213.9 232.3 225.3 200.9 100

Rate per Population 100,000 0 2009 2010 2011 2012 2013 Monroe Michigan

(Source for graph: Michigan Sexually Transmitted Diseases, Updated 10-15-2014) BEHAVIOR

Annualized Count of Chlamydia Cases for Monroe County 400

350 352 360 340 300 325 306

250

of Number reported cases 200

2009 2010 2011 2012 2013

(Source for graph: Michigan Sexually Transmitted Diseases, Updated 10-15-2014)

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The following graphs show Monroe County gonorrhea disease rates per 100,000 population updated June 20, 2013 by the Michigan Department of Community Health. The graphs show:

. The Monroe County gonorrhea rate increased from 2008 to 2012.

. The Michigan gonorrhea rate decreased from 2009 to 2013.

. In 2013, the U.S. rate for new gonorrhea cases for the total population was 106.1 per 100,000 population (Source: CDC, Reported STDs in the U.S., 2013).

. 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 Monroe County and Michigan 200 156.9 140.9 150 132.4 132

106.6 100

47 52.5 50 33.5 35.5 42.2

Rate Rate per population 100,000

0 2009 2010 2011 2012 2013 Monroe Michigan

2013 Monroe County Gonorrhea Cases, Both Sexes, by Age 30

25 27 21 20 17

15 11 10

5 3

Number of Number reported cases 0 15-19 20-24 25-29 30-44 45 & Over

(Source for graphs: Michigan Sexually Transmitted Diseases, Updated 10-15-2014)

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

. In 2013, the U.S. fertility rate was 62.5 per 1,000 women ages 15-44 (Source: CDC, Births and Natality, 2013).

SEXUAL . From 2009-2013, there was an average of 1,595 live births per year in Monroe County.

. In 2013, there were a total of 1,520 live births in Monroe County.

Monroe County and Michigan Crude Birth Rates 20

15 11.4 11.8 11.6 11.6 11.4 11.5 10.5 10.5 10.1 10.1 10

5

Rate Rate per Population 1,000 0

2009 2010 2011 2012 2013 BEHAVIOR Monroe Michigan

Monroe County Total Live Births

2,000 1,731 1,597 1,596 1,530 1,520

1,500

1,000

500

Number of Live Births Live of Number 0

2009 2010 2011 2012 2013

(Source for graphs: Michigan Department of Community Health, Natality and Pregnancy, Updated 10-15-2014)

81

The following graphs show Monroe County total number of live births by age of the mother and Monroe County and infant mortality rates updated January 14, 2015 by the Michigan Department of Community Health. The graphs show:

. In 2013, more than half (58%) of live births in Monroe County were to mothers between 20-29 years old.

. In 2013, the Monroe County infant mortality rate was higher than the state rate.

Monroe County Live Births by Age of Mother in 2012

1000 880

750 511

500

250 102 26 1 Births Live of t Number

0 15-19 20-29 30-39 40-44 45+

Monroe County Infant Mortality Rates, 2008-2012*

20

15

9.9

10 7.5 7.1 6.6 6.9 7.0 5.9 5.2 5.6

5

0.0 Rate Rate per Population 1,000 0 2009 2010 2011 2012 2013 Monroe Michigan

*Deaths occurring to individuals less than 1 year of age. *The infant death rate is the number of resident infant deaths divided by total resident live births X 1,000

*A rate could not be calculated for Monroe County in 2011 because the data was small.

(Source for graphs: Michigan Department of Community Health, Natality and Pregnancy, Updated 1-14-2015)

82

The following graphs show Monroe County and Michigan abortion rates and low birth weight rates updated January 14, 2015 by the Michigan Department of Community Health. The graphs show:

. From 2009-2013, Monroe County abortion rates fluctuated, but remained well below the Michigan rates for the same period. SEXUAL . From 2009-2013, the low birth weight rates for Monroe County were below the Michigan rates.

. In 2013, 8.0% of all U.S. live births were low birth weight births. (Source: CDC, Birthweight and Gestation, 2013)

Abortion Rates by County and State for Females, ages 15-44 2009-2013

15 13.4 11.9 12.0 11.9 11.2

10 7.4 6.6 7.0 5.7 4.3 5

Rate Rate per Population 1,000

0 2009 2010 2011 2012 2013 BEHAVIOR Monroe Michigan

Monroe County and Michigan Low Birth Weight Births*

14%

12%

10% 8.4% 8.4% 8.4% 8.5% 8.3% 8.0% 7.7% 7.1% 7.0% 8% 6.7%

6% 4% Percent of Births Live

2% 0% 2009 2010 2011 2012 2013 Monroe Michigan

*Low Birth Weight is defined as weighing less than 2,500 grams or 5 pounds, 8 ounces.

(Source for graphs: Michigan Department of Community Health, Natality and Pregnancy, Updated 1-14-2015)

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Adult І QUALITY OF LIFE

Key Findings Preventing High Blood Pressure: In 2015, 20% of Monroe County adults were Healthy Living Habits limited in some way because of a physical, By living a healthy lifestyle, you can help keep mental or emotional problem. your blood pressure in a healthy range and

lower your risk for heart disease and stroke. A Impairments and Health Problems healthy lifestyle includes: . Eating a healthy diet . In 2015, one-fifth (20%) of Monroe County . Maintaining a healthy weight adults were limited in some way because . Getting enough physical activity of a physical, mental or emotional . Not smoking problem (23% for Michigan and 20% for . Limiting alcohol use the U.S., 2013 BRFSS), increasing to 29% of (Source: CDC, High Blood Pressure, July 7 2014, from: those with incomes less than $25,000 and http://www.cdc.gov/bloodpressure/healthy_living.htm) those ages 60 and older.

. Among those who were limited in some way, the following most limiting problems or impairments were reported: back or neck problems (44%), arthritis/rheumatism (39%), chronic pain (36%), stress, depression, anxiety, or emotional problems (33%), sleep problems (27%), walking problems (21%), high blood pressure (15%), heart problems (15%), lung/breathing problems (14%), mental health illness/disorder (11%), diabetes (11%), fractures, bone/joint injuries (9%), hearing problems (9%), eye/vision problems (8%), other mental health issues (7%), tobacco dependency (5%), stroke-related problems (2%), incontinence (2%), a learning disability (2%), drug addiction (1%), a developmental disability (1%), cancer (1%), and alcohol dependency (1%).

. Monroe County adults needed help with the following because of an impairment or health problem: household chores (8%), shopping (6%), transportation (5%), doing necessary business (4%), dressing (2%), getting around for other purposes (1%), bathing (1%), eating (1%), and child care (1%).

. Monroe County adults were responsible for providing regular care or assistance to the following: multiple children (20%), an elderly parent or loved one (10%), a friend, family member or spouse who has a health problem (9%), someone with special needs (5%), a friend, family member or spouse with a mental health issue (5%), an adult child (4%), grandchildren (4%), children with discipline issues (3%), and a friend, family member or spouse with dementia (2%).

Monroe Michigan U.S Adult Comparisons County 2013 2013 2015

Limited in some way because of a physical, 20% 23% 20% mental, or emotional problem

84

The following graphs show the percentage of Monroe County adults that were limited in some way and the most limiting health problems. Examples of how to interpret the information shown on the graph include: 20% of Monroe County adults are limited in some way, 24% of males, and 29% of

those 60 and older.

QUALITY OF

Monroe County Adults Limited in Some Way 40%

29% 29% 30% 24% 21% 20% 19% 20% 16% 11% 10%

0% Total Male Female Under 30 30-59 Years 60 & Older Income Income <$25K $25K Plus

Monroe County Most Limiting Health Problems

60%

50% 44% 39% 36% 40% 33% 27% 30% LIFE 21% 20% 10% 0% Back and Neck Arthritis/ Chronic Pain Stress, Sleep Problems Walking Problems Rheumatism Depression, Problems Anxiety,

Emotional Problems

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Healthy People 2020 Arthritis, Osteoporosis, and Chronic Back Conditions (AOCBC)

Monroe Healthy Objective County People 2020 2015 Target

AOCBC-2: Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation 39% 36% in activity due to arthritis or joint symptoms

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

Physical Activity among Adults with Disabilities

. More than 21 million adults in the United States have a disability. . These are adults with difficulty walking or climbing stairs, hearing, seeing, or concentrating, remembering, or making decisions. . Adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities. . Aerobic physical activity can help reduce the impact of these chronic diseases, yet nearly half of all adults with disabilities get no leisure time aerobic physical activity. . Adults with disabilities were 82% more likely to be physically active if their doctor recommended it. However, only 44% of adults with disabilities who visited a doctor in the past year received a physical activity recommendation from their doctor. . Doctors and other health professionals should recommend physical activity, based on the 2008 Physical Activity Guidelines, to their patients with disabilities. . Adults with disabilities should consider the following when engaging in physical activity: • Engage in the amount and types of physical activity that are right for them. • Find opportunities to increase regular physical activity in ways that meet their needs and abilities. • Start slowly based on their abilities and fitness level. • Avoid being physically inactive. • Know that most aerobic physical activity may need to be modified, adapted or may need additional assistance or equipment.

(Source: CDC, Increasing Physical Activity among Adults with Disabilities, 2014, http://www.cdc.gov/ncbddd/disabilityandhealth/pa.html)

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Adult І SOCIAL CONTEXT AND SAFETY

SOCIAL CONTEXT Key Findings

In 2015, 9% of Monroe County adults were threatened or abused in the past year. 50% of adults kept a firearm in or around their home.

9% of Monroe County adults were threatened or abused in the past year.

Social Context

. 9% of Monroe County adults were threatened or abused in the past year. They were threatened by the following: someone outside their home (56%), a spouse or partner (13%), a child (9%), a parent (9%), and someone else (16%).

. Monroe County adults received assistance for the following in the past year: food (11%), prescription assistance (8%), mental illness issues (6%), utilities (5%), employment (4%), rent/mortgage (4%), legal aid services (3%), free tax preparation (2%), home repair (2%), alcohol or other substance dependency (1%), transportation (1%), credit counseling (1%), clothing (1%), emergency shelter (1%), unplanned pregnancy (1%), abuse or neglect issues (1%), homelessness (<1%), and post-incarceration transition issues (<1%).

. 3% of adults reported they went to bed hungry at least one day per week because they could not afford food, increasing to 6% of those with incomes less than $25,000 and 7% of those under the age of 30. Less than 1% went to bed hungry every day of the week.

