Community Health Needs Assessment
Bollinger County, Missouri
This assessment will identify the health needs of the residents of Bollinger County, Missouri, and those needs will be prioritized and recommendations will be made for programs to be implemented to meet these needs.
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Table of Contents
LIST OF FIGURES ...... 5
LIST OF TABLES ...... 6 EXECUTIVE SUMMARY ...... 8
KEY FINDINGS ...... 10 PRIORITY HEALTH NEEDS ...... 12
CHAPTER 1: COMMUNITY HEALTH NEEDS ASSESSMENT INTRODUCTION AND METHODS ...... 13
COMMUNITY H EALTH N EEDS A SSESSMENT D ESCRIPTION ...... 13 COMMUNITY H EALTH N EEDS A SSESSMENT R EQUIREMENTS ...... 13 IMPLEMENTATION S TRATEGY R EQUIREMENTS ...... 14 COMMUNITY H EALTH N EEDS A SSESSMENT P ROCESS ...... 15 Defining “Community” ...... 15 Identifying Partners and Individuals Representing the Broad Interests of the Community ...... 15 Gather Available Data and Current Assessments ...... 16 Develop and Conduct Primary Research ...... 16 Aggregate Primary and Secondary Research ...... 17 Identify and Prioritize the Health Needs in the Community ...... 17 Develop and Implement a Strategy to tified Address the Iden Priority Health Issues ...... 17 Widely Disseminate the CHNA...... 18 CHAPTER 2: COMMUNITY PROFILE ...... 19
BACKGROUND I NFORMATION FOR B OLLINGER C OUNTY ...... 19 DEMOGRAPHIC C HARACTERISTICS ...... 20 Population Growth ...... 20 Race ...... 20 Ethnicity ...... 21 Age Distribution ...... 21 Gender ...... 22 Household/Family Configuration ...... 23 Religion ...... 23 SOCIAL C HARACTERISTICS ...... 24 Education ...... 24 Language ...... 26 Literacy ...... 26 Marital Status ...... 26 ECONOMIC C HARACTERISTICS ...... 27 Income ...... 27 Employment ...... 28 Poverty Status ...... 28 Medicaid and ublic P Assistance Participation ...... 29 Hunger and Food Uncertainty ...... 30 Women, Infants, and Children (WIC) Participation...... 30
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Housing ...... 31 Transportation ...... 31 ENVIRONMENT ...... 31 Water Quality ...... 31 Air Quality ...... 32 Lead Poisoning ...... 32 BUILT E NVIRONMENT ...... 33 Healthy Food Availability ...... 33 Recreational Activities Available ...... 33 PUBLIC S AFETY ...... 34 Crime Index ...... 34 Juvenile Crime Rates ...... 34 FAMILY AND D OMESTIC V IOLENCE ...... 35 Child Abuse and Neglect ...... 35 Child Out-‐of-‐Home Placement ...... 35 Domestic Violence ...... 36 HEALTH P ROMOTION ...... 37 Community Health Programs ...... 37 HEALTH C ARE S YSTEM ...... 37 Access to Health Care ...... 37 Uninsured Population ...... 37 Health are C Providers ...... 38 Community Health Resources/Services ...... 40 Emergency Services ...... 40 Long-‐Term Care Facilities ...... 40 CHAPTER 3: HEALTH OUTCOMES ...... 42
MORTALITY ...... 42 Leading Causes of Death ...... 42 Cancer ...... 43 Chronic Disease ...... 44 Years of Potential Life Lost...... 45 Infant Mortality ...... 45 Motor Vehicle Accidents ...... 46 MORBIDITY ...... 46 Obesity and Overweight ...... 46 Diabetes ...... 46 Infectious Disease ...... 47 Unintentional Injuries ...... 51 Health Status at Birth ...... 54 HEALTH S TATUS ...... 57 MENTAL H EALTH ...... 57 PREVENTABLE H OSPITALIZATIONS ...... 57
CHAPTER 4: HEALTH HAVIORS BE ...... 59
DIET & EXERCISE ...... 59
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TOBACCO U SE ...... 59 SUBSTANCE A BUSE ...... 59 MATERNAL H EALTH ...... 59 Prenatal Care ...... 59 Smoking during Pregnancy ...... 60 Breastfeeding ...... 60 SEAT B ELT U SE ...... 61 PREVENTION & SCREENING ...... 61 Preventative Practices ...... 62 Diabetes ...... 64
CHAPTER 5: HEALTH ASURES ME ...... 65
CHILD AND A DOLESCENT H EALTH ...... 65 Infant Immunization Rates ...... 65 Causes of Death – Child ...... 65 Causes of Death -‐ Adolescents ...... 66 Teen Substance Abuse and Smoking ...... 66 Teen Pregnancy ...... 67 STDs in Teens ...... 68 SENIOR H EALTH ...... 68 Missouri Senior Report ...... 68
CHAPTER 6: PRIMARY RESEARCH ...... 70
FOCUS G ROUPS ...... 70 Methodology ...... 70 Question -‐ 1 What do people in this community do to people stay healthy? How do get information about health? ...... 70 Question -‐ 2 In this group’s opinion, what are the serious health problems in your community? What are some of the causes of these problems?...... 71 Question -‐ 3 What keeps people in your community from being healthy? ...... 71 Question -‐ 4 What could be done to solve these problems?...... 72 Question -‐ 5 Is there any group not receiving enough health care? If so, why? ...... 72 Question -‐ 6 Of all the issues we have talked ssues about today, what i do you think are the most important for your community to address? ...... 72 Checklist Exercise ...... 72 SURVEYS ...... 73 Survey Layout and Design ...... 73 Methodology ...... 74 Participants ...... 74 Access to Health Services ...... 77 Health Beliefs and Behaviors ...... 80 Health Issues ...... 84 Community Health Concerns ...... 85
CHAPTER 7: SUMMARY OF FINDINGS ...... 92
USING THE D ATA TO D ETERMINE N EEDS ...... 92
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SECONDARY D ATA ...... 92 PRIMARY D ATA ...... 94 CONCLUSION ...... 95
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List of Figures FIGURE 1: POPULATIONS OF B OLLINGER C OUNTY C ITIES/VILLAGES ...... 19 FIGURE 2: BOLLINGER C OUNTY P OPULATION ...... 20 FIGURE 3: RACE D ISTRIBUTION OF B OLLINGER C OUNTY -‐ 2010 ...... 21 FIGURE 4: HISPANIC M AKEUP OF B OLLINGER C OUNTY . VS MISSOURI – 2010 ...... 21 FIGURE 5: AGE D ISTRIBUTION FOR B OLLINGER C OUNTY C OMPARED TO M ISSOURI -‐ 2010 ...... 22 FIGURE 6: PERCENTAGE OF P OPULATION – MALE . VS FEMALE – BOLLINGER C OUNTY . VS MISSOURI -‐ 2010 ...... 22 FIGURE 7: HOUSEHOLDS BY T YPE – BOLLINGER C OUNTY . VS MISSOURI – 2010 ...... 23 FIGURE 8: MEMBERSHIP BY R ELIGIOUS C ONGREGATION – 2010 – BOLLINGER C OUNTY ...... 24 FIGURE 9: EDUCATIONAL A TTAINMENT (P OPULATION 25 YEARS AND OVER) – BOLLINGER C OUNTY . VS MISSOURI -‐ 2010 ...... 25 FIGURE 10: HIGH S CHOOL D ROPOUT R ATES BY B OLLINGER C OUNTY S CHOOL D ISTRICTS VS. MISSOURI ...... 25 FIGURE 11: LANGUAGE S POKEN AT H OME – MISSOURI & BOLLINGER C OUNTY ...... 26 FIGURE 12: MARITAL S TATUS (P OPULATION 15 YEARS AND OVER) – BOLLINGER C OUNTY . VS MISSOURI -‐ 2010 ...... 27 FIGURE 13: CHANGE IN P ER C APITA I NCOME FROM 2008 – 2009 – BOLLINGER C OUNTY . VS MISSOURI ...... 27 FIGURE 14: UNEMPLOYMENT R ATES FOR B OLLINGER C OUNTY . VS MISSOURI: 2006-‐2010 ...... 28 FIGURE 15: MEDICAID P ARTICIPATION BY R ACE AND A GE FOR B OLLINGER C OUNTY AND M ISSOURI – 2008 ...... 29 FIGURE 16: PERCENTAGE OF S TUDENTS E NROLLED IN F REE/REDUCED L UNCH P ROGRAM BY S CHOOL D ISTRICT IN B OLLINGER C OUNTY . VS MISSOURI ...... 30 FIGURE 17: CHILD A BUSE & NEGLECT (R ATE PER 1,000 CHILDREN) – BOLLINGER C OUNTY . VS MISSOURI ...... 35 FIGURE 18: OUT-‐OF-‐HOME P LACEMENT E NTRIES (R ATE PER 1,000 CHILDREN) – BOLLINGER C OUNTY . VS MISSOURI ...... 36 FIGURE 19: INFANT M ORTALITY R ATE – BOLLINGER C OUNTY . VS MISSOURI ...... 46 FIGURE 20: DEATH R ATE BY U NINTENTIONAL I NJURY T YPE (2007 -‐2009) – BOLLINGER C OUNTY . VS MISSOURI ...... 52 FIGURE 21: ER VISITS R ATE BY U NINTENTIONAL I NJURY T YPE (2007 -‐2009) – BOLLINGER C OUNTY . VS MISSOURI ...... 52 FIGURE 22: HOSPITALIZATIONS R ATE BY U NINTENTIONAL I NJURY T YPE (2007 -‐2009) – BOLLINGER C OUNTY . VS MISSOURI ...... 53 FIGURE 23: WORK I NJURIES R ATE – MACHINERY T YPE -‐ BOLLINGER C OUNTY . VS MISSOURI ...... 53 FIGURE 24: LOW B IRTH W EIGHT P ERCENT – BOLLINGER C OUNTY . VS MISSOURI ...... 54 FIGURE 25: PRETERM B IRTHS (P ERCENT OF TOTAL LIVE BIRTHS) – BOLLINGER C OUNTY . VS MISSOURI – 3 YEAR M OVING A VERAGE ...... 55 FIGURE 26: BIRTH D EFECTS R ATE ( PER 10,000 LIVE BIRTHS) – BOLLINGER C OUNTY . VS MISSOURI – 3 YEARS M OVING A VERAGE ...... 56 FIGURE 27: PERCENTAGE OF M OTHERS WHO SMOKED D URING P REGNANCY – BOLLINGER C OUNTY . VS MISSOURI – 3 YEAR M OVING AVERAGE ...... 60 FIGURE 28: RATE OF MOTHERS WHO D BREASTFE THEIR BABIES IME SOMET DURING INFANCY – BOLLINGER C OUNTY . VS MISSOURI...... 61 FIGURE 29: UP-‐TO-‐DATE ON I MMUNIZATIONS (R ATE PER 100 INFANTS) – WIC INFANT P ARTICIPANTS -‐ BOLLINGER C O. & MISSOURI . 65 FIGURE 30: BIRTHS TO T EENS (R ATE PER 1,000 FEMALES AGES 15 -‐19) – BOLLINGER C OUNTY . VS MISSOURI ...... 67
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List of Tables
TABLE 1: ZIP CODES IN B OLLINGER C OUNTY ...... 20 TABLE 2: TOTAL E NROLLMENT & TOTAL D ROPOUTS FOR B OLLINGER C OUNTY ...... 26 TABLE 3: % BELOW P OVERTY L EVEL B ROKEN O UT BY E ACH C ITY IN B OLLINGER C OUNTY ...... 28 TABLE 4: % BELOW P OVERTY L EVEL BY O THER C ATEGORIES ...... 29 TABLE 5: PUBLIC D RINKING W ATER S YSTEM V IOLATIONS B OLLINGER C OUNTY, 2006 -‐ 2011 ...... 32 TABLE 6: OFFENSES AND A RRESTS BY C RIME T YPE IN B OLLINGER C OUNTY -‐ 2009 ...... 34 TABLE 7: JUVENILE C OURT R EFERRALS -‐ BOLLINGER C OUNTY . VS MISSOURI -‐ 2009 ...... 35 TABLE 8: DOMESTIC V IOLENCE I NCIDENTS IN B OLLINGER C OUNTY -‐ 2009 ...... 36 TABLE 9: FIRE D EPARTMENTS IN B OLLINGER C OUNTY ...... 40 TABLE 10: LONG-‐TERM C ARE F ACILITIES IN B OLLINGER C OUNTY, MISSOURI ...... 41 TABLE 11: LEADING C AUSE OF D EATH P ROFILE 1999 -‐ 2009 (RATES PER 100,000 POPULATION) -‐ BOLLINGER C OUNTY . VS MISSOURI 42 TABLE 12: BOLLINGER C OUNTY, TOP T EN C ANCER I NCIDENCE S ITES (2004 -‐2008) ...... 43 TABLE 13: CHRONIC D ISEASE C OMPARISON -‐ BOLLINGER C OUNTY . VS MISSOURI ...... 44 TABLE 14: PREVENTABLE H OSPITALIZATIONS 2009 -‐ BOLLINGER C OUNTY . VS MISSOURI ...... 58 TABLE 15: 2007 HEALTH & PREVENTATIVE P RACTICES -‐ BOLLINGER C OUNTY . VS MISSOURI ...... 62 TABLE 16: CAUSES OF D EATH: AGES 1-‐ 14 ...... 65 TABLE 17: CAUSES OF D EATH: AGES 15 -‐19 ...... 66 TABLE 18: CURRENT S UBSTANCE U SE FOR G RADES 6 -‐12 -‐ BOLLINGER C OUNTY & MISSOURI ...... 66 TABLE 19: SEXUALLY T RANSMITTED D ISEASES: AGES 15 -‐19 ...... 68 TABLE 20: QUALITY OF L IFE FOR S ENIORS ...... 69 TABLE 21: HEALTH AND W ELLNESS FOR S ENIORS ...... 69 TABLE 22: BOLLINGER C OUNTY R ESULTS ...... 73 TABLE 23: GENDER ...... 75 TABLE 24: YOUR R ACE/ETHNICITY ...... 75 TABLE 25: AGE ...... 75 TABLE 26: RACE/ETHNICITY OF C HILDREN L IVING AT H OME ...... 75 TABLE 27: MARITAL S TATUS ...... 75 TABLE 28: ANNUAL H OUSEHOLD INCOME ...... 75 TABLE 29: EDUCATION L EVEL ...... 75 TABLE 30: EMPLOYMENT S TATUS ...... 76 TABLE 31: NUMBER OF P EOPLE C URRENTLY L IVING IN H OUSEHOLD ...... 76 TABLE 32: NUMBER OF A DULTS 65 AND O LDER C URRENTLY L IVING IN H OUSEHOLD ...... 76 TABLE 33: NUMBER OF C HILDREN UNDER 18 CURRENTLY L IVING IN H OUSEHOLD ...... 76 TABLE 34: WHAT KINDS OF CE INSURAN DO ( YOU AND/OR YOUR FAMILY) CURRENTLY HAVE? ...... 77 TABLE 35: SELECT THE PREVENTIVE PROCEDURES YOU HAD HAVE IN THE LAST : YEAR ...... 78 TABLE 36: WHERE DO YOU OUTINE GO FOR R HEALTH ? CARE ...... 79 TABLE 37: IF YOU ANSWERED SELDOM OR , NEVER WHY? ...... 79 TABLE 38: WHAT SERVICES DO SEEK YOU OUTSIDE THE COUNTY? ...... 80 TABLE 39: WHY DO YOU TRAVEL SIDE OUT THE COUNTY? ...... 80 TABLE 40: WHAT IS YOUR CURRENT HEALTH ? STATUS ...... 80 TABLE 41: SAFETY B EHAVIOR ...... 81 TABLE 42: HEALTHY L IFESTYLE B EHAVIORS ...... 82 Community Health Needs Assessment – Bollinger County, Missouri Page 6
TABLE 43: HEALTHY L IFESTYLE B EHAVIORS ...... 82 TABLE 44: HYGIENE/COMMUNICABLE D ISEASE C ONTROL ...... 83 TABLE 45: GET A FLU SHOT EACH YEAR ...... 83 TABLE 46: HYGIENE/COMMUNICABLE D ISEASE C ONTROL ...... 83 TABLE 47: MENTAL H EALTH I SSUES AND B EHAVIORS ...... 83 TABLE 48: MENTAL H EALTH I SSUES AND B EHAVIORS ...... 84 TABLE 49: ENVIRONMENTAL/HOME S AFETY ...... 84 TABLE 50: HEALTH I SSUES ...... 85 TABLE 51: PUBLIC S ERVICES C ONCERNS ...... 87 TABLE 52: CRIME & VIOLENCE C ONCERNS ...... 87 TABLE 53: SAFETY B EHAVIORS ...... 88 TABLE 54: HEALTH B EHAVIORS ...... 88 TABLE 55: HEALTH C ARE & SUPPORT S ERVICES C ONCERNS ...... 89 TABLE 56: ENVIRONMENTAL P ROTECTION C ONCERNS ...... 89 TABLE 57: HEALTH C ONDITIONS/ DISEASES C ONCERNS ...... 90 TABLE 58: MENTAL H EALTH C ONCERNS ...... 90 TABLE 59: SOCIAL & ECONOMIC I SSUES C ONCERNS ...... 91
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Executive Summary The two -‐ not for-‐profit hospitals in the city rdeau, of Cape Gira Missouri, Saint Francis Healthcare System and SoutheastHEALTH, were partners in conducting this Community eds Health Ne Assessment (CHNA). Community Health Needs Assessment Process and Requirements A CHNA must be conducted every three -‐ years by not for-‐profit hospitals in order to comply with federal tax-‐exemption requirements under the Affordable Care Act. Following the CHNA, the hospital must adopt an implementation strategy to meet the community health needs identified through the assessment, and it must report how it is addressing the needs identified in the CHNA and provide a description of needs that are not being addressed such with the reasons why needs are not being addressed. The ultimate purpose of the CHNA is to improve community health. The Community Health Needs Assessment process s consist of the following steps: 1. Define the community served by the hospital facility 2. Identify the partners and individuals representing broad the interests of the community 3. Gather available data and current assessments 4. Develop and conduct primary research 5. Aggregate primary and secondary research 6. Identify and prioritize the health needs in your community 7. Develop and implement a strategy ess to addr the identified priority health issues 8. Widely disseminate the CHNA All steps were completed for this assessment mplementation except that the i strategy is not included. That step will be completed separately by each hospital partner based on review the of CHNA. Community Profile Bollinger County is located in southeast Missouri with a mostly rural population of 12,363. Whites comprise 97.9 % of the total population and he t county has a higher percentage er of the old population, ages 4 5 – 84 than does the state of Missouri. Nearly 75% of Bollinger County residents 25 years and over have graduated from high school, % with only 14.9 going on to receive -‐ a post secondary degree. The unemployment rate % was 9.9 in 2010, which highe is r than Missouri’s B 9.4%. ollinger County has 19.7% of residents in poverty, 22 with nearly % on Medicaid, 20% on Food 8 Stamps, and 1 % uninsured. Bollinger County does not offer much in terms of health care providers as it only s ha a county health department and a federally qualified health center. The community profile chapter also includes social, economic, and environmental characteristics, information public on safety and crime, and community health programs. Health Outcomes The Health Outcomes chapter contains on informati on mortality, including leading causes of death, cancer incidence, chronic disease, infant mortality, and vehicle accidents, and on morbidity, including obesity, diabetes, infectious disease, unintentional injuries, lth and hea status at birth. ter The chap also contains information on mental health and hospitalizations. preventable The leading causes of death in Bollinger County are: • Heart Disease 35% • All Cancers (Malignant Neoplasms) 24% • All Injuries and Poisonings 6% • Chronic Lower Respiratory Disease 5% • Stroke/Other Cerebrovascular Disease 5%
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Health Behaviors The chapter on Health Behaviors is comprised ion of informat on diet and exercise, tobacco use, substance abuse, maternal health, and prevention and screening. In Bollinger County, 33% of residents are physically inactive, 76.6% eat less than s five fruit and vegetables per day, and 27.6% smoke cigarettes. Health Measures The chapter on Health Measures includes data ant regarding inf immunization rates, causes of death for children and adolescents, teen substance abuse, teen pregnancy, STDs in teens, and the health of senior citizens. The main causes of death for children and adolescents are unintentional injuries and motor vehicle accidents; however, as a cause of death for he adolescents, t rates for motor vehicle accidents and suicide in Bollinger County are more than twice the state rate. Teen substance abuse is also a great concern as the percentage of substance use in the past 30 days is higher for most substances in Bollinger County than in . Missouri Primary Research One focus group was held in Bollinger County and the questions asked can be found below. Summaries of these focus groups are included in Chapter 6. 1. What do people in this community do to stay healthy? How do le peop get information about health? 2. In this group’s opinion, what are the serious health problems in your community? What are some of the causes of these problems? 3. What keeps people in your community hy? from being healt 4. What could be done to solve lems? these prob 5. Is there any group not receiving enough health care? If so, why? 6. Of all the issues we have talked ssues about today, what i do you think are the most important for your community to address? Sixty-‐six surveys were completed Bollinger by County residents. The survey was very extensive and consisted of five different sections. The survey demographics were representative ardeau of Cape Gir County’s population. 1. Multiple Choice: questions to collect information on demographics, health care access, health status, and insurance. 2. Health Behaviors: questions to collect health behavior information. 3. Children’s Health Behaviors: questions to collect health behavior information about the participants’ children if applicable. 4. Health Issues: questions the pants partici about having particular health issues. 5. Community Health Concerns: questions the participants to choose how much of a problem they think particular issues are in their community. Summary of Findings The Summary of Findings chapter simply he summarizes t needs determined by the assessment and how those needs were determined.
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Key Findings The following lists represent the key findings of this Community Health Needs Assessment by type of need: Health Needs • Diabetes (leading cause of death) • High Blood Pressure/Strokes (leading cause of death) • Heart Disease (leading cause of death) • Overweight Adults • Overweight Children • Cancer (leading cause of death) • Mental Illness • Asthma/Respiratory Disorders • Allergies • Infectious Disease (Human Ehrlichiosis and Anaplasmosis, Legionellosis) • High Chronic Disease Rates • Health Status at -‐ Birth preterm births and birth defects • Preventable Hospitalizations -‐ bacterial pneumonia, chronic obstructive pulmonary, diabetes, immunization preventable, kidney/urinary infection, pelvic inflammatory disease, and severe ENT infections • Unintentional Injuries • Cause of Death for Adolescents – unintentional injuries, motor vehicle accidents, and suicide • High Infant Mortality • Low Infant Immunization Rates • Higher Percentage of Uninsured • Health Status – poor health rating Behavioral Needs • Preventive Practices – did not get medical care, current cigarette -‐ smoking, no leisure time physical activity, less than five fruits and day, vegetables per obese, current high blood pressure, never had blood cholesterol checked, has high cholesterol, never had a mammogram, no mammogram in the last year, no pap smear ee in the last thr years, never had a blood stool test, never had a sigmoidoscopy or colonoscopy, no sidmoidoscopy or t colonoscopy in the pas ten years • Smoking • Smokeless Tobacco • Poor Diet • No Exercise • Drug/Alcohol Use (especially adolescents with prescription drugs and alcohol) • Eating Disorders • Teen Substance Abuse – use of cigarettes, alcohol, binge drinking, inhalants, and prescription drugs • Maternal Health – no prenatal care and smoking while pregnant • Low Breastfeeding Rates for Infants • Low Seat Belt Use
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Community Needs • Hunger (children/adolescents) • Lack of Health Care Education • Child Abuse and Neglect • Domestic Violence • Health Care Affordability • Health Care Availability – primary care for senior citizens, specialty care • Access to Health Care Specialists (especially Medicaid Orthopedics for patients) • Access to Healthy Foods • Teen Pregnancy • Transportation (public) • Unemployment • Mosquitos • Job Availability • Job Security • Crime – forcible rape and juvenile crime • Housing Affordability • Racism • Child Care/Day Care • Secondhand Smoke • Recreation Opportunities • Highway Safety – motor vehicle accidents • Law Enforcement • Nursing Home Care • Emergency Preparedness • Elder Day Care • Education – high percentage of residents who did not graduate chool from high s • High Poverty ate R – including senior citizens • High Public Assistance articipation P – WIC, Medicaid, Food Stamps/SNAP, and -‐ Free/Reduced Lunch program
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Priority Health Needs Prioritization Process Members of the CHNA Team analyzed survey data, focus group data, and secondary data in the report to prioritize the community health needs for The each county. priority needs were first identified by the primary research or what the community finds most . important These high priority needs were then validated by the secondary – research looking at the community’s statistics and trends against the state’s statistics and . trends Top 5 Priority Health Needs (and Associated Behavioral Needs) • Cancer (Smoking) • Obesity (Diet and Exercise) • Chronic Disease o Stroke (Healthy Lifestyle) o Heart Disease (Smoking) o Diabetes (Diet and Exercise) o Chronic Respiratory Disease (Smoking) • Substance Abuse (Drug and Alcohol) • Health Care Availability & Affordability (Access and Uninsured)
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Chapter 1: Community Health Needs Assessment Introduction and Methods
Community Health Needs Assessment Description A community health needs assessment (CHNA) is a systematic process involving the community, to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs.