. Monroe County adults experienced the following as a child: lived with someone who was a problem drinker or alcoholic (24%), their parents became separated or were divorced (23%), a parent or adult in their home swore at, insulted, or put them down (16%), lived with someone who was depressed, mentally ill, or suicidal (13%), their parents or adults in their home slapped, hit, kicked, punched, or beat each other up (13%), a parent or adult in their home hit, beat, kicked, or physically hurt them (10%), someone at least 5 years older than them or an adult touched them sexually (8%), lived with someone who used illegal street drugs, or who abused prescription medications (6%), someone at least 5 years older than them or an adult tried to make them touch them sexually (5%), lived with someone who served time or was sentenced to serve time in prison, jail or other correctional facility (4%), someone at least 5 years older than them or an adult forced them to have sex (2%), and their parents were not married (1%).

Safety

. Monroe County residents reported the following concerns about their community: drug abuse (52%), unemployment (39%), distracted driving (33%), youth substance abuse (33%), violence (32%), opiate/prescription drug abuse (30%), bullying (29%), school funding (28%), homelessness (26%), lack of affordable healthcare (25%), senior/elder care (24%), traffic (24%), DUI (21%), alcohol use/abuse (21%), underemployment (20%), lack of physical activity (19%),

parents hosting/allowing underage drinking (18%), speeding (18%), teenage pregnancy (17%), lack of nutrition and healthy eating (16%), lack of affordable housing (13%), suicide prevention (13%), sexting (13%), tobacco use (12%), lack of health education (11%), lack of knowledge about healthy cooking (10%), bicycle safety (9%), lack of affordable transportation (8%), discrimination based on race, ethnicity or sexual orientation (8%), child care availability (7%), cancer prevention screening (6%), disaster preparedness (6%), chronic disease prevention (6%), seat belt or restraint usage (6%), falls (4%), and gambling (3%).

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. Half (50%) of Monroe County adults kept a firearm in or around their home. 5% of adults reported they were unlocked and loaded.

. Monroe County adults reported doing the following while driving: wearing a seatbelt (95%), talking on hand-held cell phone (46%), eating (40%), talking on hands-free cell phone (32%), texting (11%), using internet on their cell phone (6%), checking facebook on their cell phone (4%), being under the influence of alcohol (3%), being under the influence of drugs (2%), reading (1%), and other activities (such as applying makeup, shaving, etc.) (3%).

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 1,153 people are injured in crashes that were reported to involve a distracted driver. . In 2012, 3,328 people were killed in crashes involving a distracted driver. An additional 421,000 people were injured in motor vehicle crashes involving a distracted driver in 2012 . 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 October10, 2014, http://www.cdc.gov/motorvehiclesafety/distracted_driving/index.html)

Veterans’ Affairs

. 14% of adults reported they or an immediate family member served in the military in the past 10-15 years.

. As a result of this military service, the following have affected veterans’ immediate family members: had problems getting VA benefits (13%), access to medical care at a VA facility (11%), post- traumatic stress disorder (PTSD) (11%), major health problems due to injury (9%), access to medical care at a non-VA facility (6%), access to mental health treatment (6%), substance/drug abuse (6%), had problems getting information on VA eligibility and applying (4%), and could not find/keep a job (2%). 75% did not have any problems listed.

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The following graph shows the percentage of Monroe County adults that had a firearm in the home. Examples of how to interpret the information shown on the first graph include: 50% of all Monroe County adults kept a firearm in their home, 57% of males, and 51% of those ages 30-59 kept a firearm in their home. SOCIAL CONTEXT

Monroe County Adults With a Firearm in the Home 75%

62%

57% 52% 50% 51% 49% 50% 44% 44%

25%

0% Total Male Female Under 30 30-59 60 & Older Income Income Years <$25K $25K Plus

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 wounded, 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 from 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 with an 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)

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Adult І MENTAL HEALTH AND SUICIDE

Key Findings

In 2015, 3% of Monroe County adults considered attempting suicide. 9% of adults had a period of two or more weeks when they felt so sad or hopeless nearly every day that they stopped doing usual activities.

Adult Mental Health

. 3% of Monroe County adults considered attempting suicide in the past year.

. One percent (1%) of adults reported attempting suicide in the past year.

. In the past year, 9% of Monroe County adults had a period of two or more weeks when they felt so sad or hopeless nearly every day that they stopped doing usual activities, increasing to 12% of those ages 30-59.

. Monroe County adults dealt with stress in the following ways: talk to someone they trust (52%), sleep (37%), eat more or less than normal (33%), exercise (31%), listen to music (31%), work on a hobby (26%), work (20%), take it out on others (13%), drink alcohol (11%), smoke tobacco (8%), meditate (6%), use prescription drugs (4%), use herbs or home remedies (3%), use illegal drugs (2%), gamble/lottery (2%), and other ways (14%).

. Adults would do the following if they knew someone who was suicidal: talk to them (69%), try to calm them down (53%), call a crisis line (47%), call 9-1-1 (39%), take them to the emergency room (25%), call a friend (21%), and other (4%).

. Monroe County adults reported they or a family member were diagnosed with or treated for the following mental health issues: depression (43%), anxiety or emotional problems (34%), an anxiety disorder (33%), attention deficit disorder (ADD/ADHD) (31%), bipolar (24%), illicit drug abuse (12%), developmental disability (10%), post-traumatic stress disorder (PTSD) (8%), life-adjustment disorder (7%), a psychotic disorder (7%), and some other mental health disorder (8%). 36% indicated they or a family member had taken medication for one or more mental health issues.

Monroe County Number of Suicide Deaths, 2010-2014 Total Deaths = 100

30

23 25 22 21 19

20 15 15

10

Number of of Deaths Number 5

0 2010 2011 2012 2013 2014

(Source: MDCH, Vital Statistics)

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The following graphs show the Monroe County suicide counts. The graphs show:

. In 2014, 64% of suicide deaths were males.

. In 2014, 81% of all Monroe County suicide deaths occurred to those ages 24-59 years old.

. In 2014, there were 22 suicide deaths in Monroe County. M

Monroe County Suicide Number of Deaths by Gender 25

ENTAL 20

18 20 17

14 15 13

10 8

5 3 3 2 2

Number of of Reported Cases Number 0 2010 2011 2012 2013 2014

Monroe Males Monroe Females

(Source: MDCH, Vital Statistics)

HEALTH

Monroe County Number of Suicide Deaths By Age Group 2014 Total Deaths = 22 10

8

6

6 5 4 4 3 2

Number of of Deaths Number 2 1 1

0 19-23 24-30 31-39 40-49 50-59 60-69 70+

(Source: Monroe County Suicide Prevention Committee)

91

The following graphs show the Michigan and Monroe County age-adjusted suicide mortality rates per 100,000 population. The graphs show:

. The Monroe County age-adjusted suicide mortality rate fluctuated from year to year, and was less than the Michigan rate from 2011 to 2013.

. The 2012 Monroe County age-adjusted suicide rate was higher than the state and national average.

Monroe County and Michigan Age-Adjusted Suicide Mortality Rates

20 18 16 13.4 12.5 14 12.2 11.8 10.9 10.7 12 10 8

6

4

Rate Rate per population 100,000 2

0 2005-2007 2008-2010 2011-2013 Monroe Michigan

Age-Adjusted Suicide Mortality Rates for Monroe County Residents, Michigan, and U.S.

20 14.8 12.4 12.6 15

10

5 Rate per population 100,000

0

Monroe 2012 Michigan 2012 U.S. 2012

(Source: MDCH, Vital Statistics, Statewide Fatal Injuries, updated 1-8-15, and CDC, Fast Stats, updated 10-8-14)

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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 M . Drug abuse and dependence . Alcohol abuse and dependence . Post-Traumatic Stress Disorder (PTSD) . Eating disorders . Personality disorders ENTAL

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: HEALTH . 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 І ORAL HEALTH

Key Findings Monroe County The 2015, four-fifths (80%) of Monroe County adults Dental Care Resources – 2013 had visited a dentist or dental clinic in the past . General dentists- 48 year. The 2012 BRFSS reported that 67% of U.S. . Specialty Dentists- 7 adults and 68% of Michigan adults had visited a . Healthy Kids Dentists- 54 dentist or dental clinic in the previous twelve . Number of dentists who treated Medicaid months. More than three-quarters (79%) of Monroe patients- 9 County youth in grades 6-12 had visited the dentist . Medicaid Dental Coverage- Healthy Kids for a check-up, exam, teeth cleaning, or other Dental Fee-for-Service, Adult dental work in the past year. (Source: Michigan Oral Health Coalition, 2013) Access to Dental Care

. In the past year, 80% of Monroe County adults had visited a dentist or dental clinic, decreasing to 68% of adults with annual household incomes less than $25,000.

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

. More than four-fifths (86%) of Monroe County adults with dental insurance have been to the dentist in the past year, compared to 65% of those without dental insurance.

. When asked the main reason for not visiting a dentist in the last year, 42% said cost, 18% said fear, apprehension, nervousness, pain, and dislike going, 15% had no oral health problems, 8% could not find a dentist who took Medicaid, 6% had not thought of it, 6% had other priorities, 4% said their dentist did not accept their medical coverage, 4% did not have/know a dentist, 3% could not find a dentist who treats special needs clients, 3% could not get to the office (no transportation), and 1% could not get in to the office/clinic.

. More than one-third (35%) of adults had one or more of their permanent teeth removed, increasing to 60% of those ages 60 and over. The 2012 BRFSS reported that 45% of U.S. adults and 43% of Michigan adults had one or more permanent teeth removed.

. The 2015 Health Assessment reports that 10% of Monroe County adults ages 60 and over had all of their permanent teeth removed. The 2012 BRFSS reported that 16% of U.S. adults and 13% of Michigan adults ages 65 and over had all of their permanent teeth removed.

. Monroe County youth last saw a dentist for a check-up, exam, teeth cleaning, or other dental work: less than a year ago (79%), 1 to 2 years ago (9%), More than 2 years ago (4%), never (1%), and do not know (7%).

Monroe Michigan U.S. Adult Comparisons County 2013 2013 2015 Adults who have visited the dentist in the past 80% 68%* 67%* year

Adults who have had one or more permanent 35% 45%* 43%* teeth removed

* 2012 BFRSS Data

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The following graphs provide information about the frequency of Monroe County adult and youth

dental visits. Examples of how to interpret the information on the first graph include: 80% of all Monroe County adults had been to the dentist in the past year, 92% of those under the age of 30,

and 68% of those with incomes less than $25,000.