Value of a Community Health Needs Assessment y to the Communit County To share Background the assessment Information process and findings with the county residents and to educate local residents, health care providers, and students regarding pressing health problems To empower community members to act on issues of concern To identify emerging issues, to provide iding data for dec programmatic/organizational decisions, and to plan ve, effecti Population collaborative Characteristics interventions to promote and Demographics better health To advocate for community change with d politicians an other local decision-‐makers To promote collaboration and partnership nity among commu members and groups To furnish a baseline by which to monitor changes To serve as a reference point and a historical perspective for future assessments To provide a resource for activities such as writing grant applications
To serve as a model for other counties who are planning an assessment
Source: North Carolina Public Health Community Health Assessment Guide Book
Community Health Needs Assessment Requirements A CHNA must be conducted every not three years by -‐for-‐profit hospitals in order to comply with federal tax-‐exemption requirements under the Affordable Care t Act. The firs CHNA must be completed by the end of the first taxable year beginning after March 23, 2012. The CHNA must take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health, and it must be made widely available to the public. Following the CHNA, the an hospital must adopt implementation strategy to meet the community health needs identified through the assessment, and it must report how it is addressing the needs identified in the CHNA and provide a description of needs that are not being addressed with the reasons why such needs are not being addressed. The ultimate purpose of the CHNA is to improve community health. The documentation of the CHNA must include the following information: 1. A description of the community served by the hospital facility and how it was determined 2. A description of the process and methods used to ncluding: conduct the assessment, i a. A description of the sources and dates of the data ed and other information us in the assessment, including primary and secondary sources b. The analytical methods applied to identify th community heal needs c. Information gaps that affect the hospital’s ability to assess the community’s health needs d. If a hospital collaborates with other organizations CHNA, in conducting a the report should then identify all of the community organizations that collaborated with the hospital e. If a hospital contracts with one or more third parties to assist in conducting a CHNA, the report should also disclose the identity and qualifications of the third parties
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3. A description of the approach used to plan, develop, and conduct the assessment and how the hospital organization took into account input from individuals who represent the broad interests of the community served by the cility hospital fa , including: a. A description of when and how the organization consulted s with these individual (whether through meetings, focus groups, interviews, written surveys, correspondence, etc.) b. Community leaders who were consulted and/or collaborated lanning in the p and implementation process c. Justification of why data sources were used and selected d. Justification of the approach for primary data collection e. Explanation of successful and non-‐successful approaches to seek broad-‐based community input, especially underserved or -‐ high risk groups within the community f. If the hospital takes into account input , from an organization the written report should identify the organization and provide the name and title of at least one individual in that organization who consulted with the hospital g. Identification of any individual providing input who has special knowledge of or expertise in public health, and the report should list those people by name, title, affiliation, and include a brief description of the individual’s special knowledge or expertise 4. A prioritized description of all the community health through needs identified the CHNA, as well as a description of the process and criteria used in prioritizing such health needs a. Priorities identified through primary and secondary data b. Other processes used to rank priorities 5. A description of the existing health care facilities sources and other re within the community available to meet the community health needs the identified through CHNA Implementation Strategy Requirements The IRS guidance specifies that the CHNA results must be used to develop an implementation strategy that must be adopted by the hospital. The implementation strategy is defined as a written plan that addresses each of the community health needs that through were identified the assessment. Each hospital organization must meet the requirement to tion adopt an implementa strategy separately with respect to each hospital facility it operates. The Treasury and IRS expect the implementation strategy to: 1. Describe how the hospital facility plans to meet the health need; or 2. Identify the health need as one the hospital facility to does not intend meet and explains why the hospital facility does not intend to meet the health need In describing how a hospital facility plans to meet a health need identified through a CHNA, the implementation strategy must tailor the description to the particular hospital facility, taking into account its specific programs, resources, and priorities. The implementation strategy should also describe any planned collaboration with governmental, -‐ non profit, or other health care organizations, including related organizations, in meeting the health need. The IRS will allow hospital organizations ementation to develop impl strategies for their hospital facilities in collaboration with other organizations, including related organizations, other hospital organizations, for-‐profit and government hospitals, and state and local s agencies, such a local health departments. If a hospital does collaborate with other organizations in mentation developing an imple strategy, the strategy should identify all the organizations ch with whi the hospital collaborated.
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The implementation strategy is considered to be adopted on the date the implementation strategy is approved by an authorized governing body of ganization. the hospital or The authorized governing body means: 1. The governing body of the hospital organization (i.e. board of directors, board of trustees, or equivalent controlling body) 2. A committee of the governing body, which may be duals comprised of any indivi permitted under state law to serve on such committee, to the extent committee is permitted by state law to act on behalf of the governing body; or 3. To the extent permitted under state law, authorized other parties by the governing body of the hospital organization to act on its behalf by following fied procedures speci by the governing body in approving an implementation strategy The hospital organization must adopt an implementation ategy str to meet the community health needs identified in a CHNA by the end of the same taxable year in which it conducts that CHNA.
Community Health Needs Assessment Process The Community Health Needs Assessment process consist should of the following steps: 1. Define the community served by the hospital facility 2. Identify the partners and individuals representing the broad interests of the community a. Individuals with special knowledge or expertise in public health b. Federal, tribal, regional, state, or local health or other departments or agencies, with current data or other information relevant to the health needs of the community served by the hospital acility f c. Leaders, representatives, or members of medically underserved, low income and minority populations, as well as populations ronic with ch disease needs 3. Gather available data and current assessments 4. Develop and conduct primary research 5. Aggregate primary and secondary research 6. Identify and prioritize the health needs in your community 7. Develop and implement a strategy to tified address the iden priority health issues 8. Widely disseminate the CHNA
Defining “Community” The two -‐ not for-‐profit hospitals in the city of Cape Girardeau, Saint Missouri, Francis Healthcare System and SoutheastHEALTH, made the decision to define “community” y as their primar service area, which consists of four counties: Cape Girardeau, Bollinger, Scott, and Stoddard. The primary service area for both hospitals is based on the number of inpatient visits discharges and outpatient by patients that reside in each of these four counties. For SoutheastHEALTH, 75% of its patients are from these four counties and for Saint Francis Medical Center, 68% of its patients are from these four counties. This information is provided by the Hospital Industry Data Institute (HIDI) that is founded by the Missouri Hospital Association. ince S each county differs greatly from one another in terms of demographics, health care providers, education, etc., four separate sessment written as reports will be created and made available to the public identifying eds specific ne per county.
Identifying Partners and Individuals Representing the Broad s Interest of the Community Saint Francis Medical and Center Saint Francis Medical (“Community Center Health Needs Assessment Team”) were partners in conducting this CHNA.
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The individuals representing the broad interests of Bollinger i County ncluded involving people from the following organizations when the primary research was : conducted • Bollinger County Public Health Department • Cross Trails Medical – Center Marble Hill • Leopold School District • Woodland School District • Meadow Heights School District • Coroner’s Office • City of Marble Hill Efforts were made to include -‐ at risk, targeted populations and principle specialty areas that are served by the hospital and present within the community, such as the medically underserved, low income persons, minority groups, and those with chronic disease needs.
Gather Available Data and Current Assessments Secondary data are existing data that are collected by someone else for a purpose other than the one being pursued. Secondary research was obtained from sources various credible and is included in this written assessment report. Some areas arched that were rese include demographics, the physical environment, social factors, the economy, the transportation system, the education system, the health care system, and public safety. The assessment ing also includes exist health status and public health data. Ex amples of the data sources used are as follows: • U.S. Census Bureau • Missouri Department of Health Senior and Services • Missouri Department of Elementary and ation Secondary Educ • Missouri Economic Research and Information RIC) Center (ME • U.S. Bureau of Statistics Labor • Environmental Protection Agency • Centers for Disease Control and Prevention • University of Wisconsin’s County Health Rankings • Missouri Department of Mental Health • Missouri State Highway Patrol • Annie E. Casey Foundation Kids Count Data Center • Other Local Websites
Develop and Conduct Primary Research Primary data are data collected specifically for the purpose of answering project-‐specific questions. Primary data should be collected after the al collection and initi review of secondary data d and shoul add breadth, depth, and qualitative information to the mary secondary data. Pri research was obtained in Bollinger County through individual public surveys and focus groups. Public Surveys Surveys provide a flexible means of assessing a mple representative sa of the population to gather information about attitudes and opinions, as well as measure behaviors and population characteristics. The individual survey that used was was created by the Community Health Needs and Assessment Team can be found in Appendix A. Advantages of surveying for individual responses include: • Obtaining direct feedback from clients, ts key informan and target populations about specific issues
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• Developing public awareness problems • Building a consensus for solutions or actions • Comparing the -‐ self reported incidence and prevalence with more sources objective data • Improving perception of quality of local health care services • Improving perception on the need of specific services either in existence or under consideration Focus Groups Group surveys in the form of focus groups were also conducted. A focus group is defined as people who possess ertain c similar characteristics that are assembled as a group to participate in a focused discussion to help understand the topic . of interest The questions asked in each focus can group be found in Appendix B and a list of all focus group participants r along with thei experience, if any, can be found in Appendix C. Data was collected from the focus groups hrough primarily t note-‐taking. A writing exercise was also handed out and completed regarding each participant’s top five serious issues. Aggregate Primary and Secondary Research An Access Database was created for the survey d data to be entere and tracked. Screenshots of that tracking database an c be found in D. Appendix The Community Health Needs Assessment Team entered the surveys into the CHNA Survey Tracking was Database, which a very tedious -‐ and time consuming process due to the amount of questions asked and vey. data collected by the sur Following the entry of all surveys, the data was then exported from ated Access and manipul into usable information in Excel. The survey data will ented be pres and discussed in Chapter 6 – Primary Research of this report. The information that was from collected the focus groups will also be presented and discussed in Chapter 6 – Primary Research of this report.
Identify and Prioritize the Health the Needs in Community From the analysis of this research, community ned needs were determi based on what the community finds most important and by what the community ng is most lacki in that could have an impact on the health of its citizens. These needs primarily were determined the by primary research – what the community finds most important – along with tying that information to what the secondary research shows – looking at the community’s and statistics trends against the state’s statistics and trends.
Develop and Implement a Strategy to tified Address the Iden Priority Health Issues The implementation strategy ll wi be developed separately by each hospital partner involved in creating this CHNA. Each hospital partner will will decide what needs be addressed and how those needs will be addressed.
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Widely Disseminate the CHNA The CHNA is not considered until “conducted” the written report is made widely available to the public. Fulfilling the “widely available” requirement requires the following: 1. Posting the CHNA on a website that clearly informs users that the document is available and provides instructions for wnloading. do 2. The document is posted in a format that es exactly reproduc the image of the report when accessed, downloaded, viewed, and printed. 3. Allows individuals with Internet access to access, download, view, and print the report without the use of special hardware or software. 4. The hospital or other organization distributing the report will provide the direct website address to individuals who request a copy of the report. 5. The CHNA must remain widely available to l the public unti the next CHNA for that hospital is conducted and made widely available.
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Chapter 2: Community Profile Background Information for Bollinger County Bollinger County was officially organized in 1851 and is located in southeast Missouri . The county was named after George Frederick Bollinger, who persuaded 20 families to leave North Carolina in 1799 to settle in the region immediately to the west of Cape Girardeau, Missouri. Bollinger County is known for being the home to “Missouri’s Dinosaur,” the hadrosaur , which was discovered at a dig near Glen Allen. The county is bordered Cape by Girardeau County to the east, Perry County Stoddard to the north, County to the south, Madison and and Wayne Counties to the west. The land area of Bollinger County is 621 square miles. The major routes running through Bollinger County include highways 34, 72, and 51. The city of Marble Hill is the largest and only cit y in the county and also holds the county seat. Other smaller villages in the county include: Sedgewickville, Zalma, and Glen Allen. The populations of these cities can be , found in Figure 1 along with the population considered to be rural living outside of these cities. Only a mere 15% of Bollinger County residents live in an area of urban development, while the other 85% live in areas that are considered . rural The population density of the county in 2010 was 19 people per square mile.
Figure 1: Populations Bollinger of County Cities/Villages
Popula ons of Bollinger County Ci es/Villages 10,506
1,477 173 122 85
Marble Hill city Sedgewickville Zalma village Glen Allen town Rural village
Source: U.S. Census Bureau, 2010 Census
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There are eight zip codes found in Bollinger County and those are listed below:
Table 1: Zip Codes in Bollinger County Zip Code City Zip Code City 63662 Patton 63764 Marble Hill 63750 Gipsy 63781 Sedgewickville 63751 Glen Allen 63782 Sturdivant 63760 Leopold 63787 Zalma
Demographic Characteristics Population Growth According to the U.S. Census Bureau: • In 2010, Bollinger County had a population 12 of ,363. • The population has 2. grown 78% since the 0, year 200 compared to 6.83% statewide; however, the population decreased consistently every year since 2002 except for in 2007 until it jumped up with a 4.22% increase from 2009 to 2010. Figure 2: Bollinger County Population Bollinger County Popula on* 12,363 12,239 12,248 12,212 12,176 12,148 12,115 12,124 11,958 11,841
Year 2001 Year 2002 Year 2003 Year 2004 06 Year 2005 20 Year 2007 Year 2008 Year 2009 Year 2010
Source: U.S. Census Bureau, Population http://censtats.census.gov/cgi Estimates ( -‐bin/usac/usatable.pl) *Populations for – 2001 2009 are estimates by United States Census Bureau, 2010 is actual population based on the 2010 census
Race • The ra ce distribution of Bollinger County is very not diverse. • The percentage of the population that is white in Bollinger County (97 .9%) is considerably higher than the Missouri percentage (82.8%). All other races in Bollinger County only make up a mere 2% of the population.
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Figure 3 : Race Distribution of Bollinger County -‐ 2010
Race Distribu on -‐ Bollinger County 0.3% 0.6% 0.2% 0.1% White 0.8% Black or African American
American Indian and Alaska Na ve 97.9% Asian
Some Other Race
Two or More Races
Source: U.S. Census Bureau, 2010 Census
Ethnicity • Figure 4 shows that the Hispanic population percentage in Bollinger County is much lower than the state percentage.
Figure 4 : Hispanic Makeup of Bollinger County vs. Missouri – 2010 Hispanic Popula on of Bollinger County vs. Missouri -‐ 2010
3.55%
0.79%
Bollinger County Missouri
Source: U.S. Census Bureau, 2010 Census
Age Distribution • Bollinger County has an older population than the state with its median age being 42.0, compared to 37.9 for Missouri. • Bollinger County has a higher percentage -‐ of 45 84 year olds and a considerably lower percentage of -‐ 20 34 year olds than the state. • 26.21% of the county’s population is 19 or younger. • 16.65% of the county’s population is 65 or older.
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Figure 5 : Age Distribution for Bollinger County Compared to Missouri -‐ 2010 Age Distribu on for Bollinger County -‐ 2010 Bollinger County has a higher Bollinger County Missouri percentage of the older popula on (ages 45-‐84) 16% 14% 12% 10% 8% 6% 4% 2%
Percent Total of Popula on 0% <5 5-‐14 15-‐19 20-‐24 25-‐34 35-‐44 45-‐54 55-‐64 65-‐74 75-‐84 85+ Age Group
Source: U.S. Census Bureau, 2010 Census
Gender • The overall percentage of males and females in Bollinger County is exactly equal at 50% each. • Looking at the percentage 65 of males and older compared to females older, 65 and there is a gap with an average of 6% more , females than males but the gap is smaller than the state’s. • The percentage of the population that is male vs. female of all ages in Bollinger County very closely matches the average for the state of Missouri; however, when looking at those over 65, Bollinger County has a lower percentage of females entage and a higher perc of males.
Figure 6 : Percentage of Population – Male vs. Female – Bollinger County vs. Missouri -‐ 2010 Percentage of Popula on -‐ Male vs Female -‐ Bollinger County vs Missouri -‐ 2010 Bollinger County Missouri 57.0% 53.0% 50.0% 50.0% 51.0% 49.0% 47.0% 43.0%
Male Female Female 65+ Male 65+
Source: U.S. Census Bureau, 2010 Census
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Household/Family Configuration • The household configuration Bollinger for County is quite different than the state of Missouri. • There is a 10% higher percentage of husband-‐wife families, which resulted a in much lower percentage of female households and non-‐family households. Figure 7 : Households by Type – Bollinger County vs. Missouri – 2010
Households by Type* -‐ Bollinger County vs. Missouri -‐ 2010
58.7% Bollinger County Missouri
48.4%
34.7% 27.6%
12.3% 9.0% 4.6% 4.6%
Husband-‐wife family Male householder, no Female householder, Nonfamily households wife present no husband present
Source: U.S. Census Bureau, 2010 Census *Husband-‐wife family includes those with own children under 18; Male householder, no wife present includes h those wit own children under 18; Female householder, no husband present includes those with own children under 18; Non-‐family households include those living alone. Religion The following figure shows the membership by religious congregation in Bollinger County. Membership is counted as congregational adherents which include all full members, their children, and others who regularly attend services. Nearly 40% of Bollinger County’s population belongs to a religious congregation.
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Figure 8: Membership by Religious Congregation – 2010 – Bollinger County
Membership by Religious Congrega on -‐ nty Bollinger Cou -‐ 2010 7499
2176 1,225 718 369 205 88 82
Source: Association of Religion Data Archives
Social Characteristics Education • Nearly % 25 of Bollinger County adults age 25 and older did not graduate at from high school; th is almost double the state average of 13.9%. • The remaining 75 % graduated from high , school but only 14.9% went on receive to a post-‐ secondary degree.
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Figure 9 : Educational Attainment (Population 25 years and over) – Bollinger County vs. Missouri -‐ 2010 Educa onal A ainment (Popula on 25 years and over) -‐ Bollinger County vs. Missouri -‐ 2010 44.4%
32.6% Bollinger County Missouri
22.0% 15.8% 15.8% 12.0% 12.9% 9.2% 9.2% 6.6% 6.0% 4.7% 4.7% 4.2%
Less than 9th 9th to 12th High school Some Associate's Bachelor's Graduate or grade grade, no graduate college, no degree degree professional diploma (includes degree degree equivalency)
Source: U.S. Census Bureau, 2010 Census Figure 10 shows the high school dropout Bollinger rates for County by school district. • In 2008-‐2011, Leopold did not have any dropouts and Zalma only had one student dropout in 2009. • All school districts had lower dropout han rates t the state average each year, except Woodland, which had a higher rate . in 2010
Figure : 10 High School Dropout Rates by Bollinger County School Districts vs. Missouri
High School Dropout Rates by Bollinger County School District vs. Missouri
MISSOURI LEOPOLD R-‐III MEADOW HEIGHTS R-‐II WOODLAND R-‐IV ZALMA R-‐V
5
4
3
2
1
0 Year 2008 Year 2009 Year 2010 Year 2011
Source: MO Dept. of Elementary and Secondary Education
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The table below shows the total number that of students were enrolled in school in Bollinger County and the total number of dropouts for 2008 – 2011. The l overal percentage and total numbers are very low. This shows that most students attending school graduate from high school, so the 25% of the population that does not have a high school diploma must hool drop out from a high sc outside of Bollinger County and later move into . Bollinger County
Table 2 : Total Enrollment & Total Dropouts for Bollinger County Year 2008 Year 2009 Year 2010 Year 2011 Total Dropouts 13 11 13 6 Total Enrollment 1,957 1,916 1,886 1,843 Percent that Dropped Out 0.66% 0.57% 0.69% 0.33%
Language As is shown below in , Figure 11 Bollinger County has lmost a 100% English being the only language spoken at home.
Figure 11 : Language Spoken at Home – Missouri Bollinger & County Language Spoken at Home -‐ Missouri Language Spoken at Home -‐ Bollinger County
5.90% 0.6%
94.10% 99.4%
Speak only English Of the 5.9% that speak a language Speak only English Of the 0.6% that speak a language other than English, 61.90% speak other than English, 43.5% speak English "very well" and 38.10% speak English "very well" and 56.5% speak Speak a language English less than "very well" Speak a language English less than "very well" other than English other than English Source: U.S. Census Bureau, -‐ 2006 2010 American Community Source: U.S. Census 2006 Bureau, -‐2010 American Community Survey 5-‐Year Estimates Survey 5-‐Year Estimates Literacy According to the National Center for Education essment Statistics’ 2003 Ass of Adult Literacy, the estimated percentage of those 16 and older considered to be lacking basic prose literacy skills in Bollinger County is 11%, compared to 7% for Missouri.
Marital Status • 60% of the population that is 15 years was and over currently married and not separated in 2010, compared to only 51.7% . in Missouri • Only 20.5% of the population has never which been married, is much lower than the state average, due to older the population residing Bollinger in County.
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Figure 12 : Marital Status (Population 15 years and over) – Bollinger County vs. Missouri -‐ 2010 Marital Status (Popula on 15 years and older) 60.0% Bollinger County vs. Missouri -‐ 2010 51.7% Bollinger Missouri
28.3% 20.5% 11.5% 8.1% 6.5% 9.7% 1.7% 2.0%
Now married (not Widowed Divorced Separated Never married separated)
Source: U.S. Census Bureau, 2010 Census
Economic Characteristics Income According to the U.S. Census Bureau, the median household nflation income (in 2010 i -‐adjusted dollars) in Bollinger County is 33 $ ,938 compared to the state median of $46,262. ta The per capi income is found in Figure 13 below. From 2008 009, to 2 the per capita income increased greatly in Bollinger County, while decreasing slightly in Missouri. In fact, Bollinger County saw the greatest increase in per capita income across the state of Missouri, with an increase of $2,885.
Figure 3 1 : Change in Per Capita Income from 2008 – 2009 – Bollinger County vs. Missouri
Change in Per Capita Income from 2008 -‐ 2009
Bollinger County vs. Missouri 2008 PCI 2009 PCI
$36,884 $36,181
$28,157 $25,272
11.40% -‐1.94%
Bollinger County Missouri
Source: MERIC
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Employment • The unemployment rate Bollinger in County has remained higher than the state rate for the past five years and the trend has followed along with rate the state .
Figure 4 1 : Unemployment Rates for Bollinger County vs. Missouri: 2006-‐2010 Unemployment Rates for Bollinger County vs. Missouri: 2006 -‐ 2010
10.3 9.9
9.4 9.4 6.6
5.4 5.4
5.9
4.8 5.0
Year 2006 Year 2007 Year 2008 Year 2009 Year 2010
Missouri Bollinger County
Source: U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics
Poverty Status According to the U.S. Census – Bureau’s 2006 2010 American Community Survey, the percentage of people below the poverty level in Bollinger County % for 2010 was 19.7 compared to the state percentage of 14%. The tables below show the rty percentage below pove vel le for city, each town, or village in Bollinger County and the percentage ty below pover level for several other categories.
Table 3: % Below Poverty Level E Broken Out by ach C ity in Bollinger County Bollinger County City % Below Poverty Level Glen Allen town 30.6% Marble Hill city 39.9% Sedgewickville village 13.0% Zalma village 64.6% Source: U. S. Census Bureau, – 2006 2010 American Community Survey
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Table 4 : % Below Poverty Level by Other Categories Category Bollinger County Missouri Under 18 years 27.6% 19.3% 65 years and over 20.9% 9.3% White 19.2% 11.6% Black or African American 17.2% 28.0% Hispanic or Latino origin (of any race) 85.6% 24.3% Less than high school graduate 26.8% 25.2% Unemployed 42.3% 31.5% Source: U. S. Bureau, Census 2006 – 2010 American Community Survey Bollinger County has a higher poverty level than all the state in categories except black or African-‐ American, but only because the percentage of that n race is so low i the county. Those categories that are drastically higher include the 65 years and older category at over double the state rate and Hispanic or Latino at more than three ate. times the state r Medicaid and Public Assistance Participation Medicaid According to the Missouri Department of Health in and Human Services, 2008, 21.56% of Bollinger County residents were on Medicaid, considerably which is higher than the state rate of 14.50%. Over 98% of ose th on Medicaid were white and % a mere 0.23 were . black 47.56% were under age 18.