Monroe County Adults Visiting a Dentist in the Past Year HEALTH ORAL 100% 92%

80% 82% 81% 77% 77% 80% 74% 68%

60%

40%

20%

0% Total Males Females Under 30 30-59 60 & Older Income Income Years <$25K $25K Plus

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

79% 80% 78% 78% 78% 76% 80%

60%

40%

20%

0%

Total Males Females 13 or younger 14-16 17 or older

95

Adult І PARENTING

Key Findings How to Talk to your Teen about Safe Sex

The 2015 Health Assessment project identified that . Talk calmly and honestly about safe 78% of parents discussed bullying with their 6-to-17 sex. year-old in the past year. More than four-fifths (83%) . Practice talking about safe sex with of parents indicated their child was physically another adult before approaching your active for at least 60 minutes 3 or more days per adolescent. week. . Listen to your adolescent and answer his/her questions honestly. Parenting . Topics that are appropriate for a safe sex discussion may include: STDs and . In the past 5 years, parents indicated their prevention, peer pressure to have sex, infant slept in the following places: birth control, different forms of sexuality, crib/bassinette (with no bumper pads, blankets, and date rape.

and toys) (81%), pack n’ play (55%), in bed with (Source: American Academy of Pediatrics (AAP), them or another person (51%), car seat (42%), Safer Sex Guidelines, crib/bassinette (with bumper pads, blankets, http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/ and toys) (40%), swing (38%), couch or chair adolescent/safesex.html) (21%), and the floor (6%).

. Parents reported their child experienced the following types of bullying in the past year: verbal (36%), indirect (14%), physical (11%), and cyber (4%).

. 86% of parents indicated their child was physically active for at least 60 minutes 3 or more days per week. 65% of children were physically active 5 or more days per week. 4% of children were not physically active, including 3% who were unable to be active.

. Parents discussed the following topics with their 6-to-17 year-old in the past year:

 Bullying (78%)  Negative effects of marijuana and other drugs (38%)  Screen-time (77%)  Energy drinks (34%)

 Physical activity (65%)  Violence (32%)

 Eating habits (61%)  School/legal consequences of using tobacco/alcohol/other drugs (27%)  Body image (50%)  Abstinence/how to refuse sex (25%)

 Negative effects of tobacco (44%)  Weight status (24%)

 Dating and relationships (43%)  Birth control (23%)

 Negative effects of alcohol (43%)  Condom use/safer sex/STD prevention (22%)

 Social media issues (41%)  Negative effects of misusing prescription medication (20%)  Refusal skills/peer pressure (40%) o Anxiety/depression/suicide (20%)

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Youth І WEIGHT STATUS

Key Findings

The 2015 Health Assessment identified that 17% of Monroe County youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 30% of YOUTH Monroe County youth reported that they were slightly or very overweight. 68% of youth were exercising for 60 minutes on 3 or more days per week. 89% 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, 17% of youth were classified as obese by Body Mass Index (BMI) calculations (2013 YRBS reported 13% for Michigan and 14% for the U.S.). 12% of youth were classified as overweight (2013 YRBS reported 16% for Michigan and 17% for the U.S.). 70% were normal weight, and 2% were underweight.

17% of Monroe County youth were classified as obese.

. 30% of youth described themselves as being either slightly or very overweight (2013 YRBS WEIGHT reported 29% for Michigan and 31% for the U.S.).

. Nearly half (46%) of all youth were trying to lose weight, increasing to 58% of Monroe County female youth (compared to 35% of males) (2013 YRBS reported 45% for Michigan and 48% for the U.S.).

. Monroe County youth reported doing the following to lose weight or keep from gaining weight in the past 30 days: o 50% of youth exercised. o 42% of youth drank more water. o 36% of youth ate more fruits and vegetables. o 29% of youth ate less food, fewer calories, or foods lower in fat. o 10% of youth skipped meals. o 3% reported going without eating for 24 hours or more (2013 YRBS reported 13% for Michigan and 13% for the U.S.). o 2% reported taking diet pills, powders, or liquids without a doctor’s advice (2013 YRBS reported 6% for Michigan and 5% for the U.S.). o 2% vomited or took laxatives (2013 YRBS reported 5% for Michigan and 4% for the U.S.). 2% reported smoking to lose weight.

o

Nutrition

. 11% of Monroe County youth ate 5 or more servings of fruits and vegetables per day. 81% ate 1 to 4 servings of fruits and vegetables per day.

. Monroe County youth consumed the following sources of calcium daily: milk (80%), other dairy products (57%), yogurt (36%), calcium-fortified juice (11%), other calcium sources (12%) and calcium supplements (5%).

97

. 32% of youth reported they drank energy drinks for the following reasons: to stay awake (58%), to get pumped up (26%), before games or practice (17%), to help them perform (9%), to mix with alcohol (9%), and some other reason (33%).

. 5% of youth reported they went to bed hungry because their family did not have enough money for food at least one night per week. <1% of youth went to bed hungry every night of the week.

Physical Activity

. 68% of Monroe County youth participated in at least 60 minutes of physical activity on 3 or more days in the past week. 48% did so on 5 or more days in the past week (2013 YRBS reports 50% for Michigan and 47% for the U.S.), and 25% did so every day in the past week (2013 YRBS reports 27% for Michigan and the U.S.). 13% of youth did not participate in at least 60 minutes of physical activity on any day in the past week (2013 YRBS reports 15% for Michigan and the U.S.).

. 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 activities on at least three days per week.

. Monroe County youth spent an average of 3.3 hours on their cell phone, 1.6 hours watching TV, 1.2 hours on their computer/tablet and 1.0 hour 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 27% for Michigan and 33% for the U.S.).

. 89% of youth participated in extracurricular activities. They participated in the following: sports or intramural programs (57%), exercising (outside of school) (47%), school club or social organization (32%), part-time job (25%), church or religious organization (20%), babysitting for other kids (19%), church youth group (19%), volunteering in the community (18%), caring for siblings after school (17%), caring for parents or grandparents (4%) or some other organized activity (Scouts, 4H, etc.) (12%).

Monroe County 6th-12th Grade Youth did the following to lose weight Percent in the past 30 days: Exercised 50% Drank more water 42% Ate more fruits and vegetables 36% Ate less food, fewer calories, or foods lower in fat 29% Skipped meals 10% Went without eating for 24 hours 3% Took diet pills, powders, or liquids without a doctor’s advice 2% Vomited or took laxatives 2% Smoked cigarettes 2%

98

The following graph shows the percentage of Monroe 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: 70% of all Monroe County youth were classified as normal weight, 17% were obese, 12% were overweight, and 2% were underweight for their age and gender.

Monroe County Youth BMI Classifications YOUTH 2% 1% 2% 4% < 1% 3% 100%

80%

70% 69% 71% 67% 66% 60% 81%

40% 15% 10% 12% 9% 20% 16% 17% 21% 8% 18% 21% 11% 7% 0% Total Male Female 13 or younger 14 to 16 17 & Older

Obese Overweight Normal Weight Underweight

WEIGHT

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)

99

Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th -12th) (9th -12th) (6th-12th) (9th-12th) Obese 17% 19% 13% 14%

Overweight 12% 13% 16% 17% Described themselves as slightly or very 30% 30% 29% 31% overweight

Trying to lose weight 46% 46% 45% 48% Went without eating for 24 hours or more 3% 4% 13% 13%

Took diet pills, powders, or liquids without a 2% 3% 6% 5% doctor’s advice

Vomited or took laxatives 2% 2% 5% 4%

Physically active at least 60 minutes per 25% 27% 27% 27% day on every day in past week Physically active at least 60 minutes per 48% 50% 50% 47% day on 5 or more days in past week Did not participate in at least 60 minutes of physical activity on any day in past 13% 14% 15% 15% week Watched TV 3 or more hours per day 22% 23% 27% 33%

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Youth І TOBACCO USE

YOUTH TOBACCO YOUTH Key Findings

The 2015 Health Assessment identified that 7% of Monroe County youth in grades 6-12 were smokers, increasing to 17% of those ages 17 and older. Of those 6th -12th grade youth who currently smoked, 68% had tried to quit.

Youth Tobacco Use Behaviors

. The 2015 health assessment indicated that 24% of Monroe County youth had tried cigarette smoking (2013 YRBS reported 36% for Michigan and 41% for the U.S.).

. 4% of those who had smoked a whole cigarette did so at 10 years old or younger, and another 25% had done so by 12 years old. The average age of onset for smoking was 13.6 years old.

. 5% of all Monroe County youth had smoked a whole cigarette for the first time before the age of 13 (2013 YRBS reported 8% for Michigan and 9% for the U.S.).

. In 2015, 7% of Monroe County youth were current smokers, having smoked at some time in the past 30 days (2013 YRBS reported 12% for Michigan and 16% for the U.S).

. 16% of current smokers smoked cigarettes daily.

. 2% of all Monroe County youth smoked cigarettes on 20 or more days during the past month (2013 YRBS reported that 4% of youth in Michigan smoked cigarettes on 20 or more days during the past month and 6% for the U.S).

In 2015, 7% of Monroe County youth were current smokers, having

smoked at some time in the past 30 days.

. About three-fourths 71% of Monroe County youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days.

. 52% of youth smokers borrowed cigarettes from someone else, 45% indicated they bought cigarettes from a store or gas station (2013 YRBS reported 18% for the U.S.), 32% gave someone else money to buy them cigarettes¸ 29% took them from a family member, 29% said a person 18 years or older gave them the cigarettes, 3% took them from a store, and 6% got them some other way. No one reported getting them from the internet or a vending machine.

. Monroe County youth used the following forms of tobacco the most in the past year: e- cigarettes (17%), hookah (12%), cigarettes (12%), Black and Milds (7%), chewing tobacco or snuff (6%), swishers (5%), cigarillos (5%), cigars (4%), flavored cigarettes (4%), snus (2%), little cigars (1%), bidis (1%), and dissolvable tobacco products (<1%).

. About two-thirds (68%) of Monroe County 6th-12th grade youth smokers had ever tried to quit smoking in the past year (2013 YRBS reported 52% for Michigan and 48% for the U.S.).

. Three-fifths (60%) of Monroe County youth were exposed to second hand smoke. Youth reported being exposed to second hand smoke in the following places; home (29%), another relative’s home (27%), in the car (25%) at a friend’s home (19%), fairgrounds (10%), and park/ball field (6%).

101

The following graph shows the percentage of Monroe County youth who smoke cigarettes. Examples of how to interpret the information include: 7% of all Monroe County youth were current smokers, 8% of males smoked, and 6% of females were current smokers.

Monroe County Youth Who Are Current Smokers

30%

20% 17%

10% 8% 7% 6% 5%

2%

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

17% of all Monroe County youth had vaped e-cigarettes in the past year.