Figure 5 1 : Medicaid Participation by Race and Age for Bollinger County and Missouri – 2008 Missouri Bollinger County African-‐ African-‐ Age Groups Number % White Number % White American American Total Under 18 473,288 54.82% 1,226 47.56% Total 18-‐64 302,790 35.07% 999 38.75% 65 and Over 87,321 10.11% 353 13.69% TOTAL 863,399 70.01% 26.22% 2,578 98.37% 0.23% Population -‐ 2008 5,956,335 11,958 % of Medicaid Participation 14.50% 21.56% Source: Department of Health and Human Services, 2008.
Food Stamps/SNAP According to the U.S. Census Bureau’s 2006-‐2009 American Community Survey, households 4,807 or 20.05% in Bollinger County were receiving food /SNAP stamps . This considerably is higher than the state percentage of 11.4%. Free/Reduced Lunch Program Children from households with incomes less than 130 re percent of poverty a eligible for free lunches; those rom f households below 185 percent of poverty are eligible for reduced price lunches. The ate r is expressed as a percent of total school enrollment. According to the Missouri Hunger Atlas, in 2008, 51.5% of students were ble eligi for the Free/Reduced P Lunch rogram in Bollinger County, compared to
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42.9% in Missouri. Figure 16 shows the percentage of students enrolled in the Free/Reduced nch Lu program by school district in Bollinger . County
Figure 6 1 : Percentage of Students Enrolled in Free/Reduced Lunch Program by School District in Bollinger County vs. MO Percentage of Students Enrolled in the Free/Reduced Lunch Programs by School District in Bollinger County vs. Missouri
2008 2009 2010 2011 Every school district in Bollinger County has a higher percentage of students eligible for the free/reduced lunch program than Missouri except for the Leopold school district.
67% 67% 62% 63% 59% 58% 59% 60% 58% 53% 49% 50% 47% 48% 42% 44%
24% 24% 23% 21%
Missouri LEOPOLD R-‐III MEADOW HEIGHTS R-‐II WOODLAND R-‐IV ZALMA R-‐V
Source: MO Dept. of Elementary and Secondary Education Hunger and Food Uncertainty The Missouri Hunger Atlas from 2010 Indicators used three Need to determine the extent of food insecurity and hunger in each Missouri County. For Percent Households Food Uncertain, Bollinger County has 13.4% compared to 15.8% for the state; Percent Households with Children Food Uncertain, Bollinger County has 19.9% ed compar to 23.4% for the state; and Percent Households Food Uncertain with Hunger, Bollinger County has 4.8% 2% compared to 7. for the state. Women, Infants, and Children (WIC) ion Participat The Women, Infants, and Children (WIC) program provides federal grants to states for supplemental food, health care referrals, and nutrition education for low-‐income pregnant, breastfeeding, and non-‐ breastfeeding postpartum women, and to ildren infants and ch up to the age of five who are found to be at a nutritional risk. According to the Missouri Hunger 08 Atlas, in 20 , there 467 were monthly participants in WIC the program and 351 of those were infants and children (under Bollinger the age of 5) in County. Also, 54.4% of those five under years of age in Bollinger County are eligible for the WIC program, compared to 42.8% for Missouri.
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Housing According to the U.S. Census Bureau, the majority Bollinger of homes in County are single, detached units (74%). Bollinger County homes tend to be a little older than the state as are a whole and much less expensive with the median home value , being $92,800 and almost 55% of homes being valued at under $100,000. Nearly 79% of homes -‐ are owner occupied in Bollinger County, which is considerably higher than Missouri’s 70%. In Bollinger County, 81 households lack complete plumbing facilities 81 and households lack complete kitchen facilities. Also, another 147 households do not have any telephone service available.
Transportation Southeast Missouri Transportation Service (SMTS) is a non-‐governmental, non-‐profit general public passenger transportation service. The services of SMTS are available throughout South Central and Southeast Missouri, including Bollinger County. SMTS provides a wide variety of “curb-‐to-‐curb” passenger transportation services to all age groups. The mission of SMTS is to improve the quality of life of people through assisting their access to goods iety. and services of soc Access to transportation will assist in the prevention of institutionalization, opportunities improve for employment and training participation, and help with the utilization of medical ices. and other serv A description of services is as follows: • Long Distance Medical Service o SMTS links rural residents with state of the ogy art medical technol through the Long Distance Medical Service by providing transportation to major medical facilities in St. Louis, Cape Girardeau, and Springfield, Missouri, and to Memphis, Tennessee and Paragould, Arkansas • Local Service o This is used by local residents to fulfill their basic transportation needs, such as for shopping, medical appointments, nutrition, recreation, and personal business • Special Service o SMTS provides transportation on a contract basis fo r groups and organizations, such as sheltered workshops, dialysis transportation, w omen’s programs, and prisoner family transportation Environment Adequate environmental quality in terms of good air are and water quality prerequisites for good health. Poor air or water quality can be l particularly detrimenta to the very young, the old, and those with chronic health conditions.
Water Quality According to the United States Environmental Protection Agency (EPA), a public water system is a system that serves at least 25 people or services 15 or more connections at least 60 days per year. There are three types of public water systems: a community water system hat is one t serves the same people year-‐round, such as homes and businesses; a non-‐transient, non-‐community system serves the same people, but -‐ not year round, such as schools; and a transient, non-‐community system does not consistently serve the same people, such as a campground or rest stop. According to the EPA’s Safe Drinking on Water Informati System (SDWIS), Bollinger County has five community water systems, four non-‐transient, non-‐community water systems, and four transient, non-‐ community water systems. The SDWIS contains information about public water systems and their
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violations of the EPA’s drinking water regulations. These statutes and accompanying regulations establish maximum contaminant levels (MCL), treatment techniques, and monitoring and reporting requirements to ensure that water provided to customers is safe for human consumption. During e th past five years, – 2006 2011, one community system, one non-‐transient, non-‐community system, and three transient, non-‐community water systems in Bollinger County had health-‐based violations, where the amount of contaminant exceeded safety andard st s (MCL) or the water was not treated properly. Those e systems ar listed in the following table:
Table 5 : Public Drinking Water System Violations County, Bollinger 2006 -‐ 2011 System Name Type of Violation Month/Year MARBLE HILL SOUTH COLIFORM (TCR)* MAY 2011 DECEMBER 2007, FEBRUARY 2008, AUGUST 2008, NEW SALEM BAPTIST CHURCH & SCHOOL COLIFORM (TCR)* DECEMBER 2009 CASTOR RIVER PARK COLIFORM (TCR)* JUNE 2011, JULY 2011, AUGUST 2011 MARCH 2006, 2006, JULY JUNE 2007, FEBRUARY 2010, DUCK CREEK WILDLIFE AREA COLIFORM (TCR)* APRIL 2010, MAY 2010 TWIN BRIDGES PARK COLIFORM (TCR)* JUNE 2011, JULY 2011 Source: U.S. EPA SDWIS
*Total Coliform: Coliforms are bacteria that are naturally present in the environment and are used as an indicator that other, potentially-‐harmful, bacteria may be present. Coliforms were found in more samples than allowed and this was a warning of potential problems.
Air Quality According to the County Health Rankings developed d by the Robert Woo Johnson Foundation and the University of Wisconsin Population Health , Institute air quality is represented by the population health risks from ambient air pollution. Several pollutants, including ozone and fine particulate matter (particulates less than 2.5 micrometers in diameter), can contribute to dity increased morbi and mortality. The County Health Rankings uses those ured two commonly meas pollutants to assess the health risks of ambient air pollution, including the of estimated number days that a county’s air quality is unhealthy for sensitive populations due to either one of those pollutants. The County Health Rankings reports that Bollinger County has an annual number of unhealthy air quality ulate days due to fine partic matter equal to one n and a annual number of unhealthy air quality days due to ozone equal zero. Bollinger County is one of only 12 counties in the state least of Missouri to have at one unhealthy air quality day due to fine particulate matter. The negative consequences ent of ambi air pollution include decreased lung function, bronchitis, chronic asthma, and other adverse pulmonary effects. levels Exposure to excess of ozone or fine particulate matter are correlated with an increase mergency in hospital e room visits and hospitalizations among asthmatics and others with compromised respiratory function. Increases in these pollutants are associated with greater risk of death due to cardiopulmonary and cardiovascular conditions and ischemic heart disease. The clear impact that air quality has on human health and the importance EPA places on monitoring select pollutants shows that q the air uality focus area is a critical one to include among the County Health Rankings’ environmental measures. Lead Poisoning Lead poisoning is one of the most common and preventable ems environmental health probl today. The primary lead hazard to children in Missouri -‐ is deteriorated lead based paint. -‐ Lead based paint was
Community Health Needs Assessment – Bollinger County, Missouri Page 32 banned for residential use nationwide in 1978 t and any home buil before 1978 may contain leaded paint; however the highest risk of lead exposure is found in homes built before 1950. Fine particles of processed or recycled lead ome and/or lead dust bec a health hazard when taken into the body through inhalation ng) (breathi and/or ingestion (swallowing). Lead affects organ almost every and system in the body and the effects are the same whether it is breathed or swallowed. Lead damages the brain, central nervous system, kidneys tem. and immune sys Lead in the human body is most harmful to young children under the age of 6 and is especially detrimental to children less than 3 years of age due to their rapidly developing systems. A blood test is used to determine blood levels ted and are measured repor as micrograms of lead per deciliter of whole µ blood ( g/dL). The 2010 Annual Report from the Missouri Childhood Lead Poisoning Prevention Program of the Missouri Department of Health and Senior Services reports that of 283 total tests done on children less than 6 years of age living in Bollinger County, all 283 had levels under 10. Children are considered to have elevated blood lead level levels when the blood is µ 10 g/dL or greater, so no child in Bollinger County had an elevated blood lead level.
Built Environment The built environment refers -‐ to human made (versus natural-‐made) resources and infrastructure designed to support human activity, such as buildings, other roads, parks, and amenities. The characteristics of the built environment can affect the health of residents in multiple ways. As obesity rates have increased over the past decades, interest in looking at local food and recreational environments as potential contributors to obesity increased. has also The variety, price, and availability of healthy foods the in local environment can play a role in whether those foods are consumed. Additionally, the availability of recreational facilities influence can individuals’ and communities’ choices to engage in physical activity. Better information on the availability of healthy food and recreational facilities within the built environment will enable communities to take action to reduce the adverse health outcomes associated with poor diet, lack ty, of physical activi and obesity.
Healthy Food Availability According to the County Health Rankings developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Bollinger Institute, County has 10% of its residents with limited access to healthy foods compared to 8% for the state. Limited access to healthy foods is defined as the proportion of the population that n are both living i poverty and do not live close to a grocery store. Living close to a grocery store han is defined as less t 10 miles in non-‐metro counties. According to the Environment Food Atlas, Bollinger County has ores two grocery st and a farmer’s market. Also, according to the County Health Rankings, 25% l of restaurants in Bol inger County are fast-‐food establishments. Recreational Activities Available According to the Health County Rankings developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health the Institute, rate of recreational activities available in Bollinger County is 8, which is the number of recreational facilities population. per 100,000 The rate for Missouri is 10, Bollinger so County is lagging behind the state rate. Recreational facilities are defined as establishments primarily engaged in operating fitness and recreational sports facilities, featuring exercise and other active physical fitness conditioning or recreational vities sports acti such as swimming, skating, or racquet sports. According to the Food Environment Atlas, Bollinger County only has one recreation and fitness facility.
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The availability of recreational facilities can ndividuals’ influence i and communities’ choices to engage in physical activity. Proximity to places with recreational opportunities iated is assoc with higher physical activity levels, which in turn is associated es with lower rat of adverse health outcomes associated with poor diet, lack of physical activity, Access and obesity. to recreational facilities such as parks, sports fields and facilities, biking trails, public playgrounds pools, and can be improved by locating them closer to homes and schools, lowering costs to use the facilities, increasing hours of operation, and ensuring access to people with various ability levels and limitations. Public Safety Crime Index The Crime Index is the sum or of eight maj offenses and is used to measure the magnitude of crime in the United States. Only eight major offenses n are included i the Index because of their frequency of occurrence and the fact they are most likely w to be reported la enforcement agencies. se The Index offenses include: murder, forcible rape, robbery, ult, aggravated assa burglary, theft, motor vehicle theft, and arson. The first four make up the Violent Crime Index and the last four make up the Property Crime Index. The following table he shows t total number of offenses for each Bollinger of those crimes in County in 2009, as well as the number of s, arrests for those offense and the rate of offenses. Also shown is the offense rate for Missouri the to be compared county. Bollinger County only has a higher offense rate than Missouri in y the categor of forcible rape and much lower rates in all other categories.
Table 6 : Offenses and Arrests by Crime Type in Bollinger County -‐ 2009 Bollinger County Missouri Type of Offense # of Offenses # of Arrests Offense Rate* Offense Rate* Violent Offenses Total: 12 8 102.6 521.0 Murder 0 0 0.0 7.1 Forcible Rape 4 0 34.2 28.6 Robbery 0 0 0.0 131.3 Aggravated Assault 8 8 68.4 354.0 Property Offenses Total: 73 25 624.0 3605.6 Burglary 26 8 222.3 770.4 Theft 41 14 350.5 2485.0 Motor Vehicle Theft 4 2 34.2 307.5 Arson 2 1 17.1 42.7 Total Offenses 85 33 726.6 4126.6 Source: Missouri State Highway ’s Patrol 2009 Crime in Missouri Report *Offense Rate is per 100,000 population Juvenile Crime Rates The following table shows the number t of juvenile cour referrals in 2009 Bollinger for County and Missouri. Bollinger County’s rates are considerably higher in the overall totals on for law violati offenses and status offenses, with the rates for alcohol and drug offenses under law violations and beyond parental control, habitually absent from home, and injurious behavior being higher than the state rate specifically.
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Table 7 : Juvenile Court Referrals -‐ Bollinger County vs. Missouri -‐ 2009 Bollinger County Missouri Offense # of Offenses Rate* Rate* Law Violation Offenses Total 149 12.1 5.4 Violent Offenses 11 0.9 1.6 Alcohol Offenses 4 0.3 0.2 Drug Offenses 7 0.6 0.4 Status Offenses Total 37 3.0 2.4 Truancy 4 0.3 0.6 Beyond Parental Control 7 0.6 0.5 Habitually Absent from Home 7 0.6 0.5 Injurious Behavior 19 1.5 0.7 Source: Missouri Department of Mental Health, t Status Repor 17th Edition *Offense Rate is per 1,000 population Family and Domestic Violence Child Abuse and Neglect The following figure shows the child abuse and neglect rates for Bollinger County and Missouri for the years 2004 – 2008. The rate for the county has been higher than the state rate since 2005.
Figure 17 : Child Abuse & Neglect (Rate per 1,000 – children) Bollinger County vs. Missouri Child Abuse & Neglect (Rate per 1,000 children) -‐ Bollinger County vs. Missouri Bollinger County Missouri 45.1 43 41.0 40.7 37.9
40.5 38.4
33.0 32.6 32.1
Year 2004 Year 2005 Year 2006 Year 2007 Year 2008
Source: Annie E. Casey Foundation Kids Count Data Center
Child Out-of-Home Placement The following figure shows the out-‐of-‐home placement entries rate Bollinger for County and Missouri for the years 2004 – 2008. In 2004, rate the for Bollinger County was slightly lower than the state rate, but was higher in 2005 and remained higher through w 2008 where it sa a huge increase.
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Figure 18 : Out-‐of-‐Home Placement Entries (Rate per 1,000 – children) Bollinger County vs. Missouri Out-‐of-‐Home Placement Entries (Rate per en) 1,000 Childr -‐
Bollinger County vs. Missouri Bollinger County Missouri 15.1
5.7 4.8 4.6 4.3
4.5 4.8 4.1 3.8 3.8
Year 2004 Year 2005 Year 2006 Year 2007 Year 2008
Source: Annie E. Casey Foundation Kids Count Data Center Domestic Violence Domestic violence incidents are reported not whether or an arrest is made and include any dispute arising between spouses, former spouses, and persons with children in common regardless of whether they reside together, persons related by blood, persons related by marriage, -‐ non married persons currently residing together, and non-‐married persons who have resided together t. in the pas Domestic violence incidents are reported when an officer believes a dispute crosses an abuse threshold as indicated by harassment, stalking, coercion, assault, sexual assault, battery, or unlawful imprisonment. Domestic violence incidents are reported est by the high ranked relationship between victim and offender, regardless of the number of persons or lationships potential multiple re present during the incident. The following table shows the domestic violence incidents in Bollinger County for 2009 by the victim/offender relationship. The Missouri for rate 2009 was 619.7 per 100,000 population, which is considerably higher than the Bollinger County rate 128.2 of .
Table 8 : Domestic Violence Incidents in Bollinger -‐ County 2009 Victim/Offender Relationship Bollinger County Spouses 3 Former Spouses 0 Couples w/Child(ren) in Common 1 Blood Relatives 6 People Related Through Marriage 0 People Who Live Together 5 People Who Lived Together in the Past 0 Total Domestic Violence Incidents 15 Rate per 100,000 population 128.2 Source: Missouri State Highway Patrol’s 2009 Crime in Missouri Report
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Health Promotion
Community Health Programs The Bollinger County Health offers Center many services and community health programs, including the following: • Arthritis exercise and aquatic class • Breastfeeding classes • Emergency response planning and education • Child care consultation • Chronic disease monitoring and prevention • Communicable disease prevention and control • Environmental public health services • Family planning • Health education and promotion • Hearing and vision screening • Immunizations • Lead screening • Pregnancy testing and referrals • Prenatal case management • Screening for hypertension, diabetes, and cholesterol • Seasonal and H1N1 flu clinics • Smoking cessation classes • STD/HIV screening, prevention, and education Health Care System Access to Health Care Access to health care is a broad concept that cessibility tries to capture ac to needed primary care, health care specialists, and emergency treatment. While having health insurance is a crucial step toward accessing the different aspects of the health insurance care system, health by itself does not ensure access. It is also necessary to have comprehensive iders coverage, prov that accept the individual’s health insurance, relatively close proximity ers of provid to patients, and primary care providers in the community. There are additional barriers to access in some populations due to lack of transportation to providers’ offices, lack of knowledge about preventive waits care, long to get an appointment, low health literacy, and inability to -‐ pay the high deductible of many insurance plans -‐ and/or co pays for receiving treatment. Bollinger County is considered a primary health by care shortage area the Health Resources and Services Administration. Uninsured Population The County Health Rankings created by ohnson the Robert Wood J Foundation and the University of Wisconsin’s Population Health Institute s measure the uninsured population as the estimated percent of the population under age 65 that has no health insurance coverage. Using 2009 data from the U.S. Census Bureau, they determined that Bollinger County has ion 18% of its populat under age 65 uninsured, while Missouri has 15% of its population uninsured.
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Health Care Providers Hospitals There are no hospitals located in Bollinger County. Family Practice According to the University of Wisconsin, Population Health and Institute Robert Wood Johnson Foundation’s County Health Rankings, Bollinger a County has primary care physician ratio of 11,958:1, whereas the state of Missouri has a . ratio of 1,015:1 Cross Trails Medical Center is a federally qualified health center with a location in Marble Hill, Missouri. This facility houses the only medical county physician in the and is the only facility to offer primary care services in the county. Some of the medical services ded provi by Cross Trails include the following: • Primary medical care • Preventive health screenings and adult immunizations • Acute care for minor illness or injury • Children’s care, including immunizations ld and well chi checks • Adolescent health • Pediatrics • Geriatrics • Women’s health care, including family planning and annual gynecological exams • Participation in the Show-‐Me Healthy Women program to assist women in obtaining necessary exams • Full chronic disease program, including th education wi a Certified Diabetes Educator and a pharmacist • Laboratory services (on-‐site) • X-‐ray services (on-‐site) • Mental health/counseling • Patient Medication Assistance program • Telehealth (currently dermatology) • Contract pharmacy program • Case Management
Mental Health According to the University of Wisconsin’s Population Health Institute and Robert Wood Johnson Foundation’s County Health Rankings, Bollinger mental County has health provider ratio of 11,958:0, whereas the state of Missouri f has a ratio o 9,561:1. The Community Counseling Center offers counseling services in Bollinger County with three licensed professional counselors and one psychiatrist available Hill in the Marble location. The Community Counseling Center is -‐ a not for-‐profit behavioral health organization that offers a full array of comprehensive mental health services for several counties in southeast Missouri. They are dedicated to the treatment, support, and ultimate recovery of th those afflicted wi mental illness. The Community Counseling Center has been accredited by the Commission Rehabilitation on Accreditation of Facilities (CARF) and is certified by the Missouri Department of Mental Health. Some of the programs offered include the following: • CRISIS INTERVENTION • OUTPATIENT COUNSELING RVICES SE • PSYCHIATRIC SERVICES • COMMUNITY PSYCHIATRIC REHAB CENTER
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• ADULT TARGETED MANAGEMENT CASE • TRANSPORTATION • LOUIS E. MASTERMAN -‐ GROUP HOME • HOUSING • PSYCHOSOCIAL REHABILITATION PROGRAM • CONSUMER EMPLOYMENT • CHILDREN’S TARGETED CASE MANAGEMENT • CONSUMER ADVISORY BOARD • INTENSIVE IN-‐HOME SERVICES • COMMUNITY OUTREACH • FAMILY REUNIFICATION SERVICES • INTEGRATED DUAL DIAGNOSIS TREATMENT • CHILDREN’S ALTERNATIVE SERVICES • DISEASE MANAGEMENT • CHILDREN’S INTENSIVE COMMUNITY • COMMUNITY BASED SOLUTIONS PSYCHIATRIC REHABILITATION CENTER • INTENSIVE RESIDENTIAL TREATMENT • HEALTHCARE HOME SERVICES • PEER PHONE SUPPORT • EMERGENCY BEDS -‐ LOU MASTERMAN • APARTMENT LIVING PROGRAM CENTER • SUPPORTIVE COMMUNITY LIVING • DAY TREATMENT (InSTEPP) (PLACEMENT) • PROMOTING OLDER ADULT WELLBEING • EDUCATION
Another Licensed Professional Counselor, Tommy Ivison, PLPC, provides counseling services in Bollinger County at his Marquand location. Cross Trails Medical Center also employs licensed a clinical social worker who is able to provide the residents of nger Bolli County with an experienced ng and cari approach to counseling. The licensed clinical social worker collaborates with the primary care providers to best meet the behavioral health needs of patients. Patients can receive help in the form couple, of individual, or family counseling. Patients can also learn how to cope with chronic health problems and find tions ways to adjust transi in life such as marriage, divorce, aging, or the loss of a loved one. Dentists According to the University of Wisconsin’s Population Health Institute and Robert Wood Johnson Foundation’s County Health Rankings, Bollinger County has a dentist ratio of 12,554:1, whereas the state of Missouri has a ratio of 3,198:1. There are three dentists available in Marble Hill, two of which are employed Cross by Trails Medical Center and the other is employed at First Street Dental. At Cross Trails Medical Center, comprehensive oral health services are provided, including: • Preventive services: o Cleanings o Fluoride applications o Sealants o X-‐rays o Exams • Routine care: o Restorations o Minor surgical procedures o Dentures o Oral screenings o Fillings o Root anals c
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o Crowns and bridges • Patients needing specialized services such as orthodontics, complicated oral surgery, limited endodontics or fixed prosthetics are referred to specialists. Optometrists Clarkson Eyecare is an optometry practice that has a branch office in Marble Hill. They offer a complete line of primary and secondary professional eye care services including full medical and vision eye examinations, contact lens fittings, emergency eye care, treatment of eye diseases, and eye surgery consultations including cataracts and LASIK. Clarkson Eyecare also offers a large selection of retail eyeglasses, contact lenses, and accessory products. Other There are two chiropractic physicians in Bollinger County. Beverly Peters, Bollinger DC, of County Chiropractic and Chris Wishner, Woodland DC, of Chiropractic are both located in Marble Hill, Missouri. There is only one pharmacy available in Bollinger County. Twin City Pharmacy can be found in Marble Hill, Missouri.