Behaviors of Monroe County Youth Current Smokers vs. Non-Current Smokers Non- Current Youth Behaviors Current Smoker Smoker Participated in extracurricular activities 87% 90% Have had sexual intercourse 82% 21% Exposed to second hand smoke 71% 59% Have had at least one drink of alcohol in the past 30 days 71% 17% Had used marijuana in the past 30 days 68% 8% Had 3 or more stressors 63% 49% Had been bullied in the past 12 months 50% 42% Misused prescription medications in the past 30 days 32% 4% Attempted suicide in the past 12 months 20% 5%

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

102

Monroe Monroe

Michigan U.S. TOBACCO YOUTH County County Youth Comparisons 2013 2013 2015 2015 (9th–12th) (9th–12th) (6th-12th) (9th–12th) Ever tried cigarettes 24% 31% 36% 41% Current smokers 7% 9% 12% 16% Tried to quit smoking (of smokers) 68% 54% 52% 48% Smoked cigarettes on 20 or more days 2% 2% 4% 6% during the past month (of all youth) Smoked a whole cigarette for the first time before the age of 13 (of all 5% 5% 8% 9% youth)

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)

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Youth І ALCOHOL CONSUMPTION

Key Findings

In 2015, the Health Assessment results indicated that 48% of Monroe County youth in grades 6-12 had drank at least one drink of alcohol in their life, increasing to 68% of youth seventeen and older. 27% of those 6th-12th graders who drank, took their first drink at 12 years or younger. 21% of all Monroe County 6th-12th grade youth and 41% of those over the age of 17 had at least one drink in the past 30 days. Half (50%) of the 6th-12th grade youth who reported drinking in the past 30 days had at least one episode of binge drinking.10% of all youth drivers had driven a car in the past month after they had been drinking alcohol.

Youth Alcohol Consumption

. In 2015, the Health Assessment results indicated that nearly half (48%) of all Monroe County youth (ages 12 to 18) had at least one drink of alcohol in their life, increasing to 68% of those ages 17 and older (2013 YRBS reports 60% for Michigan and 66% for the U.S.).

. 21% of youth had at least one drink in the past 30 days, increasing to 41% of those ages 17 and older (2013 YRBS reports 28% for Michigan and 35% for the U.S.).

. Of those who drank, 50% had five or more alcoholic drinks on an occasion in the last month and would be considered binge drinkers by definition, increasing to 60% of those ages 17 and older.

. Based on all youth surveyed, 11% were defined as binge drinkers, increasing to 25% of those ages 17 and older (2013 YRBS reports 17% for Michigan and 21% for the U.S.).

. Over one-quarter (27%) of Monroe County youth who reported drinking at some time in their life had their first drink at 12 years old or younger; 32% took their first drink between the ages of 13 and 14, and 42% started drinking between the ages of 15 and 18. The average age of onset was 13.5 years old.

. Of all Monroe County youth, 12% had drunk alcohol for the first time before the age of 13 (2013 YRBS reports 14% of Michigan youth drank alcohol for the first time before the age of 13 and 19% for the U.S.).

. Monroe County youth drinkers reported they got their alcohol from the following: someone gave it to them (33%)(2013 YRBS reports 33% for Michigan and 42% for the U.S.), an older friend or sibling bought it (24%), someone older bought it (21%), gave someone else money to buy it (13%), a parent gave it to them (12%), a friend’s parent gave it to them (5%), bought it in a liquor store/ convenience store/gas station (4%), took it from a store or family member (3%), bought it at a restaurant/bar/club (3%), bought it with a fake ID (2%), bought it at a public event (1%), and got it some other way (25%).

. Monroe County youth drinkers reported usually drinking their alcohol in the past month at the following: at another person’s home (70%), at their home (51%), at a restaurant, bar, or club (7%), at a public place such as a park, beach, or parking lot (5%), while riding in or driving a car or another vehicle (2%), at a public event such as a concert or sporting event (2%), and on school property (2%).

. During the past month, 19% of all Monroe County youth had ridden in a car driven by someone who had been drinking alcohol (2013 YRBS reports 20% for Michigan and 22% for the U.S.).

. 10% of youth drivers had driven a car in the past month after they had been drinking alcohol (2013 YRBS reports 6% for Michigan and 10% for the U.S.).

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

YOUTH

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

80% 68%

60% 48% 48% 48% 50%

40% 25%

20%

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

ALCOHOL

Based on all Monroe County youth surveyed, 11% were defined as binge

drinkers.

Monroe County Youth Who Are Current Drinkers 60%

41%

40%

24% 21% 20% 17% 20%

3%

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

105

The following graph shows the percentage of Monroe County youth who were binge drinkers. Examples of how to interpret the information include: 50% of current drinkers binge drank in the past month, 59% of males, and 38% of females had binge drank. The table shows differences in specific risk behaviors between current drinkers and non-current drinkers.

Monroe County Youth Current Drinkers Who Binge Drank in Past Month*

100%

80% 59% 60%

60% 50% 50%

38% 39% 40%

20%

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

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

12% of Monroe County youth drinkers reported they got their alcohol from

a parent giving it to them.

Behaviors of Monroe County Youth Current Drinkers vs. Non-Current Drinkers Non- Current Youth Behaviors Current Drinker Drinker Participated in extracurricular activities 90% 90% Have had sexual intercourse 62% 16% Have been bullied in the past 12 months 55% 40% Have had 3 or more adverse childhood experiences 39% 19% Have used marijuana in the past 30 days 37% 6% Have smoked cigarettes in the past 30 days 24% 3% Misused prescription medications in the past 30 days 13% 4% Attempted suicide in the past 12 months 11% 4%

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

Of all Monroe County youth, 12% had drunk alcohol for the first time before

the age of 13.

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Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th–12th) (9th–12th) (6th-12th) (9th–12th) YOUTH Ever tried alcohol 48% 58% 60% 66% Current drinker 21% 28% 28% 35% Binge drinker (of all youth) 11% 14% 17% 21% Drank for the first time before age 13 12% 12% 14% 19% (of all youth) Rode with someone who was drinking 19% 22% 20% 22% Drank and drove (of youth drivers) 10% 10% 6% 10% Obtained the alcohol they drank by 33% 40% 33% 42% someone giving it to them

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 ALCOHOL • 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)

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Youth І DRUG USE

Key Findings

In 2015, 12% of Monroe County 6th-12th grade youth had used marijuana at least once in the past 30 days, increasing to 27% of those ages 17 and older. 6% of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life.

Youth Drug Use

. In 2015, 12% of all Monroe County youth had used marijuana at least once in the past 30 days, increasing to 27% of those over the age of 17.

. The 2013 YRBS found a prevalence of 18% for Michigan youth and a prevalence of 23% for U.S. youth who had used marijuana at least once in the past 30 days.

. During the past 12 months, 8% of all Monroe County youth reported that someone had offered, sold, or given them an illegal drug on school property, increasing to 11% of high school youth (2013 YRBS reports 24% for Michigan and 22% for the U.S.).

. Youth reported they had been pressured to engage in the following in the past year: drink alcohol (12%), use drugs (9%), smoke cigarettes (8%), participate in sexual intercourse (5%), and participate in other sexual activities (6%).

. Monroe County youth have tried the following in their life: o 4% used K2/spice o 4% of youth used inhalants, (2013 YRBS reports 7% for Michigan and 9% for the U.S.) o 2% misused cough syrup o 2% used cocaine, (2013 YRBS reports 4% for Michigan and 6% for U.S.) o 2% used steroids without a doctor’s prescription, (2013 YRBS reports 3% for Michigan and U.S.) o 2% misused over-the-counter medications o 2% used ecstasy/MDMA (2013 YRBS reports 7% for the U.S.) o 2% used liquid THC o 2% used posh/salvia/synthetic marijuana o 1% misused hand sanitizer o 1% used methamphetamines, (2013 YRBS reports 3% for Michigan and the U.S.) o 1% used heroin, (2013 YRBS reports 3% for Michigan 2% and for the U.S.) o 1% had been to a pharm party/used skittles o 1% used bath salts o 1% used Cloud 9 o 1% used GhB

. 6% of youth reported they used medications that were either not prescribed for them or took more than prescribed to feel good, high or more alert at some time in their life. Of those who misused medication, they reported using the following: Ritalin, Adderall, Concerta, or other ADHD medications (11%), Tranquilizers/sleeping pills, such as Valium or Xanax, barbiturates, Seconal, Ativan or Klonopins (10%), Vicodin (10%), Codeine, Demerol, Morphine, Percodan or Dilaudid (6%) steroids (4%), OxyContin (2%), and Suboxone or Methadone (1%). No one reported using Ultram.

. Youth who misused prescription medications got them in the following ways: a friend gave it to them (54%), a parent gave it to them (18%), they took it from a friend or family member (18%), bought it from a friend (11%), another family member gave it to them (7%), bought it from someone else (7%), and the internet (4%).

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The following graphs are data from the 2015 Monroe County Health Assessment indicating youth YOUTH 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 4% of youth have used inhalants at some point in their life.

Monroe County Youth Lifetime Drug Use

15%

10%

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

Total Male Female

12% of Monroe County youth had used marijuana in the past month.

Monroe County Youth Marijuana Use in Past Month 30% 27%

25%

20%

15% 12% 13% 11% 9% 10%

4%

5%

0% Total Male Female 13 or younger 14 to 16 17 or older

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The following graph is data from the 2015 Monroe County Health Assessment indicating youth lifetime prescription medication abuse. Examples of how to interpret the information include: 6% of youth have misused medication at some point in their life.

Monroe County Youth Lifetime Prescription Medication Abuse 25%

20%

15%

10% 8% 8% 7% 6% 5% 5% 2%

0% Total Male Female 13 or younger 14 to 16 17 or older

Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th-12th) (9th-12th) (6th-12th) (9th-12th) Youth who used marijuana in the past 12% 16% 18% 23% month

Ever used methamphetamines 1% 1% 3% 3% Ever used cocaine 2% 3% 4% 6%

Ever used heroin 1% 2% 3% 2% Ever used steroids 2% 3% 3% 3%

Ever used inhalants 4% 4% 7% 9% Ever misused medications 6% 8% 16% 18%

Ever used ecstasy/MDMA 2% 2% N/A 7% Ever been offered, sold, or given an illegal drug by someone on school property in the 8% 11% 24% 22% past year

N/A - Not available

Drug Facts: Drugged Driving

. Vehicle accidents are the leading cause of death among youth people aged 16 to 19. When teens’ relative lack of driving experience is combined with the use of marijuana or other substances that affect cognitive and motor abilities, the results can be tragic. . According to the 2013 National Survey on Drug Use and Health (NSDUH), an estimated 9.9 million people aged 12 or older reported driving under the influence of illicit drugs during the year prior to being surveyed. . After alcohol, THC (delta-9-tetrahydrocannabinol), the active ingredient in marijuana is the substance most commonly found in the blood of impaired drivers, fatally injured drivers, and motor vehicle crash victims. Studies in several localities have found that approximately 4 to 14 percent of drivers who sustained injury or died in traffic accidents tested positive for THC.

(Source: National Institute on Drug Abuse, The Science of Drug Abuse & Addiction: Drug Facts: Drugged Driving, http://www.drugabuse.gov/publications/drugfacts/drugged-driving, revised 12-14)

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Youth І SEXUAL BEHAVIOR

Key Findings

SEXUAL BEHAVIOR In 2015, just over one-quarter (26%) of Monroe County youth have had sexual intercourse, increasing to 57% of those ages 17 and over. 30% of youth had participated in oral sex and 5% had participated in anal sex. 23% of youth participated in sexting. Of those who were sexually active, 58% had multiple sexual partners. Four Monroe County schools did not ask sexual behavior questions.