Community Health Resources/Services The Bollinge r County Health Center is a great resource for public health, environmental health, and disaster and emergency management information and . other resources
Emergency Services Bollinger County EMS based in Marble Hill provides ambulance services in Bollinger County.
Three Fire Departments can be found in Bollinger County, located in two different areas throughout the county. The following table shows those as locations as well other information about those departments. Firefighters have many responsibilities ust besides j putting out fires and one of those responsibilities may be to provide emergency e care for peopl involved in accidents and oftentimes, firefighters are the first emergency personnel on the scene.
Table 9: Fire Departments in Bollinger County Type of Fire # of Fire # of Volunteer Non-‐Firefighting Fire Department Department: Stations: Firefighters: Volunteers: Marble Hill Fire Department Volunteer 1 20 0 Marble Hill, MO 63764 Scopus Rural Volunteer Fire Department Volunteer 1 10 4 Marble Hill, MO 63764 Patton Volunteer Fire & Rescue Volunteer 1 10 7 Patton, MO -‐ 63662 0003 Source: Fire Departments Network, Fire Department s Listing by County Long-Term Care Facilities Bollinger County has one skilled facility nursing located in Marble Hill. Woodland Hills offers the convenience of a wide range of care and rehabilitative choices in one community. Services include short-‐term rehabilitation, skilled nursing, respite, hospice, and -‐ long term care. Other long-‐term care facilities are listed in the table below showing residential care and assisted living options.
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Table 10: Long-‐Term Care Facilities in Bollinger County, Missouri FACILITY NAME LEVEL OF LICENSURE CITY DIANA'S BOARDING HOME 1 RESIDENTIAL CARE FACILITY I MARBLE HILL DIANA'S BOARDING 2 HOME RESIDENTIAL CARE FACILITY I MARBLE HILL EL NATHAN, INC RESIDENTIAL CARE FACILITY I MARBLE HILL HERITAGE HILLS LLC ASSISTED LIVING FACILITY OPTION 1 PATTON J & RESIDENTIAL J CARE FACILITY II RESIDENTIAL CARE FACILITY II MARBLE HILL MARYS RANCH, INC RESIDENTIAL CARE FACILITY II MARBLE HILL WOODLAND HILLS A STONEBRIDGE COMMUNITY SKILLED NURSING FACILITY MARBLE HILL
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Chapter 3: Health Outcomes
Mortality
Leading Causes of Death The leading causes of Bollinger death in County based -‐ on 11 year data (1999 -‐ 2009) from the Missouri Department of Health and Senior Services ws: are as follo • Heart Disease 35% • All Cancers (Malignant Neoplasms) 24% • All Injuries Poisonings and 6% • Chronic Lower Respiratory Disease 5% • Stroke/Other Cerebrovascular Disease 5% These five causes accounted for 75% of Bollinger all County deaths in that time period. The table below shows all leading causes of Bollinger death in County and Missouri. Bollinger The County rate is higher than the state in rate many categories, including: heart disease, all cancers, smoking-‐attributable diseases, lung cancer, chronic lower respiratory disease, total unintentional injuries, diabetes mellitus, motor vehicle accidents, k idney disease, Alzheimer’s disease, Septicemia, suicide, chronic liver disease and cirrhosis, and injury at work. Table 11 : Leading Cause of Death -‐ Profile 1999 2009 (rates per 100,000 population) -‐ Bollinger County vs. Missouri Bollinger County Missouri Cause of Death Compared to Number Rate Missouri Rate Rate All Causes 1406 939.0 Higher 871.5 Heart Disease 491 328.1 Higher 245.6 All Cancers (Malignant Neoplasms) 336 213.1 Higher 197.7 Smoking-‐Attributable (estimated) 265 170.3 Higher 152.2 Lung Cancer 112 69.8 Higher 61.4 All Injuries and Poisonings 88 66.7 Lower 67.0 Chronic Lower Respiratory Disease 75 49.1 Higher 48.7 Stroke/Other Cerebrovascular Disease 70 48.0 Lower 54.9 Total Unintentional Injuries 63 47.5 Higher 45.0 Diabetes Mellitus 40 25.7 Higher 23.8 Motor Vehicle Accidents 39 31.1 Higher 18.6 Kidney Disease (Nephritis and Nephrosis) 36 23.7 Higher 17.2 Alzheimer's Disease 32 22.1 Higher 21.9 Pneumonia and Influenza 27 18.6 Lower 23.1 Breast Cancer 21 13.0 Lower 14.6 Septicemia 21 13.7 Higher 11.5 Suicide 17 13.0 Higher 12.9 Firearm 14 10.4 Lower 12.7 Alcohol/Drug-‐Induced 12 8.8 Lower 16.4
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Chronic Liver Disease and Cirrhosis 12 7.8 Higher 7.3 Injury at Work 7 4.3 Higher 2.0 Homicide 3 2.0 Lower 7.1 HIV/AIDS 0 0.0 Lower 2.3 Source: Missouri Department of Health and , Senior Services Community Data Profiles Mortality rates are per year per 100,000 and population are -‐ age adjusted to the U.S. 2000 standard population. Cancer The table below shows the top ten es cancer incidence sit in Bollinger County by all sexes b and then reaks those out by males and females. While lung and bronchus makes cancer up the greatest percentage among all sexes, when looking at males and females separately, breast cancer the is most prevalent for females and prostate cancer is tied at the same percentage as lung for and bronchus males.
Table 12: Bollinger County, Top Ten Cancer Incidence Sites (2004-‐2008) Cancer Site Percent Lung and Bronchus 21.20 Female Breast 11.46 Prostate 11.17 Colon and Rectum 10.89 All Sexes Urinary Bladder 5.44 Thyroid 5.16 Non-‐Hodgkin Lymphoma 5.16 Corpus and Uterus, NOS 2.87 Oral Cavity and Pharynx 2.87 Melanoma of the Skin 2.58 Cancer Site Percent Female Breast 23.95 Lung and Bronchus 20.96 Females Colon and Rectum 10.78 Thyroid 7.19 Corpus and Uterus, NOS 5.99 Non-‐Hodgkin Lymphoma 4.79 Cancer Site Percent Prostate 21.43 Lung and Bronchus 21.43 Colon and Rectum 10.99 Males Urinary Bladder 8.24 Non-‐Hodgkin Lymphoma 5.49 Oral Cavity and Pharynx 3.30 Pancreas 3.30 Thyroid 3.30 Source: Missouri Cancer Registry, Top Ten Cancer Incidence Sites -‐ (2004 2008)
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Chronic Disease The table below shows a comparison of es many chronic diseas for Bollinger County and Missouri and the deaths, hospitalizations, and ER visits caused by those chronic diseases. Bollinger has County worse rates than Missouri in all but a few categories, which are ow. highlighted in pink bel Table 13 : Chronic Disease Comparison -‐ Bollinger County vs. Missouri
# of Events Chronic Disease Data Years Bollinger Rate Missouri Rate – Bollinger Heart Disease Deaths 1999-‐2009 491 328.2 245.6 Hospitalizations 2005-‐2009 1,145 159.6 152.38 ER Visits 2005-‐2009 886 14 12.95 Ischemic Heart Disease Deaths 1999-‐2009 323 215.6 170.32 Hospitalizations 2005-‐2009 425 58.1 55.25 ER Visits 2005-‐2009 65 0.9 0.82 Stroke/Other Cerebrovascular Disease Deaths 1999-‐2009 70 48 54.92 Hospitalizations 2005-‐2009 255 35.6 30.37 ER Visits 2005-‐2009 58 0.8 0.79 All Cancers (Malignant Neoplasms) Deaths 1999-‐2009 336 213.1 197.7 Hospitalizations 2005-‐2009 358 50.1 39.07 Colorectal Cancer Deaths 1999-‐2009 44 28.4 19.39 Hospitalizations 2005-‐2009 44 6.1 4.89 Colon and Rectum Cancer (SEER) Deaths 1999-‐2009 44 28.4 19.25 Lung Cancer (SEER) Deaths 1999-‐2009 112 69.9 61.41 Hospitalizations 2005-‐2009 50 6.6 5.18 Breast Cancer Deaths 1999-‐2009 21 13 14.55 Hospitalizations 2005-‐2009 17 2.3* 2.2 Cervical Cancer Deaths 1999-‐2009 3 2.0* 1.41 Hospitalizations 2005-‐2009 8 1.5* 0.79 Prostate Cancer
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Deaths 1999-‐2009 25 16.4 9.1 Hospitalizations 2005-‐2009 43 5.5 2.78 Diabetes Mellitus Deaths 1999-‐2009 40 25.7 23.78 Hospitalizations 2005-‐2009 101 15.6 17.32 ER Visits 2005-‐2009 85 1.4 1.7 Chronic Obstructive Pulmonary Disease Excluding Asthma Deaths 1999-‐2009 75 49.1 47.38 Hospitalizations 2005-‐2009 238 32.8 23.22 ER Visits 2005-‐2009 393 6.3 5.41 Asthma Deaths 1999-‐2009 0 0.0* 1.3 Hospitalizations 2005-‐2009 64 10.5 13.41 ER Visits 2005-‐2009 110 2 5.12 Smoking-‐Attributable (Estimated) Deaths 1999-‐2009 265 170.3 152.23 Arthritis/Lupus Deaths 1999-‐2009 0 0.0* 3.55 Hospitalizations 2005-‐2009 231 31.7 41.01 ER Visits 2005-‐2009 718 12.2 8.67 Source: Missouri Department of Health and , Senior Services County Level Study, Chronic Disease Comparison Death rates are per year per 100,000 are population and age -‐adjusted to the U.S. 2000 standard population. Hospitalization rates are per year per tion 10,000 popula and are age-‐adjusted to the U.S. 2000 standard population. ER Visit rates are per year per 1000 -‐ population and are age adjusted to the U.S. 2000 standard population. Years of Potential Life Lost The County Health Rankings created by ohnson the Robert Wood J Foundation and the University of Wisconsin’s Population Health Institute measure ature prem death by the years of potential life lost before age (YPLL). 75 Every death occurring before the age the of 75 contributes total number of years of potential life lost, so someone that dies at age 25 contributes 50 years of life lost to the county’s YPLL. According to the County Health Bollinger Rankings, County 8, had 152 years of potential life lost before age 75 per 100,000 population in 2011, compared to ssouri. 8,043 for the state of Mi
Infant Mortality The figure below shows the infant mortality Bollinger rate of County compared to the state of Missouri. The state rate has remained fairly h steady wit a slight decrease -‐ over the 10 year period, while the Bollinger County rate had trended downward until 2003, when the rate increase. began to significantly Overall, the Bollinger County rate has only slightly but trended upward, the rate has been much higher than the state for most of the 10-‐year period.
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Figure : 19 Infant Mortality Rate – Bollinger County vs. Missouri
Infant Mortality Rate -‐ Bollinger County vs. Missouri (per 1,000 live births)
Bollinger County Missouri 14.1 13.6 13.2 12.2 11.4 11.2 11.0 10.8 10.5
8.3
7.7 7.7 7.7 7.7 7.6 7.5 7.5 7.5 7.4
Year 1997 Year 1998 Year 1999 Year 2000 Year 2001 Year 2002 Year 2003 Year 2004 Year 2005 Year 2006
Source: Annie E. Casey Foundation Data Kids Count Center Motor Vehicle Accidents According to the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation’s County Health Rankings, Bollinger a County has motor vehicle crash death rate per 100,000 of 34, compared to 19 in the state of Missouri.
Morbidity Obesity and Overweight Adult obesity is measured by those persons age 20 and older that have a body mass index (BMI) greater than or equal to 30 kg/m2. According Rankings to the County Health developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, 35% of Bollinger County s re idents are obese compared to 31% of Missouri residents. Obesity is esult often the end r of an overall energy imbalance due to poor ted diet and limi physical activity. Obesity increases the risk for health conditions such as coronary heart disease, ancer, type 2 diabetes, c hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep respiratory apnea and problems, and osteoarthritis. Diabetes According to the Centers for Disease Control and s Prevention, diabetes i the leading cause of kidney failure, nontraumatic lower-‐limb amputations, and new cases of blindness among adults in the United States and it is also a major cause of heart disease and stroke. Other complications that can be caused by diabetes include: hypertension, eye problems, kidney ous disease, nerv system disease, amputations, dental disease, and complications of pregnancy. Diabetes is a group of diseases levels marked by high of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead tions to serious complica and premature death, but people with diabetes, working together with their support heir network and t health care providers, can
Community Health Needs Assessment – Bollinger County, Missouri Page 46 take steps to control the disease and lower ications. the risk of compl There are more than one type of diabetes:
• Type 1 diabetes was previously called -‐ insulin dependent diabetes mellitus (IDDM) -‐ or juvenile onset diabetes. Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that that make the hormone insulin regulates blood glucose. To survive, people with type 1 diabetes in must have insul delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. In adults, type 1 diabetes accounts for approximately 5% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may netic, be autoimmune, ge or ironmental. env There is no known way to prevent type 1 diabetes. Several clinical trials for preventing type 1 diabetes are currently in progress or are being planned.
• Type 2 diabetes was previously called – non insulin-‐dependent diabetes mellitus (NIDDM) or adult-‐onset diabetes. In adults, type 2 diabetes accounts 95% for about 90% to of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, inactivity, physical and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently among American Indians, African Americans, Hispanic/Latino Americans, and Asians/Pacific Islanders.
• Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently mong a African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese th women and wi a family history of diabetes. During pregnancy, gestational s diabetes require treatment to optimize maternal blood glucose ls leve to lessen the risk of complications in the infant.
• Other types of diabetes result from specific genetic conditions ity (such as matur -‐onset diabetes of youth), surgery, medications, infections, pancreatic and disease, other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases.
According to the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation’s County Health Rankings, Bollinger County % has 10 of adults aged 20 and ve over that ha been diagnosed with diabetes, compared 10 to % for the state. Infectious Disease Communicable Diseases The Missouri Department of Health and Senior Services’ ommunicable Bureau of C Disease Control and Prevention put out an Annual Communicable Disease Surveillance Report summarizing the different communicable diseases reported across Missouri in 2009. The diseases that were reported in Bollinger County are described below. Human ehrlichiosis and anaplasmosis are tick-‐borne diseases caused by several closely-‐related bacteria. The bacterium is maintained in nature -‐ in parasite host cycles involving ticks and mammals. Human infections are usually the result of a bite from an infected tick. Ehrlichiosis can lead to life-‐threatening
Community Health Needs Assessment – Bollinger County, Missouri Page 47 illness in otherwise healthy adults and children. People over the age of 40 and people undergoing immunosuppressive therapy or with a preexisting immunosuppressive condition are especially vulnerable to serious infections and hospitalization. Some infected people, however, never develop symptoms, and others experience only mild esolve symptoms that r without treatment. The greatest challenge to health care providers is diagnosing ehrlichiosis early in the course of the illness, when antibiotic therapy is most effective. There were two cases of ehrlichiosis reported Bollinger in County in 2009 for a rate of 5.90 per 100,000 population, compared to 2.8 per 100,000 for Missouri. Legionellosis refers to conditions associated with the Legionella bacteria called . The term legionellosis encompasses two very distinct clinical and epidemiological conditions called Legionnaires’ disease and Pontiac fever. The natural reservoirs Legionella for the bacteria are aqueous and include lakes, streams, and coastal oceans. However, the bacteria thrive in warm water and can contaminate hot water systems including showers, air conditioning cooling towers, humidifiers, whirlpool spas, respiratory therapy devices, and decorative fountains, which have all been associated with disease. The bacteria do not seem to grow in car or window air conditioners. Persons become infected Legionella when bacteria that have been aerosolized in the air are inhaled into the lungs. Symptoms of the disease usually begin -‐ 2 10 days following exposure Legionnaires’ for disease and 5-‐66 hours following exposure for Pontiac fever. The initial symptoms often include anorexia, gia, malaise, myal headache, diarrhea, cough, and a high fever. Persons with Legionnaires’ disease will develop typically pneumonia while Pontiac fever is a milder illness and is generally not pneumonia. associated with Most persons with Pontiac fever will recover fully while approximately 15% of cases of Legionnaires’ disease will be fatal despite the improved diagnostic and treatment methods. The bacteria that cause legionellosis are not spread from one person to another person. Both sporadic cases and s’ outbreaks of Legionnaire disease are more commonly seen in the summer and autumn. There were two cases of legionellosis l reported in Bol inger County in 2009 for a rate of 15.17 per 100,000 population, compared to 1.1 per 100,000 for Missouri.
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. There are three types of influenza viruses, types A, B and C, with influenza A viruses being the most haracterized severe. Influenza is c by abrupt onset of fever, often with chills or rigors, headache, malaise, a, diffuse myalgi and nonproductive cough. Subsequently, as symptoms progress, sore throat, nasal tis, congestion, rhini and cough become more prominent. Influenza affects the health of a large number of people every year. Most people recover within a week, but a cough and tiredness can linger for two weeks or longer. Dehydration, bronchitis, and bacterial pneumonia, are examples of complications from flu. The flu can make chronic health problems worse. For example, e peopl with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may ing have worsen of this condition that is triggered by the flu. Children may get sinus problems and ear infections ro as complications f m the flu. Those persons 65 years and older, children under the age of two, and persons of any age with chronic medical conditions are at highest risk for serious complications of flu. The influenza season is defined as the period between week 40 (first week of October) of one year and week 20 t (middle of May) the nex year. The rate per 100,000 population in Bollinger County was 297.1 and had a total case count of 36 for the 2009 – 2010 influenza season, compared to a rate of 517.1 per 100,000 for Missouri. Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis. Pertussis is only found in humans from and is spread person to person. People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Pertussis can cause serious and sometimes life-‐ threatening complications in infants and young children, especially those who are not cinated. fully vac Many infants who get pertussis are infected by older siblings, parents, or caregivers who might not even
Community Health Needs Assessment – Bollinger County, Missouri Page 48 know they have the disease. The disease usually starts with cold-‐like symptoms and a mild cough or fever. After one to two weeks, severe ghing cou can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or altogether absent. Infants may have a symptom known as "apnea." Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for infants. More than half of infants younger than one year of age who get the disease must be hospitalized. Pertussis can cause violent and rapid coughing, over and over, until the air lungs is gone from the and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to very throw up and be tired. In teens and adults, especially those who have been vaccinated, the not "whoop" is often there and the infection is generally milder (less severe). Bollinger County had eight cases of pertussis in 2009 for a rate of 3.89 per 100,000 population, compared to a rate of 17.2 per 100,000 for Missouri. Rabies is a fatal viral illness that affects only mammals. Although there reat is g variability in the susceptibility of various species to infection us with this vir and subsequent manifestation of disease, any mammal may be infected with the rabies as virus and serve a source of infection for other mammals. The irus v is typically present in the saliva of clinically ill mammals ten and is most of transmitted through a bite. After entering the central nervous system of irus the next host, v causes an acute, invariably progressive encephalomyelitis that is almost always fatal. The ncubation i period in animals and humans is usually several weeks to months, but may range from days to years. Rabies has the highest case fatality ratio of any infectious disease if prompt s intervention i not initiated in the case of humans; there is no po st exposure intervention for animals. Laboratory testing for rabies is useful on for confirmati of the virus’ presence in certain species and geographic locations, and for determination of the need to administer rabies prophylaxis in cases of e human exposur to a potentially rabid animal. Public health surveillance for this disease in domestic populations and wild animal is a valuable tool in the prevention of human rabies cases. No cases of rabies were detected in Bollinger County in 2009; however, two cases of Rabies Post-‐Exposure Prophylaxis (PEP) were reported. Rabies PEP is a prevention treatment started immediately after exposure to a virus in order to prevent infection and development of the disease. Tuberculosis (TB) is a disease caused by the Mycobacterium bacterium called tuberculosis. The bacteria can attack any part of your body, but it ungs. usually attacks the l TB is spread through the air from one person to another. The bacteria are expelled into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks or sings. These bacteria can stay in the air , for several hours depending on the environment. People who become infected with TB bacteria usually lose, have had very c day-‐to-‐ day contact with someone who has TB disease (e.g. a family member, friend, or -‐ close co worker). In most people who become infected, the fight body is able to the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection (LTBI). These people do not have symptoms of y TB disease, and the cannot spread TB to others. According to the Missouri Department for Health and Senior Services s Tuberculosi Information Management System, Bollinger County had zero cases of TB disease in seven 2010 and cases of LTBI in 2010. Hepatitis Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from illness a mild lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when fecal a person ingests matter — even in microscopic — amounts from contact with objects, food, or drinks contaminated eces by the f or stool of an infected person. Bollinger County had zero reports of Hepatitis A in 2009.
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Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness to lasting a few weeks a serious, ong lifel illness. Hepatitis B is usually spread when blood, semen, or another body fluid ed from a person infect with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or -‐ other drug injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth. Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection -‐ is a short term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection — can but does not — always lead to chronic infection. Chronic Hepatitis B virus infection -‐ is a long term illness that occurs when the Hepatitis n B virus remains i a person’s body. Chronic Hepatitis B is a serious disease that -‐ can result in long term health problems, and even death. Bollinger County had zero reports of Hepatitis B Acute and Hepatitis B Chronic Infection in 2009. Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness to lasting a few weeks a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected irus with the Hepatitis C v enters the body of someone who is not infected. Today, most people become infected with C the Hepatitis virus by sharing needles or other equipment to inject . drugs Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus tion infec is a short-‐ term illness that occurs within the first 6 is months after someone exposed to the Hepatitis C virus. For most people, acute infection leads to ion. chronic infect Chronic Hepatitis C is a serious t disease tha can result in long-‐term health problems, or even death. There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that ease, can spread the dis especially injection drug use. Bollinger County had 5 cases of Hepatitis C Chronic Infection ted repor in 2009. HIV/AIDS HIV is the h uman i mmunodeficiency v irus. It is the virus that a can lead to cquired i mmune d eficiency syndrome, or AIDS . There are two types of HIV, HIV-‐1 and HIV-‐2. In the United States, unless otherwise noted, the term “HIV” primarily -‐ refers to HIV 1. Both types of HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases. Within a few weeks of being infected people with HIV, some develop -‐ flu like symptoms that last for a week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, cting HIV is still affe their bodies. All people with HIV should be seen on a regular basis by a health care provider experienced with on. treating HIV infecti Many people with HIV, including those hy, who feel healt can benefit greatly from current medications used to treat HIV infection. These medications can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to transmit HIV. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer. AIDS is the late stage of HIV infection, system when a person’s immune is severely damaged and has difficulty fighting diseases and certain cancers. Before the development of certain medications, people with HIV could progress in to AIDS just a few years. Currently, people can live much -‐ longer even decades -‐ with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid-‐1990s. The Missouri Department for Health enior and S Services’ HIV/AIDS Disease Surveillance System 2010 Epidemiologic Profile does not show the number of new and living cases inger of HIV and AIDS for Boll
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County – it is only included in a total of remaining counties after breaking out the larger counties, so no definitive numbers can be listed. -‐ However, the mid year Epidemiologic Profile does show that one person living with HIV did live in Bollinger County at the time of diagnosis. Other Sexually Transmitted Diseases Sexually transmitted diseases (STDs) is a term used to describe more than 20 different infections that are transmitted through exchange of semen, blood, and other body fluids; or by direct contact with the affected body areas of people with STDs. Sexually transmitted diseases o are als called venereal diseases. STDs can have very painful -‐ long term consequences as well as immediate health problems. They can cause: • birth defects • blindness • bone deformities • brain damage • cancer • heart disease • infertility and other abnormalities of the reproductive system • mental retardation • death Some of the most sexually common transmitted diseases are described below as defined by the Centers for Disease Control and Prevention along with the number of cases reported in Bollinger County by the Missouri Department for Health and Senior Services’ veillance HIV/AIDS Sur System STD by County report. Syphilis is a sexually transmitted disease bacterium caused by the Treponema pallidum. It has often been called "the great imitator" because signs so many of the and symptoms are indistinguishable from those of other . diseases In 2011, Bollinger County had zero cases of Syphilis reported. Gonorrhea is a sexually transmitted disease Neisseria caused by gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the luding reproductive tract, inc the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. Gonorrhea is a very common infectious disease. In 2011, Bollinger County had five cases of Gonorrhea reported. Chlamydia is a common sexually transmitted disease caused by the bacterium, Chlamydia trachomatis, which can damage an's a wom reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that versible cause irre damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can ischarge cause d from the penis of an infected man. Chlamydia is the most frequently reported bacterial nsmitted sexually tra disease in the United States. Under-‐reporting is substantial because most people a with chlamydi are not aware of their infections and do not seek testing. Also, testing is not often done if patients are treated for their symptoms. In 2011, Bollinger County had 16 cases of Chlamydia reported.
Unintentional Injuries An unintentional injury that is one is not inflicted by deliberate This means. category includes those injuries and poisonings described as accidental, regardless of whether the injury was inflicted by oneself or by another person. The following figures show the Death Rate, e, ER Visits Rat and Hospitalizations Rate for Bollinger County and Missouri by type of unintentional Bollinger injury. County’s Death ate R is
Community Health Needs Assessment – Bollinger County, Missouri Page 51 higher than the state rate in drowning, injury hicle at work, and motor ve traffic. The ER Visits Rate and Hospitalizations Rate for Poison Gas/Cleaner tly is sligh higher in Bollinger County than the state and the Hospitalizations Rate for Motor Vehicle igher Traffic is h in Bollinger County. Falls and motor vehicle traffic are the largest causes of unintentional injuries.
Figure 20: Death Rate by Unintentional Injury Type (2007-‐2009) – Bollinger County vs. Missouri Death Rate* by Uninten onal Injury Type (2007-‐2009) Bollinger County vs. Missouri Bollinger County Missouri 19.5
15.5
11.6 10.2
4.2 2.5 1.2 1.5 1.8 1.4 0.0 0.0 0.3 0.0 0.0 0.3
Drowning Fall Fire/Burn Firearm Injury at Work Motor Vehicle Poison: Drugs/ Poison: Gas/ Traffic** Alcohol Cleaner
Source: Community Data Profiles -‐ Missouri Department of Health and Senior Services *Death rates are per year per 100,000 population -‐ and are age adjusted to the U.S. 2000 standard population.
Figure 21 : ER Visits Rate by Unintentional Injury Type (2007-‐2009) – Bollinger County vs. Missouri ER Visits Rate* by Uninten onal Injury Type (2007-‐2009) -‐ Bollinger County vs. Missouri
26.2 Bollinger County Missouri 23.5
9.0 9.2
1.4 1.5 0.0 0.0 0.1 0.1 0.5 0.7 0.3 0.2
Drowning Fall Fire/Burn Firearm Motor Vehicle Poison: Drugs/ Poison: Gas/ Traffic** Alcohol Cleaner
Source: Community Data Profiles -‐ Missouri Department of Health and Senior Services *ER Visits rates are per year per 1,000 population and are age-‐adjusted to the U.S. 2000 standard population.
Community Health Needs Assessment – Bollinger County, Missouri Page 52
Figure 22 : Hospitalizations Rate by Unintentional Injury Type (2007-‐2009) – Bollinger County vs. Missouri
Hospitaliza ons Rate* by Uninten onal Injury 07-‐2009) Type (20 -‐ Bollinger County vs. Missouri 28.0 26.2 Bollinger County Missouri
12.1 9.7
3.7 3.7 1.3 0.0 0.1 0.7 0.2 0.3 0.4 0.2
Drowning Fall Fire/Burn Firearm Motor Vehicle Poison: Drugs/ Poison: Gas/ Traffic** Alcohol Cleaner
Source: Community Data Profiles -‐ Missouri Department of Health and Senior Services *Hospitalization rates are per year per 10,000 population and -‐ are age adjusted to the U.S. 2000 standard population.
Injuries at Work The rate of work injuries has some fluctuated for Bollinger County, but overall is slowly trending down just like Missouri. Bollinger County has had a much higher rate than the and state from year to experienced a drastic increase in 2003. The most common injury location for machinery-‐related injuries is the wrists -‐hands at a much higher rate than all other injury locations.
Figure : 23 Work Injuries Rate – Machinery Type -‐ Bollinger County vs. Missouri Work Injuries Rate -‐ Machinery Type -‐ Bollinger County vs. Missouri
Bollinger County Missouri Linear (Bollinger County)
183.2
141.7 135.3 132.8 118.5 114.0 108.5 103.4 106.1 102.8
89.5 78.2 80.2 74.0 70.0 68.9 45.8 59.7 57.8 56.0 Year 2000 Year 2001 Year 2002 Year 2003 Year 2004 Year 2005 Year 2006 Year 2007 Year 2008 Year 2009
Source: Missouri Department of Health and , Senior Services MICA, Injury Rates per 100,000 population
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Health Status at Birth Health status at birth can a determine child’s current and future morbidity — or whether or not a child will have a “healthy start”. Low Birth Weight According to the University of Wisconsin’s Health h Rankings, low birt weight (LBW) as a health outcome represents two factors: maternal exposure to health risks and the infant’s current and future morbidity, as well as premature mortality From risk. the perspective of maternal health outcomes, LBW indicates maternal exposure to health risks in of all categories health factors, including her health behaviors, access to health care, the social and economic environment the mother inhabits, and environmental risks to which she is exposed. Modifiable maternal health behaviors — including weight gain, smoking, and alcohol and substance — use account for more than 10% of the variation in birth weight. Maternal smoking alone accounts for 7% of variation weight. in birth In terms of the infant’s health outcomes, LBW serves as a predictor of premature mortality and/or morbidity over the life course. Gestational age, which is correlated with birth weight, ated is inversely rel to psychological distress. LBW children have greater developmental and growth problems, k are at higher ris of cardiovascular disease later in life, and have a greater rate of respiratory conditions. LBW has also been associated with cognitive development problems. Several authors find W that LB children have higher rates of sensorineural impairments, such as cerebral palsy, and visual, auditory, and intellectual impairments. The figure below shows the low birth of weight percent Bollinger County compared to the state of Missouri. Bollinger County’s low birth weight percent has remained below the state rate for this 10-‐year period; however, the percent for Bollinger County is trending upward at a greater pace than the Missouri percentage.
Figure 24 : Low Birth Weight Percent – Bollinger County vs. Missouri
Low Birth Weight Percent -‐ Bollinger ouri County vs. Miss
Bollinger County Missouri Linear (Bollinger County) Linear (Missouri)
8.1% 8.1% 8.1% 8.0% 7.9% 7.8% 7.8% 7.7% 7.7% 7.7%
7.9% 7.6% 7.6% 7.3% 7.2% 7.1%
6.7% 6.5%
6.1% 5.9% Year 1997 Year 1998 Year 1999 Year 2000 02 Year 2001 20 Year 2003 Year 2004 Year 2005 Year 2006
Source: Annie E. Casey Foundation Kids Count Data Center
Community Health Needs Assessment – Bollinger County, Missouri Page 54
Pre-‐term Deliveries Preterm birth is the birth of an infant ation. prior to 37 weeks gest According to the CDC, preterm birth is the most frequent cause of infant death and is the leading cause of long-‐term neurological disabilities in children. A developing baby goes through important growth during the final weeks and months of pregnancy and many organ systems, including the brain, , lung, and liver need the final weeks of pregnancy to fully develop. Even infants born slightly preterm a are at greater risk than -‐ full term infants, but the earlier the delivery, the more likely the risk of serious disability or even death. Adverse health outcomes related to preterm cerebral birth include palsy, developmental delay, and vision and hearing impairment. Preterm births also may cause heavy emotional and economic burdens for families. Figure 25 shows the percent of preterm Bollinger births in County compared to the state of Missouri. The three-‐year moving average shows how Bollinger County started out with a lower percentage in the 1998-‐2000 date range, then exceeded the state percentage for many years before ending with a lower percentage once again in -‐ the 2007 2009 date . range Overall the state percentage remains fairly stable while the Bollinger County percentage atly. fluctuates gre
Figure 5 2 : Preterm Births (Percent of total live births) – Bollinger County vs. Missouri – 3 Year Moving Average Preterm Births (Percent of total live births) -‐ Bollinger County vs. Missouri -‐ 3 -‐ Year Moving Average 17.4 Bollinger County Missouri 16.8
15.3 15.1 15.3 14.5
12.9 12.7 12.7 12.4 13.5 13.2 13.3 13.4 13.2 12.6 12.9
11.4 11.4 11.0
1998-‐2000 1999-‐2001 2000-‐2002 2001-‐2003 2002-‐2004 2003-‐2005 2004-‐2006 2005-‐2007 2006-‐2008 2007-‐2009
Source: Missouri Department of Health and Senior Services, Community Data Infant Profiles, Health
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Birth Defects Major birth defects are conditions that cause structural changes in ts one or more par of the body; are present at birth; and have a serious, adverse velopment, effect on health, de or functional ability. According to the bout CDC, a one in every 33 babies is born ect with a birth def and birth defects are a leading cause of infant death, accounting for more than 1 of every 5 infant deaths. In addition, babies born with birth defects have a greater chance erm of illness and long t disability than babies without birth defects. Figure 26 shows the rate of birth defects per or 10,000 live births f Bollinger County and Missouri. The Bollinger County rate has considerably been higher than the state rate with all years an even bigger jump in the 2003-‐2005 and -‐ 2004 2006 date ranges.
Figure 26: Birth Defects Rate (per 10,000 live births) – Bollinger County vs. Missouri – 3 Years Moving Average Birth Defects Rate (per 10,000 live ger births) -‐ Bollin County vs. Missouri -‐ 3-‐ Year Moving Average 1093.0
Bollinger County Missouri 964.7
895.2
751.2 767.4 689.7 696.6
601.9 599.0 611.0 571.0 573.7 579.3 591.6 1999-‐2001 2000-‐2002 2001-‐2003 2002-‐2004 2003-‐2005 2004-‐2006 2005-‐2007
Source: Missouri Department of Health and , Senior Services Community Data Profiles, Infant Health
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Health Status The County Health Rankings created by The Robert Wood Johnson Foundation and the University of Wisconsin’s Population Health Institute has asures three me for which a county’s health status can be based on: 1. Poor or fair health 2. Poor physical health days 3. Poor mental health days “Poor or fair ” health is a -‐ self reported health status that is a general measure of health-‐related quality of life in a population. The measure is based on survey responses to the question: “In general, would you say that your health is excellent, very good, fair, or poor?” The value reported in the County Health Rankings is the percent of adult who respondents rate their health as “fair” or “poor.” For Bollinger County in 2011, the percentage of adults who “fair” rated their health as or “poor” was 20%, which s i much higher than Missouri’s 16%. The “poor physical health ” days measure is based on responses to the question: “Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?” T he value reported is average the number of days a county’s adult respondents report their physical health was not good. For Bollinger County in 2011, the average number of days that physical health 5.5 was not good days, which si is gnificantly higher than the state average 6 of 3. days. The “poor mental health ” days measure is based on responses to the question: “Thinking about your mental health, which includes stress, d depression, an problems with emotions, for how many days during the past 30 days was your mental The health not good?” value reported is the average number of days a county’s adult respondents report that their mental health was not good. For Bollinger County, the average number of mental days that health was not .8 good was 4 days, which significantl is y higher than the state average 7 of 3. days.
Mental Health According to the Behavioral Health Profile for Bollinger d County create by the Missouri Department of Mental Health, in 2009, one Bollinger t County residen committed suicide. In 2010, 214 residents of Bollinger County received treatment for serious mental illness at publicly-‐funded facilities, with mood disorders being the most common diagnosis category. ude Mood disorders incl mania, major depression, and bipolar disorder. Anxiety and psychotic he disorders were t next most common diagnosis category. iety Anx disorders include panic, obsessive-‐compulsive, post-‐traumatic stress disorders, and phobias. Psychotic disorders include schizophrenia onal and delusi disorders. Individuals that struggle with a serious mental disorder are at a higher risk for homicide, suicide, and accidents as well as chronic conditions including cardiovascular and respiratory diseases and substance abuse disorders. Preventable Hospitalizations According to the University of Wisconsin’s Population Health Institute and the d Robert Woo Johnson Foundation’s County Health Rankings, Bollinger a County had preventable hospital stay rate of 95 compared to 75 for the state of Missouri. Preventable hospital stays are measured as the hospital discharge rate for ambulatory -‐ care sensitive conditions per 1,000 Medicare enrollees. The Missouri Department of Health and ’ Senior Services Missouri Information for Community Assessment rates the 22 diagnoses in the table ble below as preventa hospitalizations. Bollinger County
Community Health Needs Assessment – Bollinger County, Missouri Page 57 has worse rates in seven diagnoses: bacterial pneumonia, ructive chronic obst pulmonary, diabetes, immunization preventable, kidney/urinary infection, pelvic inflammatory disease, and severe ENT infections.
Table 14 : Preventable Hospitalizations 2009 -‐ Bollinger County vs. Missouri Bollinger Missouri Diagnosis Number Rate Number Rate Angina 0 @ 377 0.7 Asthma 9 9.6 @ 6,763 13.1 Bacterial pneumonia 25 23.6 10,747 19.6 Cellulitis 10 10.4 @ 7,366 13.9 Chronic obstructive pulmonary 16 12.7 @ 7,049 11.7 Congenital syphilis 0 @ 11 0.0 @ Congestive heart failure 11 7.7 @ 5,574 9.3 Convulsions 1 1.2 @ 1,628 3.1 Dehydration - volume depletion 33 29.6 17,736 32.3 Dental conditions 1 1.1 @ 550 1.1 Diabetes 12 11.8 @ 5,954 11.2 Epilepsy 4 3.5 @ 3,093 5.9 Failure to thrive 0 @ 212 0.4 Gastroenteritis 3 3.0 @ 2,124 4 Hypertension 2 1.6 @ 1,435 2.6 Hypoglycemia 0 @ 75 0.1 Immunization preventable 1 1.2 @ 87 0.2 Kidney/Urinary infection 12 12.4 @ 4,298 8 Nutritional deficiencies 0 @ 1,545 2.7 Pelvic inflammatory disease 1 1.2 @ 490 1 Severe ENT infections 2 2.1 @ 915 1.8 Tuberculosis 0 @ 49 0.1 Total for Selection 143 132.8 78,078 142.9 Source: Missouri Department of Health and , Senior Services MICA, Preventable Hospitalizations Rates per 10,000, @ Rate considered unreliable numerator less than 20
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Chapter 4: Health Behaviors
Diet & Exercise According to the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation’s County Health Rankings, Bollinger 3 County has 3% of its residents that are physically inactive. Being physically inactive is measured by the estimated percent of adults aged 20 and over that reported no leisure-‐time physical inactivity. According to the Missouri Department of Health and Senior Services’ 2007 Health and Preventative Practices Profile, 76.6% of Bollinger County residents eating reported less than five fruits and vegetables per day.
Tobacco Use Adult smoking prevalence is the estimated percent of the adult ently population that curr smokes every day or “most days” and has smoked at least their 100 cigarettes in lifetime. According to the County Health Rankings developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, % 27.6 of Bollinger County residents smoke cigarettes compared to 24% of Missouri residents. Cigarette smoking is identified as a cause in multiple diseases including various cancers, cardiovascular disease, respiratory conditions, th low bir weight, and other adverse health outcomes.
Substance Abuse Substance abuse can have an impact on public rime, safety, health care, c and public assistance. According to the Behavioral Health for Profile Bollinger County created by the Missouri Department of Mental Health, in Bollinger 2009, County had 15 alcohol-‐related traffic crashes. This lowe number was r than 2008, which 22. was at None of those 15 traffic crashes resulted in the loss of life, but six resulted in injuries. Also Bollinger in 2009, County had 52 DUI arrests, 6 2 liquor law violations, 36 drug arrests, and 5 methamphetamine lab ures. seiz In 2009, Bollinger County residents had a total of -‐ 72 alcohol related and 78 drug-‐related hospitalizations and emergency room visits. In 2010, 92 Bollinger County residents were admitted to substance abuse treatment y at publicl -‐funded facilities. Some adverse effects excessive n drinking ca have on health and health outcomes include alcohol poisoning, hypertension, acute myocardial infarction, sexually transmitted infections, unintended pregnancy, fetal alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, as well as motor vehicle crashes. According to the County Health Rankings developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, 13% of Bollinger County residents reported either binge drinking rinks (consuming 4 d for women or 5 drinks for men on a single occasion) or heavy drinking (consuming 1 drink for women or 2 drinks for on men per day average) in the past 30 days, compared to 17% for Missouri.
Maternal Health Prenatal Care According to the Centers Disease for Control and Prevention, nearly one third pregnant of women will have some kind of -‐ pregnancy related complication. Those women who do not get adequate prenatal care run the risk that such complications will go undetected or will not be dealt with soon enough, which, in turn, can lead to potentially serious consequences for both the mother and her baby. According to the Prenatal Profile of the Missouri alth Department of He and Senior Services, n i 2009,
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Bollinger County had two mothers who received no prenatal care, which is 1.5% of resident live births compared to .8% for the state of Missouri. Another 10.5% received of mothers late prenatal care (in the 2nd or rd 3 trimester) and overall, 9.0% received inadequate prenatal care (<5 visits for ek a 37 we pregnancy or <8 for a pregnancy longer than 37 weeks). Smoking during Pregnancy Women who smoke during pregnancy put their themselves and unborn babies at risk for other health problems. Dangers of smoking during pregnancy include: • Higher risk miscarriage for • Premature birth or low birth weight • Birth defects, such as cleft lip or cleft palate • Infant death • Problems with the placenta, which is the source of the baby’s food and oxygen during pregnancy • Higher risk for Sudden Infant Death Syndrome The figure below shows the percentage of mothers who smoked during pregnancy in Bollinger County compared to the state. Bollinger County has a much higher percentage of mothers that smoked during pregnancy than the ; state however, the percentage is trending downward slightly. Figure 27: Percentage of Mothers who Smoked During Pregnancy – Bollinger County vs. Missouri – 3 Year Moving Average Percentage of Mothers that Smoked During Pregnancy *-‐ Bollinger County vs. Missouri -‐ 3 Year Moving Average
Bollinger County Missouri Linear (Bollinger County)
27.6% 27.9% 26.2% 26.4% 25.9% 25.7% 25.6% 25.5% 24.7% 24.0%
18.5% 18.3% 18.2% 18.1% 18.1% 18.1% 18.2% 18.1% 17.9% 17.4%
1998-‐2000 1999-‐2001 2000-‐2002 2001-‐2003 2002-‐2004 2003-‐2005 2004-‐2006 2005-‐2007 2006-‐2008 2007-‐2009
Source: Community Data -‐ Profiles Missouri Department of Health and Senior Services *Smoked during Pregnancy: Resident live births to mothers smoking during pregnancy and the percent this number is of total resident live births.
Breastfeeding According to the Centers for Disease Control and Prevention, both babies and mothers gain many benefits from breastfeeding. milk Breast is easy to digest and contains can antibodies that protect infants from bacterial and viral infections. Women who breastfeed may also have lower rates of certain breast and ovarian cancers. Also, a baby’s risk of becoming an overweight child goes down with each month of breastfeeding. In a report completed by the Robert Wood Johnson Foundation and Trust for America’s Health, research found many other benefits of breastfeeding for the child and the mother. For the child: reduced risk of
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ear, skin, stomach and respiratory infections, diarrhea, sudden infant death syndrome, necrotizing enterocolitis, and other bacterial and viral n infections; and i the longer term, reduced risk of obesity, type 1 and 2 diabetes, asthma, celiac disease, inflammatory bowel disease and childhood leukemia. For the mother: quicker loss of pregnancy weight, prevention of postpartum bleeding and reduced risk of breast cancer, ovarian cancer, type 2 diabetes ssion. and postpartum depre The following figure shows the rate of mothers with infants on the Women, Infants, and Children (WIC) program who breastfed their babies sometime during the infancy. Over years -‐ 2000 2008, Bollinger County had a higher rate in the year 2000, but ned then dropped off and remai lower than e the stat rate except for 2003 when it was slightly above the the state rate. Overall, rate for Bollinger County has trended upwards for those . nine years
Figure : 28 Rate of mothers who breastfed their babies sometime – during infancy Bollinger County vs. Missouri Rate of mothers who breas ed their ring babies some me du infancy -‐ Bollinger County vs. Missouri
Bollinger County Missouri Linear (Bollinger County) 56.0 54.5 53.3 52.1 52.4
49.2 48.4 48.5 53.2 46.8 47.4
47.1 46.6 46.0
42.5 40.4 39.5 37.4 Year 2000 Year 2001 Year 2002 Year 2003 Year 2004 Year 2005 Year 2006 Year 2007 Year 2008
Source: Missouri Department of Health and , Senior Services MICA, WIC Infant Seat Belt Use According to the Missouri Department of Health and Senior Services’ Motor Vehicle Crash and Outcomes Statistics, in 2008, only 82.3% of Bollinger County residents involved in a motor vehicle crash reported wearing their seat belts, which considerably is lower than the state percentage of 94.6%. Notably, of all the motor vehicle crashes that resulted 2003 in a fatality from -‐2008, 66.7% of those people killed were not wearing their seat belts in Bollinger County. Prevention & Screening Health screenings are an important part ng of maintaini good health, especially as you get older. Many deaths could be prevented if people got simple, eenings regular health scr as recommended by their doctor. Health screenings can detect problems early, when chances for successful treatment are greatest. For example, colon cancer is the most of preventable type cancer, but many times few
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symptoms occur early when it is most treatable. A routine exam can detect a colon polyp (growth) before it becomes cancerous, and it can be t easily removed. Hear disease is the leading cause of death in Missouri, but people who routinely have their blood pressure and cholesterol checked, and treated if necessary, improve their chances of preventing and ons controlling conditi that could cause a heart attack. When a person gets the health screenings recommended, they are taking a simple but very important step toward a better quality of life and quite possibly, a longer life.
Preventative Practices The following table shows the weighted Bollinger percent for County and Missouri for several health and preventative practices. The ages percent for Bollinger County are worse in all areas except for never had a Pap smear for women age 18 and older n and no blood stool test i last year for men and women age 50 and older.