Youth Sexual Behavior

. Four Monroe County schools did not ask sexual behavior questions.

. Just over one-quarter (26%) of Monroe County youth have had sexual intercourse, increasing to 57% of those ages 17 and over. The 2013 YRBS reports 38% for Michigan and 47% of U.S. youth have had sexual intercourse.

. 30% of youth had participated in oral sex, increasing to 60% of those ages 17 and over.

. 5% of youth had participated in anal sex, increasing to12% of those ages 17 and over.

. 23% of youth had participated in sexting, increasing to 38% of those ages 17 and over.

. 24% of youth had viewed pornography, increasing to 33% of males and 38% of those ages 17 and over.

. Of those youth who were sexually active in their lifetime, 42% had one sexual partner and 58% had multiple partners.

. 29% of all Monroe County sexually active youth had 4 or more partners (2013 YRBS reports 28% for Michigan).

. 8% of all Monroe County youth had 4 or more sexual partners (2013 YRBS reports 8% for Michigan and 15% for the U.S.).

. Of those youth who were sexually active, 14% had done so by the age of 13. Another 48% had done so by 15 years of age. The average age of onset was 15.2 years old.

. Of all youth, 3% were sexually active before the age of 13 (2013 YRBS reports 3% for Michigan and 6% for the U.S).

. 57% of youth who were sexually active used condoms to prevent pregnancy, 35% used birth control pills, 7% used the withdrawal method, 5% used a shot, patch or birth control ring, 2% used an IUD and 5% used some other method. 5% reported they were gay or lesbian. However, 11% were engaging in intercourse without a reliable method of protection and 9% reported they were unsure.

. 37% of Monroe County youth, who had participated in any sexual activity, always used protection when engaging in oral, anal, or sexual intercourse.

. Of those Monroe County youth that reported not always using protection when engaging in oral, anal, or sexual intercourse, they gave the following reasons: did not want to use protection (23%), did not have protection available to them (22%), their partner did not want to use protection (19%), and it did not occur to them (16%).

. Monroe County youth had experienced the following: had sex in exchange for something of

value such as food, drugs, shelter or money (2%), been pregnant (2%), wanted to get pregnant (1%), had a child (1%), had been treated for an STD (1%), had a miscarriage (<1%), and got someone pregnant (<1%). No one reported trying to get pregnant or having an abortion.

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The following graphs show the percentage of Monroe County youth who participated in sexual intercourse and oral sex. Examples of how to interpret the information include: 26% of all Monroe County youth had sexual intercourse, 20% of males, and 32% of females had sex.

Monroe County Youth Who Had Sexual Intercourse 75%

57%

50%

32% 26% 25% 20% 15%

1% 0% Total Male Female 13 or Younger 14 to 16 17 & Older

11 % of Monroe County youth who were sexually active were not using a reliable method of protection to prevent pregnancy.

Monroe County Youth Who Participated in Oral Sex 75% 60%

50% 33% 30% 26% 21% 25%

1% 0% Total Male Female 13 or Younger 14 to 16 17 & Older

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The following graphs show the percentage of Monroe County youth who participated in anal sex and sexting. Examples of how to interpret the information include: 5% of all Monroe County youth participated in anal sex, 4% of males, and 6% of females.

SEXUAL BEHAVIOR Monroe County Youth Who Participated in Anal Sex 50%

25%

12%

5% 6% 4% 3% 0% 0% Total Male Female 13 or Younger 14 to 16 17 & Older

Monroe County Youth Who Participated in Sexting 75%

50%

38%

26% 23% 23% 21% 25%

3%

0% Total Male Female 13 or Younger 14 to 16 17 & Older

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The following graph shows the Monroe County and Michigan teen birth rate per 1,000 population. The graph shows:

. The Monroe County teen birth rates were lower than the Michigan rates from 2011-2013.

Teen Birth Rates for Monroe County and Michigan* 50

45 44.5

40 41.1

38.2 35 36.8

32.1 Rate Rate per Population 1,000 30 30.5

25 2011 2012 2013

Monroe Michigan

*Teen birth rates include women ages 15-19 (Source: Michigan Department of Health & Human Services, Community Health Information)

Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th–12th) (9th–12th) (6th–12th) (9th–12th) Ever had sexual intercourse 26% 35% 38% 47% Used a condom at last intercourse 57% 58% 61% 59% Used birth control pills at last intercourse 35% 37% 22% 19% Did not use any method to prevent 11% 11% 9% 14% pregnancy during last sexual intercourse Had four or more sexual partners 8% 11% 8% 15% (of all youth) Had sexual intercourse before age 13 3% 4% 3% 6% (of all youth)

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Youth І MENTAL HEALTH AND SUICIDE

Key Findings

In 2015, the Health Assessment results 2013 Michigan Suicide Statistics for Youth MENTAL indicated that 11% of Monroe Grades 9-12

County 6th-12th grade youth had . 16% of Michigan youth seriously considered seriously considered attempting attempting suicide in the 12 months prior to the suicide in the past year and 6% survey. admitted actually attempting . 15% of Michigan youth made a plan about how suicide in the past year. they would attempt suicide in the 12 months prior to the survey. Youth Mental Health . 9% of youth had attempted suicide one or more times in the 12 months prior to the survey. . In 2015, nearly one-quarter (23%) . 3% of youth had a suicide attempt that resulted in of youth reported they felt so sad an injury, poisoning, or an overdose that had to be or hopeless almost every day for treated by a doctor or nurse in the 12 months prior two weeks or more in a row that to the survey. they stopped doing some usual activities, increasing to 33% of (Source: Centers for Disease Control and Prevention, Healthy Youth, YRBSS 2013) females (2013 YRBS reported 27% for Michigan and 30% for the U.S.).

. 11% of youth reported they had seriously considered attempting suicide in the past 12 months, the 2013 YRBS rate of 16% for Michigan youth and 17% for U.S. youth.

. In the past year, 6% of Monroe County youth had attempted suicide, increasing to 9% of

females. 2% of youth had made more than one attempt. The 2013 YRBS reported a suicide HEALTH attempt prevalence rate of 9% for Michigan youth and 8% for U.S. youth.

. Of all youth, 1% made a suicide attempt that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse, (2013 YRBS reported 3% for Michigan and the U.S.).

. Of those who attempted suicide, 14% resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse.

. 48% of youth reported they would seek help if they were dealing with anxiety, stress, depression or thoughts of suicide. Of youth who reported they would not seek help the following reasons were reported: they can handle it themselves (67%), worried what others might think (39%), did not know where to go (28%), no time (20%), cost (18%), their family would not support them (16%), and transportation (11%).

. Monroe County youth reported the following causes of anxiety, stress and depression: academic success (38%), fighting at home (26%), fighting with friends (25%), sports (24%), self- image (23%), death of close family member or friend (23%), being bullied (17%), dating relationship (16%), peer pressure (15%), breakup (15%), parent divorce/separation (13%), caring for younger siblings (11%), poverty/no money (9%), ill parent (7%), alcohol or drug use at home (7%), not feeling safe at home (5%), not having enough to eat (4%), parent lost their

job (4%), parent/caregiver with a substance abuse problem (4%), family member in the military (4%), not feeling safe in the community (4%), sexual orientation (2%), not having a place to live (1%), parent with a mental illness (1%), and other stress at home (15%).

. When Monroe County youth are dealing with personal problems or feelings of depression or suicide, they usually talk to the following: best friend (27%), parent/guardian (20%), girlfriend/boyfriend (15%), brother/sister (11%), teacher (4%), school counselor (3%), professional counselor (2%), coach (2%), pastor/priest/religious leader (3%), youth minister (3%), scout master/club advisor (1%), and someone else (6%). 13% reported they talk to no one.

115

The following graphs show the percentage of Monroe 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, 14% of males and 33% of females).

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

40% 33% 32%

30% 23% 20% 19% 20% 14%

10%

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

Monroe County youth reported the following leading causes of anxiety,

stress and depression: academic success (38%), fighting at home (26%), fighting with friends (25%) and sports (24%).

Monroe County Youth Who Attempted Suicide in Past 12 Months 15%

9%

10% 8% 8%

6% 4% 5% 3%

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

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Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th-12th) (9th-12th) (6th-12th) (9th-12th) MENTAL Youth who had seriously considered 11% 11% 16% 17% attempting suicide in the past year Youth who had attempted suicide in the past 6% 5% 9% 8% year Suicide attempt resulted in an injury, poisoning, or overdose that had to be treated by a 1% 1% 3% 3% doctor or nurse (of all youth) Youth who felt sad or hopeless almost every 23% 25% 27% 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 HEALTH . 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)

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Youth І SAFETY

Key Findings

In 2015, 19% of youth had ridden in a car driven by someone who had been drinking alcohol in the past month and 10% of youth drivers had driven after drinking alcohol. 32% of youth drivers texted while driving.

1 4% of Monroe County youth had suffered a blow or jolt to their head while playing with a sports team in the past year.

Personal Safety

. In the past 30 days, 19% of youth had ridden in a car driven by someone who had been drinking alcohol, (2013 YRBS reported 20% for Michigan and 22% for the U.S.) and 10% of youth drivers had driven a car themselves after drinking alcohol, (2013 YRBS reported 6% for Michigan and 10% for the U.S.).

. Monroe County youth drivers did the following while driving in the past month: wore a seatbelt (74%), ate (49%), talked on their cell phone (45%), texted (32%), used the internet on their cell phone (16%), used cell phone for other things (9%), checked Facebook on their cell phone (6%), used illegal drugs (6%), misused prescription drugs (4%), applied makeup (3%), drank alcohol (3%), played electronic games on cell phone (4%) and read (2%)

. 92% of youth had a Twitter, Instagram, Facebook, online gaming, or other social network account.

. Of those who had an account, they reported the following: o They knew all of “my friends” (52%) o Their account was currently checked private (41%) o Their parents had their password (21%) o They knew all of the people they play online (14%) o They had been asked to share personal info (11%) o They had been asked to meet someone they met online (8%) o Their parents do not know they have an account (7%) o They were bullied because of their accounts (6%) o They share personal information (6%) o Their friends had their password (5%) o They had problems as a result of their account (5%) o They had participated in sexual activity with someone they met online (2%)

. Nearly half (49%) 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

. 14% of youth reported in the past year they had suffered a blow or jolt to their head while playing with a sports team (either during a game or during practice) which caused them to get “knocked out”, have memory problems, double or blurry vision, headaches or “pressure” in the head, or nausea or vomiting.