Table 15: 2007 Health & Preventative -‐ Practices Bollinger County vs. Missouri
Bollinger County Compared to Missouri Indicator Weighted %* Missouri % Weighted %*
Did not get medical care 8.9 Worse 7.5 Current cigarette smoking 27.6 Worse 23.2 No leisure-‐time physical activity 32.0 Worse 25.3 Less than 5 fruits and vegetables per day 76.6 Worse 76.1 Overweight (25.0 -‐ 29.9 BMI) 35.7 Equal 35.7 Obese ( >= 30 BMI) 29.7 Worse 29.1 Current high blood pressure 23.8 Worse 19.6 Ever had blood cholesterol -‐ checked age 35 and older 84.9 Worse 89.3 Has high cholesterol -‐ age 35 and older 28.2 Worse 20.2 Never had a mammogram -‐ women age 40 and older 11.7 Worse 8.7 No mammogram or clinical breast exam -‐ in last year 32.7 Worse 27.6 women age 40 and older Never had a pap -‐ smear women age 18 and older 2.1 Better 3.4 No pap smear in last -‐ 3 years women age 18 and older 23.7 Worse 19.5 Never had a blood -‐ stool test men and women age 50 and 60.9 Worse 58.5 older No blood stool test in -‐ last year men and women age 50 85.7 Better 87.1 and older Never had a sigmoidoscopy or -‐ colonoscopy men and 43.3 Worse 36.6 women age 50 and older No sigmoidoscopy or colonoscopy in -‐ past 10 years men 50.7 Worse 40.4 and women 50 and older Source: Missouri Department of Health and , Senior Services Community Health Profiles, Health and Preventative Practices *Weighted Percent: The proportion (usually of a percentage) a population that has a defined risk factor, disease, or condition at a particular point in time. The indicators are described as follows: Ø Did not get medical – care among those who needed medical care but could not get it in the past 12 months – due to cost of or no insurance, lack of transportation, or other reason
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• Derived from "Yes" response to: "Was there a time in the past 12 months when you needed medical care, but could not get it?" reason AND "What is the main you did not get medical care? Would you say cost/no e, insurance, distanc office wasn't open when I could get there, too long a wait for an appointment, too long a wait in waiting room, no childcare, transportation, no access for people with disabilities, medical provider didn't speak my language, or other?" Ø Current cigarette smoking • Derived from Y " es" response to: “Have you smoked at least 100 cigarettes re in your enti life?” AND "Everyday" or "some days" response to the following question: “Do you now smoke cigarettes every day, some days, or ” not at all? Ø No leisure time physical activity • Derived from "No" response to the following question: “During the past 30 days, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?” Ø Less than 5 fruits and vegetables per day • Derived by calculating number of fruits es and vegetabl eaten per day using the following questions: “How often do you drink fruit juices grapefruit such as orange, or tomato?” AND Not “ counting juice, how often do ” you eat fruit? AND “How often do you eat green salad?” AND “How often do you eat potatoes not including French fries, fried potatoes or potato ” chips? AND “How often do you eat carrots?” AND “Not counting carrots, potatoes or salad, how many servings of vegetables do you usually eat?” Ø Overweight (25.0 -‐ 29.9 BMI) • Derived by calculating BMI using responses to the following questions: “About how much do you weigh without ” shoes? AND “About how tall are you ” without shoes? Ø Obese (>= 30 BMI) • Derived by calculating BMI using o responses t the following questions: “About how much do you weigh without ” shoes? AND “About how tall are you without ” shoes? Ø Current High Blood Pressure (Among those who had ever had blood pressure checked) • Derived from a response of any length of time to the question: "About how long has it been since you last had your blood ” pressure checked? AND Y " es" responses to the following questions: “Have you ever been told by a doctor, nurse, or other health professional that you have high blood ” pressure? AND “Do you still have high blood pressure?” Ø Ever had blood cholesterol -‐ checked among age 35 and older • Derived from es" "Y response from respondents age 35 and older to the following question: “Have you ever had your blood cholesterol checked?” Ø Has high cholesterol -‐ among age 35 and older who have had cholesterol checked • Derived from es" "Y responses from respondents age 35 and older to the following questions: “Blood cholesterol is a fatty substance found in the had blood. Have you ever your blood cholesterol checked?” AND “ Have you ever been told by a doctor, nurse, or other health professional your that blood cholesterol is high?” AND “Do you still have high blood cholesterol?” Ø Never had a mammogram -‐ among women age 40 and older • Derived from "No" response from women age 40 and older to “ the following question: A mammogram is -‐ an X ray of each to breast look for breast cancer. Have you ever had a mammogram?” Ø No mammogram or clinical breast exam in last year -‐ among women age 40 and older
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• Derived from a response of ">1 year" on the following questions: “How long has it been since you had your mammogram? last ” AND “How long has it been since your last breast exam (clinical breast exam by a doctor or onal)? other health professi ” Ø Never had a Pap -‐ Smear among women 18 and older • Derived from "No" response to the following “ question: A Pap smear t is a tes for cancer of the cervix. Have you ever ” had a Pap smear? Ø No Pap smear in last -‐ 3 years among women age 18 and older • Derived from response of ">3 years" to the following question: “ How long has it been since you had your last Pap smear?” Ø Never had od a blo stool -‐ test among men and women age 50 and older • Derived from "No" response to the following “ question: A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit?” Ø No blood stool test in -‐ last year among men and women age 50 and older • Derived from response of ">1 year" question: to the following “How long has it been since you had your last blood stool test ? using a home kit ” Ø Never had a sigmoidoscopy olonoscopy or c -‐ among men and women age 50 and older • Derived from "No" response to the following “ question: Sigmoidoscopy and colonoscopy are exams in which a tube is um inserted in the rect to view the bowel for signs of cancer or other health you problems. Have ever had either of these exams?” Ø No igmoidoscopy s or colonoscopy in past 10 years among men and women age 50 and older • Derived from response of ">10 years" g to the followin question: “ How long has it been since you had your last sigmoidoscopy colonoscopy? or ”
Diabetes Diabetic screening is calculated as the iabetic percent of d Medicare patients whose blood sugar control was screened in the past year using glycated a test of their hemoglobin (HbA1c) levels. According to the County Health Rankings, 81% of Medicare enrollees Bollinger in County received such diabetic screening, compared to 83% statewide. Evidence suggests that improvements in quality can of care be seen through implementation of disease management programs that target multiple components of chronic diseases. The use of HbA1c testing to measure glycated hemoglobin for long-‐term monitoring of diabetes is widely accepted as one component e of a comprehensiv disease management program. HbA1c testing is recommended for all patients with diabetes as part of the initial assessment after a diabetes diagnosis, and then on a routine basis nt’s as a part of the patie comprehensive diabetes care plan.
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Chapter 5: Health Measures Child and Adolescent Health Infant Immunization Rates The up -‐to-‐date on immunizations rate for WIC infant participants y in Bollinger Count has been substantially lower than the Missouri rate for the years 2004-‐2008. The rate has been trending upwards slightly for Missouri for those five years, trending yet has been downward for Bollinger County.
Figure : 29 Up-‐to-‐Date on Immunizations (Rate per – 100 Infants) WIC Infant Participants -‐ Bollinger Co. & Missouri
Up-‐to-‐Date on Immuniza ons (Rate per 100 Infants) -‐ WIC Infant Par cipants -‐ Bollinger County & Missouri
Bollinger County Missouri Linear (Bollinger County)
80.4 77.6 78.6 79.3 69
40.5 35.8 28.8 22.8 23.8
2004 2005 2006 2007 2008
Source: Missouri Department of Health and , Senior Services MICA, WIC Infant Causes of Death – Child According to the Missouri Department of Health and Senior Services’ Child Health Profile, Bollinger County has a much lower rate of death for all causes of death than the state of Missouri for children ages 1-‐14. Table 16: Causes of : Death Ages 1-‐ 14
Deaths Ages -‐ 1 14 Data Years # of Events Bollinger County Rate Missouri Rate
All Causes 1999-‐2009 3 12.0* 22.6 Total Unintentional Injuries 1999-‐2009 2 8.0* 8.7 Motor Vehicle Deaths 1999-‐2009 1 4.0* 4.3 All Cancers (Malignant Neoplasms) 1999-‐2009 0 0.0* 2.2 Birth Defects 1999-‐2009 0 0.0* 1.7 Homicide 1999-‐2009 0 0.0* 1.9 Heart Disease 1999-‐2009 0 0.0* 0.9 Source: Community Data -‐ Profiles Missouri Department of Health and Senior Services, Child Health * Fewer than 20 events in numerator; rate is unstable.
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Causes of Death - Adolescents According to the Missouri Department of Health and Senior Services’ Child Health Profile, Bollinger County has higher rates of deaths for adolescents age 15-‐19 than the state of Missouri overall and has double or nearly double the state rates in unintentional vehicle injuries, motor deaths, and suicide.
Table 17 : Causes of : Death Ages 15-‐19 Deaths: Ages 15-‐19 Data Years # of Events Bollinger County Rate Missouri Rate All Causes 1999-‐2009 9 93.8* 81.3 Total Unintentional Injuries 1999-‐2009 7 73.0* 44.1 Motor Vehicle Deaths 1999-‐2009 7 73.0* 35.8 Homicide 1999-‐2009 0 0.0* 12.6 Suicide 1999-‐2009 2 20.9* 9.1 All Cancers (Malignant Neoplasms) 1999-‐2009 0 0.0* 3.4 Heart Disease 1999-‐2009 0 0.0* 2 Source: Community Data -‐ Profiles Missouri Department of Health and Senior , Services Child Health * Fewer than 20 events in numerator; rate is unstable. Teen Substance Abuse and Smoking According to the Department of Mental Health’s from Behavioral Profile 2012, the availability -‐ of county level data on substance abuse is limited. However, the Missouri Student Survey that is administered to 6th through 12th grade s student can provide estimates for youth in most counties. In Bollinger County: • 61.3% of youth believe that it would be easy to get cigarettes and 52.4% have friends who smoke. • 57.5% of youth believe that it would be easy 64.2% to get alcohol and have friends who drink alcohol. • 19.8% of youth believe that it would be easy to get other drugs such as cocaine, methamphetamine, and ecstasy. The table below shows current substance 6 use for grades – 12 in Bollinger County and Missouri. 30-‐day use of cigarettes, l, alcoho binge drinking, inhalants, and Rx abuse is higher in Bollinger County than in the state.
Table 18 : Current Substance Use for -‐ Grades 6 12 -‐ Bollinger County & Missouri Substance 30 Day -‐ Use Bollinger County 30 Day -‐ Use Missouri Cigarettes 14.9% 13.7% Alcohol 24.1% 19.8% Binge* 15.7% 11.4% Marijuana 4.4% 9.4% Inhalants 5.2% 3.0% Rx Abuse 9.3% 6.7% OTC Abuse 4.5% 4.8% Source: Department of Mental Health, Behavioral le Health Profi * 5+ drinks on a single occasion
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Teen Pregnancy Teen pregnancy can be associated with poor prenatal care and pre-‐term delivery. Pregnant teens are more likely than older women to receive enatal late or no pr care, have gestational hypertension and anemia, and achieve poor maternal weight gain. k They are also more li ely to have a pre-‐term delivery and low birth weight, which increases the risk of child developmental delay, illness, and mortality. The prevention of teen pregnancy is very t important as i brings substantial social and economic costs through immediate and long-‐term impacts on teen parents and their children. According to the Centers for Disease Control and Prevention: • Teen pregnancy accounts for nearly $11 billion costs per year in to U.S. taxpayers for increased health care and foster care, arceration increased inc rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers. • Pregnancy and birth are significant ontributors c to high school drop-‐out rates among girls. Only about 50% of mothers teen receive a high school diploma age, by 22 years of versus approximately 90% of women who had not given birth during adolescence. • The children of teenage mothers are more likely to have lower school achievement and drop out of high school, have more health problems, be ime incarcerated at some t during adolescence, give birth as a teenager, and face unemployment . as a young adult The following graph shows the Teen Birth Rate in Bollinger County versus Missouri for the years 1999-‐ 2008. The Bollinger County rate fluctuates greatly from year to year, spiking s up at times and i most often significantly higher than the state rate. er, Overall howev the rate is trending downward.
Figure : 30 Births to Teens (Rate per 1,000 females ages 15-‐19) – Bollinger County vs. Missouri Births to Teens (Rate per 1,000 females ages 15-‐19) -‐ Bollinger County vs. Missouri 72.1 Bollinger County Missouri Linear (Bollinger County) 70.8
61.8
57.1 55.1 53.8 51.1 48.6 45.6 46.1 49.8
45.1 46.0 45.7 45.4 44.0 43.1 43.4 42.4 39.1 Year 1999 Year 2000 Year 2001 Year 2002 04 Year 2003 20 Year 2005 Year 2006 Year 2007 Year 2008
Source: Annie E. Casey Foundation Kids Count Data Center
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STDs in Teens According to the Missouri Department of Health and Senior Services’ Child Health Profile, Bollinger County has significantly lower rates of Sexually Diseases Transmitted for 15 -‐ 19 year olds than the state of Missouri.
Table 19 : Sexually Transmitted Diseases: -‐ Ages 15 19 STDs: Ages -‐ 15 19 Data Years # of Events Bollinger County Rate Missouri Rate Chlamydia 2005-‐2009 31 720.9 2,129.10 Gonorrhea 2005-‐2009 4 93.0* 625.3 Syphilis 2005-‐2009 0 0.0* 4.2 Source: Community Data -‐ Profiles Missouri Department of Health and Senior , Services Child Health STD rates are per 100,000 residents age 15-‐19 using population estimates for the noted years. * Fewer than 20 events in numerator; rate is unstable. Senior Health Missouri Senior Report The Missouri Department of Health and Senior the Services and University of Missouri Office of Social and Economic Data Analysis (OSEDA) generated a Missouri Senior Report in 2009 to inform state and local audiences about the contributions and needs of seniors in Missouri. Some of the findings from that report are found below: Cost Burdened by Housing. The U.S. Department of Housing and Urban Development considers families who pay more n tha 30% of their income for housing as “cost lies burdened” since these fami may have more difficulty affording necessities such clothing, as food, transportation, and medical care. Housing costs include mortgage or rent, taxes, insurance, ties. and utili Seniors that are living on fixed incomes are especially vulnerable to fluctuations in housing costs. Bollinger County has 19.3% of its seniors cost burdened by housing compared to 28.2% for Missouri. Transportation. Transportation is necessary in obtain order to goods and services and to participate in work and social activities. Whether e seniors have th capacity to meet their transportation needs is often measured by how many hold a valid driver’s license. Holding a valid driver’s license is especially indicative in more rural areas where mass transit exist often doesn’t or isn’t as abundant. Bollinger County has 89.7% of its seniors with a valid ompared driver’s license c to 84.2% for the state. Safety. This report measured safety by y the rate of propert and violent crimes per 1,000 persons in the county. Seniors who are physically or psychologically e vulnerabl are at an increased risk of suffering accidents and abuse within their own homes. rate The overall crime in a county combined with the cases of abuse and neglect reported to the Missouri Department and of Health Senior Services’ Elder Abuse and Neglect Hotline were used to determine r the indexed rate pe 1,000 persons. Bollinger County had a property and violent crime rate .5 per 1,000 persons of 26 compared to 35.4 for the state. Health Care Access. Health e car access is essential for the overall well-‐being of seniors. Reliable, convenient access to primary care increases the s capacity of senior to live independently. This report measured the ealth h care access for seniors as a rate of care the number of primary physicians per 1,000 seniors. Bollinger County only has 1.1 primary care physicians per 1,000 seniors compared to 13.1 for the state. This rate is the second to lowest in the state, ranking Bollinger County 113 out of 114 counties. The Missouri Senior Report includes six peak measures that s to the overall quality of life for seniors and those statistics are found below 20 in Table . Bollinger County has a much higher percentage of seniors
Community Health Needs Assessment – Bollinger County, Missouri Page 68 living in poverty along with a lower median value of owned housing and average income of household when compared to the state.
Table 20 : Quality of Life for Seniors Bollinger Missouri Senior Owner-‐Occupied Housing, 2008 86.8% 80.9% Seniors Living in Families, 2008 65.4% 62.6% Median Value of All Owned Housing, 2008 $90,817 $141,500 Seniors in Poverty, 2008 15.1% 9.3% Average Income of Senior Households, 2008 $29,796 $44,665 Seniors with a College Education, 2008 7.8% 16.4% Source: Missouri Senior Report 2009, Missouri Department of Health and Senior he Services and t Office of Social and Economic Data Analysis, University of Missouri 1. Owner-‐Occupied Housing: Seniors’ housing needs are more likely to be -‐ met if they live in owner occupied housing. 2. Seniors Living in Families: Family life enhances the senior -‐ population’s well being. Seniors who live alone are more likely to be socially isolated and at greater risk of accidental injury and physical and mental illness. 3. Median Value of -‐ Owner Occupied Housing: The ownership of a house represents a significant asset for most seniors, and the relative a value of housing is useful indicator of both seniors’ and community assets. 4. Seniors in Poverty: The proportion of seniors living in ct poverty is a dire measure of economic need. 5. Average Income of Senior Households 6. Seniors with a College Seniors Education: with a higher education generally tend to fare better on household and community wealth, -‐ and well being. The Missouri Senior Report includes seven measures that speak to the overall health and wellness for seniors and those statistics are shown 21 in Table below. Bollinger County has a worse percentage than Missouri in all measures except obesity and smoking.
Table 21 : Health and Wellness for Seniors Bollinger Missouri No Exercise, 2007 40.5% 38.5% No Sigmoidoscopy or Colonoscopy, 2007 45.5% 36.8% High Blood Pressure, 2007 44.5% 40.1% Obesity, 2007 22.7% 25.2% Smoking, 2007 9.2% 10.8% No Mammography, 2007 56.4% 50.0% High Cholesterol, 2007 36.5% 25.1% Source: Missouri Senior Report 2009, Missouri Department of Health and Senior Services and the Office of Social and Economic Data Analysis, University of Missouri
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Chapter 6 : Primary Research Focus Groups Methodology A focus group for Bollinger was County held on September 6, 2012, at ty the Bollinger Coun Health Center in Marble Hill, Missouri. Ten participants were present from various organizations throughout Bollinger County. The focus group process began with the h Community Healt Needs Assessment Team and/or some community members compiling a list of potential participants and then inviting those participants to the focus group via email, letter, phone call, or in person. The event took approximately an hour and a half and was held over lunch. Members of the Community Health Needs Assessment Team hosted the event, with one member serving as moderator, another member as co-‐moderator taking notes on a flip chart to make references for the group, and another member as the primary note-‐taker/recorder of the entire event. Materials that were provided to the group included a participant information form, a checklist , exercise and a list of questions asked. The participant information form asked for each participant’s name, company/organization, job title, credentials, education, affiliations, experience, and what makes them an expert – not all forms were filled out completely, but ion some of the informat collected can be found in Appendix C. The checklist exercise asked the participants to choose their top five concerns from a list the Community Health Needs Assessment Team created; the results of that exercise are provided in the Checklist Exercise section following the mmaries question su ahead. The questions asked by the moderator are listed below. Prompts were also used to get more detailed answers from the groups and to help the group along if they were not providing much information. The moderator did his best to ions ask all quest and to stay on track with the topics, but in some cases the group wandered off track and not all questions were answered completely. 1. What do people in this community do to stay healthy? How do people get information about health? 2. In this group’s on, opini what are the serious health problems in your community? What are some of the causes of these problems? 3. What keeps people in your community hy? from being healt 4. What could be done to solve these problems? 5. Is there any group not receiving are? enough health c If so, why? 6. Of all the issues we have talked ssues about today, what i do you think are the most important for your community to address? Each question is broken out into the dual following indivi sections and includes of a summary each particular question. Question - 1 What do people in this community do to stay healthy? How do people get information about health? According to the focus group participants, one of the get most common ways to exercise the in community is simply to walk and some people take advantage of the walking trail in downtown Marble Hill. Participants have noticed that some residents chang have ed their lifestyle and are getting more exercise in general. Programs that are available in Marble Hill include water aerobics at the local city pool and the FitWIC program that emphasizes physical educed activity and r television time. Wellness
Community Health Needs Assessment – Bollinger County, Missouri Page 70 screenings also help people stay healthy in the community and these are offered of to employees the school districts. The community is able to get health information through health education provided by schools and the county health department. Social media is also a main provider of health education, including the Internet (WebMD specifically), TV, radio, and newspaper. Family, friends, and of e cours physicians and nurses provide the community with health information, too. Question - 2 In this group’s opinion, what are the serious health problems in your community? What are some of the causes of these problems? One of the serious health problems mentioned in the Bollinger County focus group was prescription drug abuse, especially by adolescents. This type not of drug abuse does show up on drug tests, but the residents are aware that this problem exists. n In order to obtai prescription drugs, many adolescents steal them from their neighbors, friends, ents. and/or par Also, some residents who are taking prescription drugs may sell them expensively in , order to get money specifically the elderly who are living on a fixed income so they can use the money to buy food. One participant stated that children and teens should never know what prescription medicines their parents are taking, so they won’t be tempted to steal the drugs or abuse them. Another health problem that scussed was di was obesity. This problem covers all ages and is primarily caused by a lack of exercise and poor diet. It was mentioned that many people do not work at a job in which many calories get , burned so unless those people exercise outside of work they are not getting their required daily exercise to stay One healthy. cause of poor diet is the convenience of fast food and how often people eat it. Many families only , have one parent at home so it is difficult to make healthy meals when living a estyle. busy lif At the other end of the spectrum from obesity nother is hunger, and that a health problem found in Bollinger County. Some hool sc professionals see kids who are not getting enough food at school and this is due to the high regulations put on schools for counting calories and nutrition guidelines. Some children are from impoverished families and school only eat at because they do not have food at home and other kids that are active in sports than may need more calories those that are not as active. Other health problems stated in the focus group were child neglect, diabetes, and tobacco use. Mental health was cited as a problem as Farmington no longer has a mental health hospital to ents send pati to and the state has dismantled the mental health program. Access to health care specialists is also an issue, especially in orthopedics since the specialists in Cape Girardeau do not take Medicaid patients. Question - 3 What keeps people in your community hy? from being healt Access to health care was one barrier that was mentioned in the , focus group with specialty care and mental health care being brought up specifically. The availability of health care is also an issue, even to the point that a school nurse may be primary acting as a child’s care cian. physi Lack of education about issues health is another obstacle because oftentimes, people are unaware of health conditions they may have and what to do about them. Living stressful, busy lives is something people else that keeps from being healthy. seems This to be an excuse of almost everyone for why they do cise not have time to exer and eat healthy. Lack of access to healthy another food is barrier hat t keeps people from being healthy. er Bolling County does have a seasonal farmer’s market and some grocery stores, but they do not offer much variety. It is hard to find foods that offer many nutrients and people often do not want to take the time to cook healthy foods.
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Finances are big a factor that keeps people from being healthy in Resid the community. ents in Bollinger County are not always able to afford ambulance y, bills for an emergenc or gasoline to be able to drive Cape Girardeau to see Another a doctor. reason that relates to finances is that people think healthy food is expensive, so they often go for the cheaper, less healthy options, including fast food. Other factors that keep people from clude being healthy in a lack of transportation – people are not always able to get to a doctor or clinic when needed. One last barrier that was was described how some people in the county o are simply t o proud to get help from government aid, even though they may be eligible. Question - 4 What could be done to solve these problems? One recommendation that was made hat t could solve many of these problems was simply to provide basic health education to the – community to explain why healthy habits are needed. Other suggestions made were mostly ding regar children. One suggestion was to start educating with the younger population and get children into health programs. Someone e stated that mor activities are needed for the kids to participate in since Bollinger r County does not offe any sports leagues outside of school leagues; however, children should also create be able to their own games and fun and not have to have everything organized for them. Parents etting should stop l video games and TV “babysit” their kids and make them get involved with more active activities. Parents also need to make sure they have healthy food eir in th homes, so that when kids learn about hool, healthy foods in sc they can practice what they’ve learned at home. Question - 5 Is there any group not receiving enough so, health care? If why? The only group mentioned by the participants of the focus group as not ving recei enough health care was the rural residents of Bollinger County. Question - 6 Of all the issues we have talked ssues about today, what i do you think are the most important for your community to address? The most important issues were: mentioned • Obesity • Chronic disease • Prescription drugs and alcohol use by teens • Tobacco use Checklist Exercise The table below summarizes the Checklist Exercise that was handed out the in focus group held in Bollinger County. The concerns are ranked ghest from the hi oncern c to the lowest. se Alcohol/drug u was most commonly chosen as the greatest llowed concern, fo by Health Care Affordability and overweight adults tied as the second most commonly chosen concern. Smoking/smokeless oba t cco and transportation rounded up the top five concerns.
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Table 22: Bollinger County Results Concern Total Alcohol/Drug Use 9 Health Care Affordability 8 Overweight Adults 8 Smoking/Smokeless Tobacco 5 Transportation (public) 5 Health Care Availability 4 Highway Safety 4 Overweight Children 4 Child Abuse 2 Mental Illness 2 Health Facilities 1 Infant Health 1 Prenatal Health 1 Teen Pregnancy 1 Allergies 0 Clean Water/Water Pollution 0 Domestic Violence 0 Eating Disorders 0 Mosquitoes 0 Sexually Transmitted Infections 0
Surveys Survey Layout and Design The Community Health Needs Assessment Survey ionnaire was a quest -‐style, self-‐administered survey, available only to those participants that a hospital-‐hired intern came into contact with at certain locations. Since the survey was only completed on paper, sary data entry was neces to track, and then extract the data to be in a usable format. The survey was designed to collect data s, on health belief health behaviors, access to and utilization of health care vices, ser and concerns about community health urvey issues. The s consists of five different sections: 1. Multiple Choice: There are 32 questions that are multiple choice with part of the questions asking demographic information about the participant r and thei household and the remaining questions centering on health care access, health nce. status, and insura 2. Health Behaviors: This section lists 24 behaviors and asks the participants to mark how often they do this behavior, with options of “Almost Always,” “Sometimes.,” “Never”, or “N/A.” 3. Children’s Health Behaviors: This section lists 17 behaviors and asks the participants to mark how often any children living in their home do ame this behavior, with the s options as listed above. Many of the behaviors listed are the same or similar to the Health Behaviors Section.