. Over three-fourths (79%) of youth had been to the dentist for a check-up, exam, teeth cleaning or other dental work in the past year.

. In the past year, 8% of Monroe County youth reported using an indoor tanning device such as a sunlamp, sunbed, or tanning booth (2013 YRBS reported 13% for the U.S.).

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. Youth reported they preferred to get information about their health from the following:

parents (67%), the internet (39%), school (31%), friends (22%), siblings (10%), TV (9%), Twitter (5%), Facebook (4%), Instagram (4%), and the radio (3%).

. Monroe County youth reported that their parent or guardian regularly did the following: asked about homework (71%), talked with them about school (68%), made the family eat a meal together (57%), helped them with school work (54%), went to meetings or events at their SAFETY YOUTH school (46%), talked with them about healthy choices (45%), talked with them about alcohol, drug use or sex (33%) and talked with them about social media (33%). 9% of youth reported their parents did not talk to them about any of these issues.

. Monroe County youth reported the following adverse childhood experiences (ACE): parents became separated or were divorced (34%), parents or adults in home swore at them, insulted them or put them down (29%), lived with someone who was a problem drinker or alcoholic (22%), lived with someone who was depressed, mentally ill or suicidal (18%), lived with someone who served time or was sentenced to serve in prison or jail (16%), parents were not married (13%), lived with someone who used illegal drugs or misused prescription drugs (13%), parents or adults in home abused them (8%), parents or adults in home abused each other (6%), an adult or someone 5 years older than them touched them sexually (4%), an adult or someone 5 years older tried to make them touch them sexually (3%), and an adult or someone 5 years older than them forced them to have sex (2%).

. 24% of youth had three or more adverse childhood experiences.

Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th-12th) (9th-12th) (6th-12th) (9th-12th) Ridden with someone who had been drinking 19% 22% 20% 22% alcohol in past month Drank and drove (of youth drivers) 10% 10% 6% 10% Used an indoor tanning device in past year 8% 11% N/A 13% N/A – Not available

Adverse Childhood Experiences (ACE)

. Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACE) are common. The most common are separated or

divorced parents, verbal, physical or sexual abuse, witness of domestic violence, and having a family member with depression or mental illness. . According to the CDC, 59% of people surveyed in 5 states in 2009 reported having had at least one ACE while 9% reported five or more ACEs. . The short and long-term outcomes of these childhood exposures include a multitude of health and social problems such as: • Depression • Alcoholism and alcohol abuse

• Fetal death • COPD

• Illicit drug use • Unintended pregnancies • Liver disease • Suicide attempts • STD’s • Early initiation of smoking • Multiple sexual partners • Risk for intimate partner violence . Given the high prevalence of ACEs, additional efforts are needed at the state and local levels to reduce and prevent childhood maltreatment and associated family dysfunction in the US.

(Source: CDC, Adverse Childhood Experiences (ACE) Study, January 18, 2013, http://www.cdc.gov/ace/about.htm & Adverse Childhood Experiences Reported by Adults, Last Reviewed: June 3, 2011, http://www.cdc.gov/features/dsaces/index.html)

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Youth І VIOLENCE ISSUES

Key Findings

In Monroe County, 21% of youth had been involved in a physical fight in the past year. 5% of youth had been threatened or injured with a weapon on school property in the past year. 44% of youth had been bullied in the past year and 28% had been bullied on school property.

Violence-Related Behaviors

. In 2015, 12% of youth had carried a weapon (such as a gun, knife or club) in the past 30 days, increasing to 21% of males (2013 YRBS reported 16% for Michigan and 18% for the U.S.).

. 3% of youth had carried a weapon (such as a gun, knife or club) on school property in the past 30 days (2013 YRBS reported 4% for Michigan and 5% for the U.S.).

. 5% 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 in the past month (2013 YRBS reported 7% for Michigan and the U.S.).

. 5% of youth were threatened or injured with a weapon on school property in the past year (2013 YRBS reported 7% for Michigan and the U.S.)

. 44% of youth had been bullied in the past year. The following types of bullying were reported: o 35% were verbally bullied (teased, taunted or called harmful names) o 23% were indirectly bullied (spread mean rumors about them or kept them out of a “group”) o 10% were cyber bullied (teased, taunted or threatened by e-mail or cell phone) (2013 YRBS reported 15% for Michigan and the U.S.). o 8% 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, 28% of youth had been bullied on school property (2013 YRBS reported 25% for Michigan and 20% for the U.S.).

. In the past year, 21% of youth had been involved in a physical fight, increasing to 30% of males. 12% had been in a fight on more than one occasion (2013 YRBS reported 22% for Michigan and 25% for the U.S.).

. In the past year, 7% of youth had been involved in a physical fight on school property (2013 YRBS reported 7% for Michigan and 8% 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 9% for Michigan and 10% for the U.S.).

. 10% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months.

. Monroe County youth had been forced to engage in the following: touched in an unsafe sexual way (4%), sexual intercourse (3%), other sexual activity (2%), and oral sex (2%).

. 18% of youth had purposefully hurt themselves at some time in their lives. They did so in the following ways: cutting (11%), scratching (8%), hitting (7%), burning (4%), biting (3%), and self-embedding (1%).

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The following graph shows Monroe County youth who were bullied in the past year. The graph shows the number of youth in each segment giving each answer (i.e., the graph shows that 44% of

all youth were bullied in the past year, 38% of males and 50% of females).

YOUTH Monroe County Youth Bullied in the Past Year

75%

53% 50% 44% 50% 41% 38% 34%

25%

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

Types of Bullying Monroe County Youth Experienced in Past Year VIOLENCE 14-16 13 or 17 and Youth Behaviors Total Male Female Years younger older old Verbally Bullied 35% 33% 37% 42% 36% 25%

Indirectly Bullied 23% 13% 32% 29% 21% 19% Cyber Bullied 10% 5% 16% 8% 10% 12%

Physically Bullied 8% 11% 4% 14% 4% 8% Sexually Bullied 2% 1% 4% 3% 2% 2%

Behaviors of Monroe County Youth Bullied vs. Non-Bullied Non- Youth Behaviors Bullied Bullied Have drank alcohol in the past 30 days 28% 17%

Purposefully hurt themselves at some time in their life 27% 11%

Contemplated suicide in the past 12 months 18% 7%

Have used marijuana in the past 30 days 14% 11%

Have smoked cigarettes in the past 30 days 8% 6%

Misused prescription medications in the past 30 days 8% 5%

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Monroe Monroe Michigan U.S. County County Youth Comparisons 2013 2013 2015 2015 (9th-12th) (9th-12th) (6th-12th) (9th-12th)

Carried a weapon in past month 12% 13% 16% 18% Carried a weapon on school property in past 3% 3% 4% 5% month Been in a physical fight in past year 21% 18% 22% 25% Been in a physical fight on school property in 7% 6% 7% 8% past year Threatened or injured with a weapon on school 5% 5% 7% 7% property in past year Did not go to school because felt unsafe 5% 5% 7% 7% Electronically/cyber bullied in past year 10% 11% 19% 15% Bullied in past year 44% 40% N/A N/A Bullied on school property in past year 28% 22% 25% 20%

Hit, slapped, or physically hurt on purpose by 4% 3% 9% 10% their boyfriend or girlfriend in past year N/A – Not available

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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Appendix I І MONROE COUNTY HEALTH ASSESSMENT INFORMATION SOURCES

Source Data Used Website American Academy of Allergy . Asthma and Immunology www.aaaai.org/about -the- APPENDIX aaaai/newsroom/asth ma-statistics.aspx American Cancer Society, . 2015 Cancer Facts, Figures, Cancer Facts and Figures 2015. and Estimates www.cancer.org Atlanta: ACS, 2015 . Nutrition Recommendations . Type 1 and 2 Diabetes American Diabetes Association . Risk Factors for Diabetes www.diabetes.org . Diabetes Statistics in America American Foundation for Suicide . Warning Signs for Suicide www.afsp.org/ Prevention . Stroke Warning Signs and Symptoms . Smoke-free Living: Benefits & www.heart.org/HEART American Heart Association Milestones ORG/ . Heart Attack Warning Signs and Symptoms Arthritis at a Glance, 2012, Centers for Disease Control & www.cdc.gov/chronic Prevention, Morbidity and disease/resources/pu . Arthritis Statistics Mortality Weekly Report 2010; blications/AAG/arthriti 59(39):999-1003 & 59(39):1261- s.htm 1265 Behavioral Risk Factor Surveillance System, National Center for Chronic Disease . 2009 - 2013 Adult Michigan Prevention and Health www.cdc.gov and U.S. Correlating Statistics Promotion, Behavioral

Surveillance Branch, Centers for Disease Control

www.bradycampaign I

.org/sites/default/files/ Brady Campaign to Prevent Gun . Victims of Gun Violence GunDeathandInjurySt Violence atSheet3YearAverage FINAL.pdf

123

Source Data Used Website . Adult Vaccinations . Asthma Attacks . Binge Drinking Among Women . Breast Cancer in Young Women . Cancer and Men . Distracted Driving . Impact of Arthritis . Health Care Access Among the Employed and Unemployed Center for Disease Control and . Health Care Access and www.cdc.gov Prevention (CDC) Utilization . Health Insurance Coverage . HIV in the U.S. . Heart Health and Stroke Facts . Impaired Driving . Men’s Health Data . Obesity Facts . Physical Activity among Adults with Disabilities . Tips for Parents . Yearly Flu Shots www.cdc.gov/healthy CDC, Adolescent and School . Physical Activity Facts youth/physicalactivity Health /facts.htm

CDC, Adverse Childhood . Adverse Childhood www.cdc.gov/ace/a Experiences (ACE) Experiences (ACE) bout.htm

. Adverse Childhood CDC, Adverse Childhood www.cdc.gov/feature Experiences (ACE) Reported Experiences (ACE) s/dsaces/index.html by Adults www.cdc.gov/arthritis CDC, Arthritis . Key Public Health Messages /basics/key.htm . Violence Prevention www.cdc.gov/violenc CDC, Injury Center . Suicide Prevention eprevention/pub/yout . Youth Suicide h_suicide.html www.cdc.gov/violenc . Violence Prevention eprevention/pub/und CDC, Injury Center . Understanding Bullying Fact erstanding_bullying.ht Sheet ml . Leading Causes of Death in U.S. CDC, National Center for Health . Men’s Health www.cdc.gov/nchs/f Statistics . U.S. Female Fertility Rate astats/