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4. Health Issues: This section lists 27 health problems or diseases and asks the participant if they have ever been diagnosed by a doctor with any ses. of those problems or disea If the participant chooses “Yes”, they are then supposed to check if “I see a doctor” they see a doctor, “I am taking medications or getting treatment” if they cations are taking medi or getting treatment, and “I feel the disease is well managed” if they feel as such. 5. Community Health Concerns: This section lists 56 community issues and the participants are asked to choose how much of a problem is they think each issue in their county, with options of “Serious Problem,”,“Moderate Problem,”,“Not a Problem,”,or “Not .” Sure Methodology A total 66 of surveys were completed Bollinger by County residents, with a few surveys having some unanswered questions. A number of actual responses ach was determined for e question and the percentage of each answer was calculated based r on the numbe of responses. The survey sample was not a random sample, but more of a targeted ertain sample to ensure that c populations were surveyed. Also, some of the questions asked in the survey had tiple an option of choosing mul answers, which means that not l al of the questions have answers that are mutually-‐exclusive, so some of the total percentages will not add up to 100 percent. When an answer of “Does Not Apply” or “N/A” was chosen, those answers were excluded from calculating the percentages also since he t question did not apply to the survey participant. The process for conducting these surveys intern involved an hired by one of the partnering hospitals who then traveled to different locations the throughout county, including community businesses, organizations, and health care facilities, asking participants face-‐to-‐face to complete the survey. The intern did not verbally ask the questions to the participants, but did offer help if the participant had questions about the survey. Participants Key Characteristics • 80% are women • A mere .69 7 % are a race other than White or Black • 59% are married • 56.25% have at least some college, while 9.38% did not finish high school • 44% have a household income less than $25,000 • 60% are employed at -‐ least part time, 27 % are retired, and 9% are considered unemployed • 58% live in households one with or two members Details The tables and graphs below show certain teristics demographic charac of the survey participants in Bollinger County, including the survey takers l gender, marita status, age, education level, race/ethnicity, employment status, household income, and household age size and of members. The number of responses ranged from 34 to 66 and the percentages of each demographic category are also listed.
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Table 23: Gender Table 24: Your Race/Ethnicity Female 80.00% White or Caucasian 92.31% Male 20.00% Black/African American 0.00% N = 65 Hispanic 0.00% Asian or Pacific Islander 0.00%
Table 25: Age Native American 3.08% 18-‐24 15.15% 2 or more races 4.62% 25-‐44 19.70% N = 65
45-‐64 33.33% Table 26: Race/Ethnicity of Children Living at Home 65+ 31.82% White or Caucasian 91.18% N = 66 Black/African American 0.00% Hispanic 0.00%
Table 27: Marital Status Asian or Pacific Islander 0.00% Single/Not Married 16.67% Native American 2.94% Married 59.09% 2 or more races 5.88% Divorced 13.64% N = 34
Living with Partner 1.52% Table 28: Annual Household income Widowed 9.09% Less than $5,000 1.85% N = 66 $5,000-‐$14,999 22.22% $15,000-‐$24,999 20.37%
Table 29: Education Level $25,000-‐$49,999 29.63% Did not finish high school 9.38% $50,000-‐$74,999 16.67% High school graduate/GED 34.38% $75,000-‐$99,999 1.85% Some college 28.13% $100,000 or higher 7.41% College graduate 28.13% N = 54 N = 64
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Table 30: Employment Status Employed Full-‐Time 48.48% Employed Full-‐Time 96.88% Employed Full-‐time, Part-‐time Student 3.13% Employed Part-‐Time 12.12% Employed Part-‐Time 87.50% Employed Part-‐time, Full-‐time Student 12.50% Full-‐time Student 1.52% Employed Part-‐time, Full-‐time Student 100.00% Part-‐time Student 3.03% Part-‐time Student 50.00% Employed Full-‐time, Part-‐time Student 50.00% Full-‐time Homemaker 4.55% Full-‐time Homemaker 66.67% Retired, Full-‐time Homemaker 33.33% Retired 27.27% Retired 88.89% Retired, Full-‐time Homemaker 5.56% Retired, Unemployed due to disability or illness for r more than one yea 5.56% Unemployed 9.09% Unemployed due to disability or illness 83.33% Retired, Unemployed due to disability illness or for more than one year 16.67% *Please note, percentages do not add up he to 100% because of t option to select multiple answers to the question. N=66
Table 31: Number of People Currently Living in Household 1-‐2 57.58% 3-‐5 39.39% 6+ 3.03%
Table 32: Number of Adults 65 and Older Currently sehold Living in Hou 0 63.64% 1-‐2 36.36% 3-‐5 0.00% 6+ 0.00%
Table 33: Number of Children Under 18 Currently old Living in Househ 0 65.15% 1-‐2 28.79% 3-‐5 6.06% 6+ 0.00% N = 66
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Access to Health Services Insurance, Utilization, and Access to Care Individual and Family Insurance Nearly % 88 of survey nts responde have health insurance % with 48 also having dental insurance 31 and % also having vision insurance with along health insurance. Of the without 11% health insurance, a significant 75% have an annual household income of 00. less than $25,0
Table 34: What kinds of insurance do you (and/or currently your family) have? Health 87.69% Health 40.35% Health, Vision 5.26% Dental, Health, Vision 28.07% Dental, Health 26.32% Dental 47.69% Dental, Health, Vision 51.61% Dental, Health 48.39% Vision 30.77% Vision 5.00% Health, Vision 15.00% Dental, Health, Vision 80.00% Do not have insurance 10.77% *Please note, percentages do not 100% add up to because of the option to select multiple tion. answers to the ques N = 65
Of those with health insurance, 40.35% have a government health insurance icaid, plan (Med Medicare, VA/CHAMPUS), 38.60% have employer-‐provided health insurance, and another 7.02 % have a combination of government and employer-‐provided health insurance. Of those households without health insurance, 14% have all adults without e, insuranc 24% have at least one adult without insurance, and 5% have the entire mily fa without insurance. Over % 57 were not sure who was not covered by insurance in their household. Health Services Utilization It appears that most survey participants have sufficient access to medical services 80 as % had a routine doctor’s visit within the last 12 months. 8 An additional % had a routine doctor’s visit within -‐ 13 24 months. Of % the 80 of participants that had a routine doctor’s visit in the past 12 months, 79% of those were female and only 21% In were male. the 65 and older age group, 81 % had a routine visit doctor’s within the past 12 months. Preventive Services Adult Preventive Procedures The following table shows the preventive he procedures t participants had in the last year. Some procedures are broken down by age and certain procedures rti only apply to a pa cular gender. 75 % of women over 45 have had am a mammogr in the past year and only 46% of women over 18 have had a
Community Health Needs Assessment – Bollinger County, Missouri Page 77 pap smear within the last Nearly year. 60% of the participants had a dental only exam and a mere 1.56% had an STD screening in . the last year Higher percentage differences can be noticed between the general age group and the 45+ age group in the glaucoma test, cholesterol screen, cardiovascular screen, bone density test, and blood sugar check.
Table 35: Select the preventive procedures you have had in the last year: Mammogram Pap smear Females 45+ 75.00% Females 18+ 46.00% Glaucoma test Blood sugar check General 21.88% General 51.56% Age 45+ 30.23% Age 45+ 58.14% Blood pressure check Skin cancer screening General 79.69% General 20.31% Age 45+ 86.05% Age 45+ 23.26% Flu shot Colon/rectal exam General 51.56% General 9.38% Age 45+ 53.49% Age 45+ 13.95% Prostate cancer PSA blood screen Prostate cancer digital screen Males 45+ 28.57% Males 45+ 14.29% Cholesterol screen Hearing screening General 54.69% General 9.38% Age 45+ 74.42% Age 45+ 4.65% Cardiovascular screening Vision screening General 20.31% General 62.50% Age 45+ 30.23% Age 45+ 69.77% Bone density test Dental exam General 23.44% General 59.38% Age 45+ 32.56% STD screening General 1.56% *Please note, percentages do not add up he to 100% because of t option to select multiple answers to the question. General Population 64 N = ; All Age 45+ N = 43; Males 45+ N = 7; Females 18+ N = 50; Females 45+ N = 36 Childhood Immunizations Of the 29 responses by those having children currently living in their home, 8 over 6% of the children are current on immunizations, with 10% not being , current and over 3% that are unsure if the children are current. Type of Provider for Routine Health Care For individual participants and their children, an’s the physici office is the most predominant source for seeking routine medical The care. health department clinic is the second most predominant source for seeking routine medical followed care, by urgent care centers and community clinics.
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Table 36: Where do you go for routine health care? You Children Physician's office 86.15% 92.59% Health department clinic 15.38% 14.81% Urgent care center 7.69% 7.41% Chiropractor 6.15% 0.00% Community clinic 6.15% 7.41% Hospital emergency room 6.15% 3.70% Other 1.54% 3.70% Dentist 38.46% 29.63% Eye doctor 30.77% 18.52% *Please note, percentages do not add up to 100% because of the option to select multiple answers to the question. You: N = 65; Children: N = 27 Access to Health Providers When the survey participants were asked ten about how of they are able to see a doctor when needed, nearly 82 % answered always, 5% 1 answered sometimes, and 3% answered seldom or never. Those that answered seldom or never were then asked why see they were not able to a doctor when needed and those reasons are shown in the Nearly table below. % 67 of those respondents that are never or seldom able to see a doctor when needed is due to a lack of insurance.
Table 37: If you answered seldom or never, why? No insurance 66.67% Too expensive/cannot afford 33.33% *Please note, percentages do not add up he to 100% because of t option to select multiple answers to the question. N = 3 Seeking Care Outside the County When asked how often the survey participants outside travel of the county for only health care, 27% answered never. The 73 remaining % was broken out with 57% answering always and 16% answering sometimes. For those that did not answer “never”, follow up questions were asked about why they seek services outside the county and for seek. what services they Table s 38 and 39 below display that information. Nearly 71% of those that seek healthcare outside the county are looking for medical/doctor appointments and 29% are ental looking for d appointments. The two greatest reasons for participants traveling outside the county for healthcare is because the services are not available in the county because and they feel they can find better quality care elsewhere.
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Table 38: What services do you seek outside the county? Table 39: Why do you travel outside the county? Dental appointments 54.35% Better quality elsewhere 45.65% Hospitalization 80.43% Closer to work/home 2.17% Laboratory and other tests 71.74% Local doctors not covered by insurance 15.22% Medical/doctor appointments 100.00% Other 8.70% Other 10.87% Recently moved to this county 4.35% Outpatient treatment 67.39% Services not available in my county 58.70% Vision appointments 78.26% Too hard to get appointment with local doctor 13.04% X-‐rays 65.22% *Please note, percentages do not add up he to 100% because of t option to select multiple answers to the question. N 46 = Health Beliefs and Behaviors Health Status When survey participants were asked to n rate their ow health, over twice many as rated their health as very good or excellent 45 ( .45%) than did poor or fair . (21.21%) Table 40 shows all health status percentages. Interestingly, 64% of those who rated their health as fair or poor have an annual household income of less than $15,000 27% and another are in the household income range of $15,000-‐ $24,999.
Table 40: What is your current health status? Poor 1.52% Fair 19.70% Good 33.33% Very good 36.36% Excellent 9.09% N = 66 Survey participants were also asked how many days they have been too sick to work or carry out usual activities in the past 30 days. 17% were sick 1-‐2 days and only 3% were sick 3 or more 7 days, leaving 7 % that were not too sick in the past 30 usual days to work or carry out activities. Sources of Health Information “Doctors, nurses, and pharmacists” was the most frequent response as a source where cipants the parti obtain health-‐related information, with nearly 91% of participants choosing that source. “Friends or family” and the “Internet” are also main channels to obtain health information, with 45% of participants choosing those sources. Again, “doctors and nurses” are the person/place that the participants feel is most responsible for providing health-‐related information with 91 % of cipants parti choosing that answer. “Health department” and “hospitals” came in at second and third, with 34% and 31%, respectively. Safety Over 84% of the individual respondents indicated that they ar “almost always” we their seat belt, with an additional 12.50% indicating that they “sometimes” eir wear th seat belt, leaving only 3% responding that they “never” wear their seat belt. Regarding children using a seat belt, car seat, or booster seat as
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recommended, 90.63 % answered “almost always”. No disparities across were found the different demographics. The “almost always” percentages for the individual respondents aren’t quite as high for driving the posted speed limit or wearing a helmet when ATV, riding a motorcycle, scooter as they were for wearing seatbelts. 54.84 % of respondents said they lways” “almost a drive the posted speed limit with another 45.16% answering “sometimes”, no leaving participants responding that they “never” drive the posted speed limit. 57.14 % of respondents said they “almost always” wear a helmet when riding a motorcycle, ATV, or scooter with 10 another .71% answering “sometimes”, leaving much a higher 32.14 % that “never” wear a helmet. Regarding children wearing a helmet when riding a motorcycle, ATV, or scooter, 64.71% responded with “almost always”, 35.30 leaving % wearing elmet a h only “sometimes” or “never”. When riding a bicycle, lerblading, rol or skateboarding, 60% responded with “almost always”, leaving 40% wearing a helmet only “sometimes” isparities or “never”. No d were found across the different demographics.
Table 41: Safety Behavior Almost Always Sometimes Never Responses Individual Wear a helmet when riding a motorcycle, ATV, scooter 57.14% 10.71% 32.14% 28 Drive the posted speed limit 54.84% 45.16% 0.00% 62 Wear a seat belt 84.38% 12.50% 3.13% 64 Children Wear a helmet when riding a motorcycle, ter ATV, or scoo 64.71% 17.65% 17.65% 17 Wear a helmet when riding a bicycle/rollerblading/skateboarding 60.00% 15.00% 25.00% 20 Use seat belt, car seats, and booster seats as recommended 90.63% 6.25% 3.13% 32
Healthy Lifestyle For the individuals’ responses regarding healthy iors, lifestyle behav some tive posi findings are that nearly % 97 “never” chew tobacco, 92 % “never” drive after drinking alcoholic sing drinks or u drugs, and over % 98 “never” e us llegal i drugs. In addition, 69% “almost always” or “sometimes” apply sunscreen before planned time outside, % 89 “almost always” or “sometimes” eat rvings at least five se of ruits f and vegetables each day, 94% “almost always” or “sometimes” enough get sleep each night, 82% “almost always” or “sometimes” take vitamin pills or supplements daily, and 6 0% “almost always” or “sometimes” exercise at a moderate pace at least 30 minutes per day, five days per week. On the negative side, % over 24 are “almost always” or “sometimes” exposed to secondhand smoke at home or work, 27% “sometimes” consume more than 3 alcoholic or drinks per day f females or 5 per day for males, 75 % “almost always” or “sometimes” od eat fast fo more than once a % week, and 18 “almost always” or “sometimes” smoke cigarettes.
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Almost Table 42: Healthy Lifestyle Behaviors Always Sometimes Never Responses Individual Apply sunscreen before planned time outside 14.52% 54.84% 30.65% 62 Are exposed to secondhand smoke in your home or work 8.06% 16.13% 75.81% 62 Chew tobacco 0.00% 3.39% 96.61% 59 Consume more than 3 alcoholic drinks/day (female), 5/day (male) 0.00% 27.12% 72.88% 59 Drive after drinking alcoholic drinks or using drugs 0.00% 8.33% 91.67% 60 Eat at least 5 servings vegetables of fruits and each day 22.73% 66.67% 10.61% 66 Eat fast food more than once a week 7.81% 67.19% 25.00% 64 Get enough sleep each -‐ night (7 9 hours) 42.42% 51.52% 6.06% 66 Smoke cigarettes 10.00% 8.33% 81.67% 60 Take vitamin pills or supplements daily 46.97% 34.85% 18.18% 66 Use illegal drugs (marijuana, cocaine, meth, etc) 0.00% 1.72% 98.28% 58 Exercise at a moderate pace at least 30 min/day, 5 days/week 23.08% 36.92% 40.00% 65
For the individuals’ responses regarding their thy children’s heal lifestyle behaviors, some positive findings are that 88% “almost always” or “sometimes” apply sunscreen before planned time outside, 96% “almost always” or “sometimes” eat rvings at least five se of fruits and vegetables 100 each day, % “almost always” or “sometimes” get enough sleep each % night, 90 “almost always” or “sometimes” participate in at least one ysical hour of ph activity each 76% day, “almost always” or “sometimes” take vitamin pills or supplements and daily, 69% “almost always” or “sometimes” o are limited t two hours or less per day of TV, computer, and video game time. On the negative side, 3% over 1 are “almost always” or “sometimes” exposed to secondhand smoke in the home, 79% “almost always” or “sometimes” eat han fast food more t once a and week, 77% “almost always” or “sometimes” drink soda and/or sugar s. sweetened drink Almost Table 43: Healthy Lifestyle Behaviors Always Sometimes Never Responses Children Apply sunscreen before planned time outside 36.67% 50.00% 13.33% 30 Are exposed to secondhand smoke in the home 6.67% 6.67% 86.67% 30 Are limited to 2 hours or less/day of TV, computer, video games 27.59% 41.38% 31.03% 29 Drink soda and/or sugar sweetened drinks 16.67% 60.00% 23.33% 30 Eat at least 5 servings of fruits and vegetables each day 25.00% 71.43% 3.57% 28 Eat fast food more than once a week 10.71% 67.86% 21.43% 28 Get enough sleep each -‐ night (7 9 hours) 74.19% 25.81% 0.00% 31 Participate in at least 1 hour of physical activity each day 63.33% 26.67% 10.00% 30 Take vitamin pills or supplements daily 27.59% 48.28% 24.14% 29
Hygiene/Communicable Disease Control Nearly % 35 of the individual survey participants a “never” get flu shot each over year and % 17 “never” practice safe sex using either a condom or other barrier method.
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Almost Table 44: Hygiene/Communicable Disease Control Always Sometimes Never Responses Individual Get a flu shot each year 48.48% 16.67% 34.85% 66 Practice safe sex (use condom or other barrier method) 62.86% 20.00% 17.14% 35 Wash hands with soap water and after using the restroom 95.38% 4.62% 0.00% 65 Wash hands with soap and water before ng preparing/eati meals 89.23% 9.23% 1.54% 65
It appears as though lower household somewhat income plays a part in why some ’t participants don get a flu shot each year. Forty-‐two percent of those participants with an annual income less than $25,000 “never” t ge a flu shot each year, while 57% of those participants with income 000 greater than $50, “almost always” get a flu shot so each year. It al appears that the percentage of participants that “almost always” get a flu shot each age year increases with as is shown in the following table.
Table 45: Get a flu shot each year Age Almost Always Responses 18-‐24 20.00% 10 25-‐44 38.46% 13 45-‐64 45.45% 22 65+ 71.43% 21 Over 63% of the participants’ children “never” get a flu shot each year. Almost Table 46: Hygiene/Communicable Disease Control Always Sometimes Never Responses Children Practice safe sex (use condom or other barrier method) 83.33% 16.67% 0.00% 6 Get a flu shot each year 26.67% 10.00% 63.33% 30 Wash hands with soap and water before eating meals 72.41% 27.59% 0.00% 29 Wash hands with soap and water after oom using the restr 80.00% 20.00% 0.00% 30
Individual and Family Mental Health Issues and Behaviors Nearly 4 9 % of survey participants feel stressed lmost out either “a always” or “sometimes,” yet in spite of that stress level, over 98% of participants their feel happy about life “almost ays” alw or “sometimes”. Another 48 % feel lonely st "almo always” or “sometimes” and 25% worry about losing their job “almost always” or “sometimes.”
Table 47: Mental Health Issues and Behaviors Almost Always Sometimes Never Responses Individual Feel stressed out 15.38% 78.46% 6.15% 65 Feel lonely 6.06% 42.42% 51.52% 66 Worry about losing your job 3.92% 21.57% 74.51% 51 Feel safe in your community 89.23% 9.23% 1.54% 65 Feel happy about your life 67.69% 30.77% 1.54% 65
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Over 5% 9 of the survey participants answered “almost their always” for children feeling safe in school and 0% answered “never”.
Table 48: Mental Health Issues and Behaviors Almost Always Sometimes Never Responses Children Feel safe in school 95.24% 4.76% 0.00% 21
Home Environmental Safety Regarding the environment and home safety, 76% of respondents reported having more than one working smoke detector, yet only 65% have a fire sher, extingui only 29% have a carbon monoxide detector, and only % 6 reported having a radon test completed me. in their ho mergencies, For e only 42% have a family fire safety/evacuation f plan, 33% o children know how to dial 911, 24% know their home address and phone number, % and only 27 of households keep the poison control e number by th phone. Most 7 homes (9 %) have their emoved trash r weekly, but only a mere 6% have curbside recycling. In Bollinger County, a large percentage of homes have a well or cistern as their primary source of water (79%) and a septic tank to get rid of waste (65%).
Table 49: Environmental/Home Safety Present in Home Absent in Home Trash removed weekly 96.97% 3.03% Food put back in fridge w/in 2 hrs 96.97% 3.03% More than one working smoke detector 75.76% 24.24% Have one or more fire extinguishers 65.15% 34.85% Internet access 54.55% 45.45% Family fire safety plan/evacuation plan 42.42% 57.58% Have one or more types of exercise equipment 40.91% 59.09% Children know how to dial 911 for emergencies 33.33% 66.67% Carbon monoxide detector 28.79% 71.21% Poison control number by phone 27.27% 72.73% Children know home address and phone number 24.24% 75.76% Curbside recycling 6.06% 93.94% Radon test been completed in home 6.06% 93.94% Primary source of drinking water is well or cistern 78.79% 21.21% Septic tank 65.15% 34.85% Pets 60.61% 39.39% Provide care for older adult 3.03% 96.97% Children under 13 unsupervised -‐ in non school hours 0.00% 100.00% N = 66 Health Issues The Health Issues section of the survey t included a lis of 27 diseases and health problems and the survey asked the participants if they have ever been diagnosed by a doctor with any of those diseases or health problems. If the participant ,” selected “Yes then they were to select “I am taking medications or getting treatment” if they are taking medications reatment, or getting t “I feel the disease is well managed” if they feel as such, and/or “I see a see doctor” if they indeed a doctor for their condition.
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The results of that section are shown in the table below. High blood pressure was the most ly common diagnosed health problem at nearly 40%; and of those that were diagnosed essure, with high blood pr 68% are receiving medications or getting 52 treatment, % feel it is well 68 managed, and % are seeing a doctor for the condition. The next most common clude health conditions in high cholesterol, sinus problems, arthritis, and eye disorders.
Table 50 : Health Issues Receiving Medications Well Seeing a Disease/Health Problem No Yes or Treatment Managed Doctor Responses High Blood Pressure 60.32% 39.68% 68.00% 52.00% 68.00% 63 High Cholesterol 61.90% 38.10% 66.67% 58.33% 54.17% 63 Sinus Problems 72.58% 27.42% 64.71% 23.53% 47.06% 62 Arthritis 80.95% 19.05% 33.33% 33.33% 25.00% 63 Eye Disorders 81.25% 18.75% 33.33% 50.00% 58.33% 64 Diabetes 85.71% 14.29% 55.56% 66.67% 88.89% 63 Dental Health Problems 87.50% 12.50% 50.00% 50.00% 37.50% 64 Hearing Disorders 88.89% 11.11% 0.00% 28.57% 28.57% 63 Obesity 90.48% 9.52% 16.67% 0.00% 50.00% 63 Cancer 90.63% 9.38% 33.33% 50.00% 50.00% 64 Heart Disease 90.77% 9.23% 50.00% 66.67% 66.67% 65 Migraine Headaches 92.06% 7.94% 40.00% 40.00% 80.00% 63 Asthma 95.16% 4.84% 66.67% 66.67% 33.33% 62 Liver Disease 95.24% 4.76% 0.00% 0.00% 0.00% 63 Memory Loss 95.24% 4.76% 0.00% 33.33% 0.00% 63 Mental Disorders 96.77% 3.23% 50.00% 50.00% 50.00% 62 Glaucoma 96.88% 3.13% 50.00% 50.00% 50.00% 64 Stroke 98.36% 1.64% 0.00% 0.00% 0.00% 61 Respiratory/Lung Disease 98.39% 1.61% 0.00% 0.00% 0.00% 62 Kidney Disease 100.00% 0.00% 63 Hepatitis 100.00% 0.00% 63 Tuberculosis 100.00% 0.00% 63 Epilepsy 100.00% 0.00% 63 Lupus 100.00% 0.00% 63 Sickle Cell Anemia 100.00% 0.00% 63 Gonorrhea 100.00% 0.00% 63 HIV/AIDS 100.00% 0.00% 63
Community Health Concerns A list of 56 health, safety, and environmental issues that might be found throughout the community was included in the Community Health Concerns section of the survey and the participants were asked to select whether they feel the issue is a serious problem, moderate problem, not a problem, or if they
Community Health Needs Assessment – Bollinger County, Missouri Page 85 were not sure. The 33 issues below are of the greatest concern as more than 50% of the survey participants felt the issue was a moderate to serious problem: 1. Job Availability (98.28%) 2. Cancer (93.88%) 3. Unemployment (93.10%) 4. Overweight Adults (92.98%) 5. Mosquitos (92.59%) 6. Overweight Children (91.38%) 7. Teen Pregnancy (89.58%) 8. Allergies (89.29%) 9. Alcohol/Drug Use (88.52%) 10. Smoking (88.24%) 11. Health Care Affordability (81.48%) 12. Job Security (81.13%) 13. High Blood Pressure/Strokes (80.95%) 14. Health Care Availability (80.39%) 15. Recreation Opportunities (72.55%) 16. Smokeless Tobacco ( 71.79%) 17. Crime (71.43%) 18. Secondhand Smoke (70.45%) 19. Heart Disease (70.00%) 20. Transportation (public) ( 69.05%) 21. Asthma/Respiratory Disorders (68.18%) 22. Child Care/Day Care (68.09%) 23. Highway Safety (68.00%) 24. Law Enforcement (66.67%) 25. Domestic Violence (64.44%) 26. Nursing Home Care (63.27%) 27. Eating Disorders (62.50%) 28. Child Abuse (60.00%) 29. Emergency Preparedness (55.56%) 30. Racism (54.35%) 31. Housing Affordability (53.33%) 32. Elder Day Care (52.50%) 33. Mental Illness (50.00%)
Each health, safety, and environmental issue nto was divided i nine categories for purposes of analysis and discussion: 1. Public Services 2. Crime and Violence 3. Safety Behaviors 4. Health Behaviors 5. Health Care and Support Services 6. Environmental Protection 7. Health Condition/Disease 8. Mental Health 9. Social and Economic Issues
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Public Services Recreation opportunities, ublic p transportation, and law enforcement were all top concerns list from the Public Services category. Nearly 73% pa of rticipants feel that recreation opportunities is a moderate to serious problem ranking it 15th and 69 .05% of participants feel that transportation rate is a mode to serious problem ranking it 20th. Also, nearly % 67 feel that law enforcement is a moderate to serious problem , in which it ranked 24th. School systems and fire protection seem to be satisfactory for the survey participants. Moderate to Not a Problem Table 51: Public Services Concerns Serious Problem Responses* Not Sure** Number % Number % Fire Protection 15 31.91% 32 68.09% 62 15 Law Enforcement 36 66.67% 18 33.33% 61 7 Recreation Opportunities 37 72.55% 14 27.45% 62 11 School Systems 15 30.00% 35 70.00% 62 12 Transportation (public) 29 69.05% 13 30.95% 62 20 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the participant chose Moderate, Serious, or Not a Problem **For reference only. These numbers were not used in calculating the percentages of Moderate to Serious and Not a Problem
Crime and Violence The Crime and Violence category has four concerns that are in the Crime top issues. overall ranked th 17 with 71 .43% of participants feeling as though it is a moderate to serious problem. Domestic violence ranked 25 th with .44 64 % of participants feeling it is a s moderate to seriou problem. Child abuse ranked 28th with 60% that felt it a is moderate to serious problem, and lastly, racism ranked 30 th on the top concerns list with 54.35% of participants feeling it is a s moderate to seriou problem. The remaining concerns, elder abuse, gang activity, murder or intentional injury, and school violence seem to only be moderate problems or non-‐issues, with larger numbers of responses being “Not Sure”. Moderate to Not a Problem Table 52: Crime & Violence Concerns Serious Problem Responses* Not Sure** Number % Number % Child Abuse 24 60.00% 16 40.00% 62 22 Crime 40 71.43% 16 28.57% 63 7 Domestic Violence 29 64.44% 16 35.56% 62 17 Elder Abuse 14 36.84% 24 63.16% 63 25 Gang Activity 5 11.11% 40 88.89% 63 18 Murder or Intentional Injury 10 27.03% 27 72.97% 63 26 Racism 25 54.35% 21 45.65% 62 16 School Violence 8 19.51% 33 80.49% 62 21 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the participant chose Moderate, Serious, or Not a Problem **For reference only. These numbers were not used in calculating ages the percent of Moderate to Serious and Not a Problem
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Safety Behaviors Only highway safety on the list of Safety Behaviors below ranked in the top concerns of the survey participants, with 68% feeling though as the issue is a moderate to serious problem. Pedestrian safety and farming accidents appear to be mild concerns, but did not fall on the top concern list. Firearms do not appear to be a problem. Moderate to Not a Problem Table 53: Safety Behaviors Serious Problem Responses* Not Sure** Number % Number % Farming Accidents 21 46.67% 24 53.33% 61 16 Firearms 8 17.39% 38 82.61% 60 14 Highway Safety 34 68.00% 16 32.00% 63 13 Pedestrian Safety 15 35.71% 27 64.29% 62 20 *Response numbers not do include surveys that are Not Sure; percentages Serious of Moderate to Problem and Not a Problem are based on only those responses where the participant chose Moderate, Serious, or Not a Problem **For reference only. These numbers were alc not used in c ulating the percentages of Moderate to Serious and Not a Problem Health Behaviors All five Health Behaviors below made the list of top concerns. Overweight adults ranked in fourth place with nearly 93% of participants feeling ate it is a moder to serious problem. Overweight children is ranked 6 th on the list of top concerns with a moderate to ge serious problem percenta of 91 .38%. Teen pregnancy came in 7th with nearly 90% that a felt it is moderate to serious problem s and moking is ranked 10th on the top list with 88.24%. Lastly, smokeless tobacco was on the top concerns list with nearly 72% of participants feeling as though to it is a moderate serious problem, ranking 16 it th. Moderate to Not a Problem Table 54: Health Behaviors Serious Problem Responses* Not Sure** Number % Number % Overweight Adults 53 92.98% 4 7.02% 64 7 Overweight Children 53 91.38% 5 8.62% 63 5 Smokeless Tobacco 28 71.79% 11 28.21% 62 23 Smoking 45 88.24% 6 11.76% 62 11 Teen Pregnancy 43 89.58% 5 10.42% 62 14 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the participant chose Moderate, Serious, or Problem Not a **For reference only. These numbers were alculating not used in c the percentages of Moderate to Serious and Not a Problem Healthcare and Support Services Six of the Healthcare and Support Services concerns are list. on the top concern Health care affordability and health care availability are both on the top concerns list, ranked 11th with 81.48% and 14th with 80.39%, respectively. Child c are/day c are is ranked 22nd, nursing home care is ranked 26th, and elder day care is ranked 32nd on the list of top Emergency concerns. preparedness made the top list ranked 29th with 55.56% of participants feeling it to is a moderate serious problem. The two remaining concerns are only mild concerns.
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Moderate to Not a Problem Table 55: Health Care & Support Serious Problem Responses* Not Sure** Services Concerns Number % Number % Ambulance Services 23 44.23% 29 55.77% 62 10 Child Care/Day Care 32 68.09% 15 31.91% 62 15 Elder Day Care 21 52.50% 19 47.50% 63 23 Emergency Preparedness 25 55.56% 20 44.44% 63 18 Health Care Affordability 44 81.48% 10 18.52% 64 10 Health Care Availability 41 80.39% 10 19.61% 62 11 Nursing Home Care 31 63.27% 18 36.73% 64 15 Services for the Disabled 19 43.18% 25 56.82% 63 19 *Response numbers do include not surveys that are Not Sure; percentages of Moderate to Serious Problem and Not a Problem are based on only those responses where the participant chose Moderate, Serious, or Not a Problem **For reference only. These numbers were alculat not used in c ing the percentages of Moderate to Serious Problem and Not a Environmental Protection There are two concerns from the Environmental Protection ategory c that are on the top concern . list Mosquitos, which is ranked quite th high in 5 place, had 92.59% of participants feeling it is a moderate to serious problem. Secondhand smoke is also on the top concern list where it ranked 18th with 70.45 % of participants that felt it is a moderate s to seriou problem. Most he of t remaining five environmental concerns a re mild concerns; however, radon gas had a high number of responses that .” were “Not Sure
Moderate to Not a Problem Table 56: Environmental Serious Problem Responses* Not Sure** Protection Concerns Number % Number % Animal Control 25 49.02% 26 50.98% 63 12 Clean Water/Water Pollution 15 30.00% 35 70.00% 63 13 Mosquitos 50 92.59% 4 7.41% 63 9 Radon Gas 3 13.04% 20 86.96% 62 39 Secondhand Smoke 31 70.45% 13 29.55% 62 18 Sewage Treatment 16 40.00% 24 60.00% 63 23 Trash/Solid Waste Management 15 33.33% 30 66.67% 63 18 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the participant chose Moderate, Serious, or Not a Problem **For reference only. These numbers were not used in calculating the percentages of Moderate to Serious and Not a Problem Health Conditions/Diseases Six of the top concerns fall in the Health Conditions/Diseases category. Cancer is ranked 2nd with a combined moderate to serious percentage 93 of .88%. Allergies ranked 8 th on the concern top list with 89.29% of participants feeling it is a s moderate to seriou problem. High blood pressure/strokes and heart disease are both ranked towards the middle of the list, ranking 3 1 th at 80.95% and 19th at 70 %, respectively. Asthma and respiratory disorders is ranked 21st with 68.18 % of participants that felt it is a moderate to serious problem and eating disorders is ranked 27 th with 62.50%. Sexually transmitted infections, prenatal health, and infant health are all mild concerns just ranking outside of the top
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concerns list. A large majority of participants HIV/AIDS feel that and infectious disease are not problems. Moderate to Not a Problem Table 57: Health Conditions/ Serious Problem Responses* Not Sure** Diseases Concerns Number % Number % Allergies 50 89.29% 6 10.71% 63 7 Asthma/Respiratory Disorders 30 68.18% 14 31.82% 62 18 Cancer 46 93.88% 3 6.12% 60 11 Eating Disorders 25 62.50% 15 37.50% 63 23 Heart Disease 28 70.00% 12 30.00% 63 23 High Blood Pressure/Strokes 34 80.95% 8 19.05% 63 21 HIV/AIDS 7 21.21% 26 78.79% 62 29 Infant Health 15 46.88% 17 53.13% 63 31 Infectious Disease 9 30.00% 21 70.00% 57 27 Prenatal Health 17 44.74% 21 55.26% 62 24 Sexually Transmitted Infections 16 47.06% 18 52.94% 63 29 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the Moderate, participant chose Serious, or Not a Problem **For reference only. These numbers were alculating not used in c the percentages of Moderate to Serious and Not a Problem Mental Health Two mental health concerns made the top list. Alcohol/drug use is ranked 9th with 88.52 % of survey participants feeling it is a moderate to serious Mental problem. Illness overall ranked at the very bottom of the top concern rd list in 33 place at exactly % 50 , but mental illness also had a high number of responses that were “Not Sure”. Suicide seems to be a mild problem, but also received a high number of “Not Sure” responses. Moderate to Not a Problem Table 58: Mental Health Concerns Serious Problem Responses* Not Sure** Number % Number % Mental Illness 17 50.00% 17 50.00% 62 28 Suicide 15 45.45% 18 54.55% 62 29 Alcohol/Drug Use 54 88.52% 7 11.48% 64 3 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where chose the participant Moderate, Serious, or Not a Problem **For reference only. These numbers were alculating not used in c the percentages of Moderate to Serious and Not a Problem Social and Economic Issues Four of the top concerns fall in the ues Social and Economic Iss category. Job availability is ranked at the very top of the list as the most has important concern and a combined moderate to serious percentage of 98.28 %. Unemployment is ranked 3rd on the top concern 93.10 list with % of participants feeling it is a moderate to serious problem. Job security and housing affordability are both on the top concern list, ranking 12 th at 81.13% and st 31 at 53.33 %, respectively. Most participants feel g that ambling i s not a problem.
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Moderate to Not a Problem Not Table 59: Social & Economic Serious Problem Responses* Sure** Issues Concerns Number % Number % Gambling 10 25.00% 30 75.00% 62 22 Housing Affordability 24 53.33% 21 46.67% 63 18 Job Availability 57 98.28% 1 1.72% 63 5 Job Security 43 81.13% 10 18.87% 63 10 Unemployment 54 93.10% 4 6.90% 63 5 *Response numbers do not include surveys Sure; that are Not percentages of Moderate to Serious a Problem and Not Problem are based on only those responses where the participant chose Moderate, Serious, or Problem Not a **For reference only. These numbers were alculating not used in c the percentages of Moderate to Serious and Not a Problem
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Chapter 7: Summary of Findings Using the Data to Determine Needs The secondary data is used Bollinger to compare County to Missouri by examining quantitative data such as percentages, rates, and Bollinger trends. If County ranks worse than the state or a negative trend is occurring, then a need is presented. The primary data is qualitative and takes on in considerati the thoughts and opinions of people in a the community. If consensus arises about a concern, then a need is established. Secondary Data After a review of the secondary research -‐ found in chapters 2 5, it can be determined Bollinger that County does not well do very compared to the state of any Missouri in m areas, so there are many areas of concern. The following describes the findings ta. from the secondary da In the Education category, Bollinger County has nearly 25% of residents over age 25 that did not graduate from high school. That percentage is almost double the state percentage of 13.9%. The Unemployment rate in Bollinger County has been consistently the higher than state for five years in a row. In 2010, the unemployment rate was 9.9%. The P overty Status of Bollinger County is much worse than the state, 19.7% for the county vs. 14% for the state. In the Public Assistance Participation category, 21.56% of Bollinger County residents are on Medicaid, compared to the state which has 14.5%. There is a much higher percentage of people Bollinger in County that are on /SNAP Food Stamps (20.05%) when compared to the state (11.4%). Also, when looking at the Free/Reduced Lunch Program, Bollinger County 5 has 1.5% of students that are eligible compared to the state with 42.9% eligible, which includes all ts school distric having a higher percentage than Missouri with the ion except of Leopold -‐ R III. For the Women, Infant, and Children program, 54.5% of children under the age of 5 are eligible red in Bollinger County, compa to 42.8% in the state. Concerning the Built Environment, Bollinger County has 10% of its residents with limited access to healthy food, which is higher than the state recreational at 8%. The rate of activities available is also lower than the state rate, with Bollinger County having a rate of 8 versus Missouri at 10. Under Public Safety, the forcible rape rate is higher for Bollinger County than the state of 34.2 Missouri, versus 28.6 per 100,000 population. Also, for juvenile the crime rates, overall offense in rate Bollinger County per 1,000 population is much n higher tha the state, alcohol with offenses, drug offenses, beyond parental control, habitually absent from home, ious and injur behavior all being specifically higher than the state. In the Family and Domestic Violence category, the child abuse and neglect rate has been consistently higher since 2005 in Bollinger County than the state overall with the rate remaining steady. T he ild ch out of home placement rate for Bollinger County was nearly equal the state rate 2004 – 2007; however, the rate jumped substantially in 2008 causing Bollinger County’s rate to be significantly higher at 15.1 versus 3.8 per 1,000 children. The percentage of Uninsured is higher in Bollinger County at 18% versus 15% for Missouri. The number Health of Care Providers in Bollinger County is very small. The primary care physician ratio in Bollinger County is 11,958:1 versus 1,015:1 for al Missouri. The ment health care provider ratio in Bollinger County is 11,958:0 versus 9,561:1 for dental Missouri and the health care provider ratio in Bollinger County is 12,554:1 versus 3,198:1 for Missouri.
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The Leading Causes of Death in Bollinger County are Heart se, Disea All Cancers, All Injuries/Poisonings, Chronic Lower Respiratory Disease, Stroke/Other and Cerebrovascular Disease, which accounted for 75% of all deaths – 1999 2009. Of all leading causes Bollinger of death, County has rates worse than the state in: heart disease, all cancers, -‐ smoking attributable diseases, lung cancer, chronic lower respiratory disease, total unintentional injuries, diabetes litus, mel motor vehicle accidents, kidney disease, Alzheimer’s disease, Septicemia, suicide, chronic liver sease di and cirrhosis, and injury at work. Bollinger County has worse rates than most the state in of the Chronic Disease categories, including: • Deaths for heart disease, ischemic heart l disease, al cancers (overall), colorectal cancer, colon and rectum cancer, lung cervical cancer, cancer, prostate cancer, diabetes mellitus, chronic obstructive pulmonary disease excluding and asthma, smoking -‐attributable • Hospitalizations for heart disease, ischemic isease, heart d stroke/other cerebrovascular disease, all cancers (overall), colorectal cancer, breast lung cancer, cancer, cervical cancer, prostate cancer, and chronic obstructive pulmonary disease excluding asthma • ER visits for heart disease, ischemic heart oke/ disease, str other cerebrovascular disease, chronic obstructive pulmonary disease excluding and asthma, arthritis/lupus The Years of Potential Life Lost measure in Bollinger ounty C is worse than 8,152 the state; years lost versus 8,043. The I nfant Mortality Rate in Bollinger County has been consistently higher than the state rate since 1997. In 2006, the rate in Bollinger County was 10.5 per 1,000 live births, compared to 7.4 in Missouri. The rate Motor of Vehicle Accidents in Bollinger County is much higher than the state at 34 per 100,000 versus 19 for Missouri. The Obesity Rate is higher in Bollinger County at 34% of the population versus 31% in Missouri. Bollinger County has higher rates of h uman ehrlichiosis and anaplasmosis and l egionellosis in the infectious disease category. The rate for human ehrlichiosis and anaplasmosis is 5.9 per 100,000 population for the county, compared 2.8 to a rate of per 100,000 for Missouri. The rate for legionellosis is 15.17 per 100,000 population for the county, 1 compared to 1. for Missouri. In the Unintentional Injuries category, the death rates for motor vehicle traffic and drowning are higher than the state rates. hospitalization The rate motor for vehicle traffic is also higher in Bollinger County than Missouri. The injur y at work rate for Bollinger County has been consistently the higher than state since 2000. In 2009, the injuries at work rate was 118.5 per 100,000 population versus 45.8 for Missouri. Under the Health Status at Birth category, low birth weight in Bollinger County is lower than the state, but it has been increasing over time and was nearly last equal to the Preterm state. births Bollinger in County have been higher that the state more r. years than it was lowe The birth defects Bollinger rate in County has always been significantly higher than the state 1999 – 2007 and was last at 895.2 per 10,000 live births versus 611.0 per 10,000 live births for the state. In the Health Status category, 20% of adults in Bollinger County rated their health as “fair” or “poor” compared to 16% for Missouri. The average number of days that adults in Bollinger County reported their physical health as “not good” was 5.5 days compared to 3.6 days for Missouri and the average number of days that adults in Bollinger County reported lth their mental hea as “not good” was 4.8 days compared to 3.7 days for Missouri. Overall in Preventable Hospitalizations, Bollinger County does fair . Out of the 22 , diagnoses Bollinger County has worse rates in seven diagnoses: eumonia, bacterial pn chronic obstructive pulmonary,
Community Health Needs Assessment – Bollinger County, Missouri Page 93 diabetes, immunization preventable, kidney/urinary infection, pelvic inflammatory disease, and severe ENT infections. Bollinger County has a higher percentage of residents that use Tobacco, 27.6% versus 24% for Missouri. In the Maternal Health category, Bollinger County has a higher percentage of resident live births where no prenatal care was received, 5 1. %, compared to .8% for Bollinger the state. County also has had a higher percentage of mothers that g smoked durin pregnancy since -‐ 1998 2000 (moving average), and was at 24% of resident live -‐ births 2007 2009 (moving average), compared to 17.4% for Missouri. Bollinger County also has a lower rate of mothers who breastfed their babies sometime during infancy than the state. Regarding Seat Belt usage, in 2008, only 82.3% of Bollinger County in residents involved a motor vehicle crash reported wearing their seat belt, which much is lower than the state percentage of 94.6%. The residents Bollinger of County do terribly compared to the state in nearly all Preventive Practices measures. Those measures where Bollinger County is worse than the state did are: not get medical care, current cigarette smoking, no leisure-‐time physical activity, less than five fruits and vegetables per day, obese, current high blood pressure, ever had blood cholesterol checked, has high cholesterol, never had a mammogram, no mammogram in the last the year, no pap smear in last three years, never had a blood stool test, never had a sigmoidoscopy or colonoscopy, and no sidmoidoscopy or scopy colono in the past years. 10 Specific to Child and Adolescent Health, the infant immunization rate for WIC infants has been substantially lower since 2004 in Bollinger County. In 2008, the immunization rate was only 28.8 per 100 infants versus 80.4 for he Missouri. T c auses of d eath for a dolescents show Bollinger County having a higher rate of death than the state in several causes, including total unintentional injuries, motor vehicle deaths, and suicide. Also, teen substance use in the last 30 Bollinger days is higher in County for cigarettes, alcohol, binge drinking, inhalants, and prescription drugs than the state. The teen pregnancy rate wa s higher for most years in Bollinger County than for the state; however, the births to teens rate is trending downwards . For Senior Health, health care access is a concern in Bollinger County as there are 1.1 only primary care physicians per 1,000 seniors compared to 13.1 for the . state Also, Bollinger County higher has a much percentage of seniors in poverty compared to us Missouri, 15.1% vers 9.3%. Many of the health and wellness factors for seniors are worse , than the state including having a higher percentage of seniors that do not exercise, do not get a sigmoidoscopy or colonoscopy, do not get m a mammogra , and that have high blood pressure and high cholesterol. Primary Data After a review of mary the pri research results found in Chapter 6, it can be determined Bollinger that County has many areas of concern. The following rom lists the findings f the primary data, including the community surveys, focus groups, and checklist exercise completed at the focus groups. The issues were determined as a concern if the icipants focus group part were in agreement about and/or the issue if more than 50% of survey participants classified the issue as a moderate to serious problem. Health Problems determined by the primary research: • Diabetes • High blood pressure/strokes • Heart isease d • Overweight dults a
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• Overweight hildren c • Cancer • Mental i llness • Asthma/Respiratory isorders d • Allergies Behavioral Problems determined by the primary research: • Smoking • Smokeless Tobacco • Poor Diet • No xercise E • Drug/Alcohol Use (especially adolescents with prescription drugs and alcohol) • Eating disorders Community Problems determined by the primary research: • Hunger (children/adolescents) • Lack of Health Care Education • Child Abuse and Neglect • Domestic Violence • Health Care Affordability • Health Care Availability • Access to Health Care Specialists (especially Orthopedics for Medicaid patients) • Access to Healthy Foods • Teen Pregnancy • Transportation (public) • Unemployment • Mosquitos • Job Availability • Job Security • Crime • Housing Affordability • Racism • Child Care/Day Care • Secondhand Smoke • Recreation Opportunities • Highway Safety • Law Enforcement • Nursing Home Care • Emergency Preparedness • Elder Day Care
Conclusion This Community Health Needs Assessment is the product of a completed process of finding secondary data, performing primary research, and presenting This those findings. compiled information will allow the partnering hospitals to create an implementation strategy designed to meet some particular needs that are specific Bollinger to the County community.
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Appendix A - Survey
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Appendix B – Focus Group Questions
Community Health Needs Assessment Focus Group Questions
1. What do people in this community do to stay healthy? How do people get information about health?
2. In this group’s opinion, what are the serious health problems in your community? What are some of the causes of these problems?
3. What keeps people in your community from being healthy?
4. What could be done to solve these problems?
5. Is there any group not receiving enough health care? If so, why?
6. Of all the issues we have talked about today, are what issues do you think the most important for you community to address?
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Appendix C – Focus Group Participant Information Cross Trails Medical Center
• Medical Director/Physician: MD with 32 Meadow Heights School District years of experience in rural health • Secondary Principal: 16 years working in • Case Manager: 4 years working with public education uninsured and underserved at a Federally Qualified Health Center Bollinger County Health Center
Leopold School District • Administrator: 15 years working in public health • Superintendent: 16 years working at • Public Health Nurse: 25 years in public the Leopold School health nursing • School Nurse: 13 years working as a registered nurse City of Marble Hill
Woodland School District • Administrative Assistant
• Superintendent: 33 years working in Coroner’s Office public education • Coroner
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Appendix D – Survey Tracking Database
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