. U.S. Births to Unwed Mothers . U.S. Low Birth Weight, Live Births

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Source Data Used Website

www.cdc.gov/physic CDC, Physical Activity for . Physical Activity alactivity/everyone/g Everyone Recommendations uidelines/adults.html

www.cancer.org/can

cer/news/electronic- . Electronic Cigarettes and CDC, Press Release cigarette-use- Teenagers in the U.S. doubles-among- teenagers . U.S. Chlamydia and APPENDIX Gonorrhea Rates CDC, Sexually Transmitted www.cdc.gov/std/stat . STD’s in Adolescents and Diseases Surveillance, 2014 s/ Young Adults . U.S. STD Surveillance Profile www.cdc.gov/vaccin CDC, Vaccine Safety, Human . Human Papillomavirus esafety/vaccines/HPV Papillomavirus (HPV) /Index.html . Cigarette Expenditures . Alcohol Beverage Expenditures www.communitycom Community Commons . Beer, Wine and Liquor Stores mons.org/ . Bars and Drinking Establishments Community Health Rankings and www.countyhealthran . Healthcare Statistics Roadmaps kings.org/ . All Healthy People 2020 Target Healthy People 2020: U.S. Data Points www.healthypeople.g Department of Health & Human . Some U.S. Baseline Statistics ov/2020/topicsobjecti Services . Predictors of Access to Health ves2020 Care www.legacyforhealth. org/content/down load/582/6926/file Legacy for Health . Tobacco Fact Sheet /LEG-FactSheet- eCigarettes- JUNE2013.pdf

National Institute on Drug Abuse . Abuse of Prescription Drugs www.drugabuse.gov

www.cdc.gov/nchs/d

National Vital Statistics Report . Live Birth Data ata/nvsr/nvsr61/nvsr61 I _01.pdf#table01 www.michigan.gov/m Michigan Community Health . Incidence of Cancer dch/0,4612,7-132- Information 2944_5326---,00.html www.michigan.gov/d Michigan Department of . Medicaid Health Plan Enrollees ocuments/mdch/JE02 Community Health 072014_462792_7.pdf . Monroe County Dental Care Michigan Oral Health Coalition www.mohc.org/ Resources www.michigan.gov/m Michigan Cancer Surveillance . Age-Adjusted Cancer dch/0,4612,7-132- Program Mortality Rates 2945_5221-16586-- ,00.html

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Source Data Used Website . Age-Adjusted Mortality Rates for Diabetes . Age-Adjusted Mortality Rates for Motor Vehicle Accidents . Heart Disease and Stroke Mortality Rates . Incidence of Cancer Michigan Department of . Monroe County and Michigan www.Michigan.gov/m Community Health, Vital Statistics Mortality Statistics dch . Monroe County and Michigan Birth Statistics . Monroe County and Michigan Leading Causes of Death . Motor Vehicle Deaths . Natality and Pregnancy . Sexually Transmitted Diseases . 2013 Traffic Crash Facts www.michigantrafficc Michigan Traffic Crash Facts . Fatal Crashes and Fatalities rashfacts.org/ with Drinking Involvement www.drugabuse.gov/ . The Science of Drug Abuse publications/drugfacts National Institute on Drug Abuse and Addiction /drugged-driving, . Drug Facts: Drugged Driving revised 12-14 www.smokefreephilly. org/smokfree_philly/as Philadelphia Department of . Electronic Cigarette Fact sets/File/Electronic%20 Public Health Sheet Cigarette%20Fact%20 Sheet_2_27_14.pdf www.psychologytoda y.com/blog/teen- . Teen Angst Psychology Today angst/201301/teen- . Teen Binge Drinking binge-drinking-all-too- common The Partnership at Drugfree.org, . Synthetic Drugs: Bath Salts, www.drugfree.org Parents 360, 2012 K2/Spice A guide for parents and other influencers . American Community Survey 1 year estimate, 2013 . Michigan and Monroe County 2013 Census Demographic U. S. Department of Commerce, Information www.census.gov Census Bureau; Bureau of . Michigan and U.S. Health Economic Analysis Insurance Sources . Small Area Income and Poverty Estimates . Federal Poverty Thresholds www.wmich.edu/suici Western Michigan University . Facts About Suicide deprevention/basics/f acts

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Appendix II І MONROE COUNTY ACRONYMS AND TERMS

AHS Access to Health Services (topic area for Healthy People 2020)

Adult Defined as 19 years of age and older.

Age-Adjusted Death rate per 100,000 adjusted for the age APPENDIX 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. CBP U.S. Census Bureau’s County Business Patterns data series. CDC Centers for Disease Control and Prevention. CVD Cardiovascular Disease Current Smoker Individual who has smoked at least 100 cigarettes in their lifetime and now smokes daily or on some days. HCNO Hospital Council of Northwest Ohio HDS Heart Disease and Stroke (topic area for Healthy People 2020) 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. II High Blood Cholesterol 240 mg/dL and above High Blood Pressure Systolic >140 and Diastolic > 90

IID Immunization and Infectious Diseases (topic area for Healthy People 2020) MDCH Michigan Department of Community Health N/A Data is not available.

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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. SAMHSA Substance and Mental Health Services Administration Weapon Defined in the YRBSS as “a weapon such as a gun, knife, or club” Youth Defined as 12 through 18 years of age 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. Youth Binge Drinking Consumption of five alcoholic beverages or more on one occasion. YRBSS Youth Risk Behavior Surveillance System, a youth survey conducted by the CDC

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Appendix III І METHODS FOR WEIGHTING THE 2015

MONROE COUNTY APPENDIX III

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 Monroe County survey, a weighting was applied prior to the analysis that weighted the survey respondents to reflect the actual distribution of Monroe 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 Monroe 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 Monroe County Survey and the 2013 Census Estimates from the Census.

2015 Monroe Survey 2013 Census Estimate Weight

Sex Number Percent Number Percent Male 184 46.000000 74,604 49.273486 1.071163 Female 216 54.000000 76,804 50.726514 0.939380

In this example, it shows that there was a slightly larger portion of females in the sample compared to the actual portion in Monroe County. The weighting for males was calculated by taking the percent of males in Monroe County (based on Census information) (49.273486%) and dividing that by the percent found in the 2015 Monroe County sample (46.000000%) [49.273486/46.000000 = weighting of 1.071163 for males]. The same was done for females [50.726514/54.000000 = weighting of 0.939380 for females]. Thus males’ responses are weighted heavier by a factor of 1.071163 and females’ responses weighted less by a factor of 0.939380.

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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 1.1339998 [0.93937989 (weight for females) x 0.94935437 (weight for White) x 1.43366520 (weight for age 35-44) x 0.88694279 (weight for income $50-$75k)]. Thus, each individual in the 2015 Monroe County sample has their own individual weighting based on their combination of age, race, sex, and income. See next page for each 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 analyzing by sex and race. 8) Weight without sex or income (product of age and race weights) – used when analyzing by sex and income.

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Monroe 2010 Weighting Category % % Sample Census * Value

Sex: Male 184 46.000000% 74,604 49.273486% 1.071163 Female 216 54.000000% 76,804 50.726514% 0.939380 APPENDIX III

Age: 20-24 19 4.871795% 8,886 7.955878% 1.633049 25-34 24 6.153846% 16,343 14.632334% 2.377754 35-44 48 12.307692% 19,708 17.645110% 1.433665 45-54 83 21.282051% 24,427 21.870160% 1.027634 55-59 47 12.051282% 11,140 9.973946% 0.827625 60-64 66 16.923077% 9,935 8.895077% 0.525618 65-74 76 19.487179% 11,804 10.568443% 0.542328 75-84 27 6.923077% 6,834 6.118667% 0.883807 85+ 0 N/A 2,614 2.340386% N/A

Race: White 389 97.250000% 139,787 92.324712% 0.949354 Non-White 11 2.750000% 11,621 7.675288% 2.791014

Household

Income: Less than $10,000 6 1.759531% 3,558 6.061122% 3.444738 $10k-$15k 11 3.225806% 3,330 5.672720% 1.758543 $15k-$25k 26 7.624633% 5,933 10.106981% 1.325569 $25k-$35k 39 11.436950% 5,943 10.124016% 0.885202 $35k-$50 53 15.542522% 8,465 14.420292% 0.927796 $50k-$75k 76 22.287390% 11,604 19.767640% 0.886943 $75k or more 130 38.123167% 19,869 33.847228% 0.887839 Note: The weighting ratios are calculated by taking the ratio of the proportion of the population of Monroe County in each subcategory by the proportion of the sample in the Monroe County survey for that same category.

* Monroe County population figures taken from the 2013 Census Estimate.

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Appendix IV І MONROE COUNTY SCHOOLS

The following schools were randomly chosen and agreed to participate in the 2015 Monroe County Health Assessment:

Bedford Public Schools Bedford Senior High School

Dundee Community Schools Dundee Community High School Dundee Middle School

Ida Public Schools Ida High School Ida Middle School

Jefferson Public Schools Jefferson High School Jefferson Elementary School

Mason Consolidated Schools Mason Senior High School

Monroe Public Schools Monroe High School Monroe Middle School

Summerfield Schools Summerfield Jr/Sr High School

Whiteford Agricultural Schools Whiteford High School

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Appendix V І MONROE COUNTY

SAMPLE DEMOGRAPHIC

PROFILE* Monroe County 2015 Survey Michigan Variable Census 2013 Sample Census 2013 (1 year estimate)

Age APPENDIX

20-29 6.2% 11.6% 13.3% 30-39 9.4% 10.5% 11.5% 40-49 15.1% 14.6% 13.4% 50-59 24.0% 15.4% 14.9% 60 plus 41.8% 22.6% 21.2%

Race/Ethnicity

White 97.0% 94.8% 79.1% Black or African American 0.2% 2.3% 13.9% American Indian and Alaska Native 1.2% 0.6% 0.5% Asian 0% 0.6% 2.7% Other 0.5% 0.4% 1.0% Hispanic Origin (may be of any race) 0.7% 3.3% 4.7%

Marital Status†

Married Couple 73.8% 50.0% 47.6% Never been married/member of an unmarried couple 10.2% 27.5% 32.9% Divorced/Separated 8.9% 15.6% 13.3% Widowed 5.4% 6.9% 6.2%

Education†

Less than High School Diploma 3.4% 10.4% 10.6% High School Diploma 29.2% 33.4% 29.7% Some college/ College graduate 63.2% 55.8% 59.7% V

Income (Families)

$14,999 and less 4.2% 9.5% 9.0%

$15,000 to $24,999 6.5% 5.8% 8.0% $25,000 to $49,999 22.8% 22.5% 23.5%

$50,000 to $74,999 18.8% 20.3% 20.4% $75,000 or more 32.2% 41.9% 39.1% * 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) and those reporting “don’t know”.

† The Michigan and Monroe 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

Monroe County Population by Age Groups and Gender U.S. Census 2010

Age Total Males Females

Monroe County 152,021 75,013 77,008 0-4 years 8,719 4,432 4,287 1-4 years 6,989 3,514 3,475 < 1 year 1,730 918 812 1-2 years 3,400 1,706 1,694 3-4 years 3,589 1,808 1,781 5-9 years 9,841 5,009 4,832 5-6 years 3,804 1,932 1,872 7-9 years 6,037 3,077 2’960 10-14 years 11,053 5,622 5,431 10-12 years 6,531 3,400 3,131 13-14 years 4,522 2,222 2,300 12-18 years 15,972 8,166 7,806 15-19 years 11,219 5,807 5,412 15-17 years 7,067 3,638 3,428 18-19 years 4,155 2,171 1,984 20-24 years 8,608 4,424 4,184 25-29 years 8,146 4,059 4,087 30-34 years 8,371 4,134 4,237 35-39 years 9,464 4,675 4,789 40-44 years 10,727 5,313 5,414 45-49 years 12,491 6,168 6,323 50-54 years 12,744 6,417 6,327 55-59 years 11,237 5,637 5,600 60-64 years 9,009 4,491 4,518 65-69 years 6,493 3,171 3,322 70-74 years 4,678 2,172 2,506 75-79 years 3,540 1,496 2,044 80-84 years 3,072 1,203 1,869 85-89 years 1,753 577 1,176 90-94 years 670 173 497 95-99 years 156 27 129 100-104 years 27 5 22 105-109 years 3 1 2 110 years & over 0 0 0 Total 85 years and over 2,609 783 1,826 Total 65 years and over 20,392 8,825 11,567 Total 19 years and over 113,125 55,138 57,987

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MONROE COUNTY PROFILE

General Demographic Characteristics (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimate

Total Population 2013 Total Population 150,376 2000 Total Population 145,945

Largest City-Monroe 2010 Total Population 20,733 100% APPENDIX 2000 Total Population 22,076 100%

Population By Race/Ethnicity Total Population 150,376 100% White Alone 142,498 94.8% Hispanic or Latino (of any race) 4,981 3.3% African American 3,435 2.3% American Indian and Alaska Native 864 0.6% Asian 841 0.6% Two or more races 2,152 1.4% Other 586 0.4%

Population By Age 2010 Under 5 years 8,719 5.7% 5 to 17 years 27,958 18.4% 18 to 24 years 12,763 8.4% 25 to 44 years 28,337 18.6% 45 to 64 years 45,481 29.9% 65 years and more 20,392 13.4% Median age (years) 40.3

Household By Type Total Households 58,479 100% Family Households (families) 38,468 65.8% With own children <18 years 14,393 26.4%

Married-Couple Family Households 29,030 49.6%

With own children <18 years 9,653 16.5% VI Female Householder, No Husband Present 6,562 11.2% With own children <18 years 3,303 5.6% Non-family Households 20,011 34.2% Householder living alone 16,527 28.3% Householder 65 years and > 5,589 9.6%

Households With Individuals < 18 years 17,110 29.3% Households With Individuals 65 years and > 15,759 26.9%

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General Demographic Characteristics, Continued (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimate

Median Value of Owner-Occupied Units $132,100 Median Monthly Owner Costs (With Mortgage) $1,250 Median Monthly Owner Costs (Not Mortgaged) $393 Median Gross Rent for Renter-Occupied Units $754 Median Rooms Per Housing Unit 6.0

Total Housing Units 63,191 No Telephone Service 1,498 Lacking Complete Kitchen Facilities 235 Lacking Complete Plumbing Facilities 121

Selected Social Characteristics (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimates

School Enrollment Population 3 Years and Over Enrolled In School 37,083 100% Nursery & Preschool 3,378 9.1% Kindergarten 2,024 5.5% Elementary School (Grades 1-8) 14,643 39.5% High School (Grades 9-12) 9,154 24.7% College or Graduate School 7,884 21.3%

Educational Attainment Population 25 Years and Over 102,694 100% < 9th Grade Education 2,728 2.7% 9th to 12th Grade, No Diploma 7,909 7.7% High School Graduate (Includes Equivalency) 34,835 33.9% Some College, No Degree 26,342 25.7% Associate Degree 10,910 10.6% Bachelor’s Degree 14,146 13.8% Graduate Or Professional Degree 5,824 5.7%

Percent High School Graduate or Higher *(X) 89.6% Percent Bachelor’s Degree or Higher *(X) 19.4% *(X) – Not available

Marital Status Population 15 Years and Over 122,780 100% Never Married 33,760 27.5% Now Married, Excluding Separated 61,383 49.9% Separated 2,488 2.0% Widowed 8,441 6.9% Female 6,487 5.3% Divorced 16,708 13.6% Female 9,100 7.4%

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Selected Social Characteristics Continued (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimate

Grandparents As Caregivers Grandparent Living in Household with 1 or more own 2,872 100% grandchildren <18 years Grandparent Responsible for Grandchildren 1,467 51.1%

Veteran Status Civilian Veterans 18 years and over 10,075 8.7%

Disability Status of the Civilian Non-institutionalized Population Total Civilian Noninstitutionalized Population 149,488 100% With a Disability 19,486 13.0% Under 18 years 34,219 100% APPENDIX With a Disability 1,295 3.8% 18 to 64 years 93,028 100% With a Disability 11,422 12.3% 65 Years and Over 22,241 100% With a Disability 6,769 30.4%

Employment Status Population 16 Years and Over 120,682 100% In Labor Force 72,680 60.2% Not In Labor Force 48,002 39.8% Females 16 Years and Over 60,861 100% In Labor Force 32,784 53.9%

Population Living With Own Children <6 Years 10,364 100% All Parents In Family In Labor Force 6,855 66.1%

VI

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Selected Economic Characteristics (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimate

Occupations Employed Civilian Population 16 Years and Over 65,527 100% Production, Transportation, and Material Moving 13,989 21.3% Occupations Management, business, science, and art occupations 18,469 28.2% Sales and Office Occupations 13,371 20.4% Service Occupations 13,060 19.9% Natural Resources, Construction, and Maintenance 6,638 10.1% Occupations

Leading Industries Employed Civilian Population 16 Years and Over 65,527 100% Manufacturing 14,981 22.9% Educational, health and social services 16,066 24.5% Trade (retail and wholesale) 7,942 12.1% Arts, entertainment, recreation, accommodation, and food 6,529 10.0% services Professional, scientific, management, administrative, and 4,394 6.7% waste management services Transportation and warehousing, and utilities 3,844 5.9% Finance, insurance, real estate and rental and leasing 2,295 3.5% Other services (except public administration) 2,725 4.2% Construction 3,257 5.0% Public administration 1,790 2.7% Information 957 1.5% Agriculture, forestry, fishing and hunting, and mining 747 1.1%

Class of Worker Employed Civilian Population 16 Years and Over 65,527 100% Private Wage and Salary Workers 57,107 87.2% Government Workers 6,139 9.4% Self-Employed Workers in Own Not Incorporated Business 2,214 3.4% Unpaid Family Workers 67 0.1%

Median Earnings Male, Full-time, Year-Round Workers $54,513 Female, Full-time, Year-Round Workers $35,920

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Selected Economic Characteristics, Continued (Source: U.S. Census Bureau, Census 2013)

2013 ACS 1-year estimate

Income In 2013 Households 58,479 100% < $10,000 3,712 6.3% $10,000 to $14,999 3,662 6.3% $15,000 to $24,999 5,662 9.7% $25,000 to $34,999 6,429 11.0% $35,000 to $49,999 8,625 14.7% $50,000 to $74,999 11,586 19.8% $75,000 to $99,999 7,407 12.7% $100,000 to $149,999 7,729 13.2% $150,000 to $199,999 2,042 3.5% $200,000 or more 1,625 2.8% APPENDIX Median Household Income $53,561

Income In 2013 Families 38,468 100% < $10,000 1,823 4.7% $10,000 to $14,999 1,857 4.8% $15,000 to $24,999 2,239 5.8% $25,000 to $34,999 2,986 7.8% $35,000 to $49,999 5,669 14.7% $50,000 to $74,999 7,797 20.3% $75,000 to $99,999 6,455 16.8% $100,000 to $149,999 6,291 16.4% $150,000 to $199,999 1,996 5.2% $200,000 or more 1,355 3.5%

Median Household Income (families) $67,408

Per Capita Income In 2013 $26,825

Poverty Status In 2013 Number Below % Below Poverty Level Poverty

Level Families *(X) 10.4% VI Individuals *(X) 12.9% *(X) – Not available

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Selected Economic Characteristics, Continued (Source: U.S. Bureau of Economic Analysis)

Bureau of Economic Analysis (BEA) Per Capita Personal Income Figures

Income Rank of Michigan Counties BEA Per Capita Personal Income 2013 $39,525 12th of 83 counties BEA Per Capita Personal Income 2012 $37,709 17th of 83 counties BEA Per Capita Personal Income 2011 $36,328 17th of 83 counties BEA Per Capita Personal Income 2010 $34,185 18th of 83 counties BEA Per Capita Personal Income 2003 $30,736 11th of 83 counties BEA Per Capita Personal Income 2000 $29,726 8th of 83 counties

(BEA PCPI figures are greater than Census figures for comparable years due to deductions for retirement, Medicaid, Medicare payments, and the value of food stamps, among other things)

Employment Statistics Category Monroe Michigan Labor Force 76,681 4,803,000

Employed 72,966 4,523,000

Unemployed 3,715 280,000

Unemployment Rate* in June 2015 4.8 5.8

Unemployment Rate* in May 2015 4.9 5.9

Unemployment Rate* in June 2014 7.7 7.7 *Rate equals unemployment divided by labor force. (Source: Michigan Labor Market, June 2015, http://www.milmi.org/)

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Estimated Poverty Status in 2013 90% 90% Confidence Age Groups Number Percent Confidence Interval Interval Monroe County All ages in poverty 18,626 16,335 to 20,917 12.5% 11.0 to 14.0 Ages 0-17 in poverty 5,530 4,654 to 6,406 16.4% 13.8 to 19.0 Ages 5-17 in families in 3,980 3,291 to 4,669 15.6% 12.9 to 18.3 poverty Median household $51,643 to $55,745 income $59,847 Michigan All ages in poverty 1,625,685 to 9,669,494 17.0% 16.8 to 17.2 1,666,391 Ages 0-17 in poverty 511,344 to 522,365 23.7% 23.2 to 24.2

533,386 APPENDIX Ages 5-17 in families in 342,580 to 351,702 21.6% 21.0 to 22.2 poverty 360,824 Median household $47,825 to $48,200 income $48,575 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 > VI 3 People $18,518 $19,055 $19,073 4 People $24,418 $24,817 $24,008 $24,820 5 People $29,447 $29,447 $28,960 $28,252 $27,820 6 People $33,869 $33,869 $33,303 $32,631 $31,633 $31,041

7 People $38,971 $38,971 $38,375 $37,791 $36,701 $35,431 8 People $43,586 $43,586 $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